Issue 5 First steps north east August 2001 The first meeting of the Reference should be compared with the other op- Group to oversee the option appraisal tions. process for the future of hospital ser- Designing a large workshop to com- vices in north east took pare the different options was seen place on Friday 29th June. as urgent – it was agreed that repre- The group, consisting of MSPs, medi- sentatives of the public would be in- cal, health service managers and local vited to join the Reference Group in health council representatives (see doing this and also to advise on the panel), spent three hours clarifying its best way of communicating with the remit and discussing the technical general public. processes of option appraisal. As a result representatives attended By the end of the meeting, the group, the group’s second meeting on 27th chaired by Peter Hamilton, Convenor July including Eddie Cuisack of North of Greater Glasgow Health Council, Glasgow Community Forum, Richard reached some important conclusions: Hunter of Townhead Community Coun- · It was felt that one of the service cil, Margaret McNaughton, Bishop- configuration options on the table - briggs Community Council, Helen namely the closure of the Glasgow Scammell of the East End Social Inclu- Royal Infirmary, with concentration of sion Partnership and GPs Dr I. Brown all services at a new hospital built at of Fernbank Medical Centre and Dr P. Stobhill - would not score well in eco- Ryan of Glenmill Medical Centre. nomic terms, nor would it find much At the second meeting the option ap- support in communities or from clini- praisal workshop arrangements cians. It was therefore felt to be were discussed and it was made wrong to spend time and money clear that all of the options pro- pursuing it posed for the north east would lead · Since (unlike the Southside) the to a new Ambulatory Care and Diag- service model was still unresolved, it nostic Centre (ACAD) being built at was agreed that an option involving Stobhill. The group next meets on new in-patient facilities at Stobhill 31st August. HIP WITH THE NHS

Updated Options for NE Glasgow Hospitals Those invited to the inaugural meeting of the North East Reference Group included: 1. Glasgow Royal Infirmary as the in- patient site for the North and East. Peter Hamilton, Convenor of Greater Glasgow Stobhill as a walk-in, walk-out same Health Council (who chaired the meeting) day diagnostic and treatment centre Bill May, Greater Glasgow Health Council (ACAD) with minor injuries service. Paul Martin MSP 2. Glasgow Royal Infirmary as a Pauline McNeill MSP Sandra White MSP specialist hospital and new build at Frank McAveety MSP Stobhill as a “district general MSP hospital” for north and east Glasgow Brian Fitzpatrick MSP with integrated ambulatory services (the MSPs Bill Aitken and Robert Brown also maintain a ‘watching brief’) 3. Stobhill as a local hospital providing Dr Brendan Devine, Glasgow Royal Infirmary general medicine and general surgery Medical Staff Association services with an ACAD, including a Dr Frank Dunn, Stobhill Hospital Medical Staff ‘casualty’ service Association Bill Gouldie, Partnership Forum, North

TH BOARD IN PARTNERS 4. The “do minimum” option (The Glasgow University Hospitals NHS Trust status quo but with money spent only TRUSTS IN GLASGOW Chris Spry, Chief Executive, Greater Glasgow on remedying essential backlog Health Board maintenance problems) Maggie Boyle, Chief Executive, North Glasgow University Hospitals NHS Trust Sleeves rolled up on the Southside

The Southside Reference Group (see appraisal workshops (see ‘As Easy panels overleaf for membership) met for as A B C’ on page 3). the third time on 2nd July. Like the Also discussed were land issues, North East Reference Group, they dis- such as planning regulations as they cussed the appointment of external ad- apply to the two main sites in question. visors, such as traffic consultants, and As a new Ambulatory Care and Diag- public representation on the option nostic Centre (continued on page 2)

GREATER GLASGOW HEAL Background information on the proposals and the minutes of the Reference Groups are available by visiting our website at www.show.scot.nhs.uk/gghb Modernising Glasgow’s Acute Hospital Services (continued from front page) An Overview of the Option Appraisal Process or ACAD will be built at the Victoria Infirmary irre- The appraisal process, which started in June 2001, is spective of the new in-patient hospital going to ei- co-ordinated by a Steering Group which has member- ther Cowglen or the site of the Southern General, ship from a wide range of interested parties and is di- some time was also devoted to Glasgow City Coun- rected by Pat Kilpatrick, an independent facilitator cil’s title to the former school at Grange Road and a who is employed by a NHS Trust outwith Greater portion of the Queens Park Recreation Grounds adja- Glasgow. Members include public representatives cent to it. from the Yorkhill Patient/Public Forum, staff represen- The Group meets again on Monday 27th August. tatives from the Yorkhill and Glasgow-wide Partner- ship Forums, Greater Glasgow Health Council, Glas- Members of the Southside Reference Group: gow University, the local MSP and clinical and mana-

Gordon Craig, Trustee, South Glasgow University Hospitals NHS Trust gerial representatives from Greater Glasgow Health (Chair) Board and the Yorkhill, South and North Glasgow Bill Aitken MSP NHS Trusts. A Yorkhill Future s Group, comprising Mr J Anderson, Medical Staff Association, Southern General M Barrie, Staff Partnership Forum Representative (Southern General) of volunteer representatives from the Public/Patient Brian Beacom MBE, Greater Glasgow Health Council Forum, has been created to increase public/patient Robert Brown MSP representation during the Option Appraisal process. Robert Calderwood, Chief Executive, South Glasgow Trust Terry Findlay, Greater Glasgow Primary Care Trust Stakeholder Involvement Kenny Gibson MSP During the Option Appraisal Yorkhill NHS Trust will Janis Hughes MSP P McNally, Staff Partnership Forum Representative, Victoria Infirmary actively seek the views of staff, parents, patient sup- Dr R Sharp, Medical Staff Association, Victoria Infirmary port groups, NHS colleagues and other organisations Chris Spry, Chief Executive, Greater Glasgow Health Board who have an interest in the future of Yorkhill. All com- ments will then be fed back to the Option Appraisal Steering Group who will take them into account during The Options for South Glasgow Hospitals the option appraisal process. Timetable 1. Cowglen as the site for a new in-patient hospital – The Steering Group will hold 4 meetings up to Octo- the Victoria Infirmary has a new Ambulatory Care ber 2001 to identify all possible options, agree the cri- and Diagnostic Centre (ACAD) but no in-patient teria against which they will be judged and recom- beds. The Southern General closes 2. The Southern General becomes the site for a new- mend the preferred option for the future. This will be build in-patient hospital and the Victoria Infirmary followed by a 3 month period of public consultation to becomes the site for a new ACAD consider the recommendation before a final decision 3. The “do minimum” option (The status quo but with on the future location of Yorkhill will be made by the money spent only on remedying essential backlog Scottish Health Minister. maintenance problems) Anyone wanting to find out more about the Yorkhill Option Appraisal Process can contact Linda Fleming, Head of Corporate Planning, Yorkhill NHS Trust, Royal Hospital for Sick Children, Dalnair Street, Yorkhill off and running Glasgow G3 8SJ. Tel 0141 201 0034. Background Although the majority of proposals outlined in the Acute Hospital Services Review related to adult hos- Way out west pital services, the Review also included an idea about relocating Yorkhill to an adult hospital site on the Back in 1996, the then Secretary of State for Scot- South-side of Glasgow. In February 2001, after con- land sanctioned the closure of the Western Infir- sidering the findings of a three month period of public mary. What prompted this decision was the fact that consultation, an independent site evaluation of rede- services for west Glasgow were split inefficiently be- velopment opportunities on the existing Yorkhill site tween Gartnavel General and the Western, with clini- and an evaluation of the South-side option - GGHB cal staff wasting time that could otherwise be spent on decided that wider analysis, which took into account patients travelling between the sites several times in all the options for the future of Yorkhill, was required. the course of one day, as well as patients having to It was therefore agreed that an Option Appraisal for shuffle between the two sites. Yorkhill should be carried out which would look at the Gartnavel is therefore to be the site for a new west future location of both child and maternal services Glasgow hospital, fully integrated and with modern within the city. Maternity services were previously the equipment. Consultation with the public, patients subject of a separate review that recommended that groups and clinical staff suggested that this was an the number of units should be reduced from three to acceptable solution to providing local services, which two to reflect the falling birth rate. One of the two units cover west Glasgow and Clydebank for general hospi- will be the new Princess Royal Maternity Hospital and tal services. Therefore a project team is the the other will be either The Queen Mother’s Hospital process of coming together in order to draw up an at Yorkhill or the maternity unit at the Southern Gen- ’Outline Business Case’ to set out the changes and eral. investment needed. (continued on page 3)

Page 2 MODERNISING GLASGOW’S ACUTE HOSPITAL SERVICES (continued from page 2) day and local authorities and members of the Local medical and surgical representatives are already on Health Council are likely to represent the public interest. board the project group and other staff and patient rep- · Stage B resentatives will be recruited shortly. Early work will fo- This is a briefing session for all the people who will cus on a new multi-storey car park at Gartnavel and be involved in scoring the different options for the laboratory services. future of hospital services in different parts of the City, including the public and community representatives involved in Stages C and E. They will have the chance As easy as A B C to see how the process of option appraisal fits together, to understand how similar processes in other parts of Whatever else it is, option appraisal is not easy, al- the UK have worked and to run through the results of though everyone concerned is trying to put together the the workshop at Stage A. This will take at least one most logical and straightforward process possible. Ba- day. sically, what must happen is that the different op- · Stage C tions for Yorkhill, NE Glasgow and the Southside At this stage new workshops are run to concentrate on must in each case be compared to one another to the specific options in south Glasgow and north confirm which offers the best overall ‘package’ of east Glasgow. The Reference Groups are involved in patient and clinical benefit with long-term sustain- designing these events and ensuring that people and ability and meeting financial and economic tests groups representing patients, the public and com- which the public sector must observe. Yorkhill is munities will have a chance to take part (see ‘First working hard with various stakeholders to find a way for- Steps North East’ and ‘Sleeves Rolled Up on Southside’ ward (see ‘Yorkhill Off and Running’ on page 2) regard- on the cover). ing child and maternal services, and in the case of the The pan-Glasgow benefits and weightings defined at adult acute hospitals, the Greater Glasgow Health Workshop B are now applied to the local options and Council and the Southside Reference Group have ‘scores’ allocated by people at the workshop. Each been helping GGHB map out a practical, clearly workshop will take at least one day. staged way of making the process work. · Stage D

This is how the process sketched out so far would This doesn’t stream from a single workshop or meet- run: ing as such, but represents the work of acute hospi- The Reference Groups (NE Glasgow and Southside) tal trust finance departments and other advisers, don’t actually make the decisions on the most appro- such as transport analysts, in pulling together ‘desk priate options – what they do is oversee the option ap- top assessments’ of the economic and financial factors praisal process and make sure that it is valid, fair and required to make each option possible. To make sure consistent. The Groups also help to engage public rep- that the information provided is fair and accurate, resentatives in decision-making. GGHB’s external auditors, Price Waterhouse Coopers, · Stage A will examine it. A similar role will be taken by Partner- ships UK, the former HM Treasury PFI panel, which has The first workshop will be held with the purpose of amassed considerable experience in assembling suc- marking out exactly the benefits and standards that cessful Public Finance Initiative (PFI) and Public-Private each option must be measured against. For exam- Public Partnership (PPP) packages, such as that for ple: when clinicians talk about ‘improved patient experi- Glasgow City’s new secondary schools. ence’, what exactly does that mean and how is it meas- · Stage E ured? Another example: what is ‘acceptable’ travel dis- tance by public transport to any particular hospital The final workshop brings the whole process, and site? – 10, 20 or 30 minutes – or more? all the people involved, together one last time. All Once key definitions have been provided, the next task the different elements, decisions and findings at each is to then decide how important each type of benefit stage of the process are assembled to provide final is relative to the others – for example: again, scores against each of the options being considered, ‘improved patient experience’ as defined by clinical based on the conventions and arrangements signed up staff – is that more or less important than transport time, to back at Workshop A. and if so by what level? From this, there should be one option each in south At the end of what is going to be a very systematic Glasgow and north east Glasgow which provides the and thorough discussion, the workshop should have ar- best range of ‘scores’ across all the different factors as- rived at a series of ‘weightings’ , which are later ap- sessed. plied to the ‘score’ generated for each benefit criterion From start to finish, from A to E, the option appraisal in later workshops. The weightings reflect the relative process will probably take about three months to priority or importance attached to the benefits. complete. If Workshop A took place in early Septem- Both the definitions of benefits and the weightings at- ber, for example, the results would be clear by Decem- tached to them have to be the same across Greater ber. The final options become ‘outline business cases’ Glasgow (A benefit relating to clinical quality, for exam- sent to the Scottish Executive. If approved, then tender- ple, cannot be less important in south Glasgow than it is ing of contracts can begin and the way is open to the se- in north east Glasgow). rious building work taking place between 2005 and 2010 This rather technical workshop will take at least a full with new services starting up throughout that period.

Page 3 MODERNISING GLASGOW’S ACUTE HOSPITAL SERVICES day and option appraisal. Jargon-busting Outline Business Case In the course regenerating Glasgow’s hospitals more than a few technical terms and names will crop up fre- The option which comes out of the option appraisal—for quently. Here’s an explanation of some of them: example, to build hospital X at site Y—still has to be worked up as a proposal on paper which sets out finan- ACAD – Ambulatory Care and Diagnostic cial and service plans. This goes to the Scottish Execu- Centre or Ambulatory Care Hospital tive for approval before money can then be secured to

No matter the outcome of the acute hospitals review re- start building. There needs to be one more stage—a garding in-patient services, an ACAD is to be built at the ‘Final Business Case’—which allows fully detailed speci- site of the Victoria Infirmary and one is in the advanced fications to be put together. stages of planning for construction at Stobhill Hospital. An ACAD provides hospital treatment for those pa- Partnerships UK or ‘PUK’ tients capable of walking in or walking out on the same day. The reality in 2001 is that this is already true Partnerships UK used to be the Government’s PFI of 85 – 90% of NHS patients at Greater Glasgow’s exist- (Public Finance Initiative) Panel but was later privatised, ing hospitals – only a minority of patients in the NHS with 49% of ownership remaining with the UK Govern- actually need an in-patient bed. ment and the Scottish Executive. The company is ex- New technology and treatment methods mean that more pert in the field of pulling together financial packages, and more people can be seen as an out-patient, or as a with the bulk of the money coming from the private sec- day case or be given day surgery without the need for a tor, to pay for large scale public projects. An example of protracted stay in hospital. For example, it is not that this is the redevelopment of schools in Glasgow City. long ago that removal of a cataract might have meant a PUK will help the NHS source the over £500 million couple of nights in a hospital bed – now it is routine needed to transform Glasgow’s hospitals. Their role is enough a procedure to be taken care of in a couple of mainly linked to the procurement of finance to build the hours. new facilities. ACADs are common in the US, and similar facilities have begun to appear in other parts of the UK . The kind of model being looked at in Glasgow could NHS Greater Glasgow provide a Minor Injuries Service (lumps, bumps and sprains) plus out-patient and day case consulta- At the end of September, Greater Glasgow Health tions, as well as a wide range of minor surgical pro- Board ceases to exist when a new ‘unified’ Board re- cedures. sponsible for the functions of GGHB and overseeing the Recovery beds would be provided so that patients could NHS Trusts is launched. NHS Greater Glasgow will recuperate from the effects of anaesthetics and receive have Board members drawn from local authorities as proper pain control, but as with current day surgery ser- well as clinical professional bodies and trade unions. vices, well-organised patient selection procedures The Trusts will no longer have separate Boards of Trus- should mean very few people ever have to be admitted tees. The Chief Executive of NHS Greater Glasgow will for longer than 23 hours. be Tom Divers (currently Chief Executive of Lanarkshire Therefore, whatever the outcome of the wider option ap- Health Board) and the Chair, until July 2002, will be Pro- praisal, 85 – 90% of patients at the Victoria and Stob- fessor David Hamblen, GGHB’s current Chair. The hill can be guaranteed to be treated at these sites in- process established for the review of acute hospital ser- definitely, in brand new purpose -built buildings. vices will carry on as planned.

Option Appraisal Upcoming Board meetings The process by which different possible locations and combinations of hospital services are compared There are frequent updates on the progress being made to each other. This might include a look at land and on hospital services at GGHB (and later NHS Greater planning restrictions, operational arrangements, how the Glasgow) Board meetings. These normally take place new facilities would meet patient care needs and pre- once a month in the GGHB headquarters building, Da- dicted trends in patients types and numbers, as well as lian House, 350 St Vincent Street, Glasgow and are traffic flow and access, cost and risk assessment. The open to members of the public to attend. The meetings option that is judged to have the best levels of advan- commence at 10.00 am and the next ones are sched- tage across a range of factors (or criteria) like these uled for 21st August (to be held in the Mitchell Library) picks up the highest ’scores’ through the process of and 18th September 2001. The NHS Greater Glasgow dates will be announced soon.

For further information call Jim Whyteside, Communications Manager on 0141 201 4445, e-mail via [email protected] or write care of Greater Glasgow Health Board, PO Box 15329, 350 St Vincent Street, Glasgow, G3 8YZ.

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