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Greater Glasgow Health Board GREATER GLASGOW HEALTH BOARD ANNUAL REPORT & STATEMENT OF ACCOUNTS FOR YEAR ENDED 31st MARCH 1987 GENERAL MANAGER'S REVIEW OF THE YEAR 1. Financial Problems In early 1986 the Board was in considerable financial difficulties. Revenue expenditure was running well ahead of budget and the Capital programme had been held back to help contain this overrun. The Board has a duty under Section 85(A) of the NHS (Scotland) Act 1978 as amended by Section 6 of the Health Services Act 1980 to keep within its financial allocations in anyone year. Revenue budgets in the year 1985/ 86 had been overspent by £6.7m; this was offset by transfers from revenue reserves of £3.9m and an underspend on Capital of £2 .1 m, leaving a net overspend of £0.7m for the year. To remedy the position efficiency savings programme were urgently started in all ancillary areas such as catering, laundry and linen, cleaning, energy, transport, medical records, general services, purchasing, rent and rates and professional fees. Project Leaders were appointed and targets set. The results achieved to date are as follows: Latest 1984/85 Savings Forecast Project Expenditure Target achieved Savings Total Subject Leader Level Saving to 31.3.87 to come Savings £m p.a. £m p.a. £m £m £m p.a. Catering A. K. Bowie 16.00 1.20 0.80 0.62 1.42 Laundry/ J. Park 8.50 0.80 0.65 0.48 1.13 Linen Cleaning/ Mrs G. Pain 17.00 1.60 1.00 1.65 2.65 Portering Energy W.E. Paterson 12.00 1.20 0.65 0.78 1.43 Medical T.D. Divers 7.60 1.00 0.27 0.73 1.00 Records Transport H.L.MD. Grant 1.60 0.25 0.1 5 0.34 0.49 General Miss L. Gray 21.90 1.75 0.87 0.95 1.82 Services Purchasing J.M. Moorhouse 58.00 3.00 0.44 2.56 3.00 G.T. Craig Rent/Rates M. Cleary 13.40 0.25 0.09 0.16 0.25 £ 156.00 £ 11.05 £ 4.92 £ 8.27 £ 13.19 The objectives were to eliminate the overspend on revenue account; restore the capital fund, restore funds for medical equipment and create funds for urgently needed developments at the same time as maintaining satisfactory standards of patient care. The results for the year indicate that these objectives have broadly been achieved. 2. Results for the Year 1986/87 On recurrent revenue expenditure the Board was underspent by £2.2m and because of the difficulties in getting the capital programme fully restarted capital expenditure was underspent by £1.4m. This gives a combined revenue and ordinary capital underspending of £3.6m. Details of the underspending on a cash basis are given in the Acting Treasurer's report which shows that the Board will carry forward the 1 % maximum cash underspending of £3.9m into 1987/88. This underspend in 1986/87 has allowed the Board to create: (i) a contingency fund for 1987/88 which has proved essential to finance the costs of the emergency evacuation of the Central Block at Woodilee Hospital; (ii) a development fund for investment in the improved services referred to below. 2 3. Capital Account The original ordinary capital allocation of £6.89m was increased by capital receipts from the sale of property of £0.526m making a total of £7.416m available. (1985/86 £8.911 m). In setting revenue budgets for the year it was necessry to transfer £3.4m from capital to revenue and as a result new investment proposals could not proceed. With the easing of the financial position in the second half of the financial year it became possible to recommence investment and expenditure for the year on ordinary capital schemes amounted to £6m. Expenditure on schemes under the national capital programme amounted to £5.3m. On the special Estate Maintenance programme expenditure amounted to £5.0m which is £4.0m less than last year. There was a reduction of £2.15m in the allocation granted. Since the special allocation is subject to cash limit it was overspent on a cash basis by £230,000. 4. Development Funds The Greater Glasgow Health Board already receives in annual funding a sum which is above the level of entitlement under the SHARE formula. It is not therefore in receipt of any development funds for new or improved services and progress can only. be made if we make our own development funds from money saved by our efficieny savings. The savings achieved In 1986/87 are now available for re-Investment Into Improved patient care and the Greater Glasgow Health Board has recently authorised new developments costing £1 .79m in the fields of Mental Handicap, Mental Illness, Cervical Cytology, extra nursing staff and Oncology. In addition the Board's contingency fund, again financed by efficiency savings, has provided £2.9m for the emergency evacuation of the Woodilee Psychiatric Hospital Central Block, and for accommodation and other improvements for patients. Development funds are being invested in SHAPE (Scottish Health Authorities Priorities for the Eighties) priority areas such as Mental Handicap, Psychiatric Care, Mental Illness and Prevention (including screening). 5. Development of General Management General management was first introduced into the Scottish Health Service in the autumn of 1985 following the Government's adoption of the recommendations made by Sir Roy Griffiths. In January 19861 took up the position of the first General Manager of the Greater Glasgow Health Board. In August 1986 the Scottish Home and Health Department published a circular on the introduction of Units and Unit General Management and in September 1986 the Greater Glasgow Health Board agreed my proposals to adopt a new organisation structure and replace the previous eleven geographical Units by six new Units. They are: Unit Annual General Manager Revenue Spend Beds £m Glasgow Royal Infirmary/ Mr D. Mackay 101 .8 3017 Stobhill General Hospital Western Infirmary/Gartnavel Mr T.A. Divers 69.8 2132 General Hospital Victoria Infirmary/Southern Mr J.G. Connaghan 71.6 2636 General Hospital Mental Health Mr P. Wilson 59.4 4997 Maternity/Paediatrics To be appointed 37.1 1113 Community/Primary Care Mr J. Laing 64.2 Unit General Managers have been in post for five of the six Units since June 1987; two have been promoted from within Greater Glasgow Health Board, one is a former Chief Nursing Officer and Director of Planning of Maidstone District Health Authority, and two have senior experience in industry. General management is bringing into the Greater Glasgow Health Board a clear decision making structure, much improved financial and personnel controls, rational analysis of properly costed alternative courses of action, and strategic reviews of all services on a Glasgow wide basis. 3 6. Strategy Reviews A series of strategy reviews for each medical specialty is under way. Those completed to date are: Oncology Maternity Mental Handicap Those in hand are: Mental Illness Care of the Elderly Community Care The objective is to measure and project the demand for a particular specialty until the end of the century, measure the current levels of resources devoted to it, assess whether resources are too few, too much or about right, and to recommend a plan with financial resources identified to implement it. These reviews consider catchment areas, number of in and out patient locations, changes in medical and nursing techniques, age of buildings, and all other relevant matters. 7. Assets During the year the first steps were taken to collect the data needed to show the Board's total holdings of land and property, expensive medical equipment and plant and vehicles. This is essential to enable effective management investment decisions on replacements and additions. A review of surplus properties led to disposals of £801 ,000. A major survey of the total estate will be completed in July 1987. Further disposal of surplus property will continue into 1987/88; increased expenditure on the proper maintenance of the Board's estate is likely to be a major priority. 8. Patients During the year the number of patients treated was: TABLE 1 IN-PATIENTS TREATED 1985/86 1986/87 (a) Acute DGH Specialties 140,151 141,209 (b) Supra-Area Acute Specialties 15,015 14,442 (c) Obstetrics 22,740 22,966 (d) Long-Stay Specialties 6,774 6,939 (e) Psychiatry 6,810 6,961 (f) Mental Handicap 368 547 (9) Other i.e. , Communicable Diseases, SCBU, ITU, A & E 19,414 19,115 TOTAL - ALL SPECIALTIES 211,272 212,179 4 TABLE 2 OUT-PATIENTS TREATED 1985/86 1986/8 7 (a) Acute DGH Specialties 1,001,934 1,016,921 (b) Supra-Area Acute Specialties 89,170 84,925 (c) Obstetrics 100,244 88,978 (d) Long-Stay Specialties 4,539 4,261 (e) Psychiatry 73,410 71,875 (f) Mental Handicap 283 (g) Other i.e ., Communicable Diseases, SCBU, ITU, A & E 350,115 352,131 TOTAL - ALL SPECIALTIES 1,619,686 1,619,091 TABLE 3 ST AFFED BEDS 1985/86 1986/87 Acute Specialties 4,051 3.957 General Surgery 766 767 Orthopaedic 667 658 ENT 138 129 Ophthalmology 182 178 Urology 177 172 Oral Surgery 18 18 General Medicine 1,240 1,221 Dermatology 103 96 Respiratory Medicine 212 206 Paediatric Surgery 105 104 Paediatric Medicine 142 136 Gynaecology 279 250 GP Acute 12 12 Acute Mixed 10 10 Other Supra-Area Specialties 542 528 Neurosurgery 102 103 Cardiac Surgery 88 89 Plastic Surgery 127 113 Neurology 50 50 Radiotherapy 151 149 Spinal Paralysis 24 24 Obstetrics 518 494 Long-Stay Specialties 2,401 2,422 Geriatric Assessment 698 707 Geriatric Long-Stay 1,510 1,522 Young Chronic Sick 193 192 Psychiatry 3,642 3,550 Mental Handicap 1,208 1,192 Other 394 390 Communicable Diseases 84 84 Accident & Emergency 102 100 Special Care Baby Unit 127 126 ITU 81 80 TOTAL - ALL SPECIAL TIES 12,756 12,350 5 9.
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