Following a review of Clyde Health Services, NHS Greater Glasgow and Clyde has today approved a number of proposals as the basis for independent scrutiny in advance of formal public consultation. These include proposed changes to maternity services, mental health services, unscheduled medical care at the Vale of Leven Hospital and continuing care for frail older people at Johnstone Hospital.
The timing of the consultation process will depend on the nature and timing of the requirement for independent scrutiny announced by the Cabinet Secretary for Health and Wellbeing.
Tom Divers, Chief Executive of NHS Greater Glasgow and Clyde said: “Although there are many examples of excellent, high quality health services in Clyde there are concerns about the ability to sustain certain services. There is also a need to modernise and improve services to bring them up-to-date with arrangements in other parts of the country. This includes, where possible, shifting the balance of care from hospital to community based services.
“Collectively these proposals are designed to address these challenges and, at the same time, make a contribution to generate savings to help tackle the £30m funding gap for Clyde health services. The proposals also aim to make best use of limited NHS resources and ensure services across Clyde are delivered in the most cost-effective and efficient way.”
The key proposals are:
Integrated Care at the Vale of Leven Hospital
- The conclusion of the Integrated Care Pilot at the Vale of Leven Hospital and the transfer of unscheduled medical care to the Royal Alexandra Hospital
The Lomond Integrated Care Pilot Project, if fully implemented, would have led to the withdrawal of on-site anaesthetic and junior medical cover with local GPs, who had undergone additional training, providing overnight cover at the Vale of Leven. In September 2006, as a result of concerns raised by local clinicians with responsibility for patient safety, it was concluded that this model of care did not represent a safe way of providing emergency inpatient care at the hospital and the pilot could not proceed. We therefore had to review acute services and explore alternative solutions for sustaining anaesthetics at the Vale of Leven.
The anaesthetic planning group, which has thoroughly reviewed the options to continue to provide anaesthetics, concluded that anaesthetic services can not be sustained at the Vale of Leven Hospital. As it is not possible to provide unscheduled medical care without anaesthetic cover we have no alternative but to transfer the remaining unscheduled services to another hospital.
The possibility of transferring patients to the Western Infirmary in Glasgow was explored however it simply doesn’t have the capacity to cope with the extra patients. The Western Infirmary is also due to close before 2012 as part of wider plans to modernise hospital services across Greater Glasgow. The Scottish Ambulance Service has also confirmed that it is quicker to access emergency services at the Royal Alexandra Hospital than it is at the Western Infirmary. The Golden Jubilee Hospital at Clydebank currently only provides services for non-emergency patients and does not have the facilities required to treat emergency patients.
A number of advantages were identified for the Royal Alexandra Hospital option. These were:
- The RAH clinical team already deal with the most acutely unwell patients from the Vale catchment area including all accident and emergency patients, people with head injuries and surgical and trauma patients. Clinically there are strong arguments for treating unscheduled medical patients on the same site as these other specialities.
- The Scottish Ambulance Service are clear that the RAH is more accessible for emergency ambulances and will enable them to get patients to hospital more rapidly than a Glasgow option
- The RAH option enables the integration of unscheduled medical and surgical care
- Analysis shows that appropriate physical capacity can be developed at the RAH to accommodate the additional patients
- Where patient choice already exists to access services in Glasgow or at the RAH, the majority of patients choose to access services at the RAH (e.g. obstetric services)
- Maintaining the links between the RAH and the VOL is also important for the future of many planned day and inpatient surgery, diagnostic and outpatient services as more than 70 half-day sessions each week are delivered at the VOL by consultants who travel from the RAH.
Under the proposed option, patients would be transferred back to the Vale of Leven hospital for rehabilitation as soon as possible. Work would also be undertaken with the Scottish Ambulance Service and local transport providers to improve transport links.
John Dickson, Clinical Director for Anaesthetics in Clyde, said: “Review of activity at the hospital showed that existing anaesthetic locums were only called to deal with around one patient per week out-of-hours and just over one patient a week during normal working hours. This level of activity is not high enough to meet training requirements for doctors and would not allow consultants to maintain their specialist skills. This means that it would not be possible to have a stand-alone team of anaesthetists based at the Vale of Leven.
He added: “It is also not practical to send anaesthetists from other hospitals in Greater Glasgow and Clyde to cover duties at the Vale of Leven. This is because there are only a small number of anaesthetists who have the specialist intensive care training and experience necessary to manage emergency situations. As these specialist staff would have to provide cover at the Vale of Leven on a residential basis, this would affect our ability to sustain services in other intensive care units across Greater Glasgow and Clyde. Continuing to provide services with locum staff is not acceptable and none of the alternative models of care we explored in other UK hospitals offered a solution.”
Mental Health Services
The proposals for mental health form part of a wider strategy to modernise and improve mental health services across Clyde. This strategy aims to develop comprehensive community based services as 99% of all mental health patients can be cared for in community based facilities and less than 1% need to be admitted to hospital. It includes plans to introduce new Community Crisis Services, develop Primary Care Mental Health Services and expand existing Community Mental Health Teams across Clyde. There are also plans to provide more suitable alternatives to long-stay hospital care (by developing supported accommodation, residential care and home care services in partnership with local authorities), improve inpatient accommodation and develop a number of specialist mental health services.
- Transfer of low secure learning disability services from Dykebar Hospital to Leverndale Hospital
- Transfer of adult and elderly mental health acute admission beds from the Vale of Leven Hospital to Gartnavel Royal Hospital
- Transfer of adult mental health acute admission beds from the Royal Alexandra Hospital to Dykebar Hospital
- Re-provision of continuing care beds for older people with mental illness from Dykebar Hospital to partnership facilities
Anne Hawkins, Director of the Mental Health Partnership, NHS Greater Glasgow and Clyde, said: “These proposals are designed to modernise and improve mental health services across Clyde. Redesigning local services and shifting the balance of care towards enhanced community services will also help us to meet the needs of local service users and their families.”
Services for frail older people at Johnstone Hospital
- Key Proposal - The transfer of the continuing care service for frail, older people at Johnstone Hospital to partnership facilities
These new services would be based locally in Renfrewshire and would continue to be run by NHS consultants and nursing staff. Staff would also work closely with existing local patients and their families to address any individual concerns over future changes. There are also plans to develop an improved range of community based services to ensure that, where appropriate, older people can be supported in their own home as an alternative to hospital or nursing home care.
David Leese, Director of NHS Greater Glasgow and Clyde’s Renfrewshire Community Health Partnership, said: This proposal would deliver modern, high quality, more accessible services better suited to the needs of local patients and their families. It would also allow us to provide individual bedrooms with en-suite facilities which would increase dignity and privacy for frail, elderly patients. This reflects best practice and would bring local services into line with arrangements in other parts of Scotland.”
- Key proposal - Closure of the delivery service at the Inverclyde Royal and Vale of Leven Community Maternity Units with women retaining the choice to access consultant or midwife led services at the Royal Alexandra Hospital or maternity units in Glasgow
Cathy MacGillivray, Head of Nursing for Clyde Acute Services, said: “This proposal would ensure that the two Community Maternity Units at the Vale of Leven and Inverclyde Royal Hospital remain open and continue to provide essential local maternity services which account for the vast majority of activity. These include antenatal checks, day care, scans, early pregnancy assessment, parent education and post natal checks. Women across Clyde would continue to have the choice to give birth in a midwifery-led birthing unit while still accessing the vast majority of their maternity care in their local area. It would also make more effective use of existing staff resources and capacity and free up significant savings to contribute to the financial recovery plan for Clyde.”
For further information contact: 0141 201 4429. Copies of the papers considered by the Board can be found on the NHS Greater Glasgow and Clyde website (www.nhsggc.org.uk)