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NHS GREATER GLASGOW & CLYDE

ASR PHASE II

NEW SOUTH GLASGOW HOSPITAL, NEW CHILDREN’S HOSPITAL

AND NEW LABORATORY BUILD OUTLINE BUSINESS CASE

FEBRUARY 2008

1. EXECUTIVE SUMMARY ........................................................................................................ 4 1.1 INTRODUCTION............................................................................................................. 4 1.2 THE CASE FOR CHANGE.............................................................................................. 4 1.3 ACUTE SERVICES REVIEW (ASR)................................................................................ 5 1.4 PROPOSED FUTURE SERVICES.................................................................................. 7 1.5 EXPECTED BENEFITS OF THE PROJECT ................................................................... 8 1.6 OPTION APPRAISAL – SITE AND DESIGN OF NEW SOUTH GLASGOW AND NEW

CHILDREN’S HOSPITALS.............................................................................................. 9 1.7 LABORATORY SERVICES........................................................................................... 10 1.8 FINANCIAL ANALYSIS ................................................................................................. 10 1.9 ASSOCIATED CAPITAL WORKS................................................................................. 11 1.10 PLANNING PERMISSION............................................................................................. 11 1.11 UNIVERSITY – WORKING WITH ACADEMIC PARTNERS ......................................... 11 1.12 FACILITIES, TECHNOLOGY, WORKFORCE............................................................... 11 1.13 REDESIGN OF SERVICES........................................................................................... 12 1.14 PROJECT MANAGEMENT ARRANGEMENTS............................................................ 12 1.15 PARTNERSHIP WORKING .......................................................................................... 12 1.16 COMMUNITY ENGAGEMENT...................................................................................... 12 1.17 GATEWAY REVIEW ..................................................................................................... 13 1.18 TIMETABLE .................................................................................................................. 13 2. PURPOSE AND LAYOUT OF THE OUTLINE BUSINESS CASE....................................... 14 2.1 PURPOSE..................................................................................................................... 14 2.2 LAYOUT OF THE DOCUMENT..................................................................................... 15 2.3 FURTHER INFORMATION ........................................................................................... 17 3. BACKGROUND AND STRATEGIC CONTEXT ................................................................... 18 3.1 OVERVIEW OF NHS GREATER GLASGOW & CLYDE ............................................... 18 3.2 ORGANISATIONAL STRUCTURE ............................................................................... 19 3.3 RESPONSIBILITIES OF NHS GREATER GLASGOW AND CLYDE ............................ 19 3.4 SERVICES AND ACTIVITY........................................................................................... 19 3.5 FINANCIAL PERFORMANCE....................................................................................... 21 3.6 DEMOGRAPHY ............................................................................................................ 21 3.7 HEALTH STATUS AND HEALTH IMPROVEMENT ...................................................... 23 3.8 WORKFORCE............................................................................................................... 26 3.9 UNIVERSITY LINKS – WORKING WITH ACADEMIC PARTNERS .............................. 26 4. THE NEW CHILDREN’S HOSPITAL DEVELOPMENT ....................................................... 28 4.1 CASE FOR CHANGE AND FUTURE STRATEGY........................................................ 28 4.2 DESCRIPTION OF OPTIONS CONSIDERED .............................................................. 29 4.3 DESCRIPTION OF THE CURRENT SERVICE AND FUTURE REQUIREMENTS ....... 30 4.4 DESCRIPTION OF FUTURE SERVICE REQUIREMENTS .......................................... 33 4.5 PROJECT OBJECTIVES .............................................................................................. 36 5. THE NEW SOUTH GLASGOW HOSPITAL DEVELOPMENT (NEW ACUTE ADULT

HOSPITAL)............................................................................................................................ 41 5.1 THE CASE FOR CHANGE – ACUTE SERVICES WITHIN GLASGOW ........................ 41 5.2 OVERVIEW OF THE ACUTE SERVICE REVIEW (ASR) .............................................. 43 5.3 DESCRIPTION OF THE CURRENT SERVICE AT SOUTHERN GENERAL................. 46 5.4 PROPOSED FUTURE DEMAND - BED MODELLING.................................................. 49 5.5 SERVICE RE-DESIGN.................................................................................................. 51 5.6 PROPOSED FUTURE NEW ADULT HOSPITAL SERVICES (NEW SOUTH GLASGOW

HOSPITAL) ................................................................................................................... 54 5.7 PROJECT OBJECTIVES .............................................................................................. 58 5.8 BENEFITS..................................................................................................................... 60

New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case i

6. DESCRIPTION OF OPTIONS .............................................................................................. 62 6.1 BACKGROUND TO THE APPRAISAL PROCESS AND FORMAT OF THIS CHAPTER .. ...................................................................................................................................... 62 6.2 GREENFIELD SITE – (RE-PROVISION OF SOUTHERN GENERAL HOSPITAL

SERVICES ON ANOTHER GLASGOW SITE) .............................................................. 63 6.3 POSITION OF THE NEW HOSPITALS ON THE SOUTHERN SITE ............................. 64 6.4 BUILD OPTIONS FOR THE NEW HOSPITALS – SEPARATE BUILDINGS OR

INTEGRATED BUILDINGS?......................................................................................... 65 6.5 PREFERRED DESIGN CONFIGURATION OF THE INTEGRATED BUILDING ........... 65 6.6 EXEMPLAR DESIGN .................................................................................................... 69 6.7 DESIGN QUALITY ........................................................................................................ 72 6.8 FUTURE PROOFING.................................................................................................... 72 6.9 SUSTAINABILITY AND ENERGY CONSERVATION ................................................... 72 6.10 OPTIONS FOR DELIVERING THE NEW SOUTH GLASGOW AND CHILDREN’S

HOSPITALS AND ASSOCIATED WORKS ON THE SOUTHERN SITE ....................... 74 6.11 BENEFITS APPRAISAL ................................................................................................ 76 7. NEW LABORATORY BUILD ............................................................................................... 77 7.1 SUMMARY OF THE SHORTLISTED OPTIONS ........................................................... 77 7.2 ECONOMIC AND FINANCIAL APPRAISAL.................................................................. 78 8. RISK MANAGEMENT STRATEGY...................................................................................... 80 8.1 INTRODUCTION........................................................................................................... 80 9. FINANCIAL APPRAISAL ..................................................................................................... 81 9.1 VALUE FOR MONEY EVALUATION............................................................................. 81 9.2 AFFORDABILITY APPRAISAL ..................................................................................... 86 9.3 AFFORDABILITY OF PROPOSAL FOR NEW ADULT AND CHILDREN’S HOSPITALS

IN CONTEXT OF NHSGG&C 10 YEAR FINANCIAL PLAN........................................... 86 9.4 10 YEAR FINANCIAL PLAN.......................................................................................... 95 10. PROCUREMENT .................................................................................................................. 97 10.1 PROCUREMENT OF BUILDING – PUBLIC FINANCE PROCUREMENT ROUTE....... 97 10.2 PROCUREMENT OF EQUIPMENT .............................................................................. 97 10.3 PROCUREMENT OF IT ................................................................................................ 98 11. WORKFORCE ISSUES ........................................................................................................ 99 11.1 INTRODUCTION........................................................................................................... 99 11.2 CONTEXT ..................................................................................................................... 99 11.3 THE POPULATION PROFILE ....................................................................................... 99 11.4 WORKFORCE PLANNING ......................................................................................... 100 11.5 FUTURE WORKFORCE PROFILE ............................................................................. 102 12. FACILITIES MANAGEMENT (FM)..................................................................................... 107 12.1 BACKGROUND........................................................................................................... 107 12.2 THE HEALTH BOARD’S APPROACH TO FM............................................................. 108 13. INFORMATION TECHNOLOGY ........................................................................................ 109 13.1 OVERVIEW................................................................................................................. 109 13.2 REQUIREMENTS FOR THE FUTURE........................................................................ 110 14. CAMPUS DEVELOPMENT PLAN ..................................................................................... 113 14.1 THE “DO-ABILITY” ...................................................................................................... 113 14.2 TRANSPORT .............................................................................................................. 117 14.3 ZONING OF THE CAMPUS AND LANDSCAPING ..................................................... 117 14.4 PLANNING APPLICATION ......................................................................................... 118

New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case ii

New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case iii

14.5 UNIVERSITY – FUTURE PROPOSALS...................................................................... 118 14.6 ART AND WELLBEING............................................................................................... 118 14.7 REGENERATION OF THE AREA ............................................................................... 118 15. PROJECT MANAGEMENT ................................................................................................ 120 15.1 INTRODUCTION......................................................................................................... 120 15.2 PROJECT MANAGEMENT & GOVERNANCE ARRANGEMENTS FOR STAGE 1 .... 120 15.3 PROJECT STRUCTURE – PROJECT MANAGEMENT ARRANGEMENTS – STAGE

ONE............................................................................................................................. 121 15.4 GOVERNANCE STRUCTURE – STAGE TWO, POST OBC TO SUBMISSION OF FULL

BUSINESS CASE (FBC) ............................................................................................. 125 16. LEGAL AND ACCOUNTING ISSUES & ROLE OF EXTERNAL ADVISORS................... 128 16.1 LEGAL AND ACCOUNTING ISSUES ......................................................................... 128 16.2 ROLE OF EXTERNAL ADVISORS.............................................................................. 128 17 STAKEHOLDER INVOLVEMENT...................................................................................... 129 17.1 PARTNERSHIP INVOLVEMENT ................................................................................ 129 17.2 COMMUNITY ENGAGEMENT.................................................................................... 129 17.3 COMMUNICATIONS................................................................................................... 131 18 IMPROVING HEALTH & HEALTH INEQUALITIES........................................................... 133 19 WIDER SOCIAL ECONOMIC BENEFITS .......................................................................... 135 20. GATEWAY REVIEW........................................................................................................... 137 20.1 BACKGROUND........................................................................................................... 137 20.2 OUTCOME OF THE GATEWAY REVIEW .................................................................. 137 21. BENEFITS REALISATION PLAN ...................................................................................... 140 22. POST PROJECT EVALUATION ........................................................................................ 144 22.1 PROJECT AUDIT ........................................................................................................ 144 22.2 COST AND TIME STUDY............................................................................................ 145 22.3 PERFORMANCE STUDY ........................................................................................... 145 22.4 PROJECT FEEDBACK ............................................................................................... 145 23. TIMETABLE........................................................................................................................ 147 24. CONCLUSION .................................................................................................................... 148

New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case 1

APPENDICES

Appendix 1 – Summary of NHS Greater Glasgow and Clyde Services

Appendix 2 – Activity Figures

Appendix 3 – Key Milestones of the Acute Services Strategy

Appendix 4 – Condition Survey Report

Appendix 5 - Aerial View Showing the Boundaries of the Site Pan Glasgow Bed Model

Appendix 6 – Pan Glasgow Bed Model

Appendix 7 – Enabling Works and Phasing

Appendix 8 – Design Option Appraisal

Appendix 9 – 1:500 Design Layouts

Appendix 10 – 1:200 Design Layouts for New Adult Acute Hospital

Appendix 11 – 1:200 Design Layouts for New Children’s Hospital

Appendix 12 - Outline Business Case for the Labs Development (Removed due to Commercial Sensitivity)

Appendix 13 – Risk Management Plan

Appendix 14 – OB1 Forms for the New Adult and Children’s Hospitals and new Laboratory Facility (Removed due to Commercial Sensitivity)

Appendix 15 – Optimism Bias Assessment (Removed due to Commercial Sensitivity)

Appendix 16 - Value for Money appendices (Removed due to Commercial Sensitivity)

Appendix 17 – Risk Schedule (Removed due to Commercial Sensitivity)

Appendix 18 – Benefits Appraisal

Appendix 19 - Project Management Structure – Remit of Groups

Appendix 20 – Project Management Structure – Membership of Groups

Appendix 21 – Community Engagement

Appendix 22 – Engagement Report - Children’s Hospital

Appendix 23 - Engagement Report - Adult Hospital

Appendix 24 - Project Plan


1. EXECUTIVE SUMMARY

1.1 INTRODUCTION The purpose of this Outline Business Case (OBC) is to present proposals for the development of an integrated Children’s and Adult Hospital and a new laboratory build on the site of the current Southern General Hospital. The proposals represent the largest investment in health services undertaken in Scotland and form a major part of NHS Greater Glasgow and Clyde's Acute Services Strategy to modernise health services. This investment will transform the experience of healthcare for patients and staff alike with Glasgow becoming the home to the largest, most advanced single NHS development delivering gold standard hospitals on the Southern campus. A jewel in the crown of NHS Scotland, the new hospital campus will provide maternity, paediatric and adult acute services together on the one site. This will ensure immediate access to specialist services of all kinds and therefore the highest quality and safety standards for adults, children and babies alike. The construction of the new hospitals will give opportunity to redesign radically the way in which health services are delivered and reappraise the skills and profile of the workforce tailoring delivery of modern health services in keeping with the 21st century. The campus will have excellent transport links. Capitalising on its location besides the M8 motorway, the campus car parking capacity will more than double from the current 1400 spaces to over 3,500 spaces. Public transport will be significantly improved with many of the bus services which currently travel around the site, going through the new site. A network of new bus services providing direct access from South Glasgow will complement the existing 50 buses an hour that currently travel to the site. Major investment will be made to connect cycle and pedestrian pathways to Glasgow's core paths networks to make it easier for staff in particular to walk or cycle to work. As one of the largest single investments in the south of the city the development has the potential to regenerate and breathe new life into Govan and the wider area. Liaison is taking place with Scottish Enterprise and a number of other external organisations to establish a New Hospitals Engagement Forum to realise this potential and bring added value to the new hospitals project. The Health Board has been engaging with the Scottish Government to agree the format and content of the Outline Business Case, the outcome is reflected within this document. 1.2 THE CASE FOR CHANGE NHS Greater Glasgow & Clyde recognise the need to ensure that patients who require access to hospital care can be seen, fully investigated and treated as quickly as possible within the appropriate facilities. For patients presenting as an emergency there should be access to specialised care of the highest quality, with access to state of the art investigations and treatment facilities on a 24 hour /7days a week basis. For elective care, patients should be seen, investigated and leave the hospital with a diagnosis and treatment plan wherever possible on the first visit. Underpinning this should be effective information and computer systems which allow GPs, Specialists and patient access to all relevant information needed to deliver high quality and effective patient care.


In 2002 Greater Glasgow Health Board described the case for change, which identified that the status quo was not an option, as there was significant challenge to the sustainability of the configuration of services and to the ability to improve patient pathways and create more efficient and effective care pathways. All of the factors identified remain relevant today with additional challenges and pressures resulting in even greater need to reduce hospital sites and duplication of services. In brief the issues are:

• The need to achieve the objectives of the guidance in ‘Better Health, Better Care’ and

other key national policies. These policies drive reductions in waiting times; fast track access to rapid diagnosis and treatment; provision of services designed around the needs of the patient; modernisation of healthcare through better use of technology and improved integration with primary and social care reducing inequalities in health. To achieve these objectives a major programme of investment in buildings, information technology and redesign of services is required.

• Fragmented services, there is a requirement for patients to move within and around sites and different buildings with an inevitable loss of continuity of patient care, important co-locations of services are not possible and difficulties arise in transferring information between services.

• Increasing sub-specialisation in medicine and surgery and an increasing need to move towards larger teams to ensure all patients can access the appropriate Specialist on a 24hours a day and 7 days a week basis.

• Pressures on staff in sustaining appropriate staffing levels, for example Modernising Medical Careers and the European Working Time Directive impact upon the availability of medical staff and therefore on the sustainability of multiple rotas.

• Outdated buildings unsuitable and unfit for modern healthcare offering a poor patient environment with unsuitable facilities for modernising services, restricting capacity and creating bottlenecks and delays in treatment.

1.3 ACUTE SERVICES REVIEW (ASR) The health services in Glasgow have entered a period of dramatic and exciting change. Following a decade of planning and public consultation, proposals to modernise the acute health services in Glasgow were approved in 2002 by Malcolm Chisholm, Minister for Health and Community Care. The components of the acute service strategy are as follows: • A new Beatson West of Scotland Cancer Centre at the Gartnavel General site (2007).

• Two Ambulatory Care and Diagnostic Hospitals on the Stobhill site and on a site adjacent to the Victoria Infirmary site, this will support the future reduction from 6 to 3 adult inpatient sites.

• A reduction in Maternity services from three sites to two, those being the Princess Royal Maternity Hospital at Glasgow Royal site and the redeveloped maternity facility on the new southern campus.

• In North Glasgow, acute in-patient services will be provided from Glasgow Royal Infirmary and Gartnavel General Hospital.

• In South Glasgow, acute in-patient services will be provided from a major new development at the Southern General Hospital.

• Full A&E services will be provided from two sites, located at Glasgow Royal Infirmary and the Southern General Hospital.

• Trauma and Orthopaedic in-patient services will be provided from the two full A&E sites. Orthopaedic out-patient and day case services to be provided from all five adult sites (Gartnavel, Stobhill, GRI, Victoria and Southern General).


• Minor Injury Units will be provided from all five adult sites.

In 2004 the Minister for Health and Community Care announced that the Scottish Government would provide £100 million to enable a new children’s hospital to be built on a site which would support the “triple co-location of services”. The Royal Hospital for Sick Children is currently co-located with the Queen Mothers Hospital (QMH). The planned closure of the QMH, and the transfer of its activity and services to the Southern and Glasgow Royal sites, will leave the Royal Hospital for Sick Children (RHSC) isolated. Following an option appraisal in 2005, of potential locations for the new children’s hospital, the Southern General site was identified as the only location to offer both co-location with maternity and adult services and appropriate vacant land for building. This process was undertaken in collaboration with a Ministerial Advisory Group chaired by Professor Andrew Calder. The report of that Group, published in March 2006, affirmed the selection of the Southern General site as the location for the new children’s hospital. This recommendation was accepted by the Minister for Health and Community Care in 2006 following a period of consultation. A review of laboratory services was carried out to identify the optimal configuration of laboratory services in Glasgow to support the Acute Services Strategy. The preferred option involves: centralising the majority of laboratory services into two main sites at Glasgow Royal and the Southern site; consolidating immunology, tissue typing, stem cell lab work and all other laboratory services associated with leukaemia research and Haemato-oncology onto the Gartnavel site co-location with the West of Scotland Cancer Centre; and finally centralising pathology and genetics services onto a single site near the Southern Campus. The process to transform acute hospital services across the city is well underway with the opening of the new West of Scotland Cancer Centre in 2007 and construction of two, state of the art, Ambulatory Care Hospitals (ACH) at the Victoria and Stobhill sites. The ACH’s will be commissioned over the period late 2007 to summer 2009, which will result in not only significant modernisation of Glasgow’s healthcare facilities and creation of single centres of excellence but will also result in 4 of Glasgow’s major adult hospital sites operating below capacity. This document describes the scheme which forms the second phase of the Acute Strategy, this involves the development of the new South Glasgow Hospital campus which not only sees the single biggest phase of modernisation and rationalisation of our adult clinical services, but incorporates the creation of a new Children’s Hospital for the Greater Glasgow and West of Scotland populations and the completion of the modernisation of Glasgow’s Maternity Services. On completion of the development of the new adult hospital in 2014, the Board will be able to enact the following: • inpatient services in the Victoria Infirmary to transfer to the new development thus vacating

the Victoria Infirmary site;

• inpatient services at the Mansion House Unit (MHU) to transfer allowing closure of the MHU (Note that some of the beds will already have transferred in 2009 to the new Ambulatory Care Hospital);

• inpatient services housed in outdated buildings on the southern site to be relocated;

• transfer of Accident and Emergency services and associated beds at the Western Infirmary enabling closure of the Western Infirmary.

By 2014, following some major refurbishment and new build works within existing estate at Glasgow Royal Infirmary and Gartnavel General Hospital, sufficient capacity will be created, following the opening of the new South Glasgow Hospital, to allow the 3 site inpatient configuration of adult services to be implemented.


Phase 3 of the Acute Services Strategy sees the major redevelopment and modernisation of the Glasgow Royal Infirmary campus and this work will be developed with a view to being brought forward for funding consideration in the period beyond 2015 followed by the final phase, which would see the redevelopment and modernisation of the retained adult inpatient services required on the Gartnavel General Hospital campus undertaken. 1.4 PROPOSED FUTURE SERVICES 1.4.1 Adult and Children’s Services Adult New Build A 1,109 bedded adult new build acute hospital is planned. This will provide A&E services and acute specialist in-patient care, a small volume of medical day cases and out-patient clinics serving the local population. No day surgery will be undertaken as this will be provided by the New Victoria Hospital. New Children’s Hospital The proposed new 240 bedded children’s hospital will provide A&E services and a comprehensive range of inpatient and day case specialist medical and surgical paediatric services on a local, regional and national basis. The new development will also have outpatient facilities. The Health Board’s strategy is that all Glasgow’s Children’s Services (up to the age of 16 and up to 18 years where appropriate) will be provided at the New Children’s Hospital. The planned number of beds for the adult and children’s hospitals are shown below:

Adult Hospital Children’s Hospital Specialty Beds Specialty Beds

General Medicine (including MHDU) 407 In-patient (including critical care areas) 193

Haematology 14 Short-stay (emergency receiving) 20

Dermatology 18 Day Care/Day Investigation 27

Nephrology (incl surgery) 80 Total 240

Geriatric Medicine 93

CCU 18

ITU 20

SHDU 23

General Surgery & Vascular 169

Urology 51

Orthopaedic & Ortho Rehab 141

ENT 37

Clyde Beds * 38

Total In-patient Beds 1,109


* Clyde Beds

In line with the South of the River Strategy for Clyde, consulted and agreed on during 2006/07, the in-patient bed requirements for the following services have been included within the bed model for the new South Glasgow Adult Hospital – Vascular Surgery, ENT, Dermatology and Haematology. 1.4.2 New Laboratory Build The proposed New Laboratory build will provide biochemistry, haematology blood transfusion and mortuary services. 1.4.3 Retained Services The Southern site will retain approximately 630 beds within the Institute of Neurological Services, Maternity, Spinal Injuries and Langlands buildings. The Langlands facility provides older people’s services and also services for the young physically disabled. 1.4.4 Future Service Changes At the time of undertaking the latest bed modelling exercise for the ASR it was recognised that there might be future changes to bed numbers as the result of changes to regional services provision such as neurosciences, oral-maxillofacial services, renal services, gynae-oncology services. With the exception of renal services, which has already been factored into the new South Glasgow Adult Hospital’s bed model other potential changes to requirements in relation to beds do not affect the new South Glasgow Adult Hospital’s current proposals. 1.5 EXPECTED BENEFITS OF THE PROJECT It is anticipated that the proposals set out in this business case will deliver a range of benefits for patients. These are as follows: • Provision of high quality services which are timely, accessible and consistently available by

providing local access to core medical and surgical services and consolidating specialist and tertiary services on fewer sites within the city.

• Investment in high tech equipment and Information Technology

• Attention to design and landscaping to improve the patients overall care

• Fully accessible to all and DDA compliant (Disability Discrimination Act.)

• Reduced waiting times for treatment through the provision of more efficient services increasing clinical capacity by investment in Information Technology (IT), the concentration of clinical teams onto fewer sites, optimising departmental and functional relationships and improving access to diagnostic services such as laboratory services.

• Access to highly specialised services provided by skilled staff facilitated through the centralisation of services.

• Rapid, one stop services through high volume processing of diagnostic tests and an extended working day to fit in with new models of care.

• Protection of elective workload from disruption by emergencies thereby improving the efficiency of the service and reducing the number of cancellations.

• Enhanced staff skills and knowledge through improved retention and recruitment due to a radically better working environment

• Modern, fit for purpose facilities which meet the needs of patients, visitors and staff


• Enhanced University links through co-location of an academic centre with the new hospitals on the Southern General Campus. This will enhance teaching, and research and play a significant role in attracting and retaining high quality staff in all disciplines.

It is also recognised that the proposed new builds on the Southern site could contribute substantially to the local Govan economy and the wider area. A social economic benefits analysis was carried out by SQW Consultants, funded by NHS Greater Glasgow NHS in partnership with a number of other contributors including Scottish Enterprise and Glasgow City Council. The analysis looked at the potential impact on the immediate area around the Southern General site, the wider city of Glasgow and the Glasgow Metropolitan City Region. The analysis identified potential benefits within the following categories: economic, human and social, knowledge (e.g. research and development) and place. In brief SQW has estimated that the future service configurations on the Southern General site will have a combined direct, indirect and induced economic impact of between £30 and £40 million on the South West Glasgow economy; between £110 and £140 million on the city economy and between £240 and £290 million on Glasgow city region by 2012/13. The new builds will also contribute to opportunities for training and employment and the development has the potential to support collaboration between academic, public and private sector partners to realise opportunities in research and development, bio-medical and life sciences. In conclusion, the Southern General development is seen as a catalyst for wider social and regeneration activity contributing to the creation of higher aspirations for the physical development of the local area. 1.6 OPTION APPRAISAL – SITE AND DESIGN OF NEW SOUTH GLASGOW AND

NEW CHILDREN’S HOSPITALS 1.6.1 Greenfield Option For purposes of comparison for the Outline Business Case the option of building the new hospitals on a Greenfield site was revisited. This confirmed the outcome of the 2002 review, during which this option was first explored and dismissed because of high cost. 1.6.2 New Southern General Campus Options Site In thinking about the optimum site on the Southern General Campus for the New South Glasgow and New Children’s Hospitals a key criterion has been the need to physically link the new hospitals to the Maternity and Neurosciences buildings. This will allow ready access to a range of paediatric services for foetus in utero or new born babies and mothers access to critical care and other acute services. An area which lies between the Maternity and Neurosciences buildings has therefore been designated for the construction of the new Hospital to allow these links. Separate or Integrated Hospital Builds In comparing options to build the new hospitals separately or together as an integrated build, the latter, an integrated build, was considered to offer more benefits, less risk, increased deliverability and lower cost. A further option appraisal took place involving NHS stakeholder input to identify the optimum design solution for the integrated build. An exemplar design was then developed involving input from a wide range of users.


Supporting/Associated Developments and Works In addition to the new Adult and Children’s Hospitals and Laboratory facility there are series of associated developments and works. For the purposes of the Outline Business case two options around the Southern General site have been developed, these are option 1 with a higher percentage of new build associated developments and option 1a utilising more of the existing estate. 1.6.3 Benefits Appraisal A benefits appraisal exercise was undertaken looking at the Greenfield site, Option 1 and Option 1a. The benefits criteria were derived from the project objectives. The criteria were weighted and scored against each of the options. The appraisal of the options produced scores within a very tight band, those options involving an increased percentage of new build producing slightly higher scoring.

1.7 LABORATORY SERVICES

A Glasgow wide review of laboratory services identified centralisation of the majority of laboratory services on the Southern General site and Glasgow Royal site as the optimum configuration to support the Acute Services Strategy. A new build laboratory facility is planned for the Southern General site housing haematology, biochemistry and mortuary services. The laboratory will be located alongside the new hospitals linked via an underground tunnel. The new build will support the New Adult and Children’s Hospitals and other services south of the city. The planned model for the new laboratory development will be one of high volume processing of tests with use of automation and up-to-date integrated IT systems with extended day and 24/7 working to reflect the new patient care models.

1.8 FINANCIAL ANALYSIS

The capital cost of the proposal to provide New Adult and Children’s Hospitals on the Southern General site is forecast to be £841.7m (Option 1a, 100% single rooms). It is proposed to fund this following a public capital procurement route, combining £270m of capital resources sourced from the Board’s general allocation of capital funds and from capital receipts generated from the disposal of sites which become surplus, together with £20m from its endowment funds, leaving £551.7m to be provided by SGHD in the form of a specific allocation of capital funding to the Board. This represents the level of capital funding which the Board requires to deliver the proposal contained within this Outline Business Case, and which is the subject of the Outline Business Case. The Board has tested alternative procurement routes for delivering the new Adult and Children’s Hospitals, assessing each of these in terms of their capacity to deliver Value for Money and Affordability. The outcome of this assessment confirms that there is little to differentiate the alternative procurement routes in terms of their capacity to deliver Value for Money, however a publicly funded capital route offers the potential to deliver an affordable solution within the context of the Board’s financial plan for the 10 year period to 2017/18. In testing the affordability of a new service commitment of this scale, the Board has required to prepare a 10 year forward financial plan which examines the movements in both funding and expenditure which it is likely to face over this time period. In doing so, it has identified and assessed the key areas of risk which could impact on its financial projections, and reviewed its capacity for mitigating these through management action. On the basis of this analysis, the Board is able to conclude that the proposal which is contained within this OBC is affordable.


1.9 ASSOCIATED CAPITAL WORKS

As described, there are a series of smaller capital works and developments associated with the new hospitals, these being: clearance of the build site, development of multi-storey car parks, a clinical support facility and a 22 bedded rehabilitation facility. The capital cost of these associated works is identified and will be funded from within the Board’s Capital Allocation provided through separate business cases. Those projects above the Board’s delegated authority will be subject to Capital Investment Group, Scottish Government approval. It is proposed that all of the above projects and the new adult and children’s hospital will be planned and co-ordinated through a Site Programme Co-ordinating Group, ensuring that all potential risks that may occur in delivering a multi-construction project environment are appropriately managed.

1.10 PLANNING PERMISSION

The Outline Planning Application was submitted to Glasgow City Council on 13th April 2007. The application was considered at the Glasgow Planning Committee meeting held on 16th January 2008 and received approval subject to specific conditions and the Section 75 legal agreements.

1.11 UNIVERSITY – WORKING WITH ACADEMIC PARTNERS

Glasgow University is intending to support the development of the Southern General campus by building an academic centre on the site. This will provide a modern academic facility to support teaching and research. An area of land on the Southern Campus has been identified by the Health Board for this purpose. A new multidisciplinary Skills and Education Centre is also proposed. Partners in this include the Royal College of Physicians and Surgeons of Glasgow, the University of Glasgow and NHS Education for Scotland. A site adjacent to the new hospitals has been identified as a possible location. 1.12 FACILITIES, TECHNOLOGY, WORKFORCE The reconfiguration of services across Glasgow will have a major impact upon the workforce and the requirements for information technology and facilities. The Health Board’s intention is to provide all hard and soft FM services from within NHS Greater Glasgow and Clyde’s facilities pool and to explore the most effective methods of service delivery through benchmarking to achieve value for money and efficiency for these services. The FM services for the PFI Langlands Building in the south of the southern campus will remain with the present contractor and will not form part of this exercise. There is a need to invest in significant Information Technology (IT) infrastructure with appropriate functionality to support the reconfiguration of services and emerging models of care, which will be crucial to the successful implementation of modern efficient healthcare systems. As the largest NHS employer in Scotland, NHS Greater Glasgow and Clyde will continue to undertake effective workforce planning linked to issues of service delivery and redesign. This will allow any future workforce gaps to be identified as well as to set in motion a range of solution based action plans. The proposal to develop the South Glasgow Hospital site will consolidate a range of services which will require the transfer of staff from a number of existing sites across the city. The opportunities for redesign offered by the new investment in facilities and the consolidation of workforce onto fewer sites will allow for significant re-profiling of the workforce.


In determining the potential workforce implications of change, workforce planning methodologies have been developed in conjunction with input from Service Directors and Professional Leads. This has involved analysing a range of policy and legislative drivers for change and a review of the subsequent knock-on effect for future workforce requirements.

1.13 REDESIGN OF SERVICES

Another important aspect in the success of the project will be a proactive programme of redesign of services to:

a) ensure efficient services which:

• meet patient needs;

• offer one-stop services;

• offer quick access to diagnostic services;

• reduce the amount of time patients are in hospital;

• provide a balance of care and treatment in the community.

b) provide a high quality streamlined service within the projected bed complement;

c) influence the optimal building layout and design.

An important aspect of the redesign work will be the interface with the Community Health (and Care) Partnerships to ensure, where appropriate, services for patients are provided outside of hospital settings. A programme of redesign work is underway to address the models of care associated with the Ambulatory Care Hospitals. The programme is closely linked to the planned changes in regional workforce planning and the development and implementation of the information Management and Technology Strategy. The methodology and templates being put into place to take this work forward will be applied to the New South Glasgow Hospital ensuring consistency in care models and a streamlined flow of service provision within Glasgow.

1.14 PROJECT MANAGEMENT ARRANGEMENTS

Robust Project Management arrangements are in place to ensure that the project, and the individual elements within it, meet the expected time, cost and quality criteria.

1.15 PARTNERSHIP WORKING

The Board is committed to partnership working. There is an open and inclusive approach to staff side communication and the Board. The project management arrangements incorporate partnership working and staff side input with staff side membership on the two key project groups Project Executive Group and the Acute Services Review Programme Board.

1.16 COMMUNITY ENGAGEMENT

NHS Greater Glasgow and Clyde established a Community Engagement team in 2002 to inform and involve patients and the public in the acute services strategy. Dedicated staff have been allocated to the new hospitals and an extensive programme of consultation with patients, carers, families is ongoing. Detailed work involving communities in Greater Govan and South West of Glasgow is also occurring. The team are working in partnership with both local and national New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case 12

organisations, such as Scottish Enterprise, to develop the full potential of the project for regenerating the wider area.

1.17 GATEWAY REVIEW

The New South Glasgow Hospitals project is subject to an Office of Government and Commerce (OGC) Gateway Review. The review is an independent assessment confirming that the business case is robust to meet the business need, is affordable, achievable with appropriate options explored and likely to achieve value for money. In doing this, the review outcome highlights whether aspects of the project are red, amber or green (traffic light system). Red means that the project cannot proceed to the next milestone until the issues identified as red are addressed. Amber means that the recommendations identified must be completed before the next Gateway Review stage. Green means that the programme or project is in good shape but may benefit from uptake of any green recommendations to enhance the project. The project completed a Gateway Review Stage 1 assessment in January 2008. The outcome of the Gateway Review was that there were no red recommendations hence the project may proceed to the Board and Scottish Capital Investment Group with the Outline Business Case. There were five amber and one green recommendations and these will be addressed before the Gateway 2 Review.

1.18 TIMETABLE

A summary of the indicative timetable for the project is shown below:-

Description Target Date

Outline Planning Approval January 2008

Gateway Review January 2008

Final OBC to NHS Greater Glasgow & Clyde Board 19th February 2008

Final OBC considered at Scottish Government Capital Investment Group 26th February 2008

Submit OBC to Cabinet March 2008

Final OBC Approval April 2008

Full Business Case Submission 2nd quarter 2010

Construction Starts 2nd quarter 2010

Completion – Children’s Hospital 1st quarter 2013

Completion – Acute Hospital 2nd quarter 2014


2. PURPOSE AND LAYOUT OF THE OUTLINE BUSINESS CASE

2.1 PURPOSE

The purpose of this Business Case is to present proposals for the development of an integrated children’s and adult hospital and a laboratory build on the Southern General site. The overall capital cost of the project is £841.7m (based upon mid point build costs); the anticipated timescale for completion of the development is the 2nd quarter 2014 with transfer of services thereafter. This project has developed over a period of time and the following describes some of the background to enable an understanding of the history behind the component parts of the project.

2.1.1 New Adult Hospital Over the last 10 years Greater Glasgow Health Board, now NHS Greater Glasgow and Clyde, has been developing an acute and related services strategy to modernise the acute adult health service in Glasgow. The proposals were agreed by the then Health Minister, Malcolm Chisholm, in 2002. The Acute Strategy is composed of four distinct phases. The new adult hospital constitutes the second phase of the Acute Services Review. The main goal of the Acute Services Review is to address the mounting pressures to change the way in which services are delivered by reducing the number of acute sites across Glasgow and investing in fit for purpose facilities. In more detail the New South Glasgow Hospital development is the major part of the plans to reconfigure services by reducing the adult inpatient sites from the current six hospital sites to three, by the time the new hospital opens in 2014. Two sites, Glasgow Royal and the Southern General, will have A&E and trauma facilities. The third inpatient hospital will be Gartnavel General. These acute sites will be supported by the two new build Ambulatory Care Hospitals.

2.1.2 New Children’s Hospital The proposal contained within this business case is for a new children’s hospital on the Southern General site which will allow transfer of the current Yorkhill children’s services, thus achieving the gold standard of triple co-location as highlighted in Professor Calder’s Report (2006). Hospital services for children in Glasgow are provided by the Royal Hospital for Sick Children, which is sited at Yorkhill and co-located to the Queen Mother’s (Maternity) Hospital. The Queen Mother’s Hospital is one of three maternity hospitals in Glasgow, the others being located at the Southern General and Glasgow Royal sites. Following a review over a number of years the Health Board is reducing the number of maternity hospitals to two. The Queen Mother’s Hospital will close and its services re-locate into a £28m extension and refurbishment at the maternity hospital on the Southern General site and the recently built maternity unit at Glasgow Royal Infirmary. The transfer of maternity services from the Queen Mother’s site will leave the children’s hospital isolated. The recognised gold standard is to achieve triple co-location of children services, maternity and adult acute services. This allows safe obstetric care for mothers and preserves the links between maternal and specialist children’s services, so that a full range of paediatric back-up and advice is available for both the foetus in utero and a new born child with significant and sometimes life threatening problems. Triple co-location also offers the advantage of strengthening links between paediatric and adult services, facilitating a continuum of care for those young people with long-term conditions.


2.1.3 The Laboratory Build At present there are laboratory services on each acute site. As part of the Acute Strategy a review of laboratory services across Glasgow was undertaken to explore how the service might best support the future reconfigured clinical services, taking into account the clinical linkages between the laboratory specialties and the services needed to support the clinical service profile on each site. The preferred option is to centralise the majority of laboratory services onto two main sites the Southern General site and the Glasgow Royal site. The designated area available for a new labs build on the Southern site is in close proximity to the proposed build for the new hospitals and therefore will allow a physical link to be formed between the laboratory and the hospitals.

2.1.4 Site Available on the Southern Campus There are 2 key issues in considering the location for the adult and children’s hospital, and laboratory facility on the southern site, these are as follows: • First the requirement to achieve critical clinical adjacencies, linking the new adult and

children’s hospital to both the existing neurosciences and maternity buildings which sit at opposite ends of the site and,

• Secondly, the existing hospital services must be maintained during the construction of the

new developments. To meet the above criteria the adult, children’s and lab new builds must be clustered close together in a partially vacant area of the site situated between the Maternity building and the Neurosciences Institute. It is planned to construct the children’s and adult hospitals as a single building, (albeit with distinctive and different external and internal identities reinforced by separate approach and entrance areas), in order to benefit from the clinical co-locations and support services synergies offered by an integrated build. The new labs build will be under construction prior to the new adult and children’s build within the same area of land. In addition there are a number of capital works associated with the new hospitals, such as multi-storey car parks and a clinical services facility.

2.2 LAYOUT OF THE DOCUMENT

The structure and content of this business case is summarised in the table below.


• Section 14 describes the Campus Plan, Phasing of works, transport and opportunities for the wider environment.

• Sections 15 to 20 detail the Project Management arrangements to manage stage one and two of the project, the role of advisors, stakeholder involvement, action to address health inequalities, the wider social economic impact of the project and the results of the Gateway Review,

• Section 21 outlines the Benefits Realisation Plan.

• Section 22, gives the plans for post project evaluation.

• Section 23 shows the Outline Timetable for the scheme.

• Section 10 explores the procurement model for the scheme.

• Sections 11, 12 and 13 profile the Workforce Issues, Facilities Management and Information Technology Strategy.

• Section 8 outlines the risk management strategy.

• Section 9 details the financial appraisal.

• Section 7 gives a short summary of the laboratory proposal, the options and results of the risk and non-financial appraisals.

• Section 6 describes the site and design configuration options for the new Adult and Children’s Hospitals, design considerations and benefits appraisal.

• Section 5 details the case for change for the adult hospital, current service and demand for future services and project objectives and benefits.

• Section 3 provides a profile of NHS Greater Glasgow and Clyde and summarises its activity, performance and financial status.

• Section 4 describes the case for change for the children’s hospital, the options considered, current service, a description of the future requirements and project objectives.

Outline Business Case – Structure and Content


2.3 FURTHER INFORMATION

Any queries, comments or requests for further information in relation to this Outline Business Case should be addressed to:

Mr Alan Seabourne Project Director – New South Glasgow Hospitals Projects NHS Greater Glasgow & Clyde Project Offices 1 Jubilee Court Hillington Glasgow G52 4LB Tel: 0141 892 6711


3. BACKGROUND AND STRATEGIC CONTEXT

3.1 OVERVIEW OF NHS GREATER GLASGOW & CLYDE

NHS Greater Glasgow and Clyde (NHS GG&C), formed in April 2006, is Scotland’s newest and largest Health Board. The Board has 40,000 staff serving a total population of 1.2million people, with a budget of £2.2billion. The new Health Board joins the Clyde region of the former Argyll & Clyde Health Board with the former Greater Glasgow, to create NHS Greater Glasgow and Clyde. Acute services are delivered from 10 hospitals, 3 of which lie within Clyde and the remaining 7 are located within Glasgow city. The geographical area covered includes West Dunbartonshire, Inverclyde, Renfrewshire, East Renfrewshire, East Dunbartonshire, Glasgow City, South Lanarkshire (Rutherglen & Cambuslang) and North Glasgow (Stepps-Moodiesburn corridor). Within Glasgow, the Western and Gartnavel General Hospitals operate in tandem delivering acute care in the west-end of the city. In the north-east of the city acute care is delivered from Stobhill Hospital and Glasgow Royal Infirmary. The Victoria Infirmary serves the south-east and the Southern General Hospital the south-west of the city. Services for children are provided centrally from the Royal Hospital for Sick Children, Yorkhill. Full adult Accident and Emergency services are provided at the Western Infirmary, Glasgow Royal Infirmary, the Victoria Infirmary and the Southern General Hospital. Stobhill Hospital has a Casualty Department which is covered by Consultant staff from Glasgow Royal Infirmary and the Western. The location of these acute hospitals can be seen the in diagram below.

• Western Infirmary


3.2 ORGANISATIONAL STRUCTURE

The Health Board is comprised of an Acute Division, a Mental Health Partnership, 10 CHCPs/CHPs including some joint CHP’s with Lanarkshire and a number of Corporate functions. The Acute Division brings together all acute services across the city and Clyde under a single management structure led by the Chief Operating Officer. The Division is made up of eight Directorates of clinical services each managed by a director and clinical management team along with a Facilities Directorate. These are:

• Emergency Care and Medical Services • Women’s and Children’s Services

• Surgery and Anaesthetics • Oral Health

• Rehabilitation • Diagnostics

• Regional Services • Clyde

• Facilities

3.3 RESPONSIBILITIES OF NHS GREATER GLASGOW AND CLYDE

The NHS Board is responsible for strategic planning and investment in healthcare services to ensure that they meet the needs of the local population and that national targets and directives are implemented. NHS Greater Glasgow and Clyde’s core purposes are to assess the state of health of the people of Greater Glasgow and Clyde and plan and provide services which:

• Promote good health • Prevent ill-health • Improve health • Provide safe and sustainable and equitable treatment for patients.

In doing this, the Board works in close partnership with other NHS organisations, local authorities and other agencies to ensure that social work, education, housing, employment and environmental services unite effectively and efficiently with the NHS in tackling inequalities and underlying health problems in local communities.

3.4 SERVICES AND ACTIVITY

The Acute Division of NHS Greater Glasgow and Clyde provides a comprehensive range of services from community based care (midwives, dental services and various outreach services) in addition to the full range of general hospital services. The organisation also hosts some of the most specialised health services in the country, including: cardiothoracic services, the Beatson Oncology Centre, the new West of Scotland Cancer Care Centre, the Institute of Neurological Sciences, transplant services, world-class paediatrics and obstetrics. A summary of services provided and activity undertaken is given in Appendices 1 and 2.

The breakdown of patient activity seen within Glasgow Acute Hospitals by Health Board in 2005/06 is shown in table 1 below.


Table 1

2006/07 Patient Activity seen within Greater Glasgow & Clyde Acute Hospitals (by Health Board)

Health Board ACTIVITY INPATIENT

EPISODES DAY CASE EPISODES

NEW OUTPATIENT EPISODES

Greater Glasgow & Clyde

Actual

211,731

%

84%

Actual

107,276

%

82%

Actual

288,230

%

87%

Lanarkshire 12,975 5.2% 10,282 8% 16,773 5%

Highland 11,247 4.5% 5,732 4% 11,929 4%

Ayrshire & Arran 7,044 3% 4,283 3% 8,075 2%

Forth Valley 3,531 1.3% 2,909 2% 3,570 1%

Dumfries & Galloway 1,255 0.5% 301 0.2% 876 -

Others remaining Scottish

3,041 1% 644 0.5% 1,821 1%

Others 1,204 0.5% 73 0.1% 301 -

Total 252028 100% 131500 100% 331,575 100%

+

It can be seen that over 80% of the workload is attributable to NHS Greater Glasgow & Clyde. Lanarkshire and Highland account for approximately 5% and 4%of inpatient activity respectively. Table 2 below details the overall activity trends over the last 5 years from 2001/02 to 2006/07. It can be seen that overall in-patient activity has increased by 4.9%, day cases by 14% and out-patients by 14%. It should be noted that New South Glasgow Hospital will not undertake day case activity and will provide a local out-patient service. The growth in out-patient attendances within the south of Glasgow over the last 5 years (2002/3 to 2006/7) is 11.5%.


Table 2

Activity Trends within Glasgow Acute Hospitals over the last five years for in-patient episodes, day cases and new out-patient attendances

2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 Percentage Increase

in activity between 2001/02 and 2006/07

In-Patient Activity

224,972 221,457 227,127 228,674 227,453 235,918 +4.9%

Day Cases Activity

108,233 106,597 110,747 116,108 121,065 123,309 +14%

New Out-Patient Activity

271,213 275,542 270,870

280,116

296,936

309,302 +14%

3.5 FINANCIAL PERFORMANCE

NHS Greater Glasgow & Clyde (NHSGG&C) has an established record of sound financial management and has consistently achieved its targets. The Board’s financial plan forecasts that total expenditure will be contained within its overall funding envelope thereby enabling it to secure achievement of its revenue financial target by managing within its “revenue resource limit” (RRL). The financial plan incorporates provisions for the latest forecast of additional funding required to support implementation of the Acute Services Review (e.g. Beatson Cancer Centre, and Stobhill and Victoria new hospitals). The baseline assumption is that the new South Glasgow and new Children’s Hospitals and new Laboratory facility will be revenue neutral.

3.6 DEMOGRAPHY

3.6.1 Current population The combined mid-year estimated population of the NHS Greater Glasgow and Clyde area as of 30 June 2005, provided by the General Registrar Office for Scotland (GROS) and based on the 2001 Census, was 1,190,939. The equivalent population for Scotland was 5,094,800.

3.6.2 Projected population The Scottish population is expected by the GROS to stay around the 5 million mark for the next 18 years, only slightly increasing to 5.1m by 2019 until a decrease is forecasted for after 2036. The Scottish population will become considerably older as a result of decreasing birth rates and the aging of those born during the ‘baby boom’ (mid 1960s). There will be a shift of the population, both within Scotland, and between Scotland and the rest of the UK and the world. Specifically, significant numbers are expected to migrate from Glasgow City, and most West of Scotland council areas. Counteracting this reduction is the fact that, increasingly, people are immigrating to Scotland most recently from European Union accession states. This inward migration is serving to offset the broadly declining birth rate and the fact that deaths have exceeded births since 1996.


The NHSGG&C population is expected to reduce overall by 5.5% by 2024, although this reduction will be particularly marked for specific age groups with implications for the planning of new hospitals in Glasgow. For example, it is expected that there will be fewer children aged 0-14 years in the GG&C area by 2024. On the other hand, there will be considerably more in the older age groups with implications for the planning of the new hospitals (Table 3).

This so-called ‘demographic shift’ (ageing of the population), that has been occurring for the past 30 years since deaths exceeded births for the first time in 1976, is more extreme in GG&C than in Scotland as a whole and will continue for the next few decades (Figure 1). The octogenarians will be particularly numerous in Greater Glasgow and Clyde by 2024, having experienced a 57% rise over 2004 figures.

Table 3

The projected change in population in NHS Greater Glasgow and Clyde between 2004 and 2024.

(Data shown is based on the GRO 2004 – based population predictions (published in 2005)

Projected change in Population between 2004 and 2024NHSGG&C

-30.0 -20.0 -10.0

0.010.020.030.040.050.060.070.0

Age Group

Per

cent

age

chan

ge

-17.3 -23.4 -4.4 -15.9 -14.0 25.3 14.9 14.6 56.8

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Life expectancy

Life expectancy at birth is increasing throughout the world at around 4 months per year on average as a result of improving life conditions and medical advances. Average life expectancy at birth is greater for women than for men generally. It is greater, for both genders, in all other NHS Boards in Scotland than in NHSGG&C, confirming that the population of Greater Glasgow and Clyde remains the most socially deprived in Scotland and enjoying the shortest life expectancy as a result.


Figure 2

Life Expectancy at birth (years) for residents of NHSGG&C and for residents of Scotland between 2003 and 2005.

3.7 HEALTH STATUS AND HEALTH IMPROVEMENT

Chronic disease remains a significant problem with almost 42% of the population reported being treated for more than one health condition, with people in deprived areas (Social Inclusion Partnership, SIP status is used as a proxy for most Deprived postcode areas) slightly more likely to be receiving treatment than residents of less deprived areas (non SIP). The gap between SIP and non-SIP areas is however starting to close. The percentage of people receiving treatment for one or more condition(s) increases with age, see Table 4 below.

Table 4: Percentage of people who received treatment for one or more condition(s) by age group

Age Group Percentage

16-44 22.3

45-64 54.5

65+ 81.0

Just over three quarters of residents (78%) reported visiting their GP in the last year. Older people, women, those in more deprived areas, those in poor physical health, those in poor mental health, those who are obese and those who are physically inactive tended to make more frequent use of their GPs. The proportion of respondents that reported visiting an out patient department has reduced, (30.7% visited an outpatients in 1999, this reduced to 24.6% in 2002 and 22.9% in 2005), but attendance at Accident and Emergency looks different, where significant increases had occurred in the proportion of respondents living in SIP areas that visit A&E, as illustrated in Table 5:

Life Expec

68

70

72

74

76

78

80

Males

Yea

rs

tancy at birth, 2003-2005

Females

Scotland NHSGG&C


Table 5: The percentage of respondents who had visited Accident and Emergency in the last year

Total Sample (%) SIP (%) (Deprived Areas)

Non SIP (%) (Non deprived areas)

1999 14.2 11.9 15.1

2002 14.9 17.0 14.1

2005 14.5 17.1 13.5

Change 1999-2005 N/A 5.2 N/A

P N/A <0.05 N/A

Confidence Interval N/A 0.8-9.6 N/A

NHSGGC has established strong partnerships to deliver further Health Improvement within the population in the form of integrated Community Health (Care) Partnerships and Community Planning Partnerships and identified resources to maximize the contribution of acute and mental health services to health improvement. The aims of NHSGGC and partners including, Local Authorities, Police, Economic Development Agencies and Voluntary Organisations, are to reduce inequalities, improve life circumstances and support improved lifestyles. Let Glasgow Flourish (2006) describes the complex nature and inter relationship between risk factors and health outcome recognising that there is a ‘Glasgow effect’ that is, an excess of mortality beyond that which can be explained by current indexes of deprivation. The result being that Glasgow’s health status remains worse than that of comparable English cities like Liverpool. The significant Public Health challenges with Glasgow, highlighted by the Director for Public Health Report 2007 include:

Health Inequalities Obesity Alcohol misuse

3.7.1 Health Inequalities Much of Glasgow has now become a more affluent and ‘middle class’ city with a profile that is currently similar to most UK cities. Yet, Glasgow’s overall health status does not fully reflect these changes.

3.7.2 Mortality and Morbidity Trends in overall deaths are downward, but the mortality gap between the communities with the highest and lowest mortality has widened noticeably. When the West of Scotland councils are compared there is and eight year gap in male life expectancy with Glasgow having the lowest life expectancy (69.1) and East Dunbartonshire (77.2) the highest. Even within Greater Glasgow there are differences in life expectancy, for instance, there is an estimated 15 year gap in male life expectancy between Bridgeton & Dennistoun and Anniesland, Bearsden & Milngavie. Among West of Scotland councils, Glasgow City has one of the lowest proportions of children in its population but the highest proportion of working age.


In Glasgow the proportions of men and woman of pensionable ages are strikingly different – 22% of women compared to 12% of men. It is notable how relatively young people are when they are first affected by limiting long standing illness, as is the length of time people, particularly women, live with a limiting long-term illness. Despite overall reductions in mortality, huge health inequalities remain and indeed such inequalities appear on the basis of a number of different mortality and life expectancy measures, to have widened over the last 10 to 20 years.

3.7.3 Education Glasgow City has by far the highest proportion of pupils from minority ethnic communities of any Scottish Local Authority (10.9%), equating to 7,500 pupils. It also has the highest percentage of pupils from less affluent households – 42% of primary school pupils were eligible to receive free school meals in 2004, double the nation’s average.

3.7.4 Social Environment Homelessness applications in Glasgow have been consistently double the Scottish average for the last eight years and are much higher proportionally than in the other West of Scotland council areas. Glasgow City has the highest overall crime rate among councils in Scotland and within the West of Scotland, Glasgow has the highest rates for a range of crime types. Analysis of violent crime in Glasgow shows that male offenders outnumber females by over three to one and the peak of ages for the offenders and victims are mid-teenage years to early twenties. The areas of residence of violent offenders and victims of violence are highly correlated with deprivation. In some smaller communities in Glasgow over one in ten people have been the victim of a violent crime in the last three years.

3.7.5 Economy / Employment / Income In terms of business, it is clear that Glasgow has retained a position within the UK as a major business centre, and is rated second only to London as a retail centre. However, Glasgow’s ranking in terms of economic output has fallen relative to other UK cities in recent years. There are now more women then men in employment in Glasgow and part-time work has grown to represent more than a quarter of all jobs. The number of Glasgow residents in employment has grown in the recent years (by more than 45,000 jobs in the period 1998-2004) but employment levels remain considerably lower than the Scottish average, although the gap has reduced. The official unemployment rate and the claimant unemployment rate have both reduced greatly over the last four to five years. Relative inequalities in employment between different parts of the West of Scotland, and within Glasgow, remain however, and official unemployment rates do not provide a true measure of the extent of worklessness. In Glasgow it is estimated that there are 110,000 adults who are not economically active, equating to 30% of the working age population. The Board is committed to tackling health inequalities and has created a framework around which action plans for CH(c)P’s/CHP’s, the Acute Operating Division and the Mental Health Partnership are being developed. This is detailed in the NHS Greater Glasgow & Clyde Planning and Priorities Guidance 2007-2010 and the Board’s Single Equality Scheme 2007.


3.8 WORKFORCE

Staffing

The workforce profile and workforce issues are described in detail in Section 11. Approximately 40,000 staff members are employed by the NHS Greater Glasgow & Clyde. In addition to these, there are University and voluntary staff who also contribute to NHS Greater Glasgow’s output. The current whole time equivalent by discipline is shown in table 6 below. Table 6: Showing NHS Greater Glasgow & Clyde Headcount Figures

Categories NHSGG&C Acute

Medical (inc GP’s)

Dentist

4,154

765

Nursing and Midwifery 17,423

Therapeutic 3,253

Healthcare Science and Technical staff 2,408

Pharmacy 708

Administration/Clerical and Senior Management 7,083

Estates, Works and Ancillary 4,456

Total 40,250

3.9 UNIVERSITY LINKS – WORKING WITH ACADEMIC PARTNERS

The University of Glasgow Medical School is one of the two largest in Scotland. NHS Greater Glasgow & Clyde has a long-standing and close working relationship with the University of Glasgow and other Glasgow Universities which manifests itself in a number of ways:

Academic staff working within the NHS to provide direct clinical services Shared posts, particularly in laboratory specialties Teaching of undergraduate and postgraduate medical students Teaching of science students Collaborative research projects between NHS and academic staff which have a

significant impact on the local and national economy.


Once developed the new Southern site will be one of the largest clinical campuses in the UK in terms of the range and volume of clinical activity and the accompanying staff profile. As well as creating major opportunities and responsibilities in regard to training and education the pattern of co-located services will facilitate collaborative and innovative research activities across the spectrum of maternal, child and adult health and disease. Against that background there is a clear recognition by NHS Greater Glasgow and Clyde, the University of Glasgow and the other Universities and educational partners with whom the Health Board engages, that the site will require to sustain, and be supported by, an active programme of on-site education and research. Planning is already underway with key academic partners for the provision of academic, training and educational facilities on, or near, the new Southern site. These facilities will support clinical research programmes, ensure a modern educational environment for undergraduate teaching across the clinical disciplines and provide clinical skills and associated accommodation to facilitate the professional development of all staff groups. In addition to enabling the development of existing staff, the creation of high quality academic and educational facilities on and around the site will significantly enhance the ability to recruit and retain the numbers and quality of staff required to maintain excellence in clinical service provision.


4. THE NEW CHILDREN’S HOSPITAL DEVELOPMENT

This section describes the following aspects of the Children’s Scheme: • The case for change and the future strategy for delivery of services, • options considered, • the current service and a description of the future service requirements, • Project Objectives, in other words, the benefits the scheme is required to provide.

4.1 CASE FOR CHANGE AND FUTURE STRATEGY

Children’s hospital services are currently provided by the existing Royal Hospital for Sick Children (RHSC) which is sited at Yorkhill and co-located with the Queen Mother’s (Maternity) Hospital (QMH) and the Regional Medical Genetics Services. Apart from these services no other adult medical services are provided on the site. The main block of the current hospital was built in 1970 with a number of amendments and additional facilities added in the intervening years. A full description of the services provided by the RHSC is incorporated in the next section but the hospital is the largest children’s hospital in Scotland and provides a comprehensive range of secondary and tertiary care which is accessed locally, regionally and nationally. The adjacent QMH was opened in 1964 and part of the rationale for its location on the Yorkhill site was the perceived clinical benefits associated with co-location of children’s and maternity services. Over the intervening years the advances in the diagnostic and care options available for both the foetus in utero and a new born child with significant, and sometimes life threatening, problems have increased enormously. In response to these advances the ability to manage a pregnancy in which there is concern for foetal well-being in a setting that provides a full range of paediatric back-up and advice allows the provision of a “gold standard” of care. This becomes particularly pertinent at the time of birth when the capacity to provide full obstetric care to the mother, and equally, to offer seamless and comprehensive care to the new born child without the need for transfer or separation, ensures the highest quality and safest pattern of care for both. The availability of this pattern of care on the existing Yorkhill site currently results in mothers from all parts of Scotland, known pre-natally to be carrying a child with a significant foetal abnormality requiring early intervention, being transferred to Yorkhill for their obstetric management at the time of birth. Against that background issues relating to the overall provision of maternity services across Glasgow, combined with concerns regarding the separation of the QMH from other adult services supportive of maternal care, raised questions about the long-term maintenance of the maternity service on the Yorkhill site. The QMH is currently one of three maternity units within Greater Glasgow, the others being located at the Southern General Hospital (SGH) and the Glasgow Royal Infirmary (the Princess Royal Maternity Hospital)(PRMH). In 2006/07 these three units provide care for a total of 11,910 births (QMH 3,326, SGH 3,092, PRMH 5,492). The overall fall in the birth rate in recent years, combined with workforce drivers particularly regarding the sustainability of senior and junior medical staffing complements and rota arrangements required the Health Board to consider reducing the maternity units within the city from three to two. That concept was initially accepted by the Health Board’s Maternity Services Strategy in 1999 and in 2003 a process was initiated to determine the future configuration of maternity services within the city.


The ensuing professional and public debate was shaped by the twin aspirations of ensuring that mothers, particularly during labour, had ready access to intensive care support and that the foetus at risk received the pattern of integrated and timely care which can only be achieved by the co-location of maternal and paediatric facilities. Following completion of a consultation exercise the then Greater Glasgow NHS Board, at its meeting in April 2004, agreed a recommendation that a reduction in maternity units be effected by the closure of the QMH. The Minister for Health and Community Care, in September 2004, acknowledged the concerns expressed regarding the consequent loss of the links between maternal and specialist paediatric services afforded by the existing hospital configuration on the Yorkhill site. By way of response the Minister announced that the Scottish Government would provide £100 million to enable a new children’s hospital to be built on a site which would support the “triple co-location of services”, thereby ensuring safe obstetric care for mothers and the preservation of the links between maternal and specialist children’s services, as well as offering the option of strengthened clinical links between paediatric and adult services. In that latter regard adolescent services and facilities have long been recognised as one of the weakest areas of NHS provision across the UK. Commonly teenagers and young adult patients have to be accommodated within hospital services targeted primarily either at younger children or older adults, neither of which arrangements are suitable for the social, developmental or clinical requirements of this age group. The move of the RHSC to an acute site, implemented in conjunction with the Scotland-wide shift of the upper age limits for children’s hospitals from 13th to 16th birthday (and up to 18 where appropriate) will allow the provision of facilities specifically designed for this age group. In addition the co-location of children’s and adult services will support a collaboration between paediatric and adult specialties that will facilitate a continuum of care for those young people with long-term conditions for whom the transition from paediatric to adult services is often a very unsettling and clinically disruptive period.

4.2 DESCRIPTION OF OPTIONS CONSIDERED

The main criteria in considering options for the location of the New Children’s Hospital were the capacity to address the requirement for “triple co-location” of paediatric maternity and adult services (as identified as the gold service standard by Professor Calder’s Report) and the availability of land. The options considered for the future of children’s services were either :-

- ‘Do nothing’ – in other words leave the children’s services on the current site or - A new build on an acute site. -

For the reasons already described the ‘do nothing’ option was dismissed on the clinical grounds that it would leave the children’s services on an isolated site and would not provide the triple co-location required to maximise high quality, safe care. An additional reason for dismissing the ‘do nothing’ option was the high cost of refurbishing the current Yorkhill buildings from which children’s services are provided. The preferred option is therefore a new build within an acute site. The Minister established a Clinical Advisory Group chaired by Professor Andrew Calder with the remit to work with NHS Greater Glasgow to identify the most appropriate site for the new children’s hospital through a process of service planning, stakeholder engagement and public consultation.

(GRO – Using General Register Office 2004 based Population Predictions)


An option appraisal exercise considering all of the potential available hospital sites within the Glasgow area took place in October 2005. The Southern General site was identified as the only site which fulfilled the two aforementioned criteria, that of having available land and offering triple co-location of paediatric, maternity and adult services.

In addition, as paediatric neurosurgery is already located on the Southern site, this option also offers a range of additional clinical services which will enhance patient care.

Many children requiring neurosurgical care will also experience other clinical problems which require the advice or input of a range of paediatric specialities and support services. Currently the provision of such support requires either the transfer of the patient or the movement of staff between Yorkhill and the Southern General site. The ability to offer neurosurgical care in the context of a full complement of paediatric medical, surgical and intensive care expertise will substantially facilitate the provision of high quality, safe and comprehensive care to this patient group.

In parallel with the above, and consequent upon the Ministerial announcement in 2004, the decision to build the new children’s hospital in Glasgow was recognised in Delivering for Health (2005), the Scottish Government response to the Kerr Report, as being an integral part of the future plans for the delivery of specialist paediatric services in Scotland.

“We have already agreed funding to relocate the Royal Hospital for Sick Children in Glasgow as a centre for national expertise in specialist children’s services. It will be co-located with maternity and adult services providing a ‘gold’ standard children’s hospital” Malcolm Chisholm 2004

Following publication of Professor Calder’s Report published in March 2006, a public consultation process on the future site of the new children’s hospital was initiated in April 2006, the outcome of which endorsed the proposal to adopt the Southern General as the site for the new hospital. The proposal was ratified at a Greater Glasgow and Clyde Health Board meeting on 27th June 2006.

Confirmation was also provided by the Scottish Health Council in August 2006 that the consultation process had demonstrated compliance with the relevant guidance for such procedures.

Concurrent work is being undertaken in NHS Lothian regarding the reprovision of their children’s hospital facilities, which are currently delivered from a site which does not include maternity or adult hospital services. This project, which has already obtained Initial Agreement from the Scottish Government, also shares the goal of delivering services from a site offering triple co-location.

Clinical and managerial staff involved in the initial planning for the proposed new children’s hospitals in both Edinburgh and Glasgow recognise the need for these two projects to be taken forward in a collaborative manner that enhances the overall provision of specialist paediatric services within Scotland. To that end formal links have already been established between the two projects and there is also close interaction with the National Steering Group for Specialist Children’s Services, chaired by Malcolm Wright, which has a remit to develop a national delivery plan for specialist paediatric services within Scotland.

4.3 DESCRIPTION OF THE CURRENT SERVICE AND FUTURE REQUIREMENTS

The RHSC (Glasgow) is Scotland’s largest children’s hospital and provides a comprehensive range of specialist care on a local, regional and national basis. Annual activity for 2006-2007 comprised

Out-patient attendances: 72,791 (New: 20,307; Return: 52,484)

In-patient admissions 15,806 (Emergency 54%)


Day Cases 8,195

A&E Attendances 38,588

Surgical procedures 11,636

Within Greater Glasgow essentially all in-patient care for children up to their 13th birthday (with the exception of paediatric neuro-surgery as previously mentioned) is provided by RHSC. This includes a full range of secondary medical and surgical paediatric services.

Accident and Emergency services for children aged 12 and under continue to be provided at all the city’s current A&E Departments (excluding the Western Infirmary) although most ambulance transfers are brought straight to RHSC. Following earlier discussions within NHS Greater Glasgow agreement was reached that paediatric Accident and Emergency activity should be centralised in the children’s hospital. These plans, taken in conjunction with the planned change in age limits for children’s hospitals (see below) will involve a significant increase in the number of A&E attendances which will be incorporated into the planning of the new hospital. The parallel development of Minor Injury Units at several sites across Glasgow is designed to ensure that less severe problems can be dealt with nearer to home

The majority of paediatric outpatient activity is also dealt with at RHSC although some work is carried out in Child Development Centres and in other hospital settings (e.g. orthoptics, plastic surgery).

Children and young people aged 13-15 (inclusive) receiving in-patient or outpatient secondary care in Greater Glasgow (including Accident and Emergency attendances) are currently cared for within adult hospital services. Consequent upon recommendations in “Better Health, Better Care”, the Kerr Report, Building a Health Service Fit for the Future (2005), and the Action Framework for Children and Young People’s Health (2007) these patients will be cared for within the children’s hospital services in the future albeit with an emphasis on ensuring the provision of patterns of service and facilities that are appropriate for their age and maturity. This will result in a 5-10% increase in activity across all sectors of RHSC.

In providing local hospital services to the children and young people of Greater Glasgow it is important to recognise that, as of the 2001 census, 25% of the children in Greater Glasgow live in areas characterised by maximum deprivation (Depcat 7). This concentration of deprivation is not replicated elsewhere in the UK and impacts on both the pattern and incidence of disease as well as aspects of service use, issues that require to be reflected in the patterns of service provision.

At a regional level the hospital supports a full range of specialist paediatric services comparable to the spectrum of specialties provided in an adult teaching hospital – cardiology, haemato-oncology, neurology, specialist surgical services, endocrinology and many others. In response to the specialist nature of these services and the long-term care that many patients receiving these services require, patients frequently remain under the care of RHSC at least until 15-16 years of age and sometimes older where appropriate.

These specialist services are accessed from across the West of Scotland Health Board areas and work in collaboration with, and in support of, the services provided in the District General Hospital paediatric units within the regional catchment area.

Yorkhill campus also hosts the regional Medical Genetics Service which includes services for children, adults and families. The relocation of the children’s hospital will be accompanied by a requirement to relocate the Medical Genetics Services.

In addition to the aforementioned range of specialist regional services, RHSC is also host to a number of specialties which are designated as national services and for which, in most cases, it is the sole provider in Scotland.


These include :-

Kidney transplantation

Bone marrow transplantation

Cardiac surgery

Interventional cardiology

Extra corporeal life support (delivered in collaboration with three other centres in the UK)

Paediatric intensive care transport (shared service with Edinburgh)

Paediatric intensive care (from April 2007 – shared service with Edinburgh)

Complex airways surgery

Endoprosthetic bone replacement

Vein of Galen Aneurysm (UK service shared with Great Ormond St)

In-patient child psychiatry

Brachial Plexus Palsy

Cleft Lip and Palate (shared service with Edinburgh/Aberdeen)

The role played by RHSC in the delivery and support of both regional and national services is reflected in the fact that around 50% of the in-patient activity in the hospital arises from Health Board areas outwith Greater Glasgow and Clyde.

In considering the provision of specialist paediatric services it is pertinent to note that a number of aspects of the configuration and delivery of such services in Scotland are currently under review. This process includes, in particular, paediatric neurosurgery and haemato-oncology. The output of these reviews may realign service provision between the four specialist children’s services in Scotland and may therefore impact on future activity levels and patient pathways albeit the result of these reviews will not be available until after the submission date for the Outline Business Case and therefore will be addressed within the Full Business Case submission for the New Glasgow Children’s Hospital.

The national Cancer review will report in 2008 with the current likelihood of having no material impact on the exemplar design for the new Children’s Hospital.

Neurosurgery will provide and initial report on adult services in 2008 but with no firm date as yet for reporting on paediatric neurosurgery. This Business case does not attempt to prejudge the outcome of the review. Even if complex neurosurgery were to be centralised in Glasgow it would only comprise 1 to 2 beds. In the unlikely scenario that every head injury and shunt procedure for Scotland were to be centralised then the impact would be more significant and difficult to give an accurate figure although it is estimated it would be no more than 8 to 10 beds. This could be comfortably accommodated within the design of the new children’s hospital.


Bed Modelling

The RHSC currently has a total of 271 beds. These are configured as :-

14 ICU beds

6 HDU beds

23 Neonatal Surgical beds

185 In-Patient Ward beds (depending on activity levels some may be utilised on a five day basis)

14 Day Surgery beds

10 Medical Day Care beds

10 Short Stay Beds (23 hour acute receiving unit)

9 Child Psychiatry beds

In addition, there are approximately 8 paediatric neurosurgery beds (2 ICU and 6 HDU and ward) in the Institute of Neurosciences and an average of 12-15 in-patient beds in use across the adult sector for patients aged 13-15 years.

The RHSC currently utilises 7 main operating theatres plus a dental suite and has facilities for :-

Cardiac catheterisation Interventional radiology MRI CT scanning Nuclear medicine

There are currently a full range of dedicated paediatric laboratory support services on the Yorkhill campus :-

Haematology Bio-chemistry Microbiology Virology Pathology

In addition to supporting the work of the RHSC with specialist laboratory services and professional advice these services are also accessed in various ways by primary care and other regional centres. In particular the pathology service undertakes perinatal and paediatric post-mortems, including forensic examinations, for most of the West of Scotland Health Board areas.

4.4 DESCRIPTION OF FUTURE SERVICE REQUIREMENTS

The relocation of the RHSC to the Southern General site does not, of itself, fundamentally change the role of the hospital in the provision of local, regional and national services. Future service requirements of the hospital will therefore closely mirror those which currently pertain, namely the need to be able to provide the broad range and patterns of service currently delivered at RHSC and to accommodate the required activity levels in a way that ensures timely accessibility for all patient groups.


At a local level, in addition to providing secondary hospital-based care for children under 13 in the Glasgow area, the new hospital will require to accommodate those patients aged 13-15 years (and potentially some in the 16–18 years age group) currently admitted to adult hospitals across the city. This equates with some 1,500 admissions; 2,800 bed days; 470 day cases and 1,100 surgical procedures.

In addition, it is intended that, following co-location, the in-patient care of children undergoing neurosurgical procedures will also be provided within the new children’s hospital. This currently involves 260 admissions and 1,670 bed days annually for patients aged 0-15 yrs.

The hospital will remain the main provider of specialist care for West of Scotland Health Boards albeit there may, over time, be some capacity for different models of shared care to be developed between RHSC and regional district general paediatric units which may allow some elements of the patient journey to be delivered nearer home. In that regard it should however be noted that a number of contrary drivers, which affect the sustainability of DGH paediatric services or argue for increased specialist input into care, have tended to increase inward referrals over recent years and there is no immediate evidence that this trend will not persist.

Equally, as the largest children’s hospital and the host to a range of national services, the RHSC will continue to play a pivotal role in the overall delivery of specialist services for children and young people in Scotland. In that regard the models of care and service configuration for specialist children’s services in Scotland are currently the subject of review by the National Steering Group for Specialist Children’s Services and the resultant National Delivery Plan, circulated for consultation during spring 2008, may contain some recommendations that could impact on activity levels in a few specialities, most notably haemato-oncology. In a parallel, a national review of adult and paediatric neurosurgery may also bring forward proposals for service reconfiguration. Any such recommendations would require to be scoped and addressed in the development of the final business case.

In considering future service requirements it is also pertinent to note that for many hospital services RHSC is the sole provider either at a local, regional or, in some cases, national level. Indeed there are at least two specialities in which RHSC is one of only two or four providers in the United Kingdom. As a result there is a strong imperative to ensure that the pattern of accommodation and services provided in the new hospital is capable of maintaining activity levels commensurate with clinical demand and of coping with anticipated periods of peak activity.

In parallel there will be a requirement to ensure that known and anticipated performance targets for services for children and young people can be addressed.

A Community Engagement Team has been established to ensure patient, carer and community involvement in the development of the new hospitals. The Community Engagement Team has undertaken an extensive programme of consultation with families, support groups, charities, voluntary organisations and local community organisations.

4.4.1 Bed Model Key to the ability of the new hospital to deliver activity levels that accommodate clinical demand is the incorporation of an appropriate bed model, both in terms of overall bed capacity and also the distribution of beds between critical care, in- patients and ambulatory/day care services.

As already identified, RHSC currently has 271 beds. In addition there are, on average, between 15 and 20 beds in Glasgow occupied by patients (young people aged 13-15 or neurosurgical patients) whose care will, in the future, be delivered in the new children’s hospital. The current virtual bed pool of the patient population who will use the new hospital has therefore been calculated as 289.


In order to develop a credible bed model for the new children’s hospital NHSGGC engaged the services of CHKS who have undertaken comparable work for the Health Board in the past and are also providing advice in respect of the bed model for the new adult hospital which is incorporated in this Outline Business Case.

In developing their recommendations CHKS utilised data relating to activity patterns for patients aged 0-16 in Glasgow hospitals (excluding Clyde) for the financial year 2004-2005. Speciality-specific performance, as measured by day case rates and average lengths of stay (ALOS), were measured against two peer groups of hospitals in England – a group of six specialist children’s hospitals and a group of five teaching hospitals with significant paediatric facilities. In all areas the 2004-2005 data from the peer group hospitals was used as the comparator.

In addition, CHKS adjusted the bed model to reflect anticipated changes in the population over the next decade (based on General Register Office predictions) and differing levels of bed occupancy.

The analysis and recommendations in the CHKS report were underpinned by a number of key assumptions

• That the population would change in line with projected estimates. For the purposes of this exercise, and based on the predicted changed in the NHS GG 0-16 population over the next decade, a reduction of 11% was applied.

• That hospitalisation rates will remain steady such that a fall in population will result in a comparable fall in activity.

• That there will be no material change in existing referral patterns or service configuration.

• That all patients under 16 currently managed in Glasgow hospitals outwith RHSC would be accommodated in the New Children’s Hospital (this excludes obstetric and adolescent psychiatric patients).

Based on the incremental application of the impact of

− the predicted fall in the population of children aged 0-15

− operating at best peer performance rates across all specialities

− achieving occupancy rates of 85% elective work and 65% non-elective work

CHKS estimated that there could be a potential reduction of 72 in-patient beds albeit this would required to be accompanied by a sufficient increase in day case and short-stay beds to accommodate the necessary changes in practice in favour of ambulatory and day care that are required to deliver the overall bed reduction. Taking these issues into consideration the final recommendation from CHKS favoured an overall bed complement of 245 beds.

The CHKS review did not include any recommendations regarding in-patient child psychiatry which currently incorporates 9 beds and delivers a national service. Existing occupancy rates and patterns of use suggest that the service could be maintained without loss of quality from a pool of six beds. A further adjustment of the proposed internal configuration of services within the new children’s hospital was also agreed which was seen to offer increased flexibility and efficiency of bed utilisation and as a result the proposed bed model for the new children’s hospital is based on a total of 240 beds, a reduction of nearly 50 beds from the total bed pool currently available to the relevant patient population.


It is proposed that the total of 240 beds will be configured as

193 In-Patient beds (including critical care areas, wards, psychiatry and 23 hour beds)

20 Short-Stay beds (emergency receiving)

27 Day Care/Day Investigation

In order to deliver the desired objective of a combined neonatal medical and surgical service serving both the maternity and children’s hospitals on the Southern General site twelve of the 240 beds will be provided within the redeveloped maternity / neonatal building on the Southern General site to which the new children’s hospital will be immediately juxtaposed. These 12 neonatal intensive care cots will be accessed by neonatal surgical patients currently cared for in RHSC. As a result, the bed capacity of the new children’s hospital building itself will be 228. The proposed overall reduction in bed numbers and the accompanying shift in focus in favour of day and short stay care will require a significant redesign of patient pathways and the ways in which services are configured. A wide-ranging service redesign programme is currently being progressed within the NHS GG&C Women and Children's Directorate in order both to consolidate proposals regarding future service configurations and to ensure that there is opportunity to test new models of care well in advance of the opening of the new hospital. This programme will also incorporate work with Regional Planning structures and other West of Scotland Health Boards in order to identify and accommodate any anticipated changes in service patterns which will impact on the future role and contribution of the Royal Hospital for Sick Children.

4.5 PROJECT OBJECTIVES

The objectives of the scheme are given below. They are categorised under the four headings of :-

• Clinical Effectiveness and Safety for Patients

• Fit for Purpose of Facilities

• Positive Impact for Staff

• Maintain and Enhance Academic Links The following describes each in more detail: -

4.5.1 Clinical Effectiveness and Patient Safety

Fundamental to the rationale for locating the new children’s hospital at the Southern General site is the requirement to achieve the clinical benefits of co-location with adult and, in particular, maternity services.

Restoration of linkage between maternity and paediatric facilities which currently exists on the Yorkhill site will allow the continuance of the services which have developed to ensure high quality care for the foetus at risk and the new-born infant with serious or life-threatening problems. These services support diagnosis, advice and intra-uterine management in the case of a foetus with significant abnormalities, the appropriate management of labour and the capacity to operate or undertake other interventions on the new-born baby without unnecessary transfers or inappropriate separation from the mother.


The co-location with the adult hospital, will also support engagement with adult services and clinicians which will offer particular assistance in the management of adolescent patients. This will become particularly relevant as the age limit for the children’s hospital is elevated to the 16th birthday. Some specialties, for example gynaecology, are not replicated in paediatric practice but will be reflected in the clinical activity profile of the hospital with the change in age limits. The capacity to engage readily with specialist expertise from outwith the children’s hospital will be a major clinical advantage in such instances.

The transition of young people with long-term clinical conditions from paediatric to adult services has long been recognised as challenging for the patient and family. The presence of co-located services can facilitate better transition arrangements and minimise the difficulties encountered during the transition process.

Modern health care increasingly incorporates multi-disciplinary and cross-specialty approaches, particularly in the management of complex problems. Interventions may require the concurrent involvement of multiple specialists. The configuration of the new hospital including, in particular, the integration of theatre and diagnostic imaging and intervention suites will support the best of modern practice in these clinical scenarios.

Many clinical areas in the current RHSC are required to manage a mixture of emergency and elective activity and a mix of patients with significantly varying severity of conditions and expected lengths of stay. The complexity of such arrangements mitigates against well-structured care pathways and best practice. The opportunity to configure the hospital to specifically accommodate differing care pathways will not only increase organisational efficiency but also enhance patient care and safety.

There is a clear recognition of the benefits of much closer integration of neonatal medical, surgical and medical intensive care facilities than has previously been possible on the Yorkhill site. Arrangements are being made to take forward such integration within the existing campus but the development of purpose-built facilities designed around such an integrated service will support high quality multi-disciplinary care to this very vulnerable patient group.

Healthcare acquired infections remain a major source of morbidity and prolonged hospital stay. The new hospital will be designed in accordance with best practice in terms of infection control principles and should thereby minimise the occurrence of HAI and the allied risks.

An additional advantage of a new children’s hospital will be the opportunity to ensure the centralisation of all paediatric A&E activity. This proposal, which accords with guidance on the provision of Accident and Emergency services to children, has already been agreed in principle but would have required significant capital investment at the existing RHSC given that it will result in a substantial increase in A&E attendances. The provision of new hospital facilities will allow the development of a purpose-built paediatric A&E department designed around modern emergency care practice and supported by adequately sited and sized short-stay and assessment facilities to minimise hospital admissions.

Information technology plays an increasingly vital role in the support and delivery of best clinical practice. The new hospital will offer an opportunity to incorporate state-of-the-art information management arrangements which will facilitate good care, minimise risk and ensure efficient working practices. Telemedicine is now an integral part of the role of RHSC as a tertiary referral centre. The capacity to include telemedicine capability in the relevant areas of the new hospital will significantly enhance the hospital’s role in supporting and co-operating with children’s services elsewhere in Scotland and in ensuring patient transfers are safe and timely.

Finally, although difficult to quantify, there is evidence that the construction and environment of a hospital can have a direct impact on patient well-being and recovery times. The use of modern design principles, enhanced by other influences (e.g. artwork) that improve the built environment, should have a positive influence on patients.


4.5.2 Fit for Purpose Facilities

Although not as old as many other hospital buildings within Glasgow the RHSC is not designed around current patterns of hospital-based care. Aside from issues relating simply to the age of the building the configuration of the clinical areas is either designed around models of care from the 1950s and 60s or, in regards to more recent development, has been shaped by limitations of space and operational feasibility.

The opportunity to develop a “Fit for Purpose” hospital built around current and future patterns of patient care will offer significant advantages to staff, patients and their families. These include, in particular, the ability to support closer working between the intensive and high dependency care areas and the facilities with which they interact e.g. theatres, diagnostic imaging.

o integrated neonatal medical and surgical services

o well structured dedicated 23 hour, day and ambulatory care services

o appropriate separation of emergency and elective activity

o integrated theatres, MRI and interventional radiology facilities for complex multi-interventional procedures

In addition the resultant ease of patient and staff movement between these areas as and when required, will offer not only better, more efficient and ultimately safer pathways of care but will also have a direct impact on the sustainability of staff rotas, the delivery of Hospital at Night models of care, better infection control management and the more efficient use of resources.

The New Children’s Hospital will also provide the opportunity to ensure the centralisation of all paediatric A&E activity which will result in an increase in attendances from 38,000 to 46,000 per annum.

The scheme, through the provision of new hospital facilities will allow the development of a purpose-built paediatric A&E department designed around modern emergency care practice and supported by adequately sited and sized short-stay and assessment facilities to minimise hospital admissions.

The configuration of the hospital will also support access from A&E to Diagnostic Imaging and swift transfer to ICU as well as being able to develop any clinically useful synergies with the adjacent adult A&E department with which it will share emergency ambulance routes. Child, Parent and Family-Friendly Facilities

The different psychological, developmental and clinical needs of infants, children and young people, their dependence on parents and carers and the complex dynamics of the wider family circle require that hospital facilities for children and young people are specifically designed around their particular needs.

This requirement has been increasingly recognised in the design of children’s hospitals developed in the UK and internationally in recent years and the new children’s hospital will have the opportunity to draw on a growing range of innovative ideas and design options in order to provide an environment practically and aesthetically suited to children and families.

One particular age-group traditionally neglected in the provision of hospital facilities are adolescent patients. The new hospital, which will accommodate all children and young people up to the 16th birthday (and some 16-18 year olds) will incorporate facilities designed to address the particular developmental, psychosocial and educational needs of this patient group.


Parents and carers not only provide emotional support and comfort to children in hospital but are also key partners in their care. The current RHSC does provide a number of single cubicles and offers some space for a parent to stay with a child but the accommodation is limited and in the four bedded and other ward areas the provision for resident parents is far from ideal in terms of space, comfort, privacy or access to toilet and allied facilities.

The hospital inpatient area is planned on 57% single rooms the rest being within 4-bedded areas. This was agreed following consultation on the appropriate mix of single/multi-bed wards for Children. The outcome of the consultation with children, young people and their carers was that there was a strongly expressed preference from both patients and parents for the retention of a mixture of single rooms and small bed bays (2-4 beds). This mixture was seen to offer flexibility in addressing a number of factors including the level of the illness, the need for isolation, the need for company to aid recovery, and the preference of teenagers in particular either for privacy or companionship. Such a mixture of accommodation is also in line with extant 'best practice' statements regarding adolescent care.

The Clinical Advisory Group also agreed that there should be a mixture of single and multi occupancy rooms within wards. It was accepted that there was a need for higher levels of single rooms in assessment areas and Intensive Care.

A key element of planning within the ward areas will be the inclusion of parental bedside facilities throughout the hospital (specific and different provision will be required in intensive care areas). This will not only address the personal needs of parents or carers but will significantly enhance their capacity to contribute appropriately to their child's care as well as lessening the infection control risks inherent in crowded accommodation.

In addition to bedside parental accommodation the current RHSC benefits greatly from the availability of additional parent/family accommodation provided adjacent to the site by the charities Ronald McDonald House and CLIC/Sargent. These facilities are particularly designed around the needs of parents/families of children who require prolonged hospital stays. Clearly the decisions regarding reprovision of such facilities alongside the New Children’s Hospital will rest with the charities involved but there would be a clear intention to work closely with these respective charities to facilitate the continuation of the current, and much valued, arrangements at the new site.

Patient Security

The hospital will support parent, carer and family access in ways that differ materially from many adult departments. In the latter the pattern and volume of public movement in the hospital brings difficulties in terms of ensuring the safety and security of child patients. The New Children’s Hospital will offer options to reconfigure public movement within the premises which will allow the introduction of modern security measures which are both as effective and as efficient as possible.

4.5.3 Positive Impact for Staff

Many of the potential advantages of the new children’s hospital in terms of clinical care and a “fit for purpose” environment also constitute true benefits for staff. The capacity to facilitate high quality care with efficient care pathways and to maximise synergies within the children’s hospital and with other services on the site combined with ease of access to enhanced academic facilities and opportunities all favour more efficient working and improved professional development and offer the attraction of working in a centre capable of sustaining a high reputation for the clinical care provided.

In addition a hospital within which departmental arrangements are configured to take advantage of the synergies between individual specialties and services will foster innovative and flexible working practices across the clinical disciplines with the resultant consequence of enhancing experience and job satisfaction as well as supporting more efficient staffing structures.


Equally, a hospital built to modern standards in terms of design, facilities (including dedicated staff facilities), equipment and space will provide an attractive, healthy and safe working environment.

Potentially the opportunities offered by a new children’s hospital located in such a way as to maximise the opportunities and benefits inherent in the overall development proposed for the Southern General site are comparable to the best international centres. Such an arrangement will play a major future role in attracting and retaining high quality staff of all disciplines.

The development of an acute triple co-location campus of the size and scale which is envisaged for the Southern General site as a whole is also likely to include or attract a range of professional, social and recreational facilities either within or in the vicinity of the campus from which staff at the new children’s hospital, along with other staff working on the site, can benefit.

4.5.4 Maintain and Enhance Academic Links

RHSC, as the largest children’s hospital facility in Scotland, is a key centre of under-graduate and post-graduate teaching and clinical research. The infrastructure to support these activities on the current Yorkhill site is increasingly in need of new investment in terms of teaching accommodation, clinical skills facilities, clinical trials accommodation etc. As a result, the capacity, within the existing Yorkhill campus, to host significant local, national and international training events and conferences is extremely limited in a way that is detrimental to the hospital fulfilling its wider academic role.

The re-location to a site which will become a major hub of education and research and will have appropriate facilities to sustain these activities will address these long standing needs and thereby allow the hospital to better fulfil its potential as a major centre for teaching, research and development in the field of child health.

In addition, the opportunities afforded by co-location will foster increased academic collaboration between paediatric, obstetric and adult specialities across a range of common education research interests.


5. THE NEW SOUTH GLASGOW HOSPITAL DEVELOPMENT (NEW ACUTE ADULT HOSPITAL)

This section describes the following aspects of the Acute adult hospital development: -

• The case for change

• Overview of the Acute Services Strategy

• Description of current service at Southern General

• Proposed future adult services on the Southern site

• Project Objectives

5.1 THE CASE FOR CHANGE – ACUTE SERVICES WITHIN GLASGOW Health Services in Glasgow are on the verge of a dramatic and exciting change. Following a decade of planning and public consultation, proposals to modernise the acute health services in Glasgow were approved in 2002 by Malcolm Chisholm, the then Minister for Health. This 10 year multi-million pound strategy will see the transformation of acute services across the city including the replacement of outdated Victorian buildings, and the creation of one-stop/rapid diagnosis and treatment models for the vast majority of patients. “This has been a long and extensive process taking many views from people across Glasgow. In those three years there has been a range of views put forward during the consultation, but the common strand running through the consultation is that maintaining the status quo is not an option. It is time to move onto provide high quality, modern healthcare for patients in Glasgow. It is time to move on from the outdated buildings which are unsuitable for modern healthcare” Malcolm Chisholm 2002. NHS Greater Glasgow and Clyde recognise that the need to ensure that patients who require access to hospital care can be seen, fully investigated and treated as quickly as possible within the appropriate facilities. For patients presenting as an emergency there should be access to specialised care of the highest quality, with access to state of the art investigations and treatment facilities on a 24 hour /7days a week basis. For elective care, patients should be seen, investigated and leave the hospital with a diagnosis and treatment plan wherever possible on the first visit /same day visit. Underpinning this should be effective information and computer systems which allow GPs, Specialists and patient access to all relevant information needed to deliver high quality and effective patient care.

In 2002 Greater Glasgow Health Board described the case for change, which identified that the status quo was not an option as there was significant challenge to the sustainability of the configuration of services and to their ability to improve patient pathways and create more efficient and effective care pathways. All of the factors identified remain relevant today with additional challenges and pressures resulting in even greater need to reduce hospital sites and duplication of services.

In brief, the pressures for radical change in the way Acute Services are delivered in Glasgow are shown in the diagram below.


PRESSURES FOR CHANGE

Antiquated Buildings Not fit for purpose

National policies

Fragmented Services

The following describes these pressures in more detail.

The main drivers for changes are this

Policy Imperatives - ‘Better Health, Better Care’ drives: reductions in waiting times; fast track access to rapid diagnosis and treatment; the provision of services designed around the needs of patients; modernisation of health care through better use of technology; and improved integration with primary and secondary care and reducing inequalities in health. To achieve these objectives a major programme of redesign of services, investment in buildings and information technology is required, making services smoother, more accessible, enhancing the quality of the outcome for the patient and achieving the objectives advocated by Better Health, Better Care” and other national policy initiatives.

Fragmented services – there is a requirement for patients to move within and around

sites and different buildings with an inevitable loss of continuity of patient care. Important co-locations of services are not possible and there are difficulties in transferring information between services to support patient care.

Increasing sub-specialisation in medicine and surgery - there is a move towards

larger teams to ensure all patients can get access to the appropriate specialist treatment; whereas in the past a single surgeon may have performed a wide variety of operations, now more procedures are available and specialties increasingly deal with particular morbidities and parts of the body. Diagnosis can also be a multi-disciplinary task often requiring patients to be seen by a number of expert staff before diagnosis can be made. Having expert staff together and closely integrated facilities this process allowing treatment to commence as soon as possible

Pressures on Staffing and Rotas – currently there are too many inpatient sites each

requiring emergency on-call rotas resulting in pressures on staff. Modernising Medical

Change

Need for Sub

Specialisation

Clinical Networking

Recruitment

NHS Modernisation

Changes in Post Graduate

Training

EU Working Time Directive

Diagnostic Bottlenecks (one stop)


Careers and the European Working Time Directive impact upon the availability of medical staff and therefore the sustainability of rotas. In short, the fundamental redeployment of staff, Glasgow is facing an over-stretched workforce with patterns of working, which are difficult to sustain and are unaffordable.

Outdated buildings - many of which are Victorian, dating from 1870’s and are unfit

for modern healthcare. It is significant to note that many of the original buildings still in clinical use today were contemporary with Joseph Lister. This causes difficulties in providing an efficient, smooth running service. The Victorian buildings provide unsuitable diagnostic and imaging facilities which restrict capacity, create bottle-necks and inhibit the provision of one stop/ rapid access diagnosis and treatment models. Some refurbishment has taken place but there are still several limitations and inflexibility to: change in use, access to and within the buildings and the ability to increase capacity. Patient transport within the sites and around the sites and different building inevitably delays patient care, causes patient discomfort and increases risk of patient safety and discontinuity of patient care. In addition, co-location of interdependent services is often not possible. The existing labyrinthine circulation complicates way finding for members of the public and greatly reduces general and security efficiency.

In summary, the status quo is not an option, as it will result in the following:

• A failure to provide a safe clinical service in accordance with nationally recognised standards;

• A failure to provide good clinical services with enhanced outcomes through sub-

specialisation and redesign. • Failure to sustain services. For example, many of the existing clinical teams are too small to

sustain rotas across multiple sites. In some cases it may be possible to continue the service with significant use of external staff agencies but with a corresponding knock on affect to quality and expenditure.

• An increased incidence of elective cancellations to cope with the rising emergency

workload. The consequence of this trend will be a reduced ability to deliver elective activity with a shift towards an ‘emergency only’ service;

• Failure to attract and compete for staff, especially in areas of acute shortages; • Failure to provide a modern service with sub-specialisation and up to date technology; • Rising cost of maintaining Victorian building estate

5.2 OVERVIEW OF THE ACUTE SERVICE REVIEW (ASR)

To address the pressures discussed above the Health Board have developed a dynamic strategy of reconfiguration and investment. The key components of the acute strategy are as follows: -

• A new build West of Scotland Cancer Centre on the Gartnavel site.

• Transfer of Cardiothoracic and Interventional Cardiology Services to the Golden Jubilee National Hospital (2008).


• Two new ambulatory care hospitals (ACH’s) on the Stobhill site and the site adjacent to the Victoria Infirmary to support the future reduction from 6 to 3 adult in-patient sites. The three inpatient acute sites will be the Glasgow Royal Infirmary, the Southern Glasgow site and Gartnavel General Hospital.

• The number of maternity units in Glasgow will change from 3 to 2, these being at the Southern General Hospital and Glasgow Royal Infirmary.

• The number of Accident and Emergency Departments will be reduced from 4 units and a casualty to two A&E Trauma units, which will be based at Glasgow Royal Infirmary and the Southern General site. Trauma and orthopaedic in-patient services will be provided from these two A&E sites.

• There will be 5 Minor Injuries Units located at Glasgow Royal Infirmary, Southern General Hospital, the New Stobhill and Victoria Hospitals and at Gartnavel General Hospital.

The redesign and redevelopment of Glasgow’s acute services will address many of the pressures currently facing the hospital service. The new services will be provided in modern facilities rather than in 19th century buildings. The purpose-designed facilities will enable the one-stop/rapid diagnosis and treatment models required for the future. Concentration of services will allow the requirements of junior doctors’ hours and issues arising from increasing sub-specialisation of medicine to be addressed through the creation of larger teams and sustainable rotas for both junior and senior staff.

The formation of larger clinical teams will ensure that programmes of work, including the need to cover emergencies without interfering with waiting list and ambulatory care sessions, can be planned effectively. The concentration of in-patient services on fewer sites will help strengthen specialist services and maximise the capacity of the service.


The planned future configuration of acute hospital services in Greater Glasgow is illustrated below.

Gartnavel Acute receiving for W Glasgow On tre Op

cology Cenhthalmology

New South Glasgow Hospital

A & E/TraumaFull range of acute hospital services for S & W Glasgow Children ’ s Hospital

Victoria Ambulatory Care Hospital

Outpatients, investigations & day surgery for N & E Glasgow

Stobhill Ambulatory Care Hospital

Outpatients, investigations & day surgery for N & E Glasgow

Glasgow Royal InfirmaryA & E/TraumaFull range of acute hospital services for N & E Glasgow

Services to be transferred to Gartnavel

Gartnavel

New Victoria Hospital

New Stobhill Hospital

Outpatients, investigations, imaging, day surgery, day case treatments for

the North & East.

Closure of Stobhill Hospital building.

Glasgow Royal Infirmary

Closure of the Western Infirmary

Outpatients, investigations, imaging, day surgery, day case treatments for

South Glasgow. Closure of the Victoria Infirmary

building

Transfer of all emergencyand related services to new South Glasgow Hospital and

Glasgow Royal Hospital.

Closure of Queen Mothers Maternity Hospital & Royal Hospital for Sick Children

buildings

ransfer of Maternity service to New South

Glasgow site and Glasgow Royal Infirmary and Children’s services to Southern General site

T

A&E/Trauma Full range of acute hospital services for N&E Glasgow Acute receiving for

West Glasgow Oncology Centre,

Ambulatory Care and elective inpatient

A&E/Trauma Full range of acute hospital

services for South and West Glasgow.

New Children’s Hospital

New South Glasgow Hospital

Description of the 4 ASR Phases

The phased Implementation of the Acute Services Review

The implementation of the Acute Services Review Strategy is planned over four phases, these are described below:

The first phase is well underway and involves the two new build Ambulatory Care Hospitals currently under construction at the site adjacent to the Victoria Infirmary and Stobhill Hospital site, the centralisation of cancer services at the new Beatson West of Scotland Cancer Centre built at Gartnavel General Hospital and the development of the West of Scotland Heart and Lung Services at the Golden Jubilee National Hospital, replacing facilities currently at the Western and Glasgow Royal Infirmaries. This first phase of investment will see these new facilities commissioned over the period late 2007 to summer 2009, which will result in not only significant modernisation of Glasgow’s healthcare facilities and creation of single centres of excellence but will also result in 4 of Glasgow’s major adult hospital sites operating below capacity. Phase 2 of the Acute Strategy involves the development of the new South Glasgow Hospital campus which not only sees the single biggest phase of modernisation and rationalisation of Glasgow’s adult clinical services, but incorporates the creation of a new Children’s Hospital for the Greater Glasgow and West of Scotland populations and the completion of Glasgow’s Maternity Services modernisation. New South Glasgow and New Children’s Hospitals and New Laboratory Build – Outline Business Case 45

On completion of the development of the new adult hospital in 2014, the Board will be able to enact the following: • inpatient services in the Victoria Infirmary to transfer to the new development thus vacating

the Victoria Infirmary site; • inpatient services at the Mansion House Unit (MHU) to transfer allowing closure of the MHU; • inpatient services housed in outdated buildings on the southern site to be relocated; • transfer of Accident and Emergency services and associated beds at the Western Infirmary

enabling closure of the Western Infirmary.

By 2014, following some major refurbishment and new build works within the existing estate at Glasgow Royal Infirmary and Gartnavel General Hospital, sufficient capacity will be created, following the opening of the new South Glasgow Hospital, to allow the 3 site inpatient configuration of adult services to be implemented.

Phase 3 of the Acute Services Strategy sees the major redevelopment and modernisation of the Glasgow Royal Infirmary campus and this work will be developed with a view to being brought forward for funding consideration in the period beyond 2015 followed by the final phase, which would see the redevelopment and modernisation of the retained adult inpatient services required on the Gartnavel General Hospital campus undertaken.

The key milestones of the Acute Services Review to date can be found in Appendix 3.

Further detail about the Acute Services Review and the reconfiguration of services is available in the document ‘The Clinical Strategy for Glasgow’s Acute Services 2006/7-2013/14’. This is available from the Health Board website.

5.3 DESCRIPTION OF THE CURRENT SERVICE AT SOUTHERN GENERAL

This section describes the current patient services based at the Southern site, the current buildings and use, site constraints and opportunities.

5.3.1 Patient Services The Southern General Hospital is a large teaching hospital with an acute operational bed complement of 900 beds. The hospital is sited in the south-west of Glasgow and provides a comprehensive range of acute and related clinical services. District General Hospital services are provided for the south-west of the city, with some services provided for the whole city. Services include Accident and Emergency, Dermatology, ENT, General Medicine (including sub-specialities), Assessment, Rehabilitation and Day Services), Gynaecology, Neonatal Paediatrics, Obstetrics, Ophthalmology, Orthopaedic Surgery, Urology, Physically Disabled Rehabilitation and Continuing Care. The Obstetrics, Urology, Ophthalmology and Dermatology Departments provide the single in-patient location for the whole population of South Glasgow. The Maxillofacial Department for the city was centralised at the hospital in the autumn of 2002 providing trauma and elective surgery and specialist provision for head and neck cancer. South and West Glasgow’s in-patient Gynaecology service was centralised at the Southern General Hospital in late 2003/early 2004. The Assessment and Rehabilitation service for the Physically Disabled is provided for the whole city from the Southern General Hospital. There is also a wide range of diagnostic and therapeutic services including Audiology, Clinical Psychology, Dietetics, Occupational Therapy, ECG, Physiotherapy, Radiology (including MRI and CT provision for the general hospital service) and Speech Therapy.


The Institute of Neurological Sciences

The Institute of Neurological Sciences is based on the Southern General campus and provides Neurosurgical, Neurological, Clinical Neurophysiology, Neuroradiological and Neuropathology facilities for the West of Scotland. The Institute is equipped with 2 Magnetic Resonance Imaging Suites, SPECT Scanner, two Computerised Axial Tomography Scanners, and angiography facilities. The Institute has recently undergone a major upgrade to incorporate ENT and Oral & Maxillofacial and is now equipped with additional facilities including the development of a new ward, four additional theatres, intensive care and a new out-patient department.

Westmarc The Westmarc unit houses the clinical services for prosthetics and orthotics, including the Artificial Limb and Appliance Centre, within a purpose-built facility. The centre is staffed jointly by hospital and university personnel from the National Centre for Training in Prosthetics and Orthotics of Strathclyde University. Podiatry The Department of Podiatry has a purpose built 24-chair clinic including a minor procedure theatre. Spinal Injuries Unit The Queen Elizabeth National Spinal Unit for Scotland provides a spinal injuries service to the whole of Scotland. This is housed in a purpose-built facility attached to the Institute of Neurological Sciences. 5.3.2 Buildings The Southern General site extends over 28.9 hectares and is located in Govan, South West of the City Centre. The site and the buildings within it are owned by NHS Greater Glasgow and Clyde on behalf of the Scottish Ministers and incorporates the area of land earmarked for the development of the new Children and Adult hospitals and lab build.

The facilities which make up the Southern General consist of a mix of buildings of varying ages, architectural style and quality spread across the site. The buildings date from 1872 when the original hospital was built. In 1902-05 a facility accommodating a further 700 beds was built as the hospital continued to expand its services. A new maternity unit was opened in 1970 and the Institute of Neurology Sciences was completed 2 years later. Both of these buildings have been subject to a major external and internal refurbishment to improve patient, clinical and support accommodation. There has been a number of more modern additions to the campus over the last 5 years including the Department of Medicine for the Elderly, the Westmarc building (rehab) and extensions to both the biochemistry and pathology buildings.

There are two listed buildings within the site. These date from the mid/late 19th century and constitute a two storey hospital block with iron-crested French roofed pavilions and a small square foyer and a 3 storey hospital block with a distinctive clock tower.

The current Southern General Campus has evolved over 130 years. A large capital investment has been made in the site over the last 15 years; rationalising the sprawling Victorian layout into a more cohesive densely packed site to better meet the demands of a modern Adult Acute hospital. Despite this investment the constraints imposed by the current mix of buildings precludes further development of the estate to deliver 21st century Adult Acute care without major redevelopment.


The suitability of remodelling a large portion of the current site to meet future Healthcare demands is unfeasible. Some 30% of the existing site was constructed pre 1910, these buildings house the general medical, general surgical, orthopaedic, urology and ophthalmology inpatient accommodation for the site together with the main site Imaging department. These Victorian buildings have been refurbished many times over the last few decades in an attempt to accommodate changing demands of healthcare delivery, Best Practice and statutory legislation. At present, the majority of these buildings do not meet accepted standards for Statutory Compliance or Functional Suitability. It is doubtful, that given the constraints of the buildings, whether even with extensive Capital Investment these buildings can comply with legislation for the current clinical functions in the short term. As with all hospital sites of this vintage piecemeal development throughout the lifespan of the site has resulted in the fragmentation of clinical facilities across the campus, resulting in a number of very poor clinical adjacencies and departmental relationships. Theatres are spread throughout a number of locations on site with each theatre suite dedicated to an individual specialty. Rather than being co-located with the Regional Neurosciences and National Spinal Injuries facilities the A&E department is located next to the main rehabilitation facility for the site. At present given the sprawling layout of the site there are two imaging departments one co-located with the neurosciences/spinal complex and the other at the north of the site to service the main general medical and surgical inpatient facilities. The latter imaging facility however is not co-located but at some distance from A&E and the main outpatients department. The Condition Survey of the Southern General estate is enclosed in appendix 4. It can been seen that there are some buildings which are physically in reasonable condition but collectively not suitable to provide an efficient redesigned service.

The total square meterage of the buildings within the southern site is approx 89,000m2 and the following illustrates the main usage of the buildings:-

MAJOR CLINICAL AREAS MAJOR NON-CLINCAL AREAS

Inpatient areas 29% Clinical & Non-clinical support 12% Outpatient clinics 10% Training & Education 2% Day case facilities 3% Staff facilities 4% Theatres 8% Facilities Support 3% Diagnostic - Imaging 5% Research facilities 2% Diagnostic – Laboratories 6% Rehabilitation Facilities 7% Car parking 1500 Emergency Medicine (A&E) 2%

Other areas constitute a further 7%

5.3.3 Site Constraints and Opportunities The Southern General site is bordered and accessed from the north by Govan Road and on its west side off Hardgate Road. The eastern boundary is formed by the Clyde Tunnel approach and Moss Road. The southern boundary is bordered by residential property. Road access is not currently available along either of these edges. The north-western corner of the site between Govan Road and Hardgate Road is bordered by existing industrial land and Sheildhall Water Treatment Works. At present Hardgate Road does not extend beyond the Treatment Works and therefore does not link with Govan Road. Aerial photographs showing the boundaries of the site are shown in the Appendix 5.


The existing hospital buildings are spread out over a large area of the site and in a number of cases require elevated bridge links across the spine road. Surface car parking is distributed sporadically adjacent to the numerous entrances arising from the existing fragmented site layout. A number of bus services pass close to, or through, the site. Emergency blue light traffic use the same spine road network to access A+E, Maternity and Neuro/Spinal Injuries. An area within the site, which is 15.5 acres or 6.3 hectares, can be released by the end of 2009. This land will form the development area for the new Royal Hospital for Sick Children (RHSC), Adult Acute Hospital and new laboratory block and allows these new facilities to be built in one continuous phase while the existing SGH services continue to operate. The potential for interruption to day-to-day services and facilities within the site during construction has been carefully analysed, and will be managed by a series of enabling works to decentralise the main hospital boiler plant by isolating the construction site from the remainder of the hospital with materials and construction traffic accessing the site from a discreet entrance off Hardgate Road and a link road to Govan Road that presently exists within the site. It is envisaged that the hospital will continue to operate uninterrupted on a day-to-day basis construction and commissioning of the new facilities. 5.4 PROPOSED FUTURE DEMAND - BED MODELLING

Plans for the adult hospital include 1109 beds and an Emergency Department with the capacity for 110,000 attendances per annum. The hospital will function as an acute ‘hot’ site with an outpatient department serving the local population and a small medical day area. The surgical day case activity will take place at the New Victoria Ambulatory Care Hospital opening in 2009. The following section describes the bed modelling work which has informed the size and scope of the new hospital. Benchmarking with Peer Hospitals NHS Greater Glasgow and Clyde (GGC) appointed CHKS (an independent clinical activity analysis service which the Board has worked with for a number of years) to undertake bed modelling exercises for acute adult services across Glasgow. The objectives of the review was to: • Provide an objective assessment as to the current performance of the acute adult

hospitals across Glasgow relative to their peers;

• Identify the potential for improving efficiency in terms of use of beds and patient throughput;

• Provide a projection of future demand in 2015;

• Provide an indication as to the potential bed requirements.

The bed model also takes cognisance of better clinical adjacencies, more efficient patient pathways, projected demographics and national policy adjustments. Within the core specialties covered by the Adult Bed Model there are currently 3047 inpatient beds across the 6 acute sites, against which the future bed provision is considered. The bed model for the Acute Services was updated during 2007 using the 2005/6 activity, and performance information to identify the currently proposed bed model supporting the outline business case. In considering the Adult Bed Model 2005/06 data was used to consider the


efficiencies to be delivered through improved performance of Glasgow’s hospitals compared to the inner city peer hospitals across the UK. By incrementally applying the impact of,

a) operating at best peer performance rates across each specialty;

b) achieving occupancy rates of 85% for elective work and 82% for non-elective activity;

c) growth in medicine and the impact of demographic changes;

d) performance targets on current and future activity such as waiting times;

the number of beds required for the core specialties for implementation of the Acute Services Review suggests a bed model of 2912. This number excludes beds associated with the following services:- clinical haematology, oncology, plastic surgery and burns, oral surgery, neurosurgery, homeopathy, spinal and physical disabilities. Further detail of the bed modelling work is given at Appendix 6. Modelling work has been undertaken to consider patient flows and the extant strategy position of single site specialties in relation to the number of beds required in light of the future plan of 3 inpatient sites for the city at Glasgow Royal Infirmary, Gartnavel General Hospital and at the Southern General Hospital site. In addition, consideration has been given to potential developments to specialist services in Glasgow and changes to patient flows from Clyde in understanding the inpatient bed capacity required across the Glasgow Acute Hospitals.

At the time of undertaking the latest bed modelling exercise for the ASR it was recognised that there might be future changes to bed numbers as the result of changes to regional services provision such as neurosciences, oral-maxillofacial services, renal services, gynae-oncology services. With the exception of renal services, which has already been factored into the new South Glasgow Adult Hospital bed requirement other potential changes to requirements in relation to beds do not affect the new South Glasgow Adult Hospital current proposals and would be accommodated beside existing services.

Similarly the requirements for South of the River Strategy for Clyde, consulted on during 2006/7, indicated that changes to inpatient service provision for Vascular Surgery, ENT, Dermatology and Haematology. This work has informed the potential bed configuration that supports the 1109 beds in the New South Glasgow Adult Hospital.

As this is an iterative process the bed modelling work will continue and will be updated with a 2006/7 benchmarked position, which is currently being explored to consider the further levels of efficiency that could be implemented. This will be ongoing in the months and years ahead to ensure a continued focus on efficiency. New South Glasgow Hospitals The in-patient bed numbers used for planning purposes for the New South Hospital are as follows:


Table 7 – Planned bed numbers for the New South Glasgow Hospital.

Specialty In-patient Beds

General Medicine (Includes MHDU) 407

Haemato- Oncology 14

Dermatology 18

Nephrology (Includes Surgery) 80

Geriatric Medicine 93

CCU 18

ITU 20 SHDU 23

General Surgery & Vascular 169 Urology 51

Orthopaedic & Ortho Rehab 141

ENT 37

Clyde beds * 38

Total In-patient Beds 1,109

* Clyde Beds

In line with the South of the River Strategy for Clyde, consulted and agreed on during 2006/07, the in-patient bed requirements for the following services have been included within the bed model for the new South Glasgow Adult Hospital – Vascular Surgery, ENT, Dermatology and Haematology.

The total number of in-patient beds planned for the New South Glasgow Hospital is 1109. In addition, a small 12 trolley medical day case unit is proposed for the New South Hospital, this takes into account the activity which will be seen at the new Victoria Hospital.

Retained Beds There will be approximately 630 beds retained on the Southern Campus associated with care of the elderly, maternity, neurosciences, neurology and spinal services.

5.5 SERVICE RE-DESIGN

Service redesign will be crucial in underpinning the new hospitals. The focus of this work will be around achieving a balance of care to ensure that patients are treated in the most appropriate setting. This concept will be underpinned by the interface between Acute Services and Community Health (and Care) Partnerships (CH(C)Ps), providing new models of care to improve pathways and support other redesign initiatives.

As well as this, these new models of care will look to maximise the full potential of the new Hospitals. Key National guidance and good practice will be incorporated in the models of care, including:


• Patient centred care • Maximising the co-operation between primary, secondary and tertiary care • Investing in the latest Information Technology (IT) • Extending the roles of nurses, Allied Health Professionals and other non-medical personnel • Fully utilising the most modern healthcare equipment and technology in patient care • Improved links with Community Health (and Care) Partnerships.

The New Victoria and Stobhill Hospitals will be commissioned in 2009, and will set the scene for the new post ASR reconfiguration of services. The separation of planned and emergency care and the anticipated increase in day surgery rates will require major redesign in relation to how care is delivered. Much of the redesign work required at the new hospitals is already underway and is supported by the development of new roles; for example, the Emergency Nurse Practitioners role will be further developed to support new service models, such as the Minor Injury Units in the new Ambulatory Care Hospitals. Currently work is underway through the Ambulatory Care Hospital planning groups in terms of service redesign. The redesign process will also be closely linked to the development and implementation of the Health Information and Technology (HIT) strategy and its phased rollout across the acute division. The methodology and templates being put into place to take this work forward will also be applied to the New South Glasgow Hospital ensuring consistency in care models and a streamlined, joined up flow of service provision within Glasgow.

The sections below highlight the mechanisms for taking forward redesign in relation to scheduled care, unscheduled care and diagnostics.

Planned Care

The major thrust of the redesign of services required for elective care will be focused on improved day surgery rates, the development of integrated care pathways, which promote pre-assessment, pre-admission planning and improved discharge and follow-up procedures. A Planned Care Collaborative was established in 2006, led by the Acute Division with CH(C)P input. The workstreams that form the collaborative are being used to drive the modernisation agenda and to determine key priorities for change. This Planned Care Improvement Programme is tasked with improving and actively managing admissions to hospital or planned care. Integral to delivering these improvements will be the implementation of 5 changes, these are to:

Improve referral and diagnostic pathways; treat day surgery (rather than inpatient surgery) as the norm; actively manage admissions to hospital; actively manage discharge and length of stay; actively manage follow up.

In implementing ‘Better Health Better Care’ Boards have been tasked with achieving a shift in the balance of care and ensuring improvements are made in productivity and capacity, whilst sustaining improvements in waiting times and reducing the need for hospital admissions. The Planned Care Improvement Programme reviews the flow across the whole system and will include implementation of support processes such as Patient Focussed Booking and Referral Management Services. The “New Ways” initiative to define and measure waiting times became operational in December 2007. This redesign concept sees patients being offered three appointments or admission dates within strict criteria and ensures that patients are tracked within the system or referred back to the primary referrer.


Work has begun towards the Government’s 18 week referral to treatment commitment which has to be met by December 2011. The 18 week referral to treatment target sets out a whole journey waiting time target of 18 weeks from General Practitioner referral to treatment by 2011. This 18 weeks standard is different from previous waiting times targets as it will not focus on a single stage of treatment but rather the whole patient pathway. Meeting this ambitious target will be challenging and will require NHS organisations to carefully consider issues of service redesign, improved efficiency and, where indicated, extra activity and capacity. New approaches will be considered, developed and extended throughout the Scottish healthcare system to ensure the NHS succeeds in delivering this standard. Getting the appropriate workforce to achieve this significant change in service delivery and improvement will be key to achieving success. This will be an iterative process considering the workforce requirements both in the short term, in terms of addressing the backlog to bring us into line with the new target, but also in the longer term in relation to the ongoing service requirements. This will be delivered through existing staff working differently in redesigned services but also through a competency based approach to planning the capacity. This will help in expanding roles and avoid restricting the way services are delivered as currently in traditional roles and existing ways of working. Strong links will be required with the Unscheduled Care Collaborative. Equally, the whole system approach will require close collaboration and joint working with CH(C)Ps in order to effect the desired changes and ensure long term sustainability of performance improvements such as impact on access and waiting time targets, day case rates, length of stay, patient journey time and whole system capacity. Unscheduled Care

In the area of Unscheduled Care, work is currently underway through the Unscheduled Care Collaborative, established in 2006 and due to end in March 2008. The implementation of the Acute Receiving Project within Glasgow has modernised and transformed the front-end of the acute hospitals. This has allowed improved triage for patients, the introduction of streaming, separating patient flows and allowing minor injuries to be assessed and treated by Emergency Nurse Practitioners separate to the main A&E/Acute Receiving areas within Glasgow's hospitals. The Collaborative has reporting links both locally through the Project Sponsor and nationally through CCI. The remit of the group is to:

Support the achievement of the four hour A/E waiting time target through the Collaborative Programme and methodology application;

Collate and monitor updates from the local hospital operational groups; Agree and implement future action plans; Ensure that a co-ordinated approach to change ties in with both local and national

strategic direction Ensure adherence to unscheduled care performance milestones indicated in the Local

Development Plan

Work is also ongoing around out of hospital care (Unscheduled Care Flow Group 5) to support the development of alternatives to acute hospital attendance and admission and to facilitate timely discharge for patients ready to leave acute care. The recently launched Long Term Conditions Strategy Framework is also focussed on the above outcomes and there are specific workstreams which will work towards minimising unnecessary hospital admissions through a planned care strategy


Diagnostics

Strategic Reviews of Imaging and Laboratory Medicine Services resulted in a range of service redesign initiatives. NHS Greater Glasgow and Clyde will put in place high-volume, no-wait services which support rapid diagnosis and treatment for all patients. The separation of emergency and elective flows will support the work towards the new targets. The modernisation strategies have resulted in automation of haematology and biochemistry laboratory services and in new medical technologies such as CT/PET in Imaging. Major redesign of the workforce for Diagnostic services will include a transition to full shift working, moving away from the traditional on-call arrangements currently in place. To support the delivery of the bed model for Glasgow, Imaging Services will be provided in A&E and Acute Receiving 24/7. This redesign strategy will achieve radical increases in capacity allowing NHS Greater Glasgow and Clyde to achieve a high volume no-wait service. Much of this work has been undertaken through the Diagnostics Collaborative, providing a good foundation on which to take forward further redesign.

5.6 PROPOSED FUTURE NEW ADULT HOSPITAL SERVICES (NEW SOUTH GLASGOW HOSPITAL)

The new hospital will be zoned into hot and cold zones with inpatient and day attendances within one section of the hospital and A&E resuscitation, majors, critical care, acute assessment, within another zone.

The Health Board have considered two scenarios with regard to adult single room provision. These are a base case with single room provision at 57% and an alternative with a 100% single room provision. The results of the appraisal of these 2 scenarios is given in the Financial Appraisal section in Chapter 9.

The will be separation of patient and staff routes through the building from visitor and facilities management flows. The schedules of accommodation reflect the opportunity for both new hospitals to share facilities such as a local pharmacy dispensing facility, aseptic suite, estates maintenance, waste compound, supplies delivery and distribution, kitchen, dining and other FM services.

Finally, a helipad is required with a rapid access route into the resuscitation area within A&E. The feasibility of a rooftop helipad is currently being explored.

5.6.1 Service Profile

The profile of specialties/services that will be provided at the new South Glasgow Hospital is set out in table 8 below. All specialties will be providing inpatient care; some, but not necessarily all, will be providing outpatient clinics and medical day-care services on-site. IN-PATIENTS The New South Glasgow Hospital will be a hot acute in-patient site. The proposed in-patient services are shown in table 8 below:


Table 8: New South Glasgow Hospital - Proposed Service Profile – Inpatient Services

Surgical Specialties Medical Specialties Other Specialties/Services

General Surgery General Medicine A & E

Urology Cardiology Acute Receiving

Vascular Surgery Dermatology Minor Injuries Unit

Trauma & Orthopaedics Diabetes & Endocrinology Critical Care

ENT Gastroenterology Rehabilitation Services

Renal Transplant Surgery Haemato-Oncology (Complex Elderly, Surgical

Medicine for the Elderly

Nephrology

Respiratory Medicine

Rheumatology

Stroke Medicine & Rehabilitation

Rehab, Orthopaedic Rehab & Vascular Surgery Rehab)

OUTPATIENTS

There will be a single outpatient department on the Southern site; the only exceptions to this will be:

• Children’s Services (based in the New Children’s Hospital) • Obstetrics & gynaecology (located in the newly refurbished maternity building) • Neurosciences (provided from within the Neurosciences Institute) • Care of the elderly (provided from Langlands building)

The New South Glasgow outpatients department will provide local access to patients within the South West of the City.

The anticipated profile of outpatients clinics is shown in table 9 below:

Table 9: New South Glasgow Hospital - Proposed Outpatients Clinics

Surgical Specialties Medical Specialties Other Specialties/Services

ENT Cardiology A & E

General Surgery Dermatology Rehabilitation

Ophthalmology Endocrinology

Orthopaedics General Medicine

Urology Medicine for the Elderly and Stroke Services

Vascular Surgery Haematology

Respiratory Medicine

Rheumatology


Principal Themes of the New Model of Care

The key themes underpinning the new model of care are described below:

• Patient-focussed services • Systematic and managed services providing

- Single assessment of patients - Use of formally agreed pathways, guidelines and protocols - Shared objectives of care by different teams, professionals and parts of the

organisation • Services designed and planned on the basis of a ‘flow system’ to prevent queuing

and waiting for diagnosis or treatment. • Separation of emergency and elective pathways of care. • Single portal of entry for emergency admissions, through A & E and the Emergency

Medical Complex • Central emergency and elective operating theatres department. • Rapid access to diagnostic services. • Patients requiring rehabilitation will move through a care pathway defined by their

needs not by their age or disability. Early access to rehabilitation will be a feature of medical and surgical pathways and will include transfer to dedicated rehabilitation facilities.

• Discharge planning will commence at the earliest opportunity including pre-assessment.

• Maximum use made of extended evening and weekend working to provide diagnostic services.

• Modern career framework with both a multi-skilled and a specialist workforce. • On site facilities for education, research and study. • Separation of staff and patient, public and facilities management routes.

These key themes will be central to the design and operation of the new South Glasgow Hospital and will be at the core of the required service modernisation and new ways of working.

Scheduled Care

The majority of scheduled care at the new South Glasgow Hospital will be undertaken on an inpatient basis. The development of unscheduled care requires the separation of programmed and un-programmed care streams with the protection of capacity in relation to key facilities such as inpatient beds, operating theatres and post-operative recovery.

Elective admissions to be screened pre-admission, especially those undergoing high-risk surgery

There will be no elective day surgery at the new hospital; therefore no day surgery facilities will be required. There are 12 medical day care beds planned within the building. The majority of haemo-oncology day cases and all outpatient chemotherapy for lung, cancer, breast and colorectal will be provided at the Victoria Ambulatory Care Hospital for the South Glasgow population and the West of Scotland Cancer Centre for the West Glasgow population.


The majority of day-case endoscopies and therapeutic endoscopy, will be provided at the Victoria Ambulatory Care Hospital and Gartnavel Hospital, with the exception of ERCPs, which will be carried out at the new South Glasgow Hospital. Unscheduled Care

Unscheduled care services will be provided in an identified ‘emergency care zone’, which will house the Emergency Department, Acute Assessment and Critical Care. It is essential for patients with a high risk of being a source of infection to others to be managed “separately” to avoid the risk of infecting other patients while in the Acute Assessment Area or an Acute Admissions Ward. This will include; influenza, Norovirus, gastroenteritis, SARS, MRSA etc. This will require isolation facilities. The Infection Control Team have been fully involved in the planning of hospital to address and reduce the risk of spread infection through the design of the facilities). There will be an ‘Emergency Medical Complex’, consisting of the following four components:

• An Acute Assessment Area (AAA) • A Protocolised Management Facility (PMF) • An emergency outpatient clinic • An Acute Admissions Ward (AAW)

These units will all be co-located, alongside the A & E Department, and will be the focal point of unscheduled care provision for all patients. Although this model has been developed for emergency medicine, it will also be applied to emergency surgery and trauma. Diagnostics

It is anticipated that the majority of routine diagnostic tests for patients from South and West Glasgow will be undertaken at the Victoria Ambulatory Care Hospital and Gartnavel Hospital respectively. Investigations carried out at the new South Glasgow Hospital are therefore likely to be of a specialist nature, with the exception of support provided for out-patient attendances.

Imaging services will be providing support for A&E, out-patients and in-patients. Rapid Access imaging is particularly important for A&E, critical care beds and theatres.

To achieve this, the exemplar design arranges imaging over 2 floors. On the ground floor the diagnostic facilities can easily be accessed by both out-patients and A&E while the diagnostic services located on the first floor are adjacent to critical care and theatres but can also be easily accessed by the in-patient wards in the tower block.

Haematology, biochemistry and mortuary services will be provided in the new laboratory building at the Southern site, which will be linked to the New South Hospital via an underground passage and pneumatic tubes Critical Care

There will be six discrete critical care units, as follows: • Intensive Care • Medical High Dependency • Surgical High Dependency • Coronary Care


• Acute Stroke Unit • Renal High Dependency Unit

The intensive care and high dependency units will be located together. The only exception to this is renal HDU which will be located within the renal unit with close access to both the critical care zone and the theatres department.

The Coronary Care Unit will be in close location to the critical care beds.

The Acute Stroke Unit will be designated and managed as a high dependency unit.

Theatres

The theatre department will consist of 20 theatres with appropriate designation and separation of elective and emergency theatres.

Rehabilitation

There are 179 rehabilitation beds within the new South Glasgow Hospital. In addition to the Rehabilitation beds in the new build, some beds will be provided in the Langlands Building. Amputee patients may have up to 6 weeks lengths of stay. On average after 2 weeks these patients no longer require an acute hospital environment. It is therefore planned to transfer amputee patients who are 2 weeks post operation, to a step down facility at the Westmarc facility which provides the patient’s daily physiotherapy. The 22 beds will provide a less clinical, more appropriate environment for patients while they recover. The Westmarc Centre will continue to provide limb fitting, wheelchair provision and the regional prosthesis and orthotic service. The School of Podiatry at Govan Road entrance to the site, will continue to provide the podiatry service for South Glasgow. Therapy areas will be located alongside the rehabilitation beds, in order to enhance service integration. The exemplar design of the hospitals has been developed in liaison with a wide range of user groups and the Community Engagement Team has undertaken a comprehensive programme of consultation with patients and carers, patient groups such as ‘Better Access To Health’, and local community organisations.

5.7 PROJECT OBJECTIVES

The need to modernise patient care, speed up the patient journey, make more effective use of clinical time and to ensure patients are seen by the specialist team are at the core of the service redesign and changes within NHS Greater Glasgow and Clyde.

The fundamental aim of this project is to provide modern state of the art facilities that will deliver the redesigned patient pathways which streamline patient care, delivering improved efficiency and more effective service models, as we implement the Acute Services Strategy for Glasgow and Clyde. This will ensure that Glasgow’s Hospitals are providing the best level of patient care to the highest standard, which is as good as any to be found throughout Europe.


The key objectives to achieving this are:

• Provision of local access to core medical and surgical services and consolidated specialist and tertiary services that ensure patients all get access to the appropriate level of specialist services they require.

• Bringing together clinical teams to concentrate clinical expertise that will support meeting the European Working Time Directive and Modernising Medical Careers and will create sustainable expert teams. This will ensure 24 /7 access for patients to specialist care

• To make the best use of the workforce and reduce the number of on-call rotas across the city;

• Provision of modernised accommodation and improved facilities which meet the needs of patients, visitors and staff and are appropriate to the provision of modern health services, promoting a healing environment and improved patient access;

• Increased clinical capacity, improving access to services including diagnostics and reducing waiting times for treatment;

• Improved efficiency by separating elective from emergency care where possible, so routine elective work is not interrupted by the calls of emergencies arriving in the Hospital or arising on the wards;

• Uniform access for routine services across Glasgow; • Provision of highly specialised services provided by skilled staff facilitated through the

centralisation of specialties and through improved retention and recruitment due to a radically better working environment.

• Enhanced University links through co-location of an academic centre with the new hospitals on the Southern General Campus. This will enhance teaching, and research and play a significant role in attracting and retaining high quality staff in all disciplines

The overall aim is to provide a hospital service that offers the most up-to-date treatment quickly using specialist skills in settings that are modern, friendly and convenient. The facilities must be readily adaptable to changing clinical practice as the future unfolds, and allow related diagnostic and treatment to be close to each other. The new builds will provide a catalyst for:-

• New ways of working and so improved patient services with effective clinical adjacencies; • Increased flexibility to changing demand for services; • Facilitating the development of new staffing arrangements that closely reflect national best

practice; • Facilitating the development of the hospital site and services in a manner which enhances

departmental and functional relationships. • Creating capacity in the right place with the appropriate co-locations to deliver the

challenges of all the targets and imperatives of health policy, “Better Health, Better Care”.


5.8 BENEFITS

The benefits expected from this project are listed below:

Objective Benefit Strategic Fit -Consolidation of Services

• Acute Adult Inpatient services consolidated onto 3 sites • Specialisation and sub- specialisation models supported 24/7

with specialist cover • Focuses specialist/ experienced staff in fewer sites supporting

delivery of most effective care • Achieve new directives e.g. Modernising Medical Careers. • Reduce the number of medical rotas. • Improved co-location of services to support unscheduled care

including A&E, Theatres, Critical Care and Imaging • Maximises use of dedicated facilities such as trauma theatres • Optimises use of resources

Clinical Quality • Improved occupancy reducing the clinical risks / delays in patient care due to boarding patients out with specialty

• Improved Hospital Acquired Infection rates due to single room facilities and improved space within facilities

• Appropriate levels of specialist staff to provide and sustain clinical services with 24/7 access to specialist services

• Specialist teams working together supporting redesigned services to allow new techniques to be used and developed

• New service models supporting the reduction in unnecessary admissions

• Patient Safety Initiative input to designing safety issues out of new facilities and models of service

• Improved utilisation of facilities as purpose built with improved co-locations

• Full Benefits Realisation plan to be developed as part of Clinical Transition to identify specific key performance indicators.

Performance Improvement in Patient Services

• Facilities that support improved ways of working, creating more effective patient pathways to provide timely and fit for purpose unscheduled care

• Improved capacity created and waiting time guarantees met within GGC facilities

• Facilities that support achievement of the balance between Unscheduled and planned care pathways to safeguard targets being met

• Appropriate bed numbers by specialty that support improved occupancy levels eliminating the requirements to board patients out with the specialty caring for patient

• Number of one-stop clinics increased. – Reducing unnecessary follow-up appointments.

• Throughput of patients increased to support earlier access to treatment

Quality Environment (Meeting patient, visitors and staff needs)

• State of Art new buildings • Better environment for patients and staff – purpose built

facilities supporting effective patient pathways and enhancing


the quality of patient experience • Stimulating buildings through art and design • 100% Single room provision, reduced hospital acquired

infection. • Increased opportunity for patients and the public to be

involved in decisions around patient services and design of facilities

• Targets for carbon emissions and energy consumption met Information Management and Technology

• Improved access to patient information electronically supporting increased continuity of patient care

• New systems supporting paper light services Staff Facilities and Motivation

• Purpose built facilities • Modern amenities • Support recruitment and retention • Increased opportunity for staff to be involved in decisions

around patient services and design of facilities Accessibility to Hospital and Compliance with Travel Plan

• Better co-location of services reducing patient transport within hospital

• Easy transport links to support both patient and visitors attending the hospital

• Improved cycling and walking routes

Enhanced Links with University

• University academic centre co-located with acute services on the southern General campus

• Improved recruitment and retention • Consolidated services better supporting the training of junior

staff


6. DESCRIPTION OF OPTIONS

6.1 BACKGROUND TO THE APPRAISAL PROCESS AND FORMAT OF THIS CHAPTER The option appraisal considered the magnitude of service and physical change being planned. Given the scale and complexity of the project there were only two options that could cope with a development this size. In 2006, this became even more relevant when agreement was reached to build the children’s Hospital on an acute site within Glasgow. The two options were as follows. The first option was to build a 1900 bedded new hospital facility on a Greenfield site (this includes replacing the Neurosciences, the Spinal Unit, Maternity and Langlands buildings. The second option was to construct a new 1349 bedded facility (1109 adult beds and 240 children’s beds) on the southern site which allows the retention of the Neurosciences, the Spinal Unit, Maternity and Langlands buildings in the current retained state. While the Greenfield option had the potential to offer good benefits in terms of achieving excellent clinical adjacencies it was an extremely high cost option and therefore considered unaffordable. The new build option on the new southern site therefore became the preferred option allowing reuse of existing estate. Continuing with the appraisal process to build a new children’s and adult hospital on the southern campus two further elements were appraised to determine the best design configuration. These were:

a) to build separate or integrated hospitals b) to identify the optimal building shape to achieve the critical clinical co-locations, future

expansion space and links into Maternity and Neurosciences. Potential building shapes fell along a spectrum ranging from tall thin to low and flat

A tall thin integrated building was identified as the preferred option. This option was further adapted to enhance the clinical adjacencies and from this an exemplar design was developed. The capex cost of the new adult and children’s Hospital is based upon this exemplar design. Two sub-options were developed around the preferred option. These are option 1 which incorporates new builds for a 17,000 m2 laboratory facility and for clinical support and other services. The second sub-option, Option 1a, makes better use of the existing estate and provides a smaller 5,200m2 laboratory build. A benefits appraisal of the two sub-options was undertaken. The final part of the option appraisal process was to determine the option (Greenfield, Option 1 or 1a) offering the best Value for Money and, from this the best method of purchasing the preferred option. The results of the financial appraisal is given in Chapter 9. This chapter describes the site and design option appraisals and is laid out in the following sections. 6.2 The review of an option to build the new hospitals on a Greenfield site in the South of

Glasgow; 6.3 The key criteria considered in positioning the new hospitals on the Southern site; 6.4 The factors considered in deciding whether to build the hospitals as separate buildings or

an integrated facility; 6.5 The preferred design configuration for an integrated facility;


6.6 The development of the exemplar design; 6.7 Design quality; 6.8 Future proofing; 6.9 Sustainability and energy conservation; 6.10 Options for delivering the New South Glasgow and Children’s Hospitals and associated works on the Southern Site 6.11 Benefits appraisal 6.2 GREENFIELD SITE – (RE-PROVISION OF SOUTHERN GENERAL HOSPITAL

SERVICES ON ANOTHER GLASGOW SITE) As described above, Phase 2 of the Acute Services Review involves the development of a new adult and new children’s hospital at the Southern General site. The New Children’s Hospital site has already been determined through the work carried out by the Calder Group in 2006 who identified the Southern General site as the preferred option. An option appraisal process was carried out in 2002 for the New Adult Hospital, the Southern General site was chosen as the preferred site compared to another site within Glasgow (a Greenfield site located at Cowglen). It should be noted however that, for the purposes of comparison for the Outline Business Case, the option of building the New Hospitals on a Greenfield site was also revisited. The option to build on a Greenfield site was first explored in 2002 and dismissed by the Health Board because of cost, (Reference Health Board Paper, 18th January 2002). The Greenfield would involve the construction of the new adult and children’s hospital at a Greenfield site located in the south of the city. However as the planned retained services cannot be left in isolation these would also have to be transferred to the Greenfield site. This represents approximately 630 beds which currently constitute the Institute of Neurological Sciences, Maternity and Spinal Injuries and Langlands buildings. There would also be a need to relocate smaller capital works associated with the new hospitals such as a new build clinical support block, new laboratory build, a facility for post acute amputees and two multi-storey carparks. The Greenfield site option would therefore involve new build of approx 1900 beds and comprehensive support services along with considerable investment in transport infrastructure required by the city planning. An area of land approximately 20 hectares (49.5 acres), with good road and public transport links would need to be identified and purchased. When the Greenfield option was first explored in 2002 the land identified at that point was the Cowglen area of Glasgow, this is no longer available. In reviewing this option the capital cost has been developed on the basis of the new hospital build costs and a pro-rata calculation of the cost of replacing the retained estate. The estimated cost of the Greenfield option is £1.8 billion. This excludes land purchase on the Greenfield site and land sale of the Southern General Hospital. It is estimated that it will cost £6 million more to buy the Greenfield land than for the sale of the Southern site. However the £1.8 billion cost also excludes the development of road infrastructure and public transport network to and from the site, which would need to be capable of carrying 725,000 patients plus their visitors and 10,000 staff, and meet other planning conditions and Section 75 agreements. The economic appraisal of this option is given in Section 9.


6.3 POSITION OF THE NEW HOSPITALS ON THE SOUTHERN SITE One of the key criteria in considering the site of the new hospitals on the southern site is the need to physically link the new adult and new children’s hospitals into both the maternity and neurosciences buildings to allow ready access to a full range of paediatric services for both foetus in utero and new born babies, and to enable pregnant mothers access to critical care and other acute services. The link between Neurosciences Building and the New South Glasgow Hospital will also allow rapid access for staff between both buildings, in particular the two critical care units The site plan below shows the Southern General site as it is at present.

The Neurosciences and Maternity buildings are blocked in red and can be seen situated at the top and bottom of the plan.

All the buildings marked in red will remain on the site long term. These include, amongst others, the aforementioned Maternity building and Institute of Neurosciences, the Spinal Injuries Unit, Neurology buildings, the front section of the Medical and Surgical Block and the Langlands building. These buildings are either relatively modern, subject to extensive refurbishment or are listed. The Langlands building is a 240 bedded PFI building completed in 2001 which houses care of the elderly beds, young physically disabled and dermatology.


The buildings marked in blue are within the site designated for the New Adult and Children’s Hospitals and the New Laboratory build. This site will allow the new hospitals to achieve the links into the neurosciences and maternity buildings. There is a comprehensive plan to re-locate all the services within the blue buildings to other locations to allow demolition and clearance of the site by 2010, more detail can be found in Appendix 7. The buildings marked in green house patient services which will transfer the New South Hospital upon completion.

6.4 BUILD OPTIONS FOR THE NEW HOSPITALS – SEPARATE BUILDINGS OR INTEGRATED BUILDINGS?

An option appraisal was undertaken looking at a number of scenarios amongst them being an option to build the hospitals separately or as an integrated building. The benefits, risk, costs and deliverability were explored. The preferred option identified was an integrated build to capitalise upon: the clinical synergies around A&E and radiology; the lower risk of fewer contractors on site; decreased complexity of interface issues between the two buildings with better patient flows and streamlining of processes; better deliverability and lower build and running costs due to operational synergies.

6.5 PREFERRED DESIGN CONFIGURATION OF THE INTEGRATED BUILDING

This section details the key criteria of the design brief, desired clinical adjacencies, design configuration, option appraisal and preferred option. 6.5.1 Design Brief and Design Option Appraisal a) Design Brief

As discussed in the previous section the preferred option is an integrated build for the Children and Adult hospital. In developing the exemplar design several key criteria were considered, these were as follows:-

• the critical clinical co-locations required within the new building

• the need to maintain distinct and separate identities for both hospitals through separate public entrances and distinct public faces

• the desirability of minimal travel times throughout the hospital

• linkage into the new laboratory build

• the requirements to link the new hospitals with the existing neurosciences and maternity buildings which sit at opposite ends of the site

• the need to maintain existing hospital services during construction of the new development

• desirability of future expansion space on the campus

• impact of the new build upon surrounding neighbours (residences to the south of the site)


b) Design Option Appraisal A range of five options were developed in response to the design brief outlined above. A high level appraisal involving technical advisors and NHS Stakeholders resulted in a de-selection of two options which did not meet the full design requirements.

The remaining three designs did meet the full brief. In addition all 3 options:

• facilitate the Board’s preferred phasing strategy that allows the Adult and Children’s

hospital and labs to be built in one continuous operation.

• place the New Children’s hospital on the west of the site where it can link to both the existing maternity block and the New Adult Acute hospital to create the “Triple Gold Standard” of clinical care.

• provide a first floor link to the existing theatres and critical care areas in the Neurosciences Block.

• allow for the new Fastlink services to pass through the site entering from Govan Road and exiting via new entrance onto Hardgate Road.

• have a common location for the new laboratory facility and FM block in the northwest corner site.

An option appraisal was undertaken involving the design team, technical advisers, and NHS stakeholders.

The weighted criteria against which the options were scored included:-

• access • achievement of departmental adjacencies including journey times • Flexibility and future expansion abilities • External environment (e.g. impact upon residencies, separate identities for children and

adults hospital, landscape opportunities) • Internal environment (e.g. views out of building for patient, public and staff; ease of way-

finding; clear segregation of visitors, patients; and Facilities Management circulation) • Deliverability

The following section describes the options and the results of the option appraisal. 6.5.2 Description of the 3 Options The three options are shown below along with a description of each. In brief they lie along a spectrum ranging from a lower flatter building with 8 floors to a progressively taller, thinner building shape with 14 floors.

Option A: lower, flatter style building - This option requires the largest ground floor foot print. It proposes an adult acute block containing the emergency department (ED), theatres and critical care beds at the southern end linking the existing neuro and maternity buildings. An 8 storey block with 8 adult wards per floor engages with the acute block on the east side. The children’s hospital sits to the west and assumes inclusion of the Scottish Ambulance Service (SAS) site to provide sufficient site and direct frontage onto Hardgate Road.


Option B (Shown below) This option represents the middle option and arranges the general wards above the acute facilities containing the Emergency Department, theatres and critical care beds. This results in a 10 storey built form with 6 adult wards per floor.


Option C: This option represents the tallest option but in doing so places the height element further into the middle of the site. As with Option B, the wards sit above the acute facilities but the reduction to 4 wards per floor reduces the impact of the taller element on facilities below. This results in a 14 storey structure concentrated in the centre of the site.

6.5.3 Results of the Design Appraisal Process The appraisal process identified Option C, the tall thin building as being the preferred configuration as it was most able to meet the above criteria. The results can be found in appendix 8. In more detail Option C facilitates the desired co-locations, the vertical structure reduces travel time to less than 4 minutes between the furthest points in the building (Option A has a calculated travel time of 17 minutes between the furthest points in the building). Finally, although the building is much taller, because it has a smaller foot print, it allows for expansion space and does not over shadow residential neighbours (along the southern boundary) as the build can be placed more centrally on the site than a low flat building. Further work took place looking at alternative arrangements within the preferred Option C configuration. This was in response to concerns expressed by users at the previous appraisal with regard to the positioning of entrances, and in particular the locations of the adult’s and children’s public Emergency (walk in) entrances. Four variants were shown to a smaller Board group which concluded that Option C4 should be developed as a preferred option. This option offered separate and distinct entrances to both hospitals, it offered a shared blue light entrance and it gave separate ambulatory entrances to the A&E departments of both hospitals, however, these were co-located in the event that if a user presented at the wrong entrance they can be redirected very quickly without jeopardising patient care.


Option C4 is shown below

OPTION C4

Dining

Minors

Majors

Radiology

Renal

A+E Ent

A+E Ent

Maternity

Neuro

Blue Light

OPD

MDU (CIU)

OPD/

Physio

Hot core to wards and Helipad on roof

Cardio

Main Ent (Adults)

Multi-storey

Fast Link

Multi-storey

Main Ent (Children's)

Dining

ADJACENCY DIAGRAM

6.6 EXEMPLAR DESIGN

An exemplar design based on option C4 has been prepared by the Board to test the project brief and provide a benchmark for Outline Business Case costing. The capex cost for the new adult and children’s hospital is based upon the exemplar design. 1:500 layouts have been designed for all hospital areas and 10 key departments (5 in the new Children’s Hospital and 5 in the new Adult Hospital) have been developed further to 1:200 designs, these are contained in appendices 9, 10 and 11. The key departments are A&E, Radiology, Wards, Critical Care and Public Concourse/Entrance for each hospital. The PSC also provides future development partners with a Design Exemplar when preparing their own detailed proposals.



In developing the exemplar design one of the key aspects considered was the critical clinical adjacencies. The section below describes these in more detail.

The critical clinical co-locators are shown in figure 1 and described below.

Figure 1 – Visual Representation of the Physical Adjacencies

Neo

Paediatric Maternity

Neuroscience

Children Natal PICU

Critical Care

Theatres

Theatres

FM

Services

A+E

A+E

Wards

Adult Wards

IMAGING

Adults

Fixed on Site

Public Entrances “separate but together”

“long linkages as found on the existing hospital are best avoided if at all possible”

“Achieve the Gold Standard Triple co location of Maternity,

Children and Adult Acute”

“the adult hospital, the paediatric hospital and the maternity hospital

must be physically joined”

“separate but together”

“a fundamental principle that the maternity and children’s hospitals will

require immediate physical adjacency”

Fixed on Site

One of the areas identified for potential clinical synergies between the adult and children’s hospital is Accident and Emergency. Therefore, the two A&E departments are required to be side by side. The A&E departments need ready access to diagnostics, theatres, critical care and acute assessment.

The maternity building must be linked to the children’s new build to allow ready access to a full range of paediatric services for both foetus in utero and new born babies. The maternity building must also be linked to the new adult hospital to allow pregnant mothers access to critical care and other acute services.

There must be a link between the Critical Care in the Neurosciences building to Critical Care in the New South building to allow staff rapid access between both units.


Another key co-location is the labour suite and obstetrics theatres to the neonatal unit which, in turn, needs to be co-located with the paediatric intensive care unit. Paediatric and Intensive Care must be close to the theatres and radiology. These clinical co-locators set the parameters for the development of a 1:500 departmental relationship drawings of the new hospitals.

6.7 DESIGN QUALITY

There has been concern that many design solutions for public buildings were previously not of a sufficient high quality to meet hospital and public aspirations. Much work has been undertaken on design visioning, such that quality aspirations can be successfully built into the output specifications and objectively assessed when bids are being compared.

In line with HDL 58 ‘A Policy on Design Quality for NHS Scotland’ published in 2006 the Board appointed two Design Champions and approved a Design Action Plan in October 2007. The Design Action Plan reinforces the Board’s commitment to achieving high quality design which promotes good well-being environment within the New Children, Adult hospitals and new labs build. This aspiration applies to both the internal and external environment of the buildings through the use of good design, light, colour, building materials and landscaping with user needs a priority. User needs have been identified through a programme of meetings with clinical sub-groups for each hospital overseen by a Clinical Advisory Board and a series of focus groups held with patient and carer groups representatives (for more detail see section 17).

It is the Board’s wish to deliver an iconic development that will contribute positively to the local context and be viewed with pride by the people of Glasgow.

6.8 FUTURE PROOFING In designing the new hospitals the Board will take into account the need to future proof the buildings, for example, the consideration of the potential inclusion of 100% single rooms, the positioning of ‘soft spaces’ throughout the building and location of the diagnostic department to the outside of the building, adjacent to land which could be utilised for future expansion should it be necessary

The clinical areas of the hospital are likely to change more quickly and radically than any other area as new technology is developed and advanced treatment methods become available. To allow future flexibility it is proposed that the hospital services infrastructure is distributed in a well structured way, based on risers in vertical transport areas, adjacent to lift and stair areas. This should minimise any disruption due to internal reconfiguration of hospital departments.

6.9 SUSTAINABILITY AND ENERGY CONSERVATION

6.9.1 Sustainability

In developing the new hospitals the Board will promote economic, social and environmental sustainability, for example, increasing energy efficiency, maintaining biodiversity and encouraging green travel through walking, cycling and public transport. Also action will be taken to minimise noise and dust as much as possible during construction.


6.9.2 European Trading Emissions Scheme (ETS) The New South Glasgow and new Children’s Hospitals development will not be complete until 2014 and therefore is likely to fall under Phase 3 of the ETS, details of which are not yet agreed. The project will be reviewed in the light of these once available.

6.9.3 Carbon Trust and Waste and Resources Action Programme

The Board are working with the Carbon Trust to increase energy efficiency of the new hospital building design. The Board are also working with Waste and Resources Action Programme (WRAP) to enable more efficiency in use of building materials for the new hospitals and recycling (minimising landfill, reducing carbon emissions and improving the environment.

6.9.4 Energy Targets and Use

NHS Guidelines are that Energy use should be within range of 35-55GJpa per 100cm.

The view has been taken that the new hospitals Design Solution should at least meet the NHS and Building Regulation standards with regard to energy use current at the time the buildings are built or that are economically and technically viable to include.

The design priority is to invest in the highest quality building fabric and envelope design to reduce the demand for energy to the lowest economically possible level as these have, in general, the lowest technical risk associated with them and are often the least easy to substantially change over the building life. The energy systems within the buildings have a much shorter life, are easier to adapt and will be regularly replaced and upgraded over time based on their own life cycle and the changing technical, economic, regulatory and social pressures at the time of replacement. The building infrastructure is to be arranged to facilitate as far as is possible the likely changes that will be made.

A target of 55GJpa per 100cm at completion is proposed for the new adult and children’s hospitals.

6.9.5 On Site Renewable Energy Targets

Currently neither Section 6 of the Scottish Building Regulations or Glasgow Planning Guidance require low or zero carbon (LZC) systems to be included with the building design.

It is likely that Glasgow Planning Guidance will require up to 20% Low or Zero Carbon (LZC) energy systems to be included within the scheme before the hospitals are built. It is likely that the development will require 20% of the total energy supply to the hospital to be from LZC systems.

A central energy centre with centralised boilers and electrical supply will provide a distribution infrastructure which is adaptable to future technologies and opportunities. The fuel source can be changed relatively easily as new technology becomes resilient and economic.


6.9.6 NHS Environmental Assessment Tool

NEAT (NHS Environmental Assessment Tool) has been used to identify the environmental impact created during day-to-day operational activities. Buildings assessed using NEAT are rated as excellent or very good. The exemplar design for the New Adult and Children’s Hospital includes measures required to achieve an excellent rating. The design will invest in quality building fabric to reduce the demand for energy to the lowest economically possible.

6.9.7 Architecture And Design Scotland (A&DS)

The Board is working with A&DS to improve both the design quality of the new facility and the impact on the environment through better and more appropriate design. NHSGG&C have entered into an agreement with A&DS to provide enabling support to the project to assist in securing the optimum level of design quality.

6.9.8 Renewable Energies

The Board is also exploring the use of renewable energies as possible options for inclusion in the new build, for example, wind turbines, solar and thermal energy and bio-mass fuelling.

6.10 OPTIONS FOR DELIVERING THE NEW SOUTH GLASGOW AND

CHILDREN’S HOSPITALS AND ASSOCIATED DEVELOPMENTS ON THE SOUTHERN SITE

For the purposes of the Outline Business Case two options around the Southern General site have been developed, these are Option 1 and Option 1a. Option 1 has a higher percentage of new build for the associated developments and Option 1a utilises more of the existing estate. The section below describes each option in detail. 6.10.1 Option 1

Option 1 consists of an adult and children’s hospital integrated within a single building to capitalise upon the clinical and facilities management synergies. The building will physically link into both the maternity and neurosciences buildings.

A new 17,000m2 purpose built, multi-disciplinary laboratory facility is also planned. This will link into the new hospitals via an underground link and pneumatic tubes. There are a series of smaller capital works associated with the new hospitals these are as follows :- a number of enabling works, development of two new multi-storey car parks, a new build facility for clinical support services (such as offices, facilities management and clinical administration), and a new 22 bedded extension onto the Westmarc rehabilitation centre for post acute amputee patients. It should be noted that Glasgow University have plans for a new build academic centre near the new hospital development and an area of land on the Southern Campus has been identified by the Health Board for this purpose.


An illustration of how the southern site will look under Option 1 is given below.

The following section describes Option 1a.

6.10.2 Option 1a

Option 1a consists of the planned integrated adult and children’s hospital as described above. In this option however those associated works for which new builds were planned will now be incorporated into the existing estate. In other words the green buildings shown in the plan above, which under Option 1 will be demolished will, under Option 1a be retained and reused. In brief, the services which will be re-housed in the existing estate include, the 22 beds for post acute amputee patients and the facilities for clinical support (e.g. training, offices) and part of the laboratory services. There are plans for a smaller labs 5,200m2

build housing haematology, biochemistry and the mortuary services. This will link into the new hospitals via an underground link and pneumatic tubes.

The diagram below illustrates the southern site under Option 1a.


6.11 BENEFITS APPRAISAL

The benefits criteria were derived from the project objectives. The criteria were weighted and scored against each of the options. This produced scores in a very tight band, those options involving an increased percentage in new build producing slightly higher scoring. Detailed results can be found in appendix 18.


7. NEW LABORATORY BUILD

A Glasgow wide Laboratory Services Strategic Review was established to advise on the optimum model for the provision of laboratory services, taking into account the clinical linkages between the laboratories, the main clinical specialties and the services which require to be provided to support the clinical services profile on each site.

The key objectives of the laboratory services review process were determined as follows:

• To define and develop an agreed configuration of provision of lab services across the city which reflects the ASR strategy – consolidating from six to two major emergency and in-patient acute sites at GRI and SGH, an elective inpatient site including the regional cancer centre at GGH, new Ambulatory Care Hospitals at Stobhill and the Victoria Infirmary, and the co-location of paediatric with obstetrics on an adult site.

• To modernise the provision of laboratory services.

• To create a network of laboratory services working Pan-Glasgow, operating within a single integrated management structure.

The working principles that underpinned the review focussed on a whole systems approach to the modernisation and reconfiguration of laboratory services, with a decision-making process that reflected clinical consensus and strong partnership working

7.1 SUMMARY OF THE SHORTLISTED OPTIONS

The summary of the short listed options are illustrated in table 9 below.

Table 9

Option Description

Option 1 Minimum Change: Laboratories on all acute sites, reconfigured in line with Acute Services Review (ASR) only

Option 2* Laboratories on all acute sites, with significant reconfiguration

Option 3* Laboratories at Glasgow Royal Infirmary (GRI) and Southern General Hospitals

Option 4 One Large Laboratory at Southern General Hospital with significant Essential Services Labs (ESL) at GRI and a small ESL at GGH to service the immediate and emergency needs of the respective sites.

* The difference between options 2 and 3 is based on sizing and on the ultimate distribution of GP and specialist activity.


7.2 ECONOMIC AND FINANCIAL APPRAISAL The Option Appraisal was a fully inclusive process, led by the then ASR Director and had a robust project structure which included chairs of Specialty Reference Groups and Working Groups supporting the review, along with representatives of the partnership forum and other key stakeholders.

The Option Appraisal process involved three main components, as illustrated in diagram 1 below.

Financial B enefits Appraisal

Risk Workshop

Non Financial Benefits Appraisal

Outcome – identification of Option 2 as Clinically preferred Option

Risk Differentiation of Options

The outcome of the non financial benefits appraisal was the identification of Option 2 as the clinically preferred option. This decision was then ratified by a Risk and Financial Benefits appraisal, which confirmed Option 2 as being the most advantageous from a clinical and financial perspective.

Description of Option 2 Configuration of Laboratory Services

The description of Option 2, Configuration of Laboratory Services is illustrated in table 10 below.

Table 10

Specialty Description of Configuration of Service

Pathology Reduce from 4 sites to 1 – centralised near the Southern General, Rapid Results Laboratories (RRL) at ACAD and Essential Services Laboratories (ESL) at GRI & GGH

Biochemistry Reduce from 6 sites to 2 main labs at SGH, GRI, with an ESL at GGH (& RRL at ACAD)

Haematology Reduce from 6 sites to 2 main labs at SGH, GRI, with an ESL at GGH & RRL at ACAD.

Microbiology Reduce from 5 sites to 2 main labs at SGH and GRI. In addition Virology and Mycology will be located alongside Microbiology to create the basis for joint working and some elements of cross cover.

In addition:


• Immunology, Tissue Typing, Stem Cell lab work and all other laboratory services related to leukaemia research and Haemato-Oncology will consolidate from the WIG and GRI to one single site in the new Leukaemia Research Lab at GGH. To provide a state of the art laboratory facility on the same site as the Regional Cancer Centre and SNBTS.

• The Paediatric labs at Yorkhill including Genetics will co-locate with adult laboratory services onto the new South Glasgow Hospital Campus.

A key part of Option 2 is the construction of a 5,200m2 purpose built laboratory building at the Southern General hospital site for the provision of Biochemistry, Haematology, blood Transfusion and mortuary services incorporating the City Mortuary on behalf of Strathclyde Police and the Crown Office Procurator Fiscal Service. The cost of this development forms part of this business case.

Further detail regarding the New Laboratory Build can be viewed in Appendix 12.


8. RISK MANAGEMENT STRATEGY

8.1 INTRODUCTION

A risk is defined as an event which affects the cost, quality or completion time of a project that may or may not occur. There are a number of such events that could arise during the design, construction, commissioning and operation of the new facilities to be built. There are two core principles that should govern risk transfer in building projects: • Risk should be allocated to whoever is best able to manage and control it • The aim is to secure optimal risk transfer (optimal risk transfer is not maximum

risk transfer) Risk analysis objectives are to:

Allow the Board to understand the project risks and put in place mitigation measures to manage those risks. In order to fulfil this objective the project team has established a risk register in order to identify and mitigate any or all project risks and developed a risk management plan. Assess the likely total cost to the public sector of the investment option(s) under consideration and to demonstrate value for money The estimate of capital cost to complete the works required to achieve the construction objectives are assessed through utilisation of the optimism bias process to enable non attributable risks to be accounted for within the costs and programme plan. Risks are assessed and reduced to ensure that the CPAM can be compared with a PFI option on a like for like basis ensuring that the value of risk retained by the Board under both options is understood (see Chapters 9 and 10). To ensure that the risk allocation is adequately considered, i.e. arriving at selected procurement strategy.


9. FINANCIAL APPRAISAL

9.1 VALUE FOR MONEY EVALUATION

9.1.1. Introduction The quantitative assessment which is contained within Section 9.1, seeks to compare the risk adjusted cost of the project, in net present value terms, for 3 alternative procurement routes.

9.1.2. Background

Three options have been considered by the Board for implementing the projects. These are:

1. Greenfield Option – A new build whole site solution for all facilities currently provided at the Southern General site, together with a new Adult Acute and Children’s Hospitals, plus related facilities. Land for a Greenfield site would be required under this option.

2. “Option 1” – This option represents an entire new build solution on the current Southern General site for the Adult Acute and Children’s Hospitals, plus new build Laboratories, and other related services.

3. “Option 1A” – A new build provision on the Southern General site for the Adult Acute and Children’s Hospitals, plus the refurbishment of some existing facilities on the Southern General site to provide Laboratories and other related services.

For Options 1 and 1A, two scenarios have been considered. These are: 1) base case with single room provision at 57% within the Adult Hospital and; 2) alternative case with a 100% single room provision within the Adult Hospital.

In carrying out its VFM evaluation, the Board has considered three potential procurement routes:

1. Traditional Procurement – also referred to as the Conventionally Procured Asset Model (“CPAM”)

2. Private Finance Initiative (“PFI”) 3. Not for Profit Distribution Model (“NPD”). This model provides for the redistribution

to the Board of any excess profit which may arise, in the form of “charitable surplus”.


9.1.3. Overview of results of Value for Money Assessment For both the “base case” and “100% single rooms” scenarios, Option 1A represented the preferred option, when compared to the Greenfield site and Option 1, in terms of risk adjusted net present value. On this basis, a full value for money appraisal was carried out on Option 1A, examining the relative costs of each alternative procurement route. When assessed in risk adjusted net present value terms the three procurement routes produced very similar results, the variation between the options being only 1.1%. In terms of ranking the NPD model ranked first, followed by CPAM then PFI. The PFI and NPD options are based on a senior bank debt funding solution. For a project of this scale, it might be that funders would examine the use of a funding solution based on bond finance as this approach may offer the possibility of lower cost funding. We have tested this sensitivity and the results indicate that this approach could potentially lower the risk adjusted cost for both the PFI and NPD by 2.2% to 2.5%. However at this time there are a number of difficulties in securing this form of funding, notably the state of international credit markets together with the fact that no NPD project has to date actually used this form of funding. 9.1.4. Quantitative Value for Money Assessment – inputs and assumptions This section provides details of the main inputs and assumptions used in the VfM analysis.

(i) Capital costs

The table below includes the capital costs of the new Adult and Children’s Hospitals, Laboratories, Administration, Westmarc and YPD. This is adjusted for VAT and equipment to reach the adjusted capital costs to be included in the shadow bid model.

Greenfield

£’000

Option 1

£’000

Option 1A

£’000

Input for Shadow Bid Model 1,472,169 759,158 676,782


(ii) Optimism Bias A provision for optimism bias is incorporated into capital cost estimates to mitigate against the possibility of cost under estimation on capital projects. As such, a provision for optimism bias is designed to capture, in financial terms, the likely additional costs associated with the crystallisation of key risks. The level of provision is based on historical experience within the Public Sector and reflects advice received from the Board’s Technical Advisors.

(iii) Lifecycle and Facilities management costs

The financial model incorporates provision for lifecycle and facilities management costs. The lifecycle and hard facilities management costs, which will be incurred over a 30 year period commencing April 2010, are discounted to present values.

Hard FM costs for the Adult and Children’s Hospitals were provided by our Technical Advisors. For the other facilities the Board has based its costings on the adjusted floor areas of the additional facilities.

The Adult and Children’s Hospitals Lifecycle costs inputs from Technical Advisors have been indexed from the base date of Jan 2007 to the construction start date April 2010. The lifecycle costs for the other facilities have similarly been indexed to April 2010.

(iv) Risk Adjustment

As different procurement methods bring different risks which require to be managed, it is necessary to identify and quantify relative risk impact in carrying out VFM assessments.

Incorporated into the value for money analysis are risk adjustments based on the outcomes of risk workshops carried out by the Board. These take account of the relative impact which a wide range of different risks might be expected to have on every cost element within each of the alternative procurement routes. For the CPAM procurement model, the risk adjustment for the base case scenario equates to 19.6% of the value of the CPAM, of this 12.1% could be transferred under the NPD or PFI procurement models with 7.5% retained under all procurements.

(v) Tax Adjustment

It is necessary to take account of the relative impact of taxation applicable to each procurement route in carrying out VFM assessments. This has been provided for as required by existing Green Book Guidance at 6%.


(vi) Shadow bid (i.e. PFI and NPD) model funding assumptions

The shadow bid model is based on a senior bank debt funding solution. Funding terms have been estimated by Finance Advisors on the basis of current market conditions.

A LIBOR rate of 5.5% has been used, representing current market rates plus a buffer of c50bps. As the Board retains the risk of movements in swap rates the use of this buffer is recommended by guidance for projects at this stage of developments.

A fully indexed unitary charge has been applied.

(vii) Discount rates

The net present value calculations have been performed to a base date of 1 May 2010.

The Treasury discount rate of 3.5% real (6.0875% nominal) has been used for all cash flows except for any charitable surpluses (NPD model only)

Charitable surpluses are discounted at 6.0% real (8.65% nominal) reflecting the fact that the surplus cash flows are at risk. This methodology is consistent with previous NPD projects.

(viii) Capital Funding Option, including appraisal of potential for bond finance

The assessment of quantitative value for money between the procurement routes was based on a senior bank debt funding solution for both the PFI and NPD options. For a project of this scale funders might be expected to examine a capital markets based funding solution based on bond finance as this may offer lower cost funding. Accordingly, this funding option has been the subject of further work.

The results of this further work are consistent for both the PFI and NPD options, indicating that bond finance could potentially lower the risk adjusted NPV for both the NPD and the PFI option. In net present value terms the cost would reduce by 2.2% to 2.5%

Ranking of the procurement routes on this basis shows NPD representing the lowest risk adjusted value for money, followed by the PFI and thirdly the CPAM option.

The results of the sensitivity analysis indicate that a bond option within the NPD procurement could be the option that provided the largest quantitative value for money benefit. However it is important to note that a bond has not been used to date to finance any NPD project that has closed in Scotland. Were the project to be the first to use this structure there would be a number of challenges to be overcome, these would include:

• Developing a governance and contractual structure that was acceptable to the private sector partner, funders and the Board.

• The requirement to obtain investment grade status from appropriate rating agencies, this would cover an assessment of the financial strength of both the private sector partner and also the Board.

• Securing a financial arrangement that would guarantee payments to the bond holders


If not satisfactorily resolved, the above factors in addition to movements in the cost of market funds would impact on the pricing of the bond solution and could erode the relative value for money benefits of this potential funding solution.

(ix) Comparison of net present values of alternative procurement routes

Value for money analysis Base Case Scenario NPV Greenfield

CPAM £’000

Option 1 CPAM £’000

Option 1a CPAM £’000

Option 1a PFI £’000

Option 1a NPD £’000

NPV of CPAM/Unitary charge payments 1,618,210 892,053 788,936 939,443 937,963

Retained estate Lifecycle 9,538 9,538 9,538

Refurbishment costs 12,956 12,956 12,956

1,618,210 892,053 811,430 961,936 960,457

Risk Transferred 12.0% 194,817 94,980 94,980 0 0

Risk Retained 7.5% 120,974 58,979 58,979 58,979 58,979

Total risk Adjustment 19.5% 315,790 153,959 153,959 58,979 58,979

Risk Adjusted NPV 1,934,000 1,046,012 965,389 1,020,915 1,019,436

Tax Adjustment 6% 97,093 53,523 47,336 0 0

Charitable distributions 0 0 (9,742)

Risk Adjusted Net Present Value 2,031,093 1,099,535 1,012,725 1,020,915 1,009,694

8,190 (3,032) Value for Money 0.8% -0.3%

Value for money analysis 100% Single Room Scenario NPV Greenfield

CPAM £’000

Option 1 CPAM £’000

Option 1a CPAM £’000

Option 1a PFI £’000

Option 1a NPD £’000

NPV of CPAM/Unitary charge payments 1,653,713 918,852 815,736 969,621 968,030

Retained estate Lifecycle 9,538 9,538 9,538

Refurbishment costs 12,956 12,956 12,956

1,653,713 918,852 838,230 992,115 990,524

Risk Transferred 11.7% 193,872 95,632 95,632 0 0

Risk Retained 7.3% 121,249 59,809 59,809 59,809 59,765

Total risk Adjustment 19.1% 315,121 155,441 155,441 59,809 59,765

Risk Adjusted NPV 1,968,833 1,074,294 993,671 1,051,924 1,050,289

Tax Adjustment 6% 99,223 55,151 48,944 0 0

Charitable distributions 0 0 (10,140)

Risk Adjusted Net Present Value 2,068,056 1,129,425 1,042,615 1,051,924 1,040,150

9,308 (2,466) Value for Money 0.9% -0.2%


9.2 AFFORDABILITY APPRAISAL

This information has been removed due to commercial sensitivity.

9.2.1 Capital Costs for Option 1a


9.2.2. Revenue costs


9.3 AFFORDABILITY OF PROPOSAL FOR NEW ADULT AND CHILDREN’S HOSPITALS IN CONTEXT OF NHSGG&C 10 YEAR FINANCIAL PLAN

9.3.1. Revenue Consequences A top level 10 year financial plan is set out in the table below with a more detailed summary provided in Section 9.4. This projects the Board’s anticipated sources of additional revenue funds and likely expenditure commitments over the forthcoming 10 year period, including the additional cost commitment associated with developing new Adult and Children’s Hospitals on the Southern General site.

Table 13: Top Level Financial Plan : 2008/09 – 2017/18

08/09

£’M

09/10

£’M

10/11

£’M

11/12

£’M

12/13

£’M

13/14

£’M

14/15

£’M

15/16

£’M

16/17

£’M

17/18

£’M

Forecast additional funding

74.7 77.6 79.4 73.4 75.3 77.3 79.4 81.6 83.7 86.1

Forecast expenditure commitments

Unavoidable expenditure growth / existing

commitments

92.3 105.2 80.4 78.0 74.3 76.7 79.5 83.9 86.5 88.8

New adult/children’s hospitals - - - - - 13.0 46.5 - - -

General provision for new expenditure

commitments

- 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0

Total expenditure commitments

92.3 113.2 88.4 86.0 82.3 97.7 134 91.9 94.5 96.8

Cost Savings plan (excluding Clyde)

(26.2) (27.0) (33.4) (12.0) (13.1) (10.0) (25.6) (18.3) (14.0) (9.0)

Projected in year surplus/deficit) 8.6 (8.6) 24.4 (0.6) 6.1 (10.4) (29.0) 8.0 3.2 (1.7)


Recurring surplus/deficit) brought forward - 8.6 - 24.4 23.8 29.9 19.5 (9.5) (1.5) 1.7

Projected recurring surplus/deficit) 8.6 - 24.4 23.8 29.9 19.5 (9.5) (1.5) 1.7 -

Provision for transitional costs associated

with establishing new adult/children’s

hospitals

(8.6)

-

(24.4)

(23.8)

(29.9)

(8.5)

11.0

1.5

-

-

Projected net surplus/deficit - - - - - 11.0 1.5 - 1.7 -

Notes :

1. Forecast additional funding includes additional funding related to general funding uplift and excludes anticipated funding related to specific ring fenced funding provisions set aside by SGHD. The only exception to this is the specific provision established in respect of “Access to Services” where it is assumed that NHSGG&C will receive £23m over the 3 year period to 2010/11. It is assumed that this funding will be fully committed during this period. 2. Unavoidable expenditure growth/existing commitments comprises anticipated additional expenditure on pays, prescribing, non-pays, capital charges, and all unavoidable service commitments already entered into for the period to 2017/18. 3. The financial plan anticipates that the existing funding deficit related to Clyde is managed to a recurring financial breakeven position over a 3 year period by a combination of recurring and non-recurring cost savings and transitional funding provided by SGHD. The financial summary contained within Section 9.4 provides further details of the Clyde financial position, showing how this features within the context of the 10 year financial plan. 4. A high level cost savings summary is provided within Section 9.4. A summary of the key assumptions which underpin the financial projections shown in table 13, including an overview of the Board’s financial strategy and appraisal of financial risk, is provided below.

i) Key Assumptions

• A general funding uplift of 3.1% per annum has been assumed. This is set below the recently announced general funding uplift for 2008/09 of 3.2% to allow for the potential impact which NRAC implementation might have on the Board’s level of general funding uplift in future years.

• A general pay uplift of 2% per annum is provided for. This is reasonable in the light of current UK government policy and reflects the significant reduction in general funding uplift which will apply from 2008/09 onwards.

• An overall annual growth rate of 6% in prescribing costs is assumed across

primary care and acute care. This allows for an average annual growth rate of 5.25% in primary care prescribing costs and 8.5% in acute prescribing costs,


before cost savings and other cost containment measures. This gives an overall annual rate of growth of 6% and approximates closely to the average annual growth rate experienced in past years. This can be regarded as a reasonable basis for projecting future average cost growth over a future period which extends to 10 years.

• A provision of 1.5% per annum is made for the general growth of non-pay costs

(excluding prescribing costs), with the exception of years 1-3 where a reduced provision equivalent to 1% is made. This reduced level of provision in years 1-3 years is linked with the development of a major cost savings programme by the Board aimed at driving out cash releasing savings of 2% per annum on an annual basis in line with Government targets. The sustainability of this level of provision over a period extending beyond 3 years is considered unlikely and so a higher level of provision is set for the years beyond 2010/11.

• The financial plan includes all known existing financial commitments related to

clinical and other services. These are presented within the section “Existing Programme Commitments”. The projected step up in revenue costs associated with the new Adult and Children’s Hospitals is shown within this section. This shows a revenue cost commitment of £59.5m per annum, which is the revenue cost commitment associated with the new Adult and Children’s Hospitals and those related capital schemes which are funded by the Board’s general capital funding allocation. Provision is also made for prospective new service commitments for 2009/10 onwards at a level of £8m per annum, split 50:50 between Acute and Non Acute Services. This level of provision will require to cover all new changes/developments which the Board is required to commit to over a ten year period, including all those national, regional and local changes/developments/initiatives which are unable to be funded by the specific ring fenced funding allocations which SGHD establishes annually to fund service change/development. This represents, in broad terms, a reduction of approximately 20-30% on the equivalent level of provision in 2008/09, however is considered realistic in the light of increasing levels of centrally managed ring fenced funding allocation, and a reduced level of general funding uplift. It should be noted that £8m per annum is regarded as a maximum provision, and may be scaled back, as required, to offset unforeseen cost pressures which may arise.

• The financial plan assumes that the Board will succeed in developing a cost savings plan which is capable of delivering 2% recurring cash releasing savings per annum during the period 2008/09 to 2010/11. This is in line with the SGHD targeted level of savings for the 3 year period to 2010/11. The cost savings plan includes restoring Clyde to a position of financial breakeven within the 3 year period.

The Board is currently engaged in the process of developing a detailed cost savings plan for 2008/09, which is aimed at delivering £33m of recurrent cost savings, with the objective of completing this by June 2008. Thereafter the process of developing plans for 2009/10 and 2010/11 will commence. For the years beyond 2010/11, a reduced level of cost savings is assumed, with annual targets set within a range of 0.5% and 1% per annum. This comprises a number of specific areas of cost saving associated with implementation of those changes related to the establishment of new Adult and Children’s Hospitals, supplemented by a general annual savings programme which equates to 0.4% per annum.


At this stage, the Board has already identified £45m within its 10 year cost savings plan, specifically related to its existing Acute Services cost base, which is capable of being released to fund an anticipated step up in annual revenue cost of £59.5m associated with the establishment of New Adult and Children’s Hospitals. During 2008/09, it will work at bridging the residual “gap” in parallel with developing an overall cost savings plan for 2009/10 and 2010/11.

(ii) Overview of financial strategy The cornerstone of the Board’s financial strategy, and the most significant individual feature of the Board’s financial plan for the forthcoming 10 year period is its cost savings programme. This dominates its financial planning for the 3 year period to 2010/11, with cost savings/containment/reduction initiatives requiring in total to generate an average of £35m per annum. This level of saving is required in 2008/09 and 2009/10 to ensure that the step up in revenue cost associated with commissioning 2 ACAD’s at Stobhill/Victoria in 2009/10 is fully funded, and continues into 2010/11 as the process of building up sufficient revenue funding capacity to fund the two new hospitals, in the lead up period to their commissioning, gets underway. The scale of additional cost commitment associated with the two new hospitals, £59.5m, demands that the volume of revenue funding which is required to pay for them, is built up over a number of years leading up to the commissioning of the hospitals…otherwise the Board would be unable to accommodate the running costs of these hospitals within the envelope of its available funds, while maintaining its commitment to achieve financial breakeven. By commencing this process in 2010/11 and continuing to target further cost savings in the years beyond 2010/11 the Board’s strategy is to amass an adequate reserve of revenue funding which will match the additional cost commitment which the new hospitals will bring. The financial plan shows the build up of this funding reserve over a 5 year period commencing in 2010/11. By building up revenue funding in this way, the Board will also be able to generate in the interim period the level of transitional funding it requires on a non-recurrent basis to manage through the process of establishing the new hospitals. This is capable of being covered year on year by the build up of revenue funding identified within the financial plan. The deployment of these funds year on year will be managed within the context of the Board’s financial plan so that it complies with its statutory requirement to contain expenditure within its overall revenue resource limit.


(iii) Appraisal of Key Risks

The key areas of risks are identified below:

(a) Funding uplift reduces below 3.1%

The 10 year plan projects that NRAC implementation will impact on the Board to the extent of restricting its annual general funding uplift by 0.1% or £2m per annum. This assumes that a measured approach will continue to be taken by SGHD to the implementation of formulaic changes affecting Health Board funding levels, mirroring the approach taken to the implementation of the Arbuthnott formula in recent years.

It is reasonable to assume that SGHD will continue to adopt this approach in order to avoid the potential for financially destabilising Health Boards, particularly at a time when the level of general funding uplift has been set at 3.2%, a much reduced level than in recent years. Accordingly, a 0.1% funding adjustment is provided for in preparing the Board’s financial plan. This is equivalent to a cumulative reduction in revenue funding of £20m over a 10 year period, a significant reduction in funding availability in the context of an overall annual general funding uplift of 3.2%. On this basis it is not considered likely that SGHD would seek to implement a further restriction on funding unless the level of future general funding uplift exceeded 3.2%, in which case it is reasonable to assume that a proportionate approach would be taken.

(b) Annual General Pay Uplift Exceeds 2%

This is clearly a key area of risk. For any year where the rate of general pay uplift exceeded 2% by 0.5%, without any corresponding elevation of the rate of general funding uplift, a cost pressure of £6.5m - £7m would emerge.

The Board would seek to manage the potential impact of this within the context of its 10 year financial plan by scaling back the level of funding set aside for prospective new funding commitments. This would offer scope for containing an increased level of general pay uplift of up to 2.5% for 3 years out of the 10 covered by the 10 year plan. Beyond this, the Board would have little room for manoeuvre, however it is reasonable to assume that a more frequent incidence of annual general pay uplift exceeding 2% might lead to a review of approach on pay awards which is likely to produce an equivalent change to the level of general funding uplift so that its impact was cost neutral within the context of the Board’s 10 year financial plan.

(c) 2% cost savings target is not achievable in 2009/10 – 2010/11

The sustainability of a cost savings programme, aimed at generating recurring savings of 2% per annum, over an extended period of 3 years is also a key area of risk. It is recognised that the Board is entitled to include non-recurring cost savings and credit these towards the achievement of its 2% cost savings target over the 3 year period to 2010/11, however the generation of recurring cost savings during this period is necessary on two counts:


1) The requirement to fund the step up in recurring cost commitment associated with commissioning 2 new ACAD’s in 2009/10.

2) The requirement to release sufficient funds to provide transitional

funding cover during the lead up period to commissioning the new Adult and Children’s Hospitals.

Nevertheless, there remains the possibility that a challenge of 2%

recurring cost savings per annum proves unsustainable over a period of 3 years. In the event that this proves to be the case, with up to 50% of the target proving unachievable in years 2 and 3, the Board would face a “gap” of some £30m within its 10 year financial plan. It’s strategy for addressing this would be as follows:

1) Spread the recurrent cost savings challenge across a longer period than

2009/10 and 2010/11. 2) Identify and plug in non-recurrent cost savings to “fill the gap” in each of

2009/10 and 2010/11, thereby securing the achievement of SGHD’s cost savings target for each of these years and preserving the required level of transitional funding.

3) Reduce the level of provision set aside for prospective new programme

commitments by up to £3m per annum over a 9 year period. This particular funding provision might also serve as form of contingency fund to cover for the potential of reduced/delayed achievement of cost savings target(s) in future years beyond 2010/11.

By following the above strategy, the Board would seek to manage the risk of its cost savings programme either not delivering the targeted level(s) of cost savings or experiencing delay(s) in achieving specific targets within individual years. Indeed, the same strategy would also be applied, albeit more comprehensively, in the event that the Board is confronted by a combination of pay pressure and delay to the achievability of its cost saving programme.

9.3.2 Capital Consequences

A top level capital plan is set out in table 14 below. This reflects the Board’s preferred option for procuring its new Adult and Children’s Hospitals, which envisages these being funded by Public Capital.


Table 14: Top Level Capital Plan : 2008/09 – 2015/16

08/09

£’M

09/10

£’M

10/11

£’M

11/12

£’M

12/13

£’M

13/14

£’M

14/15

£’M

15/16

£’M

Total

£’M

Forecast Capital Funding

General funding allocation 97.6 97.6 97.6 97.6 97.6 97.6 97.6 97.6 -

Specific funding : medical equipment 9.0 9.0 9.0 9.0 9.0 9.0 9.0 9.0

: other schemes 14.6 11.0 4.0 3.0

SGHD agreed brokerage 26.9 11.4

Total Capital Funding 148.1 129.0 110.6 109.6 106.6 106.6 106.6 106.6

Allocation of Funding

Committed schemes 112.4 80.8 47.2 14.0 9.0 9.0 9.0 9.0

Provision for schemes not yet committed 5.8 13.3 0.5 40.9 37.6 30.5 39.3 75.6

Provision for minor/local schemes 15.0 15.0 15.0 22.0 22.0 22.0 22.0 22.0

New adult/children’s hospitals – enabling

Schemes

14.9 39.4 28.0 7.7 13.0 15.1 6.3 -

Less : slippage/brokerage to be identified - (19.5) (5.1) - - - - -

148.1 129.0 85.6 84.6 81.6 76.6 76.6 106.6

Residue of available capital funds - - 25.0 25.0 25.0 30.0 30.0 - 135.0

Add : Capital Receipts - 10.0 15.0 25.0 30.0 18.0 18.0 19.0 135.0

: Endowment Funding - - - 10.0 10.0 - - - 20.0

NHSGG&C : total available funding - 10.0 40.0 60.0 65.0 48.0 48.0 19.0 290.0

Proposed supplementary allocation of

capital funds by SGHD

(specific allocation)

-

17.5

100.8

176.3

170.4

94.9

10.8

(19.0)

551.7

- 27.5 140.8 236.3 235.4 142.9 58.8 - 841.7

Capital expenditure… new adult /

children’s hospitals

-

27.5

140.8

236.3

235.4

142.9

58.8

-

841.7

The total capital funding requirement associated with the provision of the new Adult and Children’s Hospitals is £841.7m. It is planned that this will be funded by combining the following sources of capital funds to create the required funding pot:


£’M £’M

1. Specific provision within Board’s 10 year capital plan, set aside from annual general capital resource allocations.

135

2. Capital receipts generated from disposal of sites declared surplus 135

3. Allocation from Board’s general endowment funds 20

4. SGHD – specific allocations of capital funds for

a) children’s hospital b) adult hospital

205

346.7

551.7

Total 841.7 ====

The Board’s capital plan provides for the capital contribution identified at (1) above to be made available out of its routine annual allocation of capital funding. This is projected to remain static over the 10 year period and so has been fixed at the 2008/09 level of £97.6m per annum. It also provides for further expenditure on enabling (preparatory) schemes totalling £88m to be funded from general capital funding….this is part of the expenditure provision shown within the “enabling schemes” category within table 14 above. Because of the heavy concentration of enabling (preparatory) schemes in the first 3 years of the plan, it has been necessary for the Board to restrict the amount(s) of capital which it is able to set aside for prospective new commitments in the first 3 years of the plan to an absolute minimum, with only £20m set aside for new schemes over a 3 year period. In addition, the amount which the Board routinely sets aside to cover minor local schemes/health and safety related schemes etc has been scaled back to £15m per annum, representing 70% of existing expenditure levels. Even after having carried out such an aggressive process of prioritisation, the Board’s capital plan is over-committed by almost £25m in total over an initial 3 year period, with the bulk of this arising in 2009/10. It is assumed that this can be managed through a combination of slippage/brokerage in conjunction with SGHD on a year by year basis, over the 3 year period. On the basis of previous experience and recognising the scale of the over-commitment, which equates to 8% of total available capital funding for the 3 year period, this should be both manageable and achievable.

It is further assumed that the Board is capable of generating £135m over a 10 year period from the disposal of sites declared surplus. This is based on a series of projections carried out by the Board’s Property Advisors, based on the potential disposal of a wide range of sites including Victoria, Mansionhouse, Yorkhill, Gartnavel (part), Stobhill (part), Dykebar (part), Broomhill, among others, which are forecast to produce capital receipts during the forthcoming 10 year period. The wide range of sites which will become available for disposal during the forthcoming 10 year period provides the necessary level of reassurance that this level of targeted receipts can be achieved. It is further assumed that the Board will be able to source up to £20m from its general endowment funds to contribute towards the capital costs of the new Adult and Children’s Hospitals. With the total amount of endowment funds, currently standing at in excess of £80m, and over £30m within general endowment funds, this can be considered to be a realistic and reasonable assumption.



The final part of the capital funding package £551.7m represents the specific allocation of funding which is sought from Scottish Government Health Department (SGHD) and which is an integral part of the proposal contained within this outline business case. If SGHD is able to approve this specific allocation of capital funding, in line with the timescales identified within the capital plan, this will provide the balance of capital funding which is required to make the provision of the new Adult and Children’s Hospitals affordable within the context of the Board’s capital plan.


9.4 10 YEAR FINANCIAL PLAN

Table: 10 Year Financial Plan

123456789

101112131415161718192021222324262728293031323334353640424344454647484953545556575859606162

6364656667

A B C D E F G H I J K L M T

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

A Opening Financial PositionClyde Deficit brought forward (19.0) (12.0) (4.0) -less Planned Recurring Cost Savings (Clyde) 7.0 8.0 4.0 -less Planned Non Recurring Items 4.0 - - -less Transitional SGHD funding (assumed) 8.0 4.0 -

Adjusted Opening Financial Position - - - - - - - - - -

B New Funding1 SEHD general funding uplift 54.0 55.7 57.4 59.2 61.0 62.9 64.8 66.8 68.9 71.12 Waiting Times 7.0 8.0 8.0 - - - - - - -3 Other 13.7 13.9 14.0 14.2 14.3 14.4 14.6 14.8 14.8 15.0

Total New Funding 74.7 77.6 79.4 73.4 75.3 77.3 79.4 81.6 83.7 86.1

C Expenditure Commitments1 Pay costs inflation 35.5 30.4 27.9 28.3 28.8 29.3 30.0 31.1 31.5 31.82 Prescribing costs growth 19.5 20.7 21.9 23.2 24.6 26.1 27.7 29.3 31.1 32.73 Other supplies costs inflation 5.6 5.7 5.8 8.8 8.9 9.0 9.2 9.5 9.6 9.74 Energy 3.5 - - - - - - - - -5 Capital charges inflation 2.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 2.06 PMS & PCS 5.3 5.5 5.6 5.7 5.8 5.9 6.0 6.2 6.3 6.47 Other Providers 4.4 4.6 4.8 5.0 5.2 5.4 5.6 5.8 6.0 6.28 Existing Programme Commitments

(i) Brought Forward 7.0 5.0 5.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0(ii) Acute Capacity Plan / Waiting Times 7.0 8.0 8.0 - - - - - - -(iii) Acute ASR Programme 0.3 21.0 2.0 - - 13.0 46.5 - - -(iv) Other Acute 4.3 5.7 0.4 5.0 - - - - - -(v) CHCP / CHP / MH / Other 2.9 2.6 1.0 1.0 - - - - - -(vi) In-Year Commitments c/f (5.0) (5.0) (3.0) (3.0) (3.0) (3.0) (3.0) (3.0) (3.0) (3.0)

92.3 105.2 80.4 78.0 74.3 89.7 126.0 83.9 86.5 88.8

9 Prospective Programme Commitments(i) Acute - 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0(ii) CHCP / CHP / MH / Other - 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0

Total Prospective Programme Commitments - 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0

Total Expenditure Commitments 92.3 113.2 88.4 86.0 82.3 97.7 134.0 91.9 94.5 96.8

(26.2) (27.0) (33.4) (12.0) (13.1) (10.0) (25.6) (18.3) (14.0) (9.0)

8.6 (8.6) 24.4 (0.6) 6.1 (10.4) (29.0) 8.0 3.2 (1.7)

Recurring Surplus / (Deficit) brought forward 8.6 - 24.4 23.8 29.9 19.5 (9.5) (1.5) 1.7

8.6 - 24.4 23.8 29.9 19.5 (9.5) (1.5) 1.7 -Projected Recurring Surplus / (Defict)

Projected In-Year Surplus / (Defict)

Cost Savings Plans (exc Clyde)

(8.6) - (24.4) (23.8) (29.9) (8.5) 11.0 1.5 - -

- - - - - 11.0 1.5 - 1.7 -Projected Net Surplus / (Defict)

Provision for Transitional Costs Associated with Establishing new Adult / Children's Hospitals

Table: 10 Year Financial Plan – Cost Savings Plan

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4

5

6

7

89

1011

12

13

14151617181920

2122232425

A B C D E F G H I J K R S

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 Total£m £m £m £m £m £m £m £m £m £m £m

ASR Cost Savings

Capital Charges 2.4 3.1 1.0 3.7 3.9 2.4 16.5

Nursing 3.0 3.0 4.5 10.5

Medical 3.0 1.6 4.6

Other 0.5 1.0 5.4 3.8 2.6 13.3

ASR Cost Savings 2.9 3.0 3.0 4.1 1.0 16.6 9.3 5.0 44.9

Other Cost Savings

Clyde Cost Savings 7.0 8.0 4.0

Other Savings 26.2 24.1 30.4 9.0 9.0 9.0 9.0 9.0 9.0 9.0

Other Cost Savings 33.2 32.1 34.4 9.0 9.0 9.0 9.0 9.0 9.0 9.0

Total Savings 33.2 35.0 37.4 12.0 13.1 10.0 25.6 18.3 14.0 9.0

less Clyde Savings separately disclosed (7.0) (8.0) (4.0)

Total Savings (exc Clyde) 26.2 27.0 33.4 12.0 13.1 10.0 25.6 18.3 14.0 9.0

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10. PROCUREMENT

10.1 PROCUREMENT OF BUILDING – PUBLIC FINANCE PROCUREMENT ROUTE

The business case considers the best way of meeting the business objectives while achieving best value for money, the optimum balance of risk and control and funding.

There was little to differentiate the alternative procurement routes in terms of their capacity to deliver Value For Money, however a publicly funded capital route offers the potential to deliver an affordable solution. The preferred procurement route is therefore through public finance. There are a range of contract options that are available to the Board, some of these transfer programme , design and cost risks better than others and the Board need to carefully consider the pro’s and con’s of each before making a final decision.

Ideally, the procurement route should try to integrate design, construction, operation and ongoing maintenance into the mix as the design develops, even if operation is not part of the service delivery. To assist the Board to consider and select the most appropriate contract form, a procurement workshop has been set up for 19th February 2008 to review options, evaluate and select a preferred route. The workshop will be attended by the Acute Division’s Chief Operating Officer, the Director of Finance, the Project Owner, the Project Director, Project Team members plus technical, legal and financial advisers.

The workshop will focus on the Board’s key requirements in respect of cost and programme risk transfer, robust and tested procurement route, value for money and whole life cost, expenditure and programme requirements. Key to the selection process is the requirement to select a process that sees a start of construction work in the 2nd quarter 2010, with completion of the new Children’s Hospital 1st qtr 2013 and the new adult acute hospital in 2nd qtr 2014.

The preferred public finance option will be submitted to the Health Board and Scottish Government for consideration and ratification as part of the outline business case. It will also be independently assessed though the OGC Gateway Review process to provide assurance to the Board and the Scottish Government that the method shown has been scrutinised and confirmed. 1

The contract form will dictate the timescales for following tasks and timetable, however it is anticipated that following market sounding and preparation of more robust design and project requirements (brief and specification) that a competitive process will follow involving at least three contracting teams over a 9-12 month process, culminating in the selection of a preferred partner completion of Full Business Case by mid 2010. The detail of the process will be expanded on completion of the workshop and confirmation of the preferred route.

10.2 PROCUREMENT OF EQUIPMENT

The retention, transfer, procurement and commissioning of new and existing equipment will be a complex project requiring detailed and effective management.

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The financial appraisal includes provision of new equipment. This includes Group 1 and specified Group 2 equipment including CT scanners, MRI scanners and Gamma cameras.

Within the contract for constructing the new hospitals it will specify the services requirement for all Group 2 equipment (large and small) in order that the specialist equipment contractors will be able to supply and fit required equipment.

It is the intention of the Board to procure all identified group 2, 3 and 4 equipment from public capital via the NHS Greater Glasgow & Clyde procurement department.

10.3 PROCUREMENT OF IT

• The project includes for the provision, maintenance of structured wiring. These elements will need to be able to support both the current and future applications.

• It will remain the Board’s responsibility to support existing and to procure new application hardware and software through separate contracts.

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11. WORKFORCE ISSUES

11.1 INTRODUCTION

The development of the new South Glasgow Hospitals will be supported by a workforce, which has the skills and competencies to provide modern, quality health care of the 21st century.

The Health Board’s workforce development plan is set within the context of the NHS Careers Framework, and over the next few years, will shift the balance of the workforce to enhance the role of support staff at levels 1-4 to allow professionally qualified staff to use their skills in the most effective way.

At the same time, significant economies of scale will be achieved in the use of medical, nursing, allied health professions and support staff, as the number of inpatient sites reduce.

11.2 CONTEXT

The latest national workforce planning report, “Better Health, Better Care: Planning Tomorrow’s Workforce Today” was published in December 2007. This strategic document sets out the direction of travel for future workforce planning, with a particular focus on integration with financial planning and service delivery. The workforce plan to support the new South Glasgow Hospital is therefore fully integrated with the service and bed model, and the affordability model. It is also set with the Board’s overarching workforce plan, which supports the Local Delivery Plan.

The “Careers Framework” was formally launched in Scotland in October 2006. It supports NHS Boards and regions to articulate the future workforce development needs through alignment with workforce planning and modelling, the implications of service redesign as well as to support robust succession planning. The “Careers Framework” is also linked to the Knowledge and Skills Framework (KSF) and to the use of national occupational standards in producing development plans for new as well as existing roles. With the support of the Scottish Government and NHS Education for Scotland, the Board are using the Careers Framework to plan the competences required in the future workforce.

11.3 THE POPULATION PROFILE

Achieving the workforce needed in the future will be challenging given the shrinking labour market. There will be a fall in the number of young people entering the labour market and an increase in those approaching retirement. At the same time, the increased proportion of the population aged over 60 and, particularly, over 75 will increase demand for health care. The following chart shows changes in the age distribution of the NHS Greater Glasgow population up to 2024.

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Population trends suggest that there will be a 17.1% fall in the number of young people entering the labour market and a 5% decrease in those approaching retiral age. There will be a 23% increase in those having just reached retiral age and an 19.8% decrease in school children. This constitutes a major shrinkage of the local labour market.

However, at the same time there has been a significant shift in the fortunes of the resident working age population of the city. At the end of the 1990s, just over half of the city’s working age resident population were in employment. By the end of the present decade, this will have risen to over seven in ten.

To better prepare NHS Greater Glasgow and Clyde to meet this challenge, the Community Health and Care Partnerships and the Community Health Partnerships are working within their local communities on employability. A significant element of this is to ensure recruitment into NHS Greater Glasgow and Clyde from a wider pool of people who would not normally access NHS employment. The Board’s pre-employment training programme, Working for Health in Greater Glasgow will continue to play a critical role in this, ensuring that people from the local communities surrounding the new hospitals are ready for employment. In planning for the future workforce, the Board are working in partnership through a “Strategic Alliance”; with the Further and Higher Education sector; and with other NHS Boards – the Golden Jubilee National Hospital and NHS Education for Scotland in particular. This will ensure that further education in particular is placed to assist in developing skills necessary for the new hospital environments

11.4 WORKFORCE PLANNING

The future workforce envisaged in the workforce plan is based on the principles of affordability, availability and adaptability.

Affordability The workforce plan is based on the Financial Plan. This assumes that pay rates increase by no more than the inflationary uplift received by the Health Board in its weighted capitated funding. It is assumed that, over the next few years, the consolidation of new contractual arrangements (Consultant Contract, GMS Contract and Agenda for Change) will lead to productivity gains. Development of new services will require to be balanced with “efficient government” gains in some backroom function (supplies, pharmacy, finance and human resources for example.) This will allow a shift from indirect to direct care within the overall resource envelope. Planning for this will involve setting indicative targets for direct care/support staff ratios.

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Availability

Using the Careers Framework the Board is developing a career pathway for the whole workforce.

The significant demographic changes in the available workforce in Glasgow over the next decade has led NHS Greater Glasgow and Clyde to focus on a series of strands of work to ensure future recruitment to the Board by widening the pool of labour available to us. NHS Greater Glasgow & Clyde is committed to the “Welfare to Work” agenda in Glasgow. “Working For Health” currently has 260 trainee places per year with a target of bringing 75% of these into employment. Working for Health is a generic pre-employment training programme but it is focused on the NHS and is demand-led in that we guarantee permanent employment on successful completion of the training programme. It started off as a six week “one size fits all” programme but has been redesigned as a flexible two, six or twelve week programme. Working for Health will provide one-third of NHS Greater Glasgow and Clyde’s non-professional recruits. While the Board currently provide continuing professional development for professional staff, and in the future more than induction and job-related skill training for the non-professional workforce will be need to be provided. There will be new roles designed to provide career opportunities for non-professional employees. Greater Glasgow has the largest Black and Minority Ethnic population in Scotland (4.5% or 39,318 people)1. 38.7% of the total Scottish black and minority ethnic population live in the Greater Glasgow area, and 45.7% of all black and minority ethnic people in Greater Glasgow are Pakistani. The black and minority ethnic population is younger than the White population (29.5% under 16 compared to just under 19% for the White groups). These figures are based on the 2001 census and, therefore, do not include the majority of asylum seekers and refugees presently residing in Greater Glasgow as they arrived after the census date. Evidence indicates that the black and minority ethnic population is under-represented in the Board’s workforce. It is important that the black and minority ethnic population is drawn on, not just in order that the workforce more fairly represents the local population, but also because the young black and minority ethnic population is likely to already be more than 5% of the population and to become a more significant proportion of the population in the future. Asylum seekers are not allowed to take up employment but can be encouraged to undertake voluntary work or training which will prepare them, if successful in seeking right to remain in the United Kingdom, for NHS employment. With the support of the Scottish Government, the Board have appointed a Refugee Workforce Development Officer to encourage and facilitate professional and non-professional refugees to join the workforce. A training programme has been developed to prepare refugees for participation on the pre-employment training programme.

1 Ethnic Group Profile From The 2001 Census - NHS Greater Glasgow Area, NHS Greater Glasgow Information Services September 2005

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Adaptability

The key to success will be in how the current workforce adapts to new roles and new ways of working. It is recognised that this will require an increased investment in education, training and development. There will be a shift of resources from indirect to direct care in rationalising and rebuilding the estate and as other efficiency savings are achieved in backroom functions. The workforce of the future will be better supported by more highly-trained but not, necessarily, professionally qualified staff.

Agenda for Change and the associated Knowledge and Skills Framework allows the reduction in demarcation between professionals and to develop new roles around the patient. A number of career framework based projects are in place across NHS Greater Glasgow & Clyde. NHS Education for Scotland is funding a project aimed at level 2/3 in nursing and across allied health professions working in rehabilitation and assessment. The Scottish Government is supporting a national project aimed at level 4 for nursing, AHPs and social work within acute services and partnerships. A further project aimed at level 6/7 is also being funded by the Scottish Government for nurses in Care of the Elderly services.

These projects will inform the development of the competences profiles required to enable staff to provide appropriate care. While some of this change will be achieved by replacing staff who choose to leave and are replaced by staff performing different roles, much of the change will involve existing staff adapting to new roles.

11.5 FUTURE WORKFORCE PROFILE

The NHS Greater Glasgow and Clyde workforce has over 40,000 substantive staff currently in post and approximately one in four of the NHS workforce in Scotland works for NHS Greater Glasgow and Clyde. Acute services including children’s services account for the majority of the workforce. The acute services workforce is deployed at Stobhill Hospital, the Victoria Infirmary, the Western Infirmary, Glasgow Royal Infirmary, Gartnavel General Hospital, the Royal Hospital for Sick Children and Queen Mother’s Hospital at Yorkhill and at the Southern General Hospital.

The current workforce against the levels within the Careers Framework is set out below.

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Current Workforce

1

2

3

4

5

6

7

8

9

NHS

Car

eers

Fra

mew

ork

Leve

l

medicalnursingAHPsscientiststechnicalpharmacyother

This shows a wide variance in the distribution of staff across the competency levels, with the largest groups of staff currently mapped to levels 6, 5 and 2. (Level 9 equates to very senior roles; Level 5 would predominantly represent new graduates entering the workplace; Level 1 equates to support worker roles.) It highlights that there are currently limited opportunities for career progression. It also demonstrates that there are two workforces: those from level 1 to level 4 and those who enter as newly qualified staff/ graduates at level 5 and have the opportunity to progress up to level 9.

The Acute Services Review will result in the following pattern of services,

• two new ambulatory care hospitals providing day surgery and outpatients at the Stobhill and Victoria sites

• closure of the Western Infirmary, Victoria Infirmary, Stobhill Hospital, Queen Mother’s Hospital and Royal Hospital for Sick Children

• movement of inpatient services to the new South Glasgow Hospital, Glasgow Royal Infirmary and Gartnavel General

The opportunities for redesign offered by the new investment in facilities and the consolidation of workforce onto fewer sites will result in a significant re-profiling of the workforce. The Board’s new workforce set against the levels in the Careers Framework is set out below.

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Future Workforce

1

2

3

4

5

6

7

8

9NHS Caree

rs Framew

ork Le

vel

medicalnursingAHPsscientiststechnicalpharmacyother

This graph suggests that in the future there will be a requirement for a more even distribution of staff across the competency levels with particular investment in levels 3 and 4. This would allow for greater flexibility and career progression underpinned by an appropriate suite of training and development opportunities.

The Medical Workforce

With the reduction in the number of acute in-patient sites, there will an impact on the medical workforce, particular in Anaesthesia, Medicine, Accident and Emergency and Surgery. At the same time the impact of Modernising Medical Careers will be working its way through. In these specialties, there will be a reduction in the rotas required to provide cover, and this will mean the loss of some training posts, which will be reflected in the training programmes in the West of Scotland. However, the impact will mainly be on PAs and availability supplements paid to Consultant medical staff reflecting a reduced burden of on-call. Similarly, as junior doctors rotas become less onerous, there will be further improvements to working hours and this will reflect in lower banding payments to junior doctors. These changes in combination are of the order of 1.7% of the overall medical staffing budget within acute care.

The Nursing and Midwifery Workforce

Nursing and Midwifery constitute the largest element of the workforce. The majority - but not all - of the workforce is ward based and their workload relates to factors such as the number of beds, the dependency of patients and the layout of the ward.

An exercise has been undertaken to measure the potential impact on the nursing workforce. This work is predicated on the development of the agreed bed model for acute services and a bed model for children’s services in anticipation of the movement to the SGH site. Workforce data and future scenario assumptions have been considered with professional leads and service directors, and these have subsequently been used to inform future workforce modelling. In this way it has been possible to work at individual directorate level as well as at a service wide level. This has allowed for due consideration as to where future efficiencies may lie.

Further work needs to be done to refine an appropriate grade mix. This will also be informed by the recommendations from the Nursing and Midwifery Workload and Workforce Planning Report. Account will also have to be taken of the workload implications of developing standards set by the Nursing and Midwifery Council.

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Specifically there will be a reduction in the number of ward manager posts, with a realignment of resources to Agenda for Change Band 5. With staff spread across fewer sites there will be a requirement for less senior managerial capacity and this will provide an opportunity to look at the way practice education and development support is deployed. There will in addition to the re-profiling of the nursing workforce be a reduction in overall headcount related to a reduced number of beds. The combination of all of these changes comprises 2.6% of the current nursing complement. These changes will be managed in line with the Boards “Managing Workforce Change Policy”. Over the next six years there will be regular review of workforce capacity. Currently, just over 11,000 nurses and midwives work within the Acute Sector, with a turnover rate of just under 7% annually. Therefore achieving the appropriate workforce profile will require the Board to carefully match demand and supply while at the same time rebalancing the skill mix, but is eminently manageable within the timescale available

The Allied Health Professions Workforce

The Allied Health Professions workforce is diverse including dieticians, occupational therapists, orthoptists, physiotherapists, speech and language therapists, podiatrists, radiographers, prosthetists and orthotists.

New models of care will be developed – particularly within rehabilitation and assessment services – and this will impact on the make-up of the workforce. Assistant practitioners, advanced practitioners and consultant Allied Health Professionals posts will be developed to provide a more balanced workforce to contribute to the new models of care. The need to use staff efficiently coupled with concerns about the future availability of certain graduate Allied Health Professionals and the impact of a shrinking labour market on student numbers and on recruitment of non-professionally qualified staff, has led to consideration of new roles and routes to professional qualification. Work has commenced on the development of competences for (generic) support worker and assistant practitioner roles.

The Administrative and Clerical Workforce

The staff groups outlined above are supported by a range of administrative and clerical staff – some working directly with clinical staff (e.g. medical secretaries) and some, indirectly, in backroom functions. Such staff make a significant provision to patient services. Backroom functions will benefit from developments in the automation of information (e.g. the introduction of a filmless x-ray service, electronic dictation and the electronic health record).

Facilities Management Workforce

The size of the facilities workforce will relate directly to benchmarked norms taking account of cost per square metre of estate. This will therefore lead to reduction in overall headcount, which will similarly be managed through the Board’s ‘Managing Workforce Change’ Policy over the next few years.

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11.6. CONCLUSION

NHS Greater Glasgow and Clyde has taken account of the requirements to develop the Outline Business Case and ultimately the Full Business Case and has invested in appropriate additional resource to support this. In developing the Board’s Workforce Development Plan, there will be a continued commitment to ensure that work is undertaken in partnership with a range of internal stakeholders, including Trade Unions, as well as external stakeholder organizations in light of anticipated service change and re-design.

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12. FACILITIES MANAGEMENT (FM)

This section outlines the Board’s approach to Facilities Management.

12.1 BACKGROUND

The proposed new Southern Campus will consist of both new build and retained estate. Part of the retained estate includes a PFI building, the Langlands building, which houses in patient beds for care of the elderly, young physically disabled and dermatology. This is located on the extreme southern end of the site. The Hard and Soft FM Services which are currently provided on the Southern site are shown in table 15 below.

Table 15 – FM services provided to the Southern campus site by NHS Greater Glasgow and Clyde

Soft FM Hard FM

Sewing Room Grounds Maintenance Portering Services Estates Maintenance Domestic Services Estates MC Works Waste Management Energy Management Linen Service Boilerhouse Supplies and logistics Estates Workshop General Services Estates Helpdesk Telecommunications Deceased Patient Movement Staff Changing Green Transport Management Catering Services Car Parking Pest Control

Within the PFI building there is a FM commercial contractor providing a small number of services, these are listed in table 16 below.

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Table 16 – FM services provided to the Langlands PFI building by commercial FM contractor.

Soft FM Hard FM

Catering Grounds Maintenance Porter Services internal to building Estates Maintenance Domestic services internal to building Estates MC Works Internal Waste Help desk Staff Changing Boilerhouse Security Estates Workshop

12.2 THE HEALTH BOARD’S APPROACH TO FM

In planning the FM strategy for the site the new and retained configuration of the estate have been taken into account. It is the Board’s intention to provide all hard and soft FM services to the Southern Campus from within NHS Greater Glasgow and Clyde’s facilities pool (with the exception of those currently provided by the commercial FM provider to Langlands). To ensure that the greatest efficiencies are achieved a benchmarking and value for money exercise will be undertaken to explore and identify the most effective methods of service delivery. In addition, work is taking place to identify any innovation that would assist the delivery of services and provide long term efficiencies. These will be investigated in more detail during the next stage of the project

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13. INFORMATION TECHNOLOGY

13.1 OVERVIEW

Health Information Systems, and the underpinning Information Technologies will be key elements in support of Patient Care in the new hospitals.

At the present time, work is ongoing to develop a National eHealth Strategy for NHS Scotland, and whilst this work is as yet incomplete, there is a set of eHealth Aims that the evolving strategy will set out to achieve. These are as follows:-

• Patient and carer involvement and experience • Evidence – based and safe care • Integrated Healthcare • Support for community based care • Support for scheduled hospital care • Support for unscheduled care • Improved information intelligence • Advanced eHealth • Effective systems to improve productivity

Certain specific objectives will be required to be put in place in order to achieve the above aims. These sets of objectives fall into four main categories:- • Information Strategy The information strategy focuses on the needs of patients - both in terms of information clinicians require, to provide the best possible standards of care, and easy access for patients to information about their care. • Software Applications Strategy An Electronic Health Record (EHR) exists to support sharing of patient information, with strictly governed access. The founding principle is that receipt and delivery of NHS care implies acceptance by patients and their clinicians that information needs to be collected to high quality standards and accessed where appropriate to ensure best possible care. The goal of EHR does not mean a single all-encompassing software application. Even if such a product existed, which is not the case at present, the strategy is founded on progressively making progress rather than ‘rip and replace’. This meaning of ‘EHR’ is therefore the umbrella term used to describe the key software applications which together make up support for all aspects of patient care. EHR in this sense will therefore be achieved through incrementally putting in place and connecting the necessary components.

• Delivery Strategy

Delivering the national eHealth Strategy must balance the need to deliver the long-term objectives and service improvements, whilst realising real service benefits from the outset and throughout the programme.

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Planning for the delivery of the national eHealth Strategy will also recognise that NHS Boards are at different stages of maturity, in terms of integrating their existing eHealth services. In addition, there are a number of differing local priorities. The Delivery Programme will therefore include a degree of flexibility in recognition of the different baseline positions of NHS Boards. • Infrastructure Strategy The Infrastructure strategy will embrace technologies and services associated with the enabling, operating and management of technical resources appropriate to the delivery of the eHealth Strategy. The approach to strategy development has been to identify the elements that contribute to the strategy together with their interrelationship with other aspects of the wider strategy, define the relevant and appropriate standards, align these to the wider strategic context and validate them against prevailing cornerstone activities and prospective procurement opportunities. Each Health Board will require to establish its own roadmap of how to progress from its current baseline systems and technologies to achieve ultimate convergence with the National objectives.

For the purposes of the Outline Business Case, this section reviews:-

• IT requirements for the future • The projects and work in progress towards achieving the above objectives • The envisaged technical and environmental infrastructures that the new hospitals

will require to house to support the evolving Information systems

13.2 REQUIREMENTS FOR THE FUTURE

a) National Strategy From a national perspective, ‘Better Health, Better Care’ promotes a comprehensive health information system built around an Electronic Health Record. The eHealth strategy is concerned with delivering that comprehensive system and NHS GG&C will work towards this goal through all of its developments. Detail of the strategy is still under development, but the ultimate objectives are to have:- • Access to a personal Electronic Health Record, for each individual patient

ultimately replacing paper records. • All healthcare professionals connected to a secure health information network

supporting integrated community, acute and inter-agency care services. • Support for integrated healthcare services through sharing of patient information

while maintaining the confidentiality of patient information. • Data sharing between the health service and its partners, based on a framework

of informed consent, supporting Community Health Partnership working • Information systems able to support the three functions of assessment of need:

care planning and co-ordination, and evaluation of quality of care. • Healthcare professionals able to access best practice information and to

participate in clinical networks.

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• Clinical staff record their interventions directly into Electronic Health Records, rather than transcribe to written records.

• Convergence over the next 5 years towards common and mandatory arrangement of IT systems across NHS Scotland.

With regard to the latter point, it is proposed that a national procurement is undertaken for a new Patient Management System that will embrace both Patient Administration functions plus a kernel of clinical functions that will include at least Order Communications, but may potentially also include A&E, Theatres, Electronic Prescribing etc. The full scope of what will be included is out for consultation.

b) Projects and Work in Progress

There are a number of initiatives that are ongoing or have recently been completed within NHSGGC which are closely aligned with the national objectives. These include:-

• Implementation of the national PACS system, commencing in Southern General

hospital with subsequent roll out which has included Victoria Infirmary, Yorkhill and progress within RAH and Gartnavel Hospitals.

• Implementation of the national A&E system initially in the Clyde and North Glasgow hospitals.

• Extended availability of the ECS (Emergency Care Summary) to A&E Departments.

• Implementation of the National system for GEMS Out of Hours service. • Improved resilience and support arrangements for further consolidation of the

Laboratory and Radiology Information Systems. • Implementation of the SCI DC and Diabetic Retinopathy system in Clyde. • Implementation of the NHSGGC Theatre Management system (ORSOS) in

Clyde. • Implementation of a new Community Nursing System. • Creation of a stable environment for the Glasgow SCI Store so that services can

be restored to GPs regarding provision of laboratory results and other clinical letters.

• Merging of the Glasgow and Clyde SCI Stores. • Preliminary work on the development of a Data Warehouse to support the

Information Services within the enlarged Board Area. • Continued roll out of SCI Gateway availability for the communication of referral

letters from GPs to Acute Care services. • Continued progress on the usage of CHI throughout the Health Board area. • Adaptation of existing systems to comply with the requirements of “New Ways of

Measuring Wait Times”. • Implementation of the National Scottish Cervical Call Recall System (SCCRS). • Implementation of improved communications infrastructure via N3 (NHS Net

version 3). • Rationalisation of the e-mail service within the enlarged Board. • Commencement of convergence of voice and data communications via IP

Telephony. • Improved CHP connectivity through Boards strategy, joined up services and

sharing information. • Commenced implementation of a Clinical Portal that will facilitate clinical access

to the current range of disparate systems. • Development of Chronic Heart Disease and Stroke electronic Health Records.

111

• Replacement of Clinical systems within Surgical and Orthopaedics. • Review of how we can best move to a 24 x 7 support model through internal and

external agencies. • Development of a strategy to support the information requirements for the new

Ambulatory Care Hospitals.

c) Technical and Environmental Infrastructures Required by the New Project to Support the Evolving Information Systems

In considering the environments required to host a range of modern systems and services, there are a number of standards and facilities that will need to be established. An IT infrastructure backbone, which will support any software, was considered a key factor in looking at requirements for the new project. The need for cabling, wireless and active communications infrastructure was reviewed along with requirements for telephone infrastructure, computer rooms, IT training rooms, patient internet services and other dependant/related services such as building management and security services interaction with medical/diagnostics equipment, and educational suites and video conferencing application software.

• Infrastructure

Application Software

Major Application Systems (e.g. PAS / HIS, Labs., Radiology, PACS and other major clinical systems) used within the new hospitals will be part of the National / NHSGGC strategies, and consequently will be funded either centrally or via the NHSGGC IT capital and revenue sources. IT Support Services IT Support Services will be Pan Glasgow/ Clyde and will be independent of site, therefore the reconfiguration of beds will not affect the support services and any increase in support connected with the roll out of National /NHSGGC software strategies will be funded either centrally or via the NHSGGC IT revenue budget. PC and Peripheral Equipment

The new adult build and children’s build will require some investment in PC and peripheral equipment. Although it may be assumed that on ongoing replenishment programme will take place in the coming years, and that it will be possible to transfer a high percentage of the prevalent stock at the time, it is estimated that approximately 10% will require to be replaced at the time of commissioning. Additionally, the configuration of the new builds in clinical areas will require new equipment.

Active Communications Equipment

There will be a cost associated with the purchase and installation of the active components of the communications equipment. This will include core switches, distribution switches, wireless controllers, wireless access points, node racks and UPSs.

The PC and active communications equipment is included in the projects cost plan.

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14. CAMPUS DEVELOPMENT PLAN

14.1 THE “DO-ABILITY” This section describes the current site, the enabling works to release the site designated for the new hospital and laboratory facility, the smaller works associated with the new hospitals and the phasing.

14.1.1 Enabling Works There is a comprehensive plan to re-locate all the services within the site designated for the new build to other locations to allow demolition and clearance of the site by the end of 2009.

Details of both the enabling works and phasing are given in Appendix 7.

The potential for interruption to day-to-day services and facilities within the site during construction has been carefully analysed and will be managed by:-

(a) a series of enabling works to decentralise the main hospital services and utilities and

(b) isolating the construction-site from the remainder of the hospitals, with materials and construction traffic accessing the site from a discreet entrance off Hardgate Road and an existing but currently disused link road to Govan Road.

With the construction-site sealed off and separately accessed from the rest of the hospital site it is envisaged that the hospital will continue to operate uninterrupted during the building and commissioning of the New Hospitals and Laboratory builds.

14.1.2 Associated Works

As described under Option 1a there are a series of smaller capital works associated with the Southern Campus. These are: • Development of two multi-storey car parks. These are to be completed in two

phases with an initial car park, phase 1, prior to the main hospital construction to relieve potential parking pressures on the site. The second car park, phase 2, will be constructed alongside the children’s hospital build.

• Refurbishment of some of the existing buildings to provide clinical support and

other services The enabling works, phases 1 and 2 multi-storey car park and the refurbishment of the existing buildings will be funded through the Health Board’s capital plan.

14.1.3 Phasing Of The Developments The graph below shows the phasing of the main hospitals enabling and associated works described above.

New South Glasgow OBC - 220508 114

In brief, the enabling works to clear the site designated for the new hospitals commenced in the 2nd quarter of 2007. These are part of a rolling programme with completion by the end of 2009. Work to provide the new services infrastructure to support the new buildings is planned to commence in the second half of 2009 and complete by mid 2014. The first multi-storey car park, Phase 1, is anticipated to be constructed over a 15 month period from the 4th quarter of 2008. The second multi-storey car park, Phase 2, will sit next to the Children’s Hospital and will be constructed during 2010 to 2102. The new laboratory build construction is anticipated to commence in Spring 2009 with completion the following year in Spring 2010. The New Children’s Hospital construction is planned to take place second quarter 2010 to 1st quarter 2013. The New South Glasgow Hospital is anticipated to take just over four years to complete, commencing in the 2nd quarter 2010 with completion in second quarter 2014. Finally, refurbishment of the existing estate is planned to commence at the beginning of 2014, and continue for 18 months with completion in mid 2015. All of these projects will be planned and co-ordinated through the Site Programme Co-ordinating Group, ensuring that all potential risks that may occur in delivering a multi-construction project environment are appropriately managed. Further details about this group are given in the Project Management section (Section 15). The plan below shows the position of each of the developments on the campus. The two multi-story car parks are shown in dark blue. The laboratory build is shown in green and located in the far north of the site, the other green buildings indicate the two refurbished areas providing the hot lab and microbiology. The site of the adult and children’s hospitals are shown in turquoise and yellow respectively. Finally, the existing estate which will be refurbished is shown in orange.


14.2 TRANSPORT

a) Traffic Impact Assessment

A traffic impact assessment has been undertaken in accordance with the guidance contained within Scottish Planning Policy (SPP 17) - Planning for Transport, the results of which have been submitted to Glasgow City Council. A copy of the Transport Assessment and Travel Plan is available from the Board.

In discussion with GCC, SPT, First Bus, Arriva and other transport providers and operators, the Board is planning to improve new and improved bus routes to the site. It will build upon the work undertaken in recent years to improve routage, frequency and quality of bus services. A number of activities that will improve access to healthcare have also been developed with SPT and a five year access to healthcare facilities has been developed.

b) Proposed Clyde Fast Link

Discussions are currently taking place with Glasgow City Council and SPT (Strathclyde Public Transport) to look at options to route the proposed state of the art public transport facility, the Clyde Fastlink, from the city centre, through the Southern General site. To accommodate this, the Campus plan incorporates a dedicated Fastlink route through the site with passenger bus stops at the Adult, Children's and A&E entrances.

c) Travel Plan

A Travel Plan is being developed to outline the Board's Strategy to encourage people to access the site through greener, cleaner travel choices for example, walking, public transport, cycling and car share will be promoted.

The design and layout of the site will improve the ease of access by non-car modes for example pedestrian and cycle routes throughout the site, bus stops near the main entrances, facilities for cyclists such as bike sheds, lockers and showers.

There are 2 multi storey car parks proposed one to service the Adult hospital in the East of the site and on in the west to service the children's hospital.

d) Scottish Ambulance Service (SAS)

The Board has been in liaison with SAS over the proposed changes associated with the campus.

14.3 ZONING OF THE CAMPUS AND LANDSCAPING

In developing the campus plan thought has been given to the following:

• Zoning of the site as a whole such that there is separation between the new hospital zone, the FM, labs and energy centre zone and the area around the listed buildings both in terms of the scale of the development and the activities associated with each zone.

• The links through the site and beyond e.g. traffic movement around and through the site, including the separation of public access, service access and emergency access and the establishment of clear way-finding strategy for building entrances, car parks and through traffic. Connection of the site to the surrounding urban fabric both in terms of car access and the fast link.


• The opportunities and constraints of the site, e.g. the land available for build, crucial service co-locations, the creation of a landscape strategy for the centre of the site at the public face of the new hospital and the areas to the rear of the new hospital and the administrative and Academic zone around the listed buildings.

14.4 PLANNING APPLICATION

The Outline Planning Application was submitted to Glasgow City Council on 13th April 2007. The application was considered at the Glasgow Planning Committee meeting held on 15th January 2008 and received conditional approval subject to the Section 75 legal agreements.

UNIVERSITY – FUTURE PROPOSALS

Glasgow University are intending to support the development of the Southern General campus by building an academic centre on the site. This will provide a modern academic facility to support teaching and research. An area of land on the Southern Campus has been identified by the Health Board for this purpose. A new multidisciplinary Skills and Education Centre is also proposed. Partners in this include the Royal College of Physicians and Surgeons of Glasgow, the University of Glasgow and NHS Education for Scotland. A site adjacent to the new hospitals has been identified as a possible location.

ART AND WELLBEING

A campus wide art group is being developed to provide and oversee an arts strategy for the campus and new buildings within. It is envisaged that implementation of the arts strategy will be supported through soft funding and will include the following key aspects:-

1. Core Integrated Art, Architecture and Landscaping: ambient art and design solutions to reduce anxiety and promote sense of well-being, assist way-finding, in waiting areas, rehabilitation zones, staff rest and dinning areas, car parks, bus shelters, entrances, external landscaping and reception areas.

2. Special Procurement and commissioning of furnishings

3. Provision of programmable spaces: suitable for exhibition of Creative (Visual Art and Creative writing) and Performing Arts (music, dance, drama and theatre), art and health work.

4. Provision of specific architectural elements: for physical and mental rehabilitation e.g. ramps and bridges in courtyards, musical sculptures.

14.7 REGENERATION OF THE AREA

The New South Glasgow Hospitals development promotes an opportunity to support regeneration on both the site and across the wider Govan area.

The Board’s principal role is as a core health provider but the Board is talking to other partners to ensure the proposals for the Southern site are compatible with other plans for the area.

The Health Board securing Outline Planning Approval for the new development provides other partners with confidence that a critical mass of health provision is coming to the area. The Board is aware of various bodies interested in acquiring space both on and around the site


This includes the potential to work with local housing associations and other providers to explore provision of affordable housing for key workers in the local area and the potential to develop joint working around childcare provision.

The Board also recognises that this development has the potential to contribute substantially to the local economy not only in terms of attracting investment but also through direct and indirect training and employment opportunities. Subsequently, the Board is pro-actively engaged with partners to ensure the development maximises employment and training opportunities.

In addition to the substantial economic benefits to Shieldhall, South West Glasgow and the City, the opportunity also exists to create a new urban centre with its own distinct identity that not only fits within the local context and contributes positively to the immediate physical environment but also takes its place in the sequence of regenerated areas coming west along the river (i.e. Govan Town Centre, Pacific Quay, Science Centre etc) and contributes positively to the emerging townscape along the waterfront.

Further detail regarding the potential of the New South Glasgow Hospitals to contribute to regeneration of the area is given in Chapter 19.



15. PROJECT MANAGEMENT

15.1 INTRODUCTION The Board has formally established robust project management structures to ensure that Stage 1 of the project, submission of the Outline Business Case, is delivered within projected timescales, cost and is of high quality. In planning for the second stage of the project the Health Board undertook a review in August 2007 with input from Partnerships UK. This was to determine additions to the project team structure and governance in recognition of the workload likely to be involved from OBC authorisation to submission of Full Business Case.

The Project Management Structure and governance arrangements for Stage 1 and proposals for Stage 2 are described below. 15.2 PROJECT MANAGEMENT & GOVERNANCE ARRANGEMENTS FOR STAGE 1 The following diagram shows the key roles and input in delivering the project, these are described over page. Diagram 2 illustrates the structure of the project groups and control mechanisms.

15.3 PROJECT STRUCTURE – PROJECT MANAGEMENT ARRANGEMENTS – STAGE ONE

Helen Byrne Director of Acute Services Strategy

Implementation & Planning Project Sponsor

Alan Seabourne Director of New South Glasgow Scottish Government Private

Finance & Capital Unit Mike Baxter

Norman Kinnear

New South Glasgow Hospital New Children’s Hospital Heather Griffin Mairi Macleod

Working Groups – Both Projects Scope and direction of each function for OBC

- Capital Planning - FM - IT - Finance - Workforce Planning - Administration - Non-Clinical Support - Equipment

- Partnership Working - Speciality Users

Communications & Community

Engagement

Project Administrator and Secretarial Team

Professional Advisers Technical Legal Planning Financial Transport Environment Landscape

Glasgow and Caledonian Universities

ADS & Enabler

Arts & Well being

Clinical Advisory Boards

Clinical Sub Groups

Robert Calderwood Chief Operating Officer

Diagram 1

Diagrammatic representation of Project Structure


Project Roles

Within the Management structure outlined above, there are a number of key designated roles. Each of the key roles is defined below identifying responsibilities and reporting mechanisms.

Project Sponsor

The Project Sponsor chairs the Project Executive Group and reports to the Chief Executive of the Board and the ASR Programme Board. (NB the ASR Programme Board is described in more detail later in this section).

The sponsor’s role is to:

• Appoint a Project Director to manage the project • Ensure adequate resources are made available to the project • Facilitate and resolve difficult issues • Provide overall internal and external leadership for the project

Project Director The Project Director reports to the Project Sponsor. The role of the Project Director is to:

• Oversee the component parts of the scheme, these being the new Children’s and Adult’s hospitals and the new laboratory build

• Oversee the development of the Southern Campus (involving for example development of the University facilities, mental health, crèche, road infrastructure etc)

• Manage stakeholders interests in the project, providing clearness and direction on their behalf, embracing direction from the Project Executive Group (Project Board)

• Appoint consultants and contractors to undertake work within the project budget, and as a direct link to the Board Executive Group, Project Board and all external organisations

• Lead the evaluation of bids and the external negotiating teams up to financial close • Regularly inform the Project Sponsor and Project Board of the project status and liaise with

other external bodice’s such as the Scottish Government

Project Managers

The Project Managers report to the Project Director. The scheme has two Project Managers, one to oversee the new Adult hospital and the other to oversee the Children’s development. Both work together as a team with shared responsibility for the overall campus and elements within it e.g. pharmacy, university, transport, office accommodation etc.

In more detail the Project Managers role encompasses:-

• Preparation of the Project Initiation Document • Identification of resources required for the Project (skills and cost) • Recruitment and management of the Project Team • Management and Leadership of the various clinical sub groups in the development of

design brief, Schedules of Accommodation, 1:200’s designs and development of the clinical output specification

• Development of the Outline and Full Business Case • Monitoring progress against the project plan and budget for the scheme • Oversee project monitoring procedures and documentation • Report progress to Project Director • Ensure stakeholder and partnership involvement



Clinical Advisory Boards (CAB)

A Clinical Advisory Board has been established for both the Adult and Children’s hospitals. The CAB provides clinical advice and guidance with regards to clinical issues (such as design brief, aspects models of care).

The following diagram shows the structure of the Project Groups and control systems in place for Stage 1 of the project.

Diagram 2 PROJECT GROUPS IN PLACE FOR STAGE ONE

Project Executive Group Chaired by Director of Acute Strategic Services Implementation & Planning (Monthly) (includes Partnership representatives)

Acute Services Review Programme Board Chaired by Board’s Chief Executive

(Meets every 3 months) (includes Scottish Government representative and Partnership Representative)

Responsible for overseeing delivery of ASR II

Responsible for managing all aspects of work to achieve OBC, FBC and financial close, construction and completion. Direct review and report on Project Plan progress

Progress work to bring Children’s OBC into line with Adult timeframe

Professional Advisers/support to carry out all work to achieve all elements of project plans

Carry out work to achieve project plan

Responsible for overseeing the delivery of ASR

Project Team Meeting Chaired by Project Director - NSGH’s

(Weekly)

New Children’s Hospital Steering Group (Monthly)

SE Meetings Chaired jointly (Monthly)

Technical Team Meetings

(Fortnightly)

Working Groups

(As agreed)

Project Director, Project Managers discuss progress and challenges and seek advice from SE


Project Executive Group

The Project Executive Group meets monthly and is chaired by the Project Sponsor. Membership of the group includes the Chief Operating Officer, Project Director, Directors of Nursing, Medicine, HR, Acute Director reps and staff side representation. The role of the Project Executive Group is to:-

• Take responsibility for decision making, strategic vision and leadership • Approve the project construction document and project plans • Monitor and approve any changes to the programme • To determine the most appropriate procurement strategy and co-ordinate the

procurement processes to maximise benefits and minimise all associated risks

• Ensure the scheme delivers expected clinical benefits, is robust and offers good public value for money, meets the risk transfer and accounting criteria

• To ensure the necessary senior managers, clinicians and staff maintain regular and on-gong involvement in the project ensuring the necessary ownership at the most senior levels in the organisations

• To ensure integration with other elements of ASR planning and other service plans and developments including national and regional planning

ASR Programme Board

The ASR Programme Board (ASRPB) is responsible for overseeing the delivery of the Acute Services Review. This includes the planning and implementation of the individual elements identified as necessary to achieve the strategic change and also the quantification of outcomes to ensure they are in line with the agreed aims and objectives of the Acute Services Strategy.

NHS HEALTH BOARD In its role of delivering the overall healthcare strategy for Glasgow, the Health Board will retain the overall decision – making authority. It’s role will include:-

• Approval of the Outline Business Case • Approval of appointment of bidders • Confirmation of the preferred bidder • Approval of the Full Business Case (FBC) • Award of contract

15.4 GOVERNANCE STRUCTURE – STAGE TWO, POST OBC TO SUBMISSION OF FULL BUSINESS CASE (FBC)

With the finalisation of the Outline Business Case the project is now coming to the end of Stage 1; the project team have developed proposals for the project management structure to facilitate the next stage, from Outline Business Case authorisation to Full Business Case through the appropriate procurement process.



A review of the breadth of skills and tasks required to complete this stage of the project has highlighted 3 key areas, these being, organisational change and procurement and financial. It is proposed that the generic Project Executive Group be replaced with 2 specialist project groups reflecting the key areas. The 2 groups will feed into a new group, the New South Glasgow Hospitals’ Executive Board which in turn will report to the ASR Programme Board. An outline of their remit is given below.

15.4.1 The ASR Programme Board The ASR Programme Board will oversee the project work and progress against the stated outputs and timescale. As described this is an existing group chaired by the Board’s Chief Executive. Given that the project is moving forward to stage 2 the terms of reference and membership have been reviewed, these are given in Appendix 19 and 20.

15.4.2 New South Glasgow Hospitals’ Executive Board The New South Glasgow Hospitals’ Executive Board will have delegated authority to make executive decisions on critical points in the project process. The role of the Board will be to oversee the overall process of the project and to co-ordinate the work streams of the two groups. The Board will meet bi-monthly or more frequently depending upon the stage of the project and will report into the ASR Programme Board.

15.4.3 ASR Systems Redesign Group The development of the New South Glasgow Hospitals will result in a number of radical changes not just in reconfiguring clinical services across Glasgow but also in working practices and the way in which patients receive their treatment. A comprehensive and co-ordinated process will be developed to take forward the re-design aspects and work hand in glove with staff, human resources and workforce planning to ensure both staff involvement and that the right number of staff and skills are available to support the new ways of working. 15.4.4 Procurement and Finance Group

There will be a requirement for specialist skills in relation to taking the procurement process forward with regard to the funding, affordability and value for money aspects. A high level of risk management and scrutiny will be needed to assure the Health Board of appropriate delivery.

15.4.5 Site Programme Co-ordination Group There is a very substantial construction programme planned over the next 6 years at the Southern General Hospital. The site will continue to operate during the full construction programme and therefore there is a requirement to establish a group to monitor, co-ordinate and control all on-site works.

15.4.6 Structure, Remit and Membership Please see Diagram 1 below, which illustrates the project management structure and remit. The remit of each group is given in more detail in Appendix 19.

Membership of the groups will reflect both skills in the specialist area and also previous experience in delivering large capital builds. Membership will also reflect a high level of Board scrutiny in all aspects of delivering this project. Detail of the membership of the main groups is given in Appendix 20.


ASR Systems Redesign Group

ASR Programme Board

New South Glasgow

Hospitals Executive Board

Governance Structures – Stage 2

Project Team

Site Programme Co-ordinating Group

Procurement & Finance

Group

Adult Hospital

SGH & ACH Directors Group

Children’s Hospital

Clinical Planning Group

Patient/ Carer User

Group

Community Engagement

Public

Acute Partnership

Forum

16. LEGAL AND ACCOUNTING ISSUES & ROLE OF EXTERNAL ADVISORS

16.1 LEGAL AND ACCOUNTING ISSUES Legal and financial advisers will provide the Board with guidance on the most appropriate form of contract to meet the Board’s procurement strategy. The legal advisers will provide key input into the procurement documentation including the development of the OJEU advert and tender documentation. 16.2 ROLE OF EXTERNAL ADVISORS Various advisors will be required to provide an advisory role to the project. These are most likely to be in the following capacities:-

• Service Specification: To provide healthcare planning advice and manage a process to define service models, departmental and operational policies and to draft output specifications for clinical and non-clinical support specifications.

• Finance and Management Consultancy: To provide specialist corporate finance

support to the procurement process together with management consultancy input to secure OBC and FBC approval.

• Design and Technical: The technical team will develop and provide accommodation

and building specification for the tender package and help to evaluate the full tender responses.

• Legal: To provide legal support/advice and to deliver contract documentation in line

with latest guidance.


17 STAKEHOLDER INVOLVEMENT

17.1 PARTNERSHIP INVOLVEMENT

Throughout the planning process of the new hospitals there has been a high degree of involvement with staff side through their staff partnership representatives. The staff partnership are represented on all planning groups including Acute Services Review Project Board (ASRPB), Project Executive Group (PEG), New Children’s Project Group and a range of working groups. The staff are also kept fully briefed through regular meetings with the Southern General Project Team and they have been involved in many of the appraisal and assessment processes. NHS Greater Glasgow & Clyde Employee Director has also been involved in key debates and discussions through the Board’s committee structure. Presentations on the progress of the new development at the Southern General Hospital have been made to many fora including the Health Board Partnership Forum. The new governance structure being proposed for the delivery stage of the project culminating in the completion of the Full Business Case (FBC) will have staff partnership members throughout the structure and involved in all discussions and decision making.

17.2 COMMUNITY ENGAGEMENT

OVERVIEW Following Scottish Government approval of NHS Greater Glasgow and Clyde’s Acute Services Strategy in 2002 a Community Engagement Team was established to inform and involve patients and the public in the Acute Services Strategy. The role of the team is to:

• manage public and patient stakeholder involvement in service change and re-design

• ensure patient and public views are central to planning and design structures • ensure compliance with statutory responsibilities for public and patient participation • build and maintain relationships with stakeholders • support the diversity agenda

COMMUNITY ENGAGEMENT STRATEGY NHS Greater Glasgow and Clyde’s Community Engagement team have put in place a strategy that focuses on three distinct engagement strands. These are:

• the New South Glasgow Adult Acute Hospital • the New Children’s Hospital; and • the New Hospitals Campus

Two dedicated Community Engagement Managers have been allocated to manage these projects. One is responsible for the New Hospitals Campus and New South Glasgow Adult Acute Hospital while another is the named lead for the New Children’s Hospital.


The process has also helped establish the foundations for long term and meaningful engagement structures to ensure the continued engagement of stakeholders and communities throughout the development, build and commissioning phases of the projects.

In brief the following lists the work undertaken under each of these key strands. This is described in further detail in appendices 21, 22 and 23.

NEW SOUTH GLASGOW HOSPITAL

• Initial scoping exercise with patients and carers to determine their views on the design of the new Adult Hospital. This exercise involved over 242 individuals and consisted of 6 focus groups, questionnaires and an audit of complaints.

• A series of presentations and inputs into local community organisations including Govan Community Council, Govan Craigton Housing Forum, Greater Govan Social Inclusion Partnership, South Glasgow Business Club.

• Establishment of a Community Engagement Advisory Group for the New South Glasgow Hospital.

• Establishment of a Renal Services Engagement Group to support the redesign of renal services in the new Adult Hospital.

• Participation in local community events including the annual Govan Fair and Govan Gathering.

NEW CHILDREN’S HOSPITAL

• Extensive programme of consultation with families, support groups, charities and voluntary organisations - over 150 groups and individuals involved.

• Development of a Community Engagement Advisory Panel with representatives from clinical and nursing staff; the Project Team; Community Health & Social Care Partnerships; family support services; families and young patients to guide the community engagement strategy and to integrate this within the existing PFPI and redesign structures within the Royal Hospital for Sick Children.

• Establishment of a Youth Panel to ensure the needs of young people are included in the design of the New Hospital and a Family Panel to facilitate the influence of families, parents and carers. Training and support is provided to facilitate the work of these Panels.

• Scoping work on the Outline Business Case involved 315 children, young people and families in focus groups, surveys and a photography project. A series of meetings with the Planning and Design teams provided feedback to families, children and young people on how their contribution had influenced the OBC.

• Regular newsletters and a website provide information, communication access to the planning process for a wide range of stakeholders.

• Joint work with children and young people’s groups in Govan has begun to build relationships between the Children’s Hospital communities and the local community in Govan.

• A network of regional and national perspectives on the new Children’s Hospital has been developed and partnerships established with the new Children’s Hospital projects in Edinburgh, Queensland and Toronto.


FUTURE ENGAGEMENT

The dedicated Community Engagement Managers will continue to lead on a programme of activity with patients, carers and community groups to ensure that their views inform the design, construction and processes associated with the building and services of the new hospitals.

The Community Engagement Team will continue to build and maintain relationships with partners in the city to develop strategic partnerships on key projects that provide additionality to the New Hospitals Campus and support partners wider regeneration objectives. This will include developing strong relationships with Scottish Enterprise Glasgow and the Local Economic Development Companies in developing the economic potential of the Campus and working closely with Land Services and Strathclyde Partnership for Transport to support joint planning around transport.

They will take responsibility for the management of the established community engagement structures ensuing their on-going maintenance and relevance to the planning process.

They will also be responsible for ensuring that the on-going community engagement processes meet Scottish Government guidance and legislation on Patient Focus and Public Involvement and Planning Guidance on Community Engagement, best practice on Community Engagement and, with the support of the Board’s Corporate Inequalities Team, championing the diversity agenda. In line with “Better Health, Better Care” we will use the engagement process to strengthen public involvement in the NHS Services in Glasgow by improving participation in the development of both hospitals and services. This will further strengthen the collaborative and integrated approach to service improvement, building on the work currently being set up in relation to the Ambulatory Care Hospitals.

Hospitals consume over half the total NHS budget and treat 25% of the population every year, in addition they are major employers and businesses within the local economy. The opportunity to maximise health improvement through health promotion, disease prevention and protection is a key aspiration of the new development. The team will continue to pro-actively meet members of the public who otherwise might not express an interest in the new hospitals via an on-going programme of outreach in public spaces i.e. supermarkets, libraries, community facilities and transport interchanges. 17.3 COMMUNICATIONS Effective communications will be vital throughout the major redevelopment of the Southern General campus. 17.3.1 Aims and Objectives The communications plan will aim to:

• Raise awareness of the plans for the new hospital and the wider redevelopment of the Southern General Campus;

• Build and maintain enthusiasm for the project amongst the local community; • Ensure staff, patients, the general public and other key stakeholders are kept

updated as plans progress – including key milestones and decisions;


• Highlight benefits for patients, staff and the local community – including new or improved facilities and services, economic impact and contribution to the wider regeneration of the Govan area.

The main methods which are, and will be used to keep stakeholders involved are:- 17.3.2 Internal Communications NHSGGC Core Brief – an electronic bulletin, which is used to brief staff across the organisation on key developments, decisions and achievements. NHSGGC Staff News - the bi-monthly NHSGGC staff magazine, which is circulated to 40,000 staff across the organisation and available online via the intranet. This has already carried several features on plans for the new Southern General Campus. NHSGGC Intranet - work is underway to create a single NHSGGC intranet that will reflect the new organisational structure and provide a key tool for communicating with staff. Each of the new acute directorates and partnerships will have the ability to populate their own local pages with details of latest news and events, key documents and reports and updates on key projects including the redevelopment of the Southern General Campus. Staff Briefings – in recognition that there is no substitute for face-to-face briefings, all the above will be underpinned and supported by a regular programme of staff briefings and open drop-in sessions to update staff on the development of the new South Glasgow and Children’s Hospitals. 17.3.3 External Communications NHSGGC Website receives around 10,000 hits a month and is currently being redesigned to create a more attractive and user-friendly site. A new section has been created for the Southern General Campus with links to the latest news and information on the two new hospitals and the refurbishment of the maternity unit. Health News – the bi-monthly NHSGGC newspaper that is circulated as an insert in the Daily Record and widely distributed across Greater Glasgow and Clyde, is a key vehicle for updating patients, the general public and other key stakeholders on the latest health news. It has already carried a series of articles on the hospital modernisation programme and will be used to provide regular updates on the redevelopment of the Southern General Campus as plans progress. Media Relations – the communications directorate will work with project leads to identify promotional opportunities to maximise media coverage on the redevelopment of the Southern General Campus. To-date there have been major features in the Govan Press, the Evening Times and key business publications. This proactive work will inform the development of an action plan of activities to promote the new hospitals on an ongoing basis. Communications will also explore opportunities to develop campaigns and joint initiatives with key media partners. Stakeholder Briefings – regular one-to-one briefings with key stakeholders such as local MSPs, business leaders and university colleagues will also be arranged to ensure they are kept updated on the development of the Campus.


18 IMPROVING HEALTH & HEALTH INEQUALITIES

NHS Greater Glasgow and Clyde is committed to promoting health improvement and reducing health inequalities. In planning the new builds, opportunities will be sought to promote health and reduce inequality through the delivery of key actions identified within the Design Action Plan 2007 and the Health Promoting Health Service ASR Action plan 2008. For example, the potential exists to:

• Incorporate a ‘shop front’ for the voluntary sector, encouraging patients to utilise the range of specialist support and counselling services in cases of disease diagnosis and bereavement.

• Improve the internal and external environment through an arts strategy. • Create a hub for health promotion services supporting both staff and patients to

address health behaviours in relation to smoking, physical activity, alcohol and weight management.

• Define areas of retail space through policy to ensure support for health living through initiatives such as a Fruit Shop, healthy vending options and considering the opportunities presented by community enterprise.

• Maximise the use of facilities where possible for staff and community use through community lets and out of hours access to rehabilitation gyms, staff training facilities etc.

• Promote accessible green space within the hospital design for use by patients and staff including well lit and clearly marked walk ways across the campus

• Develop within the contractual process social economy policies to promote local regeneration through employment and procurement.

• Promote accessibility across the campus through sufficient disabled designated parking spaces and drop-off points closely located to key departments/buildings, ensure provision for on-site transport to help less able patients move across the campus.

• Undertake to develop a broad range of accessible facilities within the building to address the range of patient needs particularly in relation to toilet and bathroom facilities.

• Maximise accessibility through design and input from those living with disabilities. • Minimise the impact of construction on the environment through consideration of

sustainable technologies, waste recycling, renewable materials and renewable energy sources.

• Undertake Equality Impact Assessments through the different stages of the development.

Benefits There are benefits for NHSGGC in developing the Health Improvement Agenda as described above include:

• Staff benefits from improved access to services and opportunities. • Civic and social benefits for the local community associated with the role of

NHSGGC as a purchaser and employer within the community as well as the role of a community planning partner in social regeneration.


• Evidence based employer benefits in relation to increased employee commitment, staff performance and productivity and reduced staff absenteeism and turnover.

• NHS service delivery benefits as a wider support is provided for patients to avoid, manage or cope with medical conditions and their implications.


19 WIDER SOCIAL ECONOMIC BENEFITS

NHS Greater Glasgow and Clyde secured funding from the following partners to commission SQW consultants to identify potential socio-economic benefits and inform future joint working around the proposed redevelopment of the Southern General site.

Communities Scotland Scottish Enterprise Glasgow Linthouse Housing Association Glasgow Centre for Population Health Glasgow South West Regeneration Agency South West Community Health and Care Partnership Glasgow City Council – Development and Regeneration Services Community Planning

In identifying the potential impacts and anticipated benefits, the analysis focussed on three geographically defined levels, namely:

the immediate local area of South West Glasgow the City of Glasgow The Glasgow Metropolitan City Region.

The analysis sought to identify potential benefits at each of the geographic levels in the following areas:

economic human and social knowledge place

Economic Benefits SQW have estimated that the future service configurations on the Southern General site will have a combined direct, indirect and induced economic impact of between £30 and £40 million on the South West Glasgow economy; between £110 and £140 million on City economy and between £240 and £290 million on Glasgow city region by 2012/13. The capital projects commissioned to build the new hospitals site will support between 1,300 and 1,700 construction jobs per year for the six years between 2008/09 and 2013/14. Capital projects will support between 260 and 340 jobs per year in South West Glasgow and between 650 and 850 jobs per year in the rest of the City. Human and Social Capital The New South Glasgow Hospitals development has the potential to impact significantly on the local housing market. Housing providers need to consider future provision and incentives for NHS workers to relocate to South West Glasgow and retain future wage expenditure in the local economy. Opportunities for training and employment are significant; partners may wish to tailor existing and new training/ employment schemes to meet future labour demands created by the NSGH development.


There exist a number of opportunities that should be explored further with local partners to identify potential joint developments and/ or shared use of local community facilities. For example the potential to work collaboratively with local childcare providers to develop nursery/ childcare provision accessible to NHS staff. Knowledge The significance of the New Hospitals Campus as a catalyst to support collaboration between academic, public and private sector partners to realise opportunities in research and development, bio-medical and life sciences has yet to be fully articulated, although they are potentially significant at all three levels. Acknowledging the importance of working at City Region, SQW argue the merits of implementing a focused set of initiatives to fully exploit the benefits from the new co-location of professionals at the NSGH site. They propose that a site specific commercialisation plan is implemented, albeit nested with a wider City Region strategy. The Southern General development is seen as a catalyst for wider social and regeneration activity contributing to the creation of higher aspirations for the physical development of the local area. A comprehensive master planning exercise encompassing the Southern General site and the wider area is required. The masterplan should encompass potential development opportunities (including public/ private investment) future land use and public realm works to facilitate investment, connectivity with existing regeneration programmes, linkages and integration to the to the green network and transport infrastructure. To support this, a comprehensive communication and marketing strategy is required. This should aim to raise awareness of the development and opportunities with partners and communities. Partnership Working The analysis identifies a number of potential benefits linked to the development of the Southern General site. However, the analysis is also clear that NHS Greater Glasgow and Clyde is not in a position to deliver many of the benefits identified. The potential impact of the new South Glasgow Hospitals Campus will only be realised through effective collaboration between partner organisations. Significant progress has been made in building effective partnerships, for example, with Scottish Enterprise Glasgow in exploiting the economic potential and Glasgow City Council and SPT in identifying opportunities for improving transport and accessibility. The analysis reinforces the need to maintain this momentum. Therefore, in consolidating existing working relationships and developing synergies with partners planning processes and investment programmes, NHS Greater Glasgow and Clyde will establish a New Hospitals Engagement Forum. This Forum’s remit will be to provide strategic leadership, act as a mechanism to inform and co-ordinate partner planning mechanisms, strategies and investment to bring added value to the new hospital projects. The Community Engagement Manager leading on the campus will service the work of this Forum and is also the Project Team’s representative on, or link with, South West Glasgow and Glasgow City working parties and organisations.


20. GATEWAY REVIEW

20.1 BACKGROUND

The New South Glasgow Hospitals project is subject to Office of Government and Commerce (OGC) Gateway Review. Projects which are commissioned critical or deemed to be high risk projects are required to go through the six stages of the OGC Gateway Review Process. The review is an independent assessment of the robustness of the business case, that it meets business needs, is affordable, achievable with appropriate options explored and likely to achieve value for money. In doing this, the review outcome highlights whether aspects of the project are red, amber or green (traffic light system). • Red means that the project cannot proceed to the next milestone until the issues

identified as identifies red are addressed. • Amber means that the recommendations identified must be completed before the next

Gateway Review stage. • Green means that the programme or project is in good shape but may benefit from

uptake of any green recommendations to enhance the project. The Southern General development has completed the Gateway Review Stage 1 which was carried out from 8th to 10th of January 2008. The review was carried out by a review team consisting of 2 Office of Government and Commerce Consultants, and two senior technical NHS Scotland managers. During the three days of the review interviews were undertaken with 18 members of staff including clinicians, senior managers, project team, staff side representatives and finance colleagues. This is the first time the Office of Government and Commerce Gateway Review has been used to assess a Scottish National Health Project although it has been used in non-health infrastructure projects.

20.2 OUTCOME OF THE GATEWAY REVIEW

In their report, the Office of Governance and Commerce Gateway Review Team identify a number of positive aspects about the project and these are listed below. The review confirms that: 1. The business case is

– robust, – likely to be affordable, – achievable, – with the appropriate options explored, – and likely to achieve value for money.

2. The Project team is well established and has demonstrated an ability to draw on

– internal skills and experience, – other projects throughout the UK.


3. There is considerable internal experience of major project delivery. 4. The Gateway reviewers were impressed by the consistent positive messages on the

level of clinical engagement and commitment to new ways of working. 5. Project has maintained close communications with the Scottish Government at all

levels. 6. There has been an open and inclusive approach to staff-side communication. 7. The project benefits from significant community engagement through the Community

Engagement team. 8. There was an acknowledgment that Community Health and Care Partnerships are

engaged. 9. There was recognition of the considerable effort expended in engaging with and

developing support from the clinicians affected by the project.

Recommendations The outcome of the Gateway Review was that there were no red recommendations, hence the project may proceed to the Board and the Scottish Capital Investment Group with the Outline Business Case. There were a number of amber recommendations which were identified as follows:- Amber Recommendations:

• The project team should ensure that the consequences of delays to decisions are made clear in all communications with the Scottish Government.

• The project team should take appropriate time to consider the full implications of a decision to adopt a traditional (design and build) procurement route.

• The project team should ensure the communications with staff-side representatives are fully understood.

• The project should produce a consolidated risk management register with regular review and reporting.

• The project team should review their draft plans for the project governance and management of the next phase.

Green Recommendations - there was one recommendation here which will be fully adopted by the project team. The five amber recommendations and one green recommendation will be addressed before the Gateway 2 review. Immediate plans include:

• A workshop organised for mid February 2008 attended by the Boards legal and financial advisers supported by a number of technical advisers to determine the optimum conventional procurement model

• More detailed information and communication with staff side representations including continuing with internal meetings between the project managers and staff side, input into the Project Groups and involvement in how information should be more widely communicated to staff.


• Development of a fully consolidated risk register. This will amalgamate the current risk register held by the Project Team, the project risk management strategy (as detailed in Appendix 13) and the technical risk register developed by the technical advisers which focuses specifically on building risks.

• The governance structures for the next phase of the project are being developed with draft proposals reflected in this document which will be subject to revision in line with the preferred Design and Build procurement model which will be identified through an option appraisal at the mid February workshop.



21. BENEFITS REALISATION PLAN

The following table summarises how the anticipated benefits of the project, which are detailed in Chapters 4 and 5, will be measured:

Benefit

Lead Responsibility

Measures Timescales

STRATEGIC FIT - CONSOLIDATION OF

SERVICES

Helen Byrne, Director of Acute Services Strategy Implementation and Planning Dr Brian Cowan, Medical Director

• Acute Adult Inpatient services consolidated onto 3 sites

• Improved co-location of services to support unscheduled care including A&E, Theatres, Critical Care and Imaging

• Evidence of specialisation and sub- specialisation models supported 24/7 with specialist cover

• Achieve new directives e.g. Modernising Medical Careers.

• Reduce the number of medical rotas.

• Maximises use of dedicated facilities (such as trauma theatres and CEPOD theatres) to deliver targets

• Focuses specialist/ experienced staff in fewer sites supporting delivery of most effective care

3 months post operation 1 year post operational and annual review 1 year post operational and annual review 1 year post operational 6 months post operational Monitored at quarterly intervals to review performance

CLINICAL QUALITY/ CLINICAL SERVICES

Dr. Brian Cowan, Medical Director Eunice Muir, Acting Nursing Director, Acute Division Rory Farelly, Head of Nursing – Women and Children’s Directorate

• Improved occupancy reducing the clinical risks / delays in patient care due to boarding patients out with specialty

• Improved HAI rates due to single room facilities and improved space between patients

• Appropriate levels of specialist staff to provide and sustain clinical services with 24/7 access to specialist services

• Specialist teams working together supporting redesigned services to allow new techniques to be used and developed

• New service models supporting the reduction in unnecessary admissions

• Patient Safety Initiative input to designing safety issues out of new facilities and

Monitored under commissioning programme and as part of Boards ongoing performance review process.


models of service

• Improved utilisation of facilities as purpose built with improved co-locations

• Full Benefits Realisation plan to be developed as part of Clinical Transition to identify specific key performance indicators.

• PERFORMANCE

IMPROVEMENT IN PATIENT SERVICES

Dr. Brian Cowan, Medical Director Eunice Muir, Acting Nursing Director, Acute Division Rory Farelly, Head of Nursing – Women and Children’s Directorate

• Facilities that support improved ways of working, creating more effective patient pathways to provide timely and fit for purpose unscheduled care

• Improved capacity created and waiting time guarantees met within GGC facilities

• Waiting time guarantees for inpatient treatment.

• Achieve balance between Unscheduled and planned care pathways to safeguard targets being met

• Appropriate bed numbers by specialty that support improved occupancy eliminating the requirements to board patients out with the specialty caring for patient

• Number of one stop clinics increased. • Reduction in follow-up appointments. • Reduction in the number of cancellation of

procedures. • Patient and staff feedback. • Throughput of new patients increased.

One year after fully operational; Annual reviews Ongoing monitoring of targets through management information

QUALITY ENVIRONMENT

(meeting patient, visitors and staff needs and

meeting building guidelines)

Tony Curran, Head of Capital Planning & Procurement Eunice Muir, Acting Nurse Director – Acute Division Rory Farelly, Head of Nursing – Women and Children’s Directorate

• Board Construction Requirements met • Art in Hospital Working Group Objectives

met. • Patient and staff feedback. • Health and Safety Record of

accidents/incidents related to uneven surfaces etc.

• Co-located services ensuring smoother patient pathways

Six months after opening; Annual review processes



ENVIRONMENTAL CONSIDERATIONS

Tony Curran, Head of Capital Planning & Procurement Eunice Muir, Acting Nursing Director, Acute Division Rory Farelly, Head of Nursing – Women and Children’s Directorate Alex McIntyre, Director of Facilities

• Board Construction Requirements met • Condition of building surveys. • Art in Hospital Working Group Objectives. • Patient and staff feedback. • FM services monitoring. • Targets for energy consumption met. • Targets for carbon emissions met. • Reduced Health Acquired Infections

One year from operational. Annual reviews.

INFORMATION MANAGEMENT &

TECHNOLOGY

Richard Copland, Director of IM&T

• ICT Strategy Plan implemented. • Improved access to patient information

electronically supporting increased continuity of patient care

• New systems supporting paper light services

3 months post completion review as part of Board’s ongoing performance review monitoring.

STAFF FACILITIES & STAFF MOTIVATION

Anne McPherson, Director of Human Resources

• Staff feedback. • Recruitment and retention analysis, lower

staff turnover.

One year from operational plus annual performance reviews.

ACCESSIBILITY TO HOSPITAL AND

COMPLIANCE WITH TRAVEL PLAN (i.e. decreased journey

times to site, less sole car occupancy,

improved cycling walking routes with

greater uptake of these)

Tony Curran, Head of Capital Planning & Procurement Eunice Muir, Acting Nursing Director, Acute Division Rory Farelly, Head of Nursing – Women and Children’s Directorate Alex McIntyre, Director of Facilities

• Board Construction Requirements met. • Patient and staff feedback. • FM services monitoring of maintenance

regime. • Complaints monitoring. • Travel plan monitoring, assessing mode of

travel, time taken, experience • Accessibility study – decreased journey

times, higher quality travel experience

6 months post completion review as part of Board’s ongoing performance review monitoring.

ENHANCED LINKS WITH UNIVERSITY

Dr. Brian Cowan, Medical Director

• University academic centre co-located with acute services on the southern General campus

• Student feedback • Recruitment and retention analysis, lower

staff turnover • Consolidated services better supporting the

training of junior staff

1 year after fully operational

22. POST PROJECT EVALUATION

A post project evaluation (PPE) will be prepared. The appraisal will be complete within 6 months of project completion and before the break up of the design team. The focus of PPE will be the evaluation of the procurement process and the lessons to be learned made available to others. The report will review the success of the project against its original objectives, its performance in terms of time, cost and quality outcomes and whether it has delivered value for money. It will also provide information on key performance indicators. The PPE review for this project will include the following elements:

22.1 PROJECT AUDIT

The project audit will include those elements shown below. • Brief description of the project objectives • Summary of any amendments to the original project requirements and reasons • Brief comment on the project form of contract and other contractual / agreement provisions.

Were they appropriate? • Organisation structure, its effectiveness and adequacy of expertise/skills available • Master schedule – project milestones and key activities highlighting planned v actual and

where they met? • Unusual developments and difficulties encountered and their solutions.

Brief summary of any strengths, weaknesses and lessons learned, with an overview of how effectively the project was executed with respect to the designated requirements of:

• Cost • Planning and scheduling • Technical competency • Quality • Functional suitability • Safety, health and environmental aspects - eg energy performance • Functional suitability • Was the project brief fulfilled and does the facility meet the service needs? What needs

tweaking and how could further improvements be made on a value for money basis? • Added value areas, including identification of those not previously accepted • Compliance with NHS requirements • Indication of any improvements, which could be made in future projects.

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22.2 COST AND TIME STUDY

The cost and time study will involve a review of the following:

• Effectiveness of: o cost and budgetary controls, any reasons for deviation from the business case time

and cost estimates o claims procedures

• Authorised and final cost • Planned against actual cost and analysis of original and final budget. • Impact of claims • Maintenance of necessary records to enable the financial close of the project. • Identification of time extensions and cost differentials resulting from amendments to

original requirements and/or other factors. • Brief analysis of original and final schedules, including stipulated and actual completion

date; reasons for any variations.

22.3 PERFORMANCE STUDY

The performance study will review the following:

• Planning and scheduling activities. • Were procedures correct and controls effective? • Were there sufficient resources to carry out work in an effective manner? • Activities performed in a satisfactory manner and those deemed to have been

unsatisfactory. • Performance rating (confidential) of the consultants and contractors, for future use.

22.4 PROJECT FEEDBACK

Project feedback reflects the lessons learnt at various stages of the project. Project feedback is, and will be, obtained from all participants in the project team at various stages or at the end of key decision-making stages.

The feedback includes:

• Brief description of the project • Outline of the project team • Form of contract and value • Feedback on contract (suitability, administration, incentives etc) • Technical design • Construction methodology • Comments on the technical solution chosen • Any technical lessons learnt • Comments on consultants appointments • Comments on project schedule • Comments on cost control • Change management system • Major source(s) of changes/variations • Overall risk management performance • Overall financial performance • Communication issues • Organisational issues • Comments on client’s role/decision-making process

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• Comments on overall project management • Any other comments

It is the intention that the project feedback not only identifies what went wrong and why, but also highlights what has been accomplished and if (and how) that can be improved in future projects.

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23. TIMETABLE

A detailed project plan is shown in Appendix 24 and is summarised in the table shown below. Please note that these timescales are indicative and will be reviewed following the Procurement Workshop to be held on 19th February 2008. As described the outcome of the workshop will be to determine the preferred conventional procurement model. The contract form will dictate the timescales for following tasks and timetable. However it is anticipated that, following market sounding and preparation of more robust design and project requirements (brief and specification), a competitive process will follow involving at least three contracting teams over a 9-12 month process, culminating in the selection of a preferred partner completion of Full Business Case by mid 2010. The detail of the process will be expanded on completion of the workshop and confirmation of the preferred route. The outcome of the workshop will be submitted to the Health Board and Scottish Government for approval and will be independently assessed though the OGC Gateway Review process to provide assurance to the Board and the Scottish Government that the method shown has been scrutinised and confirmed.

Table 17: The indicative timescale is as follows:

Description Target Date

Outline Planning Approval January 2008

Gateway Review January 2008

19th February 2008 Final OBC to NHS Greater Glasgow & Clyde Board

26th February 2008 Final OBC considered at Scottish Government Capital Investment Group

Submit OBC to Cabinet March 2008

Final OBC Approval April 2008

2nd quarter 2010 Full Business Case Submission

2nd quarter 2010 Construction Starts

1st quarter 2013 Completion – Children’s Hospital

2nd quarter 2014 Completion – Acute Hospital

Prior to placing an OJEU advert a number of tasks will be undertaken in order to optimise the marketability of the scheme. These are as follows:

• A market sounding exercise will be undertaken. • Matching of clinical and non-clinical output based specifications to design • Development of a Memorandum of Information (MOI) to act as a project summary and brief

for potential bidders • Formal presentations to potential bidders

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24. CONCLUSION

This Outline Business Case presents the proposals for a new integrated Adult and Children’s Hospital. The proposals represent the largest investment in health services undertaken in Scotland and form a key part of the NHS Greater Glasgow & Clyde’s Acute Strategy to modernise health services.

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