A public engagement process inviting comments on a “longlist” of ten possible options for the sites closed earlier month.
It was carried out as part of the development of a bid to secure government cash for either two replacement buildings for each of the ageing hospitals or the creation of one so-called “super hospital” in a central location.
The latter concept does not so far seem to have found much favour in the public mindset – although if it were to be pursued, some local services would be retained in new integrated centres in Preston and Lancaster.
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Lancashire was identified last year as one of 40 areas where the government had pledged to create new hospitals or extensively refurbish existing facilities.
While the county was given the two broad options of whether to construct one or two new buildings, the Lancashire and South Cumbria New Hospitals Programme subsequently came up with ten possible permutations to pitch to the government and the public.
These included the rebuilding of the Royal Preston and Royal Lancaster on their current sites or entirely new plots – as well as the prospect of a super hospital serving both Central Lancashire and North Lancashire/South Cumbria. Speculation has previously swirled around Garstang as a possible location for a single new hospital.
While analysis of the feedback given during the engagement process is ongoing and a quantifiable assessment of the public’s inclination has not yet been published, the head of Lancashire and South Cumbria’s New Hospitals Programme told the LDRS that it appeared “most respondents had a preference to keep the hospital close to wherever they were currently resident”.
Jerry Hawker, senior responsible officer for the programme, added: “Preston residents were keen to keep [their hospital] close to the centre of Preston and Lancaster residents were keen to keep [theirs] where it was. South Cumbria residents [asked]: ‘Can we move it a little bit further up?’”
That sentiment – captured in almost 3,000 online responses and hundreds more engagements at a series of 16 roadshows held across the region – echoes the results of separate polling carried out into the public’s thoughts on the issue of new hospital facilities in the region.
A recent meeting of the Lancashire and South Cumbria Integrated Care System (ICS) board heard that the outcome of that survey indicated that “people north and south of the region do not wish to travel in either direction for anything but the most complex treatments and [even then] for no more than an hour”.
Mr. Hawker said he was “not surprised” by the finding and revealed that residents in Ribble Valley and South Cumbria had expressed particular concern about the possible journey times to hospital under the various propositions.
“[There] has been quite consistent feedback from members of the public that the time it takes them to get to hospital is important to them. I am pleased that people do recognise that if they are going [to hospital] for more specialist reasons, it’s more acceptable to travel.
“Clearly, that would put an emphasis towards retaining the two hospital sites as being more preferable to the public than perhaps to have a single new super hospital built in the middle.
“Of course, we haven’t made any decisions on any of the options yet or [on] any sites, but it’s still very good to have that feedback and recognise that travel time is an important consideration for us to take into account,” Mr. Hawker explained.
According to the list of the government’s 40 hospital projects published last year, three urgent care hubs would also be provided in the event that a single new hospital were created for Central and North Lancashire/South Cumbria.
The engagement feedback will now be gathered and assessed against considerations including cost and outcomes for patients before the options are whittled down to a shortlist. The ICS meeting heard that “key products” had been developed in order to help create the business case that will ultimately have to be put to the government to secure the cash – and that these include a methodology for the shortlisting process.
Mr. Hawker said at the outset of the initial engagement period that coming up with a chosen option would be “a balance between what is the right thing for the population, what is feasible to do and what’s affordable”.
The LDRS understands that the shortlist is likely to be published in the first quarter of next year. If any of the options that could be pursued are deemed to constitute a major change to NHS services, a formal public consultation would have to be carried out. That is unlikely to occur until next summer because of the so-called “purdah” rules that would prevent it happening in the run-up to next year’s local elections.
Public consultation would be required for both the super hospital option and the rebuilding of either the Royal Preston or Royal Lancaster on sites away from those which they currently occupy.
Mr. Hawker stressed that even if the eventual shortlist meant a formal consultation was not needed, the NHS would continue to engage with the public so that the eventual chosen option is “owned by the people of Lancashire and South Cumbria”.
It is hoped that building work on one or more projects would begin in 2025 and the new facilities be open by 2030.
The region’s New Hospitals Programme published its “case for change” earlier this year – setting out the reasons why Preston and Lancaster were in need of new facilities.
For the Royal Preston, they included a staggering £157m backlog of maintenance work and inadequate operating theatre capacity. For the Royal Lancaster, an £88m maintenance backlog and accessibility problems were amongst the issues highlighted.
A reduction in health inequalities and the improvement of staff recruitment and retention were also identified as overarching aims of the programme.
The government has so far committed £3.7bn to its list of planned hospital projects – which is currently in the process of being expanded to 48. However, it has been estimated that in excess of £20bn will ultimately be required as the schemes are approved and taken forward.
Earlier this month, the Health Service Journal magazine reported that the Infrastructure and Projects Authority (IPA) watchdog had downgraded the nationwide new hospitals programme to a “red” rating – defined as a project that “appears to be unachievable”.
In response, the Department for Health and Social Care said that it was “addressing the IPA’s recommendations in detail” and was “fully committed to the delivery of all 48 hospitals by 2030”.
Mr. Hawker said that the feedback across Lancashire and South Cumbria to date consistently showed a public belief that both Preston and Lancaster hospitals “urgently need investing in”.
He added that ever-evolving technology and changes to the way healthcare is delivered meant that the region needed to “future-proof” its proposal for new facilities as far as possible.
“The way we treated people ten years ago is different to how we treat them today and will be different again in ten years’ time. But there are some things we are really keen to see make happen.
“We have learned a lot about infection prevention and around how people recover quicker when they are in a room on their own. So there is [a desire for people] to have greater dignity in hospital [and] have single rooms.
“When we look to the future, I think hospitals will be smaller – that’s not because we are providing less care, but technology and the way we treat people will enable us to do it in shorter periods of time [and] do more care at home.
“So I think [in] future…when you come into hospital it will be because you really need to be there and hopefully you’ll have the most advanced treatment in Lancashire that you possibly could have – that’s what excited me about the programme.
“So we can be quite brave in our vision for the future, but we’ve also got to be a bit pragmatic about affordability – we can’t have everything and there will be some compromises in this.
“But I still think we can get a fantastic solution for the people of Lancashire and South Cumbria,” Mr. Hawker said.
WHY PRESTON NEEDS A NEW HOSPITAL
These were the challenges laid out by the NHS earlier this year about the Royal Preston’s Sharoe Green Lane site.
***The condition of the facilities has reached a critical stage and, without investment, buildings and services could fail.
***More than 70 percent of clinical facilities date from the 1970s to the 1990s and are experiencing “serious dilapidation”.
***80 percent of the site requires redevelopment or demolition over the medium to long term.
***Operating theatre capacity is 40 percent below the standard expected for newly built hospitals.
***Single room provision is available for just 19 percent of patients, compared to the 50 percent standard for new facilities.
***Inadequate car parking, which forces 1,000 staff to park off-site and use a park and ride.
WHY LANCASTER NEEDS A NEW HOSPITAL
This is what the case for change document had to say about the Royal Lancaster Infirmary on Ashton Road.
***Much of the current site is located on a slope, which in some areas is too
steep for patients to be safely moved except by ambulance.
***Access is particularly challenging for people with a disability.
***Some of the 20 buildings that make up the hospital are separated from the main complex by public highways and several services are provided in temporary buildings offering poor quality accommodation.
***Running costs are double those of a new-build hospital.
***Single room provision is only half of the recommended standard and less than a third of the local ambition for 70 percent of patients to have single rooms.
***Inadequate car parking with just 460 spaces for more than 2,500 staff.
Source: Case for Change, Lancashire and South Cumbria New Hospitals Programme
STARTER FOR TEN
These were the “longlist” of options put to the public in recent months. They are now in the process of being whittled down to a shortlist, likely to be published early next year.
1. Business as usual and no change – a standard option required in all business cases.
2. Limited investment to address all maintenance backlogs – another standard “do minimum” option required in all business cases.
3. New Royal Lancaster Infirmary on the existing site, with partial rebuild/refurbishment of Royal Preston Hospital.
4. New Royal Lancaster Infirmary on a new site, with partial rebuild/refurbishment of Royal Preston Hospital.
5. New Royal Preston Hospital on the existing site, with partial rebuild/refurbishment of Royal Lancaster Infirmary.
6. New Royal Preston Hospital on a new site, with partial rebuild/refurbishment of Royal Lancaster Infirmary.
7. Investment at both hospitals, allowing partial rebuilding work on both existing sites.
8. New Royal Preston Hospital built on a new site, with the existing Royal Preston Hospital site retained for some services and partial rebuild of Royal Lancaster Infirmary.
9. Single new hospital on a new central site to replace both Royal Preston Hospital and Royal Lancaster Infirmary (with some local services to be retained in new integrated community centres in Preston and Lancaster).
10. Two new hospitals to replace Royal Lancaster Infirmary and Royal Preston Hospital (on new sites).