The longstanding suggestion of constructing a so-called “super hospital” - situated somewhere between the two - was amongst the permutations to be rejected, while the potential to completely rebuild the hospitals on their current sites was also ruled out.
That has left four options on the table - one of which involves the partial rebuilding of both the Royal Preston and Royal Lancaster in their current locations.
However, there is also the possibility of two entirely new hospitals being built somewhere else - or one of either Preston or Lancaster getting a new facility and the other city’s hospital being partially rebuilt where it now stands.
Jerry Hawker, executive director for the Lancashire and South Cumbria New Hospitals Programme, told the Lancashire Post that any options that are ultimately put to the public in a formal consultation will have to be shown to be viable.
“Obviously, that means you have got to know that the land is available if it’s a new site [being proposed] - and also that the option [is] affordable, both from a capital [building cost] and revenue [operational] point of view.
“So we can’t consult on an option that the government or NHS England has determined is not affordable - and it would be unfair to engage with [the public] on an option you know you can't deliver,”. Mr Hawker explained.
He said that for that reason, work is currently ongoing to explore “different site options” should complete new builds eventually be consulted upon.
He also hopes that the public engagement process that was carried out on the longlist of options shows residents that their voices are heard - and that it is worth them having their say as the proposals continue to be developed.
As the Post revealed late last year, feedback from over 3,000 online surveys and responses given at more than a dozen roadshows held across Lancashire and South Cumbria suggested that people wanted to see all but the most specialist of services located closer to home than a single hospital for both Preston and Lancaster would have allowed.
“The super hospital was still a very strong option in terms of the benefits it could bring - but [there was] a very strong counter-argument about the impact on inequalities and travel times. Obviously, the voice of the public and stakeholders was a very clear one - and I think it's very positive that we can actually demonstrate that [following] all the engagement and listening, we do respond,” Mr. Hawker said.
Having heard what people did not want from the proposed redesign of their hospital services, he said now was the time for residents to say exactly what they would like to see.
“It changes the narrative a bit, because a lot of the conversations with politicians and the public have all been about, ‘We don't want a single hospital’.
“[So this] gives us a chance to really turn it around now to say: 'What do you really want - what are you excited about?' It takes the conversation into a positive domain.”
However positive the discussions may be locally, NHS bosses will nevertheless have to be conscious of the financial implications of whatever proposal they end up pitching to ministers.
Lancashire and South Cumbria was identified in 2020 as one of 40 areas - currently being expanded to 48 - where the government had pledged to create new hospitals or extensively refurbish existing facilities.
However, each of those areas will still have to produce a sufficiently compelling business case - proving the worth of their plans - if they are to be given the green light by the Treasury.
The Health Service Journal reported that the government has committed around £4bn to the nationwide programme, but it has been estimated that five times that amount may be needed if all of the schemes are to get off the drawing board.
The government’s nationwide new hospitals programme is currently rated as “amber” by the Infrastructure and Projects Authority watchdog, an upgrade from the “red” status it was handed last summer. Its new rating means that it is considered to be “feasible”, but that “significant issues already exist”.
Mr Hawker is candid that there are no guarantees that Lancashire will receive any money at all - and so he does not want the inevitably cheaper partial rebuild options to be regarded as small fry.
“This is an unusual programme because you are working…in a financial regime that's been determined by the government rather than [it being] within local control.
“That’s why we’ve got both rebuild options and new-build options in the shortlist, because the reality is that there is a very significant range of capital requirements between a relatively small rebuild and a major new hospital in Preston.
“But the government has been very clear that when it says a ‘partial rebuild’, it's got to be more than just changing the A&E reception area - it has got to be visibly different.
“So you’re talking, still, about quite major results - it might be a completely new emergency department or it could be a completely new ward facility or a combination of both.
“The rebuild options are by no means a small investment - they are going to be substantial.
“[They] don't offer the scale of benefit you can get from building two new hospitals, because you've obviously got the chance to do everything right for the first time.
“But the rebuild options are still an incredibly positive contribution, because if you look at both the Royal Lancaster and Royal Preston, they desperately need investment whatever happens - and we mustn’t lose sight of that.”
As part of its “case for change” setting out why Preston and Lancaster needed new hospital facilities, the NHS in the region last year published a litany of limitations caused by the condition of the current sites and how they are configured.
In Preston, that included operating theatre capacity being 40 percent below the standard of new-build hospitals and the “serious dilapidation” of many of its clinical facilities, which could lead to services and buildings failing. The Royal Preston also has a £157m maintenance backlog at its Sharoe Green Lane home.
The equivalent maintenance bill at the Royal Lancaster is £88m, while its ageing facilities were highlighted as being hampered by the fact that they were built on a slope - meaning patients often have to be moved by ambulance to different parts of the site on Ashton Road.
Mr. Hawker told the Post that if brand new hospitals are ultimately pursued for either or both cities, the chosen sites should add wider socio-economic value - and not be selected purely through the prism of the NHS. The question of what happens to the vacated plots would also be a key consideration, he said.
“If they weren't used for a hospital [anymore], how could they add value to the local economy by being used for something else?
“This is [another reason] why we want the public to get involved, because if the public says we’d like the hospital on a new site because the existing site could be turned into a park or a leisure facility, then from a social value point of view, that’s a really important consideration."
Mr. Hawker also said that the Royal Preston's status as the base for many pan-Lancashire services, which are delivered on a regional basis, meant that any decisions about its future would have to take into account the effect they would have on patients from across Lancashire and South Cumbria.
Health bosses will now work on drawing up a so-called “pre-consultation business case” in the coming months, which will enable NHS England to assess the viability of the four remaining options - all or some of which could then be formally proposed to the public.
The final list of options is expected to be determined by the end of the year. The LDRS understands that any proposals for completely new hospitals built a significant distance from their current locations would constitute a major change to services and so require formal public consultation.
Partial rebuilds of existing facilities might not reach that threshold - but Mr. Hawker stresses that public opinion will continue to be a vital part of the process whichever path is chosen.
“Whether we [formally] consult or not does not change our commitment to engaging with the public and getting their views on every aspect of this programme.”
It is expected that any building work - on new or refurbished facilities - would begin in 2025, with an aim for it to be completed by the end of the decade.
HOW LANCASHIRE’S HOSPITALS COULD CHANGE
These are the four possible options for the futures of the Royal Preston and Royal Lancaster hospitals:
***A new Royal Lancaster Infirmary on a new site, with partial rebuild/refurbishment of Royal Preston Hospital.
***A new Royal Preston Hospital on a new site, with partial rebuild/refurbishment of Royal Lancaster Infirmary.
***Investment at both Royal Lancaster Infirmary and Royal Preston Hospital, allowing partial rebuilding work on both existing sites.
***Two new hospitals to replace the Royal Lancaster Infirmary and Royal Preston Hospital on new sites.
Note - all options also include investment in Furness General on its existing site in Barrow
Source: Lancashire and South Cumbria Integrated Care System
WHAT DOES IT MEAN FOR CHORLEY HOSPITAL?
No changes are proposed to Chorley and South Ribble Hospital as part of the revamp of its larger neighbour in Preston, which is run by the same NHS trust.
Jerry Hawker, who is leading Lancashire and South Cumbria’s New Hospitals Programme - which could see both the Royal Preston and Royal Lancaster hospitals replaced or rebuilt - said that the NHS in the region is “committed” to having a hospital on the Chorley site, as well as that of Westmorland General in Kendal.
“We have committed and continue to commit to investing in both those sites.
“Clearly, as we take forward the options, we will continue to look at what's in the best interest of patients between all of the hospital sites.
"The NHS never stands still [and] irrespective of the New Hospitals Programme, we are always looking at how we can provide services better,” Mr. Hawker said.