Where should a new hospital be built to replace the Royal Preston?
Questions abound about the future shape of hospital provision in Central and North Lancashire after it emerged that a plan is being considered to replace both the Royal Preston and Royal Lancaster Infirmary.
The Department for Health and Social Care (DHSC) made the announcement late on Friday when it confirmed a £3.7bn programme of hospital builds and upgrades across England.
The government said that its “health infrastructure plan” was making good on a manifesto pledge to develop 40 new hospitals within the next decade.
The figures and the financing have been queried in some quarters, just as they were when an outline of the scheme was first revealed in the run-up to last year’s general election – with claims that some of the projects and the cash to support them had already been announced previously.
However, the proposal for Lancashire – while not wholly new – is the most certain signal of intent to date to implement an idea that has been mooted in various forms for years.
According to the DHSC, the Royal Preston and Lancaster Royal would be replaced with “either a single or two hospitals, with three community urgent care hubs and three-out-of-hospital hubs”.
The possibility of a single facility immediately raises the prospect of a so-called “super hospital” serving a wide geographical area, with satellite urgent care and community facilities based in surrounding locations.
The government says that the final outcome will be determined by public consultation, something which is, in any case, a requirement of NHS rules when major service changes are being considered.
The location of a replacement facility – already a potentially contentious subject – would likely become even more highly-charged if the option for a standalone hospital for the wider region were to be pursued.
Previous debate over a super hospital in Central Lancashire has largely focused on finding a suitable location to replace the Royal Preston and Chorley and South Ribble Hospital. However, talk of using the site formerly proposed for an Ikea store on land at Cuerden – close to the M6/M65 interchange – came to nothing and it is now earmarked for a logistics hub.
The prospect of a single hospital serving an area stretching from South Ribble to Lancaster could yield suggested sites that would be unpalatable to those at the furthest reaches of what would be a sprawling patch.
The Local Democracy Reporting Service understands that a location around Garstang was briefly under consideration for a super hospital in recent years.
However, the Conservative MP for South Ribble, Katherine Fletcher – while not wanting to be drawn on whether she believes one or two hospitals would ultimately be built – said that she was confident that the process would yield a facility within Central Lancashire to serve the area currently covered by the Royal Preston and Chorley and South Ribble Hospital.
“This is about replacing the Royal Preston, not moving it further north than where it is now.
“That hospital was built in the 1970s to a 1950s design, it’s a very constricted site – and it’s just not suitable.
“So creating a new hospital on an accessible site will be amazing,” Ms. Fletcher added.
However, Preston’s Labour MP Sir Mark Hendrick was less enthusiastic about the government’s announcement, describing it as “jam tomorrow”.
“On the face of it, this sounds very existing. However, until we know exactly how much money will be allocated and whether it will be for one super hospital or two hospitals, there is actually little to get excited about,” Sir Mark said.
A blueprint for a super hospital in Central Lancashire, drawn up in 2016, put the price tag for such a project at £569m – suggesting that the region would have to receive a disproportionately large share of the government’s pledged £3.7bn if it were to be allocated enough to construct a single-site facility.
An added complication comes in the shape of the ongoing uncertainty about the future of Chorley A&E. A long-delayed public consultation now looks unlikely to begin this year after further hold ups caused by the pandemic and the temporary shutting of the unit.
However, it is known that the two main options on which public opinion is likely to be sought both include the permanent closure of the emergency department – but investment in the wider site as a centre for pre-planned treatments.
The prospect of a super hospital has never been able to be factored in to the consultation options because the finance for it has never previously been on the table.
Chorley MP Sir Lindsay Hoyle, who has previously indicated he could support the concept, says location is key.
“I’ve always said that any super hospital could be good or bad for Chorley depending on where it is built.
“If they go ahead and build it north of Preston somewhere, then at Chorley, we would want a 24-hour A&E and more trauma support – because we would be so disadvantaged by having a new hospital even further away than the Royal Preston is now,” Sir Lindsay said.
Tim Watkinson, vice chair of Lancashire Teaching Hospitals (LTH) – which runs the Royal Preston and Chorley sites – said last year after the pre-election pledge to include Central Lancashire on the list of areas to get a new hospital that “the benefits” of a reconfiguration of services would be needed “a lot sooner than the eight to ten years” that it would take for a new-build to be completed.
That reconfiguration is also caught up with other considerations such as closer integration between health and social care.
Last month, LTH and University Hospitals of Morecambe Bay – which operates the Lancaster Royal Infirmary and other facilities – confirmed that they were working together to develop a business case for a new-build hospital, using £10m of “seed funding” allocated by the government for that purpose.
However, in a joint statement responding to the latest government announcement, a spokesperson said that nothing had been finalised at this stage.
“No plans have been created for the future structure of any of the five hospitals (Preston, Chorley, Lancaster, Kendal and Barrow) and, as publicly stated last month, both trusts are committed to working with local people to develop and create any future plans.
“It’s long been recognised that there is a need for local health services to be delivered in a better and more accessible way for the local communities we service, so we are pleased to receive this commitment to our future plans, which will be developed and consulted upon with local people before progressing.”
The two trusts are in the second wave of the health innovation programme, meaning that any proposals will not come to fruition until the second half of this decade.
The initial long-list of options for the future of Chorley A&E alone totalled 13 – but that figure may yet be dwarfed by the plethora of possibilities that could be considered in the years to come about where to build one, or possibly two, new hospitals and appropriately locate ancillary services around them.