Summary version of our Case for Change (published July 2021)

Delivering the Lancashire and South Cumbria Clinical Strategy

Our region has higher than expected levels of emergency admissions compared to the national average. Residents are 12% more likely to be admitted for all causes, 28% more likely for coronary heart disease and 27% more likely for Chronic Obstructive Pulmonary Disease (COPD). Mortality rates (for under 75s) are greater for 50% of counties in Lancashire and South Cumbria compared to the North West region average.

The Lancashire and South Cumbria Health and Care Partnership’s Clinical Strategy (opens in new window) sets out three principle aims to help address this:

1. Improving health and wellbeing

2. Delivering better joined up care closer to home

3. Safe, sustainable high-quality services.

To achieve these aims, help to deliver on the NHS Long Term Plan (opens in new window), and support the future health needs of our population, the Clinical Strategy outlines the following priorities (highest priority integrated pathways for improvement are indicated with **):

The New Hospitals Programme will support the long term future development of our clinical priorities, including single shared services or specialty networks, which will be based on:

A single service approach across Lancashire and Cumbria, delivered from a specialised hub and with outreach across the network to provide care locally where possible

Or

Services provided from one central site as part of a single service offer for Lancashire and South Cumbria, in order to meet the volumes and co-location required to meet national standards

Or

Single service offers achieving standards across more than one site.

“These are complex and ambitious plans and we need to look beyond individual organisations to consider the structure of services across the whole system.”

The Lancashire and South Cumbria Provider Collaborative is already transforming services and exploring the benefits to patients and staff of networks and greater collaboration. Our Major Trauma Network has facilitated significant improvements to access and sustainability of these services.

Further work is taking place to inform our long-term clinical services strategy. Some of these plans may require engagement and / or consultation. 

Specialised services

Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) is the main provider of specialised care, with a hub and spoke model underpinning delivery. However, one third of our total spend on specialised hospital care is taking place with providers outside of Lancashire and South Cumbria.

Specialised services in Lancashire and South Cumbria

While some specialised services can only be delivered at a national or cross-Lancashire and South Cumbria level, some of our patients travel long distances to access care when:

(i)  We could expand choice for patients by providing services closer to home, where there is the expertise, volumes and ability to deliver outcomes in line with national standards.

(ii)  There could be opportunities for further specialist services to be provided in Lancashire and South Cumbria, where they have historically been provided elsewhere. Further work is required to understand this, but potentially some services in cardiac, neurosciences and haematology could be provided in Lancashire and South Cumbria.

How our estate impacts on the quality of clinical care and our patients’ experience

Our poor hospital infrastructure is an important contributing factor to underperformance against key national access and quality standards. This means our patients wait longer for urgent treatment, routine surgery, diagnostics and cancer treatment than they should.

In their recent study of NHS hospital build programmes (opens in new window), the Nuffield Trust found significant evidence that better infrastructure and, in particular, access to a view led to quicker recovery time for the patient.

The standards of our facilities and lack of single room provision do not give our patients the privacy and dignity they deserve and create risk of infection.

Patients wait longer for treatment than is acceptable because of the lack of capacity in and flexibility of our estate. We are below the national average position on several key performance standards.

• 70% of elective cancellations at Lancashire Teaching Hospitals NHS Foundation Trust were due to a lack of bed capacity / equipment.
• The built capacity of our emergency departments exceeds today’s patient flows – patients wait longer for urgent emergency treatment at increased clinical risk.
• Bed occupancy rates are 95% and consistently above the National Institute for Health and Care Excellence (NICE) standards.
• Inability to separate planned and elective work, in line with recognised best practice in achieving good flow and maximising patient experience elective work is a consistent theme across women’s services at Royal Lancaster Infirmary and Furness General Hospital.
• Co-location of mental health facilities, preventing an acceptable standard of care for patients with acute mental illness.
• Limited single room provision and toilet and shower facilities, negatively impacting patient experience and increasing risk of infection, as evidenced in our hospital- acquired infection rates compared to the national average.

Royal Lancaster Infirmary’s emergency department was built for a predicted capacity of 40,000 patient attendances per year, with actual attendances at around 60,000.

Furness General Hospital’s emergency department has an annual capacity of 25,000, but actual attendances are around 36,000. This means patients remain on corridors or in crowded waiting areas, with significant delays to admission or treatment and an added infection risk.

Royal Preston Hospital has a cancellation rate of 4%, well over the national average of 1%. 20% of patients in LTHTr were not treated within 28 days of a cancellation, twice as high as the national average of 9%. Over 70% of these cancellations are attributable to capacity or equipment. Central Lancashire has been the most challenged area for Delayed Transfers of Care (DTOC) across the Lancashire footprint, with 7.28% for LTHTr.

How the New Hospitals Programme will help deliver our clinical strategy

We cannot deliver our clinical strategy with our current infrastructure because we do not have:

• Quality and adaptable infrastructure that supports delivery our principle aims and key priorities.
• The capacity for specialised and support services, including the associated workforce. We have previously outlined how specialised services have expanded at Royal Preston Hospital over time without the required physical space.
• The flexible capacity to transform and accommodate services that are changing with rapidly advancing technology.
• Single room capacity to ensure the highest standards of infection control, in particular for cancer patients.
• The required capability to accommodate advances in digital technology to support care closer to home and networked hospital solutions.

New models of acute care will be needed to deliver the clinical vision for 2030. The integrated care system clinical services strategy sets an expectation for closer working of providers across Lancashire and South Cumbria to achieve this.

Development of new hospital infrastructure will be a key enabler in delivering our long-term clinical strategy, improving outcomes and delivering care closer to home for our population.