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

Our hospitals

“The estate is falling down and we must tell the truth about that. We cannot deliver 20th century, let alone 21st century care in these conditions.”

Our hospitals are some of our region’s most significant assets. They are anchor institutions providing healthcare and employment to 40,000 people.

We have now reached a critical situation with the condition of some of the hospital estate within our region: the depth and extent of problems at Royal Lancaster Infirmary (University Hospitals of Morecambe Bay NHS Foundation Trust) and Royal Preston Hospital (Lancashire Teaching Hospitals NHS Foundation Trust) are unparalleled. They have some of the worst hospital estate in the North West, if not the country.

In addition, Furness General Hospital (University Hospitals of Morecambe Bay NHS Foundation Trust) also requires investment. Located in Barrow-in-Furness, a geographically isolated area with significant population health needs, it is a major local employer. This area also houses some of the UK’s major strategic national assets. The sustainability of this site is a vital consideration for the New Hospitals Programme.

The poor condition of our hospital estate restricts our capacity to provide high-quality safe, efficient and cost-effective services for our patients and impacts our ability to attract and retain staff. Investment in our infrastructure is essential. Without it, services could fail, impacting on our population’s health, economic prosperity and the sustainability of other providers, who cannot absorb the additional demand.

Royal Preston Hospital

Services provided

Royal Preston Hospital (RPH) provides a full range of district general hospital services including: Emergency Department (ED); critical care; general medicine including elderly care; general surgery; oral and maxillo-facial surgery; ear nose and throat surgery; anaesthetics; children’s services; and women’s health and maternity. It also provides several specialist regional services including: cancer; neurosurgery and neurology; renal; vascular; plastics and burns; rehabilitation; and is the major trauma centre for Lancashire and South Cumbria.

Site layout

RPH has developed in a largely opportunistic manner, with the majority of the estate planned to 1950-60s specifications and built in the 1970s and early 80s. The site is landlocked with little space to extend.

“The Neurology ward is in a unit not physically connected to the main hospital site. This results in patients requiring an ambulance transfer within the grounds of the Royal Preston Hospital to move from the Neurology ward to the main hospital building. This provides a poor patient experience, and the reduced amount of ward space available has resulted in this location for the regional Neurology ward.”

The Case for Change

Royal Preston Hospital has suffered from decades of under-investment. 70% of clinical facilities date from 1970s to 1990s and, as a result, experience serious dilapidation.

• Backlog maintenance costs total £157m.
• Demand exceeds capacity across all clinical areas and aged buildings lack flexible capacity leading to congestion and overcrowding.
• Non-compliance with Health Building Notes (HBN), with space and single room provision at only 19%. Compared to the HBN standard, a typical 28-bed ward at Royal Preston Hospital would need to increase capacity by 220% to comply.
• Poor clinical adjacencies and lengthy circulation spaces.
• Some tertiary (highly specialised) services have developed and expanded without fully being able to meet all the estate requirements.
• Almost all operating theatres and all day case theatres are well below the HBN recommended size of 55sqm. The rationale behind these space requirements is to enhance flexibility in accommodating new technology.
• Supporting scrub, anaesthetic and sterile preparation rooms are up to 75% lower than HBN capacity requirements.
• Clinical adjacencies are poor: the radiology department, medical assessment unit and surgical assessment unit are not co-located with the emergency department. Endoscopy and maternity theatres are also further from the Critical Care Unit than HBN standards would ordinarily mandate.
• Independent appraisal has confirmed 80% of the site requires redevelopment or demolition over the medium to long term, significantly limiting opportunity for refurbishment.
• Limited potential to redevelop the current site in a way that is practically achievable and compliant with the Government’s New Hospital Programme.
• Car parking capacity is inadequate and consistently highlighted as a concern, with 1,000 staff required to park off-site and use Park and Ride.

“In Royal Preston Hospital we have episodes of flooding into clinical areas due to the age and condition of some parts of our hospital. This has resulted in operations being cancelled and damage to clinical equipment. Episodes of flooding are unpredictable, and result in some occasions of clinical care being delayed."

The need for investment at Royal Preston Hospital both to support the viability of services provided from this site and to provide the quality of care and experience our patients deserve is unequivocal.

Royal Lancaster Infirmary

Services provided

Royal Lancaster Infirmary (RLI) is University Hospitals of Morecambe Bay NHS Foundation Trust’s principal hospital, providing a range of general acute hospital services with an emergency department, critical coronary care units and various consultant-led services. Royal Lancaster Infirmary also provides a range of planned care, including: outpatients; diagnostics; therapies; maternity; and day case and inpatient surgery.

Site layout

The Royal Lancaster Infirmary site comprises of around 20 separate buildings of varying sizes and ages. Most, but not all of the buildings are linked by long passages, with some buildings separated from the main complex by public highways. As a result, staff and patients must make longer journeys than is desirable, leading to poor experiences of care and significant operational inefficiencies. Several services are provided in temporary buildings offering poor quality accommodation and others are past their useful life. Most of the site is on a slope, which in some areas is too steep for patients to be safely moved except by ambulances. The hospital lacks an obvious main entrance, which can be confusing for patients and visitors.

“Royal Lancaster Infirmary is bursting at the seams, there is no room to expand, parking is insufficient and emergency vehicles have to travel through a congested city centre.”

The Case for Change

Royal Lancaster Infirmary has suffered from under-investment, with 65% of facilities constructed before 1985.

• Backlog maintenance costs total £88m – this is predominantly relating to the condition of the estate.
• Running costs double that of a new build at £442 per square metre due to the age of the site; running costs involve replacement i.e. lifecycle costs over maintenance.
• The site is configured over a challenging geography. Access is particularly challenging for people with a disability and transport to some parts of the hospital (separate ward blocks) is only possible by ambulance, at a cost of £500,000 a year to the Trust.

“The ward is not connected to the main hospital and requires the patient to be transferred within an NHS or private ambulance. Over a three-month period, we had 130 ambulance transfers out of hours, 28 of these patients either had diagnosed dementia, undiagnosed dementia, delirium or cognitive impairment and 11 of the total had a definite diagnosis of dementia.”

Ability to manage demand is constrained by the inflexibility of the estate: during Covid-19, oxygen and electricity supply could not be increased to meet surges in demand, with oxygen supply identified as a critical area of investment need.

Non-compliance with Health Building Notes (HBN) standards for space, including single room provision:

• 28% of beds are single rooms, with 11% en-suites, compared to a HBN requirement of 50%. Many of the patient toilet facilities are inadequate patition-style facilities, with two or three toilets in one room. These create a significant risk of infection, in addition to providing a poor patient experience and lack of privacy.
• Transport to some parts of the hospital is only possible by ambulance, at a yearly cost of £500,000.
• Operating suite floors are non-HBN compliant for all areas, and are well below the HBN-recommended size of 55 square metres. Space requirements for an anaesthetic room, preparation room, scrub up and gown or dirty utility are not met.
• Multi-bedded bays predominate, which exceed the current HBN standard of four beds as a maximum. Some bays at Royal Lancaster Infirmary range from six to ten beds.
• Other compliance issues include the resus bay within the emergency department (Royal Lancaster Infirmary resus bay is 11 square metres versus minimum standard of 20 square metres) and sluice provision, which does not meet HBN standards of one sluice per 14 beds, often resulting in sewage leaks due to inadequate plumbing capacity.
• Electricity supply does not currently meet national standards.
• Car parking space provision is desperately insufficient across both sites.

Over 50% of the Royal Lancaster Infirmary estate requires demolition and the majority of the remaining site will require refurbishment if it is retained in use. There is a powerful case for investment in new estate.

Furness General Hospital

Services provided

Furness General Hospital (FGH) provides a range of general acute hospital services, with an accident and emergency (A&E) department, critical / coronary care units and various consultant-led services. Furness General Hospital also provides a range of planned care, including: outpatients; diagnostics; therapies; maternity; and day-case and inpatient surgery.

Site layout

The Furness General Hospital site has a reasonable amount of strategic expansion space available. Some of the land is currently used inefficiently. There is an opportunity to reduce the percentage of the site currently set aside for non-patient facing activities to increase and improve the estate for patients.

“Green to mean green – this will be a massive improvement in our energy consumption compared to what we literally blow out of the windows, cracks in the wall and disintegrating brickwork at the moment.”

The Case for Change

Facilities at Furness General Hospital are generally more modern than at Royal Lancaster Infirmary and the site has good functional compliance. However, Furness General Hospital is faced with a significant challenge caused by backlog maintenance in estate that fails to meet some Health Building Notes (HBN) standards and capacity requirements. This inflates the issues the hospital has in recruiting and retaining staff.

Key challenges and specific investment needed to meet the future heath needs of the local population include:

• Significant backlog maintenance, including an element of physical condition and lifecycle works. Furness General Hospital has estate running costs of £375 per square metre.
• The estate fails to meet some HBN standards and capacity requirements, in particular, the Critical Care Unit / High Dependency Unit. There is a need to improve the environment for patients and staff, including increasing the single room provision.

There is a significant risk that this site may never meet crucial carbon emission standards.

The overall quality of the Furness General Hospital estate is good. However, there is a strong case for investment to support its future sustainability in the context of its strategic importance in the provision of services to the population of Barrow-in-Furness and its proximity to major strategic national assets.