Case for Change (published July 2021)

Section 1: Executive summary

The New Hospitals Programme offers Lancashire and South Cumbria a once-in-a-generation opportunity to transform our ageing hospitals and develop new, cutting-edge hospital facilities that offer the absolute best in modern healthcare. Our ambition is to make our region a world-leading centre of excellence for hospital care.

Hospitals are widely recognised as being an essential part of the wider health system, and this funding opportunity has been ring-fenced by the Government specifically to improve hospital estates and facilities. However, this can only be delivered in close partnership with the wider health system. We understand that to achieve the absolute best, world-leading status we seek for Lancashire and South Cumbria, investment in hospitals must have a significant positive impact on life expectancy and population health in the region. 

We must help the NHS to deliver seamless, joined up care for those who rely on us the most. As such, it is our intention that funding for new hospital facilities will help the NHS to deliver our collective regional health objectives set out in the Lancashire and South Cumbria Integrated Care System strategy (opens in new window).

This case for change sets out why investment in new hospital infrastructure to replace Royal Preston Hospital and Royal Lancaster Infirmary is the number one strategic priority for our health economy to help us deliver on our wider ambitions to empower and support healthy local communities, so that local people have the best start in life and can live and age well. 

We also explain the case for investment in Furness General Hospital in the context of its strategic importance in the sustainable provision of healthcare services to the geographically remote population of Barrow-in-Furness and proximity to major strategic national assets.

Our hospitals work together with the rest of the NHS and partners in the region to provide services to a population of 1.8m people across diverse communities and varied geographies.

Across this geography, accessibility to services and travel pose a significant challenge for all public service providers as towns and cities are widely spread and the topography adds to expected travel times.

Our population is ageing, with the number of people over 65 projected to increase by 22% by 2030. Our region also faces a greater burden of mental and physical ill-health than the rest of England, along with deep socioeconomic challenges. 20% of our population lives in the 10% most deprived communities. There is a proven link between these factors and NHS activity levels – we anticipate an increase in demand on health services both in and out of hospitals in the future.

2. Ageing acute estate

Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) (opens in new window) and University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) (opens in new window) operate across five sites, with a variety of buildings largely constructed between 30 and 50 years ago and with some buildings dating back to the 19th century still in active use.

The condition of Royal Lancaster Infirmary (RLI) and Royal Preston Hospital (RPH) has reached a critical stage. Without investment, buildings and services could fail. This would create further adverse impact on our patients’ deepening health inequalities and increase the burden of ill-health on our population.

Any adverse impact on services due to the quality of the estate at Furness General Hospital would have a deeper impact due to its geographical location. Investment is needed to ensure its sustainability in this strategic context. Other providers across our region would not be able to absorb the resulting increase in demand, impacting their sustainability.

The poor condition of the hospital infrastructure is a structural barrier to our ability to recruit and retain the number of staff we need to deliver services. This is now a significant and increasing issue for our ability to operate effectively and for our sustainability as a health service within the region. 

Investment in new infrastructure is essential if we are to provoke a step change in the supply of a high calibre workforce and reduce over reliance on agency staff.

3. Specific site-related problems

Royal Preston Hospital estate

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

As the Lancashire and South Cumbria region’s major trauma centre and provider of specialised and cancer services, the impact of declining estates and the associated risks of unplanned changes to clinical services are unsustainable.

Independent appraisal has confirmed 80% of the Royal Preston Hospital site requires redevelopment or demolition over the medium to long term.

Key challenges:

1. Backlog maintenance costs total £157m.

2. Demand exceeds capacity across all clinical areas: aged buildings lack flexible capacity, leading to congestion and overcrowding, meaning that patients wait longer than is acceptable for all aspects of care.

3. Non-compliance with Health Building Notes (HBN): space and single room provision (19% versus 50% HBN) and operating theatre capacity 40% below HBN requirements. This makes it challenging to implement safe infection control measures and we cannot meet the privacy and dignity standards we expect for our patients.

4. Poor clinical adjacencies and lengthy circulation spaces adversely affect patients’ and carers’ experiences in our hospitals.

5. Some tertiary (highly specialised) services have developed and expanded without being able to meet all the estate requirements, restricting our ability to offer some specialised services that should be available to our population.

6. Car parking capacity is inadequate and consistently highlighted as a concern, with 1,000 staff being required to park off-site and use Park and Ride.

Royal Lancaster Infirmary estate

The Royal Lancaster Infirmary (RLI) comprises around 20 separate buildings of varying sizes and ages. Most, but not all of the buildings, are linked by long passages and some buildings are separated from the main complex by public highways. Consequently, staff and patients must make longer journeys than is desirable, leading to poor experiences of care, patient discomfort 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 located on a slope, which in some areas is too steep for patients to be safely moved except by ambulance. The hospital lacks an obvious main entrance, which can be confusing for patients and visitors.

Key challenges:

1. Backlog maintenance costs total £88m, this is predominantly relating to the condition of the estate.

2. Running costs are double that of a new build at £442 per m2 due to the age of the site (running costs involve replacement: that is lifecycle costs over maintenance).

3. Site is configured over a challenging topography. 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.

4. The estate fails to meet many Health Building Notes (HBN) standards – single room provision is only 50% of the recommended standard and less than a third of our ambition for 70% single rooms.

5. Outdated cancer centre.

6. Car parking is inadequate: 460 spaces for more than 2,500 staff and no electric charge points.

Furness General Hospital estate

Furness General Hospital (FGH) is faced with a significant challenge caused by backlog maintenance in estate that fails to meet some HBN standards and capacity requirements. This inflates the issues the hospital has in recruiting and retaining staff. There is also a significant risk that, as currently constituted, this site may never meet crucial carbon emission standards.

Key challenges:

Key challenges and specific investment needed to meet the future heath needs of the local population that can be addressed in line with the strategic priorities of the national New Hospital Programme include:

1. Significant backlog maintenance, including an element of physical condition and lifecycle works. Furness General Hospital has estate running costs of £375/m2.

2. 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.

3. The geographic location of FGH is remote, meaning it is essential we accommodate the latest digital technologies and robotics to create an agile network of care across the region.

Estate in summary

We believe the need for new hospital facilities in the region is unequivocal.

The age, condition and poor functional content of the existing hospital estate mean that we must address this critical need if we are to serve both the current and future needs of our local population.

However, our ambitions go much further than servicing the basic acute health needs of the population by building new infrastructure. We have an ambition to be part of a regional health system that will be regarded as one of the best in the world and play its part in revitalising the regional economy.

4. Keeping up with the best in the world

Investment in Lancashire and South Cumbria’s NHS hospital infrastructure will enable us to provide state of the art facilities and technology, strengthening our position as a centre of excellence for research, education and specialised care. This will significantly boost the attractiveness of the area to potential recruits and the highest calibre of clinicians.

We are committed to ensuring new hospitals fully embrace the benefits of digital technologies to create an agile network of care, allowing us to optimise the size of our physical footprint and minimise environmental impact. This will, in turn, enable us to provide more specialised services in our hospitals and deliver more care closer to home as part of the wider ambitions of the Lancashire and South Cumbria Health and Care Partnership (opens in new window).

We want the programme to play a leading role in tackling the key issues of our generation – cutting carbon emissions and environmental damage. Aged estate, which was built to service the needs of previous generations, is hampering our ability to be net carbon positive and run sustainably.

5. Playing a full part in rebuilding our regional economy

Our hospitals are some of Lancashire and South Cumbria’s most significant community assets: they are anchor institutions providing healthcare to our population and employment to around 40,000 people.

The New Hospitals Programme will create jobs and support the economic regeneration of our region, needed now more than ever as the global pandemic has disproportionately impacted those most in need. Investment in our infrastructure will support us to build back better and help the NHS deliver on its net zero carbon ambition.

What are the implications if we do not invest in new hospital infrastructure?

Nobody can accurately predict the future, but we can make reasonable assumptions. It is critical that we work together as a region to agree where and how to invest this funding for new hospitals; this may be our one opportunity to access investment of this scale for a generation.

If we opt not to deliver new hospital facilities, evidence shows that our buildings will become increasingly expensive to maintain, draining resources from the NHS and eventually becoming unfit for clinical use. 

At this point, services will have to be delivered elsewhere. In many cases, these services will require modern facilities to be delivered from; given that Lancashire and South Cumbria will not have appropriate facilities available without capital investment in hospital buildings, we face the risk that services will have to move out of the local area altogether.

In addition, the recruitment and retention of staff (already a significant risk factor) will be made even more difficult to achieve. Without effective, cutting edge, well-staffed hospitals across the region, it will be unlikely that the local NHS can deliver on its commitment to improve health outcomes and patient experience.

Along with the risks to healthcare provision, if we opt not to invest in new hospital estate, Lancashire and South Cumbria will also lose the wider benefits that would be delivered by an infrastructure project of this scale. These include an immediate boost to local jobs and the regional economy, along with the investment attracted by building new hospital infrastructure.

Together, we believe these factors build a compelling case for change and make the need to agree a way forward with the New Hospitals Programme mission critical.

Our case for change sets out in detail the significant problem our ageing estate presents. It also details the impact of this on our patients’ experience and health outcomes, working environments for our staff, and our ability to deliver services productively and efficiently.

All the comments contained within this document have been sourced from the many thousands posted on 'The Big Chat', an online platform which is facilitating ongoing feedback and discussions amongst key stakeholders. Around 40,000 people, including NHS staff, Foundation Trust Members and community leaders are being invited to tell us their hopes, fears and expectations in relation to new hospital facilities as part of a pre-consultation engagement programme.

"I want us to build brand new hospitals that are the most accessible in the world – where people can get there, get around and interact well with their surroundings however able they are.”