Case for Change (published July 2021)

Section 10: Our infrastructure impacts our use of resources

Around a £340m deficit exists across the NHS in Lancashire and South Cumbria, with more than 60% attributable to Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) and University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).

Planned short to medium term productivity savings at Royal Lancaster Infirmary and Royal Preston Hospital will be substantial, but will be limited by important structural problems:

• Recruitment and retention challenges, and high levels of agency spend
• Long transfer times within our hospitals, creating inefficient use of staff time
• A requirement for intra-site ambulance transfers at significant cost to UHMBT and LTHTr
• Expensive running and lifecycle costs due to the poor condition of our estate and a lack of environmental controls
• Antiquated IT systems which increase manual processing.

Investment in new hospital infrastructure is essential to support improvements in the NHS in Lancashire and South Cumbria’s long term financial position and ensure a sustainable future.

The NHS in Lancashire and South Cumbria spends around £3.7bn per annum on healthcare for its registered population. Plans are in place to significantly reduce the level of financial deficit (around £340m) in the system over the next few years. More than 60% of this deficit resides with areas served by University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) and Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr).

By the time the Lancashire and South Cumbria New Hospitals Programme is ready to start building new infrastructure, the system financial deficit will have been significantly reduced. The Carter review in 2016 evidenced how savings could be achieved in the NHS.

Subsequently the NHS Long Term Plan (2019) identified productivity gains through effective use of digital technology and improved clinical pathways. The level of productivity savings that can be achieved at Royal Lancaster Infirmary and Royal Preston Hospital is substantial, but will be limited by important structural problems:

• Lancashire and South Cumbria is a net importer of workforce due to huge recruitment and retention challenges driven by the quality of our estate. These have impacted our use of resources through high levels of agency spend.
• Poor clinical adjacencies have led to diseconomies, higher costs of treating infection rates and duplication of services across multiple sites.
• Long transfer times within our hospitals, in particular Royal Preston Hospital, which is an inefficient use of staff time.
• The requirements for ambulance transfers across sites at significant cost to UHMBT and LTHTr.
• The poor condition of our estate means it lacks sufficient environmental controls and is expensive to run.
• There is inadequate space for equipment and to provide separation for infection control.
• Antiquated IT systems, which increase manual processing times and duplication of tasks.

It is essential that investment in new infrastructure is secured to support the improvement in the long-term financial position of the NHS in Lancashire and South Cumbria.

Not only will replacing old buildings with high quality, net zero carbon buildings be cost-effective to run, but clinical services can be organised in co-located settings to make the best use of staff time. In combination with investment in our infrastructure, we will need to maximise operational efficiency to achieve the highest levels of productivity and efficiency ensuring the effective use
of public resources for Lancashire and South Cumbria. This will include:

• Improving clinical pathways to eliminate low value adding clinical activities
• Deploying advanced digital technology to streamline processes
• Organising and co-locating clinical services so that value adding clinical time is optimised
• Eliminating duplication and minimising waste
• Addressing the structural workforce supply and retention issues, which will minimise expenditure on agency staff.