Home / Case for change Section 5: Lancashire and South Cumbria Health and Care Partnership

Case for change

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5. Lancashire and South Cumbria Health and Care Partnership

Lancashire and South Cumbria Health and Care Partnership (our region’s integrated care system) is committed to improving health and wellbeing and delivering better care for all.

To achieve this, the integrated care system ‘Healthier Lancashire and South Cumbria’ strategy (opens in new window) has outlined the ambition that local people will:

Have longer, healthier lives
Be more active in managing their own health and wellbeing to maintain their physical independence for longer
Be supported to keep well both physically and mentally
Be central to decision making
Have consistent, high quality services across Lancashire and South Cumbria
Have joined up services and support, which are easier to navigate and access
Have services and support that are responsive to local need
Have equal access to the most effective support with reduced waiting times.

Directly supporting the Health and Care Partnership strategy

New hospital facilities will support the delivery of these goals. Although it will take up to 2030 to plan and build new hospital facilities, we believe that the prospect of better, more agile hospital facilities, designed to accommodate the region’s changing population demographics and health needs, will support the delivery of these goals in the short term by increasing staff morale, recruitment and retention.

The development of new hospital facilities will also indirectly but significantly, impact on the wider determinants of health and wellbeing by attracting investment into the region and contributing to the number of high-quality jobs available in the local community.

The knowledge that new, modern hospital estate will be available in the near future will also enable our clinical teams to plan delivery of the latest cutting-edge therapies and treatments. Health systems will adapt to be ready to work with the latest technology and approaches delivered within the new hospital infrastructure, with the further incentive of being part of a health network that will deliver higher standards of care across Lancashire and South Cumbria.

This work will directly align to the Health and Care Partnership’s strategic ambitions of delivering joined up support enabled by digital technology and helping reduce waiting times through more efficient, effective treatment and care, contributing to local people living longer, healthier lives.

The strategy predicts that by 2025, local people’s experience of health and care in our region will have improved. We believe that the realistic prospect of new hospitals will contribute to this, and that, once built; our new hospital infrastructure will sit within an evolved health and care landscape and will continue to contribute to delivering the Health and Care Partnership’s ambition.

Some of Lancashire and South Cumbria’s most significant health risks are: coronary heart disease, stroke, Chronic Obstructive Pulmonary Disease (COPD) circulatory disease, cancers and deaths from causes considered preventable are worse than the England average. When people experience these conditions at a chronic level, they require hospital-based care.

Specifically, new hospital facilities will align with the delivery of the Health and Care Partnership’s strategy as follows:

Health and Care Partnership ambition for 2025

Local people will benefit from:

Use of modern hospital quality resource to assist people to manage their own conditions in partnership with the NHS
Supported to improve their long term health and wellbeing

Living well before they die, in the place of their choice in peace and dignity
Living well before they die, in the place of their choice in peace and dignity
Using technology to manage their health
More involved in decision making in their area
Making best use of local housing and leisure services by connecting with integrated community teams
Living in dynamic, empowered communities where people can live, work and thrive
Benefiting from more co-ordinated and joined-up care
Receiving care from hospitals, which provide networks of services, with sustainable staffing levels and consistent pathways
Supported to live longer, healthier lives with earlier diagnosis of conditions and advice on prevention.

Staff will be:

Happier, healthier and more resilient
Provided with a wider range of roles and support to develop new skills and capabilities
Working in integrated community teams, delivering targeted and coordinated physical and mental health care to their local neighbourhoods
Better able to support people they care for, through greater access to data shared by partners
Attracted into working and living in Lancashire and South Cumbria.

Partners will be:

Able to demonstrate how public sector organisations have supported economic development and innovation, resulting in employing local people into new and different jobs in health and care
Able to demonstrate that they are getting the best value health and care
Confident in the evidence of improving life expectancy and reducing inequalities in the most deprived neighbourhoods through our approach to population health
Able to demonstrate how health and wellbeing has been considered in public policies such as education, housing, economic development, transport and retail.

Contribution of new hospital infrastructure (post-2030)

Local people will benefit from:

Use of modern hospital quality resource to assist people to manage their own conditions in partnership with the NHS
The impact of the NHS and Health and Care Partnership’s work to improve long term health and wellbeing
Use of digital and other monitoring technologies to increase patient choice about where they are treated, limiting the isolation many feel during hospital treatment
Creation of shared facilities that can be enjoyed by the entire local community to enhance their wellbeing (such as gyms, allotments etc.)
Provision of economic opportunities and well-paid jobs to local people and, as a key anchor institution, play a full part in civic life
Delivery of acute health interventions when required, as part of an overall package of care
Provision of facilities for higher-level diagnostics and expert advice (in region).

Staff will benefit from:

The opportunity to plan where and how the new facilities are appointed
New facilities, which cater specifically to staff wellbeing

New challenges, opportunities and roles for the next generation of staff in our region
Mental and physical health delivered as part of a seamless package of care
New facilities specifically designed to allow experts to collect, analyse and share data
Opportunities for staff to learn and develop and for and patients to thrive
The ability to offer equal or better working conditions, only deliverable with new hospital facilities.

Partners will benefit from:

Delivery of economic growth and employment, and creation of new and different jobs in health and care
New facilities designed to be sustainable and meet modern standards of efficiency
New hospital facilities able to deliver better therapies and treatments, extending the lives of many individuals and improving life expectancy overall
Better access for the most deprived
Significant contribution to the overall calculation of greater value added (GVA) to the region as a whole.

Working in partnership with the wider health system

The Lancashire and South Cumbria Health and Care Partnership is made up of five Integrated Care Partnerships (ICPs) across the wider geography, which are working together under the integrated care system vision to improve healthcare services across the region.

They are:

Morecambe Bay
Pennine Lancashire
Central Lancashire
West Lancashire
Fylde Coast

Each local health and care partnership contains a number of Primary Care Networks (PCN). There are 41 PCNs bringing together 202 GP practices. The PCNs are aligned to wider public and voluntary sector services within their neighbourhood. Our geography is diverse, ranging from the city status of Preston to highly remote communities such as Barrow-in-Furness.

The New Hospitals Programme will need to work in tandem with PCNs and GP practices to ensure new hospital infrastructure is fully integrated and networked with future primary care arrangements. This access is critical to the delivery of better health outcomes for the region as a whole.

Specific attention must be given to retaining and improving access to acute services for people from the most economically deprived and educationally under-attaining council wards in the region. These geographic areas are strongly aligned to the areas that suffer the most ill-health. Working closely with the PCNs and GP practices in these areas will be significant in helping us understand how we can work creatively to help address this problem.

We will be actively seeking ideas about how the New Hospitals Programme can help address some of the lifestyle contributors to ill-health. For example, can hospitals play a role in reducing prevalence of smoking, supporting people with weight loss and increasing physical activity, and reducing alcohol consumption, through coordinated health promotion activity and behaviour change programmes?

The care, treatment, services and experience delivered by our local hospitals is a fundamental component of our region’s ability to deliver on the Health and Care Partnership’s strategy for local people. As such, the New Hospitals Programme is closely aligned to the integrated care system’s ambitions and approach, with the needs, views and feedback of local people a fundamental part of shaping proposals.

Demographic demands and trends

Lancashire and South Cumbria’s hospitals serve a population of 1.8m across a diverse range of communities with widespread health inequalities. Our region’s challenges are significant and well documented.

Our region faces a greater burden of mental and physical ill-health than the rest of England, along with deep socioeconomic challenges. 20% of our population live in the 10% most deprived communities and the number of people in fuel poverty, children living in poverty and economic inactivity rates are higher than the rest of the country. With this lies a risk that opportunities to improve outcomes result in digital exclusion, and this applies to our older population.

The number of people living in Lancashire and South Cumbria is predicted to rise, with the largest proportional increase expected in our older population: the 65 plus years population is projected to see a 21.8% increase between 2018 and 2030 (source: Lancashire and South Cumbria Health and Care Partnership’s Clinical Strategy [opens in new window]). The elderly population is fundamental in terms of cost: rising numbers will create a significant proportional impact on operational and financial pressures.

Advances in medical technology and practice mean that more children are surviving with conditions that would not have been viable a few years ago. Although the population of under 19s is not increasing, the complexities of these conditions have a consequence in terms of higher costs of care.

An ageing population and advances in medical technology mean that the demand for specialised services is increasing more rapidly than other parts of the NHS (source: NHS England specialised services [opens in new window]). In Lancashire and South Cumbria, we expect a 28% increase in cancer diagnosis in the next ten years.

Life expectancy

Men and women in Lancaster, Preston and Barrow-in-Furness all have lower average life expectancy than the England average. Access to top quality acute hospital facilities can, of course, have a dramatic life-saving effect for an individual.

Female life expectancy by council area (compared to the national average of 83.1 years):

Cumbria – 82.8 years
Lancashire – 82.2 years
Blackpool – 79.6 years
Blackburn with Darwen – 80.1 years

Male life expectancy by council area (compared to the national average of 79.6 years):

Cumbria – 79.4 years
Lancashire – 78.6 years
Blackpool – 74.2 years
Blackburn with Darwen – 76.6 years

Source: Public Health England Fingertips tool

Our diverse communities

9% of residents in Lancashire and South Cumbria are from ethnic minorities. While this is lower than the England average (14%), Pennine Lancashire ICP (15.3%) is above the England average. Our ethnic minority population is rising and is of significance in terms of health service provision.

Ethnic minority groups are more likely to report ill-health and experience ill-health earlier and have more requirements for specialised care.

Health outcomes

Health outcomes in Lancashire and South Cumbria are significantly worse than the national average, with unexplained variation in outcomes for people with conditions such as cancer, coronary heart disease and mental health.

The region also performs worse than the national average on several metrics relating to infants and children. Prevalence rates for long term conditions are also higher than national averages.

Demand

The demand for our hospital services already exceeds the capacity available. Figure 2 shows activity by point of delivery and site and trends over the last three years. Most notable is the rising number of emergency admissions and emergency department attendances, which continue to rise year on year.

Figure 2: Hospitals Episode (HEDs) Data for Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) and University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT): change from 2016/17 to 2019/20 for outpatients, electives, A&E and emergency care.

Breakdown for UHMBT Hospital Episode Data:

A&E: up 32% in 2019/20 compared to 2016/17 (from 88,073 to 115,880)
Outpatients: up 7% in 2019/20 compared to 2016/17 (from 523,184 to 560,865)
Electives: 0% difference in 2019/20 compared to 2016/17 (from 47,302 to 47,400)
Non-electives: up 6% in 2019/20 compared to 2016/17 (from 36,518 to 38,830)

Breakdown for LTHTr Hospital Episode Data:

A&E: Up 19% in 2019/20 compared to 2016/17 (from 120,765 to 144,055)
Outpatients: up 6% in 2019/20 compared to 2016/17 (from 543,233 to 574,990)
Electives: up 2% in 2019/20 compared to 2016/17 (from 64,038 to 65,375)
Non-electives: up 5% in 2019/20 compared to 2016/17 (from 46,504 to 48,965)

Admissions data

Figure 3 shows that the over 65s comprise over 62% of bed days. This figure is 70% of bed days at some sites. This cohort of the population is frailer, with complex co-morbidities and the elderly spend longer in hospital when they are admitted. We know that hospital is not the best place for our older residents; they can quickly become deconditioned and institutionalised within an acute setting.

Figure 3: Occupied bed days (OBDs) for over 65 population by site for UHMBT and LTHTr

Breakdown for LTHTr occupied bed days for people aged over 65:

Royal Preston Hospital: 159,846 (52%), total: 305,843
Chorley and South Ribble Hospital: 55,598 (72%), total: 76,999

Breakdown for UHMBT occupied bed days for people aged over 65:

Royal Lancaster Infirmary: 98,930 (67%), total: 146,859
Furness General Hospital: 76,750 (71%), total: 108,860
Westmorland General Hospital: 16,003 (76%), total: 21,071

Overall total for LTHTr and UHMBT: 409,007 (62%) out of 661,751

UHMBT has a higher length of stay that its peer comparators, and specific challenges in key areas of trauma and orthopaedics (T&O) – fractured neck of femur was highlighted by the Care Quality Commission (CQC) – and elderly medicine.

Our projected bed capacity requirements

Demand and capacity modelling, using population forecasts to 2039 and target bed occupancy rates of 85%, predicts a 20% rise in bed requirements due to our increasing elderly population. Figure 4 shows that RLI and RPH will require 128 and 229 additional beds without intervention.

Figure 4: Expected increase in occupied bed days and beds for UHMBT and LTHTr

Total number of beds by hospital

Total beds 2019/20: RPH (1,023), CSRH (253), RLI (492), FGH (359), WGH (73), grand total (2,206)
Total beds 2038/39: RPH (1,252, up 18%), CSRH (339, up 25%), RLI (620, up 21%), FGH (456, up 21%), WGH (93, up 22%), grand total (2,770, up 20%)

Total number of bed days by hospital

Total bed days 2019/20: RPH (306,051), CSRH (76,563), RLI (147,946), FGH (108,103), WGH (20,830), grand total (661,610)
Total bed days 2038/39: RPH (376,592, up 19%), CSRH (103,086, up 26%), RLI (187,495, up 21%), FGH (138,001, up 22%), WGH (27,001, up 23%), grand total (835,133, up 21%)

We do not expect that the New Hospitals Programme will address
the entire capacity shortfall. Patient flow improvements and realising our integrated care system ambitions for care closer to home are also expected to redress some of this balance. Indeed, a number of reviews have demonstrated that, with the right alternative levels of care available out of hospital, hospital bed days could be reduced:

At UHMBT, 28% of admissions and 61% of stay days could be managed in a non-acute setting if suitable alternative services were available, indicating scope for a large shift of inpatients to out-of- hospital care.
For LTHTr, 18% of admissions could be avoided if suitable alternative services were available.
30 to 40% of A&E attendances involved no investigation, with no significant treatment or had the lowest level of investigation and treatment; these could have been seen in an alternative care setting at Royal Preston Hospital and Royal Lancaster Infirmary.

However, transformation of services and public health policy alone will not address these challenges or drive fundamental change. A radical approach is needed, with investment in hospital infrastructure a critical enabler of this.

The Lancaster Royal Infirmary and Royal Preston Hospital buildings were not designed to care for patients with complex co-morbidities. The age, condition, and poor functional content of these facilities means that we cannot respond even to existing pressures on demand. We need modern, flexible and adaptable infrastructure that will be able to accommodate future demand and enable the transformation of services.

"The recent pandemic has taught us key things about our estate, including flexibility. Whatever the solution, we must build in the ability to be flexible at the point of care.”

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