Caroline: Hello and welcome to the Innovation Agency podcast. I’m Caroline Kenyon, and in this episode I’m following up on the latest developments in the New Hospitals Programme for Lancashire and South Cumbria, after the announcement of a shortlist of options for major investment to transform healthcare in the region.
I’ve come to Chorley and South Ribble Hospital to talk to three of the people leading the New Hospitals Programme in Lancashire and South Cumbria.
Hello to Jerry Hawker, Som Kumar and Jane Kenny. Could you please introduce yourselves and tell us a little bit about your role?
Jerry: Hello, my name is Jerry Hawker and I am the Senior Responsible Officer for the New Hospitals Programme. My responsibility is to oversee the whole of the programme. My background is working up in Morecambe Bay, but now very much working across Lancashire and South Cumbria to see the New Hospitals Programme successful.
Som: Hello, I’m Som Kumar. I’m a Consultant Cardiologist, working at Lancashire Teaching Hospitals and I’m the Programme Clinical Lead for the New Hospitals Programme for Specialist and Elective Services.
Jane: Hello my name is Jane Kenny and I’m Lead Nurse on the New Hospitals Programme. My substantive role is as Associate Director of Nursing within University Hospitals of Morecambe Bay and I’m very much involved with the clinical aspects of the programme, for ensuring patient and staff engagement.
Caroline: Great thank you. It’s great to meet you all, and to come to Chorley to talk to you at quite an exciting stage, I think, for the Lancashire and South Cumbria New Hospitals Programme.
Jerry, if you can talk us through it, the announcement. You’ve just announced a shortlist of options for the New Hospitals Programme, which you are going to talk through in this podcast. How does it feel first of all, reaching this stage?
Jerry: Well it’s very exciting really. You have to go right the way back to June last year, when we launched the Case for Change. So much work has happened since there, engaging with our staff, with our public, with people with special interests – all bringing in their views around which of our long list of options are the best ones to shortlist. We have now completed that, so are very excited to be able to announce now the shortlist of options that we will take forward for the New Hospitals Programme.
Caroline: And the big news, I think, is that you’ve ruled out one of the options, which is building a big ‘super hospital’ to replace both Royal Preston [Hospital] and [Royal] Lancaster Infirmary. Can you tell us why that is no longer on the table?
Jerry: Yes, well the new hospital built somewhere between Lancaster and Preston was clearly one of the options on our long list, and we had much feedback from across all our different stakeholders. There clearly were some benefits in terms of some of the clinical services, but there was an overwhelming concern around the distances that people would have to travel and whether that would create greater inequalities in Lancashire and South Cumbria, which is something we are very keen to ensure that we reduce not increase, and that was an overwhelming driver behind our reason to exclude that option.
Jane: I mean we’ve had in excess of 12,000 responses around the options on the long list and I think the majority of people had concerns about travel and accessibility, and keeping local what is important to them, and that really reflects the shortlist that we’ve now arrived at.
Som: I would like to add that, although we have ruled out a single geographical location of a ‘super hospital’, there will still be an enormous collaboration between the various centres, in fact across the ICS for the New Hospitals Programme. So yes, whilst we are not going to be on a single site geographically, we will still be connected very much.
Caroline: You’ve also ruled out the option of rebuilding both [Royal] Lancaster Infirmary and the Royal Preston [Hospital] on their existing sites, is that because of the costs or the logistical difficulties?
Jerry: It’s really a combination of both. We’ve done the very thorough work looking at the costs to rebuild on the existing sites and the simple reality is it’s actually more expensive to build on the existing sites than it is to build to onto new sites. Part of that is the level of disruption and the level of phasing that would have to take place trying to build on the existing sites, and we know that’s just not in the best interest of our patients and our visitors.
Caroline: So the options we are left with – and I’ll just summarise, you can correct me if it’s not quite right – but my understanding is that there’s an option of building two new hospitals on new sites, replacing both the existing Lancaster Infirmary and Royal Preston, building one new hospital on an existing site, as well as investing in improvements on the other site, or major investment in both existing sites without going for complete new builds. Is that right?
Jerry: That’s correct
Caroline: So what are going to be the deciding factors, and I’m sure there’s a long list, but what are the key deciding factors in getting to the final option?
Jerry: Well, we were very clear in our Case for Change around a range of what we called our major outcomes, our major benefits that we wanted to see from the programme. We have a range of Critical Success Factors that all will support us to make that decision.
Examples are very clearly around looking to improve the clinical services, how our clinicians work together across Lancashire and South Cumbria. The whole programme is very much about improving outcomes and reducing inequalities. And of course, a major investment like this, we want to make sure that the hospitals are as efficient and productive as they can be and become centres that really attract new workforce and our future workforce to want to come and work in Lancashire and South Cumbria.
Jane: I think the fabric of our buildings is inadequate, and that’s what we need to address. So it’s those areas that are really struggling at the moment, and have an impact on our patient experience and our staff morale, and that retention of staff as well or that attraction of staff. And it’s a really exciting opportunity we’ve got now too, to influence that. And the shortlist again, reflects those opportunities that we’ve got. I think in reality we’ve got buildings that weren’t even built in this century, and we know when it rains, that we will have an array of buckets around the site, that our departments aren’t located where we get those real clinical efficiency and quality. And, you know, that staff at the start of their day, they know they’re going to struggle to park, and that’s an extra stress on their day. And we know from exit interviews that we’re losing staff because of that challenge. They struggle to arrive at work, and then they don’t want to work late into the evening, knowing that their vehicle is parked a distance from the site. And I think that this shortlist gives us an opportunity to almost address some of those Critical Success Factors that are really going to make a difference.
Caroline: And Som for you, as a Consultant Cardiologist, as well as being involved leading on this New Hospitals Programme, what do you think are the most important factors for you and your fellow clinicians?
Som: Absolutely I think Jane, you are spot on when you talk about the buildings not being meant to be delivering what they should in the modern day medicine world, medical world.
So we have to look for facilities which will support the clinical services.
So for example I have patients who have had tests done in Morecambe Bay and they come over to Royal Preston because of the specialist services. I cannot access them because we are not connected, and the firewalls and the system of digital infrastructure, they don’t allow these patients to be connected. Similarly people who are going into walk in centres in various places much nearer Preston, they’re having x-rays and procedures, which we cannot see, leading to duplication of results, delays with patient care, and this is going to be an enormous impact when we have a chance to overhaul the whole system and bring it together and that is what the New Hospitals Programme is supposed to provide, new facilities for the new era.
Caroline: So we if talk through the different options, one of them is building two new hospitals on two different sites, which sounds very attractive, doesn’t it? But is the cost of that going to be a lot more than simply improving the existing sites?
Jerry: Well of course, there is a difference between the costs of building two brand new hospitals and the cost of refurbishments. But costs are measured in many different ways, and that’s an important part of our considerations, thinking about what is the best option for us. The two new hospitals would enable us to reduce our costs of providing services, because they would be more efficient, more effective, we’ll be able to meet the environmental standards, and we’ll be able to design the rooms so that, both for our staff and patients, it’s easier to move round and the right equipment is in the right place.
We can do some of that with rebuilding, but of course we are on existing sites and there are limitations to what we can do on those existing sites. So there are different parts to the costs, which are important for us to consider as we start to work through that shortlist of options.
Caroline: And do you have any sites in mind for these two new hospitals, if that ends up being the preferred option?
Jerry: It’s too early to confirm what the sites will be. That is a key piece of work that we will be doing over the next few months, is looking at what the different site options are both around Lancaster and around Preston.
Caroline: What’s your views on two new hospitals?
Som: Yes I think, Jerry, you are right about we will be putting a price on each of these options, but price isn’t everything and the value needs to be considered: how long does it take for the hospital, that the money that we spend on facilities, to return on investment, and what is the equity of access? What do the new facilities bring to our patients and the local population. And attract more and more people to this area, because I’m talking about Preston here, which is providing the specialist services. My son, for example, is a Foundation Year doctor in Blackpool, and he told me Dad, if you’re going to build such facilities over here, I might stick around in the North West, which is a big boon to us.
Caroline: He’ll be typical of many, I’m sure.
Jane: I think just to revisit some of Jerry’s comments around the opportunity this provides and the different costs. I think you could look at both organisations, and we have departments that aren’t located to the same building, which means that we’re moving patients between buildings requiring them to go outside, which is an additional resource either through an NHS ambulance or a private firm. So, the costs incurred there, and we’ve heard horrendous waits of people at home, because there’s not enough ambulance crews. And then we end up moving people out of hours. So I think we did, we captured a period of time, where in three months, we moved 130 patients out of hours. And out of hours is after 10:00 o’clock at night. And if you look at our picture of our patients, there are our most vulnerable and the majority of people using our hospital beds are over the age of 70. So, we’re moving vulnerable elderly people out of hours. And of that 130 that we moved, at least 40 of them either had a diagnosis of dementia, or had some cognitive impairment or delirium. So the distress to them to be moved outside at night after being settled in a bed, I don’t think you can put a monetary value on, and then the impact to their journey, their pathway within our services, as well as all of those additional costs that you probably could put a price on, there’s that emotional. And the impact to staff, that pressure to be those people at the front door and we’re trying to move people downstream, it’s in a very emotional, stressful environment. And the ability to design a site that would allow that ease of flow is just…, the wins out of that are unbelievable.
Caroline: It does sound like a very exciting option, it has to be said. But so a second option is then to put major investment into the existing sites. What would you need to do there, how big a programme would that be and how big an upheaval would that be and what would the benefits be of that option, a major investment option?
Jerry: First of all that the opportunity to rebuild on the existing sites is still a really exciting, an amazing opportunity for us. As we’ve said earlier, the existing buildings are not fit for purpose, they’re not going to last into the future. They provide poor environment for our patients and poor environment for our staff, so the opportunity to refurbish and rebuild those existing sites is still a fantastic opportunity.
It also enables us to still build into that work some of the benefits of digital technologies, new medical practices, a significant advancement in terms of providing single rooms, a very big learning from Covid, so there are lots of really good benefits that are there from rebuilding on the existing sites, they’re just different to those that we could manage to gain from actually looking at two new build sites.
Caroline: And from the engagement you’ve done with staff and patients, what’s the response to that, sticking with what you’ve got, but putting in some large investment? What would you say?
Som: Well the staff engagement has been phenomenal. They are ultra-excited, because anything that we do is better than where we are at the moment, so that is much welcomed. Obviously we’re looking for the best that we can do with the resources that are available and that’s why we’re going through this long process of analysing the options and having bigger engagement. My peer clinicians, they are ultra-excited. And for those of you listeners, those of you who are getting on a little bit like myself, you would be excited to know that the New Hospitals Programme is not about buildings alone, it’s a wholesome approach to your health. And we are talking virtually every day with the Integrated Care System, the acute service providers, the community doctors to see how we can together bring about transformation in the healthcare in the region. So it is really a very exciting project.
Caroline: Can you tell me what you mean by that? If I’m a resident, an elderly resident in Preston or Blackpool or Morecambe Bay, what does that mean to me in terms of my day-to-day healthcare?
Som: So first of all you will have the opportunity to…, it depends on how you are accessing healthcare, so for example if you need the heart specialist, what is your current system? You go to your local GP, and the local GP will do some tests, and then he might find abnormalities in the test, and he may refer you, and that referral comes onto the system, it’s triaged, and then you’re given an appointment. So the whole process becomes tedious and then, when you walk into our clinic, we don’t have opportunity of reviewing the tests that your GP has done. The ECG that was supposed to be abnormal at your GP’s service may not be available because of the quirkiness of the system, as we are not sharing systems across the whole patch. So this leads to duplication of results, this leads to consternation, both on the clinician side and the patient side: my results are not available, my GP didn’t send across, but GP says I sent it, you didn’t get it, and I said no I didn’t get it, and then we duplicate tests, the results for tests can delay. Things like this are not going to happen in the new system, because of the digital interconnectivity.
Take the example of someone who is very sick and poorly in Morecambe Bay, in say Barrow in Furness hospital over there, there could be a virtual ward system, whereby a consultant from a remote place in Preston will be able to review him virtually over the net, because the facilities will be built in now and can make a diagnosis and support the local clinician who may be struggling with this patient. So those sort of things, virtual ward system, will be a regular part, not to talk about the zero carbon footprint that we going to embrace in our new facilities.
Caroline: What about the engagement you’ve done, Jane, with the nursing workforce as well as with the patients and public?
Jane: So just to carry on from Som for the public, one of the themes that have come through all of our public engagement, is the amount of travel our patients do to arrive at a site: the distress of trying to park, and then actually that availability of their diagnostic tests or the information. And they feel they’ve travelled for two hours, and then sit in a room and don’t have a hand laid on them, because there isn’t the right information for the consultation to progress. So that’s absolutely reinforced time and time again in terms of examples.
I think for staff they are, especially after the years that we’ve been through recently, we work differently. So we’ve already had a kind of a taste of what the art the possible is in terms of technology, and making it meaningful for patients and for staff. I think the possibility of this refurbishment, partial rebuild, of our site, allows us to increase the flexibility of our departments and Covid has really taught how constrained we are by our current buildings.
I think privacy and dignity, having, you know, adequate toileting facilities and washroom for patients, and equally for staff, for the staff to be able to get changed on site, and have somewhere where they build those therapeutic relationships with their colleagues. We currently don’t have any areas for any downtime for staff that are co-located to the departments, and I think those relationships are crucial really. And I think one of the aims of the New Hospitals Programme is the accessibility of single rooms. But we need those rooms to be able to be flexible, because for some patients being in a single room is quite isolating, and they want to mix with other patients. So I think the flexibility of the site and what digital technology could provide for people going forward, staff are really excited about.
Caroline: So, I’m getting the impression that, whatever happens in any of these options, these digital improvements, this different way of working, these better facilities for staff, that’s going to be provided whichever option you take. Is that is that correct?
Jerry: Yes very much so, yes.
Caroline: Great, ok. So the next option is, is it’s actually two options isn’t it, but it’s to rebuild of one of the hospitals on a new site and invest in the other?
Jerry: Exactly that is the option.
Caroline: How do you decide which hospital is going to have a new hospital?
Jerry: Well, clearly the work we will do over the next few months, will work through each of those options, they’ll look at the benefits, they’ll look at the risks through many, many different lenses. So through ultimately the most important is about how will it improve people’s outcomes, but how do the options improve our clinical pathways, how do they improve the way that we can network our hospital services. So there are lots of different things that we will need to look at in terms of these options. So it’s very early in the day to say one option is better than the other. Ultimately and, of course we have to look at taxpayers’ return, so all of those options will have to be assessed, not just for their patient benefit and clinical benefit and staff benefit, but benefit to the tax payer as well.
So the final thing to this, and I think it’s a really important one, is this is not just about building hospitals, it’s actually about how those hospitals work within a much wider system, not just in the NHS but with our wider partners, for the social values of these investments are much bigger than just about hospital facilities. And that’s going to be very important in looking at these options, working with the universities, working with the private sector in terms of partnerships around energy and carbon zero, lots of partnership opportunities around digital. So it’s very broad, very exciting and all this will need to be worked through, as we think about which of those options are the best ones for the future.
It’s worth pointing out that all of those options also include investment in Furness General Hospital up there in Barrow, which is a very important part of our overall hospital network.
And it’s also worth stressing that the New Hospitals Programme is not the only investment into our facilities across Lancashire and South Cumbria. Annually we are investing in new schemes improving our hospital sites. We have major programmes around community diagnostics, around elective care hubs, and these are continually, continuously improving and looking to expand on our hospitals.
Caroline: Whatever option you choose, what is going to be the impact on all the other hospitals in Lancashire and South Cumbria, for instance where we are now in Chorley and South Ribble or Westmorland General, for instance?
Jerry: I think both Jane and Som have made a similar comment several times, is that at the heart of all of this programme is about getting the right care in the right place. Over 90% of people’s healthcare is provided in their local community. What we want is to have great hospitals that can provide specialist care and the best care, when it’s the right time. So all of our hospitals across Lancashire and South Cumbria are an important part of that system, providing different types of care. So the future for Chorley, for Westmorland, for Barrow, Blackpool are all a very important part of this. The New Hospitals Programme doesn’t replace the importance of them, it actually adds to the benefit of how we build a system that really supports our public in the future.
Caroline: If anyone listening feels really strongly in favour of one of these options, how can they influence the decision making?
Jane: So we have a number of platforms that both our patients, staff and the public can access where they can give their views around which of the options they prefer and the reasons why. So, it’s really important that we capture that feedback. All feedback is good in terms of the options that we’ve currently got.
I think that also that we’ve actively sought the opinions of staff, not just on the Royal Lancaster Infirmary site or the Royal Preston site, we’ve done that much broader approach, and we have a number of workstreams on the programme. And the staff that are on those workstreams are recruited from right across our ICS, our integrated care [system]. And also we have patient reps and user reps on those workstreams as well, to really inform the work that we’re doing.
Caroline: Is there any difficulty getting people to voice their opinions, Som, where you work?
Som: I live in Chorley and I love the hospital to bits, and I can reassure you there is no difficulty in voicing opinion from this part of the world.
But, as a resident of Chorley, nothing beats a good hospital. So, a hospital which supports my needs and my family and friends’ needs is what we want. And I’m pretty sure every resident of the patch that we are working across, and this is the whole ICS in some cases, will endorse to that view. So there is no doubt that the best option, and it would not be out of place here to mention the enormous amount of background work and scrutiny that goes into every decision that the NHP takes – the New Hospitals Programme takes. There is a big communications team, there are external partners who will scrutinise and analyse data to come to the conclusions and take into account, as Jane and Jerry says, the views of the people that work here, the clinicians that work here. Huge number of clinicians involved in engagement programmes, regular meetings held every week with different subsets all across the patch, and also the views of the various managerial people like the Chief Executives, who represent their own hospitals, they are all taken into account. So it is an enormous programme, but very well scrutinised.
Caroline: I am going to ask each of you now, what is it that excites you most about the opportunities that we get to hear with this New Hospitals Programme? And I know there’s so many benefits that you described really well. But if you can picture yourself at say 10 years’ time – I’ve no idea how long it will take – but your working life in 10 years’ time, what excites you most about the potential?
Jane: I think it’s the quality of the patient care that we will be able to deliver and experience for staff. They are my top two.
Caroline: And yourself, going into work, what do you see that looking like?
Jane: I think I’ll be a user by then actually rather. [Laughs]
Caroline: [Laughs] Me too!
Som: Yes, I think Jane’s absolutely right. We are here because of our patients and that’s what a physician is for and nothing will beat that experience, that feeling. But for myself, to be able to walk into work on Monday morning and looking forward to a great week ahead in a great facility where were the flow will be easy, that’s a great thing to have.
Caroline: Jerry, what’s your vision of the future, what is it that you can see that excites you most?
Jerry: Well I think first of all is to be able to have a hospital infrastructure that we can all be proud of, whether you are a member of the public, whether a member of staff, that is a great facility that we can all love and admire, that delivers really great care. But I also have a real ambition for the future that the whole community can look at how this programme has benefited the whole of the Lancashire and South Cumbria system, that everybody had had a chance to gain from the benefits that this programme offers, which is so much more than just about providing hospital facilities.
Caroline: So what’s your call to action for people listening, whether they are residents or fellow staff, what would you be saying to them now?
Jane: To really get involved and make sure that you have your say your input about this programme, because we want to make it right for local people, that that’s the driver.
Som: I think that’s the right message. There are various ways in which people can get involved, staff can get involved, and more of that will come out from Comms team in due course. That is the key to delivering services by ourselves, for ourselves.
Caroline: And Jerry, you’re the man who is in charge of all the processes. How long is this going to take and how soon will it be, do you think, before we get to that final option?
Jerry: Well, the government has committed to the programme is to say that the hospitals will be built by 2030. We are hoping that, working with the government, that we will start building by 2025. That seems like a long way away yet, but it’s going to come very, very quickly. Lots of work to do there. So, I’m very much looking forward to the next few years, and as they’ve said, it’s really engaging with everybody to get behind the New Hospitals Programme and to share your views.
Caroline: That’s great, so exciting to hear and so good to hear from all of you. Thank you for sharing all those thoughts and experiences, and there are links in the podcast notes for anybody to get all the latest information and to the many different ways of having a say, including a survey, so thank you Jerry Hawker, Jane Kenny and Som Kumar.
Jane: Thank you.
Som: Thank you
Jerry: Thank you
Caroline: Whether you work in healthcare or you are a resident in Lancashire and South Cumbria, please do take part in this very important debate by contributing your questions and comments. You’ll find links to the relevant webpages in the podcast notes. Thank you for listening.