Feedback from the Case for Change was analysed, and a longlist of proposals to tackle the problems outlined was drafted. The longlist was announced in a blog post from the Senior Responsible Officer for the New Hospitals Programme, with information shared through external and internal communications channels.

As part of the longlisting process, a formal programme workshop was held on 4 October 2021 to discuss the draft list. Attendees included: patient representatives; Healthwatch; clinical and non-clinical staff; commissioners; and NHS estates, finance, operational and executive directors. During this workshop, participants reviewed the list of possible solutions and made recommendations to the Lancashire and South Cumbria New Hospitals Programme Strategic Oversight Group for approval and onward endorsement by the Lancashire and South Cumbria Strategic Commissioning Committee.

The longlist recommended by the workshop and endorsed by Strategic Commissioning Committee was as follows:

1. No change
2. Limited investment to address all estates backlog maintenance
3. New Royal Lancaster Infirmary on the existing site, with partial rebuild / refurbishment of Royal Preston Hospital
4. New Royal Preston Hospital on the existing site, with partial rebuild / refurbishment of Royal Lancaster Infirmary
5. New Royal Lancaster Infirmary on a new site, with partial rebuild / refurbishment of Royal Preston Hospital
6. New Royal Preston Hospital on a new site, with partial rebuild / refurbishment of Royal Lancaster Infirmary
7. Investment at both hospitals, new Royal Lancaster Infirmary and new Royal Preston Hospital, allowing partial rebuild on both existing sites
8. New Royal Preston Hospital built on a new site, existing Royal Preston Hospital site retained for some services, partial rebuild of Royal Lancaster Infirmary
9. Single new hospital on a new central site to replace both Royal Preston Hospital and Royal Lancaster Infirmary (some local services to be retained in new integrated community centres in Preston and Lancaster)
10. Two new hospitals on new sites to replace Royal Lancaster Infirmary and Royal Preston Hospital.

What we heard: NHS staff, Foundation Trust Members, patient and VCFSE representatives

A third Big Chat conversation went live on 8 September 2021 and closed on 20 October 2021. 1,895 staff, Foundation Trust Members, patient representatives and VCFSE representatives expressed which proposals they liked and disliked, why they held those views and suggested new ideas.

Only three proposals saw support above 50%: two new hospitals to replace Royal Lancaster Infirmary and Royal Preston Hospital was supported by 83%; partial rebuilding work on both existing sites supported by 73%; and the proposal for a new Royal Preston Hospital built on a new site, existing Royal Preston Hospital site retained for some services and partial rebuild of Royal Lancaster Infirmary was supported by 54%.

What we heard: patients and the public

From 7 October to 13 November 2021, Healthwatch Together facilitated a programme of 16 public roadshows. Most participants were unaware of the New Hospitals Programme prior to engagement at the roadshow, indicating that public engagement of this kind was an effective means of expanding reach.

Key themes were:

• A strong preference for keeping hospital sites and services close to home (connected with a desire for the solution to be retaining hospital sites in their current locations)
• Significant concerns surrounding the possible location of a single hospital and the associated travel distances and costs
• Substantial interest in ensuring that transportation and access (e.g., parking) is improved as part of any refurbishment
• Positivity towards refurbishment of existing sites owing to it being perceived as a more sustainable solution
• Some concerns that services would be removed from Chorley and South Ribble Hospital due to investments in Royal Preston Hospital and Royal Lancaster Infirmary
• Some concerns about potential unintended detrimental effects on University Hospitals of Morecambe Bay NHS Foundation Trust and Westmorland General Hospital
• Hopes that Chorley and South Ribble Hospital and Furness General Hospital will also receive investment.

All research methods identified investment in current facilities as the preferred route. Under-represented communities and inclusion groups were the most sensitive to changes of location and are less inclined to support any proposal that would involve such a measure. The members of these groups are also sometimes sceptical that new hospital buildings will solve problems that they are already facing such as lack of interpreters, poor signposting, and shortcomings in patient-centred care.