Kevin Lavery on the New Hospitals Programme

Kevin Lavery, Chief Executive of NHS Lancashire and South Cumbria Integrated Care Board, explains his vision for the transformational change needed to deliver health and care services in the future.

The Integrated Care Board (opens in new window) is the NHS organisation responsible for joining up health and care services, improving people’s health and wellbeing, making sure everyone has the same access to services and gets the same outcomes from treatment, and overseeing how money is spent and making sure health services are working well and are of high quality.

In this blog, Kevin talks about the progress that is needed to support the NHS in Lancashire and South Cumbria’s ambitions for the future of healthcare in parallel to the development of two new hospitals on new sites to replace both Royal Preston Hospital and Royal Lancaster Infirmary, with investment in Furness General Hospital. By then, we need to have transformed the way we deliver services to fit the growing needs of the population to manage the demand for health and care services.

The need to reset

What we need in the period between now and when we begin the design of the new hospitals, is to reset our system and reinvent to promote a community-focused approach, with more prevention and better use of our health and care partners. If we do not change the way we deliver services, we will have an unaffordable challenge.

In Lancashire and South Cumbria, we currently have a running budget of £4 billion, with 60% of our money spent on hospitals. We have some key drivers of this, such as people over 85 with multiple long-term conditions, a generally ageing population with greater health need, increased demand and longer waits for treatment as a result of long Covid, population growth, poverty and the cost-of-living crisis.

This is why we need to press the reset button now. We need to look at a major expansion over the next few years of hospital at home care (virtual wards - opens in new window). In fact, we need to start thinking about how we can deliver a virtual hospital for people living in Lancashire and South Cumbria.

We would be talking about significant expansion of intermediate care - the temporary care that people who have been in hospital, had an illness or suffered a fall may need to help them get back to normal and stay independent. We need a dynamic model so that people do not end up institutionalised in care. A system that aids early discharge from hospital, using care to get people back into the community as soon as possible, or to get them appropriate support to avoid hospital admission in the first place.

The emphasis will need to be on population health (opens in new window), primary care interventions targeting those patients who most need it based on the risk of them developing serious illnesses / conditions and the very frail elderly. It is forecast that the population of people over 85 with multiple long-term conditions is due to increase significantly in the next decade.

If we do not change our delivery model, we will not be able to provide the care that will be needed by our population in the 2030s and beyond. Approaches like the Jean Bishop Integrated Care Centre in Hull and East Riding (opens in new window), are the kinds of examples of integration that we quickly need to explore and find ways to implement in Lancashire and South Cumbria, at pace and at scale.

The need for tough decisions

Although the way we are set up to deliver care is the reason behind our challenged financial situation, we do need to change our approach to health and care because without change, outcomes and care for our residents and communities will only get worse.

We know that the scale of cuts is significant; for the ICB alone we are being asked to cut our running cost allowance by 30% by 2025/26.

As Irish playwright, George Bernard Shaw, said:

“Progress is impossible without change, and those who cannot change their minds cannot change anything.”

All the decisions we make will be backed up by the evidence that shows that the quality and safety of our services will not be compromised, and that certain communities will not be unfairly disadvantaged by those decisions.

We are committed to engaging, involving and consulting our residents and communities. In July 2023, we revised our strategy for working in partnership with people and communities (opens in new window), which builds upon engagement with public and partners throughout the past year and with support of the Public Involvement and Engagement Advisory Committee (opens in new window). We have processes in place to involve and engage, and our working in partnership with people and communities strategy will support with keeping the public, patients, carers, staff and partners informed and involved in service change and transformation including how we reach and involve those who are affected most by health inequalities.

The fact remains, we cannot continue the way we are. We must make difficult choices and we will have to stand by those choices when challenged. This does not mean that we will never review our decisions, but we must continue to make these choices in the best interests of our residents and communities. That is the only way we will be ready for our new hospitals.