Rebecca Malin on how we developed our longlist of possible solutions

One question we’ve heard recently is how we developed our recently published ‘longlist’ of possible solutions for hospital facilities in the region. In this blog, I hope I’ve answered this by providing a clear window into the process we are following for this and other important stages on our journey towards new hospital facilities.

In leading decision making, our programme team’s role is to gather all the necessary information, experts and stakeholders together to help develop proposals. For every decision we make, including developing our longlist, we apply the following principles:

1. Decisions are led by the expert views of medical and nursing professionals assisted by non-clinical experts. They are informed by data and past experience of what will actually work.

2. Acceptable proposals must reflect national NHS requirements for new hospitals, for example they must include a greater number of single rooms, infection risks have to be taken into account in every stage of planning and environmental standards must be in line with the Greener NHS programme (opens in new window).

3. We are listening to and reflecting feedback from patients, staff, and representatives of our communities who often find it hardest to be heard, including the elderly, those with disabilities and minority groups.

4. All our proposals are developed in partnership with and agreed by senior NHS leaders and local authority health scrutiny committees across Lancashire and South Cumbria. This includes representatives and board members from all our NHS Trusts, primary care and GP representatives, the Integrated Care System leadership, NHS England and Improvement, and tier-one local authorities.

So what steps have we taken to develop our longlist of possible solutions for hospitals? 

Step One: Agree the problems we need to solve

Before we started to look at possible solutions, our first step was to agree what problems we needed to solve. This was the main objective for developing our Case for Change report, which was drafted based on expert input, staff feedback and patients’ experiences, and refined through a stakeholder workshop.

At this workshop, attended by clinicians, patient representatives, non-clinical staff and estates and finance experts, we presented our draft report and asked stakeholders for their views on the challenges faced and what those meant for the objectives of the New Hospitals Programme.

Following publication of the draft report, we then gathered further feedback from staff and the public using online surveys, workshops and focus groups. Listening to this feedback, and then securing sign off on the Case for Change report from our stakeholders and regional NHS leaders, meant that we had an agreed focus for the New Hospitals Programme’s work.

Step Two: Create a draft longlist of possible solutions to those problems

With clarity on the problems that the New Hospitals Programme must address, we developed a list of ten possible solutions to these – our draft ‘longlist’.

The first two proposals on the list reflected national NHS requirements to include ‘no change’ (which we have described as ‘business as usual’ in our longlist) and ‘limited investment’ as two of our alternatives.

The remaining eight proposals were made up of various combinations of building new hospital buildings on new sites, rebuilding on existing sites and refurbishments, each of which could potentially address the pressing problems with our buildings at Royal Lancaster Infirmary and Royal Preston Hospital. All these solutions would also include improvements to Furness General Hospital.

Step Three: Work with experts and stakeholders to refine and agree this longlist

The next stage in our longlisting process was to hold a formal workshop to discuss the draft list with a range of experts and stakeholders – patient representatives, Healthwatch, clinical and non-clinical staff (from hospitals and primary care), commissioners, NHS estates, finance, operational and executive directors.

During this workshop, we asked attendees to discuss and feedback on the list of possible solutions, and ultimately to help us reach a longlist that they could approve and which we subsequently published. This workshop was minuted and notes shared with the attendees as part of our formal governance process.

Step Four: Gather feedback from NHS staff, patients and local people

Gathering and listening to the views of those most likely to be impacted by possible changes – our staff, patients, local people and those from seldom-heard communities – is a fundamental part of our process from start to finish.

All our major decision-making points – our Case for Change report, published in July; the longlist of possible solutions for new hospital facilities, published in September; and the narrowed down shortlist, which will be published in the coming months – reflect feedback collected ahead of their development, and are then subject to further feedback gathered in a range of different ways. We’ve also been working closely with Healthwatch Together, the independent national champion for people who use health and social care services, with particular focus on those who find it hardest to be heard.

Most recently, we have been seeking views on the longlist from staff, patients and the public through a range of different forums and channels including:

• Market research interviews
• Public surveys on our New Hospitals Programme website
• Online discussions and workshops for NHS staff, Trust members and patient representative
• A roadshow, visiting cities and towns around the region, hosted by Healthwatch Together (opens in new window)
• Focus groups for community representatives, also hosted by Healthwatch Together 

Thank you to everyone who has shared their views and ideas with us so far at events, meetings and through our surveys. 

Step Five: Checks and balances

All proposals and programme stages are subject to strict governance checks, and so we will review our proposals with staff, senior NHS leaders, and local authority health and scrutiny committees, representing all areas of the NHS and all impacted communities in the region. This ensures we are held to account on the direction we are recommending for new hospital facilities, and also ensures that proposed changes will work within the context of wider health and community services in the region.

What's next?

Once these steps are complete, we will use all the feedback we’ve received to help us narrow down the proposals to a shortlist. We will make sure we continue to provide regular updates on progress and how to get involved so please do keep checking back.