'It's surreal to have to work like this': Royal Lancaster nurse explains why the city needs a brand new hospital

Yet almost 20 percent of the current hospital estate dates back to before the time at which the late Sylvia began her career as a midwife and night nurse.

It was around the time that her stellar 45-year service came to an end, that what is now the main Centenary building opened at the Ashton Road site in 1996. However, several wards are still located in separate, older buildings – with two thirds of all the facilities on the sprawling plot having been constructed before 1985.

Cherish, an emergency department nurse, has a natural affection for the corridors that her grandma once walked – but even that familial connection does not blind her to the fact that the hospital in its present form is “no longer fit for purpose”.

“It sometimes means having to book ambulances to move patients from one part of the hospital to another. That can cause a backlog in patient flow, but it’s also [about] the experience for the patient – we’re very committed to giving good care, but this is a real hindrance to us.

“Then there is the time that it takes – and sometimes you just think that [it] is quite surreal for a hospital to be spread across such a vast area, but also so many individual buildings,” Cherish said.

She was speaking as local NHS leaders await a decision on their pitch for the cash to fund brand new hospital facilities for both Lancaster and Preston.

As the Lancaster Guardian revealed last month, health service bosses have said that the ambitious aim is their “preferred option” from a shortlist of possibilities drawn up following a government pledge made in 2019 to replace or extensively refurbish 40 hospital sites across the country, a figure later upped to 48.

The alternative would be to partially rebuild both the Royal Lancaster and Royal Preston in their current locations or for one of the cities to get an entirely new hospital and the other to have its service substantially rebuilt where it now stands.

According to the “case for change” document produced to justify the requested funding, the cost of transporting patients within the Royal Lancaster site can hit half a million pounds a year.

Over one three-month period, there were 130 ambulance transfers out-of-hours, 28 of which involved patients with either diagnosed or undiagnosed dementia, delirium or cognitive impairment.

Even when a patient can be moved without resorting to an ambulance, they are likely to find that their trip across the site – whether by trolley, wheelchair or on foot – takes in one of the sloping corridors that result from the topography of the land on which the hospital stands.

“It can be very difficult for our patients to get around, especially those that have mobility issues – that can be really tricky," Cherish explained. "And these corridors are long, it’s not a two-minute job – it’s a walk to get to most places.

"It's also quite awkward to be able to get a bed going one way and one going the other on most of the corridors. There are a lot of what I call 20-point turns with patients on trolleys.

"Bed capacity is a whole other issue - but, generally, we are very cramped."

The age of the Royal Lancaster is a double-edged sword for the University Hospitals of Morecambe Bay NHS Foundation Trust which operates it. Not only has the site amassed an £88m maintenance backlog, but its running costs are also double those of a new-build facility.

Half of the estate has been assessed as requiring demolition, while the majority of the remainder will need refurbishment if it remains in use. Recommended space standards are not met in several areas – including the resus bay, which measures just 11 square metres.

Just 28 percent of beds are located in single rooms, compared to the 70 percent aspiration for a replacement facility, while A&E attendances are running at 60,000 a year – half as many again as the 40,000 intended capacity.

A hospital first opened in the Royal Lancaster's current location in 1896. Cherish, who was born at the facility and lives in Morecambe, says that she just wants patients at the hospital to get the best that the NHS has to offer.

Top of the list of benefits of a brand new hospital would, she says, be the ability for the Royal Lancaster to keep pace with the medical advancements that so impressed her grandma when she returned as a patient later in her life.

“She went for a CT scan after she broke her leg and she thought it was absolutely wonderful that we had all this machinery – she was overwhelmed with the technology and couldn’t believe that there was no pen and paper involved and it was all computerised.

“I think working on A&E, we do always look to the future and what’s coming [along] that we can use to benefit our patients. If we had more space and a building that could [better] hold this more modern technology, that would be wonderful.

“We send a lot of patients to other hospitals that are specialised in different things – if we had the space [for] more innovations to come into our hospital, we’d be able to treat them here….and serve our community in our community.

“I’d also love to see designated staff wellness areas – staffrooms where we can turn off on our breaks, sit down and be able to take five – because we need it."

Having experienced the Royal Lancaster as both nurse and patient, it is a wishlist of which Grandma Sylvia would no doubt approve.

‘TIME IS RUNNING OUT TO OPEN BY 2030’

The man leading the push for new hospitals in both Lancaster and Preston says it is entirely reasonable for the NHS in Lancashire to ask the government to stump up for two totally new facilities.

Pressed by the Lancaster Guardian about whether it was realistic to go for the gold standard in both locations, Jerry Hawker, senior responsible officer for the Lancashire and South Cumbria New Hospitals Programme, said that it was important to consider the backdrop against which the ambitious request was being made.

“It’s an area that covers towards two million people - and there have been no new hospitals built in Lancashire for over 30 years. The reason why I think it’s realistic is because of those sort of facts.

“If we had had another hospital built recently, then you might say [otherwise]. But the government commitment is for 40 new hospitals - both [Lancaster and Preston] are listed in there, so we’re still very much of the ambition that we need two new hospitals and the case stacks up,” Mr. Hawker said.

Lancashire and South Cumbria is in a cohort within the national new hospitals programme which is centred around a timetable for building beginning - in whatever form it might ultimately be approved - by 2025, with a view to any new facilities being open by 2030.

To that end, Mr. Hawker is hopeful that the region will shortly hear one way or the other whether its bid has been successful.

“The construction industry is incapable of building 40 new hospitals at once, so there has got to be an appropriate balance and you’ve got to get the right construction company, so I’m quite pragmatic [about timing].

“What I am saying, though, is we need a decision soon…as the timescales are now getting very tight for us to be able to complete this work and meet the government’s commitment of having it built by 2030.”

Before that decision is made, representatives of the national programme are set to visit Lancashire to see for themselves why local NHS leaders claim that the county needs such a significant investment in its hospital facilities. Although the estimated cost of two brand new buildings has not been made public, the Guardian understands that is likely to be far in excess of an indicative £1.1bn funding envelope provided back in 2019.

Jerry Hawker says he is looking forward to the planned visit, which he believes will prove even more persuasive than the written proposal that his team has already submitted.

“I think it’s really important that people do come out and look - you can't write down the reality of what the hospitals are like and what it’s like to walk round them if you’re a patient or carer or a member of staff.

“We can still make a big step forward with [the alternative proposal of] partial rebuilds, it just wouldn't be anywhere near the same. You've got to look at this [as] being a 40-50 year return on investment.”

If the green light is given to either one or two brand new hospitals, a formal public consultation would have to be carried out first - most likely next year. As part of that process, proposed sites for the new facilities - which the Guardian understands are close to being finalised - would be put into the public domain.

The NHS has engaged a land agent to cast the net for sites within a ten-mile radius of each of the existing Lancaster and Preston hospitals. Mr. Hawker said that the distance range was a reflection of the difficulty of finding a suitable plot for such a substantial development.

“It’s easy to say you could build it here, here and here - but it's much more complex than that. Radiotherapy centres effectively have nuclear bunkers, so the ground conditions and the utilities have to be right.

“But there’s always going to be the focus, [as] we've seen from the public reaction, [on] a site having good access and good transport [links] - and obviously wherever you put it, there will be people who are winners and people who think that they are losers.

“So we’ve got to find the right balance [and] it’s important that people realise you can't just build a hospital anywhere.”

The overarching plans to date have already been informed by extensive public engagement undertaken over the last 18 months - to which more than 15,000 people have contributed, with their preference being for the same new-build options that NHS bosses have now put on the table.

A survey remains open until midnight on Monday (31st October) for residents to have their say on the blueprint for the future of hospital services in the region.

“It’s fantastic to see the overwhelming support there is for two new hospitals - it’s not surprising, but it’s really encouraging and reinforcing to see that the public recognise that we really are at a point where those hospitals need to be replaced.

“It’s only with us now stating what our preferred option is that I think it starts to feel real with the public. They can almost touch it and feel it, rather than it being something hypothetical,” Mr. Hawker said.

PARKING PROBLEMS

The case for change describes parking availability at both hospitals as "desperately insufficient".

"Car parking is consistently highlighted as a concern in our feedback from staff and patients. At Royal Lancaster Infirmary, there are 460 spaces for the 2,809 staff based there, with limited park and ride facilities," the document notes.

Royal Lancaster nurse Cherish Otoo says that her hospital's location means that there are no other options for parking in the vicinity - for staff or patients - once the car park is full.

Royal Preston A&E consultant Michael Stewart recognises that the inadequate number of spaces also poses a real problem for patients.

"One of the worst things for a patient is if they know they’ve got an appointment for [say] 10am, they arrive at 9.30, thinking there is plenty of time and then 25 minutes later they are still circling the car park - it just adds to the stress for them."