North by North West: The good, the bad, and the overlooked

There was mixed news in the long-awaited ‘new hospitals programme’ announcement, which now includes four big schemes in the North West.

On the positive side, Leighton Hospital was formally accepted into the programme along with several others built in the 1970s with reinforced autoclaved aerated concrete planks that have more than outlived their lifespan.

This had been expected for many months and was an economic no-brainer, as Mid Cheshire Hospitals Foundation Trust has been spending up to £30m a year on remedial works just to ensure the building structures are safe and don’t collapse.

Reconfiguration unlocked

The situation in Lancashire and South Cumbria, which has two schemes in the programme, had been more uncertain.

What leaders were primarily hoping for was a green light on their preferred option to build two new hospitals, replacing each of Royal Preston and Lancaster Royal Infirmary.

Although nothing was formally announced on this by the health and social care secretary, NxNW was told local leaders received firm assurances two new hospitals would be funded, rather than just major refurbs of the current sites. L&SC felt confident enough to issue a press release saying it could now go ahead with the preferred option.

This is particularly significant for Lancashire Teaching Hospitals FT, which runs Royal Preston, because it should finally unlock the door to reconfiguring services with Chorley and South Ribble Hospital.

It’s been accepted within the NHS for years that Chorley’s small accident and emergency department is unsustainable, but closing the service and consolidating staff at Preston became politically impossible when Chorley MP Lindsay Hoyle, a long-standing opponent of the plan, was elected Commons speaker.

However, if A&E services can instead be consolidated at the promised new hospital in the Bamber Bridge area, between Chorley and Preston, this would likely win the backing of Mr Hoyle and other politicians.

Chorley would then be developed as a cold site for surgery and other elective services.

The bad news for L&SC is both schemes have been pushed beyond the 2030 deadline that was originally set by NHP. But given the complexity around the reconfiguration element, this had always looked likely regardless.

Deleted outburst

The fourth North West scheme is North Manchester General Hospital, from which Boris Johnson first announced the “40 new hospitals” pledge back in 2019.

Things looked good for NMGH initially, with lots of early funding secured for designs, planning, and enablement works.

But national leaders’ subsequent insistence for standardised designs, and dramatic cost inflation in the construction sector meant the brakes were firmly applied during the pandemic, and there’s since been an aggravating lack of clarity around funding and timescales.

Staff were hoping to get more detail and certainty last week, but heard nothing from the health secretary, other than to reconfirm the existing 2030 ambition. They now fear that seven RAAC hospitals have jumped ahead in the queue.

Matt Makin, the often-outspoken medical director at NMGH, had tweeted before the announcement: “When will rebuild start, what is the financial envelope? If we can’t have these answers, it begs the question ‘what exactly has the new hospital programme delivered for us after meeting after meeting…?’”

When Steve Barclay then made no mention of NMGH and said the RAAC hospitals would be prioritised, Dr Makin exploded: “This is an utter betrayal of the people and staff of [NMGH], an absolute volte-face on what we have been led to believe by the New Hospital Programme who have been gaslighting us for 4yrs, & demonstrates that Conservatives cannot be trusted on any commitment they make.”

It’s unclear whether the RAAC hospitals are now officially ahead of NMGH in the queue, but Dr Makin deleted the posts after a conversation with the comms team at Manchester University FT.

The trust instead issued a statement saying they “very much welcome” confirmation NMGH remains in the programme’s “by 2030” cohort, adding: “We are awaiting further details on progressing our development of a full business case for this vital healthcare facility, but we hope to get going as soon as possible.”

The frustration in north Manchester is understandable. Much of the hospital was originally built as an old Victorian workhouse and patients and staff routinely have to endure mouldy walls, damp, cramped waiting areas, theatre closures, and Nightingale wards that easily overheat.

The Crumpsall hospital serves one of the country’s most deprived communities and, in terms of patient and staff wellbeing, it should arguably be the first on the programme to get rebuilt.

Overlooked

But then, at least NMGH is in the programme.

Around 20 other schemes in the North West were bidding to be included in the NHP – along with dozens more nationally – but they’ve all been overlooked and will have to now pray for further opportunities. Who knows how long that will take.

Those bids included complete rebuilds of Stepping Hill in Stockport, Warrington General, Liverpool Women’s, the Clatterbridge campus in Wirral, and the University Dental Hospital in Manchester.

Part-redevelopments were also proposed at Royal Bolton, Tameside General, Wythenshawe, Royal Oldham, Countess of Chester, Aintree, Southport, Wigan’s Royal Albert Edward, and Macclesfield General.

Bids from mental health trusts included a full replacement for Ashworth high secure hospital, new facilities in Bury and south Manchester, as well as part redevelopments of the Edenfield Centre in Bury, and the Soss Moss site in East Cheshire.

Leadership review

Away from the NHP, the Care Quality Commission is set to start a formal “well-led” review at Bolton FT, after receiving a series of whistleblowing claims about the provider’s leadership culture.

NxNW understands inspectors also went in unannounced last week to examine children’s and young people’s services.

This was partly because the well-led review needs a service inspection alongside it, but also to check progress on previous concerns in the service, as well as new concerns received by the regulator.

Remaining outliers

The ambulance handover crisis has eased in recent months, but there are still hotspots where local leaders haven’t yet found a solution.

Frustrated ambulance crews told NxNW around 160 “hours” were lost at Blackpool Victoria in a single week towards the end of May, which was half the total across the whole of the North West.

Consistent long delays have also been reported at Arrowe Park and the Countess of Chester since the turn of the year.

Each were asked why they remain outliers, given pretty much everyone is struggling with A&E pressures and discharge problems.

Blackpool said it has had to close ambulance triage cubicles temporarily due to ongoing building work, and it was disproportionately affected by the five bank holidays due to its tourist population. It also said the situation improved at the end of May.

Wirral said its performance was “directly linked to high bed occupancy and the above national average numbers of patients without a criteria to reside”, but that improvements are being made, including a new A&E department and ambulance receiving area.

Chester said it was having to balance handover delays with “risks across the urgent and emergency care pathway within the hospital” and has made recent efforts to improve discharges.