The Lancashire and South Cumbria New Hospitals Programme (NHP) contends that the region has a ‘once in a generation opportunity’ to transform hospitals for 1.8 million local people by 2030. The NHP is the central pillar of a regional strategy developed by Lancashire and South Cumbria Health and Care Partnership (HCP), one of 42 Integrated Care Systems (ICS) constituted by the Conservative Government’s National Health Service (NHS) reform outlined in Integration and Innovation as the building block of services. The strategy envisions organising services as a ‘network’ comprising existing hospital sites and services as spokes which centre around a new world-leading hospital hub. However, rather than being ‘once in a generation’, this model mirrors exactly the intentions of the original architects of the NHS. The NHP is, in fact, a generation gap. The 2030 vision is the realisation of the model which planners conceived in 1948. This paper shows how the original 1948 model emerged and how, ultimately, it was rejected. The rejection was not due to clinical or service failings in the model, but to the rivalries and jealousies of hospitals, services, and universities. This history has several lessons for current health services leaders and the NHP.