PFI HOSPITALS
Ian Dacchus said: “Several Trusts have already taken back their cleaning and other soft FM services through in-house bidding via the market-testing mechanism within the contract.”
Time can help resolve the challenge in a more effective way. The opportunity for rectification is essential. That opportunity is increased with time.”
JB: “I believe that in 2020 the NAO said that around 55% of all public sector authorities had ‘insufficient knowledge about the condition of their assets, which risks them being returned in worse quality than they expected’. Do you think there’s an issue with some of the larger (healthcare) estates where the data they have on assets held, and their condition, is not very good?” ID: “I think that – superficially – most of the data will be sound – with all the performance metrics provided for reports, joint audits, and inspections. Many of these are presented covering all the operating standards under PFI Schedules; thus standards for hard and soft FM services such as cleaning, portering, catering, security, and helpdesk provision, energy, and other elements, will have been provided for. By nature, these are things managed through the monthly, quarterly, and annual contract mechanisms of joint performance management, alongside the energy performance and the hard FM / maintenance performance. Those include issues that need rectifying, and come with response times. The condition of items and their lifecycle replacement are also worked on, because these factors present themselves via the nature of the parties working together managing a PFI hospital. So, if the flooring needs replacing every 10 years, it’s evident if it’s been replaced on that programme, and if not, there are agreements for adjustments to the lifecycle cost replacement. “What’s less evident is whether the
structure of the floor, internal roof void elements, fire compartments, and so on, were built to the required standard in the first place, and whether some of the more in-depth engineering services have been provided compliantly. That’s where you
36 Health Estate Journal June 2024
need to come in and actively take a look. If this hasn’t happened already, it needs to start. Lift those lids, and lift them early, is my advice.”
JB: “So you’d agree with another NAO conclusion – that the information on assets will be in a variety of forms, particularly given that when PFI first emerged, the digital world – as we know it – didn’t exist. There’ll thus be quite a lot of hardcopy documents, as well as digital data. So, presumably the earlier Trusts teams are gathering such information, the better?” ID: “I would be less worried about the quality of the information, nor that a lot of it is being relied upon to be provided by the consortia. That’s their role, and the contract again deals with exit mechanisms for providing that information in the right format. The significant issue is the amount and the complexity of the information, and a Trust being able to assess and assure itself that what is being provided is correct. The contract is designed within the PFI schedules for all of that responsibility to sit with the consortia, with an accompanying audit and management approach from the Trust side, and pre-agreed forums and governance, and reporting and contract regimes set in. For the handback process, someone needs to take the lid off and have that deeper look, with that specialist knowledge.”
JB: “Do you think there’s a risk that the amount of work involved in some
‘‘
handbacks will stretch already pressured hospital team resources to the limit? Could this impact service delivery, or do you think that as long as they plan well ahead, Trusts will manage it?” ID: “Again, we return to the expertise from specialists supporting Trusts, and the significant benefit of the IPA’s PFI Centre of Excellence – as a support. The Centre has suites of documents to guide Trusts through that process. They’ve got detailed guides, information, and questionnaires. I think it’s now recognised that the pre-handback processes need to be undertaken robustly, making good use of that support for local teams. The centre’s raison d’être is those concerns from the National Audit Office that many people that have been involved in PFIs were aware of – and it’s starting to help Trusts address them. “It’s not, however, viable realistically
for every Trust to have an expert team of sufficient size, and with the specialist skillset required, for that specific period to deal with the handback of their hospital. The next big question, however, is: ‘How does the NHS and the Trust / hospital manage and operate its facility once it’s handed back?’ That really is one of the bigger issues that also needs focusing on in terms of central support for their effective management, and especially the adequacy of ongoing funding. How do we ensure that the hospitals ‘handed back’ continue to be maintained in the right condition for the next 30 or 40 years, and don’t start deteriorating and joining the existing backlog maintenance debacle we’ve had for the last 30 or so? That’s the other challenge right around the corner. We can see it ahead on the road already.”
JB: “The NAO has recognised that – as it puts it – ‘transitioning service delivery and staff from a private operator to the public sector requires careful planning to avoid service disruption’. Do you think this will be a big challenge?” ID: “It’s a challenge the NHS is very experienced in – having seen the compulsory competitive tendering introduced in the early 1990s, followed by market testing and various different ways of ensuring best value in terms of outsourcing and then insourcing. We’ve also had shared services – so we’ve extensive experience in the NHS of the transferring out and transferring back
There could have been 20 or 30 dedicated people dealing with the clinical planning design, capital and construction, and negotiation with all the different parties, while the consortia would have also developed their own team
AdobeStock / nimito
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