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Darent Valley Hospital

Category: Hospitals

"Without PFI we wouldn't have a brand new hospital at all and with PFI we got the design we wanted and we had it delivered on time."

Mike Balcombe, Director, Corporate Services

May, 2003

Dartford and Gravesham NHS Trust was the first contract to be let under the Private Finance Initiative and as such it played a leading role in developing the primary legislation and helped shape subsequent PFI hospital projects.

The £177 million deal was closed in 1997 and the hospital became fully operational in September 2000.

The PPP Forum interviewed Mike Balcombe, Director Corporate Services, Dartford and Gravesham NHS Trust, Brian Semple, General Manager The Hospital Company (Dartford) Ltd and Henry Stanley, Facilities General Manager, Carillion Services Ltd, Darent Valley Hospital.

Would they have done things differently if they'd known then what they know now?

Mike: "Looking at it from the Trust's point of view, if you ask me whether we would have done anything differently I have to say I don't think we would. If you were to ask me whether it's successful here, whether it has worked, I would say yes it has. If you were to say is the design right is the lay out right or would you do it differently, the answer is that's it's as right as we could have foreseen at the time it was designed. It's inevitable that the health service will move on and the NHS will come up with new plans and different requirements. Hence we're actually considering an expansion at the moment to build a new Diagnostic and Treatment Centre. But certainly in terms of: are the right departments in the right place? Are the wards working well? Does the overall configuration work? The answer to that is a very positive yes."

Henry: "I think the partnership has worked well from the start. I think because it was the first PFI and the NHS were coming at it from their side and the private sector were coming at it from their side, I think it took quite a while for confidence and trust to establish itself. It has done now and it is very strong and I think people involved in new PFIs tend to hit the ground running because of the work we did here. There was a sense at the beginning in which we all felt that we had to draw up a contract because it would be the contract that would protect our interests. But out of that conventional contractual relationship, the partnership grew and if the team here were building another hospital they would have the benefit of that partnership being established from day one. But because we were the first PFI we had to evolve and develop that relationship and there was nothing really like it around at the time."

Mike: "Certainly when we started there was nothing else to compare with so there was a lot of midnight oil being burnt and lots of discussions with advisors about whether we were going about things in the right way and all sorts of things were exercising us that weren't terribly important and maybe some of the more important things were not really grasped and dealt with. But because we are in a partnership and because we are supporting one another's values it has worked particularly well in this case."

The brand new 422 bed facility replaced three older hospitals and the move from three sites to one was completed within 60 days. The new hospital serves a local population of around 225,000 with a full range of acute hospital and outpatient services.

Brian: "It was remarkable that it took just sixty days from handing over the building to having everyone working in it and the others closed. There was much more to do than just moving people in. All the doctors and nurses and other staff needed to learn how the new facility worked and understand where everything was and how it all fitted together. We've all worked in the health service for a long time and we've seen that a new hospital can take 6 months to commission. To do this in 60 days and keep all the services running was a remarkable effort. It's things like those six months of commissioning that people forget when they say we should go back to the traditional way of doing things."

In 1999 the National Audit Office reported that the contract was likely to deliver the services the Trust wanted and was likely to deliver additional non-financial benefits such as a faster timetable and innovative design. In 2001 the hospital won first prize in the Construction News Quality in Construction Awards. So how much say did the clinical staff have in the design of the new hospital and how do they enjoy working in it?

Mike: "Each of the Clinical Directors and Directorate management teams were involved from the start. We showed them the initial designs and asked them to tell us about the functional relationships in the building. We needed to know which bit of the hospital they wanted in which position and that part of the process was clinically led. So we've got the A&E on the ground floor right at the centre of the hospital, we've got radiology next to it which is very sensible and there's a discrete lift which takes you up to the ITU and operating theatres. Certainly a lot of their thoughts went into that. But we also needed put a cap on their thought process because under PFI you can't keep changing your mind. So as the design process went on we actually requested each of the clinical teams to sign off at each stage and the end result was a pleasing one for the doctors and the nurses and the other members of staff."

Brian: "I think you've actually got more flexibility in PFI than in conventional building because the envelope of cost has already been decided. These are very long term relationships and the builder is ruled by the investors. With the conventional methods the contractors are very happy to accept more design changes because they make money out of the variation. But with the fixed price the builder will say well we can do that but then we can't afford to do the other, so we did make changes up to the last moment but they were within the overall cost envelope."

Another benefit of this deal according to the National Audit Office in 1999 was that it should give the Trust the opportunity to concentrate on clinical services rather than building maintenance and support services. I wondered if this theory had worked in practice?

Mike: "Trust management view is that life is easier under PFI because Henry and his team manage the facilities for us. We don't have to worry about backlog maintenance and if we have any problems with FM we just pick up the phone and Henry or one of his team are there so it has allowed us to concentrate more on the delivery of clinical services and pushing forward the national agenda on health care."

Henry: "FM provides one of the biggest improvements under PFI. Because we have a fixed price contract we're able to maintain the fabric of the building in a way that wasn't always possible in the past. Quite often we used to find that the FM budget would the first to be raided in times of crisis but now we have ring fenced money and a long term maintenance plan. Also it's in the contract that the people lending on the project will carry out checks to make sure it's being kept in good order.

Each year the Patient Environment Assessment Team check the standard of our hospital for general environment, our public facilities, our catering cleanliness etc. We started with a good rating but this year we've actually improved. Imagine that in any typical 30-year-old NHS building."

Mike: "For the Trust the bottom line is that we had applied for funding under the government capital-spending programme year after year and got nowhere. Without PFI we wouldn't have a brand new hospital at all and with PFI we got the design we wanted and we had it delivered on time."