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Prospect Park Hospital

Category: Hospitals

"Our relationship with the PFI partner has been very positive. They recognize the need for flexibility and respond well to our need to change and adapt to meet the needs of patients."

Philippa Slinger, Chief Executive, Berkshire Healthcare NHS Trust

February, 2007

The building of a new mental health hospital to replace the existing unit at Fairmile Hospital, which was located in an isolated rural setting 15 miles from Reading, was completed in 2003.

The new, 203 bed Prospect Park Hospital in Reading provides care on behalf of the Berkshire Healthcare NHS Trust for the acute mentally ill, the elderly mentally infirm, intensive care and rehabilitation patients and those with learning disabilities, accommodating their privacy and dignity at a level never before achieved in Berkshire.

The PPP Forum interviewed Michael Trayford, Trust Project Director, and Nikki Kirk, the Trust’s PFI Performance Manager.

Why was there a need for a PFI project to redevelop the old Fairmile Hospital?

Fairmile was a large Victorian institution for the provision of mental healthcare for the population of Berkshire. It was old, impersonal. It lacked dignity, it lacked privacy, it needed to be modernised and the services needed to be closer to the population it served. And the PFI route was the route of sourcing finance.”

Michael brought along several photographs illustrating the deteriorating fabric of the old buildings.

These photographs show that what was built on the old Fairmile site just looks awful, like an eyesore. The old site was horrible – some of it was awful, ghastly stuff. These photos represent old Fairmile, what we were trying to get away from.

As you can see from these photographs, there is evidence of lack of privacy, dilapidation, poor state of buildings, an old 1960s block that had been boarded up, a cold unwelcoming entrance to an acute ward…it ended up being a maintenance nightmare. The fabric and surfaces were poor and it was hard and expensive to maintain. It was located in the wrong place and it was completely impersonal.

We wanted to achieve safety, dignity and privacy – for example single rooms – and for the hospital to be closer to the population it served – to make it easier for relatives to visit and for patients to interact with the community around them. We also believed it would be easier for us to recruit staff – it had become more and more difficult to recruit. And I think we have achieved all those.”

Was the project delivered on time?

Our contract was with the project company who had to deliver us this 203 bed Mental Health Hospital for a given sum – around £30 million. So we looked to them to deliver it on time – which it was. Financial close was signed on a Friday and construction started the first available day afterwards - they were ready to go. We then had a phased transfer of our services from Fairmile to Prospect Park in a way that suited us. It was relatively straightforward – working with the builder discussing design and development issues, managing Trust variations of which we had several. When the deal was done in 2001 it reflected thinking then, so when you get to 2003 your thinking starts to change.”

Did the PFI project provide enough flexibility for the Trust?

I would say that overall, yes. We had some variations and the builder absorbed those with no impact on the timescale. It cost us to achieve them – but we expected it to. The process worked for us and it didn’t impact on the service delivery date, and the builder didn’t want any additional money to undertake the extra work within the same timetable. They wanted money to do the work, but not for the potential knock-on affect on its ability to deliver the rest of the contract. So that worked.”

How was the handover managed?

The biggest impact in terms of the patients was going to be with the faces they saw every day – the domestic and catering staff. We got the FM partner to work with us in the existing hospital before we moved and they started delivering services before we moved to the site here. This meant that when the patients came to the new site they didn’t have the shock of having brand new faces delivering services on top of the shock of the move.”

Do you think that PFI helps the Trust get on with its primary aim - the delivery of clinical care?

Our Chief Executive is keen on the delivery of the facilities and the fabric of the facilities through the PFI route, because it leaves us to concentrate on our core activity which is the delivery of clinical care. All we have to worry about is making certain that the contractor is providing us with our required outputs. This means that we can concentrate on our core activities and we won’t sit here with a deteriorating asset, which the NHS sometimes does do - it doesn’t quite allow or build into its figures the ongoing maintenance. There’s a downside to all of that though - if we don’t need to use it at all we’re still committed to the unitary charge. We’re still developing a more community based service, an ongoing process. As a result we have been able to vacate a 35 bed ward, and we’ve managed to sub-let it to another client care group in the NHS to cover our costs.”

Is the project approached as a long-term partnership between both parties?

Definitely. If you didn’t you would just be battling every single day. So yes it’s fine. We like to say we never need to refer to the contract because that often means the relationship has gone wrong. The contract is a living contract that just reiterates and confirms what we all expect of each other so we shouldn’t be frightened of referring to it, which we have done. We haven’t beaten each other over the head with it too much. That happens now and again, but not too much – just because we want to make certain we get what we’re supposed to get, and pay no more than that.”

What do you think about PFI?

There are ideological arguments about PFI being an expensive way of getting to where you want to. But as far as we’re concerned, we’ve defined what outputs are required, we know what it’s going to cost us, we’ve got it, and we’ve got it now. And I know, and everyone knows, that the NHS’s ability to deliver hospital projects is pedestrian. They didn’t have a very good track record of being on budget and on time. It’s the issue about risk transfer - we’ve transferred over the risk that the hospital is delivered at a certain time at this price. The project company has taken on board that risk, and if we didn’t get the hospital delivered as we wanted it, the financial penalties would have been theirs, not ours. So there is a great motivation there. And I think it concentrates clinicians’ minds as well.

It’s about partnership. It’s such a cliché but it wouldn’t happen without the builder building it to a defined timescale, the Trust knowing what it had to do in terms of design development, with the FM partner who are going to be there subsequently to maintain it. Without all those three key people we wouldn’t have been able to build it.

For example, the builder would give us beneficial access before the end of the build contract so we could move some of our stuff in. This also meant that the FM provider was able to get access and start cleaning – to prepare the stuff for us to move in. Yes there were hiccups, but overall I think it worked reasonably well. It’s about partnership working.”

Is there any advice you would want to pass on to other people about to undertake a PFI project?

You cannot be too careful and precise about what it is you actually want to be delivered and achieved. Ambiguity just leads to misconception, misunderstanding and cost. You want something that’s going to deliver recognised flexibility - physical flexibility, something that’s capable of adapting to change. I think we’ve got that here, based on the work we’ve had done subsequently.

I think that we wanted something that was safer, provided more dignity and provided more privacy. In the time we’ve been operating we’ve had just one suicide which is a phenomenal statistic for an acute mental health hospital.”