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Queen Elizabeth Hospital, Greenwich

Category: Hospitals

"Our point of view is that PFI is beneficial because health service managers don't have to devote hours to the long term upkeep of the hospital buildings and the soft services. We have passed on both the risk and the hours needed to devote to non-clinical issues. I want to devote my time to the patients and staff, and this is what the PFI enables me to do."

Alan Perkins, Chief Executive

February, 2002

The PPP Forum interviewed Alan Perkins, Chief Executive of the Queen Elizabeth hospital in Greenwich. Mr Perkins has been managing the hospital since before the PFI took place, and so is well placed to assess the impact of the project on patients, staff, services and visitors.

"The first impression I had of the Queen Elizabeth was that it was welcoming and acccessible, with low level buildings in white and blue, surrounded by a surprising amount of grassland and space. The parking was easy, and the central reception was clean, without an imposing hospital feel. The receptionists were helpful, and although this was as busy a time as any for the hospital, it appeared unhurried and efficient."

Has the new hospital been a success with the public?

"The new hospital has undoubtably been a success. However, one of the issues with linking a new building like this to the benefits of PFI is that it is difficult to distinguish the benefits of PFI alone as opposed to the benefits of a new hospital procured under traditional finance. There was a benefit in innovative construction technology, which enabled the hospital to be completed more quickly. I am not sure we got a terrific amount of innovative design from the private sector concessionaire. Part of that was that Greenwich was unusual as it required 60% refurbishment and so retained the basic shape of the building. This has not been the case in other PFI financed new hospitals such as Norfolk and Norwich for example which were able to be more innovative in their design. However, we have created an integrated whole out of a disintegrated site, and staff and patients like the fact that it hasn't got a clinical feel; it feels much less intimidating than some older hospitals."

What have been the benefits of the new hospital from your point of view?

"There are many more clinical benefits, even though the former hospital was only finished in 1974. There are better amenities for staff and patients. It is a busy hospital but doesn't feel like it, and many people, both health professionals and public, remark on this."

Will the PFI route ever be repeated here with other projects?

"There is a second PFI deal underway with Toshiba to maintain and replace the medical equipment with state of the art technology over the next 15 years. This allows us to plan ahead with certainty."

What do you see as the main benefit to both PFI projects at the hospital?

"The private sector concessionaire needs to maintain the building for the next 30 years and that is part of what we are paying for. It lets us plan ahead. So we don't have to worry about securing capital for maintaining services and we can get on with running the hospital itself. This is the real benefit of PFI and a big plus for the NHS.

Medical and clinical staff also don't have to worry, because the long term contract brings certainty and allows us to concentrate on our jobs in running the hospital
."

What was the reaction of doctors and nurses to the PFI?

"The staff reaction was good regarding the new facilities."

Have there been any problems?

"We outsource all of the non-clinical support services. It is not working as well as we would like yet, but it is consistently improving. Like any new hospital project it is mostly teething troubles. We have had outsourcing in the health service for years. Again, some of the issues and problems that arise from this method of running non-clinical services are nothing specifically to do with PFI.

Car parking has been the biggest issue for the public. Part of the problem, which again is nothing to do with the concessionaire, is regarding planning consent. Planning for less car parking spaces was granted than the Trust wanted, so there have been problems with both staff and visitors. The new pay and display has also been an issue as some believe this can create anxiety
."

Did the transfer of staff run smoothly?

"This could have run smoother. Part of it is that PFI is a convenient vehicle for dissent, and the misinformation and scaremongering in the press can create concern. It is an issue with the ancilliary staff, as transfer to the private sector was difficult for them. Staff transferred in advance of the hospital being built in August 2000 (it was opened in March 2001) to give them a chance of working for new bosses. Although the concept was right it was thought that the concessionaire could have resourced training more adequately. Catering and portering have had teething troubles, which were felt by the staff."

How is your relationship with the concessionaire?

"We view this as not just a contractual agreement but a partnership. Our relationship with the concessionaire is a long term one. We meet regularly at meetings which I chair and these are extremely productive."

Some say that signing a long-term agreement for 30 years or so puts the public sector at a disadvantage. Do you feel that the hospital does not have sufficient control over the quality of the services provided by the concessionaire, and that you are hamstrung by a 30 year deal?

"Not at all. In fact, the performance regime for soft FM in our contract is probably too punitive! We need to have the ability to exert sanctions when services are substandard but we also need flexibility on both sides. I don't feel at all disadvantaged vis a vis the private sector - the performance regime is very hard for them.

It is a process of refinement as we both have experience of running the hospital, but I don't want to make running the FM side a bureaucratic industry in itself."

So do you think the PFI will be a success?

"Our point of view is that PFI is beneficial because health service managers don't have to devote hours to the long term upkeep of the hospital buildings and the soft services. We have passed on both the risk and the hours needed to devote to non-clinical issues. I want to devote my time to the patients and staff, and this is what the PFI enables me to do.

The relationship is definitely moving forward. The Jury is still out ten months in, on something that is to last thirty years, but it is working
."