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The Procure21 deal was supposed to offer a chosen few the opportunity to win projects from 600 trusts worth in excess of a 拢1.2bn a year. But a year after it was rolled out, some have not picked a single crumb from this cake. And as they鈥檙e paying 拢40,000 a quarter for the privilege of remaining in the framework, it鈥檚 understandable if some begin to question whether they鈥檙e getting value for money. On a 2.5% margin, say, they would need to be winning work worth 拢6.4m a year just to break even. Pearce this week became the first contractor to call it quits (see page 13).

Of course, it鈥檚 not in the gift of NHS Estates to ensure an even distribution of work. The trusts that use the framework can appoint whichever firm they like, and to date that鈥檚 mostly been Laing O鈥橰ourke. It鈥檚 up to contractors to ask themselves why that is. But even more frustratingly for the workless contractors, some of the trusts are not even using the framework at all 鈥� despite the Procure21 system winning praise from the hard-to-impress National Audit Office.

No doubt NHS Estates is as frustrated as the contractors. It has been encouraged by government to implement best practice, get projects up and running quickly and save money through the framework. But the government is also encouraging trusts generally to be more autonomous and entrepreneurial. In that sense, it鈥檚 a real achievement that so many have come on board, particularly considering the anarchic procurement base the NHS is starting from.

The truth is, though, many more must sign up if Procure21 is not to be abandoned by its 鈥減rivileged鈥� contractors. Hopefully, sceptical trusts will note the success of framework deals at the Department of Works and Pensions (page 14): it has saved 12% so far on the overhaul of its jobs centres and benefits offices. That鈥檚 a proper relationship in action. We need more of them.

Psychology for beginners

Is working on a construction site as traumatic as fighting a battle? The comparison sounds ridiculous 鈥� nobody shoots at construction operatives. But ask a worker who鈥檚 witnessed the death or maiming of a colleague, especially one who has developed post-traumatic stress disorder and turned to alcohol or drugs 鈥� then the comparison becomes valid. It does not have to be like this; employers such as the fire service go to great lengths to care for their staff鈥檚 psychological welfare. The construction industry鈥檚 support for its people, by comparison, is nonexistent (pages 36-42). Still, it鈥檚 a sign of how far the industry has moved away from its boys-don鈥檛-cry culture that bosses are at least prepared to listen to the case for counselling. And if they don鈥檛, perhaps the prospect of an appearance at court or an employment tribunal will change their minds.