Peter Dixon is the man in charge of a 拢422m PFI hospital in London. He has also written in a national newspaper that hospital PFIs have been a 鈥榗ostly failure鈥�. We invite him to explain himself 鈥� after which we get a second opinion from a woman with very definite views about the PFI 鈥�
It鈥檚 On budget, and it鈥檚 on time.
Demolition took place on a supremely difficult site 鈥� the Euston Road in the heart of London 鈥� and it brought not one complaint from the residents of the 130 neighbouring flats. Yet the 拢422m PFI University College London Hospital project has been one of the most criticised public sector projects of recent times.
Planning objections included criticisms that the 97 m high building, had a tacky and lurid turquoise-green finish. CABE said the design was at least a decade out of date. Rowan Moore, the Evening Standard鈥檚 architecture critic, described elements of the building, such as a Santiago Calatrava-inspired canopy, as 鈥減ointless鈥�, before adding: 鈥淚f the intention is to distract attention from the relentless blandness of the rest of the building, it fails.鈥�
If that wasn鈥檛 enough, the hospital is facing a judicial review over hygiene before it treats its first patients in May (see 鈥淎 case for treatment鈥�, overleaf). The result is that the hospital has become an exemplar of all that is wrong with hospital PFI projects 鈥� which, the critics say, are designed to save costs rather than patients.
If the chairman of the UCLH Trust is worried about any of this, he doesn鈥檛 show it. In fact, Peter Dixon, who combines this job with chairing the Housing Corporation, positively beams as he puts on an oversized hard hat and squeezes into his boots prior to visiting the site: 鈥淚 even told the secretary of state for health that this was a fantastic piece of construction,鈥� he says. The Amec-Balfour Beatty-Interserve consortium will be pleased.
Well, Dixon was hardly likely to tell John Reid that the government had wasted its PFI credits on a tacky, bland, obsolete turquoise-green monstrosity. On the other hand, he seems genuinely pleased with the aesthetics of the Llewelyn Davies design. He points out that the juxtaposition of the hospital with the neighbouring cruciform red brick medical school provides a 鈥渇abulous鈥� contrast against the clear blue sky of a summer鈥檚 evening. But this is a winter鈥檚 day.
A change of heart
Critics of the design contrast the hospital with Sir Michael Hopkins鈥� headquarters building for the Wellcome Trust next door. This is a stunning, supersleek building with a gorgeous glass sculpture cascading down seven stories above a pool of water at one end, overlooking 鈥� and, frankly, putting to stylistic shame 鈥�
the UCL hospital. Dixon concedes that the E E contrast is acute, but says this is explained by the differing financial resources of an NHS trust and one of the world鈥檚 foremost research organisations: 鈥淭he Wellcome Trust is a lovely building,鈥� he says. 鈥淚t was built almost without regard to expense. We wish we could do things to that kind of standard, but it鈥檚 unrealistic.鈥�
Besides, Dixon is keen to point out that 鈥渕atters of taste are just that鈥�. Shame, then, that the trust鈥檚 own chief executive, Robert Naylor, was another voice complaining about the colour of the facade: 鈥淗e took one look at it and asked 鈥榗an we change it?鈥�,鈥� Dixon chuckles, before adding, 鈥淲e had to tell him 鈥楴o, it鈥檚 too late鈥�.鈥�
And there鈥檚 the rub. It was too late to change anything because the PFI procurement process was so complex, and because the 35-year megacontracts were designed to minimise risk to the contractors. This in turn meant that Naylor could not order a different shade of Dulux. And it is part of the reason that Dixon used to be an opponent of the use of the PFI in health.
In 1997 he was non-executive director of Enfield and Haringey health authority, a position that he used to write a column for The Guardian in which he argued that the PFI in health was 鈥渁 costly failure鈥�. More recently he went on the record to describe himself as an 鈥渙ld-fashioned lefty鈥�.
PFI is very specific, very structured over 35 years. Whatever we want to do in 10 years鈥� time, we鈥檙e going to have to renegotiate
Yet here he is today, looking out of an upper-storey cardiac ward window and excitedly pointing out the sites that will receive PFI funding in later phases of the project.
He explains his change of view: 鈥淏ack in 鈥�97, nobody signed schemes 鈥� millions of pounds were being spent on lawyers. The point of the PFI set-up is to have a known level of cost so you know what you鈥檙e getting in to.
PFI has a very rigid framework. One reason why projects used to go over budget was that you could change things. If you wanted to change things here you would have profitability issues.鈥�
10 years later 鈥�
Dixon argues that profit needn鈥檛 squeeze out the needs of the patients. Even though four hospitals are being consolidated into one, the total number of beds will remained constant at 669. However, this has been achieved only by reducing in-patient care and treating more day cases.
He has been disappointingly guarded. Dixon has a reputation for frankness 鈥� so much so that he contradicts the flowery press releases of his public relations drones. But his next comment gives a hint that he may still harbour doubts: 鈥淭he jury鈥檚 out on whether or not it is expensive, but the PFI is the only game in town.鈥�
The argument develops in his mind while he walks, and he finally reveals his real concern: the rapid development of medical technology, and therefore the techniques for treating illnesses, means that hospitals must constantly evolve, and that is something that those
35-year PFI contracts and those risk-averse PFI consortiums may have difficulty with. 鈥淚 worry about potential inflexibility going forward. In 10 years鈥� time we know that we are going to want to change parts of the hospital. We鈥檒l have to negotiate a new contract after 10 years. PFI is very specific, very structured over 35 years. Whatever we want to do in 10 years鈥� time, we鈥檙e going to have to renegotiate.鈥�
An alternative
This is an extraordinary admission. Dixon is effectively conceding that an inappropriate procurement route is being used for perhaps the country鈥檚 most high-profile hospital scheme. He is saying that in 10 years, another costly negotiation process is inevitable 鈥� and when talks do begin in 2015, the firms that are managing the asset will hold all the aces.
Dixon seems to be finding his other role as chairman of the Housing Corporation a useful one to combine with his UCLH duties 鈥� not least because the corporation is situated next door on Tottenham Court Road. It has also helped him to develop a proposal for a procurement route to replace the PFI in health. 鈥淲e ought to think about the housing association model - banks lending against bricks and mortar and operational income,鈥� he says. This would mean that trusts would have greater control over their hospital schemes. 鈥淗ousing associations have borrowed about 拢30bn and no bank has ever lost money. Trusts wouldn鈥檛 have a 30- or 35-year timeframe during which they couldn鈥檛 change things.鈥�
Dixon concludes the tour by examining a nearly complete patient bay. He points to a nurse鈥檚 station and proudly announces: 鈥淭he stations are designed so that there are no barriers in front. Nurses are not going to be able to hide behind barriers, which means that they can engage with patients more easily.鈥�
Dixon may struggle to hide his doubts over the PFI, but he clearly loves the hospital it has built. He takes one last look at the bay and smiles: 鈥淚f I had to be ill, this is the kind of place I鈥檇 like to be ill in.鈥�
A case for treatment?
In November, architect Alan Spence lodged a judicial review with the High Court, arguing that the hospital beds, at less than 3 m apart, were too close together. The recommendation is that they should be 3.6 m apart to minimise the risk of spreading germs such as the MRSA superbug, thought to be responsible for at least 5000 patient deaths a year. If the review is successful, the hospital could end up with fewer beds.
The hospital was designed before the recommendations were published. Dixon says:
鈥淲e don鈥檛 believe that there is any substance to the judicial review. The logic of it is to retrofit that policy to every existing hospital in the country 鈥� you would lose at least 20% of hospital beds in the country.鈥�
He adds that microbiologists have approved the scheme and claims that bed spacing is relatively trivial in controlling infection: 鈥淩outine hygiene function is more important: how staff behave, washing their hands, air-conditioning and so on.鈥� Dixon points to several sinks. They are everywhere to encourage nurses to wash their hands.
Besides, he claims, hoist design is the reason for the narrow spaces. In most hospitals, the hoists move between beds, but here they run laterally, reducing the need for space. Dixon stands between two beds, stretching out his arms: 鈥淚s that enough space?鈥�
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