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Three years on, the bad publicity shows little sign of abating. Last February, the Commission for Health Improvement, an NHS inspection body, criticised the cramped conditions and "considerable clutter" in the wards. It castigated the NHS trust for lack of leadership, a charge that provoked the resignation of chief executive Nick Wood. The staff union, Unison, rubbed salt in the wounds by publishing its own withering 10-page dossier entitled Angry Voices Reveal Truth About New Cumberland Infirmary. These "angry voices" belonged to hospital staff, and they complain about faulty plumbing, leaking roofs, lack of storage and the PFI company's exorbitant charges for building alterations.

The hospital management dismisses much of the criticism as muck-raking by a union committed to overthrowing the whole PFI system, and the building defects are, it says, teething problems that were resolved years ago. Alan Davidson, the NHS trust's project director, claims the hospital has now "settled in", and Martin Bennett, projects director for the PFI joint venture of Amec and Interserve, says facilities management has now reached "a steady-state environment".

However, walking round the hospital, a visitor quickly senses the palpable malaise at its heart. But it is not the large new building itself, which is attractive enough with its red-brick cladding and light and airy internal mall, that strikes one as defective. It is the morale of the staff within it. And those building problems that do still exist have been exacerbated by a festering stand-off between staff and management.

According to Linda Weightman, a convenor for Unison, "Staff are seriously demoralised and undervalued. It has a very negative effect, and turnover is quite high. More than 490 nurses have left since the hospital opened, and there are a huge number of job vacancies." As a result, she says, union membership has risen from 300 to 1600 members out of a total of some 2250 staff working in the hospital for the trust and the PFI company.

Weightman blames poor management in both the NHS trust and the PFI consortium. "The trust was formed in 2001 out of two hospitals 50 miles apart, and nobody was taking decisions. It had a seriously detrimental effect on staff and strategic direction.

"And as for Interserve [the facilities management arm of the PFI joint venture], they are appalling employers. Their unofficial slogan is: 'If you don't like it here, get out.' People are sick and tired of complaining about the way they are treated. But there's nothing we can do, so we have to put up with it."

Bennett accepts that an "us and them" attitude prevails among staff. He adds: "Our main challenge is to develop a true partnership spirit with the trust and to challenge negative perceptions."

As well by abysmal human resources management, staff are alienated by the cramped, dingy working conditions in the building. Many administrative offices and consulting rooms are airless, windowless internal spaces. As a result of chronic lack of storage space, medical records have accumulated into tottering piles of paperwork on desks. The restaurant has been relegated to the lower-ground floor, with only a bare lightwell to look out to. And in the kitchen, the creative activity of cooking has been deskilled into the drudgery of putting ready-made meals into walk-in fridges and reheating them on trolleys.

Pamela Boyd, manager of the shockingly congested medical records office, reveals the consequences of excluded the end-user from the design process. "During the design stage, we were told: 'You are not a priority, so don't tell us your problems.' When we eventually got in and I saw the lack of bookshelves, I was stunned. We were never consulted about this building, so we will not take responsibility for it."

As for the facilities management contract, awarded to Interserve, this is governed by a self-monitoring system of quite amazing comprehensiveness. It is also an astonishing confidence trick played on the hospital. Performance in 10 categories, including catering, cleaning and estates management, is continually monitored 24 hours a day, seven days a week, with each category producing a box full of data each month. The results are printed on a "performance scorecard matrix". However, as Bennett admits, the scorecard appraises response rather than output 鈥� that is, whether staff turned up to inspect a fault within a given time, rather than whether they put it right. As a result, Interserve regularly walks away with performance scores of 100%.

Carol Johnston, who keeps an eye on Interserve's self-monitoring system on behalf of the NHS trust, says: "I see maintenance jobs that have not been finished, but they don't show up on the system. For instance, I reported a hole in a partition caused by a trolley a while ago, and it hasn't been fixed."

In 2001, the endoscopy unit's two administrators, Anne Nixon and Denise Whitehead, were moved into a poky, stuffy, windowless office that had been converted from a consulting room. "We phoned the helpdesk two or three times," says Nixon. "Someone comes and nothing is done. Interserve did turn heating off, but now there's no ventilation. They put a fan in, but papers fly everywhere. Now we just leave the door open, or it would get too stuffy."

Bennett counters this criticism with the assertion that there are "very few" complaints about the building. "We take very seriously every complaint," he says. "I don't think the PFI has compromised healthcare in the hospital. I think it has improved it. Since the hospital opened in April 2000, all medical facilities have been 100% available."

Alterations to the building carried out by Interserve do not come cheap, and the NHS trust is already in the red to the tune of 拢3m. There are no current building rates or menu of agreed prices in the PFI contract, but Weightman estimates that it costs 拢10 to put in a single screw. When it comes to more ambitious alteration proposals, the NHS trust's project director Alan Davidson explains another problem. "If you want a variation that would cost 拢25,000, you would need a change order from the PFI company. They would then need to inform their funders, and their advisers would have to ensure due diligence. So you could end up paying an extra 拢8000-10,000 in fees alone."

Despite these problems, the NHS trust's Davidson is proud of the new building, which "was designed with the future in mind", he says. "It's a flexible building, with dry-lined walls, wide-span structure, modular wiring and generous floor-to-floor heights." He adds, rather less convincingly, that the "teething problems" could have occurred under a conventionally procured building and should not be blamed on the PFI system. But he does admit that, with all its bureaucratic processes, the PFI contract is inflexible. This, combined with the chronic antagonism between management and staff, militates against the building being used to its full potential.