“The hospital seems to be continually in a beds crisis” – stroke nurse, Norfolk “the doors cost as much as £1,000 each, and are an accident waiting to happen” – UNISON rep Worcester “this building is not going to last”; “it’s cheap and nasty” engineering services worker, Hereford; “whoever heard of a kitchen without windows?” Norfolk and Norwich catering worker; “the path lab flooded three times in 18 months, twice with raw sewerage” UNISON, convenor – Carlisle.
These are the voices of NHS staff talking about their experiences of working on the front line in Private Finance Initiative (PFI) hospitals across the UK. A new report* from UNISON, the UK’s largest health union, examines in detail life in nine PFI hospitals and paints a damning picture of the effect of PFI on patient care and staff.
UNISON wants the Government to carry out an independent review into PFI, to establish if it is delivering and whether it represents value for taxpayers’ money. PFI is the subject of a number of critical motions at the unionÕs Health Group Conference held in Harrogate next week (Monday 7 – 9 April).
Dave Prentis General Secretary of UNISON said:
“The Government are sticking their heads in the sand about the growing financial costs of PFI. But if they won’t listen to us when we say PFI is failing miserably, perhaps they will listen to staff on the frontline. They are telling us loud and clear it is not delivering improvements in patient care and it is not benefiting staff.
“The report is a damning indictment of the whole PFI process. It is tragic that such a large and welcome hospital investment programme should have produced such universally poor results.”
The report is based on a series of interviews with nurses, porters, cooks, cleaners and admin and clerical staff. A number of key issues came up time and time again:
Bed shortages
One stroke specialist nurse in Norfolk and Norwich University Hospital said, “The single biggest thing for nurses is the constant bed crush. A porter in Worcester “The other day I had to collect a dead patient from a ward. They said hurry up we’ve got somebody here to go into that bed.” And from a nurse at the Hairmyres Hospital “compared to the old hospital they are trying to shove patients out quicker.”
All of the first-wave PFI hospitals are desperately short of beds, putting nursing staff under pressure to discharge patients more quickly. Several of these hospitals – all opened since 2000 – are looking to build new extensions, or resorting to the use of Portakabins, old buildings that should have been demolished, or local private sector beds to bridge the gap in capacity.
Reduced levels of patient care
A staff nurse at the Cumberland Infirmary in Carlisle reported “The room in outpatients where the patient had his cardiac arrest was so small they couldn’t get the equipment in.” In Worcester Acute Hospital one nursing assistant complained, “cleanliness here is a joke. Domestics have a lot of work to do in a short space of time. They clean toilets and clean the wards, but their first job of the day is to make patients’ toast.”
Most support staff are concerned about the reduced level of care they are able to give. Domestics work unpaid extra hours to clean wards and complain they are still not able to clean to their satisfaction. Catering staff resent the fact that they don’t get to cook anything any more, and cannot take more time to help patients eat their food.
Poor design and quality
From Hereford Hospitals NHS Trust a privatised engineering services worker with over 20 years experience in the NHS remarked, “It’s cheap and nasty. The boiler house opened with no water treatment plant and we had a temporary boiler stuck outside on a trailer for 6 months. A UNISON rep at the Edinburgh Infirmary said, “We have had several roof collapses so far and we are not even a year in.”
All of the buildings visited were riddled with structural and design problems. Estates staff were universally scathing about the quality of most of the materials and fittings that had been used – refuting any idea that the private sector would “engineer in quality” to hold down maintenance costs.
Financial problems
A UNISON rep in North Durham Hospital said “the PFI deal is costing the Trust £12m a year, index linked and it’s a 27 year deal.” In Baglan, Neath and Port Talbot, Wales, there are concerns about the secrecy involved “there hasn’t been any of the transparency that the Government has promised. We still do not know how much is being spent on this scheme”.
All the Trusts visited were facing extremely serious financial problems, partly through the costs of PFI and partly as a result of the pressure on front-line capacity. Some had lost vital nursing staff and were struggling to recruit and retain enough permanent staff to avoid running up hefty agency bills.
* The PFI Experience – voices from the frontline – researched for UNISON by John Lister, London Health Emergency.
