Select Committee on Health Appendices to the Minutes of Evidence


  For the information of the committee, there follows a brief commentary compiled by the Private Finance Unit and the NHS Executive Northern and Yorkshire Regional Office in response to an article published in The Observer newspaper on 8 July 2001:

1.  The Atrium

  Allegation: there is no air conditioning in the Atrium, although there is plenty of space for rent-paying shops. Temperatures have reached 110 degrees leaving nurses and patients sweating profusely.

  Fact: In accordance with NHS Estates design guidance (applicable to both publicly and PFI funded buildings) there is no air conditioning in common areas such as the Atrium. All NHS hospitals rely on natural ventilation for such areas. Air conditioning in hospitals is normally confined to areas such as operating theatres and the Cumberland Infirmary is no exception.

  The temperature in the atrium can reach unacceptable levels on warm, sunny days in mid-summer. The private sector operator accepts that errors were made in design calculations and has agreed to install, at its own expense, electronically operated solar blinds which will alleviate the problem. These were installed during September and are now operational.

  The atrium design was not a cost-cutting measure. A similar design approach was adopted for the entrance area of Chelsea and Westminster hospital, a publicly funded scheme.

  The provision of retail outlets in public entrance areas is a standard feature of nearly all hospitals. They provide a service to patients and visitors and have the added advantage of providing the trust and private sector operator a source of income which is used to off-set the hospital's operating costs, thereby increasing the amount the NHS can devote to patient care.

1.1  Flooding in Cardiac Ward

  Allegation: (PFI) " . . . has meant cardiac patients drenched with water flooding from broken pipes . . . A fortnight ago the pipe above the cardiology ward broke, causing water to cascade down on seriously ill patients and around £300,000 worth of equipment."

  Fact: On 22 June 2001 a problem arose with a control unit to a water pump, as a result of which water began to drip through the ceiling in the coronary care unit. The problem was dealt with and repaired within the hour. Four ceiling tiles had to be replaced. There was no "cascade" of water and neither patients nor equipment were affected. It was a small incident which was dealt with promptly.

1.2  Raw sewage flooding an operating theatre

  Allegation: (PFI has also meant) . . . "sewage spilling out into the operating theatre . . .just the latest in a series of floods. At one point raw sewage spewed out of sinks across the operating theatre . . ."

  Fact: An incident occurred very shortly after hand-over of the building in April 2000 but before the area concerned had been opened to patients. As a result of human error, a bung used to block the soil pipe during testing procedures was not removed. This led to the soil pipe backing up such that wastewater appeared in washbowls in an ancillary room in a theatre block (not an operating theatre as reported). The bung was removed and the problem has not recurred. No operations had to be cancelled and there was no impact on clinical procedures. There was no flood, nor has there been a series of floods, it was a minor incident, typical of teething problems following the hand-over of new buildings.

1.3  Generator Failure

  Allegation: Nurses were ". . . left ventilating patients by hand as operations are plunged into darkness . . . Six weeks ago the operating theatre was plunged into near darkness because the emergency generator stopped working for 20 minutes. The lights went out and all the life support equipment shut down without warning. Nurses had to ventilate patients under general anaesthetic by hand . . . This was just the first time the generator failed. Soon after, the hospital was left in darkness for nine minutes. When The Observer visited, all the lights went out three times."

  Fact: It is true that, following a mains power supply failure, one of three stand-by generators failed, leaving part of the hospital without power for 13 minutes. The situation was an emergency and patients were put at risk, but there were no serious consequences because of the prompt and professional actions of hospital staff. Human error resulted in a switch on the control panel having been left in the "manual" position instead of "automatic". It is accepted that this arose because of poor maintenance work by an external contractor and inadequate monitoring by the PFI operator. NHS Estates have conducted a thorough investigation of the incident and have produced a detailed report, including recommendations for future procedures to prevent the problem recurring.

  No other instances of failure of the stand-by generators have been recorded by the Trust. Regular testing of the generators has been carried out, working closely with all clinical services.

  There are no reports of the lighting having failed at any time, other than the one incident referred to above. It is, however, normal for the lights to go out from time to time in the main concourse. This occurs, automatically, not because there is a problem, but because sunlight introduced through the glass atrium provides adequate light without the need for electricity. The power supply then automatically switches off to save energy. It comes back on again if needed. This may be what the Observer reporter experienced, but it is not possible to verify this, as the reporter did not ask the trust for an explanation at the time of his visit.

1.4  Broken equipment; second rate maintenance; engineers made redundant

  Allegation " . . . the operating theatre has also been out of action because the sterile services department, which is responsible for cleaning equipment, stopped working. The washing machines are cheap and inadequate—there are not enough of them and they break down all the time....In the old hospital there was an engineer who looked after the autoclave ovens, but he was made redundant to cut costs. When all three broke down there was no-one to repair them . . ."

  Fact: Far from having a poor reputation, the sterile services unit at the new Cumberland Infirmary is regarded as a model example. NHS Estates use it as a reference site for visits by other NHS Trusts seeking to implement best practice.

  In June 2001 a problem with compressed air did lead to the autoclaves being out of service for four hours while specialist contractors carried out repairs. The work was carried out within the required timescale set out in the PFI contract and it did not have a significant impact on clinical procedures.

  Equipment breakdown and repair is a routine occurrence in hospitals. Maintenance staff are on hand to carry out repairs. There has been nothing out of the ordinary at Carlisle in this respect. The washing machines referred to were in fact supplied by the trust, not the private sector, using the NHS Purchasing and Supplies Authority to source the equipment. Exactly the same equipment would have been installed no matter how the hospital had been provided.

  It is correct that two technicians formerly employed by the trust had to be made redundant, but they had declined after an offer was made to retrain them to deal with the new equipment. In addition, the maintenance of autoclaves is now provided by equipment suppliers under contract, using engineers specifically trained for this purpose. The PFI contractor now employs six persons instead of the two made redundant, so overall there are now more staff on site. All repairs have been carried out to time.

1.5  Bed Shortages

  Allegation: ". . . in a bid to reduce costs, the hospital was built small. There are 90 fewer beds than in the hospitals it has replaced, and there is a chronic shortage of beds. The bed manager was told . . . to take patients out of bed and put them in an armchair for a few hours so their bed could be used temporarily for another patient undergoing surgery . . ."

  Fact: The overall reduction in bed numbers is 10, not 90. The attempt to link reductions in bed numbers with PFI is not new and is fallacious. The specification for the number of beds in the new hospital was laid down by the NHS before the current government came to power in 1997. At the time it was assumed fewer beds would be required as a consequence of changes to patterns of care. This has nothing to do with PFI and applied equally to publicly funded hospitals. Current procurements are required to comply with the NHS Plan, which did not exist when the new hospital in Carlisle was first designed.

  The allegation regarding use of armchairs is absolutely untrue.

1.6  Flea infested laundry

  Allegation: The laundry is flea-infested.

  Fact: Untrue. The basis for the allegation is an incident nearly 12 months ago when a doctor alleged that bites on his legs had been caused by the presence of fleas in "theatre blue" garments which had come freshly laundered. The suggestion that live fleas might have been present in clinically clean garments which had been laundered, sterilised at very high temperatures and packed in sealed containers is not sustainable.

1.7  Dirty Wards

  Allegation: PFI has meant dirty wards because of the cutback in cleaners.

  Facts: There were initially some failings in the standards provided by the cleaning service, which is provided by the private sector. The service is regularly monitored by the trust and the failings have now been addressed . The service provider has recently been achieving category A service standards for the cleaning services—the highest marks available.

1.8  Waiting times for treatment

  Allegation: (PFI has meant) ". . . dying patients remaining undiagnosed as waiting times doubled . . ."

  Facts: Completely untrue and the article makes no attempt to substantiate it.

1.9  No storage space for records

  Allegation: there is no storage space to hold medical records and copies of X-rays.

  Facts: When the new hospital was designed, it was assumed that, by the time it opened, the Trust would have moved to an Electronic Patient Records system in accordance with NHS policy. For reasons totally unconnected with PFI, this has not happened as quickly as anticipated and the trust therefore has a short-term requirement for storage space which is being addressed. This does not indicate poor design or a problem with PFI—the design was based on assumptions, which were reasonable at the time and, in the longer term, remain valid. There is no point in the trust building new facilities, which become redundant a few years after the hospital opens.

1.10  Times for examination of X-rays have increased

  Allegation: The waiting time for radiologists to examine X-rays has risen from two to seven months. It should take 10 days.

  Fact: X rays. There is not, and never has been, any delay in the examination of x-rays, which are required for the purposes of clinical decision-making. NHS procedures also require the preparation of a formal radiologist's report before the x-ray can be archived. 90 per cent of all reports are currently finalised within 10 days. In common with many other hospitals, delays have arisen in the submission of some reports as a result of staff shortages. The administrative process of relocation to the new facilities may have contributed in part to the delays, but this was unavoidable and has had no clinical impact.

1.11  Wards are too small

  Allegation: ". . . space saving means the wards are so small that the doors would not open without banging into beds. Resuscitation trolleys were too big to be able to get into the wards and they had to be specially rebuilt at a cost of £180,000"

  Fact: There were problems with the original design of bed spaces on wards, which have now been resolved by minor additional works. Since the trust approved the clinical suitability of the original design, it has had to pay for the costs of the alterations.

  The allegation regarding the resuscitation trolleys is untrue. There has been no problem with the resuscitation trolleys, which are a state of the art design and are smaller than the trolleys which were used in the old hospitals. The new trolleys provided for the PFI hospital have not had to be replaced or modified in any way.

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