Select Committee on Health Minutes of Evidence

Memorandum by Consort Healthcare (Durham) Limited (PS 7)


  Consort Healthcare (Durham Limited), "Consort", is a 50/50 joint venture dedicated PFI concession company formed for the Durham project by The Royal Bank of Scotland plc and Balfour Beatty plc. Both shareholders have extensive portfolios in various sectors of the PFI market, including healthcare. These include a further joint collaboration in the New Royal Infirmary of Edinburgh and Medical School, currently under construction.

Main Sub-contractors

  Construction—Balfour Beatty Construction Limited/Haden Young Limited.

  Non-clinical Services—Haden Building Management Limited (HBML).


  1.  OJEC Advert placed—December 1994.

  2.  Five organisations pre-qualified—May 1995.

  3.  Consort pre-qualified to bid as one of two bidders—September 1995.

  4.  Consort appointed Preferred Bidder—March 1996.

  5.  Contract financial close—March 1998.

  6.  Construction commencement—April 1998.

  7.  Doctors' Residences Completion—6 August 1998.

  8.  New Trust Headquarters Completion—7 October 1998.

  9.  Phase 1A Construction Completion—30 November 2000.

  10.  Phase 1B Construction Completion—12 February 2001.

  11.  Full Service Commencement and Clinical Operation of Phase 1A and B—2 April 2001.

  12.  Phase 2 Construction Completion—9 July 2001.

  13.  Commencement Clinical Operation Phase 2—7 August 2001.

  14.  Phase 3 Construction (external works) Completion due—30 November 2001.

  15.  Completion of Concession—March 2028.

  All key construction and operational dates have been met.


Phase 1A

  Eleven theatres.

  Accident and Emergency Department.

  Coronary Care.


  Maternity and Gynaecology (in-patient and out-patient).

  Paediatrics (in-patient and out-patient).

  Pathology, Pharmacy, Mortuary, main kitchen, Energy Centre.

  Total 22,000 square metres.

Phase 1B

  Radiology (including CT and MRI).

  Gynaecology Out-patients.

  GUM Clinic.

  Total 9,000 square metres.

Phase 2

  Main Entrance and Reception.

  Main Out-patients.

  Shop Areas.

  Medical Records.

  Rehabilitation Department.

  Physiotherapy Department.

  Medical and Surgical Offices.

  Total 9,000 square metres.

Phase 3

  Car Parks.

  Road Infrastructure.

  External Landscaping.

  Refurbishment of Retained Buildings.

  Total Hospital Area (including Plant Rooms and Service Areas) 45,000 square metres.

  Total Beds 476.



  Consort is responsible for the design, construction and funding of the facilities followed by the provision of the non-clinical services in the new District General Hospital for the concession period, some 30 years after Financial Close.

  Service operations began on completion of clinical commissioning of Phase 1A and B with the transfer of Trust non-clinical staff to Haden Building Management under TUPE provisions.

3.2  Transitional services

  From Construction Completion, during operational and clinical commissioning of each phase, Consort was responsible for providing the following services in each completed new phase:

    —  security;

    —  access control and co-ordination;

    —  cleaning;

    —  estates management and maintenance;

    —  health and safety co-ordination;

    —  provision of approved persons for medical gas and pressure systems; and

    —  management of internal and external signage.

3.3  Operational services

  From the Full Service Commencement date, Consort was responsible for the provision of the following services to the entire Dryburn Hospital site:

    —  catering (both patient and restaurant);

    —  portering (some patient movements, equipment and general duties);

    —  cleaning (of circulation areas and departments);

    —  security (both manpower and CCTV);

    —  central telephone operators (24 hours, seven days per week for a range of trust sites);

    —  linen/laundry (operation of a sewing room and full hospital linen service);

    —  grounds maintenance (of the whole site, including car parks and landscaped area, winter safety measures and litter-picking);

    —  estates management (planned and reactive maintenance for the new hospital and the old retained buildings);

    —  provision and management of the full facility including energy, mechanical and electrical services, environmental controls;

    —  provision of approved persons for medical gases and pressure systems; and

    —  car park and traffic management (public and staff).

3.4  Additional Consort responsibilities

  Throughout the operational phase of the project Consort is responsible for the following:

    —  life cycle replacement programme for the new hospital to maintain specified standard over the project life;

    —  management of health and safety relating to the services and integration with Trust procedures;

    —  procurement and management of non-clinical insurances for the UHND site; and

    —  development and support of new facilities and services to meeting changing Trust requirements.


  Fixed price and programme for construction.

  Fixed price for all non-clinical services (subject to indexation and periodic market testing).

  Full availability of the whole facility for the concession life.

  Full cost of all planned and reactive maintenance and life cycle replacement of building elements, plant and service equipment.

  Payment partially linked to patient volume.

  Land value underwritten by shareholders.

  Income from restaurant.

  Income from car park.

  Income from pay phone.


  The University Hospital of North Durham was built and opened for patients on programme in just three and a half years. The overall design and construction period was considerably less than that achieved historically for traditionally funded projects.

  The Consort solution utilised the layout and shape of the site to produce a building which blended in with existing woodland to produce a pleasant outlook from many patient areas. The design retained a number of key features of the Trust's own design but with some significant improvements. One of the most significant was to produce a hospital with only three main floors rather than six floors with a number of changes in level, as was the case under the original Trust design. This change significantly improved the functionality of the hospital.

  The relocation of the new building to the North of the site increased the redundant land to be made available for development, which enabled the shareholders to maximise their offer for the land which was used to reduce the charge to the Trust.

  The new hospital has been constructed only a few feet away from the existing operational hospital without any disruption.


  Concession period 30 years from 31 March 1998.

  Construction Capital Cost £70 million.

  Shareholder Equity and Sub-debt £16.8 million.

  Senior Debt £77.2 million.

  Annual Charges to Trust (as 1 October 2001):


  Annual charge increases with agreed indexation.

  Availability Fee is subject to deduction for areas declared unavailable.

  Service Fee is subject to deduction for poor performance.

  Services are additionally subject to periodic benchmarking and market testing.


  As the most recent privately financed hospital to commence operations, North Durham has, understandably, attracted significantly publicity.

  Regrettably, much of this publicity has been sensational and inaccurate. For the information of the Committee, there follows a brief commentary on the main negative issues which have been reported.

  1.  "Staff called a 999 ambulance to transport a patient from the old hospital to the new because no porters were available" Guardian 23 July/Newcastle Journal 24 July.

  This happened during the transitional period shortly after the Accident and Emergency Department moved to the new hospital andthe GP Out-of-Hours Service was still in the existing facility.

  The GP manning the Out-of-Hours Service, who was not a member of Trust staff, was not fully aware of how to request a porter and therefore rang an ambulance instead. Improved training and instruction has been provided by the Trust to all GPs using the Out-of-Hours facility.

  2.  "Ambulance bay too small" Newcastle Journal 24th July

  At the time the criticism was made, the Accident and Emergency entrance was being used as the temporary main entrance for all hospital activities.

  With the opening of later phases, which are now complete, there is a Main Entrance for patients, a separate entrance and waiting area for Non-Emergency Ambulances leaving the area outside the Accident and Emergency Department for emergency ambulances only. Even at busy times, all emergency vehicles can gain suitable access.

  3.  "Design of sluice areas such that staff have to drag foul waste through ward areas" Guardian 23 July/Newcastle Journal 24 July.

  The design and layout of sluice rooms, and the wards in general, were fully discussed and designed in conjunction with clinical staff and are fully in accordance with relevant Health Building Notes. This issue had not been raised with Consort prior to the article. The Trust have subsequently confirmed to Consort that they have no concerns over the layout.

  4.  "Unbearable heat in some wards" Guardian 23 July/Newcastle Journal 24 July.

  The hospital has been designed to be as "green" as possible and uses natural ventilation as far as possible. The new hospital is built adjacent to the existing facilities. The construction programme is based on a phased transfer from the old facilities to the new. At the time that the criticism was made, the old hospital was being demolished adjacent to the new hospital.

  To prevent any risk to patients from any emissions resulting from the demolition process, strict controls were put in place during the final stages of the construction programme. These included keeping windows in the new hospital closed. This clearly compromised the ventilation in the new hospital causing the high temperatures. This also coincided with a period of particularly hot weather in the early summer.

  The Trust installed temporary mobile air-conditioning units for the short term.

  5.  "New hospital has too few beds to cope with demands" Northern Echo July/Guardian 23 July.

  The number of beds within the hospital are as planned and requested by the Trust in its full Business Case in 1997.

  6.  "Generator failure plunging Operating Theatres, Intensive Care and Accident and Emergency into darkness".

  There has been no failure of the generators but there have been two occasions when mains power has been lost. On each occasion the standby generators have started and restored power within the required 15 seconds or less.

  7.  "Flood of sewage coming through the ceiling in Pathology" Guardian 23 July.

  There was an incident on Friday 13 April 2001 (Good Friday), 11 days after opening Phase 1. A blockage was caused by two pieces of wood lodged in a waste pipe. The blockage was finally cleared on Easter Saturday some hours after the call was first made.

  8.  "Pharmacy squeezed next to the mortuary without a waiting area" Guardian 23 July.

  The original design had the main Pharmacy Department located on the lower ground floor, where it now is, supported by a Satellite Unit for dispensing to Outpatients, which was to be located adjacent and convenient to the Outpatient areas, which included a waiting area. The Trust has decided to use the area of the Pharmacy Satellite Unit for an alternative purpose. This means Outpatients are required to go to the main facility on the lower ground floor. Consort has been investigating options for creating a waiting area by installing seating in the corridor adjacent to the Pharmacy Department. This proposal has recently received approval from the Fire Officer and will be implemented in the near future.

  9.  "Unbearable heat in ward kitchens, where meals brought in from a factory need to be regenerated" Guardian 23 July.

  The zonal kitchens do get very hot and Consort is looking into ways to improve this situation. There is a regimented regime for regeneration which means in the larger kitchens, virtually all ovens are on at the same time. This generates the maximum heat in the area.

  Meals are delivered to the hospital three times a week to meet the predictable (high) quality levels which are required. The system is generally believed to be safer than more traditional hospital processes. The quality of the food has generally been well received by patients.

  10.  "The hospital seems to be charging for everything it can, including bedside TVs and vases for flowers" Guardian 23 July.

  The hospital TVs are supplied by Patientline under contract to the Trust. The government's NHS plan requires installation of such systems in all hospitals by 2004. Consort is not charging and never has charged for the provision of vases.

  11.  "£30 charge to use a porter" Northern Echo 12 July.

  The majority of patients are transported by Team Assistant Supports, who are ward-based Trust employees working in accordance with the Patient Focussed Care model. These staff transport all patients who require a wheelchair. If a patient is moved with their bed, an HBML porter will assist. Since April, the Trust has expanded some aspects of the portering service provided by Consort through variations to address changes within the Trust. There has never been a charge per use of porter.

  12.  "The WRVS volunteers will have to pay rent" Guardian 23 July.

  The WRVS have been allocated space free-of-charge to provide the volunteer services normally provided by the WRVS. There is an additional space that was set aside for retail facilities to provide services for both staff and visitors as well as patients. Income from this area is used to subsidise the cost of the hospital.

  Rather than let this space to a private sector retailer, as is normal in many hospitals, it was jointly agreed by the Trust and Consort to let this prime retail site to the WRVS. The WRVS have been happy to enter into this arrangement, which is directly between the Trust and the WRVS. The full lease income paid by the WRVS is used to subsidise the cost of the hospital.

  North Durham Hospital is recognised as an excellent design, built to time and cost. Any large DGH will have "snagging" issues whether privately or publicly financed. In the case of Durham, all snagging issues have been dealt with efficiently and promptly. In respect of the services, they have only just commenced and so far there is every indication that the system is working well and that the staff, Trust and patients are very satisfied with levels provided.

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