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
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 inadequatethere 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
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 servicesthe 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
PFIthe 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
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
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