The issue of Savernake Hospital’s future and the burden of its Private Finance Initiative (PFI) payments was back on the floor of the House of Commons this week – in oral questions and in a written question about PFIs in general by Devizes MP Claire Perry.
In his answer to Mrs Perry the Health Secretary, Andrew Lansley, said that ‘much’ of the Labour government’s hospital building programme using PFIs ‘was unaffordable and poor value for money.’ Though it was not clear whether he would apply the ‘unaffordable’ or the ‘poor value for money’ to the rebuilding and extension of Savernake Hospital.
Mr Lansley said a Treasury review of the PFI system had found ways to save ‘up to five per cent’ on annual payments for future PFI projects.
During a series of oral questions to Mr Lansley, four conservative MPs asked what could be done to help trust hospitals in their constituencies which were suffering under heavy PFI charges.
Then Mrs Perry wanted to know what the Health Secretary will do to help smaller hospitals which house ‘vital local services’: “In addition to struggling hospital trusts, many, many community hospitals throughout the country, such as Savernake Hospital near Marlborough, are also labouring under the burden of an enormous PFI contract and having the indignity of vital local services hollowed out under that lot’s leadership on the Labour benches.”
Mr Lansley told her that he and his ministers were sympathetic to her concerns and went on: “By devolving commissioning responsibilities to clinical commissioning groups [CCGs], I expect the local clinical leadership, understanding fully the contribution that community hospitals can make, to be supportive of that in their commissioning intentions in her constituency and others.”
After this exchange Mrs Perry tweeted: “Sec of state answer to my Q- no more money for struggling pfi hospitals like Savernake but they will be supported by local commissioning.”
But will they? Will the new GP-led CCGs which are taking over from the Primary Care Trusts (PCTs), be able – with ever tighter budgets – to make better and more local use of community hospitals like Savernake?
In an interview with Marlborough News Online, Jeff James, the Chief Executive of NHS Wiltshire (the county’s PCT), pointed out that CCGs are intent on bringing more testing and treatment into their surgeries – offering the localised service Lansley’s Health White Paper promised and saving GPs and the NHS money.
“With diagnostic technology becoming cheaper and more reliable, and investigative technology more available, out-patient clinics in hospitals will be undermined.”
And Mr James cited a presentation this week to NHS Wiltshire’s Stakeholder Assembly by Dr Jonathan Rayner who is a GP in Ramsbury and a leader of the CCG (known as NEW for North East Wiltshire) that will serve the Marlborough area.
Dr Rayner explained how diagnosing skin problems had been brought into the surgery – with the latest equipment, training and a visiting specialist. This saved patients long and frequent journeys to Great Western Hospital or Savernake, enabled doctors to be better equipped and trained, and saved money for the NHS, for doctors and for the patients.
And who, when Mr Lansley’s complex restructuring is complete, will pay Savernake’s PFI charges? In other words, who will own Savernake once the PCT is dissolved?
Mr James said he did not think a CCG would be given ownership of a PFI-based hospital. The cost and the complex accounting regime they require would put a disproportionate burden on them and skew their commissioning decisions.
The Department of Health is still wrestling with the problem and Savernake might end up being ‘owned’ by the NHS Commissioning Board (a new nation-wide quango that is being established over the next eighteenth months) or by an existing body, like NHS Estates which looks after parts of the health service’s complicated property portfolio.
The full interview with Jeff James will be on Marlborough News Online as soon as possible.
