My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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How Andrew Lansley made PFI popular with the NHS

Filed Under (Hospitals, PFI, Secretary of State) by Paul on 27-09-2011

Yesterday I explored some possible explanations of what might lie behind last Thursday’s announcement by the Secretary of State that 22 trusts have problems of financial and clinical stability because of PFIs. Today I want to explore the NHS reaction to this to show how that demonstrates the current Secretary of State’s lack of political touch necessary to do the job.

Last week the Secretary of State achieved something that was really quite remarkable. His attack upon the potential clinical and financial stability of 22 trusts meant that he forced their CEOs and representatives to come into the public domain to say that, for their hospitals, the cost of PFI wasn’t that bad.

In over a decade of debate about PFIs I have never seen such a chorus of approval from leaders in hospitals for the value for money their PFI schemes provided.

By framing the debate as – “your PFI deal will cause your hospital to become financially and clinically unstable” the Secretary of State left trusts with no choice but to say “that’s not true – we can afford ours”. Because not to say that would mean agreeing with the Secretary of State and saying to their public that they were about to become financially and clinically unstable. So the Secretary of State left them with no alternative than to defend their PFI’s affordability.

This led to the even odder situation of the Guardian writing a story supporting PFIs.  The Guardian published data which showed that of the 22 hospitals that were said to be about to become unstable, 17 were, as far as the DH was concerned, ‘performing’ – and if these 17 are on the verge of financial and clinical instability what does this say about all the others that are classified as ‘performing’ and do not have PFIs?

North Bristol Trust said,

“The PFI deal equates to yearly repayments of less than 7% of our overall annual turnover. Repayments have been factored into our long term financial plans, so we know they are affordable”

The executive director of Walsall Health Care NHS trust said that they had just been given a clean bill of health by the DH.

The finance director of Worcestershire Acute Hospitals NHS trust said

” There have been long standing financial challenges for the Worcestershire health economy that pre date the opening of PFI. In the absence of the PFI initiative it is unclear how the NHS would have achieved its aim of modernising acute hospitals” 

Several hospitals confirmed they had not contacted Mr Lansley expressing concerns about their PFI.

I can honestly say that over the last decade I have never seen so many leaders of hospitals say both how important and affordable their PFI deals have been. But the Secretary of State left them no choice.

You might think that a clever response to this from the DH would have been to welcome the fact that so many NHS leaders were saying that their PFIs were good value and were affordable because, let’s face it, if they weren’t it would be bad news for the NHS. The fact that they are affordable should be good news for the NHS.

The DH response to the fact that CEOs were queuing up to say that their PFIs were affordable was a classic in the “hissy fit” style of statements from spokespeople. You may find it helps to read the paragraph below as a five year old shaking their shoulders with anger might.

The Department of Health commented,

“The list of 22 trusts is based on returns from NHS trusts to the Department of Health setting out the main issues that needed to be addressed for organisations to achieve financial stability. Concern about the PFI issues facing these trusts is not an attack upon the hospitals, but a recognition based upon what they themselves told us, that a review of their case should be done.”

So yah boo! Since you told us that you were having some trouble with your PFI it makes it OK for the Secretary of State to tell the world that you are on the verge of financial and clinical instability.

This really is one of the few times I can remember the DH telling off leaders of trusts because they were getting on OK!

So the next lesson that trusts need to learn from this experience is that if they say anything to the DH it may be used by the Secretary of State to publicly attack them. One suspects this will not lead to an outbreak of truth telling.

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