Private Finance Initiative

Mark Pawsey Excerpts

Thursday 23rd June 2011 Westminster Hall

[Mr Marcus Jones (Nuneaton) (Con)]

Thank you, Mrs Main, for allowing me to speak in an extremely important debate. I congratulate my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) and others on the Backbench Business Committee on securing this vital debate. It is a crucial issue that is of great interest to my constituents, and I shall focus on that constituency interest.

Hon. Members have given a very technical analysis of PFI, its failings and what we should possibly do about such arrangements. However, in very practical and tangible terms, I want to speak for my constituents and explain why this rebate for the PFI would be extremely beneficial to them. If I may put that into context, I will be talking about the huge PFI scheme at the University Hospitals Coventry and Warwickshire NHS Trust.

Let me give hon. Members the background. A large tertiary hospital on the edge of Coventry was built under the previous Government’s PFI regime. The hospital replaced the then Walsgrave hospital, where I was born in the early 1970s. The new incarnation of the Walsgrave, as we know it locally, is undoubtedly a great hospital. When I say that, I do not just mean great as in good, although it is an extremely good hospital, but great in terms of size, because it has 1,250 beds and 27 operating theatres. The hospital is a large fish in a small pond in terms of the Coventry and Warwickshire health economy.

Since the hospital started to operate in 2001, the cost of the PFI contract has been substantial, with more than 14% of the University Hospitals Coventry and Warwickshire NHS Trust budget now consumed by the PFI contract and the obligations under it. The main problem with the PFI contract is that the costs are pretty much fixed. Regardless of patient numbers, under the contract the trust must still pay over a long period for the buildings, repairs, cleaning and provision of support services. Should demand fall or patients decide to go to another hospital in the Coventry and Warwickshire health economy, inevitably those fixed costs remain and must be borne by the hospital.

[Mark Pawsey (Rugby) (Con)]

My neighbour and colleague is making a strong case about the impact of the UHCW in the health economy of Warwickshire, but my interest is my local hospital of St Cross in Rugby, which is part of the same trust. One of our big concerns is that, with such a large proportion of the health economy going into the PFI hospital, in times of budget pressure such as now, the bias will always be towards the PFI contract, which must be fulfilled and maintained, but that might be to the detriment of other hospitals locally and, in particular, those in the same trust.

[Mr Jones]

My hon. Friend, whose constituency neighbours mine, has hit the nail on the head.

In our situation, regardless of demand or whether the Coventry and Warwickshire PFI hospital wants to close a ward or to stop the activity associated with closing a ward, such as the cleaning or maintenance, the fixed costs must still be met. That is most detrimental, and it is a drain on the Warwickshire health economy.

Another concern relates to the primary care trust and the strategic health authority. That context is changing, but some of the people involved in those organisations were instrumental in the creation of the PFI hospital and, whatever happens, I suspect that they would not want to see the hospital—this landmark development in Coventry—fail. The concern is because, ever since the hospital was built—before the mortar between the bricks or the paint was dry—the local PCT, NHS Warwickshire, has been trying to reconfigure services. We immediately had an acute services review, which threatened services at my local district general hospital, the George Eliot, and to a greater extent at Rugby’s St Cross, as my hon. Friend the Member for Rugby has said. NHS Warwickshire paired St Cross up with the Coventry and Warwickshire trust which, really, subsumed it. Services were drained away from Rugby to the new PFI hospital in Coventry, regardless of whether people in Rugby wanted the choice of going to St Cross. If we do not get a grip on the situation soon, I fear that the same might happen in my constituency at the George Eliot.

That brings me to the crux of the argument made by my hon. Friend the Member for Hereford and South Herefordshire. I echo his concern about such huge beasts of projects, which are so expensive and we hear stories about, such as the £300 for changing a light bulb. They are real, tangible problems, and our constituents cannot understand why the previous Government signed the taxpayer up to such ridiculous commitments. Although the previous Government took on those contracts, I appreciate that the new Government cannot simply tear them up. Some difficulties might arise from how the contract was framed, in particular on the capital commitments. The companies that originally constructed and financed the hospitals have sold the debt on, and it might have been sold on again, so we would now find it difficult to pin down those people and to get some form of rebate.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

I will endeavour to make my contribution brief. This has been a very valuable and worthwhile debate on a number of issues. We need to consider the PFI as quite a complex challenge. Although my hon. Friend the Minister is here to help us with some of the financial issues, it is a challenge not just for her but for her Cabinet colleagues, because it is not just the finances that need to be reviewed. There are issues of complexity that we need to deal with in trying to find a way forward. Those issues are not just about the way in which the contracts are currently structured. There is also an issue about cultural change, because much of what has happened has changed the way in which decisions are made and outcomes are delivered for patients in hospitals and children in schools. That is why, although I support the argument for a rebate, it is only part of the solution. It deals with the existing, financial challenge, but it does not deal with other issues. It is right that we should be looking for a different way to do things, but it is a very complicated challenge.

The PFI was always well intentioned as a concept. It was to deliver quality and it was to deliver projects on time and on budget. In many ways, it achieved that. We have 700 schools, hospitals, prisons and other infrastructure projects that would not exist or would not be in the pipeline but for this initiative. We have £67 billion-worth of expenditure signed off.

The problems fall into at least four categories. First, the risk was overestimated, in part because of the public sector’s inability to deal with a very complex negotiation, as has been said. The consequence was that the taxpayer was lumbered with a very large part of the bill. As has been said, the amount of £210 billion is outstanding. By contrast, the investor is doing extraordinarily well. A number of figures have been cited, and I will add to that list. An EU think-tank tells me that 154 schemes are delivering a 50% return. That is huge. Clearly, therefore, one matter that we must consider is how we simplify not only future contracts, but the existing ones. I believe that we must consider renegotiating not just a chunk of money, but some of the terms.

[Mark Pawsey]

Does my hon. Friend agree that a justification for a rebate arises from the effect of the spending review on those Departments whose budgets have been reduced? If the PFI element remains fixed within the budget, by definition the non-PFI element has to reduce by a greater proportion, so budgets that may have been reduced by 2% could end up being reduced by 4%. It is entirely appropriate that those who are making the sums of money that we have heard about should bear their share of the burden of getting our country’s finances into order.

[Anne Marie Morris]

I agree. My argument is that that is part of the problem, rather than the totality of the problem. My second request is that we find a way of delivering transparency and better management of the contracts. One hospital was charged £333 to change a light bulb. I dare say that that changes the hospital’s decision about whether it will change many light bulbs. One school was charged £300 just to install an electrical socket. How many times will the school install a socket on that basis? One Army official was charged £103 for a 1-inch Land Rover screw that actually cost just over £2. That is not the right way of doing things.