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Hospital plans for Birmingham follow ‘meaningless’ survey

The University Hospital Birmingham NHS Trust recently approved a plan to build a new £214m super-hospital to replace the Queen Elizabeth and Selly Oak hospitals. But the process by which it reached this decision may have been fundamentally flawed.

The trust drew up five options consisting of retaining both sites with minor or major building work, locating all services at either hospital or a new hospital on a greenfield site.

Ten benefit criteria formed the basis of an evaluation process to determine the preferred option. But a study of the criteria carried out by the Centre for Public Services revealed major shortcomings. The criteria did not include health needs and local priorities, only minimal assessment of social justice and equal opportunities impact, no assessment of the inclusion of private health facilities under the PFI and no evaluation of the alternative use of the existing sites.

The trust not only weighted and scored all the options but also asked staff and patients’ organisations to do likewise. A newspaper was distributed to staff describing the options and including a grid for readers to weight and score the various alternative plans.

South Birmingham Community Health Council and local health trade unions were highly critical of the process, which the Centre for Public Services described as ‘inappropriate and meaningless’. The CPS argued that small adjustments to the weighting and scoring system might produce any desired answer.

In September the trust chose the ‘super-hospital’ option. But three-quarters of staff responding to a local trade union survey chose to retain the two existing hospitals.

The scale of investment required will almost certainly demand a Private Finance Initiative (PFI) project. The implications of this were not explained in the benefit criteria and appraisal.

In a letter to local MP Dr Lynne Jones, the chief executive of Birmingham Health Authority Michael Waterland recently described the advantages of the PFI as a ‘simple process of paying a premium on interest rates on capital in return for a possibly lower revenue cost (made possible by a lower wage rate) and certainly a lower risk rate in the absence of redundancy costs, pension top ups etc. Over the years Whitley Council regulations, whilst not necessarily paying “top dollar” for work done, nonetheless provide very “top dollar” in terms of underpinning financial security.’

Such a frank admission of the poorer terms and conditions which staff are likely to encounter under PFI schemes is unlikely to have won the trust new support from local health unions — nor even, perhaps, from health ministers.