The National Audit Office has reported that most PFI hospital contracts are wellmanaged and the evidence indicates that they are currently achieving the value for money expected when the contracts were signed.
There continues to be risks, however, to the long-term value for money of these contracts. The report suggests that most contracts are performing satisfactorily or better and meeting the expectations of Trusts. The cost and performance of services such as cleaning, laundry and portering in PFI hospitals are similar to those provided in non-PFI hospitals. While catering is on average slightly cheaper in PFI hospitals, hospitals with PFI buildings spend more on maintenance annually to keep the buildings to a specified high standard. The NAO points out that it is likely that Trusts will be expected to make efficiency savings over the next few years, but their ability to make savings from their PFI contracts is very limited. Because Trusts pay an index-linked fixed sum, it is difficult for them to make savings without cutting back on services. Contractors who secure economies of scale through managing multiple PFI contracts are rarely required to share these efficiency gains with Trusts. The Department of Health (DH) is responsible for helping Trusts manage their contracts and, while good practice is spread among Trusts, there is a lack of central data on the performance of the PFI portfolio. The DH does not use the leverage over the market it possesses from having 76 contracts in force. With more information on Trusts’ projects, the DH could use this leverage to update contracts on common issues or facilitate performance and efficiency improvements.
