The ideological battle over the use of PFI in the NHS has abated since the government yielded to trade union concerns on two-tier workforces. Fragile though it is, the consensus around the private provision of a core public service is transforming the NHS at the point of use in Birmingham and the West Midlands.

The ‘Towards 2010’ programme has brought together local health authorities into a major project that will transform healthcare provision in the region. One of the biggest partners in the project is Sandwell and West Birmingham Hospitals NHS Trust. One of the largest NHS teaching trusts, it runs City Hospital in Birmingham, Rowley Regis Community Hospital and Sandwell General Hospital in West Bromwich.

The trust has ‘two-star’ status, a budget of over £250m and employs more than 7,000 staff serving a population of approximately 500,000. In all its centres, PFI is being used to expand and consolidate patient care. Sandwell General has developed a new £18m Emergency Services Centre, which opens this month to replace the old Accident & Emergency department, which was destroyed in an arson attack in July 2002.

Diane Reeves, director of clinical quality for Rowley Regis and Tipton Primary Care Trust, commented: “The new emergency centre is a really good example of how primary and secondary care can work together to design and build a centre which improves services and care for patients.”

The three-storey building was completed by preferred partner Jarvis. Whilst the new centre will not provide additional capacity in its early years, the plan is to increase the number of daycases by reducing the length of stay for elective cases. Outpatient consultations will begin to be delivered differently as the ‘condition-based’, multidisciplinary assessment and diagnostic consultation takes over from the traditional outpatient system.

The emergency centre will implement ‘condition- or symptom-based referrals and clinics for outpatients’, and deliver ‘one-stop access to first-line diagnostic testing’. Local managers also want to reduce the length of stay for short stay surgical elective and emergency admissions.

At the heart of the healthcare revolution in the region is the construction of Birmingham’s first new hospital for nearly 70 years. The £521m Birmingham New Hospitals Project, which is scheduled for completion in 2011, promises to revolutionise acute and mental health services in South Birmingham.

University Hospital Birmingham NHS Trust (UHBT) was granted outline planning permission in January 2000 to build the new hospital, replacing the Queen Elizabeth and Selly Oak hospitals. Full Planning permission was granted in October. University Hospital Birmingham is one of the Midlands’ biggest employers with a workforce of 6,300 in the two current hospitals.

The main partners in the project are UHBT and Birmingham and Solihull Mental Health Trust. Additional partners include the Ministry of Defence (MoD) and University of Birmingham, while the Black Country Strategic Health Authority and Birmingham City Council are also playing a key part in the joined-up approach being fostered in the city.

Central to the development is the jewel in the crown – a 1,231-bed acute teaching hospital to take shape on the 50-acre Queen Elizabeth site for UHBT. A further 137 beds, housed in two separate facilities, will be constructed for BSMT on the same site.

Units comprising 66 beds in total will be developed away from the main site at Moseley Hall Hospital and Showell Green Lane, Stirchley. This, say local providers, will allow some patients to be treated closer to the communities in which they live. Additionally the Royal Centre for Defence Medicine (RCDM), which is currently sited at Selly Oak Hospital, is set to form part of the main new hospital building. The hospitals should be fully completed by 2011.

The new development amounts to the largest PFI project outside London and involves a wide range of public and private sector players. In January 2004 UHBFT and BSMHT signed a ‘preferred partner’ deal with Consort Healthcare. This joint-venture involves Balfour Beatty, AWG, the Royal Bank of Scotland and HSBC.

The architectural community is taking a close interest in the development. The new project promises to transform the landscape, and allow for the provision of 21st century healthcare. Mixed sex wards will finally become a thing of the past as smaller units, some offering single bed en suite rooms, become the norm.

Three towers connected by walkways, which house the main wards of the acute hospital, stand upon a four-storey base which houses the outpatients, diagnostic and treatment areas. Mental health facilities will be provided in smaller units in order to foster a greater atmosphere of sanctuary than the current facilities provide.

Car parking will be provided in a combination of multistorey and ground-level car parks, able to accommodate 4,000 cars. University station is just two stops from Birmingham New Street station on the Cross-City South line. The developers say the new hospital will sit at the centre of an integrated transport system – making the visits of patients and visitors easier.
Architects say the hospital will be set against the “spectacular backcloth” of landscaping, archaeological preservation, natural habitats and a revitalised Bourn Brook corridor.
PFI in Birmingham and elsewhere, however, remains a controversial means by which to lift standards, reduce waiting times and enhance patient care.

A study commissioned by the NHS Confederation’s Future Healthcare Network last year found that the government’s private finance initiative resulted in huge mistakes in the nationwide £6bn hospital building programme in England. Contracts signed with big private consortiums have led to poorly designed buildings – with an incorrect number of beds and insufficient flexibility to cope with changing health needs. “The private finance initiative must be reformed if we are to realise its full benefits for patients,” said the study.

Current approaches mean that future hospital builds fail to take account of changes to the healthcare environment, the body warned.
Commenting on that report, University Hospital Birmingham NHS Trust chief executive and co-chair of the Future Healthcare Network Mark Britnell said the experience of PFI to date was mixed but positive in overall terms.

“Such a huge injection of capital resources into the NHS has enabled us to replace worn-out hospitals with ground-breaking healthcare facilities that patients have a right to expect. But after a decade of healthcare PFI we have learnt lessons that now need to be properly addressed.”