Ask an NHS finance director what they hope will come out of the McKinsey review of 22 trusts with tricky private finance initiatives and they talk wistfully about a revised market forces factor – the calculation that determines any top-up paid for delivering services in a particular area.
In theory, a market forces factor would recognise the added costs of new, privately funded capital by supplementing the tariff prices paid to certain trusts.
More likely, a new centrally funded facility, effectively offering a subsidy to trusts with expensive PFIs, would need to be established to avoid minsters being embarrassed by an ensuing competition on price driven by differing tariffs.
But the real bickering would come over where the line should be drawn. The 22 currently listed are self-defined; what about the other 100 or so trusts with PFIs?
Others are looking to more pragmatic solutions. Most PFI contracts contain a clause which allows the costs for “soft facilities management” services – cleaning, portering – to be benchmarked against alternative providers. The irony is that the staff doing those jobs are often retained employees: if “efficiencies” were required their redundancy cheque would need to be signed by the NHS.
The hopeful point to Cabinet Office minister Francis Maude’s withdrawal in December of the two tier workforce code as a sign the government could take its industrial battering ram to regulations preserving the terms and conditions of outsourced workers.
The fallback option remains the South London scenario: shutting other facilities – be they acute wards, community clinics or GP centres – and stuffing them into the PFI building until it sweats.
While hospital closures attract most attention, the area to watch could be community services. The larger portion have already been swallowed up by acutes, so how long before we start hearing of the integrated benefits of hauling community service patients into PFI buildings?
Sally Gainsbury is a news reporter for the Financial Times.