Published: 18/04/2002, Volume II2, No. 5801 Page 4

Department of Health standards to ensure new hospital buildings meet stringent 'consumerist' criteria are causing 'confusion and cynicism' in the service because of the way in which they have been implemented.

Concern about the costs attached to the ambitious standards has led to calls for extra funding to support the 'biggest ever NHS building programme'.

The 10 'consumerism criteria' aim to increase standards and space in patient areas and include the requirement for new hospitals to provide 50 per cent single rooms compared with the current average of 20 per cent.

But the standards, which mirror the patient-centred ideals of the NHS plan, could increase the capital cost of an acute hospital by 1213 per cent, according to NHS Estates, which drew up the standards.

This has been reflected by an increase of just over 11 per cent in DoH departmental cost-allowance guidance used to cost schemes.

The criteria are part of a government drive to improve hospital design and a response to criticism of some of the first private finance initiative hospitals for reducing space and standards of patient accommodation.

But managers say they will increase the affordability problems on PFI schemes without extra money being earmarked for buildings.Ken Schwarz, a director of Anshen Dyer, architects for the recently opened PFI Norfolk and Norwich Hospital, said the consumerism agenda is 'laudable', 'if properly implemented'.

But he warned: 'There are several projects, in various stages of the PFI bidding process, for which features of the consumerism agenda are being requested, despite the fact that no funds have been allocated for them. This results in confusion and cynicism ... the consumerism agenda should only be implemented if the budget to support it is in hand.'

In his experience on PFI schemes, 'budget shortfalls often amount to 10 per cent to 20 per cent of construction costs' because of 'unrealistically low' capital allowances. The 'worst situation' would be that these 'shortfalls are exacerbated by new unfunded consumer requirements'.

Tina Nolan, a director with consultants RKW, said 'in practice the costs were coming out slightly higher', with a 'potential increase' of as much as 30 per cent on smaller schemes.

The standards will also increase capital charges and revenue costs, say managers. Lyndsay Simpson, project management services director (health) with consultants Cyril Sweett, believed 50 per cent single rooms 'would make a radical difference to nursing costs. I do not think they've thought that through at all'.

But how rigorously the standards will be applied and which projects are affected is unclear. A spokesperson from NHS Estates said: 'The criteria are mandatory, only because they relate to the NHS plan.'

Asked if the sevice thought the standards were mandatory, one regional official said: 'It is something We have being trying to work out all morning.'

And one trust project director commented: 'There is a lot of confusion about how official this is.

Different regions are taking different views. As for the trusts, we are confused as hell...they haven't given people the clarity and that is pissing people off.'

Tina Nolan said several schemes had been delayed at outline business case because they hadn't addressed 'consumerism'. 'Any scheme that hasn't had outline business case approval is expected to include it, ' she said.

But on schemes at later stages, 'they are not being very specific.'

Some of the smaller projects near preferred bidder stage were 'going through on the basis that they would not incorporate consumerism', only to find that the regions were 'flagging up the standards'. Ms Nolan added: 'It is anticipated on the big schemes -£200m plus - that there will be a will to make sure the money is available ... but on the smaller schemes it is not clear whether the money will be supplied centrally.'

Sylvia Wyatt, manager of Future Hospital Network, part of the NHS Confederation, said the confederation was calling for the extra cost of new buildings to be recognised.

She said: 'The inference is that extra money will be provided' to support the implementation of standards. But she said some mechanism to protect the money for the next four to five years ought to be introduced to take into account the current lack of commissioning experience among primary care trusts.