Probe request into PFI ventilation system

The National Audit Office has been asked to investigate claims that a private finance initiative hospital opened without adequate ventilation in rooms for patients with highly infectious diseases.

Norwich primary care trust director of public health Dr Peter Brambleby contacted the NAO after he was approached by three senior nurses. One is said to have lifted ceiling tiles in ward areas on the third floor of Norfolk and Norwich University Hospital, which opened in April 2001, and found air ducting lying in unconnected lengths.

Dr Brambleby said the nurses claimed the incorrect ventilation system had been installed.

In the letter to the NAO, he said he had 'been given false assurances by clinicians - 'albeit in good faith'- about the state of readiness of the hospital in the event of flu, Sars [severe acute respiratory syndrome] or tuberculosis outbreaks'.

HSJ has also seen a letter from local health protection unit staff to the trust's contracted-out facilities management in April 2002. The letter said the HPU expected the new building to provide 32 side rooms with suitable ventilation facilities for patients with drugresistant TB and other transmissible respiratory infections.

The trust, which recently spent£80,000 modifying two of the rooms, has set up an inquiry into the allegations.An interim report is due in June. It is also talking to Octagon Healthcare, the consortium that built the hospital, to establish whether those costs should be passed on to them (see box).

Dr Brambleby alleged there was a clear expectation by clinicians that they would get a system different to the one they received.

In November 2002, a consultant physician at the trust wrote to trust managers saying that he thought the hospital was 'exposing itself to a risk' because although the rooms had 'appropriate ventilation', there was no way of monitoring its function on the ward.

In March this year, trust director of facilities David Walsh wrote to Dr Brambleby confirming that while each ward was 'designed with two rooms capable of operating at both positive and negative pressure... there was a risk under certain circumstances that extract from these rooms could flow into public areas' and that was why they were not in service as negative pressure isolation facilities.

The inquiry has begun by urgently gathering evidence on the safety issues.A statement issued by the trust last week said that a clinical review of all possible risks since January 2002 had concluded that the hospital had appropriate infection control policies and these 'appear to have been followed'.

Inquiry chair David Wright, a trust non-executive director, said:

'The considered opinion of all the clinicians involved in the clinical review strongly indicates no excess risk to patients or public, and this evidence is being reviewed by the independent microbiologist on the panel of inquiry and will inform the overall conclusion.'

Last week, the trust said that since January 2002 there had been three patients with single-drug resistant TB who were 'managed appropriately with usual barriernursing procedures... The routine follow-up procedures for patients who might have been exposed to risk prior to diagnosis have been followed and are continuing and no cases have been found'.

Dr Brambleby told HSJ he wanted to see a 'full, independent third-party inspection of all aspects of health and safety at the new hospital... We are not dealing with a known risk'. He added: 'It is an unknown risk, but a serious unknown risk and as yet we are not getting answers.'

An NAO spokesperson said it was looking into the issues raised.

Specification details: the nub of the debate A spokesperson for Norfolk, Suffolk and Cambridgeshire strategic health authority told HSJ 'the details of the specification are the nub of the debate between the trust and Octagon', and the outcome would decide who was responsible for the costs.

Octagon chair Richard Jewson said: 'Octagon believes it has fully discharged its contractual obligations and continues to do so.The Independent Certifier has confirmed this.Octagon will naturally cooperate fully with any properly constituted enquiry [sic].'

Norfolk and Norwich University Hospital trust head of communications Andrew Stronach said: 'We have been in continual discussion with the hospital contractors over the issues, including responsibilities over costs.'

Norwich primary care trust director of public health Dr Peter Brambleby says Malcolm Stamp, then chief executive of Norfolk and Norwich University Hospital trust, was the 'single point of reference between the trust board and the project board, project director and all subsidiary working groups'.Mr Stamp, now chief executive of Addenbrooke's trust, told HSJ: 'I am very happy to assist the Norfolk and Norwich University Hospital in whatever way I can, should that be necessary.'

Dr Brambleby has told the National Audit Office he understood that regulatory control of the private finance initiative project was 'largely through the then regional NHS tier'- whose chief executive was Peter Houghton.He is now chief executive at Norfolk, Suffolk and Cambridgeshire SHA.Mr Houghton declined to comment, but SHA director of public health Dr Tony Jewell told HSJ on 5 May that a meeting on that day of an 'authoritative group'- which included Health Protection Agency staff, the trust's medical director and infection control staff - had left him 'satisfied there is no public health risk'.