Exclusive: government admits PFI deals mean 22 trusts will struggle to meet foundation status target

It is tendering a contract for a consultancy to investigate the problems faced by each trust. The tender document says: “PFI presents a challenge to FT authorisations given the combination of today’s market conditions and [foundation trusts’ regulator] Monitor’s financial tests. 

“PFI deals were scoped in an environment in which acute activity was growing and many of the schemes are now too large for the levels of future activity, with commissioners moving to increasing care in the community and at home.” 

The 22 form more than a quarter of the acute non-FTs left to gain foundation status.

The DH tender, issued by NHS London, said 15 of the PFIs were operational, five were in construction and two were in the procurement phase.

One of the two trusts still procuring a PFI is the Royal National Orthopaedic Hospital in London.

The document asks bidders to consider for each trust whether they require one of three categories of help.

The top level is “national financial support e.g. central adjustments”, beneath that is “regional support e.g. transitional relief, major service changes, re-structure asset utilisation”.

The lowest level consists of local actions from a trust and its health economy: “eg service changes, non Payment by Results adjustments, and transitional relief.”

The successful bidder is asked to “identify the financial gap for the affected providers to sustainable financial viability.”

The document appears to suggest that trusts with large PFIs might have unsafe staffing levels, specifically asking the consultants to “assess that the workforce assumptions (eg ratios of nursing staff per bed) that underpin trusts’ Cost Improvement Programmes & Long Term Financial Models are at an acceptable level for good quality care.”

The tender also implies a degree of distrust of the FT application process, saying: “The review should also highlight any areas where Monitor’s assessment regime unfairly penalises trusts with large PFI schemes, issues to raise with Monitor in terms of their assessment regime and any suggestions for potential variations.”

Consultants would spend three or four days at each trust and a draft report is to be submitted within six weeks, with DH sign-off a fortnight later.

The tender was issued on 6 April, after the closing date for every non-foundation trust to submit a Tripartite Formal Agreement to their strategic health authority and the DH, setting out how they would achieve FT status.