The story of the £87m Cumberland Infirmary in Carlisle should be triggering sirens and blue flashing lights at the Department of Health, Number 10 and the Treasury
This facility, which opened three years ago, was the first in a generation of PFI hospitals. It was to be the prototype for Britain's 21st-century health service. Now it's looking like a salutary lesson in how not to do healthcare procurement.

The most that you can say for the building is that it sits well in the city of Carlisle, and has a pleasing glass roof over the atrium. Look closer, however, and you discover failings in functionality and build quality – the hospital is not big enough, it overheats and it leaks. The private sector will make its customary excuses. It will point out that you can't blame it if there aren't enough beds – a standard criticism of PFI hospitals – because that was dictated by the trust. And it will suggest that it is a tad unfair to judge the whole of PFI healthcare procurement by its first stab.

Yet what is most disturbing in our review, and what will have to be ironed out in future schemes, is the breakdown of trust between public and private sectors. This is no doubt fuelled by Unison, which can barely suppress its glee when problems appear with PFI projects. Yet both sides at Carlisle admit that there is an "us and them" attitude between hospital staff and the facilities management. Much of the friction is caused by an absurd system of assessing the contractor's performance by how quickly it turns up to look at a problem, rather than if it actually solves it.

The problems we highlight at Carlisle are only a part of the difficulties that the DoH and the Treasury face in their healthcare procurement programme. Their current focus is on getting jobs from drawing board to site – and some progress seems to have been made there. The batching of large PFI projects and the drive towards the standardisation of contracts is a reality. And the Procure 21 initiative, launched two months before the Cumberland Infirmary opened, is about to begin dotting small healthcare facilities and extensions across the country.

Yet both initiatives raise questions. A good relationship between pubic and private sectors requires intimate co-operation carried out in a spirit of trust and equality. Will batching really promote that? And how can standardised contracts be reconciled with the need to come up with agreements that are suitable for each individual hospital's needs? And as for Procure 21, contractors are finding that many trusts are so wary of working with them that they are trying to get their jobs done before the programme is rolled out.

Hovering above all this is the government's enthusiasm for elite foundation hospitals. The idea is to give the best outfits control of their own finances, including the procurement of construction services. But surely this would clash with the increasingly centralist approach suggested by standardisation and batching? It seems, in short, that we are no closer to reconciling the fast and efficient delivery of hospitals with the effective delivery of healthcare within them.

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