Mark Britnell, chief executive of University Hospital Birmingham NHS Foundation Trust, remains "very optimistic" that plans for the city's first superhospital will go ahead. ..TEXT: He spoke to Health Reporter Emma Brady about the project's future...
If he looks very hard out of his office windows, Mark Britnell can just about see the new £559 million hospital which will replace three of the city's hospitals.
Actually what he can see are fenced off empty car parks, land being levelled and contractors desperate to get stuck into some "meaningful" construction.
Already £30 million has been spent preparing the site, but the only building completed so far is a new £12 million multi-storey car park.
After eight years steering the scheme through rounds of red tape and debate, he feels "a mixture of optimism, frustration and eager anticipation".
But work is in danger of coming to a halt if the Treasury fails to make a decision soon over whether the trust - which runs the Queen Elizabeth, Selly Oak and QE Psychiatric hospitals - can go ahead with its plans.
Coupled with a £325 million Sainsbury's development in Selly Oak, plus an additional £40 million invested by the supermarket, city council and trust in building new roads, this will be Birmingham's largest act of urban regeneration, costing nearly £1 billion.
But if the contract between University Hospital Birmingham NHS Foundation Trust and private partners Consort is not signed by mid February, project costs could rise by up to £49 million, resulting in the trust having to pay an extra £3 million a year for the 35 years of the repayment period.
Before any additional expenditure, the total cost is expected to exceed £1.7 billion.
Despite being dogged by delays, objections and legal negotiations, Mr Britnell remains adamant that the Government will not let the Birmingham New Hospitals Project down at the last hurdle. Health Secretary Patricia Hewitt last week insisted the hospital will be built despite uncertainty over its funding.
The chief executive said: "This Government has backed our scheme since 1998, and I believe it will back us again, allowing us to sign contracts very soon.
"They have not let us down before with this scheme and I don't expect them to leave us in the lurch.
"The fact that this project has been delayed by nearly a year has been due to complex legal issues with Balfour Beatty, Monitor and Department of Health."
After UHB achieved foundation trust status, which affords hospitals the freedom to manage their own finances, it became one of the first to pursue a PFI scheme - which tested the limits of new legislation.
Mr Britnell explained: "I still feel it was the right decision to pursue and achieve foundation status. We are able to borrow up to £77 million and can also keep land sale profits from Selly Oak, which is worth about £50 million, which allows us to invest more in patient care.
"Before we applied for that, we checked to see if we could still enter into a PFI agreement and were told we could.
"But then a problem arose when Balfour Beatty raised concerns over the legal issue of vires - which relates to who picks up the tab if things go wrong.
"Basically, if UHB did go bust the Secretary of State would have to foot the bill, which is why this process is being delayed."
But that is not a scenario he thinks will occur.
A number of issues have become caught up in the process as a string of ambitious trusts await final approval for their projects, including a £1.2 billion plan to rebuild St Bartholomew's and the Royal London hospitals.
With the NHS facing debts of £620 million, both the Treasury and private sector are getting twitchy over investing in such large schemes. Some existing PFI hospitals have paid the price for treating too many patients, such as Worcester Royal Infirmary which was forced to pay a £200,000 penalty after its bed occupancy rate rose from 90 to 98 per cent following the closure of Kidderminster Hospital.
Mr Britnell said: "Our new hospital would be able to treat 21 per cent more patients. This will mean we would be able to offer the lowest waiting times in Britain. Our contract is flexible so we've got incremental levels of bed occupancy, and we've not contracted out services like meals and cleaning, so we won't face the same problems as Worcester.
"What has not been helpful has been the disruption caused by St Bart's has made the Treasury stop the process while they deal with all the noise St Bart's are making."
He added: "The level of anxiety in staff here has been very high this week. They all want to see this new hospital built but when they saw the situation at Bart's they thought London would win and we would lose.
"Birmingham's had several kicks in the teeth over the past 20 or 30 years, some were self-inflicted but others have been about London politics, and if this PFI scheme does not go ahead our 7,000 staff will be very angry." ..SUPL: