3.33 If an authority believes that they are buying more than is required to deliver the service or are incurring additional cost as a result of inconsistent application of services standards across PFI and non PFI facilities, then a more appropriate specification could be introduced as a variation. Authorities should consult their departmental PFUs if they believe this to be the case. Measures in this category are project specific but could potentially include:
• less frequent decorating;
• changing to daytime cleaning to reduce lighting costs overnight;
• improving energy efficiency by optimising minimum and maximum temperatures;
• changing the frequency of fault inspections to reflect the history of occurrence and impact;
• longer response times for helpdesk call resolution (appropriate to need and cost);
• more appropriate comparators or standards for services or replaceable equipment (for example where standards are higher than other non PFI assets and higher than needed for the required service).
3.34 In any event, such changes should not harm the core function(s) of the project or contravene safety standards. Authorities should also consider carefully any proposed savings from short term maintenance if this strategy could increase maintenance costs in the longer term (see Annex A). Many PFI contracts deliver services as set out in an output specification, for instance requiring premises to be "secure" rather than requiring security staff to make a certain number of rounds per day. Output based specifications are an important part of PFI risk transfer and any reduction in specification should not lead to PFI provider risks being passed back to the authority without a careful VfM analysis.
3.35 Standards should not be relaxed if there is a concern that the PFI provider is not performing well against the existing requirements of the contract. In this case, the payment mechanism should be used appropriately to ensure that the expected service level is being achieved and deductions made (or performance penalties awarded) if not.
3.36 Wherever possible, authorities should seek to use industry standard performance requirements across both PFI and non PFI assets and customise only where necessary.
3.37 At the Queen's Hospital, an independent technical adviser undertook a qualitative comparison of the scope and content of the main soft services by value (catering, domestic / ward housekeeping and portering) in order to determine whether the services are being provided to a higher or lower set of standards than for comparable projects.
3.38 For each of these soft services, the technical adviser reviewed the standards that the operator is required to comply with, compared with the standards applied in other PFI projects. These standards are a combination of national hospital standards recommended by the Department for Health and applied by the Trust and other operating policies of the Trust. In addition, the adviser reviewed the measurement of the service standards under the contract, by reference to the defined Key Performance Indicators (KPIs). These set out the basic elements of the required service that must be delivered. For example for the catering service these include the service of food at the correct temperature and nutritional content, and hygiene and handling procedures. For the domestic/ward housekeeping service the KPIs include the frequency and adequacy of cleaning and provision of appropriate consumable supplies. For portering the KPIs include timely patient transport and receipt/distribution of materials and waste.
3.39 In each case, the technical adviser found that the specification and standards of the contracted soft services satisfied the basic requirements and standards applying in other comparable projects and were not gold plated'. Standard Department for Health specifications are available for use in both PFI and non-PFI schemes, and it is for each individual Trust to decide the level of service that it wants and can afford.
3.40 As part of its preparation for a scheduled five-yearly soft services market testing, the BHR Trust has been engaging with its soft services provider to review the specification for areas that could be provided more efficiently. The factors considered through this specification review are summarised below. Through this process, a discount in the pricing of elements of the soft services is being negotiated, supported by benchmarking of the unit costs of service components using independent technical advice.
• The Queen's Hospital cleaning service features a rapid response time for all spillages, a specification common to many acute hospital PFIs, but a higher service level than the Trust had prior to the PFI. At ward level, spillages are dealt with by staff on or near the clinical area, and in other areas the soft services provider mobilises a rapid response unit in conjunction with the Helpdesk. A relaxation of this response time (by disbanding the rapid response unit and moving to a model where the cleaning activities occur at fixed times) might reduce costs, but also may expose the Trust to other risks by way of infection control and risk of slips on the spillage causing personal injury. Without a detailed risk assessment, it would be unlikely that the Trust would relax the rapid response time requirement.
• Housekeeping services at the Queen's Hospital are at a higher level than being applied in the Trust's non-PFI hospital. A new working system is now being introduced at the Queen's Hospital to standardise the level of housekeeping service across both hospitals,
which will generate efficiency savings for the Trust and enable the delivery of cleaning standards in line with the most recent National Standards of Cleanliness.
• In the case of portering, a number of areas have dedicated porters supported by a small pool of porters undertaking ad-hoc duties, which is a higher standard than the BHR Trust had before the PFI and higher than may be required. A full review of all areas is being undertaken to match resource to activity, which will see some of the dedicated porters removed and a larger pool of porters being made available. The use of touch screen technology is being introduced to improve the efficiency of deployment of dedicated porters.
• In addition, the BHR Trust and its service provider have undertaken a review of the security service input hours at the Queen's Hospital and identified efficiency savings and enhancements to the service from changes to the shift pattern. The security team will be reduced and flexible supplementary resource will be provided across portering and security services (subject to appropriate training and SIA licencing).
3.41 Some other potential soft maintenance savings were reviewed by the BHR Trust and rejected. For example the BHR Trust considered amending the decoration / minor maintenance frequency at the Project but concluded there is not significant value associated with this. Specific factors influencing this judgement include:
• there is a clear split in terms of responsibility between the soft services sub-contractor and the Project Co for superficial items and items relating to the fabric of the building;
• at present, the condition survey is undertaken annually and moving to 5 yearly would save a relatively minor sum;
• amending lifecycle specifications (e.g. changing carpet to vinyl) is likely to increase the flexibility of some spaces but not lead to a significant cost reduction; and
• smaller maintenance items are done on a rolling programme approach and tracking reduced usage levels and maintenance requirements may prove challenging relative to the potential savings.
3.42 The BHR Trust examined its soft services requirements as part of the normal five-yearly market testing process, and amendments to the service requirements referred above reflect the current requirements. There is scope in the existing contractual framework for future service variations, for example should the level of one-off non-routine tasks such as deep cleans need to change. Any review is done in conjunction with a firm commitment to meeting patient, staff and visitor safety, underlying Care Quality Commission requirements and overarching current standards such the National Standards for Cleanliness.
3.43 In terms of the Medical Equipment Supply agreement at the Project and the replacement equipment specification, the BHR Trust regularly checks that medical equipment is specified to the appropriate level. The selection of equipment under the MES agreement is vendor independent, enabling the procurement of the most cost effective solution to deliver the specification.