3.14 Inevitably, changes will be needed to the building and services of a PFI contract over its lifetime, including changes to the building to accommodate changes in healthcare delivery; or updates to service specifications to reflect changing NHS guidance.
3.15 Changes to PFI buildings and services have to be made through contract variations, agreed by the Trust and the contractors. So far, this has proved flexible enough to meet the changing needs of Trusts. Major changes have included new wings, service reconfiguration within buildings, a major geo-thermal heat source pump, and revised staff terms and conditions.
3.16 Trust staff often view the change process as difficult, but recognise it brings discipline. Thirty-four per cent of Trusts said making major changes was bureaucratic and time consuming, whilst the corresponding figure for minor changes was 39 per cent. Nurses at our case studies were concerned about the cost and time that small changes such as redecorating patient rooms can take. However, 43 per cent of Trusts stated the process ensured robust decision-making for major changes, with 54 per cent saying the same for minor changes.
3.17 Our previous work on making changes to PFI projects across government highlighted a lack of competitive tendering of major changes, and inconsistent methods for validating the wide range of contractors' prices for minor changes.6 These remain risks to value for money, but Trusts are taking action to address them:
a Competitive tendering is now used in most cases for major changes in the NHS. Thirty-one Trusts reported that they have made a change in excess of £100,000, of which 23 (74 per cent) were competitively tendered. We previously found that only 29 per cent of changes over £100,000 to government PFI projects were competitively tendered, although 41 per cent had been judged to be unsuitable for competitive tendering.7
b Sixty-nine per cent of Trusts stated that they had a small change threshold, under which changes are not competitively tendered. This allows small changes to be processed more quickly using an agreed schedule of rates. Our testing of Trusts' systems found good controls for tracking changes and challenging costs.
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6 Making Changes in Operational PFI Projects HC 205 Session 2007-2008.
7 ibid.