2.30 Policy risk is a particular risk for public sector projects and relates to changes outside the control of individual organisations but which may have a material impact on the organisation and investment scheme. Such risks are common to all NHS schemes so, while they should be recognised as an additional risk, they cannot explain the failure of the Campus scheme on their own as other hospital building schemes have overcome similar hurdles. Against this it should be recognised that the Department is currently reviewing how the commissioning of major capital schemes through PFI can be reconciled with long-term affordability and policies on choice, Payment by Results and the movement of care away from acute hospitals to the primary care sector.8
2.31 The main relevant NHS policy change affecting the development of the campus was consumerism which increased space in patient areas to improve the dignity and privacy of patients. This guidance, although not mandatory, had a considerable impact and was a major factor in the increase in size of the scheme between 2000 and 2003. Further draft guidance on the proportion of single rooms in a hospital was issued for consultation in 2004. The project team was assessing the potential impact of this draft guidance on design and space requirements prior to the scheme's collapse but the May 2005 Addendum did not meet the standards in the draft guidance.
2.32 Three other policy changes affecting the affordability calculations for the scheme were the introduction of private and NHS Treatment Centres, Payment by Results and choice at the point of GP referral. These policies emerged after the scheme started in 1998. Treatment Centres and choice increase the potential that patients will choose to attend other hospitals or providers for elective care. Payment by Results ensures that money follows patients and sets a fixed price for hospital activity. There is a potential opportunity as well as a risk for Trusts if they can attract additional patients and make a financial surplus out of treating them but uncertain income increases the risks for new schemes with higher than average costs.
2.33 The underlying risk from choice/Payment by Results is that it is a new and different funding regime for NHS Trusts and is therefore very difficult to forecast, especially over the very long time horizons of PFI contracts. Each Trust will need to make their own assumptions as to how patient choice and Payment by Results will impact on their future revenues but they have no track record on which to base those assumptions.
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8 Our health, our care, our say: a new direction for community services, Cm 6737, Department of Health, January 2006.