Q91 Sarah McCarthy-Fry: I accept the second part of your point. The first part of your point, how do you know that it is the new building that has delivered those additional 23,000 patients and not additional nurses, additional doctors?
Mr Forden: Because we know how many beds we would have needed to be able to do that and we know the types of beds and the types of layouts, et cetera, we required, and that is on what we made that analysis.
Chairman: Thank you. Greg Clark.
Q92 Greg Clark: Mr Forden, did you follow national guidance from the Department of Health on how many beds you would need when you were planning this project?
Mr Forden: I know that the regional office gave us guidance as to how many beds they believed we would need, and that was clearly indicative of the guidance from the centre.
Q93 Greg Clark: So it was in conformity with guidance, and then you found that you needed 40% more beds. Did the guidance change?
Mr Forden: No, I believe what had was that there were a number of assumptions made in the Report for the regional office. Some of those came to fruition, some did not, but there were also changes in policy at the time which changed. Trying to reduce waiting lists, et cetera, was not in the original guidance and that was something that started to come along. Also the actual change in the population of Norfolk is changing constantly.
Q94 Greg Clark: These policy changes had a big impact because you had to pay one-fifth more in terms of your annual charge as a result of these changes, did you not?
Mr Forden: We certainly had to pay more. We paid one-fifth more for a 40% increase in beds, yes.
Q95 Greg Clark: A major component. Can I ask Mr Coates, has additional capacity been added at other PFI hospital projects because of a new commitment to reduce waiting lists that was not around at the time?
Mr Coates: I feel certain that there has. I do not have details with me but from memory this is the largest variation to a PFI hospital that I am aware of.
Q96 Greg Clark: Mr Coates, would you mind writing to the Committee perhaps with a full account of all the variants for PFI projects up and down the country that have been caused by an increase in the number of beds?5 Because we have seen that there has been a big increase in the cost here and I imagine that is the case around the country and I think it would be interesting for the Committee to know how much the Department of Health is responsible for increasing unnecessarily the annual bill for these things. We know from this Committee that variations to contracts once they have been let tend to be very expensive, and this seems to be an example which, through no fault of the Trust, the Department has caused some increasing costs. If you can provide us with that note?
Mr Coates: I can provide you with a note but, as I say, I think this is the most exceptional and large one that I am aware of.
Q97 Greg Clark: That is helpful to know. Are you expecting any changes in the guidelines coming up? Do you think that the recommended number of beds for new PFI projects is now right or is that something that you are reviewing?
Mr Coates: Bed numbers within PFI hospitals are not set by the Department of Health, they are set by the local health economy. They may, for example, take independent Reports on trends and development trends, et cetera.
Q98 Greg Clark: But you were given guidance on the type of provision they should make, I assume?
Mr Coates: We have just started checking or looking at OBCs, which are Outline Business Cases, which are the statement of need Trusts state for a new hospital. That goes to our capacity people who check to make sure that the assumptions-
Q99 Greg Clark: You have started, but that has not been done before?
Mr Coates: No, up to that point it was left to the local health economies.
Q100 Greg Clark: Sothere was no guidance from the centre as to what the new capacity should be in PFI hospitals?
Mr Coates: There was no central guidance I am aware of on exact capacity, no.
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