1.29 Appendix 5 and our field work indicates that some of the elements of under-performance were potentially serious for patient care, for example:
■ the Trust's performance reports for July 2003 noted that there had been a repeated waste collection failure. The Trust awarded a performance score of 94 for the month although on this occasion, there was no payment deduction;10
■ in September 2003, the Trust's Performance Management System (PMS) records noted that there was a 'collection of dust underneath beds' and 'staining on walls'. The Trust awarded a monthly performance score of 94 to Domestic Services, Window Cleaning and Pest Control leading to a payment deduction of £1,153; and
■ the PMS of September 2003 noted, 'extremely poor levels of hygiene and cleanliness of premises and personnel' in the food production area. A performance score of 93 was awarded leading to a payment deduction of £1,621.
1.30 In our opinion the scores awarded seem high in relation to the nature of the incidents. In part this reflects the subjective nature of assessments. The performance measurement system in use incorporates mainly subjective assessments and this means that there can be different interpretations of how serious a particular lapse in performance has been. This is important as lower scores would have resulted in greater deductions.
1.31 The contract allows for increasingly greater payment deductions to be made as performance scores decline (Figure 8), and deductions which were made were fully in line with these arrangements. While it has to be recognised that the cost of ensuring a perfect service would be prohibitive, there is a risk that the incentives for maintaining good performance will not bite unless the assessments made of lapses fully reflect their potential seriousness. Making assessments commensurate with the nature of events is also necessary to ensuring that good value for money is obtained from the contract. THC Dartford notes, however, that the PFI deal was priced on the basis that the consequential losses for service lapses that THC Dartford can be expected to bear are limited to its charge for the particular service in the month in which the lapse occurs.
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10 THC Dartford was able to claim a credit from the good performance of previous months.