3.6 The contract ties the Trust to a 35-year relationship with Bywest, with a possible extension to 60 years. Over this long period it is likely that the healthcare needs of the local population and therefore the Trust's needs will change. The lack of a cohesive strategy for the West Middlesex area and other parts of London, together with changes in the structure of healthcare provision add further uncertainty to the longer-term requirements of the Trust. These uncertainties pose potential risks for the long-term PFI contract. These types of longer-term planning uncertainties are not limited to PFI hospitals, and would also affect a conventionally-procured hospital. However, the long-term nature of a PFI contract would be likely to make it more expensive to terminate the ongoing arrangements than a traditionally-procured hospital. The Department considers there is a low risk of terminating this PFI contract.
3.7 One of the generic risks of PFI contracts mentioned in Figure 9 is the potential difficulty of dealing with contract variations. Changes in healthcare requirements may lead to variations. The contract therefore contains safeguards to control the rate of return Bywest can make in the event of future works variations to the contract. This protects against the risks of the Trust paying excessive prices for any variations.