- guardian.co.uk, Sunday July 8 2001 04.14 BST
The Cumberland Infirmary in Carlisle, the first public hospital in Britain built with private money, was lauded as the way of the future when it was triumphantly opened by Tony Blair in June last year.
But beneath the gleaming façade lurks a catalogue of horrors that nurses, doctors and unions insist prove the Government's much loved private finance initiative is not just bad in theory: they have lived with it, and it does not work in practice.
To them, PFI has meant cardiac patients drenched with water flooding from broken pipes, sewage spilling out into the operating theatre, nurses left ventilating patients by hand as operations are plunged into darkness, broken equipment, second-rate maintenance as engineers are made redundant, flea-infested laundry, dirty wards because of the cutback in cleaners, patients put in chairs because of the reduced number of beds, and dying patients remaining undiagnosed as waiting times doubled.
It also means the health authority paying £11m a year in rent to a consortium, run by the construction group AMEC, whose share price has soared because of the millions of pounds it expects to make from PFI. The health authority is also renting a building it used to own because the new hospital is so small it has already run out of space.
The £87m Cumberland Infirmary is the first of 68 PFI hospital projects, and Blair and his Health Secretary Alan Milburn are now preparing to promote the role of private companies in the NHS in other ways.
Horrified unions are hitting back, dubbing it Railtrack on the wards. Peter Doyle, the Cumbria co-ordinator of the health service union Unison, who has had to deal with staff complaints on the new hospital, said: 'It looks good because it is brand new. But PFI means that you have to cut so many corners in order to save money that you are left with a hospital that just doesn't work.'
You notice the cut corners as soon as you enter the gleaming new atrium, which has plenty of space put aside for rent-paying shops. But there is no air conditioning, and last week as the temperature soared to 110 F, nurses and patients were left sweating profusely. 'It was absolutely unbearable - it's really uncomfortable for us, and bad for the patients,' said one exasperated nurse.
The high temperatures also expand the water pipes, that are joined by cheap plastic sleaves rather than soldered. A fortnight ago, the pipe above the cardiology ward broke, causing water to cascade down on seriously ill patients and around £300,000 worth of equipment. Nurses were left running around, pushing patients out of the way of the water, and covering the equipment with incontinence sheets. 'It was complete chaos,' said one of the nurses who tried to cope.
That was just the latest in a series of floods. The maternity ward has been flooded a couple of times. Builders hadn't plumbed the baths in properly, and water flooded down in the wards below. At one point, raw sewage spilled out from the sinks across the operating theatre. Cheap plastic joints also led to the ceiling collapsing twice.
Six weeks ago the operating theatre was plunged into near darkness because the emergency generator stopped working for 20 minutes. The lights went out and all the life-support equipment shut down without warning. Nurses had to ventilate patients under general anaesthetic by hand. One patient was trapped with their head in a scanner and had to remain there in darkness for 20 minutes. In the recovery room, where patients are taken after their operation, nurses were left feeling their way around in the dark. 'It was really frightening - we just didn't know what to do. We were lucky no lives were lost,' said one.
That was just the first time the generator failed. Soon after, the hospital was left in darkness without equipment for nine minutes. When The Observer visited, all the lights went out three times. The construction firm AMEC blames 'teething problems'.
The operating theatre has also been put out of action because the sterile services department, which is responsible for cleaning surgical equipment, has simply stopped working.
'The washing machines are cheap and inadequate - there are not enough of them and they break down all the time,' said one of the ancillary staff.
After the equipment is washed, it is dried in three autoclave ovens, which sterilise equipment using steam under pressure. In the old hospital, there was an engineer who looked after the autoclaves, but he was made redundant to cut costs.
All three autoclaves broke down, there was no one to repair them and operations had to be cancelled. 'It's the cheapest of everything, and nothing works,' said one worker.
In another bid to reduce costs, the hospital was built small. There are 90 fewer beds than in the hospitals it has replaced, and there is a chronic shortage of beds.
The bed manager has been told - but refused - to take sick patients out of bed and put them in an armchair for a few hours, so their bed can temporarily be used for another patient undergoing surgery.
Because the hospital was built so small, there is no storage space to hold medical records and copies of X-rays. All X-ray records are now stored in the old hospital building, which means nurses have to go on a 15-minute round trip to get them. 'It takes so long, we virtually can't function,' said one nurse.
The enforced slowdown has meant that waiting times for radiologists to examine X-rays - which should be within 10 days - has risen from two months in the old hospital to seven months now.
One patient with a tumour recently had to wait two months just to get his X-ray to be examined, during which time he was given no treatment and his tumour carried on growing. 'People will die because of this, and things are getting steadily worse,' said a nurse.
Space saving means the wards are so small that the doors couldn't open without banging into beds, and the doors had to be removed.
Resuscitation trolleys, to attend to people with heart attacks, were too big to get into the wards, and had to be specially rebuilt at a cost of £180,000. The walls in the wards are so thin that nurses can't put up shelves on which to store handbooks. The lack of storage spaces means that equipment lines the corridors.
Because of the appalling conditions, staff morale is at rock bottom. 'We have a corner in our department where people just go to cry. One colleague was there last week saying they're trying to kill us. The only happy people around here are those that have handed their notice in,' said one member of staff.
It's not just the nurses and ancillary staff who are driven to distraction by the conditions of working under PFI. Doctors are starting to speak out.
Dr Paul Dyson, chairman of the infirmary's medical committee, said recently: 'The developers always think of the bottom line. You have to hold a gun to their head to get them to repair anything. If this is what Blair has in mind for the NHS, watch out.'
