Peterborough Hospital PFI

The Private Finance Initiative (PFI) uses the equivalent of a full operational lease used by many governmental authorities in the UK. Financiers form a company borrow the money to (re)build a new hospital. The PFI company then leases back the building to the local Hospital Trust, but there's a kicker. As part of the deal the PFI company also gains exclusive rights to provide services such as facilities management within the hospital. It is a very very expensive method of financing the hospital (re)build.  In recent year Governments liked this method of financing because it does not show up on the capital borrowing total for public finances, it is in effect a future operating cost. These contracts go on for 30 - 50 years. 

It would be much cheaper for the public purse if the Government was honest and just borrowed the money up front and built the hospital using their own managers. In the news today is yet another report of a Hospital Trust struggling to pick up the bill for a PFI. Peterborough and Stamford hospital Trust have been criticised by the National Audit Office for poor financial control and mounting debt.

Much of the unplanned cost comes from the provision of services not included in the original contract. Minor changes such as moving a phone or installing an extra shelve must be be purchased via the PFI company. As there is no competition these costs are greatly inflated by the PFI company.

The consequences of the "overspend" caused by the PFI is that hospital staff including nurses are made redundant. Clinical services are cut back.   Peterborough Hospital PFI was agreed in 2007, it is a very nasty financial legacy left by the Labour Party Government at the time. I've seen estimates of £800 Million required to rescue the hospital finances.

Post-Sandy situation predicted

Many of the post Hurricane Sandy problems in New York and New Jersey could have been alleviated if the authorities had followed the guidelines in my Foundation of Honour Handbook and had set up social groups to help after the event of a major regional disaster.

Such problems as:

• Lack of fuel;
• No access to power;
• Contacting lost friends and family;
• Limited food and shelter;

 could have been prepared for in advance and local populations be prepared for self help at a low cost.  Copies of the books are available on Amazon in e-book form. If anyone cannot afford the couple of bucks price contact me at alaricadair@gmail.com and I'll send you a copy free.

There are other measures the authorities could have taken like forcing gas stations to hold 15 days supply of gas with protected standby generators to allow the pumping of fuel when mains electricity is available. The "just in time" stock holding of 2-3 days gas (petrol) might make a slight improvement in short term  company profits, but it is a lousy call when it comes to public infrastructure resilience.

Wickes Kitchens

Wickes is a builders merchant in the UK. They have been around since 1972. They are part of the Travis Perkins plc group. They advertise quite frequently on the national TV projecting the image of reliability and a "Job Done" approach.

Sadly that has not been our experience. We are severely disappointed.

We purchased a fitted kitchen from them on 26th May 2012 (Order Number 890924). We paid in full on the 26th May as part of their conditions of business.  The price included fitting.  Here we are on the 8th September 2012 not knowing when this kitchen will arrive or when it will be fitted. Yesterday we had a phone call to follow up an earlier letter telling us the kitchen parts would be delivered Saturday (today) between 8 am and 10 am.  The call said the driver would call us before arrival. The fitter had said installation would start on 10th Sept.  That's 15 weeks delay on the part of Wickes.

The kitchen has not been delivered, there's no contact from Wickes and yesterday afternoon the fitter called and said he'd hurt his back and might not be able to attend on the planned Monday start date. We tried to call their Help Desk and learned it is only available Monday to Friday 9-5:30.

We want to thank Wickes for wasting our Saturday and leaving us in the dark. What happens on Monday? Do I have to make arrangements to stay at home?

Is the Travis Perkins group so short of money that it needs us to act like a bank and have us lend it £9000 free of interest for 15 weeks?

Getting the van ready to drive around the City of London

Update @ Sat 8th Aug 13:10 The truck arrives. They'd had two previous deliveries (allowed 15 mins each by Wickes) bur each delivery "took a couple of hours, because they were flats". They couldn't call us because "they didn't have any phone numbers".  We'd given Wickes a couple of numbers when we placed the order, in any case is there no reason why the driver couldn't have called their HQ and had them call us to advise of the delay?

Update Mon 10th Sept @ 10:15am
No sign of any Wickes fitters at our place this morning to install the kitchen, nor any phone call as promised to explain when this work would be done. Apparently the fitter had warned Wickes that he might be off sick (injury) today. As usual Wickes do not seem to care about inconvenience to their customers.There's no point in calling the original salesman, he was moved to another Branch.

Update Mon 10th Sept @ 13:45
I called Wickes Help Desk again, not having heard anything for a couple of hours. The regional installations manager has, after my earlier call (10:46), arranged an alternative fitter to visit tomorrow at 1pm to assess the work and possibly start on the following day (Wednesday). The manager confirmed in the call that Wickes have no formal procedures in place to check why installations are delayed past their "normal period of 4 - 8 weeks" after the date of order, it is left to the customer to raise concerns. In effect Wickes had 64 hours during which they could have resolved this before start of play today; but they didn't.

In a further example of customer friendliness I note the comment from the Wickes Helpdesk representative (S_______e)  who briefly handled my call; "You should expect it to take between 24 - 48 hours for us to handle a query."  It seems that I've had the Red Carpet treatment so far. It will be fascinating to see what Wickes manage to deliver on their latest promises in the next couple of days.

Update Wed 12th Sept
The replacement sub-contractors have commenced work on time and are getting stuck in to the work. As Wickes uses sub-contractors as its fitters there was very little handover from the previously assigned fitter so we had to do a full review of the plan. It turns out that while "everything" was delivered there was a missing item which the sub-contractors will have to contact Wickes to sort out. 
Interestingly in the original order process  and subsequent discussions I deliberately asked Wickes if their fitters were Wickes employees and was told they were employed by Wickes. Strictly speaking the fitters are not employees, they are self-employed/ working for small companies carefully selected by Wickes. They have a contract to supply services to Wickes. One consequence is the fitters will try to take on as much work as possible, which in my view could lead to scheduling difficulties. I just dislike the misleading response from Wickes which implied the fitters were direct employees.

Update Wed 19th Sept
The replacement sub-contractors employed by Wickes completed their work on Monday (17th) afternoon. They were good and took care over their work. They tidied up and placed the rubbish from the install in a large yellow bag in our front garden for collection.Sadly the Wickes design didn't fully match the room so a couple of set of draws have been return to Wickes (Monday) for refund. No news from Wickes on the refund, so I'll have to chase them again. Grrr!!

The sub-contractors managed to devise a fitting from cut-offs from the installation, so the work looks tidy (pictures, also shows floor replacement), but we didn't get what we paid for in terms of installed kitchen furniture. 

One annoying thing is that we were left with a 2.5 metre length of solid oak worktop from the installation. The designer had ordered two x 3 metre lengths to make up the parts for the installation. You would have thought that Wickes could have sourced a 0.5 Metre length off-cut of their worktop. The list price of the 3 Metre lengths is £324 each. So we (Wickes) wasted the the better part of £150 after discount, though I guess it increased the Wickes profit.

The rubbish collection is sub-contracted by Wickes to Hippowaste, but these people haven't turned up within the promised "48 hours", more inconvenience for us and our neighbours  who kindly kept that part of the street free from parked cars. This is once again poor control of process by Wickes of their sub-contracted suppliers. We still have a Hippo squashing the plants in the front garden, with no clear idea of when it will be taken away.

The effective charge per man-day of the installation was £300/man day; I'm pretty sure the sub-contractors don't see all of that money, but it might be a useful comparison if you are considering using alternative fitters to install the Wickes Kitchen unit.

In summary:

• The Wickes kitchen units look robust and well constructed, but don't buy them unless they are at sale prices;
• Their appliance prices are high, you'll get cheaper if you look around;
• Don't use Wickes for the actual installation. They retain good installation sub-contractors (Note: not employees!), but their management of those resources is poor. They do not realise when things have gone wrong. The Wickes communication procedures with the client are poor.
• Don't believe their delivery timings, you are destined to sit waiting at home for at least a whole day. Their delivery staff are helpful and efficient when they arrive.
• Don't believe their timings for waste collection.
• Double check and triple check the design produced by Wickes before signing, we had some wasted space behind cupboards and a couple of units too  large for the gaps.
• Remember Wickes insist on a 100% deposit, i.e. payment in full when you sign the order; make sure you pay by credit card or you'd have no leverage if things go wrong. 

To give Wickes their due, when I made their HQ aware of the events through this Blog I received a phone call from one of their managers who called and gave a genuine apology. They've also resolved the surplus worktop issue. Hopefully they'll benefit from my criticism and avoid inflicting this on other customers. It doesn't take rocket science to sort their procedures.

Aftermath of NHS Walk-In Centre closure

I've written earlier about the death by attrition of an NHS Walk-In Centres (WIC) in the United Kingdom. The concept of a nurse led WIC is to provide primary health care to patients who walk in off the street without appointment. The nurses are highly skilled, highly trained and carefully selected. They are examined in physical assessment skills, their work is routinely audited for best practice. They work to careful designed medical protocols which allows them to assess and manage the majority of minor illnesses. The nurses are also trained to recognise conditions which should be referred to specialist medical practitioners. The senior nurses in the team usually posses Master degree level of medical training and take separate training and assessment to be allowed to prescribe medicines.

I'm keeping track of one WIC which was closed down and the team transferred to a local A&E department of an Acute Hospital Trust. The highly skilled primary care Matron who had led the WIC nursing team was within a few days forced out of the job and was replaced by a less senior A&E nurse who had no training in primary care.

In the past 6 months the skilled WIC nurses now working under A&E management have been subjected to a programme of bullying and repeated comments that they lack the competence to undertake primary care work. The people harassing the nurses have little or no primary care knowledge/experience. There have been arbitrary bans on the WIC nurses performing the role they'd practised many years before in an autonomous way. Note that the WIC team previously had a very low rate of complaints of medical mistakes. Make no mistake, the Acute Care A&E management is trying to force the WIC nurses out of their jobs while retaining the budget funding for their primary care work.

This may all sound like internal politics, but it has a serious impact on service to the local public. The WIC in question used to have about 400 visitors a day. Some of those would be streamed away without medical treatment, but most patients were seen in less than an hour.. The local A&E now regularly breaks the four hour rule for treatment and has a much higher error rate. Skilled Nurse Practitioners like this person are the type of experienced nurses being forced out.

Edit 27th Aug 2012: Or look at Suffolk NHS who posted on their web site: 'Only visit A&E if you are dying' a few months after the decision to close their minor injuries unit and transfer the staff to A&E.

10th Sept 2012: I lose no tears over Andrew Lansley getting the sack as the Health Minister. Sadly the NHS will continue to suffer the effects of the chaos he's caused for many years.

The Foundation of Honour tunnel system

The secret tunnel system of the Foundation of Honour as mentioned in the Adam Cranford series of books need to be diverted. The Foundation has discovered the plans of the National Grid will run extremely closely to one of the Foundation's main tunnels and subterranean rail system hidden under London in the UK. The Cross Rail project comes close to one of the Foundation's tunnels, but no work will be necessary to avoid conflict.

These tunnels were mentioned in the book Company Mole but do not appear on the official records and plans It is likely that the National Grid and the Foundation tunnels will not actually intersect, but the Council of Elders have chosen to divert the existing system.

. 

Work has already commenced to resolve this problem. I'll probably include a mention of this work in the next Adam Cranford book which is work in progress. There will be no interruption of  tunnel transport services and telecommunication services during the works.

A couple of new books

I've recently published a couple of short books for the Adam Cranford Series.

The first new book The Foundation of Honour Handbook (ISBN 9781907250101) is for new members of the Foundation of Honour. It contains such things as Code of Conduct, Ranks, Membership structure, Activities and  the Foundation's role in Public Service (Civil Defence).

The second new book Design of a Foundation Moot (ISBN 9781907250118) describes the features and design of the central meeting building for a local county company of the Foundation of Honour.

At present they are only available on Amazon using their Kindle service, but don't worry if you do not possess a Kindle as Amazon provide free reader software for use on other devices such as PCs. If there is sufficient demand we'll make them available in a printed format, subject to the agreement of the publishers. All of the Adam Cranford series books are available on Amazon except for one called Teen Valour People which is on Lulu.

Finally the BBC realises!

The BBC has finally realised that NHS Walk-In Centres are being closed. I've written several blogs about this. The closures have been pushed by Andrew Lansley's GP friends.

It all boils down to less service availability for patients. Have you tried to get an appointment with your GP recently? The Government claim the services have not been cut. Well all I can say is they've not been in the street themselves. They are liars!