Written evidence submitted by Dennis O’Keeffe (PFI0001)
This submission draws upon more than three decades of senior-level public sector project leadership experience, encompassing the successful delivery of over £1.2 billion (inflation-adjusted) of NHS hospital infrastructure through a variety of procurement models, including the Private Finance Initiative (PFI), the Non-Profit Distributing model (NPD), and the Mutual Investment Model (MIM). Projects spanned acute, cancer, and specialist care facilities across multiple UK nations.
The submission integrates lived experience with insights derived from current self-funded doctoral research, reflecting on the complex social dynamics and institutional capabilities needed for effective infrastructure governance. A central theme is the importance of accredited project leadership for NHS capital delivery teams embarking on privately financed procurement routes.
a. Acute Hospital Project
Delivered a major new acute general hospital under a privately financed (i.e. PFI) route with an inflation-adjusted value of £348m. Led the project from concept through Competitive Dialogue to financial close and construction, delivering against tight timelines and achieving value for money below affordability benchmarks.
b. Cancer Centre Programme
Directed a new specialist cancer hospital developed under the Mutual Investment Model (MIM), with an inflation-adjusted value of £424m. Oversaw structured bidder engagement and worked to ensure the dialogue was tailored to local service and design aspirations.
c. Regional Health Board Capital Programme
Managed a regional NHS portfolio of capital projects with an inflation-adjusted value of £346m. Delivered concurrently across mental health and community hospital sites, piloting emerging framework models and securing national design awards.
d. Cardio-Thoracic Specialist Centre
Led the business case and design development for a new adult cardio-thoracic centre in a major urban setting, with an inflation-adjusted value of £114m, ensuring alignment with regional service configurations and strategic investment priorities.
A key contributor to delivery success has been the author's completion of the Department of Health–sponsored Postgraduate Project Leadership Diploma at Lancaster University Business School. This formed part of the formal NHS Project Director Accreditation process.
This accredited training went beyond knowledge acquisition—it embedded leadership behaviours, strategic governance insight, and negotiation fluency necessary for engaging with private sector consortia, advisory teams, and internal clinical stakeholders.
I would respectfully suggest that the Committee consider a recommendation that such NHS-specific accredited training be regarded as desirable—if not essential—for any future programme involving private finance. Should a postgraduate scheme for NHS Project Directors and Sponsors be contemplated as part of such a recommendation, I would be pleased to offer further advice based on lived experience and successful project outcomes.
Evidence from across multiple NHS hospital schemes suggests the following preconditions are critical:
- Prequalification must be robust and tailored to NHS-specific delivery contexts.
- The structure and content of Competitive Dialogue must be shaped to enable meaningful engagement, not procedural compliance alone.
- Clinical and operational team input must be embedded continuously—not episodically—throughout procurement and design.
- Quality assurance and risk processes must be project-specific and capable of identifying reputational, governance, and long-term operational risks.
Ongoing PhD research explores the use of innovative qualitative and quantitative methodologies to understand social dynamics and the practical governance, design, and procurement realities of the 'front-end' of complex NHS hospital projects proposing to use private finance. This work offers an empirical complement to retrospective audit models and helps illuminate real-time governance conditions and delivery risks otherwise missed by standard frameworks.
This submission has been anonymised in the public domain for considered and strategic reasons:
- To avoid violating institutional or professional norms related to discretion and non-disparagement.
- To reinforce the author’s role as a trusted advisor to the public interest rather than a critic of individuals or institutions.
- To enable the sharing of frank insight qua institutional experience, without risk of it being misinterpreted as personal or political critique.
Full authorship and background information are available to the Committee under parliamentary privilege. Supplementary material or oral evidence can be provided in private session if helpful to the Committee’s inquiry.
April 2025