EDITOR,—Chris Ham seems gloomy about private finance for NHS trusts for building projects.1 This could, however, herald a new era, providing modern health service building without the restrictions of the public sector borrowing requirement.

A crisis is developing in the management of acute care through the reduction of trainees' hours of duty, the introduction of higher standards2 and new treatments, and, in my specialty, an acute shortage of candidates for consultant posts. It is essential, therefore, to concentrate emergency services on as few sites as practicable; this …