BMJ 1999;319:48-51 ( 3 July )

Education and debate

The private finance initiative

NHS capital expenditure and the private finance initiativeexpansion or contraction?

This is the first of four articles on Britain's public-private partnership in health care

Declan Gaffney, research fellow ^a,  Allyson M Pollock, professor ^a,  David Price, research fellow ^b,  Jean Shaoul, lecturer ^c. 

^a Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1H 9EZ, ^b Social Welfare Research Unit, University of Northumbria, Newcastle upon Tyne NE7 7XA, ^c Department of Accounting, University of Manchester, Manchester M13 9PL

Correspondence to: Allyson Pollock allyson.pollock@ucl.ac.uk

The first 150 words of the full text of this article appear below.

Before 1948, building the hospital and community health service was primarily a local government responsibility and new investment depended on local authorities' ability to meet the cost of borrowing. The "depressed areas," which had the worst health status, were inevitably disadvantaged. Investment patterns during the interwar years contributed to the inequitable distribution of the infrastructure, which was, according the official historian of the NHS, a "ramshackle and largely bankrupt edifice."¹ The 1946 act led to the nationalisation of the inherited hospital infrastructure and the centralisation of the responsibility for financing its improvement within the ministry of health. NHS hospital building was to be financed by central government grants and funded out of general taxation and national insurance contributions.

The NHS initially made little impact on its inherited infrastructure problems because public sector investment in the postwar years was concentrated on education and housing. Aneurin Bevan, among others, suggested that spending controls could . . . [Full text of this article]

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Read all Rapid Responses

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Brian McCloskey
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