Undermines rational planning of health services

Among health service managers, healthcare professionals, and the public there is almost universal agreement that the private finance initiative has failed as an alternative source of capital funds for the NHS. The amount of public sector capital has reduced—by 15% in the past two years—but when the election was announced in March not one major privately financed hospital project had started. Most criticism has focused on this failure. In any case there is a belief that schemes under the private finance initiative can work only at a cost to the NHS (in terms of future payments for facilities) which will prove unacceptable. Hospital provision over 30 years is a high risk enterprise, and returns on private investment must reflect this risk.

An article by Pollock et al in this issue (p 1266) raises two further problems with the private finance initiative.1 The first is a lack of openness surrounding the whole process, resulting from commercial sensitivity. The second lies at the heart of the planning process for public services: the questionable assumptions that lie behind many hospital schemes in the pipeline. These criticisms are linked. The ability …