Partnership between private and NHS is not necessarily wrong

EDITOR—Smith voices concerns about the private finance initiative.1

The initiative is a procurement process. Many of his assumptions apply equally to traditional procurement. He did not highlight the advantages that can be realised from a new hospital. Through the private finance initiative, the public purse pays for this over several years in revenue payments, but traditional procurement would have increased capital charges and rates.

Smith claims that reducing bed numbers is one effect of an unaffordable system. Not so. We in Hereford are implementing a county-wide healthcare system, not just running a new hospital. Our strategy embraces recent changes in technology and management, including better use of community facilities, improved links with social services, and more home care within an NHS led by primary care. Consequently, fewer beds are needed.

However, we have not assumed we have got it right. We have planned flexibility by maintaining some beds in refurbished accommodation. We have quality new facilities and the flexibility to maintain services appropriately should other changes in health care occur.

Service delivery is not reducing in Hereford. Clinicians have fully participated in developing our project, and clinical functioning is paramount. We are satisfied with the result.

Smith discusses increasing private beds. We have no private beds. None are being planned to fund this project.

He also raises the issue of secrecy and the nature of the planning process using bed numbers “without thought for the …