Letters

PFI is here to stay

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7353.1584/a (Published 29 June 2002) Cite this as: BMJ 2002;324:1584

Select committee's report should have been given greater attention

  1. Brian McCloskey (B.McCloskey{at}worc.ac.uk), professor of public health
  1. University College Worcester, Worcester WR2 6AJ
  2. (City University)
  3. (City University)
  4. (University of Leeds)
  5. (University of Bristol)
  6. (University of Bristol)
  7. (University of Ulster)
  8. (City University)
  9. (London School of Hygiene and Tropical Medicine)
  10. (University of Oxford)
  11. (University of Lancaster)
  12. (London School of Hygiene and Tropical Medicine)
  13. (University of East Anglia)
  14. (London School of Economics and Political Science)
  15. (London School of Hygiene and Tropical Medicine)
  16. (University of York)
  17. (City University)
  18. (University of Edinburgh)
  19. (University of York)

    EDITOR—Pollock's arguments against the private finance initiative (PFI), a news item on PFI, and a report on the House of Commons Select Committee on Health's inquiry into the role of the private sector in the NHS should have been linked together and more made of the select committee's report.13

    The select committee said that it was “unimpressed with much of the University College London's Health Policy and Health Services Research Unit's (HPHSRU) research and its arguments against PFI.” Yet the BMJ has based its debate on PFI almost exclusively around articles by this unit. The committee added: “This has raised serious questions about the HPHSRU's ability to analyse rationally the finances of the NHS.” Most significantly it said: “We found the lack of sound analysis from the HPHSRU additionally worrying because it has been the source of advice for many groups including unions and professional associations, all of whom have used parts of the unit's work as a justification for their antagonistic attitudes towards the private sector.”

    The select committee found that “PFI is still being blamed for numerous ills not directly related to it whereas the many benefits ascribed to PFI have yet to be proved. The time has come for a more rational and objective debate.” It concludes: “Some of the antagonistic extreme views that are put forward by the HPHSRU and by other organisations have not helped to promote a sensible and mature debate about what is best for patients and staff in the NHS.”

    Surely the BMJ (and the BMA) should now move on from its blind antagonism to PFI. It should be more critical of the evidence it presents in its articles and engage rationally in the debate. Ultimately PFI is probably neither as bad nor as good as the extremists present. In the meantime we are being distracted from identifying and debating the real health questions that lie beyond arguments about how new hospitals are funded.

    We need to consider what priorities drive us to spend so much of our NHS resources on hospital buildings and whether those priorities are right. Should an obsession with counting acute beds blind us to the health problems that cannot be solved by a hospital bed? How can health care (and even health) be delivered outside hospitals? We need to look at developing capacity to manage illness in a whole systems way as advocated by the national beds inquiry4 and how we incorporate acute hospital planning into a holistic approach to health planning and development as set out by the King's Fund.5 These are the real questions concerned with the best interests of patients.

    References

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    Select committee's report used parliamentary privilege unacceptably

    1. Alison Macfarlane,
    2. Bob Heyman,
    3. Daniel Dorling,
    4. Dave Gordon,
    5. George Davey-Smith,
    6. Helen Dolk,
    7. Helen Roberts,
    8. Ian Basnett, (consultant in public health),
    9. Ian Roberts,
    10. Jane Lewis,
    11. Jennie Popay,
    12. Martin McKee,
    13. Miranda Mugford,
    14. Rodney Barker,
    15. Rosalind Raine,
    16. Sally Baldwin,
    17. Sally Glen,
    18. Stephen Platt,
    19. Trevor Sheldon (A.J.Macfarlane{at}city.ac.uk)
    1. University College Worcester, Worcester WR2 6AJ
    2. (City University)
    3. (City University)
    4. (University of Leeds)
    5. (University of Bristol)
    6. (University of Bristol)
    7. (University of Ulster)
    8. (City University)
    9. (London School of Hygiene and Tropical Medicine)
    10. (University of Oxford)
    11. (University of Lancaster)
    12. (London School of Hygiene and Tropical Medicine)
    13. (University of East Anglia)
    14. (London School of Economics and Political Science)
    15. (London School of Hygiene and Tropical Medicine)
    16. (University of York)
    17. (City University)
    18. (University of Edinburgh)
    19. (University of York)

      EDITOR—We are deeply concerned at the misrepresentation in the House of Commons Select Committee on Health's report, The Role of the Private Sector in the NHS, of evidence critical of the private finance initiative (PFI) given by University College London's Health Policy and Health Services Research Unit. 1 2

      We believe that the committee's criticism of research by the unit is an unacceptable use of parliamentary privilege to attack academic scholarship. Paragraphs 65 to 69 of the report give an inaccurate account of statements made in evidence and in published research. In particular, they misrepresent evidence that the unit gave to the committee and allege that the unit's research was unsound without providing any evidence of this.

      This will undoubtedly deter other researchers from acting as expert witnesses to select committees in the future, especially if their findings do not accord with prevailing government policies.

      It is important that parliamentary select committees take evidence from witnesses with a wide range of views and examine them critically and robustly in relation to government policies. Contrary to the comments made in the report, the unit's published research on public health and the private finance initiative is respected both internationally and nationally.

      We call on the House of Commons Health Committee to withdraw these unsubstantiated comments and urge others who support fair reporting and use of evidence given to select committees to reinforce this request. This can be done by writing to the House of Commons Health Committee, House of Commons, London SW1A 0AA or emailing the committee at healthcom{at}parliament.uk

      References

      1. 1.
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