“Perfidious financial idiocy” was how a previous editor of this journal described the private finance initiative (PFI), a way of securing private funding for public projects, notably hospital building (BMJ 1999;319:2-3, www.bmj.com/cgi/content/full/319/7201/2). Richard Smith based his assessment largely on the work of Allyson Pollock, who, Cassandra-like, found her message ridiculed when it wasn’t ignored. But that was then. The current unravelling of PFI, with the government bailing out projects in trouble, makes her analysis look prescient. So we should at least take notice of what Professor Pollock has since turned her attention to.

Her latest target is independent sector treatment centres (ISTCs), the beneficiaries of the British government’s policy of contracting out clinical …