Sir, The Department of Health is right to give more thought to NHS projects but quite wrong to have mortgaged the taxpayers’ future so heavily through the Private Finance Initiative (PFI). Before any patient is treated, the taxpayer is already paying private companies more than £1 billion a year.

Many of these schemes were envisaged when NHS funding was rising at a steady 7.5 per cent per annum. From 2008 this will reduce to about 3 per cent. It will be quite impossible for many trusts — not just Bart’s — to make the repayments. The taxpayer will be called on yet again to bail out the Government’s ill-judged clandestine spending spree.

PFI is off-book accounting, in the same mould as the Enron scandal. The Enron directors are now behind bars, but Gordon Brown continues, at a time of unprecedented NHS spending, to obscure the real cost to the taxpayer of his schemes.

BRIAN CLARKE
London W6

Sir, Your leader (Jan 16) is surely naive to imply that the “biggest hospital building programme in the history of the NHS” has been undertaken without public money. It is only the commitment, government-backed, to make annual payments of public money stretching into the next generation that secured this programme.

The lack of any credible way of dealing with publicly financed hospitals that fail in the business sense is a resultant shortcoming of the plans for increased patient choice. It is as glaring as it is unavoidable under the current arrangements.

The Government, belatedly recognising the availability of wider private sector resources as a missed opportunity, should move up a gear and encourage the sector to assume fuller responsibility for both finance and management of “monolithic” new NHS facilities: that is, without the prop of fail-safe guarantees.

This would better ensure that business cases were properly thought through and place the risk of financial failure where it would sit most comfortably.

PETER REEVES
Hove, E Sussex

Sir, A combination of ridiculous Whitehall red tape and the “cost plus” methodology has increased the cost of a NHS project on which we are working by almost 100 per cent.

If cost plus was an efficient method of working then it would be embraced by the private sector. It is not.

Most PPP and PFI projects are sponsored by contractors. Has anyone wondered why? To get efficiency into building for the NHS it needs to be dealt with in the same manner as supermarkets: a concept building that is amended to meet local circumstances.

Simplify the design, take a commercial approach on the land dealings and go out to public tender on the construction. The NHS will then get the building it wants at an affordable price.

N. G. TUCKER BROWN
Chief Executive,
Galliard Developments

Sir, Our radiotherapy department was opened in 1964, when the patient caseload was one tenth of that today, as an addendum to a hospital built in the early 19th century. While the cancer equipment has been updated in recent years, the infrastructure is “moribund and dilapidated”, to quote our previous chief executive.

Its reprovision and expansion is to be the “jewel in the crown” of our PFI scheme to centralise services on the Colchester General Hospital site; like that at Bart’s and the Royal London, it is due to be signed off in the near future. But this aspiration does not set clinicians against managers. Close working over many years has united all of us in trying to bring this project to fruition.

In an era of patient choice, our experience is that patients would prefer to receive timely treatment in a locally accessible, modern, fit-for-purpose environment. After 40 years are they really asking too much?

DR BRUCE SIZER
DR PHILIP MURRAY
Essex County Hospital

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