MINISTERS have discussed pulling the plug on a series of multimillion-pound schemes to rebuild Britain’s crumbling hospitals over alarm at costs, The Times has learnt.

Today 1,000 doctors at St Bartholomew’s and the Royal London hospitals, including 450 consultants, have signed a letter to The Times protesting at government plans to renege on a £1.15 billion deal to rebuild the two hospitals.

The Department of Health failed to sign off on the scheme before Christmas and has called for a review and possible exclusion of Bart’s in an attempt to cut costs.

But The Times understands that ministers are considering scaling back or even cancelling about ten schemes, including redevelopment planned in Bristol, Liverpool and Newcastle.

They are concerned that hospitals that are due to be rebuilt under the controversial Private Finance Initiative will not be able to service their debts. The initiative involves private companies raising the capital to redevelop hospitals that trusts pay off through service agreements over 25-year periods. Gordon Brown championed the scheme as a way of funding big public sector developments without the Treasury having to pay up front.

But now ministers are concerned that the spiralling costs of many schemes at a time when public finances are already stretched.

So far, 24 PFI schemes are complete and operational, with a total capital spend of £2.1 billion. Another 14 schemes are approved, to a value of £3 billion. But waiting in the wings are schemes worth another £12.1 billion.

The bigger the scheme, the greater the fear that the trust responsible will go bankrupt, leaving the Department of Health to pick up the tab.

The issue was brought into focus last month by an admission by Queen Elizabeth Hospital trust, in Woolwich, that the trust was technically insolvent. “Ministers are considering how to make it clearer that PFI schemes have to make financial sense,” a source in the department said. “They are looking at how we got into this position and how to avoid it happening again.”

In their letter in today’s Times, signatories representing more than 1,000 doctors call on the Prime Minister to rescue Bart’s and the London schemes. With contracts ready to be signed, they say that they are alarmed that the Department of Health has commissioned a “last-minute and fundamental review” that could threaten the scheme.

“These hospitals have some of the best clinical outcomes for the treatment of cancer and heart disease,” the letter says. “They serve Europe’s most ethnically diverse population. The loss of any of these services would be damaging to the health of this vulnerable population and irretrievably damage our medical school.” The letter says that the Prime Minister gave a personal commitment to the redevelopment, reversing years of indecision.

When Bart’s was faced with closure in 1998, Frank Dobson, who was then Health Secretary, promised that it would be saved. The Department of Health acknowledged that ministers’ actions would be constrained by the promise. But time for a decision is short. The contract with private partner Skanska lapses at the end of January.

The aim of the review is to see if cancer and cardiac services at Bart’s could be relocated elsewhere, and ministers say that to talk of the closure of Bart’s, Britain’s oldest hospital, is scaremongering.

But the staff of the trust say that the deal cannot be unpicked at this late stage. “They have given the national directors for heart disease and cancer ten days to look at a scheme that has taken a decade to prepare,” Dr Dymond, a consultant cardiologist based at St Bart’s, said.

“Everything is complete, down to the position of the electric sockets in the walls. Promises were made in 1997, and now at the last minute the rug has been pulled away.

“This is not about saving Bart’s. That battle was fought, and won. It is about providing 21st-century services to a huge population of East London. Cancelling that would be a betrayal of this population and would create a cardiac wasteland from Basildon to Bloomsbury.”

Among the other large PFI schemes is a £550 million programme at University Hospital Birmingham. Mark Britnell, the hospital’s chief executive, said that he was optimistic that the scheme would be signed off soon. But he questioned whether other schemes not so close to financial closure would go ahead. “We need clear guidance very quickly as the private sector is also getting nervous.”

www.timesonline.co.uk/health

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