Sir: You are to be congratulated on drawing the attention of the public to the extension of the Private Finance Initiative (PFI), a major threatened inroad of privatisation into the NHS ("Private firms to run NHS hospitals", 23 March). As you point out, the NHS "reforms" have now covertly moved us to the point where private finance can tender not only for NHS hospital buildings and capital developments but also for NHS clinical services. Trusts are compelled to accept the lowest tender.
Private finance is not going into this for its health - or ours. Its interest is in return on investment, likely therefore to be in buildings and equipment that will maximise profit. It also now appears to mean that if a clinical service can be supplied at lower than going NHS rates, this too will supplant the present methods of NHS staffing. Cost-conscious trust executives will be tempted to turn out existing clinical teams in favour of a cheaper package, or at least to use this as a further lever to bend professional staff to their will. Investors will wish to reduce the risk to their investment by exercising real control over the operation of the NHS facility. No problems of accountability here; it will be direct to the shareholders.
Professor Chris Ham, director of the Health Services Management Centre at the University of Birmingham, drew the profession's attention to the implications of the PFI in the British Medical Journal of 18 February. He noted PFI "projects to build and run entire new hospitals as well as extensions to or developments of existing buildings" in Norwich, Edinburgh, Durham, Peterborough, Swindon, London, Coventry and Worcester. All of this points to massively increased commercialisation of health care, not independent, but eating right into the heart of the NHS.
NHS Support Federation
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