Procurement of new NHS buildings through the Private Finance Initiative (PFI) is “artificially promoted and protected” because the evidence in its favour is so poor, a former health economist at the Treasury claims.
Jon Sussex, now associate director of the Office of Health Economics, identifies “a dissonance between publicly stated and privately confided views” among NHS managers, their advisers, and civil servants on the wisdom of pursuing the initiative.
In his experience, such individuals “readily admit off the record that conventionally financed schemes are generally more cost effective than PFI alternatives. But all will keep their counsel when asked the question formally.”
In an analysis for the Office of Health Economics, Mr Sussex suggests that the failure of the private finance initiative has become something of an open secret in the NHS and civil service: “NHS managers and their advisers keep their heads down and try to make the best of the PFI in the interests of winning some benefit for the local communities they serve.”
A fundamental problem, he asserts, is that hard data are unavailable to researchers attempting objective comparisons of conventional and PFI procurement. “The data that do exist may be tainted by the pressures on all concerned to make a PFI scheme look good,” Mr Sussex writes. “The extent of these analytical difficulties is such that much of the discussion of the benefits and costs of the PFI in the NHS relies on evidence that is circumstantial rather than decisive.”
NHS managers need to be given “a genuine opportunity” to follow the public procurement route where it shows promise without being pressurised and constrained to do otherwise, he suggests. This would help to end the “official ambiguity” towards the initiative that has prevailed since its inception.
According to a poll of 1000 Londoners last week, most oppose greater involvement of the private sector in the provision of health care.
The Economics of the Private Finance Initiative in the NHS, published by the Office of Health Economics, is available from www.ohe.org What Do Londoners Think of Health Care? is available at www.kingsfund.org.uk/pr110401.html
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KAI PFAFFENBACH/REUTERS
A condommanufacturer promotes its wares in Germany. The Bavarian health ministry announced on 12 April that men who hire prostitutes must wear condoms to prevent the spread of disease