By Adam Brimelow
BBC Health Correspondent
The public service union Unison has published what it calls a damning indictment of the government's PFI hospital programme.
Hospital design is important
There are more than 60 of these major projects either built or on the way: the overall cost, around £8.5bn.
Unison's report, includes disturbing accounts of bad design, affecting staff and patients.
The diggers are still busy at West Middlesex hospital, the first PFI hospital to be commissioned and constructed under a Labour government.
The building will receive its first patients in a few weeks, on time and on budget.
The £60m pound project forms the new heart of this sprawling and ramshackle site.
At present, converted milk floats are ferrying patients around from one building to another.
But Mike Anderson, the medical director, says the new hospital will transform the service they can offer to visiting patients.
"We've tried to design something that is immensely flexible because we know that during the lifetime of this building healthcare as we know it is undergoing a revolution."
In practice this means designing operating theatres so they can be contracted or expanded to accommodate new robotic technology.
It also means installing the latest digital imaging equipment for x-rays from day one to cut the number of patient visits.
And it means providing a network of tunnels in the roofing to move blood samples around.
Until patients arrive it's hard to say how well it will work. But Karen Jennings, from Unison, says the whole PFI programme is failing miserably.
"One of the issues around PFI is that there would be a vested interest in good quality design and materials because the consortium itself would have a vested interest.
"In other words it would want to stop problems emerging later on, but actually it's a nonsense because it's still shoddy".
Unison's report on life in nine PFI hospitals includes accounts of "cheap and nasty" materials, stifling temperatures, water leaking through ceilings, sewage bubbling up in sinks...the list goes on.
Yet research shows that good design improves staff retention, and encourages a quicker recovery for patients.
The Commission for Architecture and the Built Environment, which advises the government on design, says lessons from earlier setbacks have been learned.
But its chairman, Sir Stuart Lipton, is worried that some trusts are still opting for what he calls rent-slabs - maximum building for minimum cost.
"It's a question of the passion that the chairman, the chief executive the development chaps actually bring to bear.
"Do they carry out sufficient research? Do they go round the country looking for best practice, do they go abroad looking for best practice?"
Trusts with PFI schemes have come together in the Future Healthcare Network to pool ideas on good design, and to discuss the changes that are likely to take place in the new hospitals over the coming decades.
Nigel Edwards, director of the network, says they want to spread best practice.
"It's very surprising that there is so little information and literature and research on what a hospital should look like, given how much is spent on hospitals across the world.
"It's not something that people have been looking at.
"So we're trying to accelerate peoples' learning by putting them in touch with people in other countries, people in this country who've done it before, with what research there is, to try to incorporate those lessons into the hospital."
Unison says the crucial lesson on consultation hasn't been learned, and that architects are still not talking to the people who'll have to work in these hospitals.
There are concerns that the competitive bidding process restricts opportunities to task things through.
But Peter Buchan, from architect firm Ryder HKS, says a lot of the earlier problems have been ironed out, and that the consortia they work for are encouraging an innovative approach that should produce some outstanding new buildings.
"There is an opportunity to create a new icon, a re-definition of a hospital as a building, with a new level of humanity that not only functions well but treats people in a totally different way, and creates environments that celebrate health rather than sickness - buildings which engage much more positively with their community."
That's the dream. Unison's report underlines the scale of the task - not just for architects as they take on one of the biggest design challenges in a generation, but also for the government in persuading many of its own supporters that PFI is the best way forward for the health service.