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Last Updated: Monday, 4 December 2006, 06:31 GMT
NHS: In sickness and in wealth
Eleanor Bradford
BBC Frontline Scotland

This week Frontline Scotland features a special investigation into the biggest building programme ever seen in the NHS.

Health correspondent Eleanor Bradford explains the background to her investigation and why disturbing evidence is emerging that all is not well in Scotland's newest hospitals.

It's the million dollar question: how do we improve the NHS?

It's an institution held dear by millions of us, some of us owe our lives to it, but yet we often see it as a cumbersome bureaucratic nightmare which leaks our cash and lags behind sparkling health care systems available elsewhere.

When Labour came to power in 1997, the most obvious sign of years of under-investment was the very fabric of the NHS.

Victoria Infirmary in Glasgow
Glasgow's Victoria Infirmary was opened in 1890

Staff were struggling to deliver 20th Century medicine in Victorian buildings and post-war pre-fabs.

Ironically, the solution came in the form of a policy first dreamt up by the Conservatives - Private Finance Initiatives.

The idea was simple: private companies would shoulder the burden of building a new hospital, but then the NHS would move in and lease it from them.

If construction companies, banks, cleaning and waste disposal companies got together they could not only build the building but run the logistics as well, all for a set fee.

There were other opportunities to involve the private sector in providing other kinds of care too, such as elderly care beds.

A SELECTION OF PPP PROJECTS
NHS Grampian: Kincardine Community Hospital
NHS Lanarkshire: Hairmyres and Wishaw hospitals
NHS Forth Valley: New Larbert Hospital (2009)
NHS Dumfries and Galloway: Daycase and maternity services
NHS Lothian: Edinburgh Royal Infirmary

New Labour renamed them Public Private Partnerships, and set about encouraging them with gusto.

But for health boards the reality of commissioning a hospital fit for the next 30 years, which they did not own, was a minefield.

All details of the way the hospital would be used and operated had to be set down and signed off before the NHS could move in.

Yet who could predict how a hospital would be used in 2030?

Medical advances happen all the time - keyhole surgery has dramatically changed how some conditions are treated and reduced the amount of time patients spend in hospital.

But with PFI, any change to the use of a hospital would have to be approved by the private operators, and could incur costly charges.

PFI is vastly more expensive now than if we'd gone down the public procurement route
Professor Allyson Pollock
Edinburgh University

There are no rebates if a PFI hospital outlives its usefulness and is left empty.

On Wednesday, Frontline Scotland will reveal more about how some say PFI deals have forced one health board into making decisions that some say run contrary to the best interests of patients.

Health authorities also quickly discovered that they had tied themselves into very expensive contracts.

Once the hospital was up and running, the companies who built and operated it could look forward to very healthy returns.

The government argues that publicly-funded building projects often run over-budget and also have running costs (who needs reminding about the Scottish Parliament!).

But if we take a look at the biggest PFI project so far in the health sector - Edinburgh's Royal Infirmary - it cost 184m to build.

Edinburgh Royal Infirmary
Edinburgh Royal Infirmary will cost 1bn by the time the contract ends

However, Lothian Health Board is committed to repayments of 40m every year.

It will have repaid more than 1bn by the time the contract ends in 30 years.

In fact, the final bill will be three times the cost of the parliament at Holyrood.

Let's return to the question I posed at the very beginning - how do we improve the NHS?

New Labour has turned to the private sector to help it do that. PFIs are just one way in which private companies are taking over aspects of our healthcare.

The argument is that they provide better value for money.

Political interference

However, Professor Allyson Pollock from Edinburgh University's Centre for International Public Health Policy said that under PFI, the NHS would pay up to 10 times more for a hospital than it should have done.

"Of course PFI is vastly more expensive now than if we'd gone down the public procurement route," she said.

Others argue that much of the money that has been wasted in the NHS is directly connected with decades of political interference, and that the core services of the NHS actually already provide excellent value.

Even if the NHS isn't as efficient as it could be, the consequence of using private contractors is that taxpayers' money is spent not only on running a health service, but also on increasing dividends to shareholders.

You can see the full story on Frontline: In Sickness And In Wealth, on BBC One Scotland at 1900 GMT on Wednesday, 6 December.


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