NHS trusts and the crippling burden of PFI

http://www.theguardian.com/society/2015/aug/30/nhs-trusts-and-the-crippling-burden-of-pfi

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Jeremy Corbyn has yet again shown substance in policy in his proposal to end the burden of PFI on health authorities (Opinion, 27 August). I live in the small social housing element of the Quartermile district of Edinburgh. It is the site of the old Edinburgh Royal hospital and now a gleaming new city designed by Norman Foster is rising, where one-bedroom flats begin at £400,000 and penthouse suites are £3m. The hospital was rebuilt on the outskirts of the city, six miles from the centre, where it can take an hour to get to by bus. Gordon Brown insisted in 1998 that it be built by PFI, so it wouldn’t appear on his public expenditure books. So the Bank of Scotland and property companies built the new hospital and developed the old city centre site.

It would have cost £200m to build a new hospital from public funds at the time. It will cost £1.2bn over 30 years in rental payments for the new hospital. This is a huge burden on the health authority every year and, at the end of 30 years, we then have to buy the hospital or have another 30-year rental deal. Although the SNP government has ended PFI in Scotland, the burden of past deals weighs heavy on their revenue. Brown thought he was being smart at the time, but round here we know it as “Gordon’s folly”. We would welcome Jeremy Corbyn’s plan to write off the debt.Hugh KerrEdinburgh

• I fully support Sadiq Khan’s proposal to relieve NHS trusts of the burden of excessive PFI payments (Report, 27 August). However, I do not agree that local authorities should raise funds to fully pay back PFI loans. The PFI was a central-government policy and should be resolved centrally to ensure a level playing field across the nation. Without delay, the government should arrange for subsidies to be given to all PFI NHS trusts to cover elements of all PFI interest payments and associated maintenance contract charges which are in excess of market rates. The government should also assist trusts in renegotiating all PFI contracts down to justifiable rates. Any PFI loans that may be paid back via local authority loans should include reductions to reflect the excessive and unfair payments that have been made during the life of the contract. The private sector must learn that it can no longer make odious levels of profit out of the NHS.Jane MandlikLondon

• The NHS is currently striving to achieve unrealistic “efficiency savings” of £22bn, and it is expected that health spending as a share of GDP is likely to decrease sharply over the coming years. This week the Labour party claimed, following a freedom of information request, that spending on mental health services is particularly under threat (claims albeit disputed by the Department of Health). The experience of Greece has shown the devastating impact of austerity on mental health. The release last week of Jeremy Corbyn’s mental health policy was therefore particularly timely. Mental health problems often remain hidden, and there remains a high level of stigma associated with conditions such as depression and schizophrenia – and discrimination against those with them. Corbyn seems to recognise the scale of the challenges and makes a strong case for increasing spending on care.

The emphasis on the mental health of young people is particularly welcome. Over recent years, research has clearly demonstrated that investing upfront in mental health care not only is of clinical benefit but also generates economic savings through reduced subsequent service use and by keeping people in education and employment. However, it is this initial investment that commissioners may balk at if their focus is on immediate budgets – and of course many benefits may fall outside the health system. Ensuring this vital investment is achieved will not be easy, but it would surely be a candidate for the proposed policy of people’s quantitative easing.Professor Paul McCroneInstitute of Psychiatry, Psychology and Neuroscience, King’s College London

• Medical bills are not only the biggest cause of personal bankruptcy in the US, at 60% they are bigger than all other causes put together. US per capita cost is at least 2½ times the cost in the UK, yet our government continues to privatise more and more, often with American companies that then try to cut salaries by 40% or more. The NHS is a huge organisation, one of the biggest in the world. Every new government feels it must make radical changes, which causes chaos. When will they learn that it is very easy to make things worse and very difficult to make things better?Ross RandallLondon

• Simon Stevens has declared his opposition to Jeremy Corbyn’s plans to limit the NHS’s dependence on PFI deals, a financial system which is forcing many hospitals into insolvency. Mr Stevens was formerly CEO of one of Europe’s largest private healthcare companies. Rearrange the following words into a well-known phrase or saying: “Its leopard change a spots cannot.”Paul HewitsonBerlin