For twenty years PFI has been the main route for capital projects in the NHS. What we now know is that there are negative impacts that last long after the doors of a new hospital are open. In financial terms alone a high price is paid over the life-time of the contract. The number of NHS trusts now in deficit is surging and for many the burden of PFI costs is ramping up the pressure. PFI problems have been exposed in successive reports and inquiries, but there has been little progress in solving the issue. Year on year these debts are affecting the services that are available to patients and limiting the resources for NHS staff. When PFI began it was during an era of rising funding for the NHS but in recent years the NHS has seen flat funding and unprecedented cost cutting.
We have seen how PFI contracts wrap NHS trusts up in a schedule of rising payments. For some the debt has become toxic, but most contend with PFI pressure that will not recede without intervention. Despite growing consensus about its limitations there is little momentum around change. There are however options that could help to relieve the burden of PFI on the NHS, some of which have already been successfully executed.The NHS Support Federation has produced three reports on PFI and its impact on the NHS.