6 Mar 2025
Office of Chief Executive,
NHS England,
Wellington House,
133-155 Waterloo Road,
London SE1 8UG.
Dear Sir James Mackey,
Open letter: No new private finance in our NHS
Welcome to your new role as the CEO of the NHS in England. As you take up your position, please know that patients and staff are eager to work with you toward an NHS that works for all of us, and for future generations.
We were deeply disappointed to hear your predecessor, Amanda Pritchard, re-open the door to private finance in the NHS. And we are writing to ask you to rule out the reintroduction of private finance as one of your first orders of business after you take up your new position.
We all share a desire to see more investment in the NHS. As Lord Darzi’s recent report points out, there has been a significant shortfall in capital investment in the NHS over the last decade, to the tune of £37 billion. [1] Capital investment is sorely needed. Upgrading facilities and equipment will get the best out of staff and increase efficiency and productivity.
However, private finance should not be considered a viable option for funding capital investment in the health service.
Parliament has been clear in its verdict. The House of Commons Treasury Committee concluded in 2011 that the use of PFI for projects like hospitals “does not provide taxpayers with good value for money”. [2]
Similarly, the Public Accounts Committee, in a 2018 report, criticised the huge profits made by many offshore PFI investors. They said this suggests “that departments are overpaying for transferring the risks of projects to the private sector, one of the Treasury’s stated benefits of PFI”. [3]
New Statesman research revealed that many NHS trusts pay back more in PFI debts yearly than they spend on medicines for patients. [4]
And recent research from We Own It has shown that almost 80% of NHS trusts who have already paid back the capital value of their PFI facility would be able to clear the trust’s repairs backlog with what they still have to pay out in PFI repayments. [5] This research highlights that in your current role as chief executive of Newcastle upon Tyne Trust, you know all too well the damaging impact of PFI. You have been dealing with a £1.1bn PFI debt that will not get paid off until 2043.
Bodies representing NHS workers at every level, including the Royal College of Nursing [6], the British Medical Association [7], Unite the Union [8], Unison [9] and the GMB [10] have been critical of private finance initiatives in the NHS.
In 2018, the Conservative Chancellor of the Exchequer Phil Hammond officially banned the use of PFI and PF2 for future projects. In his speech, he noted that PFI neither provides “value for the taxpayer” nor “genuinely transfers risk to the private sector”. [11]
We believe that the NHS’s interest in providing the highest quality care to patients without a concern for profit is irreconcilable with private finance’s primary interest in making profit from such deals.
We urge you to rule out new private finance in the NHS – and work with us to encourage the government to directly increase capital investment for our NHS, in addition to properly funding staff pay and conditions.
Signed by:
We Own It
Unite
GMB
Keep Our NHS Public
Just Treatment
EveryDoctor
References:
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The Lord Darzi Report – https://assets.publishing.service.gov.uk/media/66f42ae630536cb92748271f/Lord-Darzi-Independent-Investigation-of-the-National-Health-Service-in-England-Updated-25-September.pdf
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House of Commons, Treasury Committee, Private Finance Initiative, Seventeenth Report of Session 2010-12, 18th July 2011
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House of Commons, Committee of Public Accounts, Private Finance Initiatives, Forty-Sixth Report of Session 2017-19, 13 June 2018
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New Statesman, “Some hospitals are spending more on PFI debt than they are on drugs”, 30 May 2022 – https://www.newstatesman.com/spotlight/healthcare/2022/05/pfi-repayments-are-costing-some-hospitals-twice-as-much-as-drugs
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We Own It, “Tony Blair’s Private Finance deals still haunt the NHS, new league table reveals”, 6th December 2024 – https://weownit.org.uk/news/tell-wes-streeting-no-new-pfi/
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Royal College of Nursing, “The independent sector: History and role in England”, 18th December 2013 – https://www.rcn.org.uk/About-us/Our-Influencing-work/Policy-briefings/pol-3113
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Written evidence submitted by the British Medical Association to the House of Commons Treasury Committee, 17th May 2011 – https://www.parliament.uk/globalassets/documents/commons-committees/treasury/PFI-Evidence.pdf
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Unite the Union, “PFI review would be a first step but government needs to go further”, 25th October, 2018 – https://www.unitetheunion.org/news-events/news/2018/october/pfi-review-would-be-a-first-step-but-government-needs-to-go-further
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Unison, “PFI abolition pledge doesn’t help public services with contracts”, 29th October 2018 – https://www.unison.org.uk/news/press-release/2018/10/pfi-abolition-pledge-doesnt-help-public-services-contracts/
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GMB, “PFI was a ‘disastrous policy saddling taxpayers with extortionate charges’”, 19th March 2021 – https://www.gmb.org.uk/news/pfi-was-disastrous-policy-saddling-taxpayers-extortionate-charges
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Budget 2018: Philip Hammond’s speech, 29 October 2018 – https://www.gov.uk/government/speeches/budget-2018-philip-hammonds-speech
