News Release

Private finance initiative is associated with NHS downsizing and bed reductions

Downsizing of acute inpatient beds associated with private finance initiative: Scotland’s case study BMJ Volume 326, pp 905-8

Peer-Reviewed Publication

BMJ

The private finance initiative (PFI) in Lothian, Scotland has not reached its targets for inpatient admissions and performance, show researchers in this week's BMJ. The effect has been a cut in services and downsizing of hospital and community facilities compared with other NHS hospitals in Scotland.

The high costs of using PFI in replacement NHS hospitals in the UK is associated with bed reductions of around 30% in first wave schemes. The Scottish Executive and Department of Health maintain that these plans will result in improvements in hospital performance and expanded community provision.

Matthew Dunnigan and Allyson Pollock analysed projected and actual trends in bed capacity and inpatient and day case admissions in Lothian in the first five years (1995-6 to 2000-1) of the PFI plan for the new Royal Infirmary of Edinburgh.

They also set out to establish whether there was a "PFI effect" by comparing clinical activity and performance in Lothian with the rest of Scotland.

By 2000-1, 81% of the planned bed cuts for Lothian had been achieved. However, the projected 21% increase in inpatient and day case admissions to all acute specialties only reached 0.3%. Inpatient admissions to surgical specialties were projected to rise by 8% but actual admissions fell by 13% due to severe capacity constraints.

Despite predictions that the length of stay in hospital would fall, the total reduction across all acute specialties was just 0.1 days, while length of stay across surgical admissions rose. Long stay geriatric beds and private nursing home beds continued to close, and the proportion of delayed discharges was higher than the Scottish average.

The analysis shows strong evidence of reduced service delivery across Lothian and its associated PFI development compared with other Scottish NHS hospitals, say the authors. Further hospital and community service downsizing may be required to meet the current financial deficit, principally due to the high costs of PFI, they conclude.

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