NHS capital no longer has a process problem. It has a delivery culture problem
The NHS has previously delivered major capital programmes at pace. PFI and ISTCs were not simpler than today’s programmes, nor less controversial. But they operated within a culture that prioritised delivery over optimisation. This article argues that NHS capital now suffers less from excessive formal process than from a deeply embedded assurance culture that slows decision-making, weakens momentum, and makes delivery harder.
If I Were an NHS CFO: Preparing for the Return of PPP in Primary & Community Infrastructure
The NHS 10-Year Plan points towards the return of public–private partnerships for primary care, community diagnostics, and neighbourhood health hubs, with acute hospitals excluded. If you are an NHS CFO, the question is whether your organisation is ready to move quickly if a new route of private capital opens. This piece sets out the groundwork: build a complete estate view, align the clinical model with estate decisions, and take priority schemes to a project-ready position.
What could a new PFI look like?
The Private Finance Initiative (PFI) was responsible for funding 694 projects across the UK. Initially loved by markets, hated by the left, and the doyenne of the centre, its gloss faded over time. Project failures and continuing bad publicity made it a problem for Government, while project disputes, especially in the NHS, made it unpopular with banks and investors.
And yet, calls to bring it back are increasing in volume. So how do we create a new PFI which is better than the original?