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The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

Published by Tom
Edited: 1 month ago
Published: June 17, 2024

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012 Since the Coalition Government‘s introduction of Private Finance Initiatives (PFIs) in 2012, the NHS has reportedly lost an estimated £10 million-a-week. This alarming statistic was revealed in a recent report by the Public Accounts Committee (PAC),

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

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The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

Since the Coalition Government‘s introduction of Private Finance Initiatives (PFIs) in 2012, the NHS has reportedly lost an estimated £10 million-a-week. This alarming statistic was revealed in a recent report by the Public Accounts Committee (PAC), which highlighted the hidden costs of these private partnerships. The PAC investigation found that the NHS had paid an additional

£22 billion

in interest payments and premiums to private companies since 1997.

The report raised serious concerns about the sustainability of these deals and their impact on the

healthcare budget

. With the NHS facing unprecedented demand and ongoing financial pressures, the continued payments to private partners are a significant drain on resources. The

health sector

has also been criticised for its lack of transparency and accountability in managing these partnerships.

Despite the significant costs, there are also arguments in favour of PFIs. Proponents argue that they allow for much-needed investment in infrastructure and can provide financial certainty through fixed payments. However, with the mounting costs and the ongoing debate about their value for money, it is clear that

urgent reform is needed

to ensure the NHS gets the best possible deal from these partnerships.

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

NHS Private Finance Initiatives: £10 Million a Week in Financial Losses Since 2012

Private Finance Initiatives (PFIs), a form of public-private partnership, have been an integral part of the National Health Service (NHS) infrastructure since their inception in the 1990s.

Definition and History

PFIs are long-term agreements between a public sector organization, in this case the NHS, and a private company. The private partner finances the construction or provision of infrastructure, while the public sector repays the cost over an extended period through service payments.

Early Promises and Benefits

Initially hailed for their potential to relieve the NHS of capital expenditure and reduce upfront costs, PFIs promised a more efficient and cost-effective delivery of public services. However, as we will uncover, these early promises have not materialized as expected.

Financial Losses Amounting to £10 Million a Week

This article will uncover the significant financial losses the NHS has incurred due to private partnerships since 2012, amounting to a staggering £10 million-a-week. By scrutinizing various reports, audits, and investigations, we will shed light on the reasons behind these losses and their implications for the future of the NHS.


Explanation of the financial situation in the NHS leading up to PFIs

Prior to the Private Finance Initiatives (PFIs), the National Health Service (NHS) faced significant financial challenges. Budget constraints and a growing demand for efficiency put pressure on the NHS to find new ways to fund and deliver essential services. The UK government, which is responsible for funding and managing the NHS, was looking for innovative solutions to address these issues.

Budget constraints

The NHS was facing increasing costs due to population growth, aging demographics, and advances in medical technology. At the same time, government funding for healthcare was not keeping pace with these costs. This created a significant budget deficit that needed to be addressed.

Demand for efficiency

There was also a growing demand for the NHS to be more efficient and cost-effective. This meant finding ways to deliver services with fewer resources, while still maintaining high quality care for patients.

Description of the process behind PFI deals

In response to these challenges, the UK government turned to the private sector for help. The PFI model was introduced in the early 1990s as a way to finance and deliver large infrastructure projects, including hospitals, schools, and roads. The PFI process involved three key players: the government, the private sector, and the NHS.

Structuring and selling PFI deals to the public

Private finance initiative deals were structured as long-term contracts between the government and private companies. The private sector would build and finance new infrastructure projects, and then lease them back to the government or NHS for a set period of time, typically 25-30 years. The public sector would make regular payments to the private sector to cover the cost of financing and maintaining the infrastructure.

Involvement of government, private sector, and NHS

The government would act as the client, commissioning the PFI project and entering into the contract with the private sector. The NHS would be responsible for providing the services that would be delivered through the new infrastructure, and would pay the private sector for the use of the facilities. The private sector would be responsible for financing, building, and maintaining the infrastructure throughout the life of the contract.


The introduction of PFIs represented a significant shift in the way that infrastructure projects were financed and delivered in the UK. By bringing in the private sector, the government was able to address budget constraints and demand for efficiency in the NHS, while still maintaining high quality care for patients.

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

I The Financial Burden of PFI Contracts on the NHS

The Private Finance Initiatives (PFI) have placed a significant financial burden on the National Health Service (NHS). The costs associated with these contracts are multifaceted and complex, requiring a detailed analysis to fully understand their impact.

Breakdown of Costs

Capital Payments and Interest Rates: PFI contracts involve an upfront capital payment for the construction or refurbishment of NHS facilities, followed by annual repayments that include both interest and capital repayments over a period of up to 30 years. These costs can be substantial, with some PFI deals carrying interest rates as high as 12%, making the overall cost of borrowing significantly more than if the NHS had funded the projects itself.

Impact on NHS Budgets since 2012

Calculation and Evidence of the £10 million-a-week Figure: It is estimated that the NHS spends around £10 million a week on PFI debt repayments. This figure, which equates to over £500 million per year, is based on data from the Department of Health and Social Care (DHSC) and represents a significant drain on NHS resources. The debt from PFI deals was estimated to be around £20 billion in 2016, with annual interest payments totaling around £3.5 billion.

Comparison to Other Potential Funding Sources

Cost Comparison: The cost of PFI deals, particularly those with high interest rates and long repayment periods, can be significantly more expensive than borrowing from traditional sources such as the Public Works Loans Board (PWLB) or other public sector lenders. For instance, the PWLB offers loans with interest rates around half that of some PFI deals.

Consequences for Patient Care and Staffing Levels

Reduced Resources for Frontline Services: The significant financial burden of PFI contracts leaves less resources available for frontline patient care and staffing, which can have detrimental effects on both the quality and accessibility of healthcare services. These budgetary pressures also contribute to a culture of rationing resources, with decisions being made about which areas of care should receive priority.

Pressure on NHS Budgets and Potential Cuts

Funding Constraints: The financial burden of PFI debts has placed significant pressure on NHS budgets, leaving little room for maneuver in the face of ever-rising healthcare costs and demands for increased services. This has led to concerns about potential cuts to vital frontline services, with some commentators warning that the NHS could face a crisis in the coming years if urgent action is not taken to address this issue.

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012

Criticisms and Controversies Surrounding Private Partnerships in the NHS

IV.1. The implementation of Private Finance Initiatives (PFIs) in the National Health Service (NHS) has been a subject of intense debate and controversy. Healthcare professionals, advocacy groups, and politicians have voiced their opinions on the merits and demerits of this policy.


Arguments for and against PFIs in the context of NHS funding: Some argue that PFIs have provided much-needed infrastructure investment to the NHS, which would have been difficult for the government to fund otherwise. They point to examples of modern hospitals and medical facilities that have been built through PFI deals. On the other hand, critics argue that the high cost of PFIs in the long run outweighs any initial benefits. They claim that the NHS could have built and maintained these facilities at a lower cost if it had used public funds.


Examples of successful or unsuccessful partnerships: The success or failure of PFI deals in the NHS varies from one project to another. For instance, some hospitals have reported cost savings and improvements in facilities as a result of PFI deals. However, there are also instances where PFI deals have resulted in financial difficulties for the NHS due to high repayment costs.


IV.2.1. Transparency and accountability are crucial in addressing the criticisms surrounding PFIs in the NHS.


Calls for greater oversight and reporting of PFI deals: There have been calls for greater transparency in the way PFI deals are negotiated, structured, and monitored. This includes more detailed reporting on the costs and benefits of these deals, as well as greater involvement of patients and local communities in the decision-making process.


Current measures to address the issue: The UK government has taken steps to address some of these criticisms, such as introducing greater transparency in PFI deal reporting and creating a new body, the Infrastructure and Projects Authority, to oversee major government projects. However, some argue that these measures do not go far enough in addressing the root causes of the criticisms.

The Hidden Cost of Private Partnerships: £10 Million-a-Week Lost to the NHS Since 2012


Recap of key findings and their implications for NHS funding: In the course of our analysis, we’ve identified several significant trends in Public Finance Initiatives (PFIs) and their role within the NHS funding landscape. Firstly, we observed that PFI schemes have led to substantial upfront costs for the NHS, which in turn have influenced the organization’s ability to allocate resources to critical areas such as staffing and patient care. Secondly, we noted that the long-term financial obligations tied to PFI contracts have resulted in increased pressure on NHS budgets. Thirdly, we found that the inflexibility of these contracts has sometimes hindered the NHS’ ability to adapt to changing healthcare needs and priorities.

Discussion on potential solutions and alternatives to PFIs

Public ownership or alternative financing models: Given the challenges associated with PFI partnerships, various alternatives have emerged as potential solutions. One such option is public ownership of healthcare infrastructure projects, which could help the NHS retain greater control over its resources and long-term costs. Another alternative financing model that has gained traction is social impact bonds, which offer incentives for private investors to fund social projects, with the potential for government repayment contingent upon successful outcomes.

Lessons learned from the past decade of partnerships

Reflecting on the last ten years of NHS-PFIs, it is clear that several valuable lessons have been learned. One key insight is the importance of thoroughly assessing the potential long-term costs and benefits of these partnerships before entering into agreements. Additionally, there is a growing recognition of the need for greater transparency and accountability in PFI contracts to ensure that public funds are being used effectively and efficiently.

The importance of considering long-term costs and benefits

The experience of the NHS with PFIs highlights the significance of carefully weighing short-term gains against long-term costs when considering such partnerships. While upfront funding may initially appear attractive, it is essential to consider the potential financial implications over the entire lifetime of the contract.

The role of public debate in shaping the direction of healthcare policy

An open and informed public discourse is essential for ensuring that healthcare policies, such as those related to PFIs, are aligned with the best interests of patients and taxpayers. Engaging the public in the debate can help raise awareness about the potential advantages and disadvantages of various financing models, ultimately influencing the direction of NHS funding strategies.

Final thoughts on the future of PFIs in the NHS and their impact on patient care

As we look to the future, it is crucial that the NHS continues to learn from past experiences with PFIs and explores alternative financing models to ensure the most effective and sustainable use of public funds. Ultimately, the goal should be to prioritize patient care above all else – a commitment that can only be achieved through careful consideration of the long-term implications of financing decisions.

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June 17, 2024