Comprehensive Reference List: NHS PFI and Capital Financing

1. NHS Official Data & Reports

ERIC (Estates Return Information Collection) 2024/25 Data

NHS Digital. Estates Returns Information Collection: Summary page and dataset for ERIC 2024/25. NHS England Digital, October 2025.

URL: https://digital.nhs.uk/data-and-information/publications/statistical/estates-returns-information-collection/summary-page-and-dataset-for-eric-2024-25
Key statistics: £15.9 billion estimated cost to eradicate backlog maintenance (up 15.7% from £13.8bn in 2023/24); £3.5 billion high-risk backlog (up 28%); 51 trusts now have £100m+ backlogs totaling £10.7bn

NHS England Capital Guidance 2025/26

NHS England. Capital guidance 2025/26. Published 30 January 2025, last updated 14 February 2025.

URL: https://www.england.nhs.uk/long-read/capital-guidance-2025-26/
Key section: "Capital freedoms and flexibilities" – Tier 1 and 2 systems with breakeven or better positions can invest CDEL above allocated budgets (£20-30m limit) using cash balances; £4.9bn system-level allocation; £750m estates safety funding

New Hospital Programme Announcement (January 2025)

Department of Health and Social Care. Government to deliver all schemes in New Hospital Programme. GOV.UK, 20 January 2025.

URL: https://www.gov.uk/government/news/government-to-deliver-all-schemes-in-new-hospital-programme
Implementation Plan: https://www.gov.uk/government/publications/new-hospital-programme-review-outcome/new-hospital-programme-plan-for-implementation
Key details: £15 billion over consecutive 5-year waves; Wave 0 (7 schemes completing within 3 years), Wave 1 (16 schemes, 2025-2030), Wave 2 (9 schemes, 2030-2035), Wave 3 (9 schemes, 2035-2039); 7 RAAC hospitals prioritized outside main programme

Hansard. New Hospital Programme Review. House of Commons Debate, 20 January 2025.

URL: https://hansard.parliament.uk/commons/2025-01-20/debates/A73A2D21-F1E7-4405-BD2D-C49C57F241C4/NewHospitalProgrammeReview

ONS PFI Accounting Treatment

Office for National Statistics. Wider measures of public sector debt: December 2018. ONS, December 2018.

URL: https://www.ons.gov.uk/economy/governmentpublicsectorandtaxes/publicsectorfinance/articles/widermeasuresofpublicsectornetdebt/december2018
Key finding: Estimated additional £28 billion of PPP liabilities would be added if off-balance sheet PPPs recorded on government balance sheet; approximately £6 billion in finance lease liabilities for on-balance sheet PPPs at end-March 2018

Office for Budget Responsibility. Treatment of PFI contracts in National Accounts and WGA.

URL: https://obr.uk/box/treatment-of-pfi-contracts-in-national-accounts-and-wga/
Key point: Under IFRS (used in WGA), nearly all PFI assets and liabilities are on-balance sheet for government

Infrastructure Projects Authority Rating

Infrastructure and Projects Authority. Infrastructure and Projects Authority Annual Report 2023-24. Cabinet Office/HM Treasury, 16 January 2025.

URL: https://www.gov.uk/government/publications/infrastructure-and-projects-authority-annual-report-2023-24
HTML version: https://www.gov.uk/government/publications/infrastructure-and-projects-authority-annual-report-2023-24/infrastructure-and-projects-authority-annual-report-2023-24-html
Key finding: New Hospital Programme rated Red ("Successful delivery appears to be unachievable. There are major issues with project definition, schedule, budget, quality and/or benefits delivery"); upgraded to Amber after January 2025 review

2. UK Government Sources

Philip Hammond PFI/PF2 Abolition (October 2018)

Hammond, Philip. Budget 2018: Philip Hammond's speech. HM Treasury, 29 October 2018.

URL: https://www.gov.uk/government/speeches/budget-2018-philip-hammonds-speech
Key quote: "I have never signed off a PFI contract as Chancellor… and I can confirm today that I never will. I can announce that the Government will abolish the use of PFI and PF2 for future projects."

HM Treasury. Private Finance Initiative (PFI) and Private Finance 2 (PF2): Budget 2018 brief. 29 October 2018.

URL: https://www.gov.uk/government/publications/private-finance-initiative-pfi-and-private-finance-2-pf2-budget-2018-brief
PDF: https://assets.publishing.service.gov.uk/media/5bd70a2540f0b604cbff22f2/PF2_web_.pdf

Health Secretary Statement on NHP

Streeting, Wes (Secretary of State for Health and Social Care). Statement in Government to deliver all schemes in New Hospital Programme. GOV.UK, 20 January 2025.

URL: https://www.gov.uk/government/news/government-to-deliver-all-schemes-in-new-hospital-programme
Key quote: "The New Hospital Programme we inherited was unfunded and undeliverable. Not a single new hospital was built in the past 5 years, and there was no credible funding plan to build 40 in the next 5 years."

Treasury Green Book

HM Treasury. The Green Book: appraisal and evaluation in central government. Latest version 2022, updated May 2024.

URL: https://www.gov.uk/government/publications/the-green-book-appraisal-and-evaluation-in-central-government/the-green-book-2020
Collection page: https://www.gov.uk/government/collections/the-green-book-and-accompanying-guidance-and-documents
Business case guidance: https://www.gov.uk/government/publications/business-case-guidance-for-projects-and-programmes

NHS Confederation Reports

NHS Confederation. Towards a new co-investment model: what is next for NHS public-private partnerships? 7 September 2025.

URL: https://www.nhsconfed.org/publications/towards-new-co-investment-model
PDF: https://www.nhsconfed.org/system/files/2025-09/Towards-a-new-co-investment-model.pdf
Key recommendations: Public sector seat on PPP boards; keep facilities management in-house; outcome-focused contracts; use LIFTco as basis for neighbourhood health centres

Barron, J. and Jones, E. Investing to save: the capital requirement for a more sustainable NHS in England. NHS Confederation, November 2023.

URL: https://www.nhsconfed.org/publications/investing-to-save-NHS-capital-England
PDF: https://www.nhsconfed.org/system/files/2023-11/investing-to-save-nhs-capital-england.pdf
Key finding: "NHS needs an additional £6.4 billion per year in capital (a total additional £19.2 billion investment over three years). This is essential to efforts to boost NHS productivity growth to 2 per cent per year."

Jones, E. and Barron, J. Raising NHS capital funds: options for government. NHS Confederation, 2024.

URL: https://www.nhsconfed.org/publications/raising-nhs-capital-funds-options-government

Barron, J. et al. Capital efficiency: how to reform healthcare capital spending. NHS Confederation, February 2025.

URL: https://www.nhsconfed.org/publications/capital-efficiency
Key quote: "Private capital investment should once again be an option available to ICSs to address the capital investment cap."

3. NHS Trust Specific

Barts Health NHS Trust PFI

Barts Health NHS Trust. Annual Report and Accounts 2020-21. NHS England.

URL: https://www.england.nhs.uk/wp-content/uploads/2022/09/barts-health-nhs-trust-ara-20-21.pdf
Key statistics: PFI unitary charge payments £126m per year (2020/21); future total net PFI liability £966m; contracts run to 2048

Nuffield Trust. Making Sense of PFI.

URL: https://www.nuffieldtrust.org.uk/resource/making-sense-of-pfi
Key data: Barts has largest PFI scheme in NHS with capital value of £1.149 billion

The Conversation. The trouble with the floundering flagship that is Barts Health. 2015.

URL: https://theconversation.com/the-trouble-with-the-floundering-flagship-that-is-barts-health-38020
Key statistics: Treasury figures show PFI cost £1.15 billion; total projected payments to 2048: at least £6.5 billion

Guy's and St Thomas' NHS Foundation Trust

The Lowdown NHS. Backlog maintenance bills are dragging down our NHS – new figures show. 2025.

URL: https://lowdownnhs.info/comment/backlog-maintenance-bills-are-dragging-down-our-nhs-new-figures-show/
Key statistics: Guy's and St Thomas' FT backlog: £532m (2024-25 ERIC); St Thomas' Hospital building: £308m

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield Teaching Hospitals NHS Foundation Trust. Capital Programme Report to Board. July 2020.

URL: https://www.sth.nhs.uk/clientfiles/File/E%20-%20Capital%20Programme%20Report%20to%20BoD%2028072020.pdf
Key statistics: Capital expenditure plan 2020/21: £50.8m; five-year capital plan 2020/21 to 2024/25

Shelford Group. Sheffield Teaching Hospitals NHS Foundation Trust Profile.

URL: https://shelfordgroup.org/sheffield-teaching-hospitals-nhs-foundation-trust/

Imperial College Healthcare NHS Trust

National Audit Office. Review of Capital Expenditure in the NHS. HC 43, Session 2019-20, 5 February 2020.

URL: https://www.nao.org.uk/wp-content/uploads/2020/02/Review-of-capital-expenditure-in-the-NHS.pdf
Key statistics (Page 14-15, Figure 4): Imperial College Healthcare NHS Trust total backlog maintenance (2018-19): £691 million; high-risk backlog £334 million (31% of all NHS high-risk backlog); ranked #1 highest backlog among all 227 NHS providers

The Lowdown NHS. Updated backlog figures 2024-25.

URL: https://lowdownnhs.info/comment/backlog-maintenance-bills-are-dragging-down-our-nhs-new-figures-show/
Key statistics: Imperial backlog (2024-25): £902m (highest in NHS); St Mary's Paddington £296m; Charing Cross £425m; Hammersmith £132m; high-risk backlog on three main sites: over £420m

Imperial College Healthcare NHS Trust. Improving our estate. 2025.

URL: https://www.imperial.nhs.uk/about-us/news/improving-our-estate
Key statistics: Investment planned for 2025/26: £115m across five hospitals

Hansard. New Hospital Programme and Imperial College Healthcare NHS Trust. House of Commons Debate, 13 June 2023.

URL: https://hansard.parliament.uk/commons/2023-06-13/debates/A9BF070B-2599-4EF2-B3F3-E6130C9D4C7D/NewHospitalProgrammeAndImperialCollegeHealthcareNHSTrust
Key points: Parts of St Mary's estate date back to 1845; most facilities at least 70 years old

PFI vs Non-PFI Trust Comparisons

Committee of Public Accounts. The New Hospital Programme. HC 77, Session 2023-24.

URL: https://publications.parliament.uk/pa/cm5804/cmselect/cmpubacc/77/report.html
Key statistics: NHS maintenance backlog rose from £4.7 billion (2013-14) to £10.2 billion (2021-22); DHSC diverted £4.3 billion from capital to revenue budgets (2014-15 to 2018-19)

Centre for Health and the Public Interest. PFI: Profiting from inflation?

URL: https://www.chpi.org.uk/blog/how-private-finance-is-crippling-health-and-social-care
Key statistics: 99 NHS PFI schemes generated £1.9 billion in pre-tax profits (2004-2021); over £1 billion paid in dividends; estimated additional PFI costs from inflation (2022-24): £470 million

4. International Evidence

France - CADES

CADES Official Website.

About: https://www.cades.fr/en/about
Financial Information: https://www.cades.fr/en/financial-information
Current status: €396.5 billion assumed since inception (as of 2024/2025)

Marchandot, B. and Morel, O. "The Financialization of Healthcare in France: Trends and implications." Public Health in Practice, 9:100620, 9 May 2025.

URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC12142523/
Key statistics: "France established CADES in 1996 to refinance social security debt via market-issued securities. From 1996 to 2018, it absorbed €260.5 billion in debt, over €147 billion from healthcare, and paid €72 billion in interest and fees."

Cordilha, Ana Carolina. "Public health systems in the age of financialization: lessons from the French case." Review of Social Economy, 81(2): 246-273, 2023.

France - ACOSS Commercial Paper

URSSAF/ACOSS Investor Relations.

Commercial Paper: https://www.urssaf.org/en_GB/home/investisseurs/commercial-paper.html
Euro Commercial Paper: https://www.urssaf.org/en_GB/home/investisseurs/euro-commercial-paper.html

Marchandot, B. and Morel, O. (2025) – as above.

Key statistics: "By 2018, 93% of short-term needs were market-financed, with €2 trillion issued in European commercial papers, making ACOSS the top global public issuer."

France - Public Hospital Debt

Marchandot, B. and Morel, O. (2025) – as above.

Key statistics: "Public hospital debt rose from €12 billion in 2003 to €30 billion in 2018, with annual interest payments doubling to €1 billion by the 2010s."

France 24. "France boosts health funding to offset public hospital crisis." 20 November 2019.

URL: https://www.france24.com/en/20191120-france-boosts-health-funding-offset-public-hospital-crisis-strike-protest-edouard-philippe-emergency-package

France - Orpea Scandal

MarketScreener/Reuters. "France's scandal-hit Orpea reaches restructuring agreement." 1 February 2023.

URL: https://www.marketscreener.com/quote/stock/EMEIS-4799/news/France-s-scandal-hit-Orpea-reaches-restructuring-agreement-42862456/
Key statistic: "Orpea's shares fell by around 93% in 2022 following the publication of a book in France that outlined possible malpractice at its care homes."

Statista. "Monthly share price of Orpea on the Paris Stock Exchange." 6 February 2023.

URL: https://www.statista.com/statistics/1365102/orpea-share-price-development-monthly/
Key statistic: Share price dropped from €107.25 (June 2021) to €2.28 (February 2023)

Investigate Europe. "Orpea: police raids across Europe after Investigate Europe exposé." 2024.

URL: https://www.investigate-europe.eu/posts/orpea-france-police-investigation-raids-europe
Key quote: "In December 2023, the French state took a majority stake in the debt-ridden enterprise as part of a bailout involving €605 million."

Castanet, Victor. Les Fossoyeurs: Révélations sur le système qui maltraite nos aînés. Fayard Publishing, 26 January 2022.

Recipient of Prix Albert-Londres 2022

Germany - Hospital Ownership

HealthManagement.org. "The Privatisation of Hospitals in Germany: Lowering Confidence of Germans in Their Hospitals?"

URL: https://healthmanagement.org/c/hospital/issuearticle/the-privatisation-of-hospitals-in-germany-lowering-confidence-of-germans-in-their-hospitals
Key statistics: "While in 1991 46% of the hospitals were public, in 2006 this proportion was reduced to 34.1%. The share of hospitals with a private for-profit owner increased from 14.8% to 27.8%."

Fresenius. "Fresenius Helios."

URL: https://www.fresenius.com/fresenius-helios
Key data: "Helios is Europe's leading private health care provider, with 128,000 employees... more than 80 hospitals in Germany, about 220 outpatient care centers... 2024 sales totaled more than €12.7 billion."

Tiemann, O. and Schreyögg, J. "Hospital ownership and efficiency: A review of studies with particular focus on Germany." Health Policy, 104(2):163-171, 2012.

DOI: 10.1016/j.healthpol.2011.11.010
PubMed: https://pubmed.ncbi.nlm.nih.gov/22177417/

Australia - PPP Reviews

Monash University. "When Public Private Partnerships." Working Paper, 2017.

URL: https://www.monash.edu/__data/assets/pdf_file/0020/2052092/WP2017-03.pdf
Key quote: "There is a paucity of empirical evidence on Australian PPPs..."

Infrastructure Partnerships Australia. "Performance of PPPs and Traditional Procurement in Australia." (Raisbeck, Duffield and Xu study, 2010)

URL: https://infrastructure.org.au/wp-content/uploads/2016/12/IPA_PPP_FINAL.pdf

Liu, L.X., Clegg, S., Pollack, J. "The Effect of Public–Private Partnerships on Innovation in Infrastructure Delivery." SAGE Journals, 2024.

URL: https://journals.sagepub.com/doi/10.1177/87569728231189989
Key quote: "Lember et al. (2019) found 'very little evidence … to support the claim that innovation was a pervasive and inherent quality of infrastructure PPPs.'"

Canada - P3 Assessments

Canadian Council for Public-Private Partnerships.

Main site: https://www.pppcouncil.ca/
Why P3s: https://www.pppcouncil.ca/why-p3s
Key data: "300+ projects valued at more than $139 billion"

CCPPP. "Breaking New Ground: P3 Hospitals In Canada."

URL: https://www.pppcouncil.ca/web/P3_Knowledge_Centre/Research/Breaking_New_Ground__P3_Hospitals_In_Canada.aspx

Infrastructure Ontario. "FAQs - Public Private Partnerships (P3s)."

URL: https://www.infrastructureontario.ca/en/what-we-do/major-projects/faqs---public-private-partnerships-p3s/

ScienceDirect. "The perceived efficacy of public-private partnerships: A study from Canada."

URL: https://www.sciencedirect.com/science/article/abs/pii/S1045235418301096
Key quote: "There is a vast body of evidence suggesting that they [P3s] do not consistently deliver superior Value-for-Money."

New Zealand - Treasury Reports

New Zealand Treasury. "Financing Infrastructure Projects: Public Private Partnerships (PPPs) (PP 06/02)." 2006.

URL: https://www.treasury.govt.nz/publications/ppp/financing-infrastructure-projects-public-private-partnerships-ppps-pp-06-02

New Zealand Treasury. "Public Private Partnerships."

URL: https://www.treasury.govt.nz/information-and-services/public-sector-leadership/partnerships/public-private-partnerships
Key quote: "The New Zealand PPP Programme commenced in 2009."

New Zealand Treasury. "Public Private Partnerships: Blueprint for Future Transactions."

URL: https://www.treasury.govt.nz/publications/guide/public-private-partnerships-blueprint-future-transactions

Office of the Auditor-General New Zealand. "Part 2: Introducing public private partnerships." 2011.

URL: https://oag.parliament.nz/2011/public-private-partnerships/part2.htm

Netherlands - Hospital Finance

Cambridge University Press. "Health care reform and financial crisis in the Netherlands: consequences for the financial arena of health care organizations." Health Economics, Policy and Law.

URL: https://www.cambridge.org/core/journals/health-economics-policy-and-law/article/health-care-reform-and-financial-crisis-in-the-netherlands-consequences-for-the-financial-arena-of-health-care-organizations/2D7A19F673004546CA993C82830C275C
Key findings: "Regulatory agencies sought to mitigate the consequences of the financial crisis through new regulatory frameworks introduced in 2009 and 2011: Basel III for banks and Solvency II for insurers. Both regulations had unexpected consequences for health care organizations."

Springer - European Journal of Health Economics. "Assessing the relation between financial performance and long-term bank loan interest rates for healthcare providers in the Netherlands."

URL: https://link.springer.com/article/10.1007/s10198-023-01629-z
Key quote: "The Dutch health system is financed predominantly by commercial bank loans... The European BASEL III and Solvency 2 legislation limited risky behavior of financial institutions."

De Nederlandsche Bank. "Health insurers."

URL: https://www.dnb.nl/en/sector-information/open-book-supervision/open-book-supervision-sectors/insurers/balance-and-capital-pillar-1/health-insurers/
Key quote: "Effective from 1 January 2016, all private health insurers come under the European risk-based supervision framework, Solvency II."

5. Academic Sources

Bagust, Place and Posnett 1999 (85% Bed Occupancy)

Bagust, A., Place, M., and Posnett, J.W. "Dynamics of bed use in accommodating emergency admissions: stochastic simulation model." BMJ, 319(7203):155-158, 1999.

DOI: 10.1136/bmj.319.7203.155
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC28163/
PubMed: https://pubmed.ncbi.nlm.nih.gov/10406748/
Authors' affiliation: York Health Economics Consortium, University of York
Key finding: "Risks are discernible when average bed occupancy rates exceed about 85%, and an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more."

PFI Value for Money Research

Pollock, A.M., Shaoul, J., and Vickers, N. "Private finance and 'value for money' in NHS hospitals: a policy in search of a rationale?" BMJ, 324(7347):1205-1209, 2002.

DOI: 10.1136/bmj.324.7347.1205
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC1123165/
PubMed: https://pubmed.ncbi.nlm.nih.gov/12016191/
Key findings: "The financing costs account for 39% of the total project costs under the PFI. Publicly financed capital does not incur these costs"; "In all cases risk transfer almost equals the amount required to bridge the gap between the public sector comparator and the PFI."

Gaffney, D., Pollock, A.M., Price, D., and Shaoul, J. "NHS capital expenditure and the private finance initiative—expansion or contraction?" BMJ, 319(7201):48-51, 1999.

DOI: 10.1136/bmj.319.7201.48
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC1116147/

Gaffney, D., Pollock, A.M., Price, D., and Shaoul, J. "PFI in the NHS: is there an economic case?" BMJ, 319(7202):116-119, 1999.

DOI: 10.1136/bmj.319.7202.116
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC1116198/

Pollock, A.M., Dunnigan, M., Gaffney, D., Price, D., and Shaoul, J. "Planning the 'new' NHS: downsizing for the 21st century." BMJ, 319(7203):179-184, 1999.

DOI: 10.1136/bmj.319.7203.179
PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC1116276/

Shaoul, J., Stafford, A., and Stapleton, P. "The cost of using private finance to build, finance and operate hospitals." Public Money and Management, 28(2):101-108, 2008.

Hellowell, M. and Pollock, A.M. "The private financing of NHS hospitals: politics, policy and practice." Economic Affairs, 29(1):13-19, 2009.

DOI: 10.1111/j.1468-0270.2009.01861.x

German Hospital Corporatization

Tiemann, O. and Schreyögg, J. "Hospital ownership and efficiency: A review of studies with particular focus on Germany." Health Policy, 104(2):163-171, 2012.

DOI: 10.1016/j.healthpol.2011.11.010
PubMed: https://pubmed.ncbi.nlm.nih.gov/22177417/
Key findings: Between 1995 and 2008, share of inpatient beds changed from 56% public/6% for-profit to 49% public/15% for-profit

Tiemann, O. and Schreyögg, J. "Effects of ownership on hospital efficiency in Germany." Business Research, 2(2):115-145, 2009.

URL: https://www.researchgate.net/publication/41842606_Effects_of_Ownership_on_Hospital_Efficiency_in_Germany

Healthcare Financialization

Bayliss, K. "The financialisation of health in England: lessons from the water sector." FESSUD Working Paper Series, No. 131. Leeds: Financialisation, Economy, Society and Sustainable Development Project, 2016.

URL: https://ideas.repec.org/p/fes/wpaper/wpaper131.html
Key finding: Identifies four mechanisms of financialization in NHS: internal markets, NHS funding for non-NHS providers, private income for NHS providers, PFI

Stafford, A. "Counter Accounting and Counter Accountability: A Post-COVID-19 Study of England's Hospital Infrastructure Crisis." Abacus, 2025.

DOI: 10.1111/abac.12345
URL: https://onlinelibrary.wiley.com/doi/10.1111/abac.12345

Shaoul, J. "A critical financial appraisal of the private finance initiative: Selecting a financing method or reallocating wealth?" Critical Perspectives on Accounting, 16(4):441-471, 2005.

6. Recent Statements & News

Amanda Pritchard BBC Radio 4 Today Programme (February 2025)

Health Service Journal. "Pritchard backs private borrowing for NHS capital." 13 February 2025.

URL: https://www.hsj.co.uk/finance-and-efficiency/pritchard-backs-private-borrowing-for-nhs-capital/7038668.article

LaingBuisson News. "NHSE chief exec joins calls for private capital investment in the NHS." 13 February 2025.

URL: https://www.laingbuissonnews.com/healthcare-markets-content/nhse-chief-exec-joins-calls-for-private-capital-investment-in-the-nhs/
Key quote: "We need to think much more radically, particularly about capital. I think we now must consider private capital investment in the NHS."

British Orthopaedic Association. "New Hospital Programme (England): Plan for Implementation."

URL: https://www.boa.ac.uk/resource/new-hospital-programme-england-plan-for-implementation-january-2025.html
Full quote: "The government have given more capital to the NHS this year, which is hugely welcome, but in the current financial context we can't keep asking the government for more state funding. We are not going to fill the gap that way."

Wales Mutual Investment Model

Welsh Government. "Mutual investment model for infrastructure investment." First published 2 October 2017, last updated 20 May 2024.

URL: https://www.gov.wales/mutual-investment-model-infrastructure-investment
Key differences from PFI: Public sector invests 15% risk capital via Welsh Development Bank; public interest director appointed; excludes soft services; mandatory ethical employment code

Welsh Government. "Mutual Investment Model Report 2022-2024." May 2024.

URL: https://www.gov.wales/sites/default/files/publications/2024-05/annual-mutual-investment-model-report-july-2022-to-march-2024.pdf
Key statistics: MIM schemes will foster approximately £1.4 billion investment

European Investment Bank. "Improving the public private partnership model in Wales."

URL: https://www.eib.org/en/stories/wales-infrastructure

Scotland NPD Model

Audit Scotland. "Privately financed infrastructure investment: The Non-Profit Distributing (NPD) and hub models." 28 January 2020.

URL: https://audit.scot/publications/privately-financed-infrastructure-investment-the-non-profit-distributing-npd-and-hub
Key finding: £3.3 billion investment programme enabled; NPD projects average 58% of repayment costs of PPP projects

Scottish Parliament. "Meeting of the Parliament: 20/02/2025 - The Ongoing Impact of PFI/PPP on Scotland's Public Finances." 20 February 2025.

URL: https://www.parliament.scot/chamber-and-committees/official-report/search-what-was-said-in-parliament/meeting-of-parliament-20-02-2025?meeting=16263&iob=138946
Key statistics: Total PFI/PPP unitary charge payments 2006-07 to 2022-23: £14.173 billion; 2025-26 payments projected at £1.25 billion (highest single year)

Scottish Government submission. 23 February 2023.

URL: https://www.parliament.scot/-/media/files/committees/citizen-participation-and-public-petitions-committee/correspondence/2023/pe2004/pe2004_a.pdf
Why NPD was abandoned: Eurostat changed rules in 2014 so full cost counted as public sector liability if government legally committed to long-term lease payments, undermining the "off-books" accounting benefit

7. Historical Context

Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis Report)

Francis, R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. HC 947. London: The Stationery Office, 6 February 2013.

ISBN: 978-0-10-298146-9
Full Report PDF: https://assets.publishing.service.gov.uk/media/5a7ba0faed915d13110607c8/0947.pdf
House of Commons Library Summary: https://commonslibrary.parliament.uk/research-briefings/sn06690/
Health Foundation Overview: https://www.health.org.uk/about-the-francis-inquiry
Key finding: "Allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care"

Historic NHS Hospital Building Programmes

Ministry of Health. A Hospital Plan for England and Wales. Cmnd 1604. London: HMSO, January 1962.

Enoch Powell, as Minister of Health, launched the plan proposing 90 new and 134 substantially remodelled hospitals over 10 years

O'Hara, G. "Health Care and the NHS." In From Dreams to Disillusionment: Economic and Social Planning in 1960s Britain, Chapter 7. London: Palgrave Macmillan, 2007.

DOI: 10.1057/9780230625488_7
URL: https://link.springer.com/chapter/10.1057/9780230625488_7

Cutler, T. "Economic liberal or arch planner? Enoch Powell and the political economy of the Hospital Plan." Contemporary British History, 25(4):469-489, 2011.

DOI: 10.1080/13619462.2011.623860
URL: https://www.tandfonline.com/doi/abs/10.1080/13619462.2011.623860

Mohan, J. Planning, Markets and Hospitals. London: Routledge, 2002.

URL: https://www.taylorfrancis.com/chapters/mono/10.4324/9780203455890-5/

Carillion Collapse

National Audit Office. Investigation into the rescue of Carillion's PFI hospital contracts. HC 68, Session 2019-2021. London: NAO, January 2020.

Report Page: https://www.nao.org.uk/reports/investigation-into-the-rescue-of-carillions-pfi-hospital-contracts/
Full Report PDF: https://www.nao.org.uk/wp-content/uploads/2020/01/Investigation-into-the-rescue-of-Carillions-PFI-hospital-contracts.pdf
ISBN: 978-1-78604-285-9
Key findings: Carillion collapsed 15 January 2018; Royal Liverpool Hospital 5+ years delayed, total cost rose from £746m to £1,063m; investors and insurers lost at least £603m

House of Commons Treasury Committee. Private Finance Initiative. Seventeenth Report of Session 2010-12, HC 1146. London: The Stationery Office, 2011.

Key finding: Private finance has always been more expensive than government borrowing; cost of capital for typical PFI project 6-7% vs government borrowing at 1.5-2.5%

Additional Infrastructure Crisis Coverage

NHS Support Federation. "Crumbling infrastructure."

URL: https://nhscampaign.org/issues/staff-shortages-copy-5/
Key statistics: Backlog trajectory: £5.5bn (2016/17) → £6bn (2019) → £9bn (2021) → £10.2bn (2022) → £13.8bn (2024) → £15.9bn (October 2025)

Stafford, Anne. "The growing infrastructure crisis in English NHS hospitals." University of Manchester Policy Blog, 7 January 2025.

URL: https://blog.policy.manchester.ac.uk/posts/2025/01/the-growing-infrastructure-crisis-in-english-nhs-hospitals/

GOV.UK. "Reinforced autoclaved aerated concrete (RAAC) in hospitals: management information." Updated 10 September 2025.

URL: https://www.gov.uk/government/publications/reinforced-autoclaved-aerated-concrete-raac-in-hospitals-management-information
Key statistics: 41 hospital sites with confirmed RAAC; 7 most affected hospitals part of NHP for full replacement; over £1.3 billion allocated since 2021-22

GOV.UK. "Patients and pupils to benefit from school and hospital repairs."

URL: https://www.gov.uk/government/news/patients-and-pupils-to-benefit-from-school-and-hospital-repairs
Key statistics: £750 million for over 400 hospitals; services disrupted over 4,000 times in 2023-24 due to poor quality buildings