The politics of the private finance initiative and the new NHS

The private finance initiative does not provide new money for public services as the government claims. The high costs of capital under the private finance initiative translates into service and workforce cuts. The reduction in public provision of long term care, NHS dentistry, optical services, and elective surgical care shows the trajectory for the NHS under the private finance initiative. In the NHS, shrinkage in service provision combined with budget constraints could force primary care trusts to redefine entitlement to NHS care and to seek privately funded solutions for those who can afford to pay, leaving a rump service. The private finance initiative is a regressive instrument and is likely to increase inequalities in health and in wealth.