‘No more waiting lists to repair our NHS’

Lord Hutton of Furness is a former Health Minister and Chair of the Association of Infrastructure Investors in Public Private Partnerships (AIIP).

Six years ago, Boris Johnson promised to rebuild 40 hospitals. Many of those won’t even start building until 2039. By contrast, in the late 90s and early noughties, under PFI (Private Finance Initiative), 90 hospitals were built in a decade.

We need to end the waiting lists to repair our NHS.

This is not a theoretical crisis. According to the National Audit Office, the crumbling state of NHS infrastructure is causing 5,400 clinical service incidents each year –  closed departments, cancelled appointments, suspended services. That’s the human cost of delay, decay, and indecision.

READ MORE: ‘PFI was a disaster — Labour mustn’t repeat it’

The NHS 10-Year Plan said it would consider if PPPs (Public Private Partnerships) could be used for neighbourhood health centres, and the Budget next week will make a final decision on whether to go ahead.

This has worked in the past. Programmes like NHS LIFT built 350 health centres in some of the most deprived communities, which benefitted the public and NHS staff and provided value for money. They also gave a financial stake in the buildings to the public sector, a genuine partnership bringing public and private together. An NAO report found that it could deliver value for money and was “an effective means of improving primary health and social care”.

It provides a good basis for delivering the new Neighbourhood Health Centres that Wes Streeting is promising.

Other countries — including Australia, Canada, and New Zealand — continue to use evolved PPP models to build hospitals, schools, prisons and other critical infrastructure. The UK, ironically the pioneer of PPP, is now lagging behind.

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Since the early 1970s, the UK has spent less than half our OECD peers on physical capital investment. The closest we came to the OECD average was during the PFI period in the 2000s.

Across the world, the evidence for PPP success is growing, not shrinking – the UK should not be an outlier. The National Audit Office’s March 2025 report found that PPP projects are “usually delivered on-time and on-budget.”

Similarly, the NHS Confederation has found that past private finance projects “appear to offer better value for money than the recent New Hospitals Programme, once delays and overspend costs are accounted for.” If we want to rebuild public trust in the NHS, we must also rebuild the buildings where that trust is delivered.

PPP does more than deliver new bricks and mortar. It provides guaranteed maintenance, future-proofing against the kind of capital starvation that has led to today’s £14 billion maintenance backlog. Overall in the public sector there is a staggering £49 billion maintenance backlog and associated life safety risk, according to the NAO.

And crucially, modern PPP models can be tailored to reflect what we’ve learned: transparent, accountable, and structured to ensure risk sits with those best placed to bear it — not the taxpayer. A report by the AIIP, which represents infrastructure investors, makes a number of suggestions to simplify contracts and provide better independent oversight of projects. Breaking down charges can ensure the right contractors are held to account against their promises.

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Opponents claim that the taxpayer pays more than the original build cost of the health centre or the hospital. But that is totally misleading – they are comparing the construction costs with the long term maintenance costs, as if there is some magical way in which if you build NHS centres with traditional procurement you never need to repair them. Sadly, the huge repair backlog in our NHS shows the opposite is true.

We need to unpick the ideology that is holding back the NHS from delivering.

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