A MASSIVE multi-million-pound redevelopment of hospital services is being planned for Brighton. Health reporter RACHEL PALMER, left, looks at a controversial scheme, in which private firms build and own hospitals, that could pay for the work.

The NHS once prided itself on being one of the best health services in the world. Now, as a new millennium gets under way, it is stretched to its limits.

It limped through last winter desperately short of beds and workers, wincing at every pound spent.

Health planners have realised one of the best ways forward could be to build state-of-the-art hospitals to process patients more quickly and safely that would attract top-flight specialists to hone medical specialties.

But hospital redevelopment is big business and the NHS is struggling to find the cash.

Enter the Private Finance Initiative (PFI) - a scheme that has drawn support as well as scepticism from medical circles and that could be used to fund the shake-up of hospital care in Brighton.

Under the PFI, private firms design, build, own and operate public services for an annual fee from a hospital trust or other Government body during a contract that usually lasts from 25 to 35 years.

PFI deals involve roads, bridges, hospitals and prisons.

Those in favour point to its ability to draw vast sums of capital for public works more quickly than Government investment alone.

Those against see it as privatisation by another name, where profits come first and things such as hospital beds and jobs are cut to balance the books as part of a gradual takeover of public services by large corporations.

They are also concerned about services such as medical records and information systems being contracted out to firms.

The replanning of healthcare in Brighton would see care provided by the Royal Alexandra Hospital for Sick Children, Brighton General Hospital and the Royal Sussex County Hospital combined at the Royal Sussex site in Eastern Road.

It could cost up to £40 million over several years.

The call for changes stems from a review of healthcare in East and Mid Sussex that suggests Brighton and Haywards Heath would offer more comprehensive care by serving a combined population of around 500,000 together, instead of treating their immediate populations separately.

Some children's services and maternity care have already been transferred from Haywards Heath to Brighton, where there is not enough work to train doctors effectively in those two areas.

Although the exact costs and funding arrangements are far from finalised, Stuart Welling, chief executive of Brighton Health Care NHS Trust, which runs the Royal Sussex, said PFI could be the way to pay for the merger of the three Brighton sites and a closer working relationship with Haywards Heath.

Inflexible

Paul Milligan, Brighton Health Care's deputy chief executive, was closely involved in a £220 million PFI redevelopment of an 870-bed teaching hospital and medical school in Edinburgh before he moved to East Sussex.

He said: "It's very early days in Brighton. An awful lot of work still has to be done and it involves a very detailed process.

"The primary emphasis is always on deciding what is appropriate for the local population.

"You look at what is required to deliver clinical services and you do not compromise that in any subsequent developments. Developing clinical services is paramount."

Mr Milligan said PFI allowed hospital managers to hand over the problems and risks of day-to-day tasks such as maintenance and engineering and concentrate on healthcare.

He said: "The NHS is not a property company. It is an organisation devoted to the delivery of healthcare. Clinical services are not being run by anyone but the NHS."

The King's Fund, a charity researching the impact of health policy changes, claims that despite the large investments PFI can attract, private involvement in hospitals raises serious questions about accountability and access to public information.

The charity fears PFI could make the health system inflexible because trusts become tied to fixed 30-year plans that may not allow changes later.

Mo Marsh, chairman of the Brighton, Hove and Lewes Community Health Council patients' watchdog, said: "Ideally, I wish the Government would fund this in a different way.

"PFI can be usefully explored, but there must be very strong measures in place with strict controls outlining who is responsible for what."

The Department of Health said PFI meant corners were unlikely to be cut in hospital design because contractors had to maintain buildings and services at their own expense - an incentive to do things properly from the start.

It said PFI also meant the NHS was no longer at the mercy of the stop-go economic cycle for equipment replacement and hospital building, but could spread capital costs out over a number of years.

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