Mackey reveals PFI revival plan

NHS England has confirmed plans to introduce a mechanism to allow private finance investment into health service infrastructure within months.

Sir Jim Mackey confirmed today he wanted government to “introduce an off–balance sheet capital investment mechanism”. It is part of a “100 day plan” for his first few months as NHSE CEO, published today.

HSJ understands discussions between NHSE and the Treasury over how this would be used and what form it would take are ongoing. Government is due to publish a new infrastructure strategy in coming weeks; whole 10 Year Health Plan drafts have included proposals for more social investment.

A move to revive off-balance sheet capital would pave the way for private investment to be once again used to build NHS hospitals, after the previous Labour government used private finance initiatives to invest widely in health service buildings in the late 1990s and 2000s.

Under the arrangements, the private sector builds and maintains an asset in exchange for annual payments from the public sector over the course of the contract. Because the private sector bore the up-front construction costs, this did not count as government borrowing.

However the model was criticised heavily over value for money concerns, and was banned by former chancellor Philip Hammond in 2018.

Read full story (paywalled)

Source: HSJ, 11 June 2025