Architect Sounds Alarm on PFI Legacy for NHS Estate
Wes Streeting, the Health Secretary, was pictured arriving at Downing Street last week, as a stark warning emerges about the perilous state of many NHS buildings constructed under the Private Finance Initiative (PFI). A retired expert has urged the government not to repeat the 'folly' of a scheme that has left a legacy of design flaws and financial burdens for the health service.
The 'Quality Gap' in PFI Buildings
In a direct response to a previous letter from Lord Hutton, chartered architect and retired barrister Martin Cook has highlighted independent research from UK auditing authorities. This research revealed a significant 'quality gap' in public buildings procured under PFI when compared to those from traditional, design-led methods.
Cook, who included these findings in his 2007 book The Design Quality Manual: Improving Building Performance, points to serious flaws identified as early as the Audit Commission’s 2003 report on PFI in schools. The problems were not minor; they included poor functionality, the use of short-life materials, and even non-compliance with building and safety regulations.
Contractors, Not Architects, in the Lead
A core issue, according to Cook, is that PFI contracts are typically led by building contractors rather than architects. He draws a chilling parallel, noting that the refurbishment of Grenfell Tower followed a similar model. While this approach might appear to save on initial construction costs and time, these savings are often illusory.
Too often, these apparent savings are achieved at the expense of good design and quality materials, while being coupled with exorbitant long-term finance and facility support costs. This creates a financial millstone for the NHS for decades.
A Looming Crisis as Contracts Expire
As the first wave of PFI buildings approaches the end of their 25- to 30-year concessions, a new concern is emerging. There are widespread fears that some contractors may abandon these assets, handing them back to the public sector in a severely depleted condition.
This scenario would see the NHS inheriting buildings suffering from neglected repairs and facing spiralling maintenance costs, creating a fresh crisis for an already stretched public purse.
Martin Cook's conclusion, drawn from these hard lessons of history, is unequivocal: PFI is no way to procure durable public buildings cost-effectively. His urgent message to policymakers is that this failed model must not be repeated for the future of the NHS estate.
