Scores of hospitals being built under the £7bn NHS private finance initiative are in danger of becoming white elephants unable to adjust to changing health needs, the government was warned last night. The King's Fund, an independent think tank respected by health ministers, said the PFI projects were being managed under binding 30-year contracts without the flexibility needed to keep up with changing policies and technological progress.
The fund's researchers said the NHS had never been good at taking the needs of local people into account when making investment decisions.
Mistakes would continue to be made at hospitals built by the public sector as well as those contracted out under the PFI. But the private contracts would be harder and more expensive to correct.
"New hospitals are being built without regard to how they fit in with other health services. That could leave the NHS with expensive hospital buildings which become outdated within a few years, but for which it still has to pay," the fund said.
Anthony Harrison, one of the report's authors, said: "The biggest users of hospital care are older people. Their health depends on the existence of good quality primary and community services, working closely with local hospitals. Building new hospitals under 30-year binding contracts with private companies, without also planning community services, could turn out to be wasteful and inappropriate."
The report said all new hospitals should be commissioned regionally instead of leaving decisions to local NHS trusts, with design competitions to bring in ideas about how hospitals could respond better to patients' needs.
The NHS national plan published in July promised 100 new hospital schemes over the next 10 years. A £7bn investment programme would include "an extended role for PFI", it said.
The Department of Health said the PFI approach improved the quality of investment because it focused minds on planning for the future. "These hospitals are built with the long term in mind with more flexibility to handle change," a spokesman said.
• Alan Milburn, the health secretary, was preparing last night to instruct the chief executives of NHS trusts and health authorities to prepare to increase hospital beds for the first time in a generation.
Sources said he would call for a "new NHS culture". Instead of aiming for higher throughput of patients using fewer beds, he will say the service should plan for growth.
The scheme is being introduced to achieve the targets in the national plan to provide 7,000 extra beds in England by 2004.
