Reactions to the announcement of 11 new hospital developments, 10 funded by PFI, vary from 'great news' to 'reckless'. Lyn Whitfield reports

We cannot build an NHS for the 21st century with hospitals built in the 19th century, ' declared health minister Alan Milburn, announcing 11 new hospital developments 'worth almost£1bn'.

'The hospital building programme is a key part of the government's 10-year modernisation of the health service. It is great news for patients, staff and local communities.'

Nobody with a project on the list is disagreeing - particularly in London, which gets half the£1bn, and where four schemes delayed by Sir Leslie Turnberg's review of the capital's services have now been given the go-ahead.

Derek Smith, chief executive of King's Healthcare trust, says its£64m plans represent 'the largest development since the hospital was built in 1913'.

Manchester, too, is a big beneficiary, with approval for a£162m scheme that includes a new children's hospital.

James Barbour, chief executive of Central Manchester Healthcare trust, says this is 'great news'.

He recalls that the Royal Infirmary moved to its present site in 1908. 'This project ensures that just as we started this century with a brand new hospital, so we will go into the next with a new world-class healthcare complex.'

But not everyone is as enthusiastic.

Unison general secretary Rodney Bickerstaffe last week attacked the PFI programme as 'reckless'.

And in Leeds, Peterborough, Tunbridge Wells and Portsmouth, managers are angry and disappointed that PFI schemes backed by regional offices have not been included in the second wave of approvals.

When Labour came to power last year, it 'inherited' 43 PFI schemes.

Fourteen were given the go ahead after a PFI prioritisation exercise last June, with another at Greenwich added later. Five have now reached financial close.

Trusts with projects left out of the 'first wave' were told they could apply for consideration by a new capital prioritisation advisory group. It met earlier this year and examined 11 schemes put forward by regional offices, two of which were not involved in last year's exercise.

Peter Howlett, PFI project director for Portsmouth Hospitals, says he is 'very disappointed' that one of these, a project to centralise acute services in Portsmouth, failed. But he says the trust has received 'no feedback' on 'what was wrong with a project that had a lot of support'.

Political correspondents in London were briefed on the hospital building plans in time to make headlines in Tuesday's national papers. But Portsmouth Hospitals trust learned its project was not in the list when the local paper rang on Tuesday afternoon.

In Leeds, managers are furious that£58m development plans have been knocked back for the second year running. The project changed substantially between the two waves - starting as a new children's wing at St James' Hospital and ending as a site for cancer services.

But Bill Kilgallon, chair of the new Leeds Teaching Hospitals trust, says it is 'very difficult to understand the decision' to reject the project since it now forms part of a Leeds-wide cancer care strategy.

The NHS Executive is expecting CPAG to evaluate more schemes later this year. Mr Kilgallon says Leeds will resubmit its plans 'at the earliest opportunity'.

Chris Banks, finance director of Peterborough Hospitals trust, says it will take stock before deciding whether to go through the 'emotionally draining' process of submitting its project for the third year running.

'I think the government now has a policy on this, and it is sort out the Victorian stuff first, ' he says. 'I can understand that. But if that is the policy there is probably not much point going forward with schemes like ours.

'Our argument was that for the money we have to spend on our 1950s tower block, we could have a new hospital with bells and whistles on it. But I think we lost the argument a year ago.'

The NHS Confederation also warned this week that headlines about shiny new PFI hospitals could be hiding stories about a lack of capital investment across the NHS. Policy director Tim Jones echoes Unison concerns that the 25-year pay-back period for PFI projects could leave some trusts struggling to pay the bills.

'It is important to say we are delighted to see hospitals being built, ' he says.

'Our concern is how these projects mature in the future.'

PFI: the second wave

Newcastle Upon Tyne Hospitals and Newcastle City Health trusts -£59m - new facilities at Freeman Hospital and Royal Victoria Infirmary.

West Berkshire Priority Care Services trust -£25m - replacing Fair Mile Hospital near Reading with new mental health facilities.

West Middlesex University Hospital trust -£33m - 'purpose built diagnostic and treatment centre' including A&E and theatres.

Dudley Group of Hospitals trust -£62m - acute services rationalisation.

Walsgrave Hospitals trust -£174m - acute services rationalisation.

Central Manchester Healthcare and Manchester Children's Hospitals trusts -£126m - reconfiguration of services and new children's hospital.

University College London Hospitals trust -£115m - acute services centralisation.

King's Healthcare trust -£64m - acute services rationalisation.

St George's Healthcare trust -£40m - neurosciences and cardiothoracic services development.

Royal Hospitals trust -£250m - new hospital at Whitechapel.