Published: 05/08/2004, Volume II4, No. 5917 Page 9

Nearly two-thirds of the private finance initiative projects announced last week will see significant investment in community as well as acute services.

Many of the projects, including the most expensive - in Liverpool at just over£1bn - the£310m scheme in North Bristol and South Gloucestershire, and the£100m Southend Hospital redevelopment, will see the creation of networks of community services and community hospitals.

Almost£270m of the ambitious£1bn North Mersey Future Healthcare Project will be used to redevelop facilities at the Royal Liverpool Children's Hospital. A children's health park will seek to promote healthy living locally.

The restructuring will also see the closure of all psychiatric wards in the acute sector and their replacement with five mental health resource centres in community settings.

Project director Kate Abenstern described the new configuration oftheir mental health services as 'very different to anywhere else in the country'.

'All the other trusts are working on integrated service models with the acute sector, ' she said.

'Merseyside will be the only area in the country with just community mental health services.

Even the intensive psychiatric unit will be based in the community.'

The Merseyside PFI scheme will also see Royal Liverpool University Hospital redeveloped at a cost of£499m.

An elective care centre will also be built at University Hospital Aintree, expanding wards and diagnostic facilities for£99m.

Sandwell and West Birmingham Hospitals trust's£591m PFI project is also boasting that its new acute sector facilities will include the development of community-based alternatives to hospital care.

But Mike Sharon, project director of Sandwell and West Birmingham PFI project, said the trust was examining a range of options, including one that would not change the way care was delivered but just see 'the estates brought up to scratch'.

Both Ms Abenstern and Mr Sharon identified payment by results as the key risk to their PFI projects, with the servicing of the PFI loan dependent on the level of patient activity in the acute sector.

'We are expecting a higher demand in our hospitals, ' said Ms Abenstern, 'but they will be high-tech treatments with shorter stays'.

However, both acknowledged that if their public health projects were so successful that it caused a drop in demand for hospital interventions, they would have difficulty paying back the loan.

Two other parts of the country are celebrating investments in mental health estates, the subject of an HSJ campaign last autumn.

Leicestershire Partnership trust has been given£52m while South of Tyne and Wearside Mental Health trust receives£50m.