A trust's 'achievement' in bringing the first major PFI project to completion has been tempered by claims that the way it has been funded is a 'disaster'. Patrick Butler reports

There is a pleasing lack of triumphalism in the way Carlisle Hospitals trust appears to be treating its achievement in bringing the first major private finance initiative hospital project to completion.

'I can see PFI for what it is and what it is not, ' says trust chief executive Brian Waite. 'There are pluses and minuses, just as there are with publicly funded projects. Everything is not hunky-dory and it's going to be tough next year. '

A little euphoria might be excused - Carlisle has been waiting 30 years for a new hospital, and the£87m building promises to deliver some important improvements to the quality of care the trust can provide.

But the measured tone is appropriate. The Cumberland Infirmary development - especially in recent months - has been accompanied by tough questions about cost, affordability, bed numbers and staffing.

Last November a report revealed that expected cost-saving targets could not be met, and the health authority would have to find more cash. A month later, Unison published a scathing report alleging the project was based on a 'politically manipulated' business plan, and was affordable only with cuts in services and beds.

Unison general secretary Dave Prentis - ironically the butt of criticisms that he is too soft on Labour's health policy - used the Carlisle report to label PFI 'one of the greatest financial and political disasters of late 20th century British government'.

The report argued that the basis on which the cost of PFIs was compared with public finance was flawed - a criticism also levelled at Dartford and Gravesham Hospital by the National Audit Office - and that as a consequence public capital funding would have proved cheaper.

There have also been controversies over whether the PFI deal should transfer non-emergency ambulance staff to the private consortium managing hospital facilities (they weren't); and concern that some nursing jobs would be lost.

Mr Waite insists - a little wearily - that the Unison criticisms have been dealt with. Bed numbers have been reduced, but not critically so - from an original plan of 474 to 444.

'We can bring in new beds if required', Mr Waite adds. The trust insists there will be no nursing redundancies.

He says funding hitches have occurred but only as they do in all major capital schemes. And the savings shortfall has been sorted.

Rather than deliver savings all at once, the trust has been allowed to reschedule the delivery of revenue savings over a two or three-year period.

'It's going to be tough, ' says Mr Waite. 'But we are still going to save£1m next year. That's fairly reasonable. '

He emphasises the£750,000 saved by raising private capital through an innovative bond issue, rather than borrowing direct from the banks. The success of the bond forced banks to cut their PFI lending charges, he says.

'It's probably the most cost-effective scheme in the country. '

Willie Reid, the trust's medical director, is convinced that putting all services on one site instead of the current three will pay dividends in terms of quality and safety of care.

He is cautiously satisfied that the trust can manage on its reduced bed numbers. 'Probably the number of beds will be adequate; but we have to change practice. '

Carlisle's Labour MP, Eric Martlew, is a former chair of Cumbria HA. He says: 'In an ideal world it would be built under the old (publicly funded) system. But we wanted a new hospital 20 years ago and we did not get a sniff of it until the PFI came along. '