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Whither the private finance initiative? For a year now, NHS managers have been awaiting further ministerial guidance on the PFI procurement process and publication of a review which would set boundaries for what the private sector could and could not provide. Nothing has appeared - other than in versions leaked to HSJ (28 January) - and the resounding silence has become a standard joke at NHS finance conferences.

Into the vacuum the National Audit Office's report on the NHS's first PFI project has burst this week (see news, page 2). It will add to the uncertainty surrounding PFI's long-term future, and is sure to be seized on by the initiative's numerous critics. For the NAO suggests the new Dartford and Gravesham Hospital may prove as costly to build as traditionally financed projects.

The trust miscalculated the savings it would make - not£17m but£5m, and these uncertain - while it has had to cut the level of services the hospital will provide in response to a hefty price hike from the contractor. The NAO cautiously does not rule out altogether the possibility that 'the PFI solution could prove to be more expensive than traditional procurement'.

So could this be the death knell for PFI in the NHS? Given health secretary Frank Dobson's Old Labour convictions, that drastic outcome might be unsurprising - but it is unlikely. The Dartford project was born in difficult circumstances, the result of the previous government's determination to get a PFI project under way come what may. The NAO notes that the Treasury and NHS Executive consider the trust to have done a good job. It does not deserve to be damned for its mistakes given the complex nature of what it was pioneering. But it is imperative others learn the lessons of its errors.

Elsewhere, PFI enjoyed a fillip this week. In Scotland, where opposition to it has been most marked and its future appeared most unsure, the Labour- Liberal Democrat coalition government unexpectedly reaffirmed its commitment to the policy.

PFI looks set to remain pretty much the only show in town, and it is in that spirit that NHS managers will continue to pursue it. But the need remains for health minister John Denham to break his silence on the subject and point the way forward.