Chairing a session at a recent Unison conference on the future of the NHS I chided Clive Efford, Labour MP for Eltham in south London, after he had cheerfully abused consultants. I think the word he used was 'spivs', unaware that the room was full of them, including the nice woman sitting next to him.

All were concerned for the health service, as is Mr Efford, with whom I chatted later.

As a result he sent me a dossier on the financial plight of his local NHS. It is chiefly the result, he says, of the way the new Queen Elizabeth Hospital at Woolwich was built under the private finance initiative, compounded by the impact of the resource accounting and budgeting (RAB) regime.

By coincidence, I had on my desk last month's Commons public accounts committee report on the shambles created by the abortive attempt to replace three run-down hospitals on the other side of London - St Mary's, the Royal Brompton, and Harefield - with a grand new 'campus' in what is known as the Paddington basin.

There's not a lot to link the two cases. The Paddington scheme was approved in 2000, a£300m project due to be finished by late 2006. With costs approaching the£1bn mark and two of the three 'campus partners' (you call them hospitals) pulling back, it was cancelled by the Department of Health in June 2005.

MPs on the committee were assured by all concerned that there were 'no more Paddingtons' in the pipeline and that lessons had been learned. But they protested that many opportunities to scrap the doomed scheme had been missed as proposed bed numbers fluctuated between 835 and 1,200. The DoH was insufficiently engaged, they argued, and some£15m was wasted in preparing the proposals.

As the committee noted, the DoH's£13bn capital investment programme is being reviewed with a view to scaling it down to£7bn-£9bn - more in keeping with 'long-term affordability, policies on choice, payment by results' and the shift to primary care. The DoH website is full of advice on how to handle PFI, including a new one, ex gratia payments on cancelled schemes.

Where does that leave Mr Efford's local NHS? In trouble, as both the Audit Commission and PricewaterhouseCoopers reports confirm. The Queen Elizabeth Hospital was a PFI pioneer, funded in 1998 by an index-linked bond at a fixed interest rate; one that has proved higher than events justified. Short of buying out the City bondholders - which would cost a lot upfront - the PFI firm and its client are stuck paying£15m a year (inflation linked) until 2028.

One thing most people do agree is that lessons have indeed been learned. PFI schemes are financed differently now. But the way NHS London has chosen to deploy RAB means that it deducts the equivalent of prior years' deficits from the annual allocations.

Add the RAB problem to PFI difficulties and local MPs tell me that adds up to a serious problem, despite Queen Elizabeth Hospital trust chief executive John Pelly's heroic drive for greater efficiency. Add recent attempts by the DoH's commercial division to insert an unneeded independent sector treatment centre into the area and you have what MPs call 'lunacy' and 'complete nonsense'.

The ISTC would not be located at the underused PFI set-up in neighbouring Lewisham Hospital, where sensible efforts are under way with the Queen Elizabeth to cut back on costly service duplication. It would be at Queen Mary's Hospital, Sidcup, causing wider disruptive ripples.

I could not contact Mr Efford at the weekend, but. spoke instead to Nick Raynsford, MP for Greenwich, who should have made cabinet rank.

His style is less confrontational, but the message is the same. The MP has been privately urging Patricia Hewitt to show leadership by insisting that the Queen Elizabeth's 30-year bond be renegotiated, as many others have. She should also drop the ISTC plan and take the Audit Commission's advice by abandoning RAB.

Tony Blair is dashing around proclaiming new guns bans and weekend shifts for surgeons as part of his 'legacy'. He should be more worried that dud PFIs will still be part of it - in 2028.

Michael White is assistant editor (politics) of The Guardian.