on behalf of the NHS Consultants' Association, Radical Statistics Health Group, and the NHS Support FederationWe aim to promote efficiency, to improve services and to stimulate fresh flows of investment. We want to harness the private sector's management expertise and resources, bringing a new approach to investment in a whole range of activities and services traditionally regarded as the exclusive domain of the public sector.Kenneth Clarke, chancellor of the exchequer, November 1993 The private finance initiative (PFI) for public sector projects was launched by the government in 1992 to transform "public sector organisations from being owners of assets and direct providers of services into purchasers of services from the private sector."1 The types of projects funded under the scheme range from the building and operation of trunk roads, computer systems, and vehicle fleets to the construction of hospitals and delivery of NHS support systems.2 New hospitals are leased back to the NHS at market rates for 20-60 years. NHS land and buildings are often sold to the private companies as part of the deal.We consider here some of the implications of the use of private capital to fund NHS hospital developments, based on the plans produced for those schemes that have reached an advanced stage (table 1). We look at three of these in detail. A second wave of trusts already negotiating contracts include trusts in Glasgow, Newcastle, and the Midlands. Given the speed with which trusts have taken up the private finance initiative, it is important to examine the assumptions underlying the projects and the impact these projects will have on health services in their localities. First wave schemes will affect around 5% of acute NHS beds in England and almost a quarter in Scotland. Hence these projects are not just a local issue. They indicate the likely configuration of hospital services in England and Scotland if current policies continue.
How PFI contracts are negotiatedManaging any type of private deal is complex and expensive. For example, Bromley Hospitals Trust has spent £3 million on planning and procurement. The costs to the private sector have been estimated to be seven times higher than those of conventional tendering for public works. Total tender costs for all bidders can reach nearly 3% of the total project costs.
4Large hospital developments begin with the preparation of an outline business case. The guidelines state that this "should normally assume that private finance will be sought."5 Once the outline case is approved by the NHS regional executive, the trust issues an invitation to negotiate and an "output specification," 5 6 which states, not the number of beds needed, but the expected level of clinical activity.
5The consortia responding to the invitation suggest the number of beds (and non-clinical services) appropriate for that level of activity.
Summary pointsThe private finance initiative (PFI) is intended to attract private finance for public sector projects, such as roads and hospitals Several hospital ...
Organisms 'discount the future' when they value imminent goods over future goods. Optimal discounting varies: selection should favour allocations of effort that effectively discount the future relatively steeply in response to cues promising relatively good returns on present efforts. However, research on human discounting has hitherto focused on stable individual differences rather than situational effects.In two experiments, discounting was assessed on the basis of choices between a smaller sum of money tomorrow and a larger sum at a later date, both before and after subjects rated the 'appeal' of 12 photographs. In experiment 1, men and women saw either attractive or unattractive opposite-sex faces; in experiment 2, participants saw more or less appealing cars. As predicted, discounting increased signif icantly in men who viewed attractive women, but not in men who viewed unattractive women or women who viewed men; viewing cars produced a different pattern of results.
Homicide is an extreme manifestation of interpersonal conflict with minimal reporting bias and can thus be used as a conflict "assay." Evolutionary models of social motives predict that genetic relationship will be associated with mitigation of conflict, and various analyses of homicide data support this prediction. Most "family" homicides are spousal homicides, fueled by male sexual proprietariness. In the case of parent-offspring conflict, an evolutionary model predicts variations in the risk of violence as a function of the ages, sexes, and other characteristics of protagonists, and these predictions are upheld in tests with data on infanticides, parricides, and filicides.
Frequencies of homicide victimization of wives and husbands, while cohabiting and when separated, are reported for all spousal homicides known to the police in Canada (1974-1990), in New South Wales, Australia (1968-1986), and in Chicago (1965-1990). In all three data sets, the degree to which spousal homicide victimization was female-biased was significantly greater when the couple were estranged than when they were coresiding. Victim counts and population-at-large estimates of coresiding and separated nowmarried spouses were combined to estimate differential homicide rates incurred by coresiding and estranged married persons. Wives in all three countries incurred substantially elevated risk when separated as compared to when coresiding.
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