A multi-million pound private finance deal which paid for the surgical centre at Kingston Hospital has emerged as a key factor which could help decide which hospitals lose services next year.

Private Finance Initative (PFI) schemes are one of the "fixed points" which the 95 clinicians conducting the South West London Review will not be able to touch because of the huge contracts involved.

Kingston is one of the few hospitals in south west London locked into a PFI deal after £27.6m was borrowed in November 2004 to build the five-storey surgical centre.

By 2034 the hospital it will have paid back £337.59m to Prime Care Solutions - a consortium of investment company Equion, construction firm Costain and ISS Mediclean, which also provides the hospital’s catering and security.

Concerns have been raised that under the review, if Kingston is locked into running elective surgery by the PFI, the hospital might be forced to lose another service like A+E or maternity instead.

Edward Davey, Kingston and Surbiton’s Liberal Democrat MP, said: "The concern I have is, if the PFI in Kingston can’t be used for anything else and they say let’s keep electoral surgery at Kingston it is just possible that they say Kingston needs to take its share of the pain."

Healthcare for South West London said it was far too early to start looking at sites or estates.

A spokesman said: "Elective surgery is not carried out within the surgical centre (which was funded as a PFI) at Kingston Hospital but the centre houses the surgical wards for pre and post operative care for urgent and elective surgery.

"The centre also offers a range of other services including physiotherapy, an early pregnancy and acute gynaecology unit, an education and training centre and the hospital’s restaurant.

"The PFI contract does not preclude changes to the services provided at this building."

Kingston Hospital said a variation of use could be sought but there may be a cost implication or financial penalty.

A spokesman said: "Given that the taxpayer has agreed to pay for the PFI for 30 years, it will clearly be important to get value for the money the taxpayer will be paying.

"Indeed much of the estate of Kingston Hospital is modern and we believe that this is one of the reasons why Kingston Hospital is in a strong position going forward."

None of the other hospitals which face losing major services under the review - Mayday in Croydon and Epsom and St Helier hospitals - have PFI schemes, according to a list from the Treasury.

St George’s Hospital has a 32-year £46.1m PFI deal and nearby Wandsworth Primary Care Trust has a 30-year £75.4m PFI deal to run Queen Mary’s Roehampton.

The biggest PFI deal in London is for an “acute site rationalisation” - redeveloping Bart’s and building a new Royal London Hospital in Whitechapel.

Some of the hospital PFI deals in London Barts & the London NHS Trust borrowed £1,000m for acute site rationalisation - will pay back £5,295m over 30 years.

Kingston Hospital borrowed £27.6m - will pay back £337.59m over 30 years.

St George’s Hospital borrowed £46.1m to build neurological and cardiac units - will pay back £319.25m over 32 years.

Wandsworth Primary Care Trust borrowed £75.4m to redevelop Queen Mary’s Roehampton - will pay back £466.68m over 30 years.

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