The UK now follows the International Financial Reporting Standards ("IFRS") rather than UK Generally Accepted Accounting Practice ("UK GAAP") which was previously the case. UK GAAP had a risk based approach to the classification of projects as on or off balance sheet. On the basis that a DBFM project could demonstrate that the majority of the project's risk was held by the private sector provider the project was classified as off the public sector's balance sheet.
However, under IFRS, which has a control based approach to asset classification, as the asset will be controlled by the NHS it will almost inevitably be regarded as on the public sector's balance sheet1;
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1 There needs to be a clear distinction between budgetary treatment and accounting. In an accounting sense these projects will be on balance sheet but in accordance with HMT guidance if they are service concessions under IFRIC12 and pass ESA 95 test they are budgeted for as off balance sheet