Shaoul, J., Stafford, A, Stapleton, P
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Public–Private Partnerships for Hospitals Martin Mckee,A Nigel Edwards,B & Rifat Atun C
Public–private partnerships for hospitals Martin McKee,a Nigel Edwards,b & Rifat Atun c Abstract While some forms of public–private partnerships are a feature of hospital construction and operation in all countries with mixed economies, there is increasing interest in a model in which a public authority contracts with a private company to design, build and operate an entire hospital. Drawing on the experience of countries such as Australia, Spain, and the United Kingdom, this paper reviews the experience with variants of this model. Although experience is still very limited and rigorous evaluations lacking, four issues have emerged: cost, quality, flexibility and complexity. New facilities have, in general, been more expensive than they would have been if procured using traditional methods. Compared with the traditional system, new facilities are more likely to be built on time and within budget, but this seems often to be at the expense of compromises on quality. The need to minimize the risk to the parties means that it is very difficult to “future-proof” facilities in a rapidly changing world. Finally, such projects are extremely, and in some cases prohibitively, complex. While it is premature to say whether the problems experienced relate to the underlying model or to their implementation, it does seem that a public–private partnership further complicates the already difficult task of building and operating a hospital. Bulletin of the World Health Organization 2006;84:890-896. ميكن اﻻطﻻع عىل امللخص بالعربية يف صفحة Voir page 894 le résumé en français. En la página 895 figura un resumen en español. -
The New Health and Social Care Economy Sefton MBC, Liverpool and Greater Manchester City Regions and North West Regional Economy
The New Health and Social Care Economy Sefton MBC, Liverpool and Greater Manchester City Regions and North West regional economy Dexter Whitfield New Directions Head Office 3rd Floor, The Investment Centre 375 Stanley Road Bootle L20 3EF Tel: 0151 934 3726 www.ndirections.co.uk A care provider owned by Sefton Council July 2015 (Continuing the work of the Centre for Public Services) Dexter Whitfield, Director Adjunct Associate Professor, Australian Workplace Innovation and Social Research Centre, University of Adelaide Web: www.european-services-strategy.org.uk The European Services Strategy Unit is committed to social justice, through the provision of good quality public services by democratically accountable public bodies, implementing best practice management, employment, equal opportunity and sustainable development policies. The Unit continues the work of the Centre for Public Services, which began in 1973. Research has included health and social care economy studies for the North West and East of England regions; two social and economic audits of health care in North Ireland; critical analysis of the case against the sale of residential care homes and/or outsourcing adult social care in over 15 local authorities, many in the North West; a successful alternative to the outsourcing and offshoring of prescription processing by NHS Business Services; the case for a Public Duty for Age Equality; the gender impact of outsourcing; and a analysis of the original Cashing in on Care proposals in 1984. THE NEW HEALTH AND SOCIAL CARE ECONOMY -
PFI and the National Health Service in England
1 PFI and the National Health Service in England Allyson M Pollock, Professor David Price, Senior Research Fellow Queen Mary, University of London June 2013 Key points By April 2011, across the public sector, more than 700 PFI contracts had been signed in the United Kingdom with an estimated capital value of almost £50 billion in England alone and annual repayments estimated at £8 billion for 30 to 60 years. PFI has been the dominant form of procurement for large national health service (NHS) projects. More than 90% of the £11.6 billion of capital expenditure contracted to take place under England’s hospital-building programme has come through PFI. By April 2009, 101 of the 133 new hospitals built between 1997 and 2008, or under construction, were privately financed. PFI costs drive service closures, bed and staff reductions due to the high cost of debt servicing and enormous transfers of resources from patient care to bankers, shareholders and financiers. PFI lacks accountability as the contracts are secret and hidden from public view. PFI involves a long term, 30 to 60 year, contract between the public and the private sector. Sovereign debt is always cheaper that finance borrowed privately for individual investments (‘project finance’). Successive governments have argued that the higher cost of private finance reflects risk transfer to the private sector, which generates savings that outweigh the extra cost. However, risk can be transferred to the private sector by using fixed price contracts and public borrowing instead of private finance. Although governments justify PFI on cost efficiency grounds, they are usually thought to adopt the policy for fiscal not efficiency reasons. -
The Wrong Medicine
The wrong medicine A review of the impacts of NHS reforms in England New Economics Foundation (NEF) is an independent think-and-do tank that inspires and demonstrates real economic well-being. We aim to improve quality of life by promoting innovative solutions that challenge mainstream thinking on economic, environmental and social issues. We work in partnership and put people and the planet first. Contents Summary 2 Introduction 4 The ground prepared: changes prior to 2012 7 Changes since 2010 13 Where is the evidence? 24 Lessons from UK experience 27 Costs of market reforms 41 Who will bear the brunt of the changes? 44 Conclusion 45 End notes 47 2 DiversityThe wrong and medicine Integration Summary The NHS is rated more highly than any other comparable healthcare system in the world. But it is often thought to be beset by crises and in danger of falling into decline. Market-based reforms have been presented as “solutions” to a continuing “problem” of an under-performing public institution. Does the evidence support these changes? Market-based reforms began in the 1980s, when support services were first contracted out, and continued in the 1990s, with the creation of an internal market for clinical services. In the 2000s, patients were allowed to choose where they received some treatments; prices were attached to units of completed healthcare; the first privately owned centres were established to take on NHS business; some hospitals became independent foundation trusts; and private companies built most new hospitals, recovering their investment by renting them back to the NHS for 30 years or more. -
The British Labour Government and the Private Finance Initiative in the National Health Service: a Case of Pragmatic Policy-Making?
The British Labour Government and the Private Finance Initiative in the National Health Service: A Case of Pragmatic Policy-Making? Dr Eric Shaw Department of Politics University of Stirling Stirling FK9 4LA Scotland, UK Email: [email protected] Abstract In Britain no issue is at present more controversial than the Labour Government 's advocacy of 'Public Private Partnerships' or the importation of private capital, managerial techniques and business practices into the public sector. The most important single policy measure here is the Private Finance Initiative, a scheme for the involvement of private sector capital and operating methods in the delivery of the public services. It has been described by the Blair Administration as ‘a cornerstone of the Government's modernisation programme for the public services’. The PFI has been presented as the main policy embodiment of 'New' Labour’s and explained as an example of ‘policy learning’. This paper provides a critical analysis of the operation of the PFI in the UK National Health Service, contends that the explanation of its adoption in terms of a shift from ideology to pragmatism is misleading and suggests an alternative approach. Introduction Countries throughout the western world find their welfare state under pressure and especially so in their healthcare systems. A combination of factors – the pressures of an aging population, the mounting costs of medical technology and drugs, rising expectations and, not least, intensifying budgetary constraints – are propelling governments of all stripes to re-evaluate the bases of their health-delivery systems. The most common response has taken the form of a move towards greater 1 reliance on the private sector and upon market incentives. -
North Cumbria University Hospitals NHS Trust Annual
North Cumbria University Hospitals NHS Trust Annual Report and Accounts 2018/19 1 Contents Foreword ................................................................................................................ 4 1. PERFORMANCE REPORT ................................................................................ 7 1a Overview ............................................................................................................... 7 Our Year at a Glance .......................................................................................... 8 Our Values .......................................................................................................... 9 Our Priorities 2018/19 ....................................................................................... 10 Principal Activities of the Trust .......................................................................... 10 Our Key Issues and Risks ................................................................................. 12 1b Performance Analysis ......................................................................................... 12 Care Quality Commission (CQC) Registration and Inspections ........................ 20 Our Achievements 2018/19 .................................................................................. 29 2. Accountability Report ........................................................................................ 32 3a Corporate Governance Report ............................................................................ 32 Charitable -
At the University of Edinburgh
This thesis has been submitted in fulfilment of the requirements for a postgraduate degree (e.g. PhD, MPhil, DClinPsychol) at the University of Edinburgh. Please note the following terms and conditions of use: • This work is protected by copyright and other intellectual property rights, which are retained by the thesis author, unless otherwise stated. • A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. • This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the author. • The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. • When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. A fair return for risk? An examination of structure, competition and profitability in the market for private finance in the National Health Service By Mark Hellowell This thesis is submitted in fulfilment of the degree of Doctor of Philosophy, University of Edinburgh Global Public Health Unit Social Policy School of Social and Political Science University of Edinburgh i Title: A fair return for risk? An examination of structure, competition and profitability in the market for private finance in the National Health Service. Abstract Since 1993, the Private Finance Initiative (PFI) has been the dominant form of large-scale infrastructure procurement used by National Health Service (NHS) organisations in the United Kingdom. As of April 2011, 123 PFI projects for new hospital facilities had been agreed between NHS organisations and private sector consortia, representing privately financed investment of £15.9 billion (in 2010 prices), and a projected long-term cost to the NHS of £70.5 billion.