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Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Abstract

Aim

There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities.

Subject and methods

A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n = 23) and private sector staff (n = 2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT).

Results

We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency.

Conclusion

PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.

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References

  1. Ailinger R (2003) Contributions to qualitative evidence to evidence-based practice in nursing. Rev Lat Am Enfermagem 11(3):275–259

    Article  PubMed  Google Scholar 

  2. Beck M, Toms S, Mannion R, Brown S, Fitzsimmons D, Lunt N, Green I (2009) The role and effectiveness of public-private partnerships (NHS LIFT) in the development of enhanced primary care premises and services. Report for the National Institute for Health Research Services Delivery and Organisation Programme, University of York, York, UK

  3. CRD (2008) Systematic review: a CRD guidance for undertaking reviews in healthcare. CRD, University of York, York, UK

  4. Department of Health (2001) Public private partnerships in the NHS: modernising primary care in the NHS—local improvement finance trust (NHS LIFT) prospectus. DH, London

    Google Scholar 

  5. Department of Health and Partnerships for Health (2003) NHS LIFT strategic partnering agreement (version 5). DH, London

    Google Scholar 

  6. Dickson H, Glasby J (2010) Why partnership working doesn’t work: pitfalls, problems and possibilities in English health and social care. Public Manag Rev 12(6):811–28

    Article  Google Scholar 

  7. Evans D (2002) Database searches for qualitative research. J Med Libr Assoc 13(3):290–293

    Google Scholar 

  8. Fischbacher M, Mackinnon J, Pate J, Beaumont P (2007) Improving population health in Glasgow: managing partnership for health improvement (phase 1). Dept. of Management, University of Glasgow, Glasgow

    Google Scholar 

  9. Fitzsimmons D, Brown S, Beck M (2009) Does the UK Local Improvement Finance Trust (LIFT) initiative improve risk management in public-private procurement? J Risk Gov 1(2):137–156

    Google Scholar 

  10. Giacomini MK, Cook DJ (2000) For the evidence-based medicine group: users’ guide to the medical literature, XXIII—qualitative research in health care—are the results of the study valid? JAMA 284:357–62

    CAS  Article  PubMed  Google Scholar 

  11. Hunter D, Perkins N, Bambra C, Marks L, Hopkins T, Blackman T (2010a) Partnership working and the implications: issues affecting public health partnerships. NIHR Service Delivery and Organisation Programme, London

  12. Hunter D, Marks L, Smith KE (2010b) The public health systems in England. The Policy Press, Bristol, UK

    Book  Google Scholar 

  13. King’s Fund (2008) Under one roof: will polyclinics deliver integrated care? King’s Fund, London

    Google Scholar 

  14. Marchal B, Dedzo M, Kegels G (2010) A realist evaluation of the management of a well-performing regional hospital in Ghana. BioMed Cen BMC Health Serv Res 24:1–14

    Google Scholar 

  15. Mays N, Pope C, Popay J (2005) Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 10(1):6–10

    Article  PubMed  Google Scholar 

  16. National Audit Office (2005) Innovation in the NHS. NHS, London

    Google Scholar 

  17. Pawson R, Tilley N (2004) Realist evaluation. Paper prepared for the British Cabinet Office, London

    Google Scholar 

  18. Peckham S, Exworthy M, Powell M, Greener I (2005) Decentralization, centralisation and devolution in publicly funded health services. Report for NHS Service Delivery and Organisation Research and Development Programme. SDO, London

    Google Scholar 

  19. Perrot J (2006) Different approaches to contracting in health systems. Bull World Health Organ 84(11):859–866

    PubMed  PubMed Central  Google Scholar 

  20. Pollit C, Bouckaert G (2000) Public management reform: a comparative analysis. Oxford University Press, Oxford

    Google Scholar 

  21. Pollock AM, Price D (2006) Privatising primary care. BMJ 56:565–566

  22. Powell M, Glendinning C (2002) Introduction. In: Glendinning C, Powell M, Rummery K (eds) Partnerships, new labour and governance. Bristol Policy, Bristol. UK

  23. Ritchie J, Lewis J, Nicholas CM, Ormaston R (2004) Qualitative research practice: a guide for social science students and researchers. Sage, London

    Google Scholar 

  24. Saltman RB, Bankauskaite V, Vrangbaek K (2007) Decentralization in healthcare. European observatory on health systems and policies series. McGraw Hill-Open University Press, Maidenhead, UK

    Google Scholar 

  25. Stevens S (2004) Reform strategies for the English NHS. Health Aff (Millwood) 23:37–44

    Article  Google Scholar 

  26. World Bank (2006) Public-private partnership units: what are they, and what do they do? Financial and Private Sector Development. Vice Presidency Note Number 311, World Bank, Washington, DC. http://siteresources.worldbank.org/EXTFINANCIALSECTOR/Resources/282884-1303327122200/311Dutz_Harris_Dhingra_Shugart.pdf. Accessed 15 October 2015

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Acknowledgements

This article draws on a public health research project hosted by the IHHD at UEL. We thank the study participants and the health officials for their support and cooperation during the study. We would also like to thank Dr Patrick Tobi, University of East London UK, and Dr Colin Thunhurst, Coventry University UK, for their insightful comments in preparing this paper.

Authors’ contribution

This manuscript is a joint effort between the authors (OM and KR) in design, data analysis and interpretation, and final review.

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Correspondence to Krishna Regmi.

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The authors declare that there is no conflict of interest.

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Mudyarabikwa, O., Regmi, K. Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK. J Public Health 24, 91–100 (2016). https://doi.org/10.1007/s10389-015-0701-8

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Keywords

  • Efficiency
  • Public-private partnerships
  • Primary care buildings
  • LIFT
  • NHS
  • UK