| 1. |
INTRODUCTION |
6 |
| 2. | EXECUTIVE SUMMARY |
8 |
| 3. | THE STATE HEALTHCARE MARKET IN THE UK |
12 |
| 3.1 | STRUCTURE AND REFORM OF THE NHS IN ENGLAND |
12 |
| 3.2 | LEGISLATIVE DRIVERS |
12 |
| 3.3 | THE PRIMARY CARE SECTOR |
14 |
| 3.3.1 | GP Surgeries/Health Centres |
14 |
| 3.3.2 | Treatment Centres |
14 |
| 3.4 | SECONDARY/ACUTE CARE |
15 |
| 3.5 | HEALTHCARE SPENDING IN THE UK |
16 |
| 3.5.1 | Total Healthcare Spending |
16 |
| 3.5.2 | NHS Spending |
17 |
| 3.5.3 | Primary Care Spending |
18 |
| 4. | CONTRACTORS OUTPUT IN THE HEALTHCARE SECTOR |
20 |
| 4.1 | THE NHS BUILDING PROGRAMME |
20 |
| 4.2 | CONTRACTORS OUTPUT IN THE HEALTHCARE SECTOR |
21 |
| 4.3 | HEALTHCARE OUTPUT - GOVERNMENT TARGETS AND PROGRESS TO DATE |
22 |
| 4.4 | PRIMARY HEALTHCARE ESTATE IN THE UK |
25 |
| 4.5 | HEALTHCARE PROCUREMENT |
26 |
| 4.5.1 | Private Finance Initiative (PFI) |
26 |
| 4.5.2 | NHS LIFT |
28 |
| 4.5.3 | Procure21 |
28 |
| 5. | OVERVIEW OF NHS LIFT IN PRIMARY CARE DEVELOPMENTS |
30 |
| 5.1 | BACKGROUND TO NHS LIFT |
30 |
| 5.2 | HOW NHS LIFT WORKS |
31 |
| 5.2.1 | Ownership of GP Premises under LIFT |
31 |
| 5.3 | INVESTMENT IN NHS LIFT |
32 |
| 5.3.1 | Government Investment in LIFT – Spend Over a Period |
32 |
| 5.3.2 | Total Capital Value of LIFT Schemes |
35 |
| 5.4 | LIFT – SCHEME UPDATE AND CURRENT PROGRESS |
37 |
| 5.4.1 | Fourth Wave of LIFT |
39 |
| 5.4.2. | Fifth Wave of LIFT and Beyond |
41 |
| 5.5 | THE PROCUREMENT PROCESS UNDER LIFT & CONTRACT DOCUMENTATION |
42 |
| 5.5.1 | LIFT vs. Traditional PFI |
42 |
| 5.5.2 | Strategic partnering & LIFT |
42 |
| 5.6 | NHS LIFT IN PRACTICE |
43 |
| 5.6.1 | Benefits of LIFT |
43 |
| 5.6.2 | Disadvantages of LIFT |
44 |
| 5.6.3 | Higher Rental Costs |
45 |
| 5.6.4 | The LIFT Building as an ‘Investment’ |
46 |
| 5.6.5 | Lack of Bidders |
46 |
| 5.7 | PRINCIPAL CONSORTIA AND LIFT PARTNERS |
47 |
| 5.7.1 | Major Contractors Involved in LIFT |
51 |
| 5.8 | FUTURE OF LIFT AND KEY DRIVERS |
53 |
| 5.8.1 | LIFT in Other Regions |
53 |
| 5.8.2 | Lift in Other Areas |
54 |
| 6. | OVERVIEW OF THE NHS PROCURE21 FRAMEWORK |
57 |
| 6.1 | BACKGROUND TO PROCURE21 |
57 |
| 6.2 | HOW P21 WORKS |
58 |
| 6.2.1 | Supply Chains in P21 |
58 |
| 6.2.2 | Recent Changes to the P21 PSCP Line-Up |
59 |
| 6.3 | INVESTMENT IN P21 |
60 |
| 6.4 | P21 – SCHEME UPDATE AND CURRENT PROGRESS |
60 |
| 6.5 | THE PROCUREMENT PROCESS UNDER P21 |
62 |
| 6.5.1 | Use of the NEC Contract in Procure21 |
62 |
| 6.5.2 | Use of Partnering in P21 |
63 |
| 6.6 | P21 IN PRACTICE |
64 |
| 6.6.1 | Advantages of Procure21 |
64 |
| 6.6.2 | Advantages to NHS Clients |
65 |
| 6.6.3 | Main Criticisms of Procure21 |
67 |
| 6.7 | PRINCIPAL SUPPLY CHAIN MEMBERS AND P21 PARTNERS |
70 |
| 6.8 | FUTURE OF P21 AND KEY DRIVERS |
73 |
| 6.8.1 | Overview and Future Prospects |
73 |
| 6.8.2 | Future Management and Direction of Procure21 |
74 |
| 6.8.3 | Introduction of P21 in Wales |
74 |
| 7. |
FUTURE PROSPECTS FOR THE HEALTHCARE SECTOR |
76 |
| | APPENDIX 1 | 79 |
|
TABLES AND CHARTS |
| TABLE 1 | SUMMARY OF MAJOR CAPITAL SPENDING PROGRAMMES IN THE PUBLIC HEALTHCARE SECTOR |
8 |
| CHART 2 | VALUE OF UK NHS EXPENDITURE 2003-2010 (£ BILLION) |
17 |
| TABLE 3 | UK NHS PRIMARY CARE TRUST SPENDING ALLOCATIONS – 2003-2010 (£BN) |
18 |
| TABLE 4 | UK NHS CAPITAL SPENDING – 2003-2010 (£M) |
20 |
| TABLE 5 | CONTRACTORS’ OUTPUT OF HEALTH SECTOR WORK (PUBLIC/PRIVATE) 1995-2005 (£M) |
22 |
| TABLE 6 | CONSTRUCTION ACTIVITY IN THE UK HEALTHCARE SECTOR – PROGRESS TO DATE JUNE 2006 |
24 |
| TABLE 7 | NHS LIFT SCHEMES – ENABLING FUND ALLOCATIONS TO DATE (2005-06) (£M)* |
34 |
| TABLE 8 | TOTAL NUMBER OF LIFT SCHEMES IN WAVES 1-4 BY INITIAL CAPITAL VALUE (£M |
36 |
| TABLE 9 | CAPITAL COST OF SCHEMES IN TRANCHES 2 & £ OF NHS LIFT (WAVES 1-3) (£M) |
37 |
| TABLE 10 | NHS LIFT – CONSTRUCTION PROGRESS TO DATE (WAVES 1-3) (£M) |
38 |
| TABLE 11 | FOURTH WAVE OF LIFT – SHORT LISTED BIDDERS |
39 |
| TABLE 12 | LIFT WAVES 1-3 TIME TAKEN TO REACH FINANCIAL CLOSE |
45 |
| TABLE 13 | MAJOR NHS LIFT PREFERRED BIDDERS/CONSORTIA TO DATE |
48 |
| TABLE 14 | MAJOR CONTRACTORS INVOLVED IN NHS LIFT |
52 |
| TABLE 15 | SUMMARY OF PROCURE21 SCHEMES – JUNE 2006 |
61 |
| TABLE 16 | MAIN ADVANTAGES OF PROCURE21 |
65 |
| TABLE 17 | MAIN CRITICISMS OF PROCURE21 |
68 |
|
TABLE 18 |
HEALTHCARE CONSTRUCTION – GLOSSARY OF TERMS |
79 |
