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PFI IN THE UK HEALTH SECTOR 2002
Buy a copy of the PFI in the UK Health Sector Market Report from AMA Research
Introduction/Overview Summary Of Contents List of Contents & Tables  
       

CONTENTS and LIST OF TABLES & CHARTS 

1.

INTRODUCTION

5
1.1 DEVELOPMENT OF PRIVATE FUNDING FOR PUBLIC SERVICES - INITIAL STAGES 7
1.2 THE NEW LABOUR GOVERNMENT IN 1997 9
1.3 THE MAY 2001 ELECTION AND THE LABOUR PARTY MANIFESTO 9
1.4 HEALTHCARE IN THE UNITED KINGDOM 10
1.4.1 General 10
1.4.2 Primary Care 11
1.4.3 Intermediate Care 12
1.4.4 Acute Care 12
1.4.5 Capacity Limitations 12
2. EXECUTIVE SUMMARY 13
2.1 DEVELOPMENT OF PFI/PPP IN HEALTHCARE 13
2.2 ECONOMIC BACKGROUND 13
2.3 UK PUBLIC HEALTHCARE MARKET DRIVERS OF DEMAND FOR HEALTHCARE SERVICES 13
2.4 THE SCOPE FOR PFI/PPP IN THE HEALTHCARE SECTOR 14
2.5 PROGRESS TO DATE 15
2.6 CASE STUDIES 15
2.7 KEY ISSUES 16
2.8 EVOLUTION OF THE ROLE OF THE MAJOR PLAYERS 17
2.9 INTERNATIONAL PERSPECTIVE 17
2.10 FUTURE PROSPECTS 18
3. ECONOMIC BACKGROUND 20
3.1 GDP 20
3.2 INFLATION & INTEREST RATES 21
3.3 UNEMPLOYMENT & CONSUMER SPENDING 22
3.4 CONSTRUCTION 24
3.5 STERLING 24
3.6 CONCLUSIONS 24
4. UK PUBLIC HEALTH CARE 25
4.1 ORGANISATION OF NHS 25
4.1.1 England 25
4.1.2 Scotland 28
4.1.3 Northern Ireland 29
4.1.4 Wales 29
4.1.5 Comment 30
4.1.6 Summary 30
4.2 CONTINUATION OF THE NHS PLAN 30
4.2.1 Focus 31
4.2.2 Performance Improvement 31
4.2.3 Investment and Expansion 32
4.3 GOVERNMENT POLICY SINCE MAY 2001 33
4.4 THE IPPR REPORT 33
4.5 ROLE OF THE PRIVATE SECTOR IN THE HEALTH SERVICE 33
4.6 TARGETS AND CAPACITY CONSTRAINTS 35
4.7 CLINICAL STAFF SHORTAGES 35
4.8 USE OF OTHER FACILITIES 36
4.9 RE-ORGANISATION 36
4.10 FINANCING THE NHS 37
4.11 COMMENT 37
5. PFI/PPP IN THE HEALTH SECTOR 39
5.1 TOTAL HEALTHCARE MARKET SIZE 39
5.2 SIZE OF NHS MARKET 40
5.3 LOCAL AUTHORITY EXPENDITURE 42
5.4 NHS NET EXPENDITURE, 2000-01 43
5.5 POPULATION MIX 45
5.6 MIX OF CARE CATEGORIES 46
5.7 MAJOR INITIATIVES 47
5.7.1 NHS ProCure 21 47
5.7.2 NHS LIFT 48
5.8 MAJOR NEW HOSPITALS 52
5.8.1 First Wave 52
5.8.2 Second Wave 53
5.8.3 Third Wave 54
5.8.4 Fourth Wave 55
5.8.5 Fifth Wave 56
5.8.6 Sixth Wave 57
5.8.7 Others 57
5.9 DIAGNOSTIC CENTRES 58
5.10 PROGRESS TO DATE 59
5.10.1 Establishing The Process 59
5.10.2 The Process from the Point of View of the Bidders 63
5.11 SUMMARY 68
6. KEY ISSUES AFFECTING PFI/PPP IN HEALTH CARE 70
6.1 GENERAL ISSUES 70
6.1.1 Redevelopment 70
6.1.2 Refinancing 70
6.1.3 Insurance 71
6.1.4 Competence and Commitment of Client 71
6.1.5 Design Quality and Fitness for Purpose 71
6.1.6 Payment Mechanism 72
6.2 HEALTHCARE SPECIFIC ISSUES 72
6.2.1 Transfer of Personnel 72
6.2.2 Provision of Clinical Services 73
6.2.3 Waiting Lists 73
6.2.4 Concordat with Private Sector 74
6.2.5 Use of Foreign Facilities 74
6.2.6 Hypothecation of NHS Revenue 75
6.3 SUMMARY 75
7. CASE STUDIES 76
7.1 INTRODUCTION - LIMITATIONS 76
7.2 UNIVERSITY COLLEGE LONDON HOSPITAL, UCLH 76
7.2.1 Background 76
7.2.2 New Facilities 77
7.2.3 Procurement Process 78
7.2.4 Special Technical Characteristics 78
7.2.5 Facilities Management 78
7.2.6 Contractual 79
7.2.7 Financial 80
7.2.8 Comment 80
7.3 CHESTER LE STREET COMMUNITY HOSPITAL 80
7.3.1 Background 80
7.3.2 Description of Facilities 81
7.3.3 Basis for PFI Option 81
7.3.4 Financial Envelope 83
7.3.5 Procurement Process 84
7.3.6 Comment 84
7.4 HIGHLAND PRIMARY CARE TRUST 85
7.4.1 Background and Description 85
7.4.2 Advantages 86
7.4.3 Procurement 86
7.4.4 Comment 86
7.5 SUMMARY 87
7.6 STATUS OF MAJOR PROJECTS 87
7.7 VALUE AND TOTAL NUMBER OF PROJECTS SIGNED 93
8. MAJOR SUPPLIERS 96
8.1 IT PROVIDERS 96
8.2 CONSTRUCTION AND FACILITIES MANAGEMENT 97
8.3 COMMENT 101
9. INTERNATIONAL PERSPECTIVE 102
9.1 INTRODUCTION 102
9.2 FRANCE 102
9.3 GERMANY 104
9.4 SPAIN 105
9.5 SWEDEN 107
9.6 COMMENT 109
9.6.1 Funding 109
9.6.2 Capacity 109
9.6.3 Intermediate Care 110
9.6.4 Role of Private Sector 110
9.6.5 Cost Containment 112
9.6.6 Reform and Politics 113
9.6.7 Comparison with the UK 113
9.6.8 Summary 114
10. FUTURE PROSPECTS 115
10.1 THE 2002 BUDGET 115
10.2 LIMITATIONS 117
10.3 SUMMARY 118
APPENDIX 1 - SOURCES & CONTACTS 120
  APPENDIX 2 - GLOSSARY OF TERMS 125
TABLES & CHARTS
TABLE 1 EXPENDITURE LEVELS AS A PERCENTAGE OF GDP 1989-98 10
TABLE 2 GDP PERCENTAGE CHANGE PER ANNUM 1980-2004 21
CHART 3 INTEREST RATES AND INFLATION (RPI) FROM 1990-2004 22
CHART 4 PDI & SAVINGS RATIO 1980-2004 23
CHART 5 EXISTING ORGANISATION OF THE NHS IN ENGLAND 26
CHART 6 PROPOSED ORGANISATION OF THE NHS IN ENGLAND 27
TABLE 7 ANALYSIS OF HEALTH AUTHORITY AND NHS TRUST EXPENDITURE (YEAR END 31 MARCH) 39
TABLE 8 SUMMARY CASH PLANS £ MILLION 41
TABLE 9 SUMMARY CASH PLANS £ MILLION 42
TABLE 10 SUMMARY CASH PLANS £ MILLION 43
TABLE 11 SUMMARY CASH PLANS - HEALTH SERVICES £ MILLION 44
TABLE 12 BASIC POPULATION DATA RESIDENT POPULATION ESTIMATES MID-YEAR 1999, BY AGE, PERSONS & DEPARTMENT OF HEALTH REGIONAL OFFICE AREAS (AS AT 01/04/99) 45
TABLE 13 ANALYSIS OF HEALTH AND COMMUNITY HEALTH SERVICES 46
CHART 14 FORMAL PROCUREMENT PROCESS. 61
TABLE 15 DIFFERENT RECTIFICATION PERIODS. 66
TABLE 16 DEPARTMENT OF HEALTH PROJECTS 88
TABLE 17 NUMBER OF PROJECTS SIGNED PER ANNUM 93
TABLE 18 VALUE OF PROJECTS SIGNED PER ANNUM 94

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