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Barry Francis Consultancy

NEWS & INSIGHT

Integration in global healthcare infrastructure

WHJJUD

I wrote an article on healthcare infrastructure for the World Healthcare Journal recently. This is pdf talks about how we can pull together a host of services to make infrastructure investment more effective and more efficient, how we could maximise return on investment and improve care for the same money

I have read a lot of articles recently from healthcare professionals, from consultants  and from politicians about the ned to integrate care, whether it is joining up ‘social care’ with ‘health care’ or integrating primary and secondary/ tertiary care. The ideas are obviously right but why is it so difficult? Entrenched positions? Professional rivalry? Different skills relying on different mindsets? Or is it just that joining up is difficult and generates extra spending in transition ? And we cannot just start again?


Why is PFI blamed for so much but praised for so little? And why does it matter?

I have written an article for issue 2 of Hospital Times ( http://www.hospital-times.co.uk) (http://(https://edition.pagesuite-professional.co.uk/html5/reader/production/default.aspx?pubname=&edid=e6d0bc32-4e0c-4853-818b-946dc281816)) .  It is on pages 46 to 47, sitting amongst some interesting stuff, including articles on  public health, vaccinations, universal health coverage and workforce shortages.

In the UK,  a lot of shortfalls in healthcare delivery are blamed on the private finance initiative .  I have seen shortfalls in this delivery model. But many problems can be attributed to contract management resourcing  and would benefit more from careful analysis instead of knee jerk headlining.  Of course things go wrong in hospitals. They are complicated places where people do very difficult things which matter a lot.  They tend to go wrong more often and more seriously when healthcare expenditure is inadequate, healthcare systems are inefficient and there are not enough staff.  PFI could address some of these problems but by no means all and there are pros and cons: a balancing act in deciding priorities. And there are, of course,  other ways of doing things.

But if we look around the world we see PFI  (or PPP) being adapted to help in the provision of healthcare infrastructure and assist in the goal of universal healthcare coverage.  n Uk we have over 100 extant PFI hospital projects and over 300 other PPP healthcare facilities. It is not wise to ignore them. If we do so, expense will increase and we will get even less of the healthcare we want.


Flexibility in financing/ Concentration on need/ Universal Health Coverage

I wrote this article which has just been published in World Healthcare Journal. I believe it correctly identifies the expectations for complex solutions to complex problems, the need to concentrate on care with physical infrastructure as a tool not an end in itself, and the need for flexibility in financing solutions. It is rather UK centric in terms of solution providers but I don’t think that detracts from the key messages.


NHS infrastructure- what is to be done? Doing is not easy.

https://accountablecarejournal.com/newsdit-article/58c752a1f15f7ec223bb6d84989efab7/

I have been spending most of my time over the past few months looking at healthcare infrastructure projects outside the UK and the potential for UK exports. I will be writing more about this shortly, but in the meantime here is an article I have written for Hospital Times which has appeared online in Accountable Care Journal ( link above) . It covers the need to improve our infrastructure, both ‘traditionally’ owned and that developed through PPP models, looks at models for delivery and identifies some of the constraints on actually getting things done

 


NHS infrastructure- what is to be done? Doing is not easy.

https://accountablecarejournal.com/newsdit-article/58c752a1f15f7ec223bb6d84989efab7/

I have been spending most of my time over the past few months looking at healthcare infrastructure projects outside the UK and the potential for UK exports. I will be writing more about this shortly, but in the meantime here is an article I have written for Hospital Times which has appeared online in Accountable Care Journal ( link above) . It covers the need to improve our infrastructure, both ‘traditionally’ owned and that developed through PPP models, looks at models for delivery and identifies some of the constraints on actually getting things done

 


How to make PPPs better: Just saying they are bad does not get you there

I have just been reading an article in public finance international (http://www.publicfinanceinternational.org/news/2018/03/eu-public-private-partnerships-not-economically-viable-say-auditors?utm_source=Adestra&utm_medium=email&utm_term=). It tells us that the European Court of Auditors  suggest that PPPs lead to inefficient and ineffective spending. A report from the UK’s National Audit Office in January this year ( https://www.nao.org.uk/wp-content/uploads/2018/01/PFI-and-PF2.pdf) was also critical of this procurement methodology.

From my own experience in procuring and  negotiating PPP contracts, and in helping achieve complicated variations  to these transactions and sorting out some very difficult disputes, much of what is said rings true. As The ECA said ‘projects were poorly prepared by public partners and…contracts with private concessionnaires were signed before relevant issues had been solved.’  And this, coupled with poor or under resourced contract and project management, goes to the heart of the problem.

Many public infrastructure projects are under intense political pressure to get started. There is a shortage of competent project management teams. Scarce resources often lead to the disbandment of project teams once the deal is signed: you cannot sign and forget complicated contracts, skilled and knowledgeable people have to keep on top of them.

Carillion has been a high profile private sector partner in PPP and outsourcing projects in the UK and other countries. Its  recent very high profile collapse  has been used to suggest that these deals are bad. But are they? Carillion’s investors will absorb much of the loss. Maybe some contracts had been signed ‘before all the issues had been resolved’. It would seem that close government oversight of Carillion as major supplier may not have been as close as originally planned.

What all of this comes down to is that if you intend to procure a very complicated and expensive project you should be clear what you want, specify that before you contract and keep a careful eye on the contract. That applies whatever the structure of the deal.

 

The reports highlight the needs to do things better, not to start all over again.


The role of the workplace in a healthier society

A great deal of attention is given to new hospital buildings and to questions of NHS structures and finances (or lack of them). These are all important things but much improvement in health and the happiness of society can be achieved in other ways. One is to reach out into the workplace and encourage employers to recognise the financial, commercial and social benefits of creating healthier places to work. This covers many areas such as food, eating, flexibility, decent pay and attention to mental health problems.

The London Healthy Workplace Charter  (https://www.london.gov.uk/what-we-do/health/healthy-workplace-charter) encourages employers in London to commit to improving health in the workplace and last Monday I was privileged to chair an awards ceremony where over 60 organisations were recognised for their contributions to making work in London healthier. As the Mayor of London, Sadiq Khan, said in his press statement : “Congratulations to all of the organisations and businesses who’ve been recognised through the Healthy Workplace Charter. Without a high-performing and healthy workforce, London would not be the fast-paced and successful  city it is. It is great to see so many businesses and organisations showing true commitment to the health and wellbeing of their employees. Their dedication to their workforce is an example of how local businesses can prosper, attract the best talent and reap the rewards of investing in their staff.”

Healthy Workplace Awards 2017 for Greater London Authority at City Hall – 13Nov17

Healthy Workplace Awards 2017 for Greater London Authority at City Hall – 13Nov17


A small boast

It was gratifying to be recognised as ‘one of the leading lawyers’ in the healthcare sector in the recently published Chambers guide. There is certainly a great deal occurring in the English and in the global sectors as infrastructure and services needs change. These challenge the ingenuity of those charged with structuring finance and corporate models to help make delivery happen. Interesting times.