| AM75062 |
| AMA RESEARCH Market Report : UK PFI in the Health Sector : March 2002 |
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Introduction and Overview
| AMA Research has published the first edition of a report covering "PFI in The UK Health Sector 2002" - incorporating primary research and drawing upon extensive primary and secondary sources, it focuses upon the development of PPP/PFI for the health sector, assessing recent history, and future prospects for the sector, the latter particularly relevant given the recent budget announcements of additional funding for health. |
| Over 120 pages, the report covers:- |
| PPP/PFI in the UK Health Sector - market size, development of funding, Local Authority influence, Mix of Care Categories. |
| Major New Initiatives - new hospitals, new schemes, Refinancing etc. |
| Key Issues - NHS LIFT, NHS Pro-Cure Insurance, Design Quality, Payment Mechanisms Waiting Lists, Concordat, etc. |
| UK Public Health Sector - a perspective. |
| Major Players in PFI are also covered. International Perspective. |
| The recent budget highlighted the current state of Healthcare in the UK and introduced a programme of additional funding to take the total amount spent on healthcare to £108 billion by 2007/2008. This includes all healthcare expenditure, but capital expenditure on IT and buildings should be raised significantly over the next 10 years from £2.2 billion to £5.5 billion per annum, meaning that approximately one third of all hospital real estate and all GPs surgeries would be replaced or refurbished. |
| The market for capital investment is therefore likely to remain buoyant over the next few years as the level of capital expenditure is increased, making this an attractive sector for any company providing building products, construction or outsourced facilities to the health sector. |
| Other Reports in the PPP/PFI Industry: |
| PPP/PFI in the UK Defence Sector 2002. |
| PPP/PFI in the Republic Of Ireland 2002. |
| PFI Issues in the UK 2001. |
| PFI Intelligence Bulletin - Ongoing. |
| PFI and Specification Issues in UK Social Housing 2002. |
| PFI in the Local Authority Sector 2002. |
| Key areas of coverage in the report will include: |
| DEVELOPMENT OF PFI/PPP IN HEALTHCARE |
| The role and development of PPP and PFI within the healthcare sector. |
| Total Healthcare expenditure in the UK, NHS expenditure. Relative to GDP, comparison with Europe. |
| Government's commitment to improve Healthcare in the Public Sector. The NHS Plan, limitations thereof, increased capacity. Health Authority and NHS trust expenditure. |
| Signed Project List 1995-2001. |
| SCOPE FOR PFI/PPP IN THE HEALTHCARE SECTOR |
| NHS LIFT - a major initiative to improve Primary Care conditions and delivery. The need for a committed local partner. Project size issues, Project bundling, local management capacity scheme deliverability. |
| The scale of the task and the limitations on capacity increases in terms of internal and external resources. Summary Cash Plans - health sector, local authority sector. |
| Outsourcing of ancillary staff. Soft and Hard FM provision - trend to the latter. |
| Assessment of the differing sectors of Primary, Intermediate and Acute Care and the issues associated with each of these areas. The scope for layering of hospital facilities. |
| Progress To Date - cumbersome process, projects are complex, output specifications, levels of service, delays. |
| Experiences in Scotland, particularly on residential projects. |
| Percentage Mix of Health and Community Services. |
| Value £m of signed PFI projects 1995 to 2001. |
| CASE STUDIES |
| UNIVERSITY COLLEGE LONDON HOSPITAL, UCLH - Background, New Facilities, Procurement Process, Special Technical Characteristics, Facilities Management, Contractual, Financial, Comment. |
| CHESTER LE STREET COMMUNITY HOSPITAL - Background, Description of Facilities, Basis for PFI Option, Financial Envelope, Procurement Process, Comment. |
| HIGHLAND PRIMARY CARE TRUST - Background and Description, Advantages, Procurement, Comment. |
| SUMMARY - helpful pointers for the evolution of PFI projects in the Healthcare sector |
| STATUS OF MAJOR PROJECTS |
| KEY ISSUES |
| At a general level these include - Site redevelopment, Refinancing of loans, Insurance and performance guarantees, The competence and commitment of the client, Design quality and designation as fit for purpose. |
| At a Healthcare specific level Key Issues in the UK include - The transfer of personnel, The provision of clinical services, The length of waiting lists, The Concordat with the private sector, The use of foreign facilities, The hypothecation of NHS revenues. |
| The recent budget, the Wanless Report. |
| Major suppliers of finance and construction and facilities management companies. |
| OTHER ISSUES |
| Procurement process and step by step analysis. |
| International Perspective - Sweden, France, Germany, Spain. Bismarck and Beveridge schemes. |
| Consolidation within the PFI/PPP industry. |
| Future Prospects - influence of the recent Budget, Likely developments etc. |
| GDP analysis, population statistics, inflation and interest rates |
Executive Summary
| AMA Research has published the first edition of a report covering "PFI in The UK Health Sector 2002" - incorporating primary research and drawing upon extensive primary and secondary sources, it focuses upon the development of PPP/PFI for the health sector, assessing recent history, and future prospects for the sector, the latter particularly relevant given the recent budget announcements of additional funding for health. |
| Over 120 pages, the report covers:- |
| PPP/PFI in the UK Health Sector - market size, development of funding, Local Authority influence, Mix of Care Categories. |
| Major New Initiatives - new hospitals, new schemes, Refinancing etc. |
| Key Issues - NHS LIFT, NHS Pro-Cure Insurance, Design Quality, Payment Mechanisms Waiting Lists, Concordat, etc. |
| UK Public Health Sector - a perspective. |
| Major Players in PFI are also covered. International Perspective. |
| The recent budget highlighted the current state of Healthcare in the UK and introduced a programme of additional funding to take the total amount spent on healthcare to £108 billion by 2007/2008. This includes all healthcare expenditure, but capital expenditure on IT and buildings should be raised significantly over the next 10 years from £2.2 billion to £5.5 billion per annum, meaning that approximately one third of all hospital real estate and all GPs surgeries would be replaced or refurbished. |
| The market for capital investment is therefore likely to remain buoyant over the next few years as the level of capital expenditure is increased, making this an attractive sector for any company providing building products, construction or outsourced facilities to the health sector. |
| Other Reports in the PPP/PFI Industry: |
| PPP/PFI in the UK Defence Sector 2002. |
| PPP/PFI in the Republic Of Ireland 2002. |
| PFI Issues in the UK 2001. |
| PFI Intelligence Bulletin - Ongoing. |
| PFI and Specification Issues in UK Social Housing 2002. |
| PFI in the Local Authority Sector 2002. |
| Key areas of coverage in the report will include: |
| DEVELOPMENT OF PFI/PPP IN HEALTHCARE |
| The role and development of PPP and PFI within the healthcare sector. |
| Total Healthcare expenditure in the UK, NHS expenditure. Relative to GDP, comparison with Europe. |
| Government's commitment to improve Healthcare in the Public Sector. The NHS Plan, limitations thereof, increased capacity. Health Authority and NHS trust expenditure. |
| Signed Project List 1995-2001. |
| SCOPE FOR PFI/PPP IN THE HEALTHCARE SECTOR |
| NHS LIFT - a major initiative to improve Primary Care conditions and delivery. The need for a committed local partner. Project size issues, Project bundling, local management capacity scheme deliverability. |
| The scale of the task and the limitations on capacity increases in terms of internal and external resources. Summary Cash Plans - health sector, local authority sector. |
| Outsourcing of ancillary staff. Soft and Hard FM provision - trend to the latter. |
| Assessment of the differing sectors of Primary, Intermediate and Acute Care and the issues associated with each of these areas. The scope for layering of hospital facilities. |
| Progress To Date - cumbersome process, projects are complex, output specifications, levels of service, delays. |
| Experiences in Scotland, particularly on residential projects. |
| Percentage Mix of Health and Community Services. |
| Value £m of signed PFI projects 1995 to 2001. |
| CASE STUDIES |
| UNIVERSITY COLLEGE LONDON HOSPITAL, UCLH - Background, New Facilities, Procurement Process, Special Technical Characteristics, Facilities Management, Contractual, Financial, Comment. |
| CHESTER LE STREET COMMUNITY HOSPITAL - Background, Description of Facilities, Basis for PFI Option, Financial Envelope, Procurement Process, Comment. |
| HIGHLAND PRIMARY CARE TRUST - Background and Description, Advantages, Procurement, Comment. |
| SUMMARY - helpful pointers for the evolution of PFI projects in the Healthcare sector |
| STATUS OF MAJOR PROJECTS |
| KEY ISSUES |
| At a general level these include - Site redevelopment, Refinancing of loans, Insurance and performance guarantees, The competence and commitment of the client, Design quality and designation as fit for purpose. |
| At a Healthcare specific level Key Issues in the UK include - The transfer of personnel, The provision of clinical services, The length of waiting lists, The Concordat with the private sector, The use of foreign facilities, The hypothecation of NHS revenues. |
| The recent budget, the Wanless Report. |
| Major suppliers of finance and construction and facilities management companies. |
| OTHER ISSUES |
| Procurement process and step by step analysis. |
| International Perspective - Sweden, France, Germany, Spain. Bismarck and Beveridge schemes. |
| Consolidation within the PFI/PPP industry. |
| Future Prospects - influence of the recent Budget, Likely developments etc. |
| GDP analysis, population statistics, inflation and interest rates |
Companies Mentioned
205 Cap Gemini, Deloitte, L-Soft, Balfour Beatty, AMEC, Amey, Carillion, Jarvis, The Miller Group, MJ Gleeson, Morrison Construction, John Laing plc, Sir Robert McAlpine, Kier, Bouygues, Interserveplc, ISS, Taylor Woodrow Facilities, Caxton, Rentokil, Aqumen, Sodexho, Tilbury Douglas, WS Atkins., Gleeson, Bouyues.
List of Contents
| 1.1 | DEVELOPMENT OF PRIVATE FUNDING FOR PUBLIC SERVICES - INITIAL STAGES |
| 1.2 | THE NEW LABOUR GOVERNMENT IN 1997 |
| 1.3 | THE MAY 2001 ELECTION AND THE LABOUR PARTY MANIFESTO |
| 1.4 | HEALTHCARE IN THE UNITED KINGDOM |
| 1.4.1 | General |
| 1.4.2 | Primary Care |
| 1.4.3 | Intermediate Care |
| 1.4.4 | Acute Care |
| 1.4.5 | Capacity Limitations |
| 2 | EXECUTIVE SUMMARY |
| 2.1 | DEVELOPMENT OF PFI/PPP IN HEALTHCARE |
| 2.2 | ECONOMIC BACKGROUND |
| 2.3 | UK PUBLIC HEALTHCARE MARKET DRIVERS OF DEMAND FOR HEALTHCARE SERVICES |
| 2.4 | THE SCOPE FOR PFI/PPP IN THE HEALTHCARE SECTOR |
| 2.5 | PROGRESS TO DATE |
| 2.6 | CASE STUDIES |
| 2.7 | KEY ISSUES |
| 2.8 | EVOLUTION OF THE ROLE OF THE MAJOR PLAYERS |
| 2.9 | INTERNATIONAL PERSPECTIVE |
| 2.1 | FUTURE PROSPECTS |
| 3 | ECONOMIC BACKGROUND |
| 3.1 | GDP |
| 3.2 | INFLATION & INTEREST RATES |
| 3.3 | UNEMPLOYMENT & CONSUMER SPENDING |
| 3.4 | CONSTRUCTION |
| 3.5 | STERLING |
| 3.6 | CONCLUSIONS |
| 4 | UK PUBLIC HEALTH CARE |
| 4.1 | ORGANISATION OF NHS |
| 4.1.1 | England |
| 4.1.2 | Scotland |
| 4.1.3 | Northern Ireland |
| 4.1.4 | Wales |
| 4.1.5 | Comment |
| 4.1.6 | Summary |
| 4.2 | CONTINUATION OF THE NHS PLAN |
| 4.2.1 | Focus |
| 4.2.2 | Performance Improvement |
| 4.2.3 | Investment and Expansion |
| 4.3 | GOVERNMENT POLICY SINCE MAY 2001 |
| 4.4 | THE IPPR REPORT |
| 4.5 | ROLE OF THE PRIVATE SECTOR IN THE HEALTH SERVICE |
| 4.6 | TARGETS AND CAPACITY CONSTRAINTS |
| 4.7 | CLINICAL STAFF SHORTAGES |
| 4.8 | USE OF OTHER FACILITIES |
| 4.9 | RE-ORGANISATION |
| 4.1 | FINANCING THE NHS |
| 4.11 | COMMENT |
| 5 | PFI/PPP IN THE HEALTH SECTOR |
| 5.1 | TOTAL HEALTHCARE MARKET SIZE |
| 5.2 | SIZE OF NHS MARKET |
| 5.3 | LOCAL AUTHORITY EXPENDITURE |
| 5.4 | NHS NET EXPENDITURE, 2000-01 |
| 5.5 | POPULATION MIX |
| 5.6 | MIX OF CARE CATEGORIES |
| 5.7 | MAJOR INITIATIVES |
| 5.7.1 | NHS ProCure 21 |
| 5.7.2 | NHS LIFT |
| 5.8 | MAJOR NEW HOSPITALS |
| 5.8.1 | First Wave |
| 5.8.2 | Second Wave |
| 5.8.3 | Third Wave |
| 5.8.4 | Fourth Wave |
| 5.8.5 | Fifth Wave |
| 5.8.6 | Sixth Wave |
| 5.8.7 | Others |
| 5.9 | DIAGNOSTIC CENTRES |
| 5.1 | PROGRESS TO DATE |
| 5.10.1 | Establishing The Process |
| 5.10.2 | The Process from the Point of View of the Bidders |
| 5.11 | SUMMARY |
| 6 | KEY ISSUES AFFECTING PFI/PPP IN HEALTH CARE |
| 6.1 | GENERAL ISSUES |
| 6.1.1 | Redevelopment |
| 6.1.2 | Refinancing |
| 6.1.3 | Insurance |
| 6.1.4 | Competence and Commitment of Client |
| 6.1.5 | Design Quality and Fitness for Purpose |
| 6.1.6 | Payment Mechanism |
| 6.2 | HEALTHCARE SPECIFIC ISSUES |
| 6.2.1 | Transfer of Personnel |
| 6.2.2 | Provision of Clinical Services |
| 6.2.3 | Waiting Lists |
| 6.2.4 | Concordat with Private Sector |
| 6.2.5 | Use of Foreign Facilities |
| 6.2.6 | Hypothecation of NHS Revenue |
| 6.3 | SUMMARY |
| 7 | CASE STUDIES |
| 7.1 | INTRODUCTION - LIMITATIONS |
| 7.2 | UNIVERSITY COLLEGE LONDON HOSPITAL, UCLH |
| 7.2.1 | Background |
| 7.2.2 | New Facilities |
| 7.2.3 | Procurement Process |
| 7.2.4 | Special Technical Characteristics |
| 7.2.5 | Facilities Management |
| 7.2.6 | Contractual |
| 7.2.7 | Financial |
| 7.2.8 | Comment |
| 7.3 | CHESTER LE STREET COMMUNITY HOSPITAL |
| 7.3.1 | Background |
| 7.3.2 | Description of Facilities |
| 7.3.3 | Basis for PFI Option |
| 7.3.4 | Financial Envelope |
| 7.3.5 | Procurement Process |
| 7.3.6 | Comment |
| 7.4 | HIGHLAND PRIMARY CARE TRUST |
| 7.4.1 | Background and Description |
| 7.4.2 | Advantages |
| 7.4.3 | Procurement |
| 7.4.4 | Comment |
| 7.5 | SUMMARY |
| 7.6 | STATUS OF MAJOR PROJECTS |
| 7.7 | VALUE AND TOTAL NUMBER OF PROJECTS SIGNED |
| 8 | MAJOR SUPPLIERS |
| 8.1 | IT PROVIDERS |
| 8.2 | CONSTRUCTION AND FACILITIES MANAGEMENT |
| 8.3 | COMMENT |
| 9 | INTERNATIONAL PERSPECTIVE |
| 9.1 | INTRODUCTION |
| 9.2 | FRANCE |
| 9.3 | GERMANY |
| 9.4 | SPAIN |
| 9.5 | SWEDEN |
| 9.6 | COMMENT |
| 9.6.1 | Funding |
| 9.6.2 | Capacity |
| 9.6.3 | Intermediate Care |
| 9.6.4 | Role of Private Sector |
| 9.6.5 | Cost Containment |
| 9.6.6 | Reform and Politics |
| 9.6.7 | Comparison with the UK |
| 9.6.8 | Summary |
| 10 | FUTURE PROSPECTS |
| 10.1 | THE 2002 BUDGET |
| 10.2 | LIMITATIONS |
| 10.3 | SUMMARY |
| APPENDIX 1 - SOURCES & CONTACTS | |
| APPENDIX 2 - GLOSSARY OF TERMS |
Tables and Charts
| TABLE 1 | EXPENDITURE LEVELS AS A PERCENTAGE OF GDP 1989-98 |
| TABLE 2 | GDP PERCENTAGE CHANGE PER ANNUM 1980-2004 |
| CHART 3 | INTEREST RATES AND INFLATION (RPI) FROM 1990-2004 |
| CHART 4 | PDI & SAVINGS RATIO 1980-2004 |
| CHART 5 | EXISTING ORGANISATION OF THE NHS IN ENGLAND |
| CHART 6 | PROPOSED ORGANISATION OF THE NHS IN ENGLAND |
| TABLE 7 | ANALYSIS OF HEALTH AUTHORITY AND NHS TRUST EXPENDITURE (YEAR END 31 MARCH) |
| TABLE 8 | SUMMARY CASH PLANS £ MILLION |
| TABLE 9 | SUMMARY CASH PLANS £ MILLION |
| TABLE 10 | SUMMARY CASH PLANS £ MILLION |
| TABLE 11 | SUMMARY CASH PLANS - HEALTH SERVICES £ MILLION |
| 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) |
| TABLE 13 | ANALYSIS OF HEALTH AND COMMUNITY HEALTH SERVICES |
| CHART 14 | FORMAL PROCUREMENT PROCESS. |
| TABLE 15 | DIFFERENT RECTIFICATION PERIODS. |
| TABLE 16 | DEPARTMENT OF HEALTH PROJECTS |
| TABLE 17 | NUMBER OF PROJECTS SIGNED PER ANNUM |
| TABLE 18 | VALUE OF PROJECTS SIGNED PER ANNUM |
Text © 2002 AMA Research
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Last updated by Amanda Porteous 2002
