Capital Investment in Health & PPPs: Decide's sweet spot
Will you still like us when we’re 64? Decide Insight on Capital Investment in Health
Capital investment, infrastructure, contracting and PPPs: Decide’s sweet spot
Capital Investment in Health is one the main drivers of change and transformation of health systems. It also happens to be the second cost driver (34%!) of achieving the health-related SDGs targets according to WHO’s SDG Price Tag.
Your Decide – Health Decision Hub was always ideally placed to design operational solutions for decision makers committed to filling the infrastructure gap, optimize asset life cycle management and “sweat the assets”.
So here's the point of this newsletter: to offer view a sample of the insight we garnered, created or co-produced.
63 blog entries, news and analytics on capital investment, infrastructure, PPPs and health asset optimisation to secure value for money (VfM).
After all, Decide is the global network for value for money in health, and the European Federation of Hospitals and Healthcare (HOPE), as well as the first investor in social infrastructure in Europe the Council of Europe Development Bank (CEB) or health contracting and PPPs expert Centre for Health, Ethics, Law and Development (CHELD), not to mention the World Health Organization (WHO) are all Board members of Decide!
Infrastructure, capital investment, as well as the whole complex contractual instrument framework which enables a diverse participation of the private sector to the provision of health assets and related clinical or ancillary services: this is enshrined in the DNA of your Decide – Health Decision Hub.
Indeed, CIH, PPPs and the optimization of assets are amidst the priority areas that compose the mission of the Decide Hub according to its Terms of Reference.
These workstreams translate into the design of a unique operational solution for decision makers: the CIH Tool which allows health stewards to “sweat the assets” or optimize capital projects throughout their lifecycle and manage feasibility, design, financing, construction, operation, management, maintenance, or divestment phases.
This unique tool which is in its beta version is based on best-in-class good practices, case studies and instruments used by the key players in this segment of industry.
It is also bolstered by the breadth and depth of experience brought by the Decide experts working on infrastructure innovation, contracting instruments and asset optimization to ensure value for money.
Drawing considerable interest across regions of the world, the CIH tool is tested in different settings but also adapted at the request of WHO to help health stewards develop or transform cancer services.
Decide is also working on developing:
- A series of case studies to illustrate the variety of complex contractual arrangements in the healthcare sector
- A comprehensive repository of tools & instruments for VfM across infrastructure phases
- A map of interested partners (MIP) to point out the variety of expertise across public and private sectors for health assets optimization.
And of course, there is the regular flow of data, analytics and knowledge that we bring to the community. Since the inception of the Decide Hub barely two years ago, it is no less than 63 original contents that were offered to our ecosystem.
These insights are harvested through a myriad of sources, analytics on hot topics. These include:
the greening of health infrastructure, the development of new models of PPPs, the generation of revenue for health facilities, guidance for high-performance delivery, the rise of ancillary services outsourcing and much, so much more.
Missing one and we’re up to 64, prompting us to pay tribute to the Beatles’ immortal song. We could have of course waited for our newsletter which will offer more intel on hospital revenue generation, the UK construction playbook or energy performance global contracts for hospitals.
But the headline would certainly not make us conjure up the brilliant melody that we all know and that brings us all together. Just like our commitment to the best possible quality in health capital projects!
Brain drain of facility managers: is the public sector doing something wrong?
It looks like Public Private Partnership (PPPs) contracts in the UK are having a bad week. After the concerning downgrading of the bond financing a PFI/PPP hospital in the Greater Manchester by rating agency Moody’s (click here to access the latest news brought to you by Decide), Scotland is the stage of new shenanigans.
Accelerating surgical procedures – Can the private sector help?
A private sector stance
Leading Public-Private Partnership publication the Partnership Bulletin echoes the recent proposal borne by the English Royal College of Surgeons to create a “new deal for surgery”. This entails to fast track a response to the backlog of elective surgeries which lag behind due to the COVID-19 pandemic through a quick, massive investment in “surgery hubs”...
Court of Auditors: PPPs in health deliver performance but….
Partnerships Bulletin, the leading journal on Public-Private Partnerships (PPPs) and a partner of your Decide Hub highlighted this week the conclusions of the Court of Auditors of Portugal which reported on the performance of Hospital PPPs.
More specifically, the national audit office of Portugal underlined that four of the hospital PPPs of the country were saving €200 million to...
A practitioner's perspective on public private collaboration in capital projects for the health sector:
My practice of public and private collaboration in health infrastructure and capital projects led me to share this opinion with the Decide community.
WHO’s analytics built a strong case to prioritise capital investment in health in order to fast track the realization of health targets across the Sustainable Development Goals. The global estimates of these...
Ever heard of the Başakşehir Çam & Sakura City Hospital? Based in the vicinity of Istanbul, this $1.6 bn project is the third largest health Public Private Partnership (PPP) countrywide.
The name “Çam & Sakura” refers to the consortium formed by Turkish investment and infrastructure facility management firm Rönesans and their Japanese partner Sojitz corporation: it literally means...
Energy performance is at the heart of the recent normative agenda affecting public infrastructure, amongst which health assets. In a nutshell, increasingly stringent norms are enshrined in legislation and regulations to ensure that public buildings contribute to a greener planet: drop in CO2 emissions, use of more environmentally-friendly sources of fuel, reduction of waste.... energy efficiency is the relatively new kid on the block when it comes to global contracts...
With the prospect of Valentine’s day looming over, now is not a bad time to reflect on relationships. Across the policy spectrum, private sector participation to public activities such as the provision of health services is gaining traction as increasingly public decision makers show interest in tapping into a set of skills which are not necessarily available at public level : design and construction of health infrastructure combined...
On 10th March, the World Health Organization launched the Global Health Facilities Database. An extremely useful repository underpinned by geospatial identification technology, this global public good responds to structural needs to better plan, manage and organize healthcare.
A world-class innovative product run by WHO’s Division of Data, Analytics and Delivery for Impact, it reflects this team’s commitment to delivering...
Delivering outcomes: Australia commits to high-performance infrastructure
Nowhere is the infrastructure scene more edgy, vibrant and innovative than….down under. Australia, and the State of Victoria in particular, are behind the most rigorous and inspiring legal, contractual, and management guidelines to make the best of Public-Private Partnerships (PPPs) and deliver best value for money.
Your Decide Hub recently highlighted the Frankston Hospital PPP project that sprung from Victoria’s commitment...
Famous rating agency Moody made quite a splash in the Public Private Partnerships (PPPs) world this week, with the downgrade of the Tameside of the PFI hospital. Unfortunately this is not the first downgrade for this project, adding gloom to the mood.
This PPP which already was singled out for a number of defects claimed by the public authority –...
With a strong support for health PPP investment from external funders
Uzbekistan is moving forward with a bold Public-Private Partnerships (PPPs) agenda. Strongly accompanied by the IFC, the Government purports to support complex contractual arrangements to procure infrastructure across the public policy spectrum.
As a result, international invitations to tenders mushroom for a wide range of projects across sectors. A good example of this is the influx of...
Health staff accommodation in Wales: innovative PPP model
The Welsh health authorities….Well the Velindre University NHS Trust again, issued recently a prior information notice for a Public-Private Partnership of a particular nature. This PIN will enable to test the market’s appetite for this type of project and ultimately validate its feasibility.
This time, the aim is to provide accommodation for 700 staff across different sites and within a...
Back in August 2020, your Decide Hub informed you of a specific type of contractual arrangement that took over the Public-Private Partnerships (PPPs) agenda in Wales, UK. Click here to access our news at the time.
The Mutual Investment Model, which in legal form and substance was akin to the Design Build Finance Own Operate Maintain and Transfer model, was defined by the...
Hospital Bundle: an ambitious PPP agenda for the Kingdom
Major players of the capital investment ecosystem are involved in the constant development and growth of Public-Private Partnerships in Saudi Arabia. Banker HSBC or Legal eagle Clifford Chance can be seen shouldering the NCP, the national agency in charge of these complex contractual arrangements marrying the procurement of an asset programme backed by the provision of a streams of services...
Amongst so many -often justified and valid- fears expressed regarding the use of complex contractual arrangements in the health sector, the dominant one is that public health authorities may not always be in the driver’s seat of the public-private partnership they contract.
Do PPPs in mature markets such as Australia tell of different story, given the stability and steady growth of...
Public-private partnerships: the preferred option for Uzbekistan
There is a considerable appetite for private investment in large public infrastructure which transcends regions of the world or levels of economic development of countries.
This, coupled with a policy commitment to beat the SDGs clock, may in part explain the growing interest for complex contractual arrangements that marry the procurement of infrastructure-related stream of services and tapping into private finance...
Edinburgh Health innovation PPP: investment worth US$ 1.36 billion
The announcement went with a bang: a massive tender was launched on 5th November by 3 contracting authorities, i.e. the City of Edinburgh Council - Scottish Enterprise – and the University of Edinburgh to expand the Edinburgh BioQuarter.
The Edinburgh bioQuarter is a cutting-edge collaboration, research and innovation development centre which dynamics impress way beyond the sole Scotland area...
Decide’s friends at the Public-Private Partnership Bulletin raised the flag recently on the lack of clarity and transparency of the gains and savings made by special purpose vehicles (SPVs which operate large complex contractual arrangements to provide infrastructure-based stream of services to public authorities, eg. PPP in health).
Ever since the first wave of Private Finance Initiative contracts in...
PPP and insurance gains: How to restore public trust?
Decide’s friends at the Partnerships Bulletin raised the flag this week on the lack of clarity and transparency of the gains and savings made by special purpose vehicles (SPVs which operate large complex contractual arrangements to provide infrastructure-based stream of services to public authorities, eg. Public-Private Partnerships - PPPs in health).
Far away from greenwashing....how to decarbonise healthcare?
Prof. Ole Norheim and colleagues have long invested in researching how to limit the pollution generated by healthcare assets. In an article published recently by the BMJ and titled "Priority setting and net zero healthcare: how much health can a tonne of carbon buy?", Ole scopes the challenges faced by healthcare systems looking at limiting their carbon footprint.
Hospital accomodation: more than ancillary services
The French national agency for health performance support (ANAP) is a leading provider of operational tool for healthcare managers and teams in the field of health care organization, performance, contracting as well as a trail blazer in charge of framing health innovation and crafting practical solutions for hospital teams.
Amongst its latest tools is a practical guide to….hospitality. An important topic that...
Green bonds – a preferred investment option in the UK
Green bonds are all the rage. They are young, effective and purpose-driven: think about financing instruments harnessed with tax-incentives and aiming at environment protection and you’ll understand why these fixed-income instruments are more than the zeitgeist.
They have a future because they are the future. Or strive to take care of it, as illustrated by the UK Chancellor...
Welsh “MIM”: new cancer centre bolstered by concession
Assiduous readers of the Decide news will have recognized the acronym of the Mutual Investment Model which is popular in Wales, UK at the moment to enable private sector participation in the health capital projects.
The MIM is a glorified concession really, with the private partner of the public health authority expected to design, build, finance and maintain the new...
Filling the infrastructure and health service delivery gap?
The Government of Uzbekistan launched in 2019 a request for expressions of interest to accelerate the availability of dialysis services in the country. The Public-Private Partnership aimed at the financing, building and operation of a network of outpatient dialysis services.
This led to a competitive bidding process and the subsequent award of the contract in December 2020 to Indian care...
The Asian Development Bank announced its support to Pakistan to optimize the use of Public-Private Partnerships (PPPs) in healthcare
What do development banks know about the best contracting solutions in healthcare? The seemingly provocative question raises an important point, as relatively scarce evidence of a seasoned, demonstrated expertise in contracting for health infrastructure.
Such expertise would cover the whole spectrum or stream of services that is typically contracted...
The Public-Private Partnership agenda in the hospital sector is progressively subdividing into the provision of overarching infrastructure and related-services, typically the design, building, financing (well, prefinancing really) operation and maintenance of ancillary services, and the support to health stewards in more specific projects which require a particular skill set, technology, technical aptitude or all of the above.
The Australian State of Victoria has always played a leading-edge role in the design of complex contractual arrangements to harness the strengths of public and private sector in the delivery of high-performance health infrastructure and related services.
Victoria pioneered Public-Private Partnerships PPPSs and paved the way for an infrastructure revolution of private sector involvement in global contracts with a comprehensive set of services spread over a long period of time...
Qatar published in September 2020 a call for Expressions of Interest for a large Public-Private Partnership healthcare programme. More specifically, the PPP in question will aim at the development of primary health care corporation centres.
Let’s row back a back as PPPs, as complex contractual arrangements, are relatively new in the Qatari legal landscape. While PPPs are part of an ambitious infrastructure investment agenda which will represent a total...
The PPP bulletin recently sketched out the consequences of the COVID-19 crisis on the contracting landscape in the UK, with stakeholders of the PPP industry severely affected as well.
The dramatic heading “a new Carillion” refers to the difficulty for public authorities to step in in the event of their service provider going into liquidation, with dire consequences on the infrastructure, the contract, the cost-effectiveness of the project....and ultimately the service provided...
Novara Teaching and Research Hospital: A €320M PPP for the Piemonte Region in Italy!
A 4 year planning and construction Phase for a 26 year-concession arrangement and a split of risks and investments, with more than €219M private investment and €100M public investment. The project’s ambitious aim?
The new Hospital will provide the city with a strong urban value as an open space. The basic project conditions envisage a close...
PIN issued for Welsh health PPP project: a prior information notice has been issued for the New Velindre Cancer Centre Project in Cardiff. This is a 8,500-bed, £180 million project with support from the European Union.
This illustrates the importance of PPPs and complex contracting to:
- tackle the growing burden of cancer and other NCDs;
- offer innovative solutions for agile infrastructure delivering value for money over their life cycle...
Paris hospital selling real estate to fund refurbishment
Agendas colliding: while the Decide Capital Investment in Health working group is busy sorting out the main challenges of capital projects and infrastructure value chain, including the generation of additional revenue for health assets, a singular project drew our attention.
A hospital in Paris, owner of the Hôtel Scipion, the mansion which belonged to Queen Caterina di Medici’s banker and...
A recent study in Canada flagged a trend that affects infrastructure and technology, i.e. under investment in capital and a risk of inequity in access to health services.
The study confirms in particular a pattern observed in different health systems across settings: the lack of sufficient capacities in the public health sector for adequate capital planning, allocation and use to strengthen infrastructure while filling the gap, in line with SDGs...
Joint Ventures are contracting vehicles enabling public sector decision makers such as health stewards to partner with the private sector and leverage capital and resources for typically large projects.
JVs have been around for some time but with the growing capital investment agenda backed by the need to fill the infrastructure gap, Joint Ventures appear an innovative way for the public sector to secure high level of capital leverage, risk...
This is it….the Capital Investment in Health working group is officially launched!
The CIH group will get inspiration from its very successful sister the Decide CEDAS group (see www.decidehealth.world/cedas) and launch a very operational series of collaborations to help health stewards design, finance, operate and maintain their infrastructure over the life cycle of the asset and secure value for money.
COVID-19 entails a global shortage of construction materials
This is the double backlash effect: the global market of materials and supplies is affected by the COVID-19. To put it mildly, supply chains are in tatters while prices are sky rocketing. Newspapers the world around express concern about the consequences of this shortage on the construction sector.
Wood, aluminium, steel? Price increases can range from 50 to 80%, bolstered...
UK Infrastructure Bank: a catalyst for a greener change?
Prof Mazzucato, Chair of the WHO Council on the Economics of Health for All delivers an analysis of the potential and opportunities for the newly set up UK Infrastructure Bank. This is particularly important at a time where governments strive to beat the clock and deliver on their SDG commitments -and infrastructure in health is the second cost driver of attaining...
Stemming from the National Infrastructure Plan, here comes the Infrastructure Bank!
Driving Economic and social growth through capital investment projects is often seen as a policy option to fast-track economic development or recovery. This was probably on the mind of Rishi Sunak, Chancellor of the Exchequer and himself a former investment banker, who stands behind the National Infrastructure Strategy recently unveiled, and which aims at stimulating the country economy...
The UK Infrastructure Plan does not lack ambition. For the health sector only, it is confirmed that a whooping and much needed £3.7 billion will be available for 40 hospital projects, making it the biggest capital funding programme for health facilities over more than 20 years.
The breakdown of projects shows that by 2030 48 new hospitals in total will be delivered by 2030, and backed by news standards...
Filling the infrastructure: a priority, today more than ever!
Everyone agrees: investing in social infrastructure is essential. Analytics published by WHO provide a striking illustration of the economic and social growth impact of investment in social infrastructure, with health infrastructure the second cost-driver of achieving the health targets across all the SDGs (with a staggering 36% of all investment needed in LMICs).
This is the heading of the draft Infrastructure Investment Plan for Scotland for the next 6 years, with a number of priority projects including health. In fact, it appears that the planning exercise was influenced by the COVID-19 pandemic:
We will build back better by focusing on the following shifts in our capital investment, to seek
to address the economic, health and social impacts of...
The Wales Government (i.e. the political body in this region of the UK that is devolved large powers to organise public services) is cognisant of the infrastructure gap, particularly in terms of social assets. In order to remedy this shortage of infrastructure, a call for public private partnerships to leverage capital funding for large projects:
The Mutual Investment Model (MIM) is an innovative way to invest in public infrastructure...
Infrastructure expert and practitioner Luke Houghton, from Deloitte Australia, summarizes the beat-the-clock agenda that underpins most policies aiming at increasing capital investment in public assets.
This is in the context of the Global Infrastructure Hub’s work to help fill the infrastructure gap. The GIH is a G-20 initiative that strives to harness competencies across public and private sectors.
A common ambition across countries and multinational organisations is to meet the...
The Italian region of Piemonte has it all: its capital city is Torino, a royal city (with a famous and venerable football team), a network of infrastructure, global industries -Torino is home of the FIAT group-, culture....it is even the city of coffee giant Lavazza! It also boasts worldwide renowned wines in Langhe, Asti or Alba. Piemonte values nature and its environment.
Energy performance tackled through private sector participation?
Like all public buildings, health assets are faced with increasingly stringent energy performance norms. Regulations pertaining to the control and reduction of CO2 emissions, use of environmentally friendly sources of energy, control of consumption and waste of energy or improvement of recycling and waste management cycles are but a few of the challenges presented to public infrastructure in general, and which may...
Hydrogen at the heart of the infrastructure decarbonizing agenda
The Welsh Government triggered a serious climate alarm in 2019 and followed through a steady agenda to decarbonize public infrastructure, leading to the announcement at the end of March 2021 of the NHS Wales decarbonization strategic delivery plan which is accessible on this page to download (or click here to access it directly).
This comprehensive -and inspiring- strategy scans...
Why the jellyfish? Oh it is simple enough: they are a sure illustration of clean waters (jellyfish abhors pollution and their presence, however worrying on other accounts, is a good indicator of cleanliness of the marine environment).
There is more to it: jellyfish sting, thus resembling some coercive policy measures……The latest exemplification of which can be found in the new procurement rules...
Hydrogen: a new fuel landscape to green infrastructure?
Your Decide Hub regularly informs you about the trends and evolution of green energy as the development of “greener” fuel sources is a key challenge for public infrastructure.
Given the increasingly stringent CO2 emission reduction targets and environmentally friendly norms that apply to public assets -amongst which health assets of course- this topic appears to be the crux of capital...
Health, COVID-19 and procurement: where is the missing link?
There is increasing interest -exemplified by webinars- to better grasp the lessons of the COVID-19 pandemic and the lessons that could be taken away to improve the procurement procedures countries face.
It appears once more that the health sector with its array of sophisticated idiosyncrasies and high level of technicity, but also unfathomable volatility poses a challenge to infrastructure...
Decide Friends and partners at Partnerships Bulletin published a call to health public-private partnerships (PPP) specialists interested in helping the Government of Ukraine and the World Bank (Global Infrastructure facility and IFC), with a deadline for response on 11 March 2021!
With the need to upgrade and modernize the health system, the policy agenda supported by the World Bank seems to prioritise private finance...
A dynamic health PPP agenda: what is the rationale?
Healthcare transformation in Ukraine is gaining significant momentum. The Ukrainian PPP agency announced at the end of January 2021 that pilot Public-Private Partnership projects would be rolled out in the healthcare sector, with talks engaged between Ministries of economy, health, and the world bank.
As a result a road map was drawn and specific projects identified, amongst which the...
ESG? As long as it is meaningful for credit analysts. And than means climate change!
Ratings agency supports PPPs as a vehicle to bolster green agenda, according to our friends at PPP Bulletin, the leading publication in infrastructure and partnerships.
An article recently published (click here) highlighted that the ratings agency Kroll Bond Ratings Agency (KBRA) supported in its “Financing the Green Transition” the potential role...
Insurance companies cannot help but look at the cost of climate change….
It made the headlines of the French newspapers last week, as the country struggles with worrying flooding, snow episodes and even sandstorm from the Sahara! The CEO of behemoth insurance company AXA gave an interview to share his concerns about the multiplication of climate-change triggered dramatic events.
In essence, AXA CEO Jacques de Peretti underlines that...
Peter Pan’s writer JM Barrie gave copyright to London GOSH.
In 1929 London’s Great Ormond Street Hospital (GOSH) was bequeathed the rights to Peter Pan by JM Barrie’s estate. Ever since, the copyright to the book as well as a significant proportion of derived products represented a substantial revenue and source of income for this major London hospital for children.
Of course, copyrights tend to expire. It did first...
Interested in securing adaptability and performance of health assets? Look no further!
Written by specialists of hospital design, architecture, planning and medical devices experts, this guide aims at helping health stewards make the best of their infrastructure project to ensure sustainability against a constantly changing health environment: this guide is to help design a hospital around delivery platforms, value for money and sustainability.
If you are interested in complex contractual arrangements such as public-private partnerships (PPPs) and the conditions under which these legal instruments can foster a culture of collaboration between public and private stakeholders in health, you must have come across the PPP Bulletin.
The Partnerships Bulletin is the gold standard of publications focusing on synergies across investment programme to fill the infrastructure gap. It analyses trends, highlights projects and offers...
One of the most interesting areas of work of our Capital Investment in Health group -and perhaps the broader community of health infrastructure specialists- certainly is related to third-party revenue generation.
Behind the somewhat cryptic wording lies the possibility for health facilities to generate an income based on activities that are ancillary to their clinical set of services or completely disconnected.
