Tackling surgery backlogs through PPP: the wrong idea?

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”.

How would this work? Well with a minimum of £50 million per scheme and a staggering £1 billion capital investment need, it may trigger some doubt and uncertainties.

PPP Bulletin underscores quite rightly that financing instruments already exist for the purpose of health systems reorganization or transformation, such as the successful LIFT programme. The Local Improvement Finance Trust (LIFT) was designed precisely to shift the English health system towards a better distributed, more effective and for-purpose built PHC facilities (health and social assets).

Interested in this perspective: click here for the thought-provoking blog published by our friends at Partnerships Bulletin.

A bit of (health) controversy?

Now for a bit of controversy….or rather for once: let’s agree to disagree! Your Decide Hub is very open to private sector participation in health and rather versed in complex contractual arrangements such as PPP, which are a part of the Capital Investment in Health Decision Tool in development (see www.decidehealth.world/cih).

However, at Decide where health and capital investment specialists work on health systems performance to secure value for money the question arises: are PPPs really useful in this matter?

There are a few elements that ought to be factored in and which may advocate for other procurement routes:

Why go for the private purse?

If there is a need for a massive influx of capital, is project finance the most cost-effective route, one that can resist the stress test of delivering value for money as opposed to budgetary or extra-budgetary sources? Would it not be simpler and cheaper to tap into the funding facility of public investment banks?

Urgent? PPP procurement route is everything but fast

If there is a need for urgent infrastructure projects, are PPPs the right vehicles (no pun intended) as procurement and contracting routes (including competitive dialogue, integrated solutions and a consortium of contractors providing the right expertise)? The selection of a successful bidder can typically take up to 18-24 months!

Risks you said?

Will the risk assessment and allocation -which is arguably the basis and the most important factor of a successful PPP- be adequately carried out in the event of a large series of urgent contracts?

Have alternative solutions (care pathway redefinition, hospital master plan transformation or in many cases operating theatre time/optimal utilization

Do Capital Projects specialists agree?

Last but not least (and very happy to carry on the conversation): is this call for clinical staff also supported by health decision makers entrusted with capital / infrastructure projects, i.e. hospital managers, architects, or project managers? This would certainly add weight to the proposed solution.

Alternative routes: PHC more than ever…

If COVID-19 taught us something, it certainly is the incredible and incommensurable wealth of dedication, commitment and capabilities of health workers.

Taking the infrastructure building and operating burden off care providers may be tempting, but it can certainly be achieved through a number of means: contracting public and private providers on a geographical basis to increase the availability of beds or operating theatres in a given catchment area is one of them.

Entrusting additional resources to existing public structure to transform their assets can also be considered, together with licensing -under conditions- new private care providers.

First and foremost, the investment in Primary Health Care facilities and services will prove the fulcrum of the optimization of health services transformation.

This echoes the call of WHO to prioritise PHC investment. It is essential as it will yield the best health returns but also enable to make the best of specialized and tertiary care facilities thus helping respond in a rational way to the backlog of elective surgeries.