Construction procurement strategies of national health service in the UK: A critical review
| Date | 01 March 2010 |
| Published date | 01 March 2010 |
| Pages | 31-67 |
| DOI | https://doi.org/10.1108/JOPP-10-01-2010-B002 |
| Author | Ahmed Doko Ibrahim,Andrew Price,Malik M. A. Khalfan,Andrew Dainty |
| Subject Matter | Public policy & environmental management,Politics,Public adminstration & management,Government,Economics,Public Finance/economics,Texation/public revenue |
JOURNAL OF PUBLIC PROCUREMENT, VOLUME 10, ISSUE 1, 31-67 SPRING 2010
CONSTRUCTION PROCUREMENT STRATEGIES OF NATIONAL HEALTH
SERVICE IN THE UK: A CRITICAL REVIEW
Ahmed Doko Ibrahim, Andrew Price,
Malik M. A. Khalfan and Andrew Dainty*
ABSTRACT. In the UK healthcare sector, funding and provision of public care
facilities has been primarily the responsibility of government through the
National Health Service (NHS). After decades of under-investment and
consequent effects on the quality of care, new procurement routes are
currently being used to improve the standards of facilities to meet the
requirements of modern care services. This paper critically reviews these
new procurement routes in terms of concepts and suitable areas of
application, and examines how the principal procurement methods have
evolved into the forms used for UK healthcare facilities. The paper outlines
recommendations for further research in assessing the suitability or
otherwise of these new procurement methods, both for construction projects
generally and specifically for healthcare facilities.
INTRODUCTION
The United Kingdom’s National Health Service (NHS) was
established in post-war Britain (1948) as a social contract between
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* Ahmed Doko Ibrahim, PhD., is a Senior Lecturer, Quantity Surveying
Department, Ahmadu Bello University, Nigeria. His teaching and research
interests are in cost modelling, public procurement, and continuous
improvement. Andrew Price, PhD., and Andrew Dainty, PhD., are Professors,
Department of Civil and Building Engineering, Loughborough University, UK.
Dr. Price’s current teaching and research interests are in innovative design
and construction solutions for health and care infrastructure, continuous
improvement, and sustainable urban environments. Dr. Dainty’s current
teaching and research interests are on human social action within
construction and other project-based sectors, and particularly the social
rules and processes. Malik M. A. Khalfan, PhD., is a Senior Lecturer, RMIT
University, Australia. His current research interests are supply chain
management, public procurement and trust in construction.
Copyright © 2010 by PrAcademics Press
32 IBRAHIM, PRICE, KHALFAN & DAINTY
the government and the people, based on explicit values of
universality and equity. It is considered to be an icon worldwide, both
as a social insurance system and as a nationalised health delivery
service (Baggot, 2004). The NHS is responsible for maintaining the
health of the over 60 million population, spending an annual budget
of around £40 billion and providing a working environment for over
1.2 million people (Department of Health (DoH), 2005). A wide range
of services, largely free at the point of delivery, is provided by the
NHS. However, around 12 per cent of the population have private
health insurance to supplement NHS provision, primarily for elective
procedures (Leatherman & Sutherland, 2004).
The structure of the NHS healthcare planning has been subject to
considerable change and the current configuration has been
illustrated in Figure 1. The NHS policies are determined nationally by
the DoH, which is responsible for providing direction, and maintaining
standards, resources and choice. The policies are implemented by
the NHS Executive, the NHS’s over-arching management body which
operates through regional offices across England. It also sets targets
and checks performance. The Strategic Health Authorities (SHAs) are
FIGURE 1
Structure of Healthcare Planning System in the UK
Department of Health
Policy and Direction
Standards & Resources
Choice
Strategic Health Authorities
Performance Management
Strategic Capital
Developing local strategies
Primary Care Trusts
Commissioning services
Delivery of Primary and
Community Services
Improving health
NHS Trusts
Delivery of Acute and
Mental Health Services
CONSTRUCTION PROCUREMENT STRATEGIES OF NATIONAL HEALTH SERVICE IN THE UK 33
responsible for assessing the health needs of their populations and
ensuring these are met through appropriate provision of services by
the Primary Care Trusts (PCTs), NHS Trusts and other agencies. The
PCTs commission services and deliver primary and community
services whereas the NHS Trusts (including Foundation Trusts) –
deliver acute and mental health services. The reforms to the NHS’s
organisational structure are continuous with attendant changes to
the configuration and functions of SHA and PCTs. However, the
reform likely to have the most profound impact on capital investment
is the transition of further NHS Trusts to NHS Foundation Trusts (NHS
FTs) status, the fundamental difference being that the NHS FTs are
free to reinvest all cash generated from their operations, rather than
having to rely on operational and strategic capital allocations for the
maintenance and replacement of their assets, and they may borrow
from a loan facility to fund further capital investments (DoH, 2007a).
The NHS was considered remarkably frugal as the UK has been
among the lowest health care spenders within Organisation for
Economic Cooperation and Development (OECD) countries for over
four decades, both in absolute terms and as a proportion of gross
domestic product (GDP) (Wanless, 2002). The relatively low
expenditure, which was once celebrated as a virtue achieved through
efficiency, has increasingly been seen as under-investment that has
compromised the system’s ability to meet the population’s health
care needs (Leatherman & Sutherland, 2004). Access is mediated by
a tradition of “surreptitious rationing” based on the “5 D’s” of delay,
defer, deter, dissuade and decline (Leatherman and Sutherland,
2004). Grimsey and Graham (1997) further reported that the
fragmentation of responsibilities under the traditional healthcare
delivery arrangements was responsible for non-achievement of co-
ordinated planning, service delivery and investment. In addition,
investment for the provision and improvement of healthcare facilities
were ad hoc and on a piecemeal basis for some decades. As a result,
the condition and functionality of healthcare facilities became
unsuitable for the provision of modern integrated healthcare delivery,
with facilities not able to meet patients’ expectations and access to
health care was slow and fell below acceptable standards (DoH,
2000). The introduction and review of the Disability Discrimination
Act in 1995 and 2005, respectively, have also made physical access
a critical issue in health care estates. These limitations in premises
used to deliver healthcare severely hampered service development
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