Friday, September 01, 2006

Public-private partnerships are systemically flawed

Much of the effort that UK New Labour has put into public-private partnerships has led to unintended consequences. From my perspective they are conceptually and systemically flawed primarly because they create institutional arrangements that conflate citizen values with consumer values (see Mark Sagoff's, 1988 book, 'The Economy of the Earth' where these distinctions are fully developed). By doing so thay fail to understand how power is enacted and what forms of praxis are required to deliver change for citizens.

It is therefore interesting to read: 'PENSIONER WINS GP PRIVATISATION BATTLE AT COURT OF APPEAL' from the 'Keep Our NHS Public Campaign' website. Here is a flavour:

'Pam Smith has today won her appeal to prevent a US healthcare corporation from running a GP surgery in Derbyshire. Lord Justices Keene and May quashed the selection of United Health Europe - the British arm of America's biggest healthcare corporation - to run the practice, and ordered North Eastern Derbyshire primary care trust to start the tendering process from scratch. They also awarded Pam Smith 100 per cent of the costs.

The decision is a stunning victory for a pensioner who dared to stand up to the might of the government, the NHS and a multi-national corporation. It is a blow for the government's reform programme of bringing in private companies to run GP services, and may discourage other private companies from involvement in the scheme.'

For a compelling critique of the New Labour culture associated with public-private partnerships see 'Plundering the Public Sector'. Chapter 10 deals with Connecting for Health, the national programme for IT in the NHS, which I described in an earlier posting. Here are some excerpts:

"The total annual budget of the NHS is around £70bn. So whatever the final cost of CfH, it means that over the next few years a huge amount of money is being taken out of, and will continue to be taken out of, patient care to fund the CfH programme. Assuming about one million employees in the NHS will be affected in some way by the programme, CfH is going to cost over £35,000 per employee - that is really quite a lot of money for management and IT systems consultancy. In fact, with CfH we are seeing consultancy support per health service employee that is almost on the scale of the £45,000 per employee paid to consultants during the catastrophic Child Support Agency programme. '"

"This brings us to the fourth phase of failing or failed IT systems projects - blame. This is when the original budget has been overspent by millions, tens of millions, hundreds of millions or even, as will be the case with CfH, billions. Years after the planned date, either nothing is yet installed or else some sort of system may be working, but it does incomparably less than was originally promised, is tortuously difficult to use and is probably costing more per transaction than the previous, largely manual way of doing things. At this point, those responsible for the system’s implementation blame those who work with it for continually changing their requirements and for not using it properly. Although by November 2005 CfH was far from completion, a rather unsightly public spat had already broken out between the director of the programme and the head of the NHS. Richard Granger reportedly wrote to a senior civil servant at the Department of Health claiming ‘ehoose and Book’s IT build contract is now in grave danger of derailing (not just destabilizing) a £6.2bn programme. Unfortunately, your consistently late requests will not enable us to rescue the missed opportunities and targets.’"

The authors have suggestions as to what should be done next.

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