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Ambulance service trusts in England have historically had little or no competition for non-emergency patient transport services (NEPTS), but following the imposition of the NHS Procurement, Patient Choice and Competition (PPCC) Regulation (Number 2) 2013, NHS commissioners could accept suitable bids for NEPTS work from third-party commercial competition. This paper describes how NEPTS evolved in England and how an Ambulance Service Trust Board had to step-up their approach to bidding for NHS NEPTS work and to protect their brand and financial position in a competitive commercial market place.

The Trust Board developed a competitive bidding strategy with a market research project using “grounded theory” to identify and categorise stakeholders' issues followed by re-engineering to achieve new operational goals. A fundamental element of the bid was an opportunity to share patient information between local NHS facilities using a common access data warehouse. This would represent a serious barrier to entry to any third-party non-NHS commercial competitor.

Key projects were identified in the bidding process, including relocation of NEPTS resource bases, use of third-party resources and the establishment of a local NHS-wide data warehouse. They were all self-financing within the contract period and accepted by the commissioners. However, the establishment of NEPTS hubs at hospitals with clinics scattered throughout their grounds was rejected by the commissioners due to incompatibility with existing hospital practices.

This case study defines the challenges and opportunities faced by an English Ambulance Service Trust Board when responding to an invitation to tender (ITT) from NHS commissioners for NEPTS and competing with third-parties on a commercial basis. Any emergency service would face similar challenges bidding for work in a competitive environment.

The National Health Service (NHS) hospitals in Britain are currently in a state of decay following many years of underinvestment in the estate. The NHS urgently requires billions of pounds of investment ranging from total hospital new builds to small refurbishment of existing facilities. The previous Conservative government put forward the Private Finance Initiative (PFI) as the procurement mechanism to address this problem. The new Labour government currently appear to be committing themselves to the same approach. PFI project sponsors have spent upwards of £30m bidding for around 30 major PFI schemes. Despite this, by the time of the UK election in May 1997 not one scheme had reached financial close and many sponsors were expressing their disillusionment with the process. Unlike PFI on other Government infrastructure and service schemes, each PFI hospital is tendered by a separate Trust with their own limited budgets. Many Trusts have demanded schemes without realising that they cannot afford them and whilst these schemes may work out cheaper than publicly financed hospitals over 30 years or more, charges are higher in the early years. This is primarily due to the market for loans, the conditions attached to these loans in terms of repayment periods and cover ratios, and the requirement of the sponsors to generate a reasonable return on their investment. This paper discusses the major issues and analyses some of the technical financial problems surrounding the PFI in the NHS. The authors draw on practical experience of financial structuring and modelling hospital projects to build a generic model to analyse NHS PFI economics.

This paper seeks to report the findings from a seven‐year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. It explores the relationship between policy and practice in the introduction of a large‐scale national ICT programme at an estimated value of £12.4bn.

Using a longitudinal research method, data are collected on the policy‐practice nexus. The paper applies institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalisation.

The findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health‐care environment. A process analysis shows that, as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process.

This research is limited in its generalisability to national, regional and local ICT implementations due to the complexity of the policy and practical issues at stake. Despite the longitudinal research approach, the use of institutional theory can only offer a flavour of how institutionalised values, norms and behaviours influence health IT policy and practice.

The paper demonstrates the complexity of translating centralised ICT policy in healthcare to practical solutions for clinicians and other stakeholders. It shows how a large‐scale ICT programme based on procurement of technology is unlikely to succeed where important issues of user engagement and a sound “business case” have not been achieved.

This research contributes to the theoretical literature on institutionalism by addressing the dichotomy between institutional and technical environments. While technology is often discussed in isolation of an institutional process, it may become embedded in organisational practices, reaching a process of sedimentation (institutionalisation) or fail to take hold and fade from view.

To examine the processes used to procure and develop new primary health care premises in the United Kingdom and in particular the use of the private finance initiative and related methods.

An in‐depth study of two local improvement finance trust schemes to procure new primary health care premises. These are contrasted against the ad‐hoc arrangements for the traditional procurement of general practice doctor's surgery premises. Interviews were undertaken with key participants on both sides of the negotiations.

The process can be an unequal struggle between large consortia and small, inexperienced clients that may result in a wasted opportunity to obtain the optimum design and price.

The research is limited to early use of the local improvement finance trust process and procedures; client bodies, such as primary care trusts, may benefit from the experience of earlier projects. The method of procurement will evolve and be refined and will become more widely used, not only for health but also in the education sector. Further examination of the procurement of education buildings using similar methods would be beneficial.

This method of procuring buildings is relatively new, and therefore, largely untried.

Competition is now widely used as the means of choosing the providers of essential public services in the USA and the UK. Many different approaches are found in the USA and there are useful lessons for the UK. With particular reference to mental health and substance abuse services, describes the effects of using competitive tendering on users, providers, purchasers and citizens and examines the problems of specification, transaction costs, the use of consultants, supply, the level playing field, trust, innovation, local accessibility and accountability. Ends with discussion of co‐operation and collaboration and the emergence of monopolies and integrated delivery systems in the USA and concludes by finding politics and political decision making of overriding importance.

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.

The UK Government has now adopted Private Finance Initiative (PFI) as a major vehicle for the delivery of additional resources to the health sector in order to achieve a greater investment in healthcare facilities. The purpose of this paper is to examine the trends and risk assessment of the PFI in the healthcare sector.

The paper employed secondary data and interviews of key participants in two hospital PFI projects to highlight developments in healthcare PFI and the risk management of hospital projects.

The results show that the use of PFI in the provision of healthcare is increasing in terms of number, capital value and size of projects. What emerged in the healthcare PFI project was a usage of a plethora of risk management techniques, albeit to varying degrees. Experience appeared to be the prime risk assessment technique employed, while risk avoidance was first explored before pricing and allocating any residual risks. “Risk prompts”, such as using checklists and risk registers were also useful in the identification of risks. Among all participants, insurance cover and sub‐contracting appear to be the most prominent strategies employed for managing out the risks.

The negotiations that precede the signing of a healthcare PFI project contract had an impact on the final choice of facilities or their specifications. The two contracting parties sought a balance between an optimal allocation of risks, choice of facilities and project price. Although the risk management techniques being used are generic in nature, there is still no evidence at the moment to show that these are appropriate for PFI projects. It is important that further investigation is undertaken to assess the level of current skills in risk management techniques to deal with PFI projects and the extent to which these techniques are appropriate to tackle complex healthcare PFI projects.

As the practice of outsourcing business activities has become more common than ever, partnerships have increasingly been forged. The aim is to ensure superior performance through organizational relationships characterized by trust and cooperation. Strategic human resource (HR) management highlights the importance of practice for competitive reasons. However, companies' strategic decisions on outsourcing are primarily driven by economic and financial aspirations. As a result, the HR issues fundamental to the effectiveness of the outsourcing practice are often overlooked. Based on a distinctive outsourcing activity involving a public‐private partnership, the purpose of this paper is to reveal how the outsourcing process influences employee commitment and citizenship behavior (willingness to go the extra mile), and to provide insights for strategists, executives and HR managers to enhance their strategic HR practices in line with their outsourcing decisions.

The paper is an embedded case study of a British National Health Service hospital based on quantitative and qualitative data collected from: 101 questionnaires completed by ancillary (non‐clinical) staff employed by the NHS but seconded to a private partner under the ROE (Retention of Employment) model; and 15 semi‐structured interviews with managers and frontline staff.

The findings reveal that: whilst employees developed notably strong emotional attachment to their managing organization their bonds with the employing organization, the hospital, seem to have weakened somewhat; moreover, employee commitment proved to be an effective predicator of citizenship behavior and job performance; and the nature of the contractual relationship, performance management and HR management practices had significant influence on employees' job performance and the private company's ability to meet the performance requirements defined by the NHS.

Although based on a unique case of the public‐private partnership, the findings reflect the challenges of strategic HR management in outsourcing in public and private sectors.

The findings offer practical insights for company executives, HR managers and policy‐makers. When selecting an outsourcing partner and managing outsourcing activities the structure and nature of the inter‐organizational relationship and the strategic potential of employees and employee management need to be considered.

The paper provides first‐hand insights based on viewpoints from employees at different levels who are involved in the NHS outsourcing activities under a partnership arrangement. The findings caution strategists, executives, managers and policy‐makers to re‐visit their outsourcing and HR practices.

This paper investigates how symmetrical learning activity is, between the public client and the private contractor in the contracting and operation of complex, long-term infrastructure projects. Drawing on empirical material from two United Kingdom (UK) private finance initiative (PFI) cases, the paper analyses differences in the absorptive capacity and learning capability between parties. It suggests the private contractor appears to be better equipped to acquire, embed and renew their learning. These findings reflect less than 5 years of a 30-year contract, suggesting a skewed (imbalanced) relationship, where the contractor gains more learning capabilities than the client. The paper concludes with implications for management practice and suggestions for future research directions.

This paper seeks to develop a system of how to judge the merit and worth of Private Finance Initiative (PFI) projects in the UK National Health Service (NHS) once they are operational. This concern is couched in relation to whether PFI can be seen to provide long‐term “value for money” (VFM) using a broad definition of this term. This paper does not attempt to further the debate that has focussed on the broader macro economic VFM arguments; rather, the focus is upon developing a model for evaluation at the organisational level where there is a paucity of direction and clarity. Whilst there are many VFM criteria available to guide whether PFI in the NHS should be pursued at the pre‐decision stage, there is little in the way of post‐project evaluation systems to judge VFM once decisions have been taken. Little thought has been given to the design of these post‐project evaluation systems let alone the experiences of how such systems may operate. This paper is addressing these lacunae but only in the sense of suggesting a design for a system for post‐project evaluation. This is drawn from PFI pre‐decision processes, post‐project intentions of some PFI schemes and evaluation theory. It is not about the judgements that come from the use of such a framework which the paper conclude will take some time to be forthcoming.