Evaluation of the Planning and Implementation of NHS Local Improvement Finance Trust (LIFT) in East London

Procurement of NHS primary care buildings was reserved for the DH working through PCTs until LIFT was introduced. The DH anticipated that LIFT would effectively mobilise private sector finance and expertise in improving the quality of buildings. But LIFT’s suitability to achieve this is questioned on grounds that it uses market mechanisms that may fail when applied in health. This case-study explored with people directly involved in LIFT their views and experience of how it helped them in procuring desired buildings. It was driven by desire to understand whether and how contextual factors and mechanisms in LIFT supported staff efforts, hoping the findings would influence DH officials in revising the guidance to make LIFT effective. Evidence was primarily collected through in-depth interviews with 25 informants drawn at two PCTs, the LiftCo and LIFT buildings. Data from interviews was complemented by documentary analysis and tours to make observations at four LIFT buildings. The data was coded for analysis in NVivo. The key findings were organized into four analytical categories aligned with the research questions for interpretation to generate relevant answers. The study revealed that the important factors for progress in LIFT involved commitment of PCT boards; engaging PCT managers in strategic decisions and empowering them in influencing governance issues. Progress may be enhanced through DH officials encouraging increased collaboration between LIFT partners and promoting contractor competition in service delivery. Barriers to progress included the LiftCo over-prioritising efficiency, hiring of contractors lacking experience in health, and the DH not sufficiently supporting PCT managers in increasing their capacity to make LIFT effective. Informants believed LIFT could improve procurement provided ways of addressing the barriers were explored. LIFT outcomes are a result of factors in its contexts influenced by policy-makers and decisions taken by operational staff. Recommendations are offered for these constituents in LIFT and for future research. DH officials should get feedback on practicalities of LIFT guidance by engaging PCT managers in making strategic decisions and empowering them in translating their experiences into actions. This could make LIFT effective and reduce the risks that were highlighted

Refugee and Immigrant Community Health Champions:a Qualitative Study of Perceived Barriers to Service Access and Utilisation of the National Health Service (NHS) in the West Midlands, UK

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study higlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals’ healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands

Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities. Subject and methods A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n = 23) and private sector staff (n = 2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT). Results We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency. Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient