PPP, bad deal
No Canadá tambem houve enorme expectativa em relação às PPP (P3/AFP), como forma de financiamento de novos hospitais públicos link
«The government is using the AFP approach to finance and construct major, more complex projects in the healthcare and justice sectors. AFP leverages private sector resources, expertise and efficiencies and transfers risks to the private sector, including cost overruns associated with time delays, design modifications and additional construction costs. This ensures that projects are delivered on time and on budget. To date, the government has announced approximately 30 hospital projects will be financed using the AFP approach. »
«The government is using the AFP approach to finance and construct major, more complex projects in the healthcare and justice sectors. AFP leverages private sector resources, expertise and efficiencies and transfers risks to the private sector, including cost overruns associated with time delays, design modifications and additional construction costs. This ensures that projects are delivered on time and on budget. To date, the government has announced approximately 30 hospital projects will be financed using the AFP approach. »
De acordo com o estudo seguinte, link o recurso à APF ter-se-à saldado num fracasso rotundo traduzido na derrapagem dos custos na ordem dos 27% em relação às estimativas iniciais.
«During its first term in office, Ontario’s Liberal government introduced the “alternative financing and procurement” (AFP) model for public infrastructure.
The government claims that this model provides greater transparency than Public Private Partnerships (P3) financing and will yield savings for the public purse.
An examination of Infrastructure Ontario’s “value for money” assessments of hospital projects suggest that AFPs are lacking both in transparency and in protection of the public purse.
Infrastructure Ontario has conducted a value for money assessment of all AFP projects. These estimates compare the costs associated with the AFP project to a public sector comparator. Both Infrastructure Ontario and the provincial government rely on these assessments to demonstrate that AFP is a better way to fund public infrastructure than traditional financing. A look at the methodology behind these assessments raises serious questions.
To begin with, the information made available in these assessments is insufficient — it fails the true transparency test. The limited information that is publicly available raises serious questions about the validity of the value for money assessments’ results.
The province’s value for money results hinge on two questionable assumptions:
• The first questionable assumption is that a substantial amount of public money can be saved by transferring risk from the government to private sector AFP service providers. It assumes that risks associated with large, complex construction projects such as supplier disruptions, bad weather or changes in specifications can be borne more cheaply by the private, stand-alone entities responsible for AFP projects than by the government.
• The second questionable assumption is that financing costs for these projects are far below what the available evidence indicates that they would be.
Using the data from Infrastructure Ontario assessments and its method of estimating a public sector comparator starting from the winning AFP bid, we constructed alternative estimates of value for money for Ontario’s hospital projects and came to vastly different conclusions than the government.
Our estimates include alternative assumptions on risk transfer, financing, transactions costs, taxes and insurance premiums. These alternative assumptions are more conservative than the available evidence suggests that they should be.
Yet, using these conservative assumptions, we found the AFP hospital projects could result in a cumulative increased cost to the public purse of $585 million, compared to Infrastructure Ontario’s optimistic estimate that the province will save $341 million.
We cannot conclusively say these projects will actually cost the government $585 million more using an AFP method of financing for one simple reason: because Infrastructure Ontario doesn’t provide us with enough information.
What we can say is this: the AFP saving for Ontario hospitals could be — at most — $341 million. But the AFP disadvantage could cost the Ontario government at least $585 million.
This represents a significant chasm between Infrastructure Ontario’s estimates, which show a 16 per cent saving from using AFP, and ours, which show a potential 27 per cent increase in costs. »
From P3s to AFPs, new branding but same bad deal, OAB maio 2008
«During its first term in office, Ontario’s Liberal government introduced the “alternative financing and procurement” (AFP) model for public infrastructure.
The government claims that this model provides greater transparency than Public Private Partnerships (P3) financing and will yield savings for the public purse.
An examination of Infrastructure Ontario’s “value for money” assessments of hospital projects suggest that AFPs are lacking both in transparency and in protection of the public purse.
Infrastructure Ontario has conducted a value for money assessment of all AFP projects. These estimates compare the costs associated with the AFP project to a public sector comparator. Both Infrastructure Ontario and the provincial government rely on these assessments to demonstrate that AFP is a better way to fund public infrastructure than traditional financing. A look at the methodology behind these assessments raises serious questions.
To begin with, the information made available in these assessments is insufficient — it fails the true transparency test. The limited information that is publicly available raises serious questions about the validity of the value for money assessments’ results.
The province’s value for money results hinge on two questionable assumptions:
• The first questionable assumption is that a substantial amount of public money can be saved by transferring risk from the government to private sector AFP service providers. It assumes that risks associated with large, complex construction projects such as supplier disruptions, bad weather or changes in specifications can be borne more cheaply by the private, stand-alone entities responsible for AFP projects than by the government.
• The second questionable assumption is that financing costs for these projects are far below what the available evidence indicates that they would be.
Using the data from Infrastructure Ontario assessments and its method of estimating a public sector comparator starting from the winning AFP bid, we constructed alternative estimates of value for money for Ontario’s hospital projects and came to vastly different conclusions than the government.
Our estimates include alternative assumptions on risk transfer, financing, transactions costs, taxes and insurance premiums. These alternative assumptions are more conservative than the available evidence suggests that they should be.
Yet, using these conservative assumptions, we found the AFP hospital projects could result in a cumulative increased cost to the public purse of $585 million, compared to Infrastructure Ontario’s optimistic estimate that the province will save $341 million.
We cannot conclusively say these projects will actually cost the government $585 million more using an AFP method of financing for one simple reason: because Infrastructure Ontario doesn’t provide us with enough information.
What we can say is this: the AFP saving for Ontario hospitals could be — at most — $341 million. But the AFP disadvantage could cost the Ontario government at least $585 million.
This represents a significant chasm between Infrastructure Ontario’s estimates, which show a 16 per cent saving from using AFP, and ours, which show a potential 27 per cent increase in costs. »
From P3s to AFPs, new branding but same bad deal, OAB maio 2008
Por cá, não vai ser preciso muito tempo para começarmos a chorar sobre o leite derramado.
Etiquetas: Parcerias da Saúde
9 Comments:
Os súbditos de sua majestade, face ao fracasso das PP no Reino Unido decidiram exportá-las como forma de recuperarem o dinheiro perdido.
«If the private finance initiative dies in the United Kingdom it may still have a life beyond these shores. Rather like general practice fundholding, it has created a cadre of experts who can now offer their services to the rest of the world. The United Kingdom may, once again, be at least as successful in exporting its failures as its successes.»
link
The Private Finance Initiative (PFI) is the cornerstone of the UK government’s healthcare modernization agenda whereby Britain’s aging hospitals are to be renewed. The government claims that PFI will deliver greater value for money (VFM) over the life of the projects because the private sector is more efficient and innovative than the public sector, assumes some of the financial risks (and costs) that the public sector would otherwise carry, and builds to time and budget (Treasury, 2003).
(a conversa do costume)
This article analyses the cost of using private finance to build hospitals under the UK government’s Private Finance Initiative (PFI). Hospital trusts’ annual payments to their private sector partners are higher than expected and are taking 11% of their budget. The additional cost of private over public finance for the first 12 hospitals is about £60M a year, which is 20–25% of the trusts’ income. link
PFI charges create budget inflexibilities and are increasing the pressure on the NHS to cut their largest cost: the jobs, working conditions and pay of their staff.
Jean Shaoul, Anne Stafford and Pam Stapleton, PUBLIC MONEY & MANAGEMENT APRIL 2008
PFI in the NHS is there an economic case? link
The private finance initiative substantially increases the cost of hospital building. Total costs (construction costs plus financing costs) in a sample of hospitals built under the private finance initiative are 18-60% higher than construction costs alone (table 1). Shareholders in private finance initiative schemes can expect real returns of 15-25% a year.1 The consortiums involved in these schemes charge the NHS fees equivalent to 11.2-18.5% of construction costs (table 2). If the Treasury were to finance new hospitals directly out of its own borrowing it would pay a real rate of annual interest of 3.0-3.5%. It has been estimated that the £2.7 billion Scottish private finance initiative programme will cost, at a conservative estimate, "£2 billion more than if the Treasury had acquired the assets directly."2 The higher costs will be met locally through cuts in clinical spending and nationally through subsidies from NHS capital budgets.
Medical staff are deeply implicated in hospital private finance initiative schemes. Clinical directors approve and medical directors sign off the full business case, clinical posts are lost, and heroic targets are set for gains in medical productivity. Clinical concerns are generally met by assurances that the largely undisclosed price of the private finance initiative is well worth paying because schemes approved by the initiative offer better value for money than public procurement. This claim is based on the fact that, for approval purposes, all privately financed schemes are compared with a notional publicly funded equivalent, the public sector comparator. However, this comparison is carried out using an appraisal methodology under which the cash payments associated with each option are "discounted," and costs are adjusted to reflect "risk transfer." Both these factors have an influence on the results of the comparison. The appraisal methodology is prescribed in government guidance and plays a crucial part both in the selection of schemes for the initiative and in making the case for the private finance initiative as a policy.
Declan Gaffney, research fellow a, Allyson M Pollock, head a, David Price, research fellow b, Jean Shaoul, lecturer
Será que o PKM, o lula da silva e o lula não se querem associar na discussão desta evidência?
The case against PFI
Reason 1. The public service ethos
Public services are not like other commodities. They exist to support the social, economic and environmental well being of communities and where a community decides that the market alone cannot provide a particular activity. The state then assumes some degree of responsibility for the service: by funding the service or by regulating for its quality and delivery. In a post election Mori poll for UNISON over 80% of people rejected the use of private companies to run public services.
Reason 2: PFI is driven by public finances not public services
PFI was conceived by a Conservative government that had lost control of public borrowing. The current government's desire to keep borrowing off the public sector balance sheet remains the main driver for PFI. Public authorities know that PFI is the only way to get finance, which partly explains the unspent millions in the public coffers. The Government can afford to pay for the entire PFI programme from its reserves.
Reason 3: PFI costs more
PFI schemes cost much more than conventionally funded projects. The private sector borrows at higher rates than the public sector since governments can borrow at much lower rates. Audit Scotland have calculated these costs as adding £0.2 - £0.3 million each year for every £10 million invested. They have high set up costs, due to lengthy negotiations involving expensive city lawyers and consultants employed by both sides. The first 15 NHS trust hospitals spent £45 million on advisers an average of 4% of the capital value. The private sector demands high returns and despite very low risks, profits from PFI are extremely high.
There is a growing body of evidence that PFI projects escalate both in scale and cost. These are not simple cases of costs going up for a project but reflect the very nature of PFI itself. The higher costs inevitably lead to an affordability gap for the procuring authority that is often met by reductions in services and capacity, subsidies from other parts of public authority budgets and pressures on labour costs. A recent article in the British Medical Journal found that there were 20% cuts in staffing levels in PFI hospitals.
Reason 4: PFI profits from people
UNISON has conducted research into the impact of contracting out in local government on the terms and conditions of the workforce. UNISON's survey found evidence of a two-tier workforce, something commented on by both the Treasury and Health committees of the House of commons.
•Over 90% of those contacted said pay levels for new employees were worse that for transferred staff.
•1 in 5 of contracts showed a difference in the standard working week
•Pensions are a high value item for employees and a high cost item for contractors and public authorities.
•Guidance from government means that successful contractors are obliged to offer a comparable pension scheme to transferred employees. Our research could not find a single comparable scheme open to new employees. There was either no scheme or else it was inferior and often the contractor made no contribution whatever.
•There is inevitably a gender impact with women increasingly bearing the brunt of these new privatisations, just as they did under CCT and market testing. PFI contracts are at least 25 years long. As the first tier gradually disappears and only those staff on private sector terms and conditions are left, there will be a whole class of women workers providing public services who will have no occupational pensions and who will be working on inferior terms and conditions.
Reason 5: PFI goes wrong
There have been many claims that the private sector is more efficient than the public sector but there is no evidence offered to support this. Now that PFI schemes are coming on stream there is growing evidence that they are not producing the anticipated improvements in delivery to time or cost nor are they meeting the quality standards expected. After all, many of the same companies that were involved in pre-PFI cost and time overruns are also building PFI schemes.
Reason 6: PFI does not give 'value for money'
For many PFI projects, it is only the transferred risks that make the project value for money. Research for UNISON by Professor Allyson Pollock, looking at schools and hospitals, shows that the calculations of risk are arbitrary and unreliable. The National Audit Office has called the value for money calculation "pseudo-scientific mumbo jumbo where the financial modelling takes over from thinking".
Reason 7: Private companies make unacceptable profits
As well as the huge returns made by private companies they are refinancing their deals and yielding huge profits at the expense of the public sector. The principal risks transferred to the private sector in PFI projects are those met during the construction phase, risks that disappear at an early stage of the project. Despite this, the risks are treated as if they were spread over the whole length of the contract and it is therefore very profitable for contractors to refinance projects. At Fazakerley prison the National Audit Office reported that the net result is that the rate of return for the initial shareholders has tripled from 12.8% at the start to 39%.
There is a growing use of the Private Finance Initiative or Public Private Partnerships to allow private companies to raise money for major public service projects. But it costs more for private companies to raise money than it would for the government or local government. The only way private companies will make their money back is to cut either services or staffing costs. That means public service workers and users pay the real costs.
PFI: perfidious financial idiocy
A "free lunch" that could destroy the NHS link
Much evidence is accumulating to show that private finance initiative schemes are costing much more than traditional public funding of capital developments.
The £2.7bn ($4.3bn) Scottish private finance initiative programme, for example, will cost some £2bn ($3.2bn) more than it would have done if the Treasury had acquired the assets directly. Trusts embarking on private finance initiative projects thus have a considerable gap to fill. The first way they try to do so is by reducing the proposed capacity of the new hospitals possibly, even probably, to a point where they won't be able to do the job. Hereford's plans, for example, began with a requirement for 351 beds.1 This proved unaffordable. The latest scheme envisages around 250. Funds also have to come from reducing service delivery, meaning fewer staff. Because no scheme funded through the private finance initiative is yet fully up and running we must wait to see how much staffing will be reduced to meet the extra costs. What's more, the NHS as a whole is having to underwrite these extra costs, meaning that resources shift from providers who remain in public ownership to those privately owned,1 undermining still further the goal of greater equity in the NHS.
Por agora, lanço mais uns estudos para a discussão.
É fundamental desenvolver aqui uma discussão aprofundada sobre as PPP.
1. - "A new name can't save a poor policy ALLYSON POLLOCK, 24.01.08link
2. - "Written evidence to finance committee of the Scottish Parliament with regards to its inquiry into the funding of capital investment" link
3. - "A report on the cost of PFI and its impact on health services in England" link
4.- "HM Treasury:Tendering and benchmarking in PFI- Sixty–third Report of Session 2006–07 link
5.- "Top architect dumps P3 hospital December 12, 2007"
link
6.- "Good design 'must be a PFI priority'" link
Caro beveridge,
Penso que PKM tem aproveitado ultimamente os seus tempos na ENSP para ler alguns destes textos que o professor desconhecia de todo.
Nada de censurável.
A aprendizagem deve fazer parte do nosso quotidiano.
Ainda estamos à espera dos estudos prometidos sobre as gordas evidências que invocou aqui na defesa do reforço do sector privado da saúde.
Ao contrário do que aqui referi, já começei a ler o livro americano do professor. Vamos a ver se vale o investimento. Ou muito me engano ou vou ter pano para mangas, para a postagem de uma dezena de textos aqui na saudesa.
Cara Clara
A melhor forma de honrarmos o espírito fundador do SNS passa por participarmos, activamente, num movimento de esclarecimento social e de discussão técnica e científica sobre a sua utilidade e o valor social que encerra. O SaudeSA está a prestar um bom serviço à verdade. A publicação, nos últimos dias, de um grande número de reflexões e citações de documentos e artigos contribui, decisivamente, para contrariar o “marketing científico” daqueles que maltratam a verdade apenas com o intuito de confundir e gerar uma “onda” de inevitabilidade de privatização acrítica quer do financiamento quer da prestação de cuidados de saúde.
É preciso consolidar um forte movimento de resistência que seja capaz de explicar aos cidadãos os riscos que correm com o desmantelamento oportunista de uma das mais significativas realizações sociais dos últimos trinta anos.
O enorme peso político e económico dos interesses que se movem em torno do sistema de saúde torna a luta muito desigual. Não nos devemos esquecer de que não são apenas os grupos privados os interessados. Em torno deles gravitam consultoras e os vendors de todo o tipo de espécie que só têm a ganhar com a pulverização do sistema e a generalização maciça dos point of service.
Há que enfrentar os algozes do sistema no terreno da evidência técnica, científica e social. Desmistificar que se trata “apenas” de um debate ideológico. Ainda assim não temer que assim seja. A globalização selvagem e a disrupção económica e social demonstram o quão importante é a recuperação dos valores e das ideologias.
Enviar um comentário
<< Home