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MOLDOVA WORKSHOP ON PPP DEVELOPMENT “BEST PRACTICE IN SOCIAL INFRASTRUCTURE DEVELOPMENT”

MOLDOVA WORKSHOP ON PPP DEVELOPMENT “BEST PRACTICE IN SOCIAL INFRASTRUCTURE DEVELOPMENT” Leo McKenna Chair, UNECE TOS PPP International Centre of Excellence and Specialist Centres CHISINAU 10 OCTOBER, 2012. Typical National Infrastructure Context

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MOLDOVA WORKSHOP ON PPP DEVELOPMENT “BEST PRACTICE IN SOCIAL INFRASTRUCTURE DEVELOPMENT”

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  1. MOLDOVA WORKSHOP ON PPP DEVELOPMENT “BEST PRACTICE IN SOCIAL INFRASTRUCTURE DEVELOPMENT” Leo McKenna Chair, UNECE TOS PPP International Centre of Excellence and Specialist Centres CHISINAU 10 OCTOBER, 2012

  2. Typical National Infrastructure Context • Historically; procurement used public capital funding • Delivery; majority over time and over budget • Poor / little maintenance • Assets in poor condition nor fit for purpose • Not enough public capital to fund infrastructure needs

  3. Good social accommodation PPP begins with a strategic service model, not with an architect’s drawing

  4. PPP Social Accommodation Development • Identify national sectoralneeds • Develop sectoralStrategic Service Models (SSM) – Total System Design • Develop costed infra plans using Schedules of Accommodation; • accurate outline cost estimate – know what you can afford • 4. Clear Specification – use standardised spec for facility commoditisation • 5. Transparent and simple procurement process

  5. Example: Healthcare PPP Best Practice • Strategic Service Model: Planning Trends; • Migration of care from hospitals into community • “Care to Patient” not “Patient to Care” • Fewer and smaller hospitals • More 21st century community facilities • HAI – need for single rooms not multi-bed wards • Technology: Community Diagnostics • Connected Health; telemedicine – physician and patient separation chronic condition management - remote monitoring • Elderly care, Elective surgery, Mental health, GP

  6. Healthcare Strategic Service Model • Tertiary: Centres of Excellence – Telemedicine Tertiary Services; Neurosurgery, Burns, Cardiology, Paediatric Surgery • Local & Acute: District General Hospitals • Elective Surgery: Dedicated Facilities • Mental Health: Inpatients, Crisis Response Home Treatment • Primary and Community Health & Social Care Consultant Outreach, Integrated Care & Treatment, Triage • Community: Diagnostics, Radiology, Labs, Near Patient Testing • Connected Health: Home / Remote Monitoring • Elderly Care • Physical Disability and Learning Disability • Childcare Services

  7. Diagnostic Imaging(1) OOH Service Diagnostic Testing (1) Minor Injuries Diagnostic Imaging(2) Assess. Beds OOH Service GP Beds Diagnostic Testing (2) Minor Injuries Step-down Beds CDU Rehab. Beds Diagnostic Imaging(3) Acute Beds Full A&E CAA Critical Care Unit Diagnostic Testing(3) GP Consulting Treatmt. Room Limited AHP Specialties PRIMARY CARE CENTRE GP Consulting Treatmt Rooms Full Range of AHP Specialties Other Public Sector Social Services/ Community Care Professions Comm Resource and Vol. Sector Satellite Out-Patients Consulting Proced. Rooms Appropriate Private Sector COMMUNITY CARE CENTRE OPD Treatmt Rooms Full Range of AHP Specialties Social Services/ Community Care Professions Endos. Suite Day Surgery Theatres Mental Health Unit LOCAL HOSPITAL Specialist OPD Main Theatres Maternity Unit Paediatric Unit + Fracture Unit Psychiatric Unit ACUTE HOSPITAL: ADDITIONAL

  8. SSMs - Factors Influencing Location of Services • Regional Strategy and Driving Principles • Urban or rural setting • Catchment population • Travel times / distances • Critical mass for staff • Critical mass for specialist equipment • Current facilities • Improved accessibility / reduced waiting times / reduced hospital admissions • Affordability

  9. Healthcare PPP Best Practice National Healthcare Infra Plan: Facilities Service Models SSM set – you now know the location of services So, for each facility you now have a Service Model Next, convert the Facility’s service model into a Schedule of Accommodation for modern facility – international standards From all the SoAs, you now have an national infra plan

  10. Healthcare PPP Best Practice • Range of Facilities; • 3ry – Specialist Centres • 2ry / Acute (DGH) • 1ry / Community / Social Care / GP • Elective Surgery Centres • Mental Health Facilities • Elderly Care • So, which are suitable for PPP development? • It’s all about risk and pricing…….

  11. Healthcare PPP Best Practice Range of Possible Healthcare PPP Service Elements Health Planning – Conceptual Design Detailed Design Build Finance Medical Equipment Services Facilities Management; Hard FM, Soft FM Technology / Telemedicine / RFID ICT Pharmacy & Laboratory Services Clinical Services Social Services Estate Asset Management

  12. Healthcare PPP Best Practice Community Healthcare PPP: co-location of services Public Health Services Emergency Services Police Services Social Services Leisure Services Education – Schools Libraries Private Health Retail / Commercial Services “Community Hub” Concept

  13. Healthcare PPP Best Practice Flexibility Models of care continually evolve Technology continually evolves Patient needs continually evolve Patient demographics continually evolve – elderly care explosion Your PPP Model needs to be flexible 1. Flexible physical design of facilities: “spine + module” 2. Flexible PPP Contract; 3/5 year review periods, Benchmarking / market testing of services, Lifecycle technology, Medical Equipment “Equivalence”

  14. Healthcare PPP Best Practice Key Success Factors 1. Need for Soft Market Testing of PPP model prior to procurement 2. Public Sector should conduct its own conceptual design process before procurement – reduces bid time and costs 3. Transparent procurement process 4. Standard Form of Contract for PPP Healthcare 5. Should include all FM; Hard and Soft 6. No property deals 7. Separate MES PPP from Hospital PPP 8. No refurbishment 9. Need a strong public sector team and top public advisors

  15. CORRECT services CORRECT facilities CORRECT design CORRECT locations CORRECT price

  16. THANK YOU FOR LISTENING Leo McKenna Chair, UNECE TOS PPP International Centre of Excellence and Specialist Centres

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