Value for Money Evaluation of Three Operational NHS Private Finance Initiative Contracts

This thesis draws on the analysis of data from interviews, observations, documents and archival records to examine the conditions of possibility for PFI procurements by three English National Health Service (NHS) Trusts and the extent to which these projects are affordable and delivering Value for Money (VfM). Drawing from Bourdieu’s Theory of Practice and his social praxeology, the thesis problematizes the critical explanations for the adoption of PFI by NHS Trusts and the VfM evaluations in operational projects. It contributes to the literature by theorising and empirically examining the operational conditions that have made NHS PFI a viable possibility, and the affordability and VfM issues arising from choosing and implementing PFI. On the conditions of possibility, the thesis finds that the state, through a statecraft of modernisation, structured local dispositions for PFI programmes using multi-layered and multi-directed reforms. Reforms restructuring the bureaucracy and financing of healthcare delivery, together with state-wide neoliberal practices, made Trusts more receptive to the use of the PFI. In addition, the increasingly evolving demands from national healthcare delivery frameworks in their applications to insufficiently resourced Trusts, defined the spatio-temporal adoption of the PFI. The thesis also finds that the projects are relatively unaffordable, but the reasons for their unaffordability are complex and multi-layered. In addition, VfM in operational projects is polysemous; has largely become symbolic and inconsequential, with its pursuit and constitution taken for granted. Ex-post evaluation programmes are not executed as procurers hold the costs of such exercises to outweigh the benefits. Furthermore, HM Treasury’s regime for VfM determination, in application, constructs a VfM reality removed from the ‘lived’ experiences of the procurers; and accounts for the apathetic inertia in PFI procurements. However, this same regime works to the benefit of stakeholders vested with financial and ideological interests in the functioning of the PFI.