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.

The Political Economy of Reproduction: Motherhood, Work and the Home in Neoliberal Britain

This thesis investigates how the processes and practices of reproduction have been transformed not only by the ascendant political rationality of neoliberalism but also by women’s struggles that have reconfigured motherhood, the domestic home and the gendered organisation of employment. Through exploring both the 1970s feminist demand for “free 24- hour nurseries” and the contemporary provision of extended, overnight and flexible childcare, care that is often referred to as “24-hour childcare”, the research contributes to feminist understandings of the gendered and racialised class dynamics inside and outside the home and the wage. The research repositions the ‘Woman Question’ as, yet again unavoidable and necessary for comprehending and intervening in the brutalising consequences of capitalist accumulation. Situated within the Marxist feminist tradition, the work of reproduction is understood as a cluster of tasks, affective relations and employment that have historically been constructed and experienced as ‘women’s work’. The interrelation between the subjectivity of motherhood and the political economy of reproduction is analysed through a feminist genealogy of 24-hour childcare in Britain. Using ethnographic encounters, archival research and interview data with mothers and childcare workers, the research tells a story about the women who have worked both inside and outside the home, raised children, cooked and cleaned, and who, both historically and in the present, continue to create an immense amount of wealth and value. As women's labour market participation has steadily increased over the last 40 years, the discourse of reproduction has shifted to one in which motherhood is increasingly constructed as a choice. Within neoliberal discourse the decision to have a child is constructed as a private matter for which individuals bear the costs and responsibility. The thesis argues that, as a result of motherhood being constructed more and more as something that is chosen, the spaces of resistance and opposition towards motherhood have been limited and resistance has been individuated and privatised.