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.

Misaligned and Polarity-Reversed Faces Determine Face-specific Capacity Limits

Previous research using flanker paradigms suggests that peripheral distracter faces are automatically processed when participants have to classify a single central familiar target face. These distracter interference effects disappear when the central task contains additional anonymous (non-target) faces that load the search for the face target, but not when the central task contains additional non-face stimuli, suggesting there are face-specific capacity limits in visual processing. Here we tested whether manipulating the format of non-target faces in the search task affected face-specific capacity limits. Experiment 1 replicated earlier findings that a distracter face is processed even in high load conditions when participants looked for a target name of a famous person among additional names (non-targets) in a central search array. Two further experiments show that when targets and non-targets were faces (instead of names), however, distracter interference was eliminated under high load—adding non-target faces to the search array exhausted processing capacity for peripheral faces. The novel finding was that replacing non-target faces with images that consisted of two horizontally misaligned face-parts reduced distracter processing. Similar results were found when the polarity of a non-target face image was reversed. These results indicate that face-specific capacity limits are not determined by the configural properties of face processing, but by face parts.