Joining the dots

By - World Infrastructure Journal

Universal Health Coverage presents a huge challenge in a complicated world. Vast differences in human and financial resources and in political priorities preclude any universal healthcare solution - there is no ‘UHS’.

But there are common themes which should guide both those procuring solutions and those seeking to supply them.

Healthcare infrastructure, or the built environment does not exist in isolation, so procurers or suppliers should look at the need for new hospitals, clinics or other facilities as part of the wider systems within which they are to operate.

Healthcare UK’s support in infrastructure is designed, and is being developed, to reflect the need and expectations for integrated solutions.

As part of the UK’s Department for International Trade, HCUK is concerned primarily with trade.

The inherent complexity of demand and the variations in available resource can drive a search for solutions which require trade and aid, as well as a whole range of skills and abilities, to be joined up.

And since the agendas and drivers of the various actors are diverse, if not divergent, ‘joining up’ is no small challenge.

UK organisations have a big part to play in all this. They have experience in the UK of procuring and delivering more than 100 large and complex hospitals and more than 300 primary and community care centres over a short space of time.

These projects use a variety of delivery models and sources of finance, all against a backdrop of changing healthcare needs and varying political imperatives as part of a national agenda for a national health service delivering universal health coverage.

Many of those organisations have vast experience of operating on the international stage.

Joining up the UK components

A major component of any infrastructure project is finance and it is common for a main contractor or investor to be responsible for financing a project, whether on an EPC+F (Engineering, Procurement Construction and Finance) contract or through a PPP (public private partnership) arrangement or some other collection of initials common in the infrastructure world.

UK expertise in healthcare infrastructure, finance and the necessary risk allocations are well known. UK based firms and financiers will usually be seen in major transactions.

But a key aspect is the availability of UK Export Finance guarantees which can substantially reduce the cost of a project by reducing the cost of borrowing.

More detail on how UKEF can support a project and UK exports features in other parts of this edition. In very broad terms, UKEF has a group of products that can directly support an exporter (credit insurance, working capital support and so on) and others that can support the project either by direct lending to a procuring government or, much more usually, providing guarantees to a commercial lender.

This support depends on a number of factors which HCUK can help address. The most obvious is providing support to buyers and suppliers in achieving UK export content.

We are working with UKEF, DIT’s network of geographically-focused support teams, suppliers and supplier organisations to develop arrangements to link suppliers with potential purchasers.

We are also working with main contractors and investors to encourage them to establish procurement hubs or some other ways to make it easier and more efficient for suppliers to export.

We are working with aggregators and integrators skilled in relevant export markets to make it easier to join up offerings and to take some of the headaches out of exporting.

So, the message to potential exporters and buyers is that HCUK is here to help achieve significant UK content in projects wherever they are built and wherever the main contractor or investor is headquartered.

In many cases, finance provided by commercial and multilateral development banks will be sufficient, and there will also be aid-funded projects. The World Bank has identified challenges with blending commercial lending with aid or concessional lending, especially in social infrastructure, but we continue to be interested in identifying where this can help make projects happen which would otherwise struggle to deliver; all ideas gratefully received!

Finance and excellent UK content is, however, nothing like the whole story. UK expertise can help get the most healthcare for limited resources, and make projects happen that might otherwise struggle to deliver best value.

In many parts of the world, UK master planners are looking at the optimum location of healthcare facilities in view of the demographic and transport profile of cities as well as helping to design ‘healthy cities’.

UK consultants are working on feasibility studies for healthcare programmes, while UK architects and technical consultants are designing world class hospitals reflecting the latest in healthcare thinking. They are also helping to shape facilities to meet basic healthcare needs efficiently and effectively.

Healthcare UK is working with consultants who look to maximise return on infrastructure and equipment investment by ensuring that the systems within which they are to operate are optimised, and that staff are trained to operate them efficiently.

Drawing on NHS expertise can be a huge benefit and they can also draw on the ever-developing options of artificial intelligence and other ‘digital solutions’ in which UK organisations specialise.

As a result, the UK offering in infrastructure joins up the range of world class resources and skills to meet the complex needs of procurers seeking value for money in the journey to universal health coverage.