Use the selection boxes below to find reports concerning a specific country or sector or subject (or a combination), and click 'Apply'.


  • Challenges of digital government - Dec 2013Jane Lethbridge

    This report was commissioned by PCS.  It examines how digitalisation has affected employment in the retail sector and how a group of countries, Singapore, Denmark, Germany and Japan, have approached the digitalisation of government services.  The recent experience of digitalisation in UK government services is analysed as well as the issues faced by service users.  The report concludes that training of civil servants is crucial for the success of digital government.  Strategies are required to meet the needs of a wide range of service users if a digital ‘divide’ is to be avoided.

  • List of water re-municipalisations worldwide - November 2013 - Dec 2013Emanuele Lobina

    This report identifies 86 examples of water re-municipalisation that have taken place over the past 15 years.

  • Steria profile - Nov 2013Jane Lethbridge

    This report is a corporate profile of Steria, a French multi-national company, which has moved from providing IT support to central and local government to providng new ways of organising administrative and financial services for the public sector.  

  • CIVICA PROFILE - Sep 2013Jane Lethbridge

    This report provides a profile of CIVICA, a company providing ICT and other management services such as ‘agile’ working, Electronic Data Management and workflow to local authorities and other public sector agencies in the UK, Australia, New Zealand, Singapore, Canada and the United States. 

  • Renewable energy depends on the public not private sector - Jun 2013
    David Hall
    Sandra Van Niekerk
    Steve Thomas
    Tue Anh Nguyen

    This report presents empirical evidence on the central role of the public sector in investing in renewable energy, and the limitations and problems of expecting private sector investment in renewable energy.  

  • Progress with Energy markets inEurope - Jun 2013Steve Thomas

    A critical appraisal of the European Commission Communication ‘Making the internal energy market work’ (2012) 367 final

    It is 15 years since the European Commission’s electricity liberalisation Directive came into force quickly followed by a similar gas Directive. At the heart of the policy was a belief that the monopoly electricity and gas industries could be transformed into competitive industries with significant benefits to consumers. This paper examines the European Commission’s
    review published November 2012 of progress towards competitive energy markets.

  • Ambulance, emergency and firefighting services in Europe Increasing commercialisation? - May 2013Jane Lethbridge

    This paper examines the extent to which ambulance, emergency and firefighting services in Europe are threatened by the processes of commercialisation and privatisation. There are different traditions of provision of ambulance, emergency and firefighting services in European countries.  They can be analysed in terms of providers of services but also the extent to which services are publicly funded and free at the point of delivery.  In the majority of countries ambulance, emergency and fire-fighting services are publicly funded and delivered by the public sector.  

    National arrangements for ambulance and emergency medical services are influenced by the historical background to the provision of emergency services. Recent changes in healthcare systems, including contracting out of services, is beginning to impact on the ambulance and emergency medical services.  The United Kingdom has contracted out patient transport over the last ten years but there are indications that a for-profit ambulance sector is developing.  Falck, the Danish provider, has expanded into several European countries since 2000 and in the last three years the company has expanded into North and South America.

    Ambulance and firefighting services are still predominantly provided by the public sector in Europe but there are developments that show that processes of commercialisation are beginning to impact on these services, e.g the expansion of Falck.


  • Care home versus home care? Which direction for care services in Europe? Eligibility for European Works Councils - May 2013Jane Lethbridge

    The aim of this paper is to consider the eligibility of multinational companies working in the care sector for European Works Councils.  It does this in the context of European and national policies impacting on care, particularly home care, and the strategies of multinational companies operating in this sector.


    Long term care is a political issue for almost all Western European countries because the population is ageing.  National governments are approaching the provision of care in different ways in some cases providing cash for care services, in others making it mandatory for individuals to be part of social insurance or private insurance schemes.  In other countries older people are given a right to a basic package of care but no extra funding is made available to fund services.   The way in which individuals can access long term care, whether through care allowances, vouchers, directly provided services, influences the way in which care services are organised, which impacts on care workers, often negatively.  In Eastern/ Central Europe care services are in an early stage of development, with limited development of local not-for-profit services delivered in the community.

    The for-profit sector is still trying to identify the most profitable strategies for care homes and home care.  Several countries are experiencing a decline in care homes beds with an increase in home or domiciliary care.  Private equity investors remain active in the care home sector but are also investing in home care companies.  The for-profit care home sector has been shown to deliver poor quality services in several countries. This has led to a questioning of whether outsourcing of care services is the best way of delivering care.  The use of business models that depend on borrowing capital during a period of global financial crisis has undermined the profitability of the for-profit sector in the UK. 

    The extent of multinational care company expansion has not changed significantly since 2010.  French care companies continue to acquire companies in neighbouring countries (Switzerland, Spain, Belgium and increasingly Germany) but are not owned by private equity investors although are starting to engage in joint ventures with property investors.  Nordic care companies, with private equity investors, continue to operate in the Nordic region but with little expansion.  Two companies in Sweden have been criticised for poor quality care, with one now being put up for sale. 

  • Expansion and consolidation? Major trends and eligibility for European Works Councils - May 2013Jane Lethbridge

    This paper reviews multinational companies involved in the healthcare sector in 2012, focusing on companies that either have, or are eligible for a European Works Council (EWC).  It builds on previous papers.      The paper starts with an overview of EU legislation and the development of public health and healthcare policy at European level. Although EU treaties acknowledge the importance of health and health promotion, the implementation of specific Treaty clauses is through EU strategies rather than through the use of Directives, which would have more influence.  The promotion of the health of the population or public health is seen as more of an advisory activity targeted at national governments and not an integral part of the stronger internal market policies. 

    Although subsidiarity has been an important principle that has enabled national health services in Europe to determine their own policies, several EU Directives, for example, cross border health care and the movement of professionals, and the internal market are beginning to influence national health systems directly.   The European Court of Justice (ECJ) has influenced health policy through decisions about cross border healthcare as well as medicine and pharmaceuticals. 

    In 2011, the final Directive on ‘Cross-border health care’  to facilitate access to safe and high-quality cross-border healthcare and promoting cooperation on healthcare between member states was published.   It represented an important development in the growing role of the EU in healthcare.  The aim of the Directive is to both ‘respect the case law of the European Court of Justice on patients' rights in cross-border healthcare while preserving member states' rights to organise their own healthcare systems’. The European Council finally approved the text on 28th February 2011, although Austria, Poland, Portugal and Romania voted against and Slovakia abstained.

    There is still a lack of clarity about which “health services” are covered by the Directive.  Health services are defined as services delivered by health professionals to “assess, maintain or restore …..state of health, including prescriptions, administration of drugs and medical products”.  It does not cover long-term/ care services for older people.  Reimbursement of costs depends on the eligibility of the individual to services within their home country.  However, if a country does not provide a service, it is unclear what will happen if the patient is unable to afford to pay for treatment.  A member state can pre-authorise on the grounds of the general interest for: hospital care, non-hospital care requiring medical technology infrastructure; treatments presenting a risk for the patient and a healthcare provider where there is concern about the quality and safety of care.  

    A second issue where action at EU level is affecting national healthcare systems is the movement of professionals. EU Directives relating to free movement of (health) professionals are based on a provision for mutual recognition of qualifications.  This has implications for health professionals working in national healthcare systems.  Educational programmes have to comply with basic standards, which are usually defined in relation to length of training.  Health professionals are considered to have reached the level of competence to work anywhere in the EU once they have completed a series of qualifications, defined by length of training.   

    In a further revision of the 2005 Directive, a proposed Directive amending Directive 2005/36/EC on the recognition of professional qualifications and regulation on administrative cooperation through the Internal Market Information System was published in 2011.  The proposed Directive highlights some of the potential problems in facilitating the movement of professionals, particularly health professionals, between countries.  It recognises that health professionals are an increasingly mobile workforce but some of the recommendations threaten to weaken the scope of national systems of professional registration.  The Directive proposes the creation of an Internal Market Information System (IMI) European Professional Card which would make the recognition of professionals quicker when moving from one country to another.  The card would be voluntary and its success would depend on national registration authorities having sufficient resources to deal with this process.

    Although national governments retain the responsibility for health care policy, many policies, for example, contracting and outsourcing, adopted by national government have created markets in national healthcare systems. Services delivered by national health systems are, as a rule, now considered as an economic activity, according to ECJ rulings and EC policies of recent years, for which the rules of Community law, on the fundamental freedoms of the internal market, public procurement and state aid in principle, apply.  Exemptions, exceptions and limits can and need to be decided by making reference to other policy goals, such as health, social and employment policy, and by invoking ‘overriding reasons of general interest’ or ‘public service obligations’.  What often starts with the contracting-out of ancillary services evolves into more extensive contracting-out of diagnostic and clinical services, which are unambiguously healthcare services, leaving reduced core services directly delivered by the public sector. 

    In countries of Central and Eastern Europe the transformation of publicly funded and publicly provided healthcare systems has taken place since 1989.  New legislation has created a legal basis for private providers to operate and charge fees.  Decentralisation of hospitals and health care institutions has been accompanied by a reduction in health care budgets which have led to the introduction of user fees and subsequent limits to publicly provided or financed healthcare access.  User fees have contributed to the corruption at local and national levels.  All these changes have contributed to the weakening of public healthcare systems.  Although there have been attempts to challenge these reforms and struggles to maintain publicly funded healthcare systems continue, there have been some fundamental changes which make healthcare vulnerable to continued commercialisation.  

     Companies involved in the healthcare sector in Europe can be divided into five main groups, which are not exclusive:

                        Service companies – facilities management;

                        High technology equipment for diagnosis and treatment, e.g.renal care; 

                        Laboratory services – pathology services;

                        Healthcare companies that provide healthcare directly

                        Public-private partnerships

    The impact of the economic/ financial crisis and austerity policies in many European countries can be seen on several companies.  Austerity policies in many European countries have reduced public sector budgets with some reductions of contracting-out but austerity policies can also lead to increased contracting out. 

     A series of short company profiles include a) companies eligible for EWCs and b) companies not yet eligible for EWCs but which have shown signs of expansion outside their domestic market.

  • Why the private sector kills more than it cures Countering arguments in favour of privatisation - May 2013Jane Lethbridge

    The aim of this briefing paper is to counter the arguments that are made in favour of health care privatisation.  Pressures on national governments, from international and regional agencies, to reform public healthcare systems have been unrelenting for several decades.  Underpinning these pressures was a widely promoted assumption that the private healthcare sector was more efficient and effective than the public healthcare sector.  This briefing paper draws on recent research to show that the private healthcare sector is not more efficient and effective than the public healthcare sector. More importantly, the private healthcare sector contributes to worse health outcomes.  The research is drawn from studies of countries at different levels of development and income.

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