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This is opinion material. The opinions expressed here are those of the author.
During the current emergency health care situation, Sofia Wallström, Director General of the Inspectorate for Health and Care, IVO, presented a highly relevant report on New Karolinska Solna, NKS, as a public-private partnership, PAHO. The final report is called Structural Change and Investment in Healthcare: Lessons Learned from the NKS Example, SOU 2020: 15.
The questions after the implementation of NKS have been many, of great importance and relevant to the entire country. Unfortunately, this research in no way manages to clarify many of the issues raised by NKS as OPS. It is a shame, as there are certainly many lessons to be learned from this project. Let me address a single question that the investigator completely passed.
Public investigations of the state follow a certain form. Part of the research is about current law, that is, what the law says. The final report of the Public-Private Partnership, Governance and Control Commission also contains a mandatory part on how public procurement must be carried out in Sweden to be legal. Although this part of the investigation has its own shortcomings (it does not describe what was valid when the county council began the acquisition, but what it is today, which in itself is incomprehensible), in any case it manages to convey that there is a regulatory framework to be followed. Nothing is said about the consequence if the regulations are not followed. Therefore, the reader is not aware that the awarded contract could have been declared invalid.
When it is stated in the investigation that “only one offer was received” and that the county council deviated from its own established requirement of “sufficient jurisdiction”, it is at least strange that the investigation does not draw any conclusions from this. Otherwise, one conclusion could have been that the legislation regarding the acquisition of large complex projects of the NKS type is not satisfactory and should be amended somewhere. Another conclusion could have been that there is nothing to comment on the regulations and that there is nothing to change. This would also have been a valuable insight and conclusion, if this had been the case. A third, and perhaps more obvious, conclusion could have been that the county council violated the law by changing the content of the tender issue after the tender period expired. We received no answers to these questions from NKS’s extensive research.
You do not need to be a lawyer to understand that the acquisition of NKS, as described in the investigation, is problematic from a legal perspective. The reason for this is simple: if the strict public procurement rules were not followed, the agreement that was created after the procurement could have been voided.
Of the many quirks reported by the research, a particular question stands out without being answered. What was the legal analysis that gave the green light to county council politicians to make radical changes to the hiring issue without simultaneously redoing the hiring? As the investigation describes the matter, the county council has made the most fundamental mistake in any public procurement: changing the content of the object for bidding after the end of the bidding period. And this in an acquisition that only attracted one (!) Bidder. The investigator appears almost oblivious to the problem, meaning other parties might also have been interested and submitted bids if they had known that the county council would later eliminate the bidder’s risk of not receiving payment during the construction period. The change made is described in detail, but nothing is said about the consequences of this change.
In our society, we have a need to be able to leave NKS behind and move on. It is regrettable, then, that the research initiated by the government cannot answer the question of whether PAHO may be an opportunity for future large projects, in particular health care, but also other social functions. For the region that, of course, is considering implementing a hospital through PAHO, there are few answers in this report, and PAHO as a model for the development of society remains after the political death of NKS. It’s unfortunate
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