Yesterday I told you about a KPI regime that seemed a horror story.

Today, I bring you another that kills.

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Kills contract, I mean.

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I often tell people that vertical PPPs are not my cup of tea.

Hospitals… I run away.

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Too complicated.

Too political.

Too high stakes.

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Take the wave of hospital PPPs in the UK during the 2000s.

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On paper, they looked brilliant: new facilities, modern equipment, long-term maintenance secured.

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But still… the KPI regime was written by bureaucrats with too much coffee and not enough common sense.

They would have never impose themselves such stupid KPIs… but I guess that their consultants were paid by the hour… or by the horror – who knows.

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Imagine this:

Thousands of tiny service specifications. An army of people to supervise, another army to justify non-performance, and more and more people to dispute everything.

Everything.

Every cleaning delay, every lukewarm meal tray, every flickering lightbulb was a “breach.”

Deductions triggered daily, weekly, monthly.

More bureaucrats and technicians than patients.

Two people per bulb, 10 patients per doctor.

A regime so rigid that even the best operators couldn’t keep up.

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Instead of focusing on outcomes — “is the hospital clean, safe, and functional?” — the contract focused on minutiae.

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And that minutiae created a war of spreadsheets.

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Public vs. private.

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Every fault logged.
Every invoice challenged.
Every meeting a dispute.

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It wasn’t a partnership.
It was a never-ending battle over compliance.

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The result?
Hospitals where the energy went not into patient care, but into contractual trench warfare.
Operators demoralized.
Governments blaming “greedy contractors.”
And taxpayers footing the bill for armies of lawyers and auditors instead of doctors and nurses.

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The lesson?
A KPI regime that looks like a punishment manual doesn’t guarantee performance.
It guarantees conflict.

Hospitals deserve better.
Patients deserve better.

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And PPPs sure as hell deserve better.

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Many of these issues would have been prevented if people followed the common sense of these 100 Q&A.

​100 Q&A About PPP that you MUST KNOW​

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