Public-Private Partnerships have been a popular public procurement policy in a number of countries including Australia, the UK, and New Zealand since the early 1990s. This article examines the experience of the Port Macquarie Base Hospital (PMBH), the first public hospital delivered under the Public-Private-Partnership (PPP) model in the State of New South Wales, Australia. Using a framework adapted from Macário, this study focuses on the political climate in which this PPP mechanism was implemented, identifying the underlying motives driving the use of a PPP to deliver public health services and clarifying the essential conflicts undermining the PPP process. The article covers the entire life cycle of the PPP hospital, from the initial contracting process to its eventual sale. A political desire to reduce public debt, allied with an ideology assuming private sector superiority, made this approach particularly attractive, but failed to deliver the desired outcome. The success of PPPs would appear to depend strongly on goal alignment in a multi-level political system. Auditing processes during the implementation process need to take account of the presence or absence of such alignment.
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