Table 4.

Cross case comparison of NHS England and RHS Tuscany cases – Context.

	NHS England	RHS Tuscany cases	Comparison (commonalities and differences)	Explanation for difference
Centralisation and outsourcing	Outsourcing from public to private sector organisation to assure end-to-end supply chain control	Centralisation and outsourcing to specialised public-founded organisations to assure end-to-end supply chain control	Tuscany operations required centralising before they could be outsource. Here, the decision to outsource to a public body was developed partially to solve legal and bureaucratic issues arisen after the procurement centralisation within the Consortia.	The decision to outsource to the private or public sector contemplates a number of political implications. The search for efficiency needs to be balanced with the objectives of equity, accountability and ethics, typical of public organisations
Reasons for outsourcing	Fiscal constraints; cost savings; increase service level; standardisation and rationalisation of product categories	Fiscal constraints; cost savings; increase service level; standardisation and rationalisation of product categories	The rationale behind the centralisation and outsourcing are similar for the NHS England and RHS Tuscany
Procurement and logistics network structure	Three level procurement and logistics network structure (national, regional and local level)	Three geographical clusters (AV) in the Tuscany region	The Tuscany established three different public providers (one for each AV) with identical structure and functions, whereas the England private provider is a single organisation at a national level	The England case seeks to aggregate volumes and standardise products at a national level for economies of scale, whereas Tuscany is at a regional level. The presence of three ESTAVs generated non homogeneous outcomes