LIFT is proving one of the great success stories of investment in public infrastructure. Not only is it delivering substantial improvements in the quality of facilities and services in primary care, but it is also facilitating better joint working between the health and local government sectors.
There are now 48 Local Improvement Finance Trusts, covering half England’s population. These have provided investment of £1.6bn into primary health care and local government facilities since LIFT was established in 2001. Ambitious plans promise to extend the investment and success across the rest of England.
LIFT is now providing much higher quality premises than were previously available, replacing, in particular, GP surgeries that were out-of-date, unsuitable and often inhospitable to people with disabilities. State-of-the art new buildings not only accommodate these demands, but will also be the basis for the future structure of primary care delivery. And they can co-locate services in ways that significantly improve users’ experience and cut costs for providers.
One of the most exciting examples of this is the new Mill Rise village in Newcastle-under-Lyme in Staffordshire. Dr Ann Pursey is managing director of the LIFTCO, Prima 200, that leads the Mill Rise development and comprises a partnership of the primary care trust, two local authorities, two housing bodies and the Homes and Communities Agency.
“It brings together extra care facilities for older people and primary care facilities,” says Pursey. “If you look at health and local authority services from the public’s point of view, they don’t understand why it is so difficult to work together, or who provides what. The purpose [of Mill Rise] is to provide services to end users – patients and their families.”
Mill Rise integrates regeneration, extra care housing and previously disparate health services. It has 60 one and two bedroom flats, supported by a laundry, cafe, restaurant, bar, function room and hairdresser. Three GP practices are located in the centre, as are physiotherapy and pediatry facilities. Some community health services will move into Mill Rise. Next door – to be built on the same disused former factory site – will be a new mixed tenure housing estate.
The guiding message, says Pursey, is that public bodies can work together to provide seamless services. “We need to get into a culture of how to achieve things, rather than saying it is all so difficult or impossible,” she explains. “It was about people believing that this could happen and making compromises to make it happen.”
Dr Sam Everington was a founding director of the LIFT programme and his Bromley-by-Bow surgery is the best practice model that inspired LIFT. “The first principle [at Bromley-by-Bow] is holistic health care,” he says. “It’s about addressing people’s education, employment, creativity and their environment, all at the same time.
“We run a whole series of courses, many designed to get people into employment. That follows into education, which is also about health and wellbeing. There is a great emphasis on public health – from breast feeding to English as a second language.”
Both the LIFT programme and health minister Lord Darzi’s Next Stage Review envisage many more of the Mill Rise and Bromley-by-Bow type centres, integrating health and community services. LIFT is the mechanism that delivers these closer partnerships, procuring the premises using private finance.
“I am a huge supporter of the LIFT programme,” says Professor David Colin-Thomé, the Primary Care Tsar. “It fits in beautifully with our policy direction.” This not only promotes co-location of related and complementary services, but also focuses on improving the quality of life as a means of promoting good health. Integrating, for example, GP premises with leisure services and libraries, supports this approach.
For this strategy to be successful, Colin-Thomé explains, councils must be partners in LIFT. “Local government has far more to do with healthcare than we in the healthcare system could ever achieve,” he says. “It is important to work together so there is a synergy between local government and us that will make that significant difference.”
The Local Government Association has taken a similar view in supporting LIFT. Cllr David Rogers, chair of its Community Wellbeing Board, says: “Helping people be active and stay healthy is something councils and the NHS are already working closely on. The key to looking after our increasingly ageing population is to offer as much early advice and support as possible so people avoid ill-health and can stay out of care homes or hospitals. Councils have excellent knowledge of their local areas and can help decide how and where health services and leisure facilities can best be provided so they’re of benefit to the maximum number of residents.”
Joe Montgomery, director general for regions and communities at the Department for Communities and Local Government, is urging closer involvement by local authorities in the planning and delivery of LIFT schemes. In particular, he wants strong relationships between LIFT and Building Schools for the Future, but also with the rest of local authorities’ capital programmes, including regeneration. “Regeneration is not just about knocking down houses and building new ones; it is actually about making sure that all of these natural neighbourhoods, all of these natural communities, have all the ingredients that make up a high quality, sustainable place,” he says.
Yet until now, there have been barriers to rolling-out LIFT to much of the country, because about half of PCTs do not have partnering arrangements with local LIFT companies. This is now being resolved through the Express LIFT programme, enabling all PCTs to benefit from LIFT. A national procurement framework provides PCTs with a list of approved private sector partners, through whom new primary care facilities can be procured. PCTs – often working with local authorities – can obtain strategic advice, design skills, management of a supply chain and access to funds. The programme will speed-up procurement and cut costs.
Health minister Ben Bradshaw believes that establishing Express LIFT will drive further progress. “Express LIFT will make it quicker and easier for PCTs to use LIFT to develop their primary and social care infrastructure,” he says. “Suddenly, the LIFT programme will become open not just to half the PCTs as now, but to all of them.”
The Treasury has also stressed its commitment to LIFT. Last November’s Pre-Budget Report promised that new models of Public Private Partnerships would be developed to support LIFT, enabling its application to be extended across the management of the entire estate of PCTs.
Bradshaw argues that LIFT benefits from having a strong and skilled national broker making its case – Community Health Partnerships (CHP). “I know that CHP is ready to step up to the plate and offer all the support that PCTs and local authorities might need to fulfil the potential of a programme that is doing so much to build healthier communities,” he says.
Community Health Partnerships – called Partnerships for Health until 2007, when it came under the wing of the Department of Health – has developed significant expertise, enabling it to provide greater support for PCTs working with LIFT.
Dr Sue O’Connell, CHP’s chief executive, is positive about the future. “The outlook points towards the programme going from strength to strength,” she says. “This is because of the innovative partnerships involved in LIFT, the sound flexible processes, the track record of delivery, and, now, the certainty around the policy direction. Most of all, there is a real imperative on local organisations to deliver on the ground. All this should give huge confidence to those committing funding, both in the public and private sectors.”
And there is optimism that the credit crunch will not seriously undermine the LIFT programme, because individual schemes are relatively small – typically between £5m and £25m – and remain attractive to lenders.
Chris Whitehouse is chief executive of LIFT LOBI – the Liaison Organisation for Business Investors. He explains: “Finance is still available. It is a more challenging market and we are having to work harder, but we are still successful. The reason for that is that LIFT is a mature investment vehicle, with a record of success and it is operating in the direction of travel of government policy and opposition policy. It is secure and it is an investment vehicle of choice at a local level. Financial investors are saying it is very secure and delivering a reasonable rate of return in what are otherwsie challenging markets.
“Our members are extremely bullish. LIFT has three major ways in which to expand. First, to secure more specific projects in the primary care NHS sector. That is starting to happen. Secondly LIFT needs to roll out geographically to cover those areas not currently covered. That is happening through the Express LIFT process. Thirdly, LIFT has become a mature investment vehicle that has a track record of delivering high quality projects on time and on budget. Local authorities challenged to deliver more co-location of services and joined-up provision will find it a welcome, convenient and reliable way to deliver a programme of priorities, particularly in social care.”
It seems that nothing, not even a global crisis, will stop LIFT now.