Sir John Bourn, head of the National Audit Office, reported today that the Local Improvement Finance Trust (LIFT) initiative, launched in 2001, is an effective means of improving primary health and social care. The LIFT model has a number of strengths: it takes a long term strategic approach to local health provision which combines the benefits of national support and local control. There is more that can be done to measure performance and ensure accountability but with approximately 50 new buildings expected to open in 2005, the positive impact of the initiative will soon be seen.
A LIFTCo is a local joint venture made up of local stakeholders (typically Primary Care Trusts, Local Authorities and GPs), a private sector partner and Partnerships for Health, itself a national joint venture between public and private sectors. The LIFTCo takes ownership of the premises it builds or refurbishes and then leases the space to health and social care providers.
As a result of years of under investment in primary care services, many GPs’ premises are of poor quality. 81% were below the required size in 2000. LIFT will mean better premises, which in turn should help in the retention and recruitment of GPs. Patients will also benefit from different providers being brought together under the same roof. A wide range of services will be available in a primary care setting such as minor surgery and scanning. In particular, there will be better management of chronic diseases which account for 80 per cent of GP consultations.
LIFT appears to be an effective and flexible procurement mechanism, capable of producing value for money. Although not suitable for all areas, LIFT has advantages over alternatives such as third party development or procurement under the Private Finance Initiative. Developments are more likely to meet local needs while benefiting from standardised documentation and LIFT is better suited to small scale deals than PFI.
The Department of Health, on the whole, managed well the setting up of the initiative. The initial deals that the NAO examined are robust. They offer clear long term benefits to both the public and private sector, with value for money safeguards built into the contracts.
Inevitably when establishing a new initiative and aiming for quick results there were some problems. The local use of enabling funds was not monitored routinely and some schemes did not utilise funds in a timely manner. The target 12 month timetable for establishing the LIFTCo and agreeing initial developments was too ambitious; the quickest, Ashton, Leigh and Wigan, completed in 13 months. Once a LIFTCo is set up, the procurement process for new projects will be simpler.
On the whole, local LIFT schemes appear to be operating well although some proposals have faced local opposition. Lessons can be learned in the light of experience. In particular, local areas, guided by the Department of Health and Partnerships for Health, need to ensure accountability and improve the ways they measure performance. In particular, the Department should develop ways of evaluating the progress and contribution of LIFT to improvements in people’s health.