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News archive - September 2013
Giving the healthcare estate a LIFT
The NHS Local Improvement Finance Trust (NHS LIFT) was launched in 2003 to drive much-needed improvements to the healthcare estate. A decade on, hdm looks at the impact it has had on primary and community services.
In the 1990s England began a major hospital redevelopment scheme, a move that has seen the creation of a new generation of acute healthcare facilities to rival the best in the world.
Predictably as these projects pushed ahead, the focus shifted to the primary and community estate, which in many cases was a more complex challenge on a much larger scale.
Whereas there is usually only one hospital for each town or region, there can be GP surgeries and community health centres in every village or even, in some cases, in every street.
Also driving this transformation were tougher regulatory demands, which meant that traditional single-doctor GP surgeries, often delivered out of converted residential properties, were deemed no longer fit for purpose. What was needed, and quickly, were a number of purpose-built, modern centres.
But, as the economy struggled and capital funding became scarce, the problem was finding the money to fund these improvements.
In 2003 the NHS Local Improvement Finance Trust (NHS LIFT) was launched with the aim of creating the highest-quality primary and community estate, serving the needs of local communities and contributing towards improving the health and wellbeing of entire populations.
The initiative is basically a pre-agreed framework through which the now-defunct primary care trusts, and the replacement GP clinical commissioning groups, can fund new developments and estate improvements.
In each area of England there is a LIFT company - 49 in total - which are locally-based joint ventures between public and private sector partners.
The first was set up by Newham, Hackney and City and Tower Hamlets primary care trusts in May 2003. It has since steered the development of several new facilities, with others still under construction.
The resulting buildings are multi-functional and flexible, serving both primary care and in some cases community and social care as well as the third sector and social enterprises.
As well as the commissioning NHS trust, each LIFT company also comprises architects, construction companies, quantity surveyors and other parties crucial to the development of new infrastructure. Because these organisations work together on each scheme, they develop strong relationships and this can often driving down delivery times and/or costs.
In total, across the country to date NHS LIFT has delivered 314 facilities and has created employment opportunities for more than 30,000 people. This equates to a total investment of £2.2billion worth of capital. Of all the projects, 119 were in the country’s most-deprived areas, where access to health services was historically poor. These buildings make up 42% of the overall NHS LIFT floor space and 40% of the total spend on LIFT buildings - £891m.
To mark the milestone 10th year of the programme, and to measure the impact it has had, research was carried out by Amion Consulting and a report has recently been published.
Entitled The Impact of the Local Improvement Finance Trust Programme, the evidence shows the initiative has had a profound effect on the estate and on entire communities.
Dr Sue O’Connell, chief executive of Community Health Partnerships (CHO), which has overall responsibility for NHS LIFT and commissioned the research, said: “There is much to celebrate within the past 10 years and as the national LIFT programme lead, we wanted to explore the impact of the programme during that time in more detail, recognising that while the core rationale behind LIFT is the delivery of more effective and accessible health services, there are also many other potential benefits and impacts.”
The researchers found one of the biggest impacts of the initiative was increased service integration. The report states: “This co-location of a range of service providers in one building has enabled better service integration and, in turn, facilitated improved joint working, as well as better integration of primary and secondary care and specialist services. It has also helped to reduce unnecessary hospital appointments and allowed more efficient referrals, avoiding people getting lost in the system.”
An example of such integration can be found in Liverpool where some LIFT developments have the Citizens Advice Bureau, Sure Start projects and third sector providers in fields such as mental health, smoking cessation and counselling services all based together under one roof.
It has also helped to futureproof healthcare facilities.
The report says: “LIFT developments are facilitating much better access to a greater range of services, often in areas where a significant number of residents suffer from socio-economic disadvantage including poor health and wellbeing.
“As well as providing modern facilities that are accessible to mixed communities and are necessary to efficiently meet health needs, LIFT project accommodation also enables a flexible response to the varying needs of populations undergoing rapid change.”
In conclusion the researchers state: “Overall LIFT has brought care closer to patients and integrated a greater range of services under one roof, in better environments. It has also facilitated other programmes aimed at promoting healthier lifestyles and more outpatient activity.”