Published: 10/04/2003, Volume II3, No. 5850 Page 34 35
As the ink dries on the first wave of LIFT contracts, Steve Mathieson outlines some of the lessons the second and third waves would be wise to heed
The first of the local improvement finance trust projects, East London and City, was due to reach its financial close late last month.
The early schemes are producing some innovative ideas, such as sharing buildings with other public and private-sector services.
However, the challenge of later ones will be to match the ambition of the pioneers while coping with greater numbers. There are just six schemes in the first wave of the programme, designed to help meet NHS plan targets of 500 new one-stop primary care centres and 3,000 enhanced GP premises by 2004.
But the second wave contains 12 projects and the third 24.
One person well aware of the potential involved is Dr Sam Everington. He is a nonexecutive director of Partnerships for Health UK, the body that takes a stake in each LIFT project. Dr Everington says that some new LIFT schemes are unimaginative, such as a recent proposal for five standalone GP surgeries, each with their own separate waiting room.
'I thought it was such a missed opportunity, ' he says.
Dr Everington is a GP at Bromley-by-Bow health centre in London, used as an exemplar by the Department of Health for LIFT schemes. The centre includes facilities for art classes, pottery, sculpture, exercise and computer training, its own garden, a workplace crèche and a vicar.
'The artists did my practice leaflet, ' he says, as well as providing paintings and sculpture for the open-plan reception area. This is shared by all the facilities, cutting costs and creating a friendly atmosphere. And the GPs can 'prescribe' use of the other facilities in the centre. 'We have an internal referral system, ' says Dr Everington.
The vicar can help with bereavement and counselling, while the various courses on offer can help patients in a variety of ways. 'Our prescription armoury is so much wider.'
Some of the LIFT schemes close to construction include a wide range of facilities.
Manchester, Salford and Trafford, which expects to reach financial close with private sector consortia Jarvis Primary Health or ExcellCare in the first week of July, has plans for libraries in Salford, community and health facilities in Trafford and co-locating with the local ambulance service.
'LIFT will be the backbone for Salford's library service in future, ' says project co-ordinator Chris Wright. In Trafford, two buildings will be constructed side-by-side, the primary care centre through LIFT, the other a healthy living centre funded by the government's New Opportunities Fund and the local authority.
'There will be plenty of community space, perhaps for classes, adult learning, a community crèche and cafeteria, ' says Mr Wright.
'That kind of thinking is the way we hope to go with the other local authorities.'
Marion Rex, project director of East London and City LIFT - speaking before the project reached its financial close, planned for 21 March, with Group 4 Falk Global Solutions and Babcock and Brown - says that all its initial sites include space for the voluntary sector.
'The slant depends on that community's priorities.' The same is true for retailers within the schemes. 'One of our GPs would like to move in an alternative-therapy shop window, rather than a pharmacy, ' she says.
Housing will be provided within these sites, though the first batch will not include lower-priced accommodation for key workers. Social housing should follow in future projects: 'There is a particular shortage of married key worker housing, because of the assumption that key workers are single.
But GPs are likely to be married with small children, ' says Ms Rex.
East London and City will be a few weeks late in closing its project, a process that is meant to take 12 months. 'I think we can be excused slippage, because where there were not documents we had to produce them, and where there were, we had to road-test them, ' says Ms Rex. 'In future, people will not have very much difficulty in following them.'
But Stephen Gale, director of health and social care projects at Leicester City West PCT, expresses doubts. 'LIFT is a very ambitious scheme, with a lot of things being done quickly. There is no doubt it has a very challenging timetable. You have got to have a fairly detailed strategy to attract partners, then show them around the estate, then reduce them to three, then There is quite a lot of work. I wouldn't underestimate what the PCTs undertake, and the private sector too.'
To this end, there has been a reduction in the number of recommended sample projects used in the procurement process: East London and City learned the hard way. 'We thought it was clever going out with 11, but it wasn't clever at all, ' says Ms Rex.
'We went down to six. We are now working in detail with three. Basically, you can't deliver the entire LIFT programme in one year and you do not want to, with a 20year relationship.
'It is about phasing - you need to get bidders to show their skills.'
Joe Clyne, policy lead on LIFT at the DoH, says three is now the maximum recommended number of sample schemes. 'It is easy to underestimate the amount of work involved, ' he says.
The private sector has welcomed the smaller number of sample schemes within each project. Sylvie Pierce, once chief executive of the London borough of Tower Hamlets, is managing director of Capital and Provident Regeneration, bidding as part of a consortia for LIFT projects. 'How do you encourage people into this market - apart from the usual PFI suspects, lovely as they are?
One of the ways is, you reduce the cost by having fewer sample schemes.
'If we end up with four or five [consortia] bidding and winning all the LIFT schemes, I think that will be rather depressing.'
One problem with the rising numbers of LIFT schemes is that those away from the big cities, where making extra money from the properties could be harder, may find themselves short of bidders.
Stephen Rickwood, PFI director for management consultancy Cyril Sweett, has been working for the public sector on Norfolk's LIFT project.
'They are having problems getting consortia to bid for it, ' he says, adding that London LIFT schemes can attract more than a dozen bids.
Mr Rickwood says that one solution is to build consortia from local businesses.
Several of those involved in LIFT compare it favourably to the PFI process. Mr Rickwood says this is down to the way that public and private sector staff have to plan work together over years, rather than all at the start of the project.
Ms Rex says much of the documentation is standardised and that property prices are agreed by the district valuer, removing two major haggling points. 'It just feels much more promising than PFI, ' she says.
'I worry that people think LIFT can deliver the entire NHS plan overnight, ' she says.
'It can't, but it can start to do it. Once the vehicle is there, it can churn out as many projects as people have the imagination to want to do. It also means people in primary care can do far more of the specialty they want to do.'