Ups and downs of LIFT

11 January 2010

Upgrading primary care facilities such as doctor’s and dentist’s surgeries to provide modern, functional and accessible facilities is underway through the LIFT programme, as Gerry Askew explains

THE ROLE OF THE NHS HAS ALWAYS BEEN to provide a consistent health care service to all residents and visitors in the UK. In terms of facilities, however, the reality is slightly different. There is no common standard for healthcare facilities or access to those facilities, except for hospitals and specialist clinics.
According to the Department of Health in 2007 over 60 percent of primary care premises
including doctor’s and dentist’s surgeries were not located in a purpose-built environment. These buildings are often converted domestic homes and not always fit for purpose. Consider also the issues around disabled access, EPCs and the fact that there is no standardised maintenance regime. The challenge for the NHS is to motivate doctors and dentists and other healthcare professionals who are effectively running businesses contracted to the NHS, to put away any concerns about increasing their overheads and to upgrade their premises.
The LIFT (Local Improvement Finance Trust) scheme was introduced to do just that. To date there are 47 LIFT and 220 primary care facilities have been built or are under construction. The public purse has made £210m available with an estimated further £1,500m of private funds. A form of PPP, the LIFT scheme is a means of funding improvements to healthcare facilities and access to healthcare services. The aim is to provide a comprehensive set of services in one location which are specific to the needs of the local area. Unlike a ‘polyclinic’, which has to have a prescribed and very broad set of health care services. A suitable location and set of healthcare services are identified by the Primary Care Trust (PCT) and existing health care service providers are then encouraged to participate in the scheme.
Herein lies one of the many double-edged swords for contractors awarded the design, build and management of these projects. A significant debating point on the LIFT schemes is the moral consideration of private sector involvement in a public healthcare organisation. Years of underinvestment have meant that maintenance budgets are regularly diverted to subsidise core healthcare budgets leaving the infrastructure depleted and in great need of repair. With government funds limited the private sector is the only option. It may not be palatable that business makes money out of healthcare facilities, but the fact is without it stepping up to the plate there is no alternative to continuing comprehensive locally available healthcare services.
Each PCT identifies a series of schemes to be commissioned for which bidding consortiums tender. The tendered bundle is then awarded to the successful bidding consortium with a caveat that the PCT cannot be held accountable to commission every project that is listed in the bundle. If all of the projects listed in the bundle are commissioned there is obviously a more significant return on investment than if only one or two are realised from the bundle.
As these are long term projects, many factors can change the course of the schemes identified in the bundle. Any reduction in the number or scope of the schemes can cause financial headaches for those businesses that make up the consortium, requiring business models to be adjusted and costs to be assessed. Bidding for LIFTs can in effect be a bit of a gamble.
Each scheme from the bundle is commissioned sequentially. The PCT issues a five year window to commission each project from when the framework agreement is signed. As the contractor team remains the same for the development of each scheme there are opportunities to drive efficiencies across subsequent projects. As the FM provider is part of the consortium that tendered for the bundle, as each project develops the FM partner is part of the solution development at the start of the design process as well as at the delivery and mobilisation stages. This has significant benefits for the life cycle management aspect of the project. An important factor as the clauses under which the LIFT project operates, are similar in nature to those for PFI and Building Schools for the Future schemes. Developing the relevant set of services is as critical to the successful operation of the LIFT scheme as for any other environment.
Detractors of the LIFT projects come from both the practitioners who would potentially rent the space and the users of the healthcare services. Worried about increased overheads and sharing spaces with other services, the practice owners are intent in seeking out value for money and are therefore a highly discerning customer. Users of the services are often to resistant to change given that their GP may have moved to a less convenient location, and some find the large premises more intimidating than a small single service practice.
There is more pressure to ensure the specification of the FM services is spot on from day one. If the building is running smoothly from the day of occupation, the better the chance of impressing the stakeholders who are occupying the building. Although the set of services is very similar to that of any healthcare environment, the emphasis for the provider must be on delivering a much higher standard of service than the stakeholders experienced before, notwithstanding the need to overcome the emotive subject of outsourced cleaning in a healthcare environment.
When it comes to mobilisation there is often no existing team for TUPE transfer. The FM provider has that rare opportunity of recruiting a brand new team specific to the needs of the new environment. Selecting those with experience of healthcare environments is critical. The delivery team needs to be sensitive to the users of the specialist services, understand the need for discretion and confidentiality of patients being treated, as well as delivering to the exacting levels of service required. For example the Hornsey Central Neighbourhood Care Centre includes a dementia day care centre where individuals are assessed and take part in group therapy activities, access and interaction with service users has to be a consideration of the FM service provider’s induction and ongoing training programmes.
No one is pretending that the LIFT scheme runs on a smooth road. It was developed with the best of intentions but it can be a difficult journey for health care practitioners, the PCTs and the consortium members alike. Yet users of the speech and language centre in South East Essex, the dementia day care centre in Hornsey, or the community clinics for smoking cessation or healthy eating in Southampton would say it is worth it for the improvement to their daily lives.Now that’s something to be proud of.
● Gerry Askew FM Director for SGP Property and Facilities Management Ltd LIFT. Projects (SGP) Ltd works with Assura Ltd, the lead on the projects illustrated.
Adelaide Health Centre South West Hampshire
4,500 sq m over three floors open in autumn 2009.
Health care services: GP surgeries, Podiatry, Leg ulcer and tissue viability, Physiotherapy, Health visitors,Community neurological rehab
FM Services: Hard FM, Cleaning,Security, Car park management, Grounds maintenance, Facility Management
Hornsey CentralNeighbourhood Care Centre
Barnet, Enfield and Haringey 5,400 sq m over three floors open in summer 2009
Health care services: GP surgeries, Blood tests, Ultrasound, Physiotherapy, Diabetes clinic, Podiatry, Community nursing, Minor surgery, Dementia day care centre, Sexual health clinic
Central Canvey PrimaryCare Centre, South East Essex
2,960 sq m over two floors open in spring 2009
Health care services: GP surgeries, Speech and language services,Community nursing, Children’s services, Minor surgery, Community pharmacy, Stop smoking services