16 September 2010,

The Times: The Brave New World of Local Health Services Needs a LIFT

The following article is from The Times newspaper:

17th September 2010

The Brave New World of Local Health Services Needs a LIFT

The days of hospitals providing a full range of services are numbered. The Government plans to shift provision from hospitals to communities, via small specialised centres. Whether you believe that this is a great idea, there is a bigger issue: just how can the infrastructure support this new model?

There has been investment in new clinics and community facilities, but the landscape is set to change and mass cuts in spending are around the corner. Public funding will not be able to foot the bill. To my mind, there is a very clear solution: new private finance to deliver the facilities. One such initiative is the Local Improvement Finance Trust (Lift), which creates partnerships between private sector investors/developers and public sector organisations-and could deliver consistently on a much larger scale.

Since the first Lift partnership was set up in 2002, a further 234 schemes have been delivered and others are in the pipeline involving a total investment of £2 billion. Yet for a number of reasons, the number of forthcoming projects is low.

Lift has, on many occasions, delivered community facilities for multiple uses and allowed joint procurement between different authorities. Take the Edlington Centre in Doncaster, which houses two GP practices, minor-surgery facilities, dental services, a library, office space for Doncaster Council, and district nursing and health visitor teams. This involves a partnership between NHS Doncaster, the council and Community Solutions, the private sector investor and development partner for public sector projects.

Lift may have a proven track record, but making a strong business case and being allocated funding are not the same thing. Some primary care trusts (PCTs) claim there is a Lift postcode lottery. Other trusts complain that the Department of Health has installed a highly bureaucratic process around Lift. For those whose proposals were rejected, it is little consolation that plenty of Lift companies have been set up successfully.

It can take a great deal of resources and external consultants' costs to prepare a business case, much of which is wasted if the Strategic Health Authority (SHA) does not approve the case for a Lift company. There is also little incentive for the aspiring partnerships that could reap the benefits. The government is keen to make its mark with a fresh face for healthcare provision, but this new vision cannot be successful with the existing stale processes.

For Lift to be reinvigorated, and to create a new appetite for both NHS trusts and private investors and lenders, a less onerous and time-consuming process needs to be put in place. Uncertainties about how the scheme will progress when the PCTs and SHAs are abolished must also be addressed.

Perhaps then this vital programme will move to centre stage to support the reform of our healthcare provision.

Author - Tim Care - Partner in the Public Services Practice at the law firm Dickinson Dees