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Local Improvement Finance Trusts (LIFT)

5th January 2007

10072006_drswaitingroom1.jpgWhat is LIFT?

NHS LIFT was established in 2001 to increase the provision of modern, fit-for-purpose accommodation for primary and social care in England.

The scheme encourages PCTs to work closely with local councils, stakeholders and the private sector to develop innovative, integrated approaches to service provision. It aims to provide modern primary care facilities in areas where previously there have been low levels of investment. 

This investment is delivered through the creation of a long term strategic partnership and local joint venture between the public and private sector.

Why has LIFT been introduced?

Research indicated that many primary care premises are inappropriate for delivering modern health and social care. For example:

• Only 40% of primary care premises are purpose built.
• Approximately 50% are adapted residential buildings or converted shops.
• Less than 5% of GPs’ premises are co-located with either pharmacy or social services.
• 80% are below the recommended size.

NHS LIFT is being used to address this situation and deliver the following primary care targets set out in the NHS Plan:

• Invest £1bn in primary care estate.
• Upgrade/ replace up to 3,000 primary care premises.
• Create 500 one stop primary care centres.
• Co-locate GPs, community services and social care agencies where possible.

How does LIFT work?

At a national level

In 2000 the Government established Partnerships UK (PUK) to accelerate the development, procurement and implementation of public private partnerships. PUK is jointly owned by HM Treasury, the Scottish Executive and a range of public sector interests. It aims to:

• Support the development of the PPP market.
• Establish new forms of PPPs.
• Deliver individual PPP schemes which provide good value for money.

The organisation works exclusively with / for the public sector and is itself a public private partnership (PPP).

In 2002 the Department of Health established a joint venture, known as Partnerships for Health (PfH) with PUK to deliver the LIFT initiative. The purpose of this joint venture is to:

• Develop LIFT as a new market for investment in primary care and community based facilities and services.
• Work in partnership with local health economies to establish local LIFT companies (LIFTcos) and establish local developments. 

At a local level

Local LIFTcos are joint ventures comprising local stakeholders (typically PCTs, Local Authorities and GPs), a private sector partner and PfH as shareholders. The purpose of private sector involvement in LIFTcos is to access capital and skills in property development / management, construction, service contracting and project management.

The main functions of a LIFTco are to:

• Help the local public sector to plan future premises requirements which meet the care needs of the local community.
• Deliver the agreed investments and services.
• Receive payment for delivering the investments to the agreed performance standards.

Each LIFTco is responsible for managing and implementing a long term investment strategy (typically 20-25 years) to develop local facilities and services. The LIFTco has a:

• Board of directors which reflects the shareholding split within the company.
• A long term partnering agreement to deliver investment and services in local care facilities.

The local health and social care community monitor the performance of the LIFTco through a Strategic Partnering Board. This board reviews progress and approves new projects for development on an annual basis.

The contractual framework for a LIFTco comprises:

• A partnering Agreement to foster close co-operative working relationships between the private and public sector.
• A Shareholders Agreement to regulate LIFTco. (Typically the shareholding of each party is around 60% for the private sector partner, 20% for local public sector and 20% for PfH).
• A Lease Plus Agreement which sets out obligations in respect of individual schemes.

These are in line with the national framework agreements developed by PfH and their advisors.

What is involved in setting up a LIFTco locally?

The local health and social care community:

• Establish an ongoing joint planning process to develop a Strategic Service Development Plan (SSDP) for the local area.  This enables all statutory bodies, with a responsibility for improving health in a locality, to plan for the health needs of their population. 
• Run a competitive procurement process to identify a private sector partner who is best able to demonstrate:
o Commitment to developing and maintaining an effective long term working relationship.
o Robust and affordable proposals to deliver the schemes set out in the SSDP.
o Capability to deliver future schemes which emerge through the joint planning process.
• Establish a local LIFTco with the private sector. This includes the long term partnering agreement to build, maintain and operate primary care buildings and assist the local health and social care community to develop the best solutions to its service needs. 

How many schemes are operational?

There have been 4 waves of schemes to date with a total of 49 projects approved.

• Wave 1: 6 schemes - Newcastle and North Tyneside; Barnsley; Manchester, Salford & Trafford; Sandwell; Camden & Islington and East London and City.
• Wave 2: 12 schemes - Barking and Havering; Birmingham and Solihull; Bradford; Cornwall and Isles of Scilly; Coventry; East Lancashire; Hull; Leicester; Liverpool and Sefton; West Kent (Medway); North Staffordshire; Redbridge and Waltham Forest.
• Wave 3: 24 schemes -. Ashfield (N Notts); Ashton, Leigh and Wigan; Barnet, Enfield and Haringey; Brent and Harrow; Bristol; Bromley, Bexley and Greenwich; Colchester and Tendring; Derby; Doncaster; Dudley; Ealing, Hammersmith and Hounslow; E Hants, Fareham and Gosport; Gedling (Gt Notts); Lambeth, Southwark and Lewisham; Leeds; Norfolk; Oldham; Oxford; Plymouth; SE Sheffield; SW London; St Helens, Knowsley and Warrington; Tees Valley; Wolverhampton.

• Wave 4: 7 schemes - Bolton, Rochdale and Heywood & Middleton; Bury, Tameside and Glossop; South East Essex; South Midlands; South East Midlands; South West Hants; Swindon and Wiltshire.

In all, there are 49 NHS LIFT projects at various stages of development. The 42 projects in waves 1 – 3 have reached financial close and commissioned facilities with a total capital value of £951 million. The remaining fourth wave projects are developing detailed proposals and appointing preferred partners. In November 2006 the 100th centre, funded through LIFT, was opened in Liverpool. The £3 million Longview Drive Primary Care Centre in St Helens houses a GP practice with an enhanced minor surgery suite, health visitors, midwives and cardiac nurses.

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