Select Committee on Public Accounts Forty-Seventh Report

Conclusions and recommendations

1.  Primary Care Trusts have limited sources of public funds for developing new premises other than through LIFT. Very few new primary care premises are funded through conventional public finance. The Department has, therefore, encouraged new premises to be developed through LIFT, in particular by providing funds to get the programme started. The main alternative is for Primary Care Trusts and GPs to commission a private contractor to develop premises which they can then lease, which is not always feasible in deprived areas.

2.  Providing new, purpose built primary care premises is more expensive than continuing with the existing estate. The higher cost of LIFT mainly reflects the capital cost of new, high quality buildings compared to the cost of existing premises which are often much cheaper but not always suited to the delivery of modern primary care services.

3.  The higher cost of new provision, whether through LIFT or commissioning from contractors, could displace other primary care spending. In preparing business cases for LIFT projects Primary Care Trusts should compare the cost of LIFT to the cost of the alternative procurement routes available, and make the implications for spending on other primary care facilities and services explicit.

4.  Primary Care Trusts in some areas subsidise other tenants to take space in buildings to encourage them to participate in LIFT. Where Primary Care Trusts are paying sizeable subsidies to make LIFT affordable for other organisations, there should be a business case to support the value of the subsidy and the expected benefits should be made transparent. Subsidies should be used as a short term measure to encourage tenants into the buildings unless there are exceptional reasons that justify continued subsidy.

5.  The Department and Partnerships for Health have not yet developed a mechanism for evaluating LIFT although they have started to do so. They should complete this work quickly and publicise the underlying mechanism and methodologies so that meaningful quantitative evaluation of the value for money of the LIFT programme and its schemes can be made.

6.  There is no explicit provision to target cost reductions over time. Earlier LIFT schemes are expected to cost more than later ones, with costs reducing once the model is rolled out more widely. Strategic Partnering Boards, in consultation with the LIFTCo, should set cost reduction targets for new projects in the light of experience in the local LIFT area. There should be an annual review of progress against the targets, once buildings are operational.

7.  Under the Lease Plus Agreement, the LIFTCo is responsible for all repairs and maintenance. There is no threshold level in the standard LIFT contract for minor alterations within a building. Some tenants within LIFT buildings are frustrated that they cannot procure minor alterations without prior consent from the LIFTCo and without going through a time consuming and bureaucratic process. Partnerships for Health should consult with the private sector partners and agree threshold levels of expenditure below which any reasonable minor alterations could be carried out promptly and without recourse to the LIFTCo.

8.  New methods of care leading to centralisation of services can result in access problems for patients. New arrangements sometimes lead to less convenient locations for patients, which can be a particular problem for those with mobility or transport problems. Primary Care Trusts should liaise with other relevant parties on location and access issues and give these priority in Strategic Service Development Plans and the business case for developments.

9.  The effectiveness of Strategic Partnering Boards is crucial to the performance of LIFT. Chairs of Strategic Partnering Boards are appointed and remunerated by Primary Care Trusts. Members come from local stakeholder bodies. There is a risk that the Board can become a forum for discussion rather than a decisive and results focussed body. Partnerships for Health should help Primary Care Trusts and local authorities, where relevant, develop a framework for appraising the effectiveness of the Boards.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 4 July 2006