Select Committee on Public Accounts Forty-Seventh Report

2  Realising the expected benefits of LIFT

13. It will be many years before the expected benefits of delivering services to local communities through LIFT can be realised. Some important groups of stakeholders, notably GPs, pharmacists, dentists and Local Authorities, are not all supportive of the LIFT model.[22] For example, in the East Lancashire scheme local independent pharmacies have said they were discouraged from competing for a tenancy in the LIFT buildings because they perceived that contracts were likely to be awarded to national players who were not interested in forming a consortium with them. In the Church Road development in East London, however, local independent pharmacists have formed a consortium enabling them to provide services from the LIFT building.[23]

14. One intended benefit of LIFT is the co-location of a range of healthcare services. Secondary care can be made available in a primary care setting, allowing faster and more convenient referrals, where the relevant specialists hold clinics in LIFT premises. There is concern, however, that such benefits may not be fully realised in the absence of integrated IT systems allowing quick referrals and data transfers between GPs and the hospital patient administration systems, which control access to specialists. Where there is no such integration, the GP may still have to write formally to the hospital to arrange a referral for their patient, even when the specialist works in the same LIFT building.[24]

15. The quality of local implementation of LIFT will have a big impact on its success. As a central oversight organisation, Partnerships for Health can play an important role in helping local LIFT areas realise their longer term strategies. Partnerships for Health helped local areas establish their LIFTCos through the provision and dissemination of guidance, stimulating interest in LIFT through forums and conferences and by providing a facilitator to assist each scheme.[25] Now that LIFTCos are operational, Partnerships for Health have a director on each LIFTCo Board reflecting their 20% shareholding in each local scheme. Partnerships for Health are, therefore, well placed to ensure that knowledge is shared and disseminated and that lessons for the future continue to be learnt.[26]

16. New patterns of care can affect the location of developments and, therefore, have an adverse impact on access to services for some patients. For example, GPs currently serving deprived areas of cities and towns may be encouraged to relocate more centrally within the new LIFT buildings, with the result that patients have to travel further. The location of health services is the responsibility of the Primary Care Trusts and should be based on meeting the priorities outlined in their Strategic Service Development Plans. Provision for the patients within a LIFT area who are likely to find it difficult to reach a LIFT building, such as the elderly and people dependent on public transport, needs to be considered within this wider aim. This early involvement of the local authority, particularly in relation to public transport, is likely to have a beneficial impact. [27]

17. The creation of well designed and fully functional buildings, suitable for delivering the primary and social care needs of the local population over the next 20 years, is an important factor in ensuring LIFT can realise its full potential. Partnerships for Health has collaborated with the Commission for Architecture and the Built Environment (CABE) since LIFT's inception and are now, together with CABE and the Department's Estates team, undertaking full design reviews of all buildings provided to date with the intention of learning design lessons for the architects on future schemes. This collaboration should avoid last minute concerns about the design of LIFT buildings and modifications being made at a late stage as has been the case, for example at the St Peter's health and leisure development in Burnley.[28]

18. Formal guidance on accountability and governance frameworks was only developed after the initial LIFT schemes became operational. The Strategic Partnering Board holds the LIFTCo to account, and is responsible for commissioning new LIFT developments and services. Primary Care Trusts appoint the Chair of the Strategic Partnering Board. Members are from key stakeholder organisations within the local health economy such as Strategic Health Authorities, Local Authorities, Primary Care Trusts, and healthcare professionals. They are accountable to their own organisations. No central body holds the Strategic Partnering Board to account. By its nature there is a risk that the Strategic Partnering Board may become a forum for debate rather than the decisive, results oriented body needed to make LIFT effective.

22   C&AG's Report, para 2.14; Qq 10, 21-26, 30-37 Back

23   Qq 23-26 Back

24   Qq 83-88 Back

25   C&AG's Report, paras 1.13-1.14 Back

26   ibid, paras 1.26, 3.11 Back

27   Qq 27-29 Back

28   C&AG's Report, Appendix 3; Q 20 Back

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