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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