A Briefing Note for Parliamentarians by dfhrf555fcg



                                                                   LIFT LOBI
                                                                   Local Improvement Finance Trust
                                                                   Liaison Organisation for Business Investors
Check against delivery

                  The Benefits of LIFT as a delivery vehicle for social care facilities
         Address delivered by Chris Whitehouse, Chair of LIFT LOBI, to the conference organised
                                 by 4Ps on Wednesday 27th June 2007.


Ladies and Gentlemen.

If I had been asked to deliver this speech 18 months ago I would have to have talked not of the future but
the present.

For 18 months ago LIFT‟s future was clouded in uncertainty; mired in doubt and in urgent need of a boost.
But if a week is a long time in politics, 18 months is an awful long time in the life of LIFT.

Whilst many used to do so, no sensible commentator can realistically now suggest that LIFT has no role to
play in the future health and social care economy. Indeed, it has a bright, exciting and expanding future.

I hope to use my time here this afternoon, firstly, to explain what LIFT has achieved; its unique and
impressive record of delivery.

Then I would like to challenge the LIFT community, the people in this room and beyond, to ask just what
else can be delivered through LIFT, in terms not just of social care but also in terms of social housing,
regeneration and community investment.

For whilst being content to see LIFT merely as a redevelopment programme for GP surgeries is not what
people want, they also do not want it to be put in a straight-jacket. LIFT can and does „do‟ social care. LIFT
can and does „do‟ leisure facilities.

But, routinely, it can do this more and it can apply these principles to being the investment route for
changing communities and delivering better services to the people in these communities.

It is that which I want to focus on here today.

Record of Delivery: Primary Care

General practice forms the frontline in patient care, providing care for more than 300 million patients
annually. This is 90% of all patient contact with the NHS. And for less than 10% of the NHS budget.

But historically, there have been difficulties in securing this vital service for all. Deprived pockets persisted
in poor, often inner-city areas where GP recruitment and retention was near to impossible. Health
inequalities were exacerbated by poor access to services.

LIFT was conceived to tackle these failings and has achieved this objective quietly and efficiently. LIFT has
encouraged major investment in these deprived communities and the development of modern facilities
which are a joy to work in; giving GPs a reason to relocate to the areas where they are needed most. In the
long term this will achieve major improvements in the health and wellbeing of some of the poorest
communities in the country.


                                                                LIFT LOBI
                                                                Local Improvement Finance Trust
                                                                Liaison Organisation for Business Investors
At the most recent count, almost half of GP facilities were in adapted residential buildings or converted
shops. 80% were below the recommended size. Less than 5% of GP premises were co-located with
pharmacy or social services.

Since then, LIFT has had an unprecedented impact on the quality of primary care facilities around the
country. It has delivered 120 new buildings open to patients with another 74 under construction, supported
by over £1.2 billion of investment.

Though, inevitably, LIFT has vocal detractors – many driven by a misplaced ideological distrust of the
private sector. To them, commercial involvement in the NHS is anathema. But the private sector has
always supported the NHS since its inception. GPs – the cornerstone of the NHS - are essentially
independent contractors and entrepreneurs.

Most pharmacists, opticians and dentists are self-employed professionals. Each year, 20% of the NHS
budget is spent on drugs supplied by private pharmaceutical companies.

For these ideologues, the private sector shareholding in the LIFT Co eclipses all else and much is made of
the potential commercial gain. But what is lost in the political noise is that the Department of Health, PCTs
and other public sector bodies have a 40% stake. So, two fifths of all financial surpluses are ploughed back
into the local health economy.

LIFT has been a quiet revolution in investment and improvement in the primary care estate not matched
since the inception of the NHS itself.

Modern facilities, enabling the major shift in service provision away from the acute sector and to
environments close to the patient‟s home.

An agenda driven by changing patient expectations and choice.

Most procedures able to be carried out in primary care settings which are more convenient for the
individual and at greater value for money to the NHS.

LIFT is making this a reality.

Embedding Reform

At £92.6 billion, the NHS budget has almost trebled over the past ten years. The increase in public
spending between 2000 and 2005 was the second highest of any OECD country.

But health spending is widely expected to take a downward trend after this year.

The health sector can no longer rely upon major cash injections to help meet demanding national targets
and patient expectations. Instead, extra capacity will need to be found through service redesign and
increased efficiencies.

LIFT is playing a vital role in embedding and extending reform, transforming the way in which health
services are delivered.

In speaking to people up and down the country they are telling me:


                                                                    LIFT LOBI
                                                                    Local Improvement Finance Trust
                                                                    Liaison Organisation for Business Investors
       The offer to patients in these settings, the most important yardstick for any health service reform, is
        of the very highest quality.

       GP recruitment and retention problems are being aided by LIFT as the quality of service grows with
        staff in LIFT facilities finding them a joy to work in.

       Health inequalities in areas of high deprivation are being tackled, assisting some of the least well
        off in our society.

       Patients are benefiting from real and demonstrable choice; able to take control of their own care
        and enjoy first rate treatment up and down the land.

The government‟s reform agenda for health is a bold and ambitious one; placing the patient at the heart of
the service. LIFT represents the building blocks of this reform, underpinning the service transformation and
providing ballast to the changes that have been seen throughout the NHS.

For some of the best clinical staff in the world it is vital that they have the facilities needed to deliver the
services that patients and the public expect and LIFT is doing this to great effect.


LIFT also offers a true partnership approach which incorporates the very best the private sector has to offer
– innovation, expertise and enthusiasm – with local health knowledge and skills. No other procurement
model can offer this mix.

Across the country, LIFT has debunked the outdated nostrum that partnership working leads to
interminable discussion, a lack of accountability and inertia.

On the contrary, as the Treasury recently highlighted, LIFT is one of the most efficient of all public private
partnerships with an average procurement time of only 21 months. In contrast, the National Audit Office
recently criticised PFI for an average time to financial close of nearly three years.

And PFI will become less attractive to the Department from next year, when major hospital deals are
moved on balance-sheet and, for the first time, will contribute to net Government debt.

LIFT‟s ability to deliver has been recognised by the Department. It has been chosen as one of the three
routes for the development of schemes under the flagship community hospitals programme. This £750m,
five-year programme will support the shift in care away from the acute sector. Brand new centres will
enable out-patient procedures, step-down care and diagnostics to be carried out in bright, modern facilities
close to the patient‟s home.

In many areas, the private sector partners and PCT have been working toward shared objectives for years
and initial tensions have evaporated. Where there was distrust, there is now open cooperation toward
shared objectives. And increasingly, the two are acting together as a powerful unit to ask of the local
authority what more can be achieved in a wider approach to the development of local facilities and

Many agencies are now increasingly looking to LIFT as a vehicle to meet the needs identified in their
localities; encouraging co-location of health and social care facilities - joint service centres, housing, health
villages, art and leisure centres, libraries and swimming pools.


                                                                  LIFT LOBI
                                                                  Local Improvement Finance Trust
                                                                  Liaison Organisation for Business Investors
The Brierley Hill Health and Social Care Centre in Dudley is a clear example of joint working between the
NHS, Local Authority and the private sector to use public sector service development as a catalyst for the
regeneration of an area. This 13,000 sq m, £28 million, facility has been achieved through the LIFT Co
securing Regional Development Agency funding to remediate an old industrial site that was in private
sector ownership pre Financial close.

In Burnley, St Peters Integrated Health and Leisure Centre is a £27 million LIFT scheme which opened last
year. The 47m high, 11-storey structure is the tallest in Burnley and combines modern primary care
premises and sports and leisure facilities. This joint approach opens up the possibility to combine public
health and healthcare in a way that has never before been possible. It has removed economic and social
barriers to physical activity and given health and wellbeing a new profile in the town.

As David Peat, Chief Exec of the East Lancs PCT and Chair of the Lift National Steering Group, pointed
out recently to two Government Ministers at a private meeting to discuss the future of LIFT, the decision by
the local authority and PCT to develop the St Peters Centre right at the heart of the area of the racial
disturbances in Burnley a few years ago was a powerful unifying and uplifting statement to the local
community by the public sector. It was a visible and tangible demonstration of their determination to rebuild
civic pride and community spirit. The political impact is huge, and the boost to integration and morale

In St Helens the LIFTCo will soon begin work on a four thousand square metre health centre with retail and
residential elements alongside GP and primary care services. Not only will this facility help to address
historic health inequalities, it will improve roads, renovate shops and breathe new life into a whole

And in Thetford, Norfolk, the local LIFTCo has worked tremendously hard, in conjunction with its Local
Authority partner, to develop a one-stop shop for health care along with a Local Authority/ PFI operated
leisure centre with a brand new local community developed Innovation Centre.

Many LIFT companies are now setting their sights even higher, embracing the challenge of injecting new
life into run-down areas.

Across the country, LIFT projects are acting as catalysts for major regeneration in run-down areas, where
private investment could not otherwise be secured. LIFT is no longer seen as simply a tool to rebuild GP
surgeries but a vehicle for the delivery of integrated investment, boosting health, economic development,
well-being and civic pride.

In the past it used to require private sector developers to decide to regenerate an area with new housing
and retail. Now the public sector can act as the catalyst of change with new health, social care and leisure
facilities leading the regeneration process.

And regeneration is not only about money, it is about real people, and their daily lives. It is about raising
individual aspirations, enhancing opportunity, and creating better life chances for generations.

As Dr Sam Everington recently told the same Ministers, in his patch, Bormley by Bow, one of the most
deprived, racially mixed, and historically divided communities in London, the local LIFT scheme has been a
force to transform attitudes. It has, he said, delivered, and I quote, “revolutionary integration of

“Revolutionary integration” and that from the Chair of the Council of the British Medical Association, proving
the lie that GPs do not see the benefit of LIFT when they experience it for themselves.


                                                                  LIFT LOBI
                                                                  Local Improvement Finance Trust
                                                                  Liaison Organisation for Business Investors

And the Community Venture model is an alternative route for the delivery of the Department‟s community
hospitals programme. It establishes new ground for an expansion of the LIFT model into service delivery; a
development many in the sector have been discussing for some time.

Traditionally, the LIFTCo has helped the PCTs and their stakeholders shape service solutions to meet
community needs and put in place a supply chain to plan, fund, construct and maintain buildings to support
these services.

The prospect of LIFTCo expanding to deliver innovative solutions to diagnostics, therapy, elective
procedures and intermediate care will provide even greater benefit to the local health and social care

One further benefit of partnership is seldom proclaimed and that relates to the fact that private sector
involvement in scheme development allows public sector officials to be released from non core activities
and therefore frees them to concentrate on their primary task of identifying and delivering health care
service improvements

But what else? Where next for LIFT?

One thing that we do know is that LIFT works and that it is proven. Mainstreaming it as an investment
vehicle for health, social care, leisure and regeneration should be and must be the next step. Why set a
limit on what it can do and where it can go when the surface has barely been scratched?

Don‟t just take my word for it, Paul Cohen, Chief Executive of the Local Government Association recently
talked of LIFT as “one of the most powerful shows in town” when it comes to delivering joint working at
local level.

Social Care

At any one time in the United Kingdom there are at least 1.5 million people who rely on social care
services, ranging from meals on wheels for the elderly, home help, support for the disabled to fostering.
The budget for the service is £12.5 billion annually with one million people working in this area.

Many of those people who they support will be some of the most disadvantaged in society and from some
of our most deprived communities. These communities may no longer provide the support base that people
need, leaving the state to pick up the pieces.

And there is little doubt that the pressure on the service, the financial pressure that leads to cuts in long-
standing services or a less personal service for the individual, is not going to relent any time soon.

Derek Wanless, the author of so much NHS reform following his landmark reports at the turn of the
decade, believes that by 2026 spending on social care for older people alone will represent 1.5% of GDP.
This would amount to £24 billion, up from £10.1 billion in 2002.

Direct funding from the taxpayer is unaffordable.

Yet means testing leaves many without care and dignity in dying or adequate support for all those that
need it a fallacy.

Anne Williams, the President of the Association of Directors of Social Services, said in May this year:


                                                                   LIFT LOBI
                                                                   Local Improvement Finance Trust
                                                                   Liaison Organisation for Business Investors

“Social care providers must respond and adapt to changing needs and models of service. New areas of
service will emerge where not working in partnership with other providers will simply not be a realistic

“More and better quality joint commissioning and joint monitoring, with pooled budgets and lead
commissioning; continued partnership working with providers; widening opportunities for innovation with
new providers, and a real focus on outcomes, independence, social inclusion, employment, and re-
ablement are all important targets to be pursued.”

This vision for social care, backed up by many in government and a model of working for children‟s
services for some years, brings with it great possibilities but also huge challenges.

And LIFT is already responding to some of these challenges.

The Clifton Cornerstone Centre in Nottingham has brought together the PCT, the Local Authority and
Nottingham City Homes to develop a centre serving an ageing population which enables visitors to address
health, social and housing needs in one visit.

Local social care teams deliver vulnerable adults and older people services, occupational therapy and
support to those with learning disabilities.

And being co-located with GPs, employment services and support to children and young people has
brought significant benefits with 82% of the local population stating that services are better now than they
were previously when fragmented throughout the area.

Mental Health

And what about mental health?

At any given time nearly a sixth of all adults are experiencing depression or anxiety.

Mental illness accounts for a third of all illness in Britain.

And the total cost to the nation of mental ill health is as high as £77 billion each year in lost earnings,
productivity and reduced quality of life.

There is acceptance that specialist mental health services have improved since the National Service
Framework of 1999, but problems persist. Most notably, according to Professor Louis Appleby, National
Director for Mental Health, barriers and boundaries that let people receive support with employment,
training, housing and social support.

GPs are being encouraged to move away from referring to hospital-based specialists for those that do not
need it. A single care pathway may be more appropriate for some, with care in the community almost
always preferable and likely to engender trust in the system.

For both social services and mental health there exists a dire need to invest and continue reform. If the
healthcare system fails these people it fails everybody. Finding mechanisms to deliver what both Anne
Williams and Louis Appleby talk about will be crucial.

But we are not there yet and questions emerge:


                                                                     LIFT LOBI
                                                                     Local Improvement Finance Trust
                                                                     Liaison Organisation for Business Investors

How can these services be driven locally?

How can continued improvement be achieved?

Where will the money come from to do it in a tight spending review period?

And how can trust, so vital in managing true partnerships, be sustained?

Finding an answer to these questions will be central to social care and mental health policy for years to
come; indeed, has been true for many years already.

But in finding solutions to these questions, in LIFT there already exists a vehicle for making things happen
and finding service mechanisms that genuinely deliver.

Now and in the future, we in the LIFT community must ask ourselves whether LIFTCos will be building
buildings or whether they will also be acting as catalysts for change.

Whether after refurbishing GP surgeries they will move away into the shadows and quietly manage those
investments or look to the horizon for fresh challenges and opportunities.

I know which members of LIFT LOBI would prefer and will be working hard to acheive.

And let us be clear, the model that is LIFT has lessons to teach the public sector wherever it needs
buildings to provide services. I even heard it suggested with every seriousness that in addition to health,
leisure, social care, and housing, the LIFT model could translate into every government sector, including
the Ministry of Defence.

The Future of Reform

It would be remiss of me if I did not mention the other big news story of today; that of a change of Prime

Tony Blair and his government, through a series of Blairite Secretaries of State, from Milburn to Hewitt,
have driven NHS change for longer than a decade. Much of that change has been radical; certainly
controversial. Much of it has improved patient outcomes and increased patient choice.

But without the infrastructure, without the facilities and without the first rate buildings much of this would
have been bogged down and could not have been achieved. What LIFT has quietly got on and done is
make some of the changes in primary care possible.

And what I have talked of today, that of using this existing investment vehicle which involves the private
sector to deliver genuine change will continue to be controversial, not least in some of the communities
where it is most needed.

It will require vision and strength of purpose.

It will need people from top to bottom who believe it can work.

But, and this is crucial, it will rise or fall on whether the political will exists to take LIFT further than many
thought possible when it started and it will require top level backing from those who matter.


                                                                    LIFT LOBI
                                                                    Local Improvement Finance Trust
                                                                    Liaison Organisation for Business Investors

The establishment of a Ministerial level group on LIFT, which will involve Ministers‟ from health and local
government will help give LIFT a focus at this level. Andy Burnham, no matter where he now goes, has
given the LIFT community a roundtable forum that can help sustain its growth for many years to come.

And Mr Burnham‟s Ministerial counterpart in the Department for Local Government and Communities, Phil
Woolas MP, also delivered a real shot in the arm for LIFT enthusiasts when he tasked Treasury officials
with looking at the financial position for local authorities to see how they could be incentivised to enter more
actively into such joint working through LIFT. And to the eyes of his own constituents, Mr Woolas, added,
LIFT schemes are seen as “new, shiny and local”.

Two young, able, ambitious Ministers, both with a bright future under Gordon Brown I hope, who can see,
and make no secret of their love of the fact, that LIFT can and will deliver exciting new projects for
Ministers formally to open, cutting ribbons and being photographed in the regional media, in a
comparatively short space of time.

I know that LIFT LOBI will be keen to support the Ministerial Working Group no matter who is at the table
and will be pressing the case for expansion, ongoing development and imagination in making sure this
investment vehicle continues to be used in a manner befitting of its core strengths.

And we expect our messages to continue to fall on sympathetic political ears. Not just because Ministers
and local MPs like cutting ribbons on newly built and popular local facilities, but because with its impact on
public health, economic regeneration, integration, and aspiration, LIFT delivers what Gordon Brown needs
if he is to realize his genuine personal lifelong ambition of ending social exclusion.


In closing, LIFT is going with the political flow and delivers the answer to rising consumer demands.

LIFT has a strong future. It is expanding well beyond its original parameters.

It is no secret that Partnerships for Health is planning changes to LIFT later this year; to promote to a wider
constituency the positive differences it is making in primary care, social care and local services.

Whether that constitutes a re-launch, a re-brand or a lick of paint will remain to be seen, but I know that
they are as passionate as LIFT LOBI as to what LIFT can achieve and want to work together to get there.

As importantly, a greater awareness of the kind of schemes I have talked about in Burnley, St Helens and
elsewhere will lead local authorities and PCTs to ask “what can LIFT do for me”. And the answer, as we
see in these examples, is a great deal.

LIFT can act as a catalyst for change in local communities, regenerating areas of the country that need
investment and delivering real service change to people in their localities.

LIFT is young, its future is bright, and it is playing a vital role in supporting the reforms which will sustain a
60 year old health and social care service into the 21st century.

LIFT is driven by people with passion and energy and the model‟s strengths are bringing real and lasting
change to some of the most deprived areas in the country.

We must never forget to celebrate what has already been achieved.


                                                                 LIFT LOBI
                                                                 Local Improvement Finance Trust
                                                                 Liaison Organisation for Business Investors

But as I hope I have outlined here today, much work lies ahead, and in improving the fabric of Britain‟s
communities and the people whose lives are affected by what we do, LIFT has an enormously important
role to play over the years to come.

And as a final word, as the Minister Andy Burnham recently said, it is raising the life aspirations of
individuals that will be the greatest legacy of LIFT.

Thank you.


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