Local integrated care receives a massive lift

When the Department of Health established the local improvement finance trust (LIFT) programme, the aim was to develop new primary care and community based facilities in England, and to address inadequate and often piecemeal investment in health and social care services. 

Now, 10 years after the first LIFT company was formed in east London, the programme provides modern, integrated health services in high quality, purpose built premises in every region of the country, with a particular focus on economically disadvantaged areas.

‘To date, 12 new multipurpose health and community facilities have been delivered, transforming the estate and raising standards’

An example of its regional benefits can be seen in Hull, where the Citycare LIFT partnership has delivered a £100m estate partnership since 2004. Prior to its introduction, more than 85 per cent  of patients used GP premises that did not meet current standards. Meanwhile, more than 75 per cent of practices were more than 25 years old, which made it difficult to recruit new GPs to the city.

The aim of the LIFT programme in Hull was to create nine custom built centres. Following a thorough procurement process, Hull Citycare was formed in 2004 and became the public-private partnership that set out to revolutionise Hull’s healthcare facilities with its partners.

Improved patient access

To date, 12 new multipurpose health and community facilities have been delivered, transforming the estate and raising standards to improve patient access to services, alongside an extensive refurbishment programme of the retained NHS estate.

One such facility is the Bransholme Health Centre, the largest of the LIFT facilities in Hull. It brings together a range of health, community, council and voluntary services − a true one-stop shop for local people. The centre enables service providers to cater for the ever growing Bransholme population, previously one of the most under-doctored areas in the country.

It houses eight GP practices with shared reception spaces to encourage collaboration. It also houses a minor injuries unit alongside Hull City Council’s customer service centre, which was relocated to improve service delivery and secure savings. The ground floor public space with a café and comfortable seating area encourages visitors to spend time in the building.

The full range of services includes:

• eight GP practices;
• a district nursing team;
• a midwifery team;
• a wellbeing team;
• Hull City Council services − rent office, parking fines, pay bays, advice; and
• Community Home Care Provider services – diabetes, podiatry, weight loss clinics, audiology, speech and language therapy, minor injuries unit.

Local economic benefits of the Bransholme Health Centre include:

• 108 jobs created;
• 15 apprentices;
• 81 per cent construction spend was with local companies; and
• 30 local companies worked on the project.

On a wider city level, the key achievements of the LIFT programme in Hull include:

• GP practices have been relocated, providing opportunities for 74 per cent of GP Practices to work more closely together;
• the health centres house more than 100 health and community services;
• GP list sizes have been reduced, with six new practices introduced;
• £234m has been put back into the local economy;
• 1,200 jobs have been created in Hull;
• 120 young people have been given an apprenticeship opportunity;
• 70 per cent of Hull residents now access health services at LIFT buildings; and
• GP premises that do not meet the latest standards have been reduced from 85 to 34 per cent.

As part of the 10 year anniversary of the LIFT programme, Community Health Partnerships commissioned an independent report to explore the socio-economic impact of the LIFT programme.

The report found that one of the most important outcomes of the LIFT programme has been the increased access to health and social care services for people in underprivileged communities. The report’s key findings include:

Improving the health and wellbeing of communities

• A high proportion of LIFT buildings provide services in areas where a significant number of residents suffer from socio-economic disadvantage, including poor health and wellbeing. For example, 119 projects are based in the 10 pr cent most deprived areas of England.
• There are 3.3 times as many LIFT projects in multicultural areas than would have been expected given an even distribution across all area types.
• LIFT accommodation has brought care closer to patients and integrated a greater range of services under one roof, so that individuals can access a range of health and social care services in one visit.

Supporting 21st century healthcare

• The programme has driven significant improvements in the quality of health service accommodation, enhancing working conditions and facilities for a wide range of service providers including GPs, primary and community healthcare providers, local government services and voluntary organisations.
• The co-location of GPs and other service providers, including third sector support services, has enabled a more united service.

Boosting local economies and creating jobs

• The construction of LIFT buildings has been an important source of economic activity during the recent period of financial hardship. To date, the LIFT programme has directly generated employment opportunities for approximately 30,000 people.
• An estimated 80 per cent of construction spend has been with local businesses, with an estimated £1.31bn injection into small and medium-sized enterprises.
• As well as employment during the construction phase, these developments accommodate a significant number of jobs, often in areas where there are few other employers.
• Projects have often resulted in an increased market for businesses located in or near the developments. These include private and third sector providers of health services, pharmacies, cafes and other local retail and lifestyle businesses.

Nationally, more than 500 GP practices have been accommodated in new, purpose built premises through the programme and they have benefited from raised standards of accommodation, additional capacity, co-location with other service providers and also efficiency gains.

Prior to the inception of the LIFT programme there was enormous variability in the standard and scope of GP surgeries and primary care facilities across England and particularly in areas of greatest health need where it had been so difficult to attract any capital investment.

‘An increase in the integrated use of the estate across the public sector is likely to require more innovative approaches to funding’

The buildings were no longer able to support a modern, broader focused, better integrated model of primary care that allowed a greater range of higher quality services to be delivered locally. The estate was becoming a block to service improvement and not a support, as it should be.

In the future, an increase in the integrated use of the estate across the public sector is likely to require more innovative approaches to funding. LIFT is a proven and innovative approach to funding a healthcare infrastructure programme and Private Finance 2, the government’s new approach to public-private partnerships, contains many of the characteristics (including co-investment by public and private sectors) that we have worked with in LIFT over the past 10 years.

The present financial environment means that we all need to work smarter and be more innovative − by working in partnership with public and private sector organisations and embracing the skills and experience offered by each.

Dr Sue O’Connell is chief executive at Community Health Partnerships