NHS LIFT (Local Improvement Finance Trust) projects are proving to be a practical and highly cost-effective mechanism for upgrading local health facilities. Service providers find they need a flexible and innovative approach to ensure effective service delivery.
With public spending cuts now beginning to make their presence felt, the private sector is in a position to make a positive contribution to ongoing investment in public sector facilities. Very often this is achieved through innovative procurement mechanisms.

A case in point is the NHS LIFT concept, a Public Private Partnership (PPP) arrangement that enables health authorities to construct and manage new health facilities while transferring financial risk to the private sector. As such, they parallel the philosophy of other PPP contracts.

However, in our experience, there are certain unique aspects to such projects that can only be dealt with to maximum effect by transcending traditional contractual constraints to focus on the needs of customers.

For example, one of the ways that the LIFT concept has been used is in the construction and ongoing management of new health centres. These will often bring several GP practices together under one roof, combining them with dental, nursing, pharmacy and other complementary services. A typical contract period for the facilities management provider could be 25 years.

In such cases, the new health centre becomes the focus for health-related issues for the community, so it's very important that such a new concept is well received by local people.

The key role of the service provider therefore, is to understand what those people want from such a facility and ensure they get it. It's not rocket science. Essentially, they want easy access to services in a well-run, clean and comfortable environment. Similarly, people working at the centres expect to enjoy the benefits of a well-run building.

Meeting those expectations requires a customer-focused service from the service provider and commitment to resolving problems quickly and efficiently. Very often, that means putting the contractual detail to one side and getting the job done first, then worrying about the paperwork.

A case in point is the Oxford NHS LIFT, comprising the design, construction and ongoing facilities management of two new health centres in East Oxford. FM and energy management services are outsourced to a third party service provider for a period of 25 years.

'The success of this project, and its acceptance by the local community, depended on the facilities running smoothly from day one,' explained an Oxfordshire PCT spokesman. 'Without a flexible response and commitment to nipping potential problems in the bud, we would have made a less auspicious start. Thanks to our service provider, both new health centres have received acclaim from stakeholders at all levels,' he added.


Delivering such a strategy and meeting these key criteria is greatly facilitated when the service provider provides dedicated project management, through an emphasis on self-delivery rather than sub-contracting. This is unusual for LIFT projects as most contractors consider them too small to justify dedicated management, and service levels often suffer as a result.

A further benefit of self-delivery is that contractual wrangles are less likely to act as a barrier to 'getting the job done'. For example, when card readers for automatic doors at one of the Oxford health centres failed this was clearly urgent.

Fixing them was outside the remit of the contract but going through official channels would have necessitated long delays, so Cofely carried out the work immediately at no extra charge.

Similarly, the original design did not account for coat/picture hooks, additional shelving and notice boards around the building and adding them later should have been a variation on the contract. However, Cofely fitted them at no extra charge.

Another major benefit to PCTs is the transfer of financial risk to the contractor. A number of LIFT projects benefit from this arrangement (including the nine projects managed by Cofely), where the service provider bears all of the financial risk relating to technical FM and energy management, with life cycle planning - including refurbishment and plant replacement over the term of the contract - integrated into the payment mechanism.

Clearly, service delivery needs to be assessed on a range of key performance indicators (KPIs) including service availability, health and safety compliance and customer satisfaction.

Of these, customer satisfaction is seen as a high priority KPI and there are obvious benefits to teaming up with GP surgeries at the centres to operate joint customer satisfaction surveys and share the results.

Similarly, services should be delivered with a proven best practice model as a benchmark for operational performance and a strategy for continuous improvement that can be applied to all LIFT projects. To that end, experience of a range of LIFT projects helps to ensure that each subsequent project benefits from the lessons learned on previous projects.

• Graham Evill is director of FM with Cofely