REPORT OF THE DIRECTOR OF CUSTOMER AND SUPPORT SERVICES
TO THE REGENERATION INITIATIVES CABINET WORKING GROUP
ON 22nd AUGUST 2005
NHS LIFT: PROJECT REVIEW AND PROGRESS REPORT
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PURPOSE OF REPORT
1.1
To provide a review of the LIFT initiative in Salford and to report progress
made to date.
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BACKGROUND
2.1
The NHS LIFT project for Manchester, Salford and Trafford is a public-private
partnership that will procure and manage new buildings, primarily for the
provision of primary healthcare, but also containing local authority facilities.
2.2
LIFT (Local Investment Finance Trust) was originally devised as a
procurement model to meet an urgent need to improve primary care
premises, identified in the NHS Plan. In Salford, the opportunity has been
taken to use LIFT to redesign and deliver a wider range of services. Better
services will be provided because health and local authority services will be
provided in a new and more ‘joined up’ way, in community locations which
people regularly use.
2.3
LIFT facilities in Salford are intended to be inclusive and responsive to the
wider needs of the community in which they are located. New buildings will
offer traditional health services with other functions that attract the widest
range of visitors into each facility. For example, the four largest centres will
include public libraries, community meeting rooms and one-stop shops, where
visitors can access information on services provided by all partners.
2.4
LIFT therefore helps meet the objectives of the council’s Libraries Plan,
locating libraries within multi-agency buildings. It integrates libraries with the
information service provided by Salford Direct, with a single point of public
contact in each of the main buildings. Inclusion of local authority services
helps create welcoming buildings that are not “clinical” and encourages
access to health advice as part of an integrated public service in a proactive
rather than reactive manner and, hence, not a building used only when you
are ill.
2.5
LIFT in Salford also helps deliver one of the aims of the SHIFT Project
(Salford’s Health Investment for Tomorrow), reducing the number of visits to
Hope Hospital by allowing some specialist clinical procedures to be carried
out outside the hospital ensuring that treatments and clinical procedures do
not unnecessarily result in a hospital admission/stay.
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PROJECT GOVERNANCE
3.1
The MaST LIFT partnership includes the Department of Health, Salford
Primary Care NHS Trust, the Greater Manchester Ambulance Service NHS
Trust, Salford City Council, the local authorities and primary care trusts in
Manchester and Trafford and ExcellCare, the private sector partner.
3.2
ExcellCare has a 60% shareholding in the Company. The Department of
Health has a 20% shareholding. The council and PCT each have a 1.8%
shareholding. Mike Burrows, Chief Executive of Salford PCT, is the board
member appointed to represent the interest of all ten local shareholders.
3.3
The Strategic Partnering Board is the forum where local health and social
care needs and requirements to be provided by LIFTCo are agreed by the
local shareholders. Councillor Hinds is the council’s representative.
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PROJECT HISTORY
4.1
Manchester, Salford and Trafford were selected as one of six national pilot
sites for the establishment of a LIFT Company, in 2001. At the time, the
Department of Health intended that all new buildings procured through the
first wave of LIFT should be open by December 2004. However, the scale
and complexity of buildings being planned far exceed the assumptions made
when the original project and timescale were conceived.
4.2
In September 2002, Cabinet endorsed proposals to procure six new buildings
in the first wave of LIFT, four of which would include council facilities. PCTs in
Manchester and Trafford agreed to procure another seven buildings in this
first wave.
4.3
A selection process was undertaken to choose a private sector partner for the
LIFT Company and ExcellCare were identified as preferred partner in April
2003. Several targets for commercial and financial close were missed,
reflecting the complexity of the project and the ambitious nature of the original
programme. The MaST LIFT Company was not formally established until
June 2004.
4.4
The private sector partner was slow to adequately resource the new LIFT
Company. It has not yet established an identity of its own. Despite being
established in June 2004, a permanent general manager did not begin work
until July 2005.
4.5
The first financial close was achieved in July 2004. Only four of the original
thirteen first wave schemes were included in this batch, with only one building
in Salford (Charlestown).
4.6
Financial close on a further three schemes, including a second building in
Salford (Lower Kersal) was achieved in April 2005.
4.7
None of the four schemes including council accommodation have yet reached
financial close. It is intended that these four will be included in a further batch.
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Details of the individual schemes are set out below; however, in general,
detailed design work is on hold while negotiations on scheme affordability are
concluded, to ensure that delays are not faced further down the design
process should affordability issues be encountered that require a subsequent
redesign.
4.8
Current estimates provided by LIFTCo suggest that the capital cost of the four
buildings is some £36.27 million, which would equate to an annual lease plus
cost to the PCT and council of some £4 million. This is not considered
affordable. Comparisons of these estimated costs against other competed
LIFT schemes suggest that they are in the upper quartile and LIFTCo are
under pressure to reduce costs. The current draft designs are also being
reviewed to identify potential savings.
4.9
The earliest possible date for financial close for these four schemes now
appears to be March 2006, although this depends on agreement being
reached on affordability.
4.10
It may not prove possible to reach agreement on affordability with MaST
LIFTCo. In that case, alternative means of procuring these important local
facilities will need to be considered. Initial investigations suggest that
borrowing under the prudential code would currently be more cost effective for
the council. However, as the PCT has committed to an exclusivity clause
within the LIFT agreement, achieving completion of each of these buildings
via the LIFT procurement vehicle is still the desired outcome, to ensure the
public partnership is further developed.
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SERVICE REDESIGN
5.1
Work on the LIFT initiative has been the catalyst for the council and PCT to
work collaboratively on service redesign, and the issues around sharing
premises.
5.2
The vision is for truly seamless, joined up services so that when people walk
into an public service building, they don’t need to know which agency is
providing the service– all they want are answers to questions and solutions to
problems from whichever person is standing behind the reception desk.
5.3
Discussions on the vision of what a truly joined up partnership might provide
led to two things:
5.4

The desire for both organisations to work together in innovative ways to
share not just the buildings, but also the responsibility for providing
residents with first class service, whatever their query or problem, and

The will to start partnership working and experiment to improve health
issues for residents – long before the doors of the LIFT centres open.
The council and PCT have won a Municipal Journal award for Transforming
Customer Services Achievement of the Year for the “Improving Health in
Salford” project.
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5.5
The pilot flu-jab campaign resulted in an additional 2,000 people attending
vaccination sessions across the city, all of whom were given a free flu jab and
a benefit health check. Not only did only vaccination supplies run out, but
also the campaign contributed to an increase to 73% take up across Salford
before the target date.
5.6
The LIFT project recognises that both health and social care services have to
be delivered in locations where customers visit. It is therefore logical that
libraries are included in the new LIFT buildings. However, the council and
PCT are already reaching out to customers in existing libraries. 2004 saw the
completion of a training programme for all library staff in how to advise
customers on general housing benefit matters. City council locations are now
being used to promote health campaigns such as smoking cessation, and in
some cases are the local venues for flu jabs.
5.7
Joined up working within both the council and the PCT, together with a cross
fertilisation of ideas, has led to the development of a Life Events Model which
will enable the two organisations to provide a holistic approach to life events
e.g. bereavement. For example, after the death of an elderly person, a
relative or friend might have to make a large number of phone calls to sort out
the deceased’s affairs. It is planned that a phone call to book an appointment
to register the death with the local authority would trigger actions to cut out a
great deal of work for the relative. With the caller’s permission it is planned to
share information of the death with all services throughout the council and
PCT.
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BUILDING PROJECTS
6.1
The Charlestown building is next to St Sebastian's church hall, Douglas
Green. The contract has a value of £2 million. Building work is well advanced
and is on programme to be handed over to the PCT in September 2005, with
the building to be operational early in October 2005.
6.2
The Lower Kersal site is at St. Aidan's Church, Littleton Road. An enabling
works contract, involving the demolition of the vicarage and partial demolition
of the existing church building, is now complete. A second phase of enabling
work are currently being progressed, funded via LIFT enabling monies and
contracted by the church directly. Work on the main contract, with a value of
£2.9 million, is due to start on site in October 2005, with the building due to be
handed over to the PCT in October 2006.
6.3
The location of the Charlestown and Lower Kersal buildings, and the range of
services they will contain, were developed through the health programme of
the New Deal for Communities Partnership. Although most of the
accommodation is to be leased by Salford PCT, a community group, CHAP
(Charlestown Health Action Partnership) intends to lease elements of the
space across the two sites. The City Council is not leasing space in either
building.
6.4
The Walkden building will be on the site of the recently demolished flats at
Fitchfield and Cloverfield Walk, on Bolton Road. Planning permission has
previously been granted for a building on this site, but the design had to be
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revised following withdrawal of Job Centre Plus. The revised design has been
presented to ward members and signed off by lead member for customer and
support services. However, submission of the planning application is on hold
pending the review of costs of the 1C batch, although this particular scheme
does not appear to create any immediate affordability issues.
6.5
The Pendleton building will be developed on the site of the recentlydemolished Lime Court, fronting Broadwalk. The design has been presented
to ward members and signed off by lead member for customer and support
services. However, submission of the planning application is on hold pending
the review of costs.
6.6
The Eccles scheme is being progressed as two discrete phases. Each phase
will be the subject of a separate planning application and financial close.
6.7
The first phase will include the main health and local authority facilities. This
building will be developed as an extension to the original Carnegie Library,
replacing the 1960’s library extension, with car parking on the sites of the
clinic and social services building on Corporation Road. The remodelled
library would include space in both the retained Carnegie building and the
new building. Design work is on hold pending the review of costs and no
scheme has yet been presented to ward members or lead member.
6.8
The second phase will comprise an integrated education and training centre,
in partnership with Greater Manchester Ambulance Service NHS. Trust. This
will be built to the rear of phase one, on the former clinic site. The schedule of
accommodation for this building is currently being finalised and initial design
meetings with the architectural team area already being progressed.
6.9
The Swinton building will be a redevelopment of the existing Lancastrian Hall
building, at the junction of Chorley Road and Station Road. There are
outstanding issues to be resolved in respect of the extent of demolition of the
existing structure, the location of off-site drop-off facilities and the potential
need for additional car parking facilities. However, agreement in principle has
now been reached with the new owners of the precinct, on issues such as
construction access and creation of a physical link to the precinct. Currently,
discussions with the owners of the precinct are being progressed to
understand the most appropriate design solution for this scheme that best
suits the needs of all stakeholders. At this stage no scheme has yet been
presented to ward members or lead member.
6.10
Each of the Walkden, Pendleton, Eccles and Swinton buildings will contain
council library and community meeting space. The council are also
responsible for the single building receptions, staffed jointly with- the PCT,
which will include one-stop shop services.
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FUTURE SCHEMES
7.1
The PCT have indicated that the next wave of investment in health facilities is
likely to include Ordsall, Broughton, Little Hulton and Irlam/Cadishead.
However, no significant work has yet been carried out to determine the range
of services to be provided from, and potential location of, any new building.
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7.2
The PCT is contractually committed to procure all significant building work via
the MaST LIFT Company, subject to a value for money test. The City Council
has no such commitment. As the Council and PCT aim to continue
developing an integrated service delivery and estates strategy, there will be a
continuing relationship with LIFT. However, unless MAST LIFTCo can
achieve more competitive pricing and demonstrate a track record of effective
project management and delivery, LIFT is unlikely to be the best option for
further building procurement for the council. In this case, the PCT and city
council may have to discuss in greater detail how the various joint services
proposal across the economy should be achieved.
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CONCLUSIONS
8.1
The MaST LIFT programme is an ambitious project, involving a new
partnership of service providers, delivering 13 complex buildings, whilst
piloting an untried procurement mechanism. Given this background, it is not
surprising that the programme has suffered delay, did not meet the very
ambitious targets originally set, and that some problems remain unresolved.
8.2
ExcellCare has recently increased resources available to MaST LIFTCo and
there is reason to be optimistic that affordable, deliverable schemes will be
achieved early next year. However, the four proposed buildings are important
for the regeneration of the city and the continued improvement of service
delivery. Further delay in the delivery of the programme would not be
acceptable and it may prove necessary to consider alternative means of
procurement.
8.3
Nevertheless, given the agenda for further service integration, the PCT’s
contractual commitment to procurement through LIFT and the PCT and city
council’s shareholding in MaST LIFTCo, it would be in the best interest of the
city for the Company to become established as an effective and affordable
building provider.
ALAN WESTWOOD
Director of Customer and Support Services
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