A number of key reports over the summer have offered clear guidance to the way we can expect the NHS and community services to develop in the coming years. First was ‘High Quality Care for All’, Lord Darzi’s final report for his NHS review. The other prominent one was ‘Our Vision for Primary and Community Care’, chaired by Professor David Colin-Thomé and also published as part of the Next Stage Review of the NHS.
Together, these documents call for a focus on personal well-being, rooted in individual choice and integrated, high quality, public services. It is a broad approach demanding strong partnerships combined with flexible, creative ways of delivering services.
Examining these reports, it is possible to extract some key themes that those charged with transforming service provision must understand if we are to succeed in reflecting fast changing community needs. As facilitators of the LIFT programme, Community Health Partnerships has been examining this brief in order to build the tools and expertise to deliver an ambitious agenda.
The policy themes broadly fall into seven categories: integrating health and social care; shifting care into the primary sector; world class commissioning; safe and secure environments; tackling health inequalities; improving health and wellbeing; increasing patients’ choices.
Taking each of these themes in turn, it becomes clear why the government is so enthusiastic about LIFT. That enthusiasm helps explain the announcement earlier this month of plans to make it easier for Primary Care Trusts not currently in the LIFT programme, together with local authorities and other NHS Trusts, to use an ‘express’ model of LIFT to quickly engage the necessary expertise to effectively and efficiently plan and develop their infrastructure to facilitate the realisation of the policy themes outline above. Soon, all the PCTs in England – not just the current 50 per cent – will have the option to access to the benefits of the LIFT model to help them to deliver their strategic objectives.
I would like to take each of these themes in order, beginning with integration of health and social care. ‘NHS Next Stage Review’ calls for more integrated services for patients. It says that ‘the good primary and community care services of the future will not simply be more efficient and responsive versions of what we have now. They will have seized the opportunity to provide a much wider and more integrated range of services. ‘
This key vision is now being realised on a wide scale within the LIFT programme. Its processes are focused on partnership, planning and integration. So LIFT facilities now include a wide variety of provision from traditional primary healthcare and relocated hospital services through to social care, advice centres, sports facilities, swimming pools, police services and council payment centres. And ‘High Quality Care for All’ shows us the way forward, by piloting new Integrated Care Organisations (ICOs).
One result of LIFT is the much sought after shift to the communities of hospital based facilities such as diagnostics, outpatients clinics, management of long-term conditions (e.g. diabetes care and asthma) and minor procedures. This important shift in capability means that LIFT developments are now in a position to support innovative services and real choice for commissioners.
LIFT, in short, is at the heart of world class commissioning. The modern, flexible, future-proofed facilities are adaptable to changing commissioning needs and allow multiple services to be commissioned in one building. The learning springing out of the LIFT programme, gathered and disseminated by our knowledge transfer networks, is empowering commissioners in their task of understanding what the best can look like.
LIFT is sometimes criticised around cost because of its commitment to high quality premises and to long-term maintenance to ensure they retain peak condition throughout their useful lives. However, the emphasis of the Government reports released during the summer on safe and secure environments, demonstrates the value of this focus. LIFT buildings point the way to the rest of the NHS on how to ensure that facilities not only meet but also exceed legislative and regulatory minimum standards, are efficiently functional with excellent access, have high levels of maintenance and are a joy to use for clinicians and the public alike. As ‘High Quality Care for All’ states: ‘The first dimension of quality must be that we do no harm to patients’.
Tackling health inequality is a challenge that is easy to fudge, given that all citizens are already supposedly free to access NHS services, free at the point of delivery. The reality, we all know, is not so fair. The record of the LIFT programme perfectly illustrates its potential for making the equality ambition a reality. Its innovative funding model had enabled long overdue investment in deprived areas, facilitating better access to collocated or integrated key services.
Perhaps one of the most striking features of the LIFT programme is the way it has embraced the government’s agenda shifting the NHS from an illness service to one developing individual health and well-being. As Ben Bradshaw, the minister of State for Health Services, has said: ‘LIFT projects have brought together not only health and social care but also LA housing departments, gyms, pharmacists, swimming pools, GPs, benefit advisers, respite care beds, speech centres, nurseries, job clubs and mental health nurses.’
Innovative developments such as St Peter’s Centre in Burnley, Lancashire, show how far and how quickly LIFT has changed the face of care to a holistic approach. The 10-storey health and leisure facility in the middle of town, with gleaming swimming pool sitting beside GP services and a wide variety of community services tells the story clearly.
In the end, as ministers emphasise, all this change is about quality for individuals. A big theme for policy makers is choice for patients. How well does LIFT measure up in this regard? Simply ask patients who in the past have had to travel long distances for dialysis, meaning major disruption of their lives, damaging their opportunities to work. As one patient in Wigan Health Centre says about its dialysis service that saves him an 80-mile round trip: ‘I have noticed a huge change in my life, in terms of how I feel and the time I have been given back by no longer having to travel for my treatment.’
His experience is just the tip of iceberg. Right across the country, we are seeing LIFT developments that make easy access to an array of locally-based services a reality. These are often in areas where NHS facilities were once sparsely available.
So what of the future? Ben Bradshaw has made clear that LIFT has an important place in the government’s plans for transforming services. In his message to the Annual LIFT Awards earlier this year, he declared: "There will be new and exciting opportunities particularly in primary care. Our guiding principles are what benefits patients and is good value for the taxpayer. LIFT meets both these criteria. "
Ben Bradshaw’s sentiments were echoed last month by Mark Britnell, director general commissioning and system management at the Department of Health, when he announced plans to expand LIFT across all PCTs. Mark Britnell said: "LIFT has proved highly successful, allowing Trusts to upgrade inadequate or ageing facilities around the country and address the historic legacy of under investment in NHS primary care facilities. "
"Allowing the LIFT scheme to rapidly expand will enable more Primary Care Trusts and local authorities to take advantage of its benefits - faster builds, improved working conditions for staff, better care environments for patients, and better overall facilities available for the local community."
At Community Health Partnerships, we look forward to forging new partnerships with the benefits felt by an increasing number of local communities.