Evaluation of the planning and implementation of NHS Local Improvement Finance Trust (LIFT) in East London

Procurement of NHS primary care buildings was reserved for the DH working through PCTs until LIFT was introduced. The DH anticipated that LIFT would effectively mobilise private sector finance and expertise in improving the quality of buildings. But LIFT’s suitability to achieve this is questioned on grounds that it uses market mechanisms that may fail when applied in health. This case-study explored with people directly involved in LIFT their views and experience of how it helped them in procuring desired buildings. It was driven by desire to understand whether and how contextual factors and mechanisms in LIFT supported staff efforts, hoping the findings would influence DH officials in revising the guidance to make LIFT effective. Evidence was primarily collected through in-depth interviews with 25 informants drawn at two PCTs, the LiftCo and LIFT buildings. Data from interviews was complemented by documentary analysis and tours to make observations at four LIFT buildings. The data was coded for analysis in NVivo. The key findings were organized into four analytical categories aligned with the research questions for interpretation to generate relevant answers. The study revealed that the important factors for progress in LIFT involved commitment of PCT boards; engaging PCT managers in strategic decisions and empowering them in influencing governance issues. Progress may be enhanced through DH officials encouraging increased collaboration between LIFT partners and promoting contractor competition in service delivery. Barriers to progress included the LiftCo over-prioritising efficiency, hiring of contractors lacking experience in health, and the DH not sufficiently supporting PCT managers in increasing their capacity to make LIFT effective. Informants believed LIFT could improve procurement provided ways of addressing the barriers were explored. LIFT outcomes are a result of factors in its contexts influenced by policy-makers and decisions taken by operational staff. Recommendations are offered for these constituents in LIFT and for future research. DH officials should get feedback on practicalities of LIFT guidance by engaging PCT managers in making strategic decisions and empowering them in translating their experiences into actions. This could make LIFT effective and reduce the risks that were highlighted.