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Is this concept of partnering a house built on sand?

Richard Nugent, Chairman, Oldbury and Smethwich PCT and Chairman, Sandwell LIFT Project Board

As a Primary Care Trust, the primary objective is not to produce wonderful buildings, it is to improve the health of the population.

PCTs are used to partnerships - they are part of many existing partnerships such as Local Strategic Partnerships, the local health economy and have a tradition of joint working and joint commissioning.

Characteristics of partnerships are common objectives, similar values, some financial incentives and some joint targets.

The Local Improvement Finance Trust legal framework has a strategic partnership agreement, a lease plus agreement and a shareholder agreement. Partnership is a key criteria for selecting a LIFT partner - eg how well did they work together as a partner and how well did we think we could work with them as a team.

The timescale for LIFT is breakneck and may lead to some missed opportunities.

The members of the strategic partnering agreement are Liftco, PCTs, other NHS trusts and local authority(s) - but some are more involved than others. The agreement has many positive aspects about what should be achieved - eg high quality accommodation, open book relationship, agreed mutual objectives - but also notes that the "parties recognise and agree that the partnering ethos, principles and objectives…are aspirational and not intended to give rise to legally binding rights…"

Anything we want to build in the next 20 years will have to be built by Liftco. There is also a relatively low threshold for Liftco work - £20,000.

The strategic partnering agreement is administered by the Strategic Partnering Board (SPB). One of the board's key task is to review the SSDP and approve it. Concern that SSDP does reflect the true strategic development requirements of the PCT and does not 'drift off' and become something disassociated, which has happened in the past. The SSDP must reflect the Local Delivery Plans (LDP) or LIFT will not deliver what it should deliver.

The Strategic Partnering Board must be careful not to create barriers between other partnerships. It should enhance the Local Strategic Partnership. Other partners can be nervous because they see it as 'just about health'. But other partners can be added to the SPB.

LIFT should be seen as a delivery method for the wider partnership. We will miss a trick if we only see LIFT as being about a few health centres; it should be used as part of the wider regeneration programme.

There is an issue about possible conflicts between Lift shareholders and consumers; PCTs are mainly consumers and purchasers of services and affordability is a bigger issue for PCTs than promises of future dividends.

Benefits and risks to local health economy

Benefits

• free to concentrate on core business - health
• access to capital without 'construction' risks
• relative certainty over costs and quality
• potential for integration with other services - hoping that we can bring in other partners and services in the next wave

Risks

• uncertainty for future need - we can change, but at a cost and we can't say what our use will be in ten years
• locked into single provider
• long term financial commitment
• head lease - GPs do not seem to want to enter into lease plus agreements, they don't want to enter into long leases

Benefits and risks to Liftco

Benefits

• guaranteed income
• captive market for future health business
• toe hold in local economy

Risks

• construction risks
• third party tenant risks
• future business probable but not guaranteed
• financial risks

Some LIFT issues

• need to shift emphasis from process to outcome - too much emphasis so far on developing the process, now need to concentrate on what we are trying to achieve from it
• common objectives or common understanding of different but compatible objectives?
• extended scope or limit and refine what we do?
• future role of Partnerships for Health? Who are they representing?
• design is not the overriding consideration

Richard Nugent is an architect by training. He is currently Chairman of Oldbury and Smethwick PCT, and Chairman of Sandwell LIFT Project Board. He was formerly Director of Estates, Director of Purchasing and Development, and responsible for Strategic Planning of Health Services for West Midlands RHA.

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