FINANCE & LEASING SERVICES
David Pokora, executive director of the LIFT Council, discusses the role of the LIFTcos in a reformed NHS and the continuing relevance of the public-private model for financing, developing and maintaining the NHS estate.
T
he cost pressures on the NHS and the need to make
efficiency savings are common throughout the organisation, not least in managing the organisa- tion’s facilities and estate.
Since 2005 the LIFTCos – and the LIFT Council, representing 95% of the industry – have delivered scores of buildings for the NHS.
Its executive director, David
Pokora – who spent 26 years in the NHS, including 11 as chief executive of an acute trust – says they have as much a role today as ever in helping NHS organisations make the necessary savings.
Pokora said: “The role of the LIFT- Cos in helping the NHS make ef- ficiency savings is quite consid- erable. The reason I say that is because the NHS has historically found it difficult to invest the right kind of cash and incentive in max- imising the use of the NHS estate. I say that not as a hard-nosed pri- vate sector individual – I used to be in the NHS, and so I say it hav- ing been inside the health service. I recognise the difficulties that there are, with the predominant effort being on clinical services rather than on estate.
“LIFTCos, given that they have re- ally only got one purpose in life, which is to actually be an expert asset manager, have the skills and the private sector companies that support them have got access to a whole portfolio of skills that would help the NHS derive better value from its estate.”
More for less
“It can do that in two respects,” Pokora says, “through the use of tools and techniques that will actu- ally improve utilisation of existing premises, but also using tools and techniques to look across a whole geographic area and assess what facilities are actually required and how they could be changed or adapted to derive better value.
They can also help to allow more extensive use of the estate, rather than patients having to go to hos- pital.”
The healthcare reforms will obvi- ously produce an NHS that looks, structurally, very different from what came before. But what will the LIFTCos themselves look like and will their role change? Pokora said: “Some of that we don’t yet know. PCTs have a 20% shareholding in each of the LIFT- Cos. Where that 20% shareholding will go is anybody’s guess at the moment and I’m sure that the De- partment of Health have got many bigger issues to consider than that! Ultimately, it will have to be deter- mined and obviously that change will have to be made.”
44 | national health executive Sep/Oct 11 Fragmentation
Pokora acknowledged: “As far as the NHS is concerned, I think it’s likely to be, for a LIFTCo, a little bit more fragmented in terms of who they have to deal with. That’s because there’ll be aspects of what they do where the NHS Commis- sioning Board will need to have input from LIFTCos , and LIFTCos will have to have input from the regional outposts – or whatever they’re ultimately called – of the NHS Commissioning Board. But then it’s down to individual GPs and indeed other providers.
“So, NHS bodies, social enter- prises – there will be different solutions in different parts of the country, because the architecture
of the NHS will be different on the provider side in different parts of the country. It will be a bit more fragmented, but, at the end of the day, the fundamental need for proper primary and community care estate doesn’t go away.
“You can change the shape and position of the deckchairs on the ship’s deck to your heart’s content, but you still need a ship and you still need a deck and something that can provide healthcare ser- vices. So, that fundamental need does not go away whatever the ar- chitecture of the NHS.”
Unsurprisingly, Pokora remains convinced that the public-private partnership model remains the best one to finance, develop and maintain the NHS estate.
He said: “Absolutely it’s still the best model. The NHS has proven in its past – and, as I say, my back- ground was in the health service, so I’m not saying this as a carping comment from the outside, this is a recognition of what it’s like in- side the health service – the NHS has not ever been a good procurer of buildings where it has been the individual entity paying for it di- rectly. Cost and time over-runs
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