INFRASTRUCTURE INVESTMENT
Lowe House Health Centre, St Helens.
gardening projects for vulnerable adults, we have been proud to deliver some award-winning initiatives to further support local health priorities, and drive huge social value in the local community. But while many other private sector organisations have
Sarah
Beaumont- Smith
Sarah Beaumont-Smith is an industry leader in the infrastructure sector, with more than 15 years’ experience in financing, developing, and delivering schools and health centres, property schemes, and transport networks. As UK strategy director for health investor Fulcrum Infrastructure Group, Sarah has overseen the delivery of more than 40 health centres in England under the NHS LIFT Programme and has now taken on a wider new role to lead Fulcrum’s discussions with government and industry about the use of public-private- partnership models in social infrastructure. Alongside this, Sarah continues to chair The LIFT Council and in November 2025 she became the chair of the Neighbourhood Health Forum – a collective new voice for private investors in neighbourhood healthcare. In 2025, Sarah was named the ‘Leading Woman in Infrastructure’ at an industry awards event in recognition of her achievements in delivering vital infrastructure across the UK, and her work to create more opportunities for women to enter, thrive, and lead in the industry.
tackled head on. If we look again at MIM, we can see a clear step-change that better prioritises the quality of the buildings being delivered under PPP arrangements. By way of illustration, the delivery of new schools and colleges in Wales under MIM has embedded a focus on quality from the outset, backed with clear intervention measures should quality issues start to arise. This includes some simple but hugely effective steps, such as establishing a clear and detailed ‘output specification’ for each asset – this then becomes a contractual obligation on the private partners, backed by financial penalties if standards are not met through the life of the project. It includes the appointment of an ‘Independent tester’ to oversee the quality of works throughout construction, and with the power to bring works to a stop if there are concerns. And it includes a minimum four week settling in period between construction completion and practical completion. This ensures everyone has the opportunity to settle into the building and are happy with it – before the final sign-off. As has been seen with older PFI models and projects, issues with the quality of construction or misuse of the building can become a huge operational issue in the long-term. MIM and other PPP models have learned from this, with a much greater focus on quality from the start, it has changed the dynamic of the public-private delivery and ensured that buildings are built to last. The same will be key in the delivery of new NHS buildings, so as a new PPP model for health is developed, embedding similar measures that prioritise quality will be an essential step.
4. The need to deliver social value Over the last few decades, there has rightly been a growing recognition of the need to deliver community benefits and lasting social value alongside major new public infrastructure. It is an area that the NHS LIFT programme has a strong
track record in over the last 25 years, with LIFT buildings often becoming far more than just a health centre. Instead, they have evolved into vital community hubs for local residents, delivering a wide range of benefits and services far beyond simply health provision. Through my own organisation Fulcrum Infrastructure
Group, I have been involved in a range of community initiatives and social value projects delivered alongside our 42 NHS health centres. From Active Ageing sessions for older patients and legal clinics for local residents, to drama groups for pregnant women, and community
54 Health Estate Journal August 2026
also taken a similarly proactive approach to delivering social value, there is always the underlying risk that it is seen as a ‘nice to have’ and something that can be quietly dropped over time, as cost pressures and other challenges emerge. To help tackle this, MIM has again delivered a significant step change, where contracts build in stretching targets for investors to deliver community benefits and social value (including local job creation, training and apprenticeships, and community initiatives) with financial penalties for non-delivery. If the government is to be successful in delivering new Neighbourhood Health Centres, it will need to get local communities on-board and be supportive of the plans. Embedding clear community benefits and social value within the new PPP model is a clear way to achieve this.
5. The need for flexibility and a refined approach to FM
An enduring (and sometimes fair) criticism of some older PFI models were that they tied the public sector into complex, rigid contracts, particularly in terms of Facilities Management and maintenance. We have all heard the ‘£300 to change a lightbulb’ example which, while possibly apocryphal, underlines the challenges we need to overcome if we are to reintroduce private finance in health infrastructure. However, what this overlooks is that in many of the newer PPP models that have followed – including NHS LIFT – important lessons have been learned with contracts that are now much more flexible, allowing changes to be implemented more easily and regularly. Likewise, our experiences under MIM have pointed to
an improved, refined approach to FM which we believe a new health PPP model could look to replicate. This includes a six-month grace period for FM companies to allow them to focus on properly mobilising their teams and systems before facing the deductions included in the payment mechanism. Ensuring FM teams are properly mobilised at the start will lead to a better overall service delivery over the long-term. MIM contracts also look to include ‘wipe clean’ provision, which improves the ability of the public sector partners to re-procure FM services if needed – the inclusion of these ‘break clauses’ (e.g. at 5, 10, 15 years). This ensures a long-term commitment from the FM partner, but with incentives to deliver high quality every day. There are many other examples from other PPP models, but LIFT and MIM demonstrate the importance of building flexibility and efficient ‘change mechanisms’ into any investment and delivery model for new health infrastructure.
Grounds for optimism So, to conclude, there are grounds for huge optimism in health estates, with the government’s neighbourhood health plans starting to offer clarity and a roadmap to how the private sector can support the next decade of the NHS.
But as we look to the future, there are often important lessons to be learned from the past. The 25th anniversary of LIFT, and experiences from many other partnership delivery models, all offer important signposts we should follow as we look to tackle the NHS estates’ challenges of tomorrow.
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