Q31 Ms Johnson: I wanted to ask about that because, as you were saying, you can become a tenant of the premises as a local authority without being a shareholder. Are most local authorities taking up the option?
Mr Johns: I could not quote exact numbers but the majority of local authorities have signed up to the partnering agreement, that is the long-term agreement, which means that they can actually commission the schemes from the LIFTCo. As Mr Coates said, they do not actually have to be shareholders in the company to have that facility. The majority have taken that option and, having done that, they can be tenants in LIFT buildings going forward.
Q32 Ms Johnson: I want to refer you to paragraph 2.5 in the Report which talks about the constraints preventing the full involvement in LIFT which local authorities have found. What were these constraints and have they started to be addressed?
Mr Coates: I think the constraints relate to their own corporate governance arrangements within the local authority. There are no barriers of which we are aware to prevent local authorities becoming shareholders within LIFTs. My recollection of the Barnsley transaction is that the local authority there did seek legal opinion on whether they were entitled to invest or not and eventually came to the conclusion that they could do so. There are obviously the usual things about change and doing things differently. All we can say is that over time local authorities have become more accustomed to the idea of LIFT and you often see articles now in papers and periodicals written by the 4Ps, local authority advisory group encouraging local authorities to participate in LIFT and become more fully involved in it.
Q33 Ms Johnson: So there are no structural barriers, it is just a perception that this is not how they have operated in the past.
Mr Coates: Not that I am aware of.
Mr Stewart: There is one practical point which is that when the LIFTCos are set up for the first time there are the sample schemes which are bid on. In practice the local authorities have not had a very significant involvement in these sample schemes, but they will have a much greater involvement downstream. They are looking at a LIFTCo and they are wondering whether they are involved, whether it is worth putting their equity in and becoming a shareholder in the LIFTCo from day one, probably thinking it is not really and that they can sit on the strategic partnering boards. That is the very practical consequence of the makeup of the first schemes.
Q34 Ms Johnson: What interests me about this is the idea that you can bring together the primary care sector and the care sector that the local authority provides. Is there any kind of condition or coercion about making these two work together in a more coherent way? At the moment it just seems to be left that if people feel this might be helpful they will do it. Is there a way of making people work together?
Mr Coates: We have to provide a framework within which the local communities can work together and deliver services on a collective basis. I confess I cannot answer questions about any specific examples where we can give incentives to the voluntary sector. We obviously have good examples locally where people have come together, but all these things depend on the gradual learning from others who do successfully involve the voluntary sector, for example. There is no framework here.
Q35 Ms Johnson: May I turn to GPs? I want to ask about the extent to which you think that LIFT will contribute towards an increase in recruitment and retention of GPs?
Mr Coates: There is evidence from the LIFTs we have, indeed we heard it from our visit on Thursday, that people generally, not just GPs, want to come and work in LIFTs because of the buildings, because of the better quality facilities, but we are collecting no data to try to demonstrate whether that is the case or not.
Q36 Ms Johnson: So it is just a feeling that it might help.
Mr Coates: We do have evidence from individual LIFTs saying that it is helping recruitment and retention, but we do not try to collect data in that area.
Q37 Ms Johnson: Why do you think that there is a problem with dentists and opticians being interested in getting involved in LIFT?
Mr Coates: I think in the Report it was their associations which said that rather than the individuals. All we can say is that when we try to have those facilities within our buildings by and large we are able to attract the tenants and the one you saw last week did have both optometrists' and dentists' facilities.
Q38 Ms Johnson: I was also interested that in the Report there is mention about PCTs having to subsidise rents to meet the wider health agenda. I think it is paragraph 2.14 of the Report. How often is that happening and is this an indication that rents are too high?
Mr Coates: It is partly a reflection of the ability of the location to attract enough of these businesses and certainly for chemists there is the ability for the PCT to subsidise the rents. It is one of those areas and situations where it is up to the local PCTs to talk to the health economy more widely and demonstrate the benefits of bringing together these services on one site.
Q39 Ms Johnson: What is concerning me is that again this might be taking money away from the local health economy to subsidise rents; that concerns me somewhat.
Mr Johns: The way the PCTs look at it is that they see pharmacists as part of primary care. Pharmacists can provide a substantial amount of assistance to GPs in the work they do and it is in those circumstances that PCTs have elected to provide some sort of subsidy for the pharmacists to come in there. If that were not the case, because the pharmacy has the opportunity of over-the-counter sales and that opportunity does not exist for GPs, the LIFTCo could be charging a more commercial rate for the pharmacy. If the pharmacist is assisting the GP to provide primary care services, then in those circumstances the PCT may subsidise part of that rent.
Mr Coates: However, we do accept your point that there is this perception that as you develop one area it seems to suck resources in out of other areas. All we can say is that there is record funding going into the NHS and over time these things will equalise.
Q40 Ms Johnson: Just switching a little bit, I want to ask you about the non-executive chairmen you are appointing. The Report is indicating that there is a problem with recruitment and at one stage one of the LIFTCos did not actually have a chairman. What is the problem about recruiting somebody to be a LIFT chairman?
Mr Johns: I do not think there is so much of a problem. When the Report was written by the NAO, there was certainly one area which had not appointed a chairman of the LIFTCo and that changed afterwards. They have had a chairman. The task for the LIFTCos is to make sure that they get a chairman who has the appropriate skills to balance the public and the private sectors on the boards of LIFTCos to make sure that fair play is seen for both sides. I think the Report notes that inevitably a lot of hard work was put into place to get the LIFTCos established in individual areas and to get the individual schemes closed. People's attention focused more on that and they did not focus attention on getting chairmen. Since then we have chairmen of both the LIFTCos and strategic partnering boards across the country.