In 2000 the Department of Health (DH) announced the establishment of NHS Local Improvement Finance Trusts (LIFT) to develop primary and social care services buildings and facilities in England. LIFT is based on long term joint ventures at national and local level: nationally, Partnerships for Health is a joint venture between DH and Partnerships UK (itself a joint venture between the Treasury, Scottish ministers and the private sector); locally the local joint venture company (the LIFTCo) is owned by representatives of the local health economy, Partnerships for Health and a private sector partner. Unlike PFI deals, LIFT deals are based on the local LIFTCo owning the premises which it builds and refurbishes. This report examines whether LIFT will meet local needs and provide value for money. 42 local schemes had been approved by August 2002, mostly in deprived inner city areas, with a total capital value of £711 million. Most LIFTCos are operational, though few buildings are open; most of the developments have been well received by local stakeholders. NAO conclude that LIFT will work. Nationally it is an attractive way of securing improvements, and local schemes appear to be effective and offer value for money. Local management frameworks need to be strengthened.