Clinical Service Redesign, supported by the NHS Institute

High rates of unwanted pregnancies, teenage pregnancies and sexually transmitted infections, including HIV, in Lambeth and Southwark prompted a system-wide review of local sexual health services and revealed the need for extensive clinical service redesign.

The judges praised the project as being "ambitious and innovative", with an "impressive range of user and client involvement".

The Camberwell Sexual Health Centre resulted from three years of partnership working between service users, staff and stakeholders. The service includes touch-screen technology, self-management of sexual health, a modern, dynamic and welcoming environment, one-stop-shop provision of contraception and sexually transmitted infection management and the new role of client support worker.

Innovative approaches were used to engage with traditionally hard-to-reach sexual health service users, such as using feedback from graffiti boards in toilets.

The centre is open from Monday to Friday, 9.30am to 7.30pm, and Saturday mornings, and also provides a walk-in service. It is located on the high street and is immediately identifiable as a sexual health centre.

The service has successfully attracted key target groups such as men and young people. Overall, in the first nine months of opening, there were 15,735 attendances, compared to 9,122 for the same period in the previous year, an increase of 73 per cent. The number of chlamydia tests increased by 137 per cent, the number of blood tests (primarily for HIV testing) increased by 250 per cent and attendance for STI treatment went up by 249 per cent.

There was a 57 per cent increase in the number of coils inserted and an 85 per cent increase in contraceptive implants inserted. The Camberwell Sexual Health Centre, contact rachel.paxford-jenkins@kch.nhs.uk

Highly Commended: St Helens and Knowsley Teaching Hospitals trust

Turnaround times of MRSA screening and urine analysis by the microbiology department have been improved.

A five-day rapid improvement event involved looking at the end-to-end pathology of routine urine samples and MRSA screening samples through process mapping. This quickly identified areas of concern that were leading to high turnaround times. Turnaround times for MRSA screening decreased from 74-44 hours and for routine urine analysis from 41-28 hours.

The department identified a£23,000 yearly saving by improving other areas within microbiology, using lean principles. The judges said it was a "classic redesign".

Microbiology department, contact beverley.duffy@sthk.nhs.uk

Finalist: Bolton PCT

A programme of rapid lean redesign across 10 older people's, adult and child clinical services - all considered high risk and unlikely to meet the elective target - has led to significant reductions in referral to treatment times and an increase in staff improvement capabilities.

From programme start in April 2007 to May 2008, referral to treatment times for these services came down from a maximum of 20 weeks to an average of four weeks.

Stronger streaming of patients to new clinical pathways and active length of stay management has seen caseload sizes halved and referral to assessment times reduced by 50 per cent.

Lean thinking programme, contact elizabeth.bradbury@bolton.nhs.uk

Finalist: Calderdale and Huddersfield foundation trust

Waiting times for histology results were improved, using lean methodologies and a rapid improvement event.

A first-in, first-out system was introduced for non-urgent specimens, to help reduce turnaround times. Batch sizes were decreased from more than 100 at a time to a maximum of 20 and the specimen reception area was relocated to reduce the walking required. Judges praised "fantastic results with sustainability".

Turnaround times were reduced by 43 per cent and the time for processing specimens decreased by 32 per cent. Stock levels were reduced, with annual stock savings of£3,000 achieved.

Reduction in end-to-end turnaround times (histology department), contact emma.godfrey@cht.nhs.uk

Finalist: West Sussex Health/West Sussex PCT

Twenty virtual wards were created across West Sussex, consisting of population practices of around 20,000-50,000 and aligned to practice-based commissioning clusters. The wards formed the basis for commissioning core and enhanced services, with the aim of providing care closer to home, maintaining health and preventing unnecessary admission into hospital.

"The scale and complexity is impressive," said the judges.

Integrated teams worked 24/7 alongside partner organisations including the acute sector, ambulance trust, adult services, community hospitals and the voluntary sector. Advanced nurse practitioners worked with GPs to provide care overnight.

Virtual wards: teams without walls/pushing the boundaries of care, contact lucy.botting@westsussexpct.nhs.uk