Supported by Carillion

Judges

  • Professor Sir Ara Darzi, clinical professor, Imperial College London
  • Dr Roger Boyle, national clinical director for heart disease
  • Maree Barnett, senior policy manager, Department of Health
  • Adrian Bull, managing director, Carillion

Winner Croydon PCT

The judges made note of the novelty and simplicity of the virtual ward, an extremely well implemented concept which mimics the workings of a hospital ward in the patient's own home

The judges praised this winning project for its objective needs-based approach to identifying a population of actual need that traditional services have not always addressed. Furthermore it clearly enjoys widespread support both in and beyond the primary care trust.

The model was developed from the diaries of vulnerable patients with a history of frequent and numerous admissions. These records clearly showed a lack of confidence in services outside the hospital. As inpatients they felt reassured by ward rounds and the perception that a large multidisciplinary team (MDT) was taking charge of their care.

The virtual ward mimics the workings of a hospital ward while delivering care to the patient in their own home. Groups of GPs are offered the chance to commission a virtual ward, with catchment areas reflecting patterns of social deprivation. A community matron manages the day-to-day work of the MDT, cutting down on duplication of care.

So far, Croydon has piloted two virtual wards, but in future up to 10 virtual wards with a capacity of 100 beds each will be targeting care at patients with the highest risk of unplanned hospital admission. A predictive algorithm identifies these patients and when a bed becomes vacant it is offered to the next person on the list.

Good communication is key. A ward clerk has a single telephone number and e-mail and passes information from and to patients and staff. Up-to-date shared electronic notes inform and alert care organisations to the patient's status.

Levels of support alter to reflect dependency. Improved disease control will be the outcome for many, while approximately a third of patients admitted to the ward will benefit from enhanced end-of-life care. A period of several 'uneventful' months will prompt a discharge review.

Highly commended East Sussex Hospitals Trust

The proposal to use a minimally invasive procedure as a catalyst for service delivery improvements was introduced at a multidisciplinary forum in November 2004. Working as a team increased the potential for people to engage with the process, establish their role and contribute to its success.

The move to overnight stay discharge for suitable patients was timetabled for six months from the start of the project. Enthusiasm for the new model of care saw that goal achieved in three months.

Innovations in the short-stay programme include pre-operative 'rehabilitation' teaching in the use of crutches and a combined low dose spinal and general anaesthesia during surgery. Patients are mobilised at four hours and control their post-operative analgesia through a local pain pump that is removed at 48 hours. Discharge from hospital takes place the morning after surgery providing the patient is safe and comfortable. An 'outreach team' that divides its time equally between ward and community provides continuity of care.

The success of the project and the reduction in bed occupancy has seen the same model used for all joint replacement procedures and a reorganisation of pre-assessment clinics and theatre lists. Results of the programme are better than any published in the UK. The project has also attracted significant new revenue for the trust.

Conquest orthopaedic short-stay programme, contact simon.purkiss@esht.nhs.uk

Finalist Havering PCT

The spinal and musculoskeletal assessment service gauges back pain and offers advice and onward referral where appropriate

The patient-focused back pain service is led by an experienced physiotherapist with extended skills and is designed to be flexible, responsive and cost effective

Physiotherapists at the service prescribe x-rays and MRI scans and the service has strong links with local job centres and leisure facilities to facilitate a return to work and function for those with chronic conditions.

Approximately 200 referrals a month - 73 per cent of all referrals to orthopaedics - are seen at the service. This has resulted in reduced waiting times and a fall in commissioning spend of£166,000 in the first 12 months of operation.

Spinal and musculoskeletal assessment service, contact spinalassessment.service@nhs.net

Finalist Swindon and Marlborough Trust

A number of different services - public and patient involvement, complaints and bereavement services among them - have been brought together under the umbrella of the patient advice and liaison service (PALS) to the benefit of patients, the local community and the trust

High-level commitment to the nurse-led PALS team gives the service authority and credibility throughout the organisation. The single point of contact improves continuity and confidentiality and a responsive and proactive service.

While the team has seen an increase in year-on-year activity, its quick response time has seen formal complaints reduce 45 per cent in its first year.

Integrating the patient experience, contact chris.birdsall@smnhst.swest.nhs.uk

Finalist Tameside and Glossop PCT

To achieve its service aims of facilitating appropriate patient access and choice for all those with potential peripheral arterial disease, the lower limb vascular triage service has redesigned the care pathway from primary care to vascular consultant

Primary care referrals now undergo a two-stage podiatry-led triage that consists of remote assessment and subsequent face-to-face PCT assessment appointment booking or fast-track referral to the vascular consultant. All referrals to primary services receive proactive disease management plans.

The service has saved the PCT about£65,000 in tariff payments over 12 months. It has also reduced vascular consultant waiting by 10 days.

Lower limb vascular triage service, contact michaelcunliffe@nhs.net