Bradford HA covers 486,000 residents. It is the eighth most deprived district in the UK and its population experiences wide inequalities in health: factors that contributed to it becoming a first-wave health action zone.
The HA sees community involvement and partnership working as crucial. It has established a team of community involvement workers to pull people into the HAZ and the developing work of the district's four primary care groups. It has also worked closely with community health councils on a system for reporting back experiences of local health services: good and bad. The HA helped the district's four PCGs move to primary care trust status last month. More than 20 partners are involved in the HAZ and health improvement programme.
The HA has established a staff development programme as part of a re-engineering project that will re-focus the organisation on two roles: planning services and providing strategic leadership for improving health and tackling inequalities.
It has already received regional recognition for best practice in a number of areas, including local implementation of Information for Health, the implementation of the HAZ plan and PCG development.
And it has seen a significant fall in waiting lists, improvements in dentistry and the development of a successful multi-agency winter and emergency planning process.
The judges said:
Bradford HA has really grabbed hold of the agenda and is shaping up for the future. It had to come from behind, yet it was the first HA in Yorkshire to have all its PCGs convert to PCTs. It is keen on and committed to partnership working and has good evidence of success - especially with the local authority. Organisationally it has a well-structured approach to implementing change and its own new role.
East Kent HA
Has established a leading role in the development of clinical governance in the UK through the Primary Care Clinical Effectiveness Project, the single largest primary care health improvement project of its kind in the country.
The project has been running for two years and now covers 77 per cent of the local population. It is designed to reduce inequalities in healthcare provision and build consistent, high-quality care, measured by outcomes or proxy outcomes for 14 disease areas.
It is overseen by a steering group involving a wide range of agencies and representative bodies.
Ensuring that the project was seen as supportive rather than punitive has been crucial to its success. The project has already been evaluated by the National Primary Care Research and Development Centre at Manchester University, which found practices were keen to participate because it was seen as good for patients.
It has also been highlighted in the national service framework for coronary heart disease as a model for improving the management of CHD in primary care.
The judges said:
East Kent HA is a national leader in terms of clinical governance, which has been very well rolled-out across the county, with great clarity and good logistical support. It has worked hard to find real measures of outcome and is a model for emulation across the country.
Sandwell is a network of six West Midlands towns that have been hit by the decline of many traditional industries and show high levels of chronic disease as a result.
The HA is committed to involving and empowering local users. It has a plan for community involvement and an active community development team.
But it also has a clear view of itself as a leader, set out in its business plan and underpinned by a corporate review based on the European Foundation for Quality Management's excellence model.
The review set a baseline for pursuing continuous improvement as an organisation - a second review will be carried out in March 2003, with smaller scale reviews every six months.
It set 18 targets when the area became a health action zone:
these are monitored through the health improvement programme. Eight of the 10 judged suitable for one-year review have moved in the right direction.
Schemes are also being rolled out to prevent hospital admissions and speed up the discharge of patients from hospital.
The judges said:
An excellent HA: so much so that it could almost rest on its laurels. This HA is actually delivering on health where many focus just on the NHS. Yet it is honest about areas that are not improving - and tight auditing means it can capture that and have another go.