Patient-Centred Care

Judges

• Sir Harry Cayton, national director for patients and the public
• Sir Ian Carruthers, chief executive, NHS South West
• Dr Simon Wallace, physician executive, Cerner

Winner Croydon PCT

Croydon's virtual wards scheme mimics the workings of a real ward while treating patients in their own home. Patients can expect improved disease control and, for a third of patients, enhanced end of life care

In the opinion of the judges what stood Croydon's entry apart from others in the category was the realisation that patients feel safe on wards. Building on this simple premise and responding to anxieties arising from the shift in emphasis to community care, the PCT is developing the original concept and practice of the virtual ward

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 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 will be 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 multi-drug therapy, cutting down on duplication of care.

So far Croydon has piloted two virtual wards, but in future up to 10 virtual wards each with a capacity of 100 beds 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 to the efficient running of the service. 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.

Virtual wards, contact steve.hunt@croydoncpt.nhs.uk

Finalist Dorset and Somerset SHA

The project was devised to champion the benefits of self-care across the regional health community through the development of proactive clinical leadership

A key objective was to demonstrate to health and social care professionals the importance of promoting good self-care. Techniques for achieving such an outcome are included in the handbook Promoting Optimal Self Care, which contains a comprehensive guide to the major principles, psychological support interventions and practical methods for making improvements in long-term care. The end of the project in April 2006 was marked by the launch of the clinicians' handbook.

Clinical leadership for self-care, contact martin.carter@dsha.nhs.uk

Finalist Northumbria Healthcare Trust

DAFNE is a five-day outpatient education programme that gives adults with type-1 diabetes the skills and understanding they need to manage their own condition

Learning to match their insulin to their food choices empowers adults and gives them the chance to enjoy the same level of dietary freedom as someone without diabetes.

By improving glycaemic control, the programme significantly reduces retinopathy, renal disease and neuropathy. While improving quality of life, cost analysis shows that DAFNE pays for itself after four to five years.

The programme is now available at more than 50 centres across the country.

Dose adjustment for normal eating (DAFNE), contact gillian.thompson@northumbria-healthcare.nhs.uk

Finalist Southern Norfolk PCT

Norfolk Healthline is a public-private partnership project between Southern Norfolk PCT and Health Dialog UK that helps patients find their way around healthcare services

The free telephone-based service is supported by predictive risk modelling and is focused on disease management across five long-term conditions and decision support for preference-sensitive conditions.

The patient-centred care model provides interventions and resources at various stages and according to patient dependency. Registered nurses trained in shared decision-making work with patients to help them become more involved in their own health management and maintain their independence. Early results show that 96 per cent of patients felt it acted on the outcome of their call.

Norfolk Healthline, contact janice.bradfield@norfolk.nhs.uk

Finalist Sunderland teaching PCT

Listening to patients is an action research project that captured the views of COPD patients as they used a new urgent care pathway

Changes were made to the service on the basis of real rather than perceived need. Key themes identified by the research showed how patients relied on emergency services to avoid the stress of long waits often suffered at home and in isolation. Many considered their illness a low healthcare priority and had low expectations.

The urgent care team has improved care for these patients through extended access to skilled professionals, increased choice and assurance in services.

Listening to patients, contact dawn.ridsdale@suntpct.nhs.uk

Finalist Sunderland teaching PCT

The redesign and modernisation of Sunderland's busy accident and emergency services - at 98,000 admissions per year it caters for twice the national average - was informed by focus group consultation

Reasons cited for such a heavy volume of use included lack of choice and convenience of location. Service development consistent with the NHS plan sought to improve the patients' experience of urgent care by providing more choice in more suitable venues.

The 30 strong nurse-led urgent care team now provides care in the primary setting and now sees up to 650 patients a month.

Urgent care team, contact dawn.ridsdale@suntpct.nhs.uk