The best in collaborative working and effective care were on display in entries for this year's Health Management Awards. Here, the judges explain how they chose the winners

Celebrating excellence in health service management was the theme of HSJ's 18th annual Health Management Awards . And almost 300 distinguished guests assembled at London's Park Lane Hotel to hear junior health minister Lord Hunt announce the results and present the prizes.

Among them were the speaker of the House of Commons, Betty Boothroyd, former health secretary Virginia Bottomley, defence minister John Spellar, junior health minister Gisela Stuart and a host of government and opposition backbench MPs.

This year, the scope of the awards was broadened and based on new categories, aiming to reward whole organisations and departments - rather than individual projects - for outstanding performance.

Entrants were measured against stringent criteria compiled by Birmingham University 's health services management centre. The judges wanted evidence of how well they understood their users and customers, of collaboration and partnership, of leadership and high-quality management. They looked at how entrants had gone about improving their performance and, finally, examined the candidates' visions for the future.

HSJ editor Peter Davies said the introduction of the New NHS reforms in April had been 'one of those historic turning points for the service' and that for managers particularly 'the workload has been as profound as any in the NHS's history'.

Lord Hunt said the government recognised that the pressure on managers was 'incredibly intense'.

'Neither I nor my ministerial colleagues doubt your commitment. Never, of course, has it been more needed.' The government had a 'historic mission to take the ideals and values of the Bevanite NHS of 1948 and make the NHS fit for the 21st century'.

'Above all we need the people, and I think we have them, ' he said. 'I don't think we could wish for a more committed and hard-working group than our managers.'

Judges

Professor George Alberti president, Royal College of Physicians

Virginia Bottomley MP secretary of state for health, 1992-95

Lord Harris of Haringey former director, Association of Community Health Councils for England and Wales

Barry Elliott chair-designate, Healthcare Financial Management Association

Helen McCallum director of NHS communications, Department of Health

John Northrop director, Pay & Workforce Research

Alison Forbes head of press and PR, King's Fund

Steve Gillam director of primary care programme, King's Fund

Nikki Atkins project manager, Glaxo Wellcome UK

David Knowles director of education and leadership development, King's Fund

John Cooke director of industry and government affairs, Glaxo Wellcome UK

Tony Haggar Arthur Andersen & Co Marion Drummond finance and information manager, Glaxo Wellcome UK

David Bewers assistant director of resources, King's Fund

Catherine Sharman human resources manager, Glaxo Wellcome UK

Lucy Leverett head of communications, Glaxo Wellcome UK

Jo Wilson director of clinical services, Healthcare Risk Resources International Ltd

Alison Hill director of effective practice programme, King's Fund

The Health Management Awards are organised by HSJ in association with Glaxo Wellcome, and sponsored by the King's Fund and Healthcare Risk Resources International. The judging criteria were compiled by Birmingham University's health services management centre.

Category Health authority/health board of the year

Winner

Birmingham health authority This claims to be the largest HA in the country, serving a population of more than 1 million, many of whom live in deprived circumstances.

The present Birmingham HA has overcome many difficulties. The result of a merger between North and South Birmingham HAs and the family health services authority, it has overcome deficit problems, downsizing issues and a history of difficult relationships with the local authority, the local medical committee and the unions.

The judges commented: Many of Birmingham's achievements were attributed to the turnaround in working relationships with the local authority, the local medical committee and the unions, in particular. Waiting lists have been substantially reduced. The panBirmingham working group to address winter pressures is recognised as a model of good practice. The HA led a single regeneration budget bid to help make£24m available for the family support strategy, and has made significant strides to address its chief public health concern, cardiovascular disease.

The HA's strengths in public consultation and community involvement were exemplified through exercises to involve service users in GP commissioning and the establishment of an independent review panel. It continues to implement an action plan on race. The proposal was clearly laid out and purposeful, the right blend of strategic and factual detail, with achievements and future priorities delineated.

Runner-up

North and East Devon health authority North and East Devon HA covers a predominantly rural and coastal area, stretching from the north to the south coast of Devon. This means that service planning needs to be tailored either to a dispersed model of delivery or to an acceptance of long journeys for staff and patients. The HA has demonstrated a systematic approach to developing patient services in a number of areas including instigating service reviews and action plans, commissioning performance teams and giving a high profile to clinical audit.

The judges commented: The challenges facing HAs in mixed urban-rural districts can be underestimated. The population is widely dispersed with increasing numbers of older people. Hence the need for a participative model of community ('small area') reviews. A sense of solid achievement characterised this submission. The judges were impressed by the HA's commitment to collaboration with a broad range of partners. Joint working with the district council was evident at both strategic and operational levels in many spheres: for example, on health initiatives such as the HA's hip protector pads project and the 'Below the belt' men's health campaign.

The mark of a learning organisation is its readiness to use audit and benchmarking to effect change. A financial deficit has been turned around, and the authority already fares well in terms of many performance indicators.

However, it was encouraging to see several areas of below average performance - such as day-case surgery rates - singled out for comment. Finally, North and East Devon HA appears to give serious consideration to staff support and development.

Runner-up

Croydon HA Since its formation in April 1996, following the merger of Croydon district HA and Croydon FHSA, Croydon HA has built a reputation for innovation and delivering results. It has made significant improvements to services while maintaining financial equilibrium. For instance, Croydon boasts of reducing hospital inpatient waiting lists by 13 per cent between April 1998 and March 1999, and has ensured that all women with breast cancer have a hospital appointment within two weeks.

The judges commented: This submission imparted a clear vision for health in Croydon, exemplified in the integration of health improvement priorities, service and financial plans. Serving a diverse multicultural population, a number of initiatives reflected a commitment to addressing mental health. The HA has engaged innovatively with the public through health panels, new patients' networks set up by primary care groups, and the community involvement framework. The systematic use of key indicators for regularly monitoring the HA's progress was also notable. In addition to exceeding waiting-list targets and implementing a number of successful winter pressures initiatives, Croydon HA had made significant advances in the prevention and management of breast cancer.

Evaluation of these services is particularly important to a trust which was originally set up to develop community based patient services. Its achievements include streamlining continuing care. As a result of these initiatives, West Herts is ranked tenth in the country for this high-level performance indicator.

The judges commented: The trust aims to be user-centred in a way that acknowledges the individual's rights and promotes self-respect and dignity. This is one of its particular strengths. The service has clearly been shaped by the users and carers, and this philosophy underpins the trust's work. There were good examples of partnership working: for example, in successfully bidding for European Social Fund money, and benchmarking work was clearly linked to improving clinical outcomes. A good overall performance clearly centred on the needs of the community served by the trust.

Runner-up

Sandwell Healthcare trust Sandwell Healthcare trust employs 3,300 staff who provide integrated hospital and community healthcare to an ethnically diverse population of 300,000. The trust's strategic aims include supporting GPs so they can offer more services from their surgeries, improving services for black people and those from ethnic minority backgrounds, and working in partnership with other providers of health and social services to ensure they maintain safe and cost-effective services. Sandwell is especially proud of the leading role it plays in one of the country's first health action zones, established to bring about positive and practical change in one of the most deprived areas of the country.

The judges commented: Against its complex background, the judges were impressed with the efforts this trust has made to seek out and act on the views of its diverse user groups.

The judges were equally impressed with the trust's work in developing partnerships, in particular the development of the Neptune Health Park. This one-stop health and community centre brings together a number of statutory, voluntary and commercial organisations, and is one of the first of its kind in the country. Also noteworthy was Sandwell's efforts in benchmarking, as evidenced by its long-standing membership of a benchmarking club.

Category Trust of the year

Winner

Newham Community Health Services trust Newham Community Health Services trust operates in one of the poorest London boroughs, with a hugely diverse population, so it faces a greater range of challenges than most. The trust's aim has been to move away from a 'federation' of services towards developing an organisation providing comprehensive complementary services which focus on a clear vision of a model service.

To this end, the trust has placed emphasis on developing strategies particularly for care groups and primary care.

This work has been underpinned by working in partnership with other agencies and service users.

The judges commented: There was a consensus among the judges that Newham's performance against each of the criteria for the awards was consistently good. The trust was highly rated for its development of some imaginative partnerships and collaborative initiatives. The area in which Newham particularly stood out was in leadership and management. The trust has clearly put a lot of emphasis on generating a distinctive organisational ethos, which the judges felt laudable in the context of its socioeconomically deprived environment. Its application gave a strong sense of an organisation that knew what it had to do and how to get there.

Runner-up

West Herts Community Health trust West Herts Community Health trust provides a full range of community services to half a million people in Hertfordshire. Its six main service areas are primary care, mental health, children's services, learning disability, adult rehabilitation services and elderly care services.

Category Finance department of the year Winner Finance department, London Ambulance Service trust The London Ambulance Service claims to be the world's largest urban provider of accident and emergency prehospital healthcare. It also provides a patient transport service to more than 40 London healthcare providers.

Before April 1996 the finance department had minimal infrastructure in place, and performance levels were low.

Morale was poor and sickness levels high.

The judges commented: LAS drew from evaluated tangible evidence to demonstrate that it could verify improvements in its finance department's performance. It also developed and measured itself against relevant key performance indicators, annotating and collating evidence in a clear and concise way.

A very strong and favourable feature of the entry was the department's holistic approach to improving its output while improving the competencies and career pathway of staff members. The entry was focused on the improvement of the finance function and its role with its clients. It avoided the tendency to concentrate solely on the organisation's objectives.

Runner-up

Finance department, Bromley health authority At the beginning of 1993, a new chief executive and finance director were appointed to Bromley HA. At that time, the exact extent of a significant financial deficit was unknown, no plan was in place to bring the HA back into balance and the finance department consisted of only a few unqualified accountants.

The financial deficit was eliminated within a year, a long-term plan was produced and the HA has maintained a sound and robust financial position in the past five years. The department has also expanded to include nonfinancial functions such as acute commissioning, information management and technology.

The judges commented: This entry covered the HA's strategies and explained the strategic role finance had played within corporate policy. It showed clear evidence of achievement in helping primary care groups, both at board level and within the organisations. The department also demonstrated considerable achievements in primary care in agreeing financial protocols with the local medical committees. The future strategies were well evaluated, but to some extent still needed more detailed work, and evidence to support benchmarking outside the normal parameters could have been more fully explained.

Runner-up

Finance department, North Staffordshire Hospital trust The newly appointed finance management team at North Staffs found itself in a challenging position in late 1998.

Financial performance had been poor, and the trust had accumulated a significant budget deficit. External audit had identified that corporate governance was weak, with many financial policies and procedures non-existent or in need of revision. Staff morale was poor, and the department's credibility was at stake. But the team has reversed this situation after a radical review of structure and services. The deficit is being recovered, the capital programme is within budget and a cost-reduction plan is being implemented.

The judges commented: The entry showed evidence of a coordinated and direct approach. Overall the application demonstrated the impact a finance function could have on a changing organisation with considerable financial problems. More evidence of a holistic approach would have strengthened the evidence about sustainable improvements. The team showed significant achievements, but relied on outputs rather than detailed key performance criteria.

Runner-up

Human resources department, Hillingdon Hospital trust Hillingdon's HR department supports a trust with 2,000 staff and is organised into four areas: employee relations, recruitment and temporary staffing, medical staffing, and training and development. Over the past two years, the department has moved from being a corporate administrative function to one supporting clinical and non-clinical areas of achievement. Acutely aware of the national shortage of some professions, particularly nursing, Hillingdon makes a great effort to develop good relationships with its staff, the local community and potential future staff. It monitors the views of these groups to ensure appropriate HR policies and solutions are in place.

The judges commented: Hillingdon's application began with a well-judged overview, setting out the context and covering the full range of HR work.

Excellent examples are given of outreach to customers and service users. The benchmarking section would have been strengthened by more indication of the precise standards against which activity and outcomes are measured. The application would also have been helped if it had highlighted the link between improvements set out and an HR plan showing how operational priorities are derived from broader objectives.

Category Human resources department of the year

Winner

Human resources directorate, Chelsea and Westminster Healthcare trust At Chelsea and Westminster, the human resources team's wide-ranging remit includes all aspects of the HR function, such as providing strategic HR direction and professional leadership, setting a trust-wide framework of good HR practice and development, and pay and policy negotiations for the trust. Specialist employee relations and workforce planning expertise, developing medical education and research strategies, and training and development are also emphasised.

The judges commented: The HR team clearly identified its customers and those it had to work with. The team had developed a wide range of collaborative and partnership arrangements, and continued to identify opportunities for further collaborative work. The team also showed evidence of strong leadership and management in its structures. These supported a strong customer-focus as well as clear links with the organisation's strategic direction and business-planning process. It developed tools to monitor the effects of its policies and procedures and introduced both internal and external benchmarking for key performance indicators.

We particularly liked its organisational pledge - which provides a number of staff support mechanisms - and its managers' pledge, which ensures staff are developed effectively.

Runner-up Directorate of personnel, Thameside Community Healthcare trust Thameside personnel directorate's mission is 'to contribute to the business of the trust by providing expertise and support on all matters relating to the effective management of people, and promote an environment where employees feel valued and are able to realise their full potential'. The trust believes personnel management is primarily line managers' responsibility. The directorate's main function is to offer expertise and support to managers.

Recent initiatives have included launching a personnel newsletter on issues such as employment law, planned initiatives and tips for managers.

The judges commented: The personnel directorate at Thameside appears to have responded well to poor customer feedback in 1997 and made great efforts to improve the service provided. By setting up a personnel user group with senior managers from other directorates, the department's effectiveness is reviewed quarterly. The use of feedback forms at the end of disciplinary, sickness absence and recruitment cases enables it to obtain managers' feedback regularly. Now the department has addressed the concerns of its customers, it should be able to take this forward with some more innovative projects in the future. Many HR processes are in place to ensure the department runs efficiently. Perhaps it could have provided more data on benchmarking.

Category Clinical risk management team of the year

Winner Specialist learning disability service, North Derbyshire Community Health Care trust Individuals with learning disabilities and mental health problems are often in the greatest need of care and support. Research indicates that people who present with severe problems do not make rapid progress, and may continue to present serious risks for many years.

With as many as 1,200 families in the region who have a member with a learning disability, North Derbyshire Community Health Care trust recognised the need for greater understanding of the issues and for a robust interagency mechanism to best serve this sector of the community. Its solution has been to develop the significant risk advisory group, which deals with the most challenging aspect of the wider clinical risk management process.

The judges commented: This team clearly recognises the importance of an integrated approach to clinical governance, incorporating risk management with clinical effectiveness. In a spirit of wide co-operation and partnership, its programme is embedded in the community it serves, and is comprehensive in providing effective care and safeguards. The model it has established will be helpful to many other organisations.

Runner-up

Risk management department, West Cumbria Health Care trust West Cumbria Healthcare trust's philosophy is that risk management can only truly work by involving committed clinicians. The team is concerned with every patient and the quality of treatment and care they receive. Therefore, gleaning regular feedback from patients is a priority, as is ensuring that best-practice standards are used.

As a combined trust, it is able to offer care across acute and community services, using the same policies, procedures, training and risk management processes.

The judges commented: Showing a breadth of understanding about its customers and partnership links, this team stressed the importance of interdisciplinary communication. It showed a clear and thoughtful strategic leadership and a wealth of activity across its complex organisation.

West Cumbria Health Care has a vision for the future that is broad, inclusive and emphasises training for staff at all levels. We liked its determination to work across trust boundaries towards a commonly held vision of proactive clinical risk management that will enable any new organisation to hit the ground running.

Runner-up

Department of old-age psychiatry, East Wiltshire Health Care trust The department of old-age psychiatry aims to deliver a unified specialist service to improve the quality of life and offer continuity of care to elderly people and their carers, while incorporating the care of younger people with dementia.

This calls for a flexible service, which is constantly evolving and responsive to the needs of its target group.

Taking an innovative approach, the East Wiltshire team has developed the elderly mentally infirm risk tool, which is specific to the clinical risk management of elderly people.

The judges commented: East Wiltshire trust fully integrates clinical risk management into the department's objectives and development plans. Its understanding of leadership and management is particularly strong.

It demonstrates a bottom-up approach, and has achieved ownership by allowing clinical staff to lead a project to develop a promising-looking risk-assessment tool with commendably clear endpoints, recorded as decisions taken on action at the end of the process. Its plans for the future were far-sighted and practical.

On the one hand, this included influencing health policy to encourage better integration of service delivery in the community to mentally vulnerable older people.

On the other hand, it encourages a wider understanding of clinical risk management among all its customers and collaborators.

Category Communications department of the year

Winner

Communications department, Peterborough Hospitals trust The key objective of this communications department is to ensure a well informed staff, public and media. By undertaking communication audits and surveys, and building relationships with patient groups, Peterborough Hospitals communications team has excellent knowledge of what its customers want and need.

Effective partnership working with Cambridgeshire health authority and North West Anglia Healthcare trust has resulted in a series of high-profile projects such as a Health Fair, promotion of NHS Week and ongoing work around the year 2000. The communications department also believes that the way to improve is to seek feedback from service users. The team has used feedback to improve the content and style of patient information leaflets, and to create Cliniweb, a secure website for GPs and other local healthcare professionals.

The judges commented: This department is an excellent example of achieving a great deal with slim resources through a focused and strategic approach. The two-person team has embedded good communications practice based on clear and achievable objectives.

The judges suggest the next step is to focus on the diverse community this trust serves, based on high-quality opinion research. This would develop already strong relationships by providing intelligence highlighting priorities for local people.

Runner-up

Communications department, Barts and the London trust The hospitals comprising Barts and the London trust were the first in England to have a complete medical school, founded in 1758. Their prominence and long history mean the trust is frequently in the public eye, which is a particular feature of the communications challenge it faces.

The department places particular importance on understanding the needs of its community through twoway communication, and has proactively taken steps to go into the community and listen to service users. In addition to making use of conventional communication tools such as newsletters, this has included chairing public meetings, developing strategic partnerships across both the public and the voluntary sector and commissioning specific research.

The judges commented: Barts has responded sensitively to a diverse local community. The trust has invested in a relatively large communications department, which integrates internal, external and media relations with officers dedicated to co-ordinating GP and community communications. The judges would like to see Barts give more focus to internal staff communications over the next year, but felt that in many ways the department exemplified NHS communications best practice.

Runner-up

Public relations department, Guy's and St Thomas' Hospital trust Four years ago, Guy's and St Thomas' had a reputation for being particularly unhelpful to journalists. The BBC's Fergus Walsh and The Guardian 's Polly Toynbee publicly criticised the public relations department for its lack of openness and for being generally obstructive. How times have changed. The department now has a range of informal and formal tools for communication, and has expended considerable effort in building relationships both within the community it serves and with the external media.

The judges commented: This is a team with strong skills, offering a professional PR service and demonstrating provision of that service across a large and complex trust.

Based on a consultancy model, its particular strengths are the production of high-quality communication vehicles and the identification of partnerships with local organisations. However, the judges would like to see the team develop an even stronger strategic approach focused on the trust's objectives.