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'It is amazing the amount of difference you can make with one lady, a screwdriver and a van. It's cheap, too.'

Others put it differently. But as managers discussed tactics to tackle millennium winter pressures, the view of Peter McGinnis, director of nursing and quality at Leeds Community and Mental Health Services Teaching trust, was often repeated.

The problems - increased pressures, short-term planning, funding and patients slipping through gaps in services - were familiar. So, too, the catch-all solution - joined-up thinking and inter-agency partnership.

Mantras aside, delegates were keen to share the lessons they had picked up over the past two winters - of which the key one seemed to be 'think small' - and get rid of bedblockers by repairing their homes.

Conference chair Richard Meara discussed the benefits of 'small, focused interventions' to tackle perennial problems of bedblocking and unnecessary admissions.

Extra equipment, extra porters, more pharmacy staff - and the employment of a handyman or woman to tackle minor repairs which delay patient discharges - all measures which were 'small in terms of additional resource' and 'had a disproportionate effect on the whole system'.

Mr Meara suggested it would take some 18 months after the start-up of such schemes before their impact could be properly evaluated. 'We are getting to that point now,' he added.

But he admitted that research by the Emergency Services Action Team was 'cautious' about whether the projects were preventing admissions or 'providing a service for people who might never have needed it in the first place'.

Mr McGinnis said the Leeds community action teams - based on quickly transferring patients into the right level of care - 'were no more expensive' than mainstream services 'and certainly made life a lot easier'.

He admitted that there had been 'some resistance' to the concept of fast- tracking patients through a tiered system of care.

Dr Janet Ballard, clinical director of Ealing Hospital trust's intermediate care services, gave a candid account of their attempts to avoid unnecessary admissions, and speed discharge arrangements via multidisciplinary working.

'Was the pressure relieved? Well, no. But demand has been escalating over the past two to three years... acute admissions were through the roof.'

Admission avoidance was 'probably the most cost-effective part' of the integrated service set up by the trust and Ealing social services.

Estimates suggested that the scheme 'saved' a total of 40 inpatient beds - of which about 18 were made up of admissions avoided, and 13 by early discharge.

The project centres on a multidisciplinary core assessment team led by service manager and social worker Steve Clarke, which aims to support patients back into independent living.

A range of schemes - which began with challenge and winter pressures funding and look set to receive three years' permanent joint funding - include a package of six weeks' free, non-means-tested home care. But Dr Ballard said that 'tribalism' between social services and health was a problem to begin with.

Her social services counterpart, head of commissioning Alan Clarke, had described it as a question of, 'You show me yours, I'll show you mine.'

Dr Ballard suggested the chances of such a scheme being successfully replicated elsewhere were highly dependent on the local health economy, GP relationships and politics.

Mr Clarke identified the timescales set by government - and the reliance on one-off winter pressures funding - as key 'threats'.

'I think the short-term view coming from the centre can be quite dangerous,' he said, contrasting 'five-day deadlines' for winter pressures bids with local government planning cycles and quarterly social services meetings.

Despite widespread agreement of a need for permanent funding over 'one- offs', there was concern as to whether extra cash would be released for millennium winter pressures.

'I remember at last year's conference being told there would be no new money - just days before the winter pressure money was announced,' reminisced Mr Meara. 'It is probably inconceivable that new money will not be made available - how it will be badged we don't know,' he added.

NHS Executive head of millennium planning Andrew Cash promised communications strategies and planning support 'in a style very similar to' Dr Peter Homa's national patients access team - but remained silent on the question of cash.

He did reveal an almost touching lack of faith in modern technology for one charged with carrying the NHS through the millennium. 'I hate these things,' muttered Mr Cash, as he battled to activate a slide projector.