Winner Wirral PCT
Wirral PCT exemplifies the direction that an organisation seeking the right type of innovation for the right kinds of improvements should take with service redesign clearly demonstrating genuine clinical engagement and a leadership that reaches out across organisational boundaries.
Patient and public involvement and meaningful partnership working is central to the planning, commissioning and review of a provision aimed at reducing health inequalities. Investment in staff development is matched by the enthusiasm and positive approach of the trust's management.
The Wirral is in the bottom 20 per cent of districts for life expectancy. Gradually though, thanks to the earlier work of the two organisations that merged to form the new PCT, the gap between local figures and the national average has been closing. The Healthcare Commission annual Health Check for 2006 found that these trusts offered a 'good' quality of service. Wirral PCT’s strategic aspirations reflect the commitment to maintain and grow this legacy.
Intermediate heart centres have featured significantly in the trust's recent delivery of a three year Local Public Service Agreement to prevent coronary heart disease related premature deaths. The achievement brought with it a£1m reward grant and sees the centres being expanded with the purchase of echocardiography scanning equipment.
Wirral PCT now uses Health Equity Audit to keep its focus on where the need is most keenly felt. This tool has helped to identify the under representation of BME groups among the trusts stop smoking service users, a situation being addressed through a local stretch target.
A number of mechanisms ensure that the voice of the district’s communities is heard. In addition to its Patient and Public Involvement Forums, the trust participates in area forums with Wirral MBC and jointly funds a citizen panel programme. Wirral PCT also employs a ten-strong team to help service users speak out.
One new facility they might want to consider will be the new ‘Have Your Say’ programme – which provides the opportunity to makes views known directly to trust mangers via text messaging and web-links. Real-time feedback to influence planning and commissioning is also being introduced through the web based ‘Patient Opinion’.
Illustrating its collaborative and arms-length approach to service provision, the new primary care provider directorate brings together both PCT employed staff and self-employed contractors to work alongside other provider directorates. Wirral PCT employs three practising GPs as primary care medical directors to head up the localities within this structure. The trust board supports clinical engagement, integrated planning and joint working, a design feature that secured more than£500,000 of savings over the last financial year.
Dedicated support is provided to the four PBC clusters that bring all the districts GP practices together. Thanks to initiatives such as a user helpdesk and training, referrals through Choose-and-Book, stand at above 60 per cent. Schemes introduced under PBC see a shift of£1.5m from secondary care contracts and the establishment of community dermatology, minor and oral surgery.
Wirral PCT is financially strong and has been able to make the transition from an inherited deficit to a surplus for 2007/08.
Highly Commended BirminghamEast andNorth PCT
There is clear evidence of strength and sustainability in Birmingham East and North PCTs working structure and methods. A lot of that is down to the continuity brought by the single management team that began leading the new PCT more than a year before its formal merge.
The trust – which spans areas showing marked differences in deprivation, ethnicity and life expectancy - is a national leader in practice based commissioning. It achieved full sign-up to its locality structure and has already been commended during the Fitness for Purpose exercise for its exemplary clinical engagement in this sphere. The focus of commissioning has switched. The emphasis is now on services that support well-being and empowerment and there is full engagement of patients with the commissioning process.
Partnership working, another strong point, has enabled a number of cost-effective improvements with positive health outcomes. A prior approval pathway for a number of key conditions, jointly implemented by acute and primary clinicians and cited by the DH for good practice, is just one example.
'Birmingham OwnHealth' is a self-care initiative that brings the best of the commissioning and partnership strands together. The telephone-based programme has been devised with Pfizer Healthcare Solutions and NHS Direct to support people with diabetes, heart failure and COHD to get better control of their conditions and is a highly valued service.
The PCT was also an NHS Institute 'Making the Shift' programme pilot site. Its three main change delivery projects were praised for demonstrating strong leadership and are now being scaled up for mainstream provision.
The network of 24 new health and social care centres being created by Heart of Birmingham tPCT and its local authority and primary care partners is tangible evidence of the trusts commitment to providing care closer to home.
Transforming the local healthcare system through such an extensive development shows how Heart of Birmingham works to deliver on centrally driven policies and targets while maintaining a real focus on local priorities.
The£700 million building programme is well under way, with one centre already open and three others in the construction phase. Services – including outpatients, urgent care and diagnostic facilities - will be closer to the trusts ethnically diverse population, some of whom live in the city’s poorest and most deprived wards.
The capital programme is part of a bigger long-term strategic approach – the 2010 project – requiring a further£43 million of revenue investment and reflecting sound financial planning and partnership work. Surplus funds from the past two years have allowed Heart of Birmingham to increase money going in to health promotion and reduce its dependence on acute provision.
Practice managers and GPs have been using detailed information provided by the trust to highlight inefficiencies in services and care pathways and have developed several innovative business redesigns. One of these, a series of new community based paediatric clinics designed with the participation of carers and children, has significantly reduced levels of non-attendance.
Thanks to it health promotion work the PCT now has the second highest smoking cessation rate in the country and coronary heart disease has dropped by 43 per cent in five years.
When things are coming together on the pitch, you need look no further than trust partners Walsall football club to see the difference that a good team spirit can make to performance.
It is a factor evident in abundance at Walsall and is reflected in the strength of the primary care trust's community involvement. Beyond the football stadium Walsall enjoys strong partnerships with the local council and education authorities, New Deal and the police.
The influence of users, patients and carers on services is also fundamental to the organisations approach to service delivery, quality and access. Their participation in assessment and planning processes is exemplified in the siting of a new health centre at Pelsall.
The trust’s sponsorship of the local football ground is just one feature of its pioneering work in health promotion and social marketing. Innovations include the first major SMS health messages texting scheme in the UK and the continued use of highly visible bus advertising. The trust is able to assess the benefits of its media campaigns through its own evaluation system. Extended promotional reach has been matched by a 50 per cent reduction in communication spend over four years.
Value for money and improved efficiency are apparent at all levels and saw the trust return£9.9 million to SHA reserves in 2006-07, the sixth consecutive year that it has been able to deliver financial surplus.
Investment in new services however has improved public health and Walsall now reports 239 fewer deaths a year from cancer and cardio-vascular disease.
Tower Hamlets PCT
The PCT sets out its strong and coherent vision of primary and community care in a strategy jointly developed with the London Borough of Tower Hamlets. Improving Health and Well-Being demonstrates the links between an extensive exercise in local consultation and the practical implementation of public health.
Many of the services commissioned to reduce health inequalities and meet the needs of one of the UK’s fastest growing, most diverse and deprived communities demonstrate ambition, innovation, sensitivity and resourcefulness.
Commissioning priorities have included the implementation of enhanced GP practices – offering phlebotomy, smoking cessation and a depression service - and pharmacy services providing flu vaccines and the morning after pill.
A stop smoking campaign included advertisements on Bengali TV station Channel S, an inpatient detoxification unit was opened for young Bangladeshi men and the trust employed refugee dentists to provide culturally appropriate services.
The Fitness for Purpose review saw Tower Hamlets get a green rating in all areas and receive particular praise for its patient and public involvement. Highlights from the 2006/07 annual health check include a sharp fall in deaths from heart disease, a steady rise in life expectancy, half of all appointments made through choose and book and extended opening hours in over 30 GP surgeries.
The PCT ended the last financial year with a£6.7 million surplus and over the same period its practice-based commissioners were able to demonstrate savings of£600k.
Tower Hamlets was also one of only two NHS organisations to make lesbian and gay charity Stonewall’s most recent Top 100 employers list.