TCS Leadership Challenges 2011

National Report of the TCS

Award Winners
 South East Coast
14th February 2011

The service improvement idea is to develop a

high quality multi-disciplinary specialist weight
management service for adolescents and their
families in east Kent.

The 2008 Foresight Report Tackling Obesity:

Future Choices estimates that by 2050 more
than 60% of adult males; 50% of adult females
and 25% of children will be clinically obese.
The most recent National childhood
Measurement Programme (NCMP) data for
east Kent (2009/10) showed that obesity rates
range between 16% to 20% in year 6 pupils.

Winner: Teen Success

MEND (Mind, Exercise, Nutrition … Do it) is a national programme that has been developed to tackle
children who are overweight or obese in the 7-13 year age group.
However, it is clear from the data produced by MEND that there is a cohort of children who achieve limited
success only.
These children are generally in the morbidly obese category with co-morbidities and more complex issues
underlying their weight.
The “Teen Success” service will meet this need by providing a holistic multi disciplinary treatment
programme for obese 11-17 year olds.
Contact: Beverley.Falconbridge@eastcoastalkent.nhs.uk

Runners Up
Team Name Service Improvement Idea Team
One Call, One Team Community management of unscheduled care Sussex Community NHS Trust, Western Hospitals NHS Trust
and SEC Ambulance Trust
West Kent Community Developing wound care services within East Kent , West Kent Community Health service.
Health Team Sapphire Neurological Rehabilitation Unit - Introduction of
patients in permanent/persistent vegative state
East Surrey Health One Stop Heart Failure Clinic in the Community Surrey Community Health, NHS Surrey and ESyDoc.
Failure Team
Team Trinity Self administration of Injections Eastern and Coastal Kent Community Health NHS Trust
PRISM (Predictive, Complex care pathway, Multi-agency panel, single point Surrey Community Health, Thames Medical.
Redesign, Integrated, of access
Service Model)

Health aging and Occupational Therapy-'Healthy Ageing and Reablement Central Surrey Health , Medwyn Surgery Dorking
Reablement Service Service

Guildford and Waverley Implementation of a comprehensive stroke review Surrey Community Health, Royal Surrey County Hospital NHS
Stroke Services Team pathway Foundation Trust, Stroke Association (Surrey Adult Social Care)

Rehabilitation Solutions 24 hr Integrated management of people with mobility Sussex Community NHS Trust and Brighton & Hove City Council
Team Issues

NHS Brighton & Hove Improvement of the quality of patient care through routine NHS Brighton & Hove, Brighton & Hove City Council, Sussex
inhaler technique Team teaching and checking of inhaler technique Community Trust, Ross Pharmacy, Brighton, NHS Brighton &
Hove and Portslade County Clinic, Portslade, Brighton & Sussex
University Hospitals Trust

East Sussex Community Community IV cellulitis treatment pathway Bird In Eye Surgery, ESDW PCT, ESCHS,
Health Services (ESCHS)

Page 2 of 11
 East Midlands
18th February 2011

The service improvement idea is to develop an

elite team who will provide targeted, effective
delivery of intra-venous therapies to individuals
within a community setting: this will include
patient homes, nursing homes and alternative
suitable community settings, also introducing the
use of mid lines for patients with long-term
conditions.
This is a growing area of need, as there are
approximately 59,905 adults in Lincolnshire with
a long-term condition. This figure is predicted to
rise to 79,968 by 2020.

Winner: Socius, Lincolnshire Community Health

Cost and Quality Benefits
IV services are currently provided by the local acute Trust and by a private provider. Initial costings
indicate that the service can be provided within the community at significantly less cost, and with improved
quality as indicated by patient experience feedback.

The service will be developed in close collaboration with GP consortia. Once the benefits of the project will
have been realised it is hoped that the newly formed GP consortia will commission this service going
forward.
Contact: joanne.wright-Lakin@lpct.nhs.uk

Runners Up
Team Name Service Improvement Idea Team
DIVAS (Dales IV Access Service) IV therapy Access Derbyshire Community Health Services

Millennium Healthy Airways Improvement in the management of COPD NHS Leicester City

Admission Avoidance Team Responding to and redesigning services for Lincolnshire Community Health Services and Wellcom
admission avoidance Consortia

Inclusive Change IAPT (improving access to psychological Leicester Partnership Trust

therapies), LCPT integration, and service
improvement for clients with psychological
disorders who use substances.

The productive change maker Integration of Health and Social Care Nottingham NHS CitiHealth and NHS Nottingham City

Integrated Long Term Conditions Heart Failure and COPD clinical outcomes on Nottingham West Consortium, Nottingham University
Solutions. commissioners desktops NHS Trust, Saxon Cross Surgery and Church Walk
Surgery

Bassetlaw Infant feeding in focus Breast Feeding Bassetlaw Community Health, Children's Centres and
Hospital and North Nottingham College.
(BIFF)

Leicester, Leicestershire and Rutland Children's Behaviour Pathway Leicester County and Rutland Community Health
Community Children's Services Services, Leicester Partnership Trust and Leicester
behaviour pathway for children 0-14 Community Child Health Services.
years of age

Innovation in Memory Services Memory Services Leicester partnership Trust, Leicester city council.

Diabetic Education Team TIME (type 2 insulin management education) Derbyshire Community Health Services, NHS Derbyshire
County, Derby City PCT.

Page 3 of 11
 North West
28th February 2011

The service improvement is to teach patients who are

homeless and vulnerable how to self-manage their
alcohol misuse.

The improvement was developed because there was

found to be a need within the local economy with
community caseload figures reaching 40% (as
compared to national figures of approximately
24%). Patients continually ask for help, but given their
chaotic lifestyles are unable to access current
services.

Winner: WHIPS Wellspring Health Improvement Programme Service

The service is delivered from “The Wellspring”, a voluntary organisation that supports the homeless and
vulnerable of Stockport. The Wellspring, Stockport Homes, the Community Drug/Alcohol Outreach worker, A
& E and the PCT will work together to provide a collaborative approach to addressing the needs of this
vulnerable client group.
Cost and Quality Benefits: Addressing this problem has the potential to save £650,000 per year as well as
benefits realised from avoided admissions and self-management. Success will mean that patients will have a
more stable life, the ability to maintain housing, the ability to get back into work and the ability to feel proud of
their achievement.
Contact: lucymcjannett@nhs.net

Runners Up
Team Name Service Improvement Idea Team
Enhanced Intermediate Delivery of mental health in an intermediate care Northgate Village Surgery, Cheshire and Wirral Partnership NHS FT,
Care environment Community care Western Cheshire, Cheshire West and Chester.

Proactive care team Proactive care LCH, PSS, Liverpool Social Services, LPCT.
Corner Stone Mobile health and well being unit Cornerstone Practice, Street Pastors, BwDt pct
Trafford's Lovely Bones To improve access for patients following a first Trafford provider Services, Trafford Healthcare NHS Trust, Women’s
fragility fracture Royal Voluntary Service

Oldham Leadership Admission avoidance for palliative Care patients NHS Oldham, Oldham Borough Council, Pennine Care, North West
Team Ambulance Service.

Totally Connected Care pathway for adults with acquired brain injury Warrington PCT, 5 boroughs Partnership NHS Trust.
(ABI) and mental health needs

Community services bury Prevention and healing of heel ulcers in the high Community Services Bury.
Diabetes risk patient

Viable Velocity Working Well Scheme Salford Community Health.

Stockport Dementia Reducing Antipsychotic Medication for People Pennine Care NHS Trust - CMHT, Park View Group Practice, Stockport,
Improvement Group with Dementia in Stockport. Stockport PCT, Alzheimer's Society
TABA commissioning Preventing admission for patients in nursing TABA Comissioning Consortium, Ashton Leigh & Wigan.
Consortium homes

Bolton Respiratory Team Early community palliation for advanced lung Royal Bolton NHS Foundation Trust, Bolton PCT
disease

The Captains Initiatives Rest of Life Care for patients in Care Homes. Central and Eastern Cheshire Community Health GP Nursing Home
Scheme, Cumberland House Surgery, Weston Park Care Home.

Page 4 of 11
 Yorkshire and Humber
1st March 2011

Health trainers and health champions, who

are already successfully working alongside
patients with other long-term conditions such
as diabetes and heart disease, will be
trained to support patients with chronic pain
in community settings. They will facilitate
self-management of chronic pain through
appropriate education and advice in the form
of 1:1 support as well as sign posting to
other community and NHS resources.

Winner: Nerves of Steel - Community Pain Management Initiative

Cost and Quality Benefits: It is estimated that 1 in 7 people live with chronic pain in the UK. Studies
suggest that 5-7 % of the population have ‘significant pain requiring regular medical input or advice’. Within
Sheffield, pain management provision is mainly hospital-based. This is expensive and ignores the vast
majority of pain management, which occurs in the community or primary care settings.

It was evident to our MDT that precious NHS resources could be better targeted at facilitating patient self-
management within the community and provide a better quality of care and patient experience. It is
estimated that re-allocation of resources from secondary care to community and primary care settings
would save NHS Sheffield £500 000 a year. Contact: tim_williams101@hotmail.com

Runners Up
Team Name Service Improvement Idea Team
Hull Health School and community based multi- Haxby Group, St Michael's Youth Project Hull, Haxby Group
Collaborative Team disciplinary lifestyle clinics for young Pharmacy, Cornerhouse Yorkshire, Hull Youth Council, CHCP
people in areas of deprivation.
North Doncaster North Doncaster early intervention Doncaster community Healthcare, Doncaster Metropolitan Borough
Partnership for Change collaboration council., Action for Children, Doncaster PCT
Team

Ripon and Rural Triage Team NYYPCT, Harrogate District Foundation Trust, North Yorkshire and York
Community Triage Team PCT, North Yorkshire Social Services, Park street surgery Ripon, Ripon
CVS.
Connecting Calderdale Case management plus NHS Calderdale, Calderdale Metropolitan Borough Council, Calderdale &
Team Huddersfield Foundation Trust, Station Road Surgery
Improving Health Team Supporting health & wellbeing for people with NHS Calderdale, SWYPFT, Calderdale Council
mental health issues
No Place Like Home Team Management of frequent callers and Kirklees CHS, Mount Pleasant medical centre, Dewsbury District Hospital,
reduction of acute admissions to hospital, Yorkshire Ambulance service
GP and OOH Services
Sleep North Yorkshire Sleep North Yorkshire Children & Young Peoples Specialist Nursing Team Harrogate/Craven,
Team Children’s Health Team ( Learning Disabilities) Scarborough, Child
Development Centre, Harrogate District Foundation Trust,, North Yorks
County Council, Scarborough and North East Yorks Acute Trust,
Communication Partners Improving communication access for stroke Rotherham Foundation Trust, Rotherham Community Health Services,
patients
EPAS Orienteers EPAS orienteers Tees, Esk & Wear Valleys NHS Foundation Trust, North Yorkshire County
Council Integrated Mental Health Services, Filey GP Practice, Alzheimer’s
Society, Teesside University
Sheffield PCT - Provider Personal Health Facilitator: Shoe fitter Sheffield PCT Provider Services
Services service

East Riding Life is for Life is for Living NHS East Riding of Yorkshire, East Riding of Yorkshire Council,,
Living Team Holderness GP Consortia, Beverley & Driffield GP Consortia,

North of North Yorkshire Improving primary and community dementia NYY Community Mental Health Services, North Yorkshire County Council,
care South Tees Hospital Trust,,

Page 5 of 11
 East of England
4th March 2011
The improvement idea ”My Needs Now” is to add a
Specialist Neurological Coordinator to the already
formed Hertfordshire Community NHS Trust
services who care for this group of patients,
alongside our voluntary sector and other partners.
This will ensure timely planning and intervention is
delivered.
Over the next year this scheme will ensure people
with these conditions feel confident that they know
who can help and will be able to make better
informed choices about living with the disease. They
will be able to access support when they need it,
Winner: My Needs Now, Hertfordshire Community NHS Trust
People with rapidly progressive neurological condtions have different needs from the patients who can be
served by the usual local neurological or palliative care pathway. The conditions are rare and complex, with a
relatively short time from diagnosis to death, when compared to other neurological conditions. Early
coordination between neurological services , palliative care services, voluntary sector , GPs, adult care services
and other community services can ensure that patients are prepared for the fast changes in their condition and
are in full control of decisions about their treatment and care options
Cost and Quality Benefits: “My Needs Now” will also support the local Health Economy in delivering savings
through the decrease in emergency hospital admissions expected from this improvement idea, enabling people
to die at home rather than in hospital. We would expect at the end of the year one to also evidence the value of
expanding the service to a wider group of neurological patients. Contact: Sally.Pollitt@hchs.nhs.uk

Runners Up
Team Name Service Improvement Idea Team
Bedfordshire Baby Improving information and care for BCHS, Bedford Borough Council, Ivel Valley GP consortium, NHS
Brasseries breastfeeding mothers in Bedfordshire Bedfordshire, Sure Start CC Cauldwell, Bedford, Bedford Hospital

Bedfordshire LTC Telehealth Telehealth Sandy Health Centre and Ivel valley Commissioning Group, Bedfordshire
Team community health services, East ambulance trust , NHS Bedfordshire,
bedfordshire links

Total Care Team Plus Total care and mental health Ipscom, Suffolk Community Healthcare, ACS, Suffolk, Suffolk Mental
Health Partnership

Journey's end (NHS Suffolk Palliative Care Co-ordination Woolpit Health Centre, Suffolk community healthcare services, St Elizabeth
& Marie Curie) Hospice, ASC, Allied Healthcare Group, NHSS, Suffolk Family Carers

Hunts RISC Risk Stratification Hunts Health, Ramsey Health Centre, CCS

Right Care, Right People, improving quality of care in care homes NHS Bedfordshire, BEDOC, GP practice
Right Time
WE (West Essex) Care West Essex Carer Initiative West Essex Community Health Services, Social Care, General Practice,
East of England Ambulance Service

WE Essex DET (Diabetes
Empowerment Team)
Hertfordshire Neurological
Service
A review of the service to people with
diabetes who are unable to administer their
own insulin.
One stop clinic for patients with Neurological
Condtions
West Essex Community Health Services, Lister Medical Centre,
Palmerstone Homecare
Herts Community NHS Trust, Parkinson's UK, Buntingford Medical Centre

Stalham Staithe Stalham’s Big Society – supporting people Staithe Surgery, Voluntary Norfolk, Norfolk Community Health and Care,
and places NHS Norfolk

This is about me Team
ICE (Integrated care of the
Elderly) Team
Personal health plans for people with Long
Term Neurological conditions
Improving liaison between primary and
secondary care
Herts Community Healthcare Trust, VOwNET (voluntary organisations
working with Neurological conditions), Hertfordshire Neurology Service
Cambridgeshire Community Services (CCS), Cambridgeshire and
Peterborough Mental Health Trust, Cambridge University Hospitals NHS
Foundation Trust, Addenbrookes Hospital, Firs House Surgery

Page 6 of 11
 North East
8th March 2011

The service improvement idea will

enhance the patient pathway experience
following fractured neck of femur, by
supporting early discharge.

Winner: HIP Northumbria Team

This service improvement will develop and evaluate the effectiveness and acceptability of an early
supported discharge scheme for patients with a hip fracture. This service will act as a ‘bolt on' to the
current Community Rehabilitation Service (CRS) in South East Northumberland. Expanding the well
established CRS with additional therapy and support staff will facilitate timely transfers from the
acute setting back into the patient's own environment with seamless rehabilitation and, where
necessary ongoing home care.

Cost and Quality Benefits: there are significant benefits both in terms of cost and quality in
providing this service. We expect efficiency savings in year one and in line with the post 30 day
discharge policy this service will be developed in line with the NE reablement agenda.
Contact: Louise.Lewis@northumberlandcaretrust.nhs.uk

Runners Up
Team Name Service Improvement Idea Team

Newcastle diabetes team Supporting people with diabetes Newcastle PCT, Newcastle Nutrition, Savill
requiring insulin therapy with a terminal Medical Group
illness

County Durham & Darlington Review of surgical emergencies CDDFT, CDDCHS

Community Services Team

South of Tyne & Wear Total patient involvement at the end of life, NHS SoTW Community Health services, Glen
Community Services Team Medical Practice South Tyneside, South Tyneside
Foundation Trust,

Mobile Workers Team Maximising the benefits of tough books North Tees and Hartlepool Foundation Trust,
Queens Park Medical Centre

Aspire Team Hospital at home,short-stay assessment units, CDDCHS, CDDFT

pain management

Derwentside Paediatric Team Reductions in short stay paediatric NHS County Durham and Darlington
admissions.

Specialist Palliative Care Team
Dales Community diabetes service
Durham Dales GP Led Commissioning Cluster,
NHS County Durham and Darlington NHS
Foundation Trust, NHS County Durham, Station
View Medical Practice, Barnard Castle Surgery,
Willington Practice

Page 7 of 11
 South West
11th March 2011

Epilepsy is the most common neurological

condition in Torbay, Devon.

The service improvement idea is to develop an

epilepsy care pathway for use by primary,
community, acute and social care teams based
on national guidelines and involving all both
patients and partners in the planning.

Winner: South Devon Epilepsy Group - Epilepsy Care Pathway Project

At present in South Devon services for people with epilepsy are provided by three neurologists, one
community epilepsy specialist nurse and two community learning disabilities teams. It is proposed to develop
an integrated pathway to ensure all patients with epilepsy have a care plan, access to local services and
appropriate support. This will include education and training to family members, carers and the profession.
Cost and Quality Benefits: patient experience will be enhanced with access to supportive information and
services. It is expected that emergency admissions for this group of patients will decrease given the support
and self-management provided.
Contact: helen.skinner3@nhs.net

Runners Up

Team Name Service Improvement Idea Team

North Somerset PUPAS Team Pressure ulcer prevention and assessment Service North Somerset Community Services
(PUPAS)

Bridgwater Enhancers Team GP Enhanced Care Hub (ECH) Bridgwater Federation of General Practices, Somerset
Community Health, Registered Care Providers Association,
Eddington Surgery

All Change at Swindon Team Shifting the setting of care for specific IV and venesection NHS Swindon, Old Town Surgery, Care & Support
from acute to the community Swindon

BANES Community Neurology Proposed merger of the Neurological Rehabilitation and NHS Banes
& Stroke Team Community Stroke Services within NHS Banes;

The Brainwaves Team A personalised care plan for people with long-term Bristol Community Health, Pembroke Road Surgery, Clifton,
conditions. Bristol City Council

Frome Valley Community Developing a system to help frequent attenders use health Frome Valley Medical Centre, Avon and Wilts Mental Health
Team resources appropriately Partnership, South Glos PCT,

Gloucestershire Podiatry & Lower limb screening and triage service for Peripheral Gloucestershire Care Services, NHS Gloucestershire
Friends Team Arterial Disease (PAD), including an Intermittent
Claudication Clinic.

Integrated Care Pathway Team Integrated Care Pathway Team Headway Dorset, Dorset Health Care NHS Trust, Spinal
Injury Department at Salisbury Hospital, Poole Social
Services Commissioning, Providence Practice Bournemouth

Safe Prescribing Transfer Improving medicines management services across the Chilcote Medical Practice, Torbay Care Trust, Old Mill
Team interface of discharges and transfers of care Surgery, Sarsons Pharmacy, Brixham

Page 8 of 11
 West Midlands
15th March 2011

HYPE aims to improve and strengthen existing care

pathways into a integrated youth model with one
focal point of access. Clear referral criteria will be
developed that will be inclusive and transparent and
young peoples service’s 14-25yrs will be delivered
by strengthening existing youth networks, developing
new pathways and models of early intervention,
prevention and recovery (early intervention is a cost
effective evidence based model averting long term
mental illness).

Winner: HYPE Team (Helping Young People Early)

The impact of untreated mental health problems can have a devastating effect on young people. Current
services in Solihull set a transition boundary for CAMHS up to the age 17 with a transition to AMHS marked
with significant failure’s to engage young people or provide appropriate access and intervention.

Cost and Quality Benefits young peoples experience will be greatly enhanced ensuring that they receive the
appropriate support and treatment. Mental health and quality of life will be significantly increased which will
impact on unnecessary admissions or “lost in system impacts”. Contact: Elaine.Kirwan@solihull-ct.nhs.uk

Runners Up
Team Name Service Improvement Idea Team
Coventry Taking Health to the Maximising the effectiveness of a mobile unit Coventry Community Health Services, Grapevine (Coventry and
Community Team to take healthy lifestyles advice, health Warwickshire), H team Grapevine (Coventry and Warwickshire) Ltd
promotion, and screening closer to home
Team Cure Children's urgent care review Royal Wolverhampton Hospitals NHS Trust, Wolverhampton City PCT –
Provider, Wolverhampton City PCT - Primary Care, Wolverhampton City
Council
Birmingham Community Musculoskeletal service redesign Birmingham Community Healthcare NHS Trust (BCHC), Heart of
Healthcare England Foundation Trust, Swanswell Medical Centre, Acocks Green.
One Direction Team One Integrated Patient Flow Team Royal Wolverhampton NHS Hospitals Trust , Wolverhampton City PCT –
Provider, Wolverhampton City Council.
Vitality Partnership Vitality Community Leg Service Vitality Partnership, Heart of Birmingham PCT, Age Concern,
Birmingham Community Healthcare NHS Trust, Handsworth Wood
Medical Centre, Wards Chemist , Laurie Pike Health Centre &
Community GPSI Dermatology Service, Primary Care & Community
Services Directorate.
The Difference that makes The Integrated intermediate care proposal to NHS Worcestershire Provider Arm, NHS Worcestershire, Worcestershire
Difference Team increase choice and opportunity for those mental health partnership trust,
with Dementia.
Fortune Favours The Bold Implementation of a citywide single point of Birmingham Community Healthcare NHS Trust, GP Icos steering
Team access and referral management system for committee, Birmingham City Council
Community adult

Birmingham Team for Parents
with a Learning Disability
Sandwell Mental Health Team
The ADEPT (Affordable
Delivery of Patient -centred
Treatment) team
Renaissance Team
A screening tool for parents with Learning Birmingham Community Health Care, Advocacy Matters
Disabilities in Birmingham.
Back where we belong Sandwell Mental Health and Social Care NHS Foundation Trust
Essential competencies for clinical staff in Shropshire County PCT
primary care
Food for Life North Staffs Community Healthcare, Scope UK

Black Country LD Consortium The Development of a community forensic Dudley Community Services, Wolverhampton PCT, Walsall Community
service for people with Learning Disabilities Health, Heart of Birmingham tPCT/ University of Birmingham, Sandwell
across the Blackcountry Mental Health and Social Care NHS Foundation Trust, Integra Care
(Private sector Organisation)

Page 9 of 11
 London
18th March 11

Tackling Talking Together aims to provide

intensive, planned, intervention therapy to 32
children (3-5years) and their families in a
central, accessible location close to their home
environment.

Winner: Tackling Talking Together (Multi-disciplinary Family orientated language project)

There is currently a 40% DNA rate at child language groups in Hammersmith and Fulham (White City).
Children’s behavioural and language problems are unable to be addressed, resulting in potential future impacts
on health, education, work and crime. Parents have cited childcare issues and behaviour management
problems as the biggest obstacle preventing them from attending.

Cost and Quality Benefits: This proposal aligns with the QIPP agenda reducing DNA rates, promoting better
compliance and increased productivity. It also significantly increases the quality of care provided to children and
their families by providing them with self-management strategies, which will enable improvements in both health
and behaviour. Contact: sduggins@nhs.net or Jacqueline.Goddard@lbhf.gov.uk

Team Name
Community Health Newham:
Expert Patient Project Team
Runners Up
Service Improvement Idea Team
Newham Extended Primary Care Scheme Newham Health Partnership (NHP) Pathfinder Consortium,
Community Health Newham, East London NHS
Foundation Trust

Greenwich Long Term Conditions Health-Nav.co.uk - a comprehensive interactive Conway rd, surgery, Thamesmead Medical Associates,
website for people with long term conditions and their Greenwich Community Health Services,
carers

Redbridge partnership with young Life skills for life NHS Redbridge / Redbridge Children's Trust, London
adults and their families Borough of Redbridge, Interface(Aiming High for Disabled
children)

Work it Out Team Multi-professional vocational support service for clients Royal Free Hospital trust
with long term neurological conditions

Brent LTC Team Patient Held Records for multidisciplinary/ integrated Brent Community Service
Case Management of patients with LTCs

Bromley Healthcare Care Passports for Bromley PACE patients Bromley PCT, London Borough of Bromley Council, BHC,
British Red Cross

The Federation Integrative Orthopaedic Service Merton Healthcare Ltd, London Borough of Merton/St
Georges Hospital Elective Orthopaedic Centre

Camden Provider Services and SKYPE Clinic: Development of a new clinic aimed at Camden Provider Services, Royal Free Hospital,
partners housebound patients living with complex health care

Havering Rheumatology One Stop Community Rheumatology Service Harold Hill Health Centre, Queens Hospital, BHRUT
Innovation Team

Tower Hamlets Multidisciplinary Patient Education Programme. Tower Hamlets Community Health Trust, NHS Tower
Team Hamlets, Barts and The London NHS Trust

AT Rejeuv AT Medics, The Young Foundation

Page 10 of 11
 South Central
21st March 2011

Our vision is to provide a pan Berkshire service that

provides:

A database of activities within Berkshire that are

available to people with learning disabilities.

A friendship/dating matching service that is sensitive

to safeguarding and risk assessment procedures

A structured programming of education and

awareness raising for people with learning
disabilities, their family, carers and other supportive
agencies.

Winner: Berkshire CTLPD

People with a learning disability are at risk of isolation and less likely to live active and inclusive lives. Barriers
to mainstream activities include unsafe social networks, social/lifestyle activities, education and employment
opportunities. Our service improvement will facilitate the development of a safe and secure social network: with
education and support to explore relationship skills, friendship and sexual knowledge. This network will be
“owned” and run by its members, coordinated by CTLPD Berkshire.
Cost and Quality Benefits: People with a learning disability will have life enhancement and be able to enjoy a
supportive full and active social life. It is estimated that there will be reductions in mental health issues such as
depression or loneliness and hence medication prescriptions and a decrease in safeguarding issues. The
improvement will be evaluated after year 1 and it is hoped that given efficiency savings and quality
enhancement the service will expand and be re-commissioned.
Contact: john.gardiner@berkshire.nhs.uk

Team Name
Portsdown Group Practice
Runners Up
Service Improvement Idea Team
To improve the quality of care of patients with long Portsdown Group Practice, Solent Healthcare, GP Health ,
term conditions through the adoption of new
innovative I.T. models of care based in the
community.

ADHD 'everybody's business' ADHD Care Package Berkshire Healthcare Foundation NHS Trust, West
Berkshire Council,

Earl Mountbatten Hospice Implementing child, young people and family friendly Earl Mountbatten Hospice
facilities across Earl Mountbatten Hospice

Earl Mountbatten Hospice Social Complexity: The Multi-Professional Integrated Basingstoke & North Hampshire Hospital
Approach to Pregnancy.

Team Jigsaw Transfer of Daily Admissions Data between Stantonbury Health Centre, Milton Keynes Community
Secondary and Primary Care Health Services, NHS; Milton Keynes, Milton Keynes
Council, Age UK, South Central Ambulance Service

Andover Team Integrated Nursing Home Liaison Andover Practice Based Commissioning (PBC) Group,
Hampshire Partnership NHS Trust, Hampshire Community
Health Care, Hampshire County Council (Adult Services)

Page 11 of 11