NHS Dorset clinical commissioning group: leadership award runner-up

Clinical leads from Dorset CCG. The Great Leaders programme has helped family doctors to speak authoritatively about their work and priorities. Photograph: Dorset CCG/Columbia Photography

The Great Leaders programme developed for GPs in Dorset has given them the confidence they need to take on their new role as NHS commissioners, with responsibility for a £900m budget and a 766,000 patient population.

The scheme, which involves 40-50 GPs who have lead roles in the county-wide clinical commissioning group (CCG), has also made family doctors more "media savvy", so that they can speak authoritatively and clearly about the work they are doing and their priorities.

Since the programme was launched in June last year, the GPs involved in it have increased their public profile. They were behind an awareness campaign concerning when the public should use the new 111 out-of-hours telephone advice line and they also launched The Big Ask public consultation exercise seeking patients' views about local services.

GPs also organised two large public meetings to invite comments about the CCG's strategy.

On the commissioning front, the GPs were instrumental in introducing new dementia services following negotiations with their local authority health and wellbeing boards. They have also lad on commissioning services that help avoid emergency hospital admissions, as well as others such as targeting chronic obstructive pulmonary disease services in the over-75s and establishing a community-based pain management service.

The CCG's director of engagement and development, Charles Summers, says the list of achievements illustrates the success of the programme, as the GPs have moved from taking responsibility for the care of their own practice list to having responsibility for a county-wide population.

Having confident GP commissioners has also changed the focus of conversations with providers for the better. "It's now about 'how can your contract support me and my patients?', often in the past those conversations have been financially lead," says Summers.

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D2 Digital by Design: service delivery innovation award runner-up

Service users are sent personalised messages of support by the Response Prevention Project team. Photograph: Jason Lock/Jason Lock Photography

Text messages that support people recovering from alcohol misuse has significantly cut the number of people who relapse and have to be referred back to services.

Daily personalised support messages – which prompt a service user who has recently completed an alcohol misuse programme to reflect on their recovery – are delivered automatically as part of the Bolton Response Prevention Project called Shine.

The questions take into account the user's triggers to drink, such as the time of day they are likely to crave alcohol and also what motivates them to stop drinking such as their relationships with their family.

Service users are also asked whether they feel OK, or are struggling and need more support, and are sent appropriate messages.

Project manager Renate Kalnina at digital technology company D2 Digital by Design in Manchester, which is behind the initiative, says: "If they respond 'OK' we send them back a congratulatory message; if they are 'struggling' then the personalised intervention messages come into play.

"If they say that they need more support then the services get notified within 15 minutes and they get in touch with the client."

Service users are also sent a reminder via text message for appointments as part of the project, which ran from April 2010 to December 2012 in partnership with alcohol misuse services in Bolton.

Only 2.2% of Shine service users had to be re-referred for treatment, compared to 9.5% of non-Shine service users; a significant" reduction according to an analysis of the project.

Clients' attendance rates for relapse prevention programmes improved – rising from 42% to 72% in tier three services (medical intervention and psychosocial support) and from 17% to 72% in tier two services, which offer less intensive support and aftercare, the analysis revealed.

It is estimated the initiative has saved between £68,260 and £399,150, depending on individual client need.

D2 Digital by Design is in discussion with Public Health England about using the same model to support opiate users.

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Sandwell and West Birmingham hospitals NHS trust: technology innovation award runner-up

Dr Matthew Lewis (far right) takes part in an electronic board round with his team.

Sandwell and West Birmingham hospitals NHS trust's established electronic bed management system (eBMS), which runs across its three acute hospitals, was expanded to help reduce bed-blocking and improve the quality of patient care.

The system can track a patient from admission to an acute medical unit until they are discharged to go home and keeps a log of the care they receive along the way.

Dr Matthew Lewis is the trust's group director for medicine and emergency care and a consultant in gastroenterology. He says: "At an individual patient level it's a single tool which enables us to co-ordinate the care we provide in different teams both inside and outside the hospital."

The eBMS, says Lewis, has become "the centrepiece of an electronic board round", where every day a ward's multi-disciplinary team will refer to the system to discuss a patient's progress and his or her readiness to go home.

The eBMS has other benefits too. "On a different level, it is also used as a way for us to look at the [bed] capacity issue. It means at any one time we can see whether we are on track or not," he says.

The eBMS has real-time operational dashboards, which track variations in patient flow, showing any reduction in length of stay, bed turnover intervals and delayed discharge. "The dashboards allow key staff to monitor at ward level any specific area of patient care during the inpatient stay which will cause a queue," says Lewis.

eBMS also includes 44 manual flags that can be applied to highlight a clinical patient alert and another 37 clinical alert flags are automatically triggered via electronic messaging from the hospital's other IT systems. These alerts are passed on to doctors via text, email, dashboard or bleep.

Lewis adds: "The combined functionality of patient-flow tracking, coupled with the many alerts and flags, enables the clinicians to have up-to-date information in real time to enable them to make informed clinical decisions quickly, that not only saves lives but improves the overall experience of patients during their inpatient stay."

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Healthcare Innovation Awards - profiles

Connect and Do, delivered in Lambeth, brings people together through shared interests and a desire to meet new people

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Guardian Healthcare Innovation Awards ceremony - in pictures

Richard Stubbs, head of commercial and international innovation at NHS England addresses the audience at the innovation awards. Photograph: Anna Gordon

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Department of primary care health sciences, University of Oxford: winner, service delivery innovation award

Daniel Lasserson, senior clinical researcher, and Maggie Webb, unit manager, in the emergency multidisciplinary unit.

An emergency unit designed exclusively for old and frail patients is keeping them out of acute hospital and helping to prevent bed-blocking.

The emergency multidisciplinary unit (EMU) established at Abingdon community hospital in Oxfordshire is hoped to become the national model for the future of emergency care for older people.

Patients can be referred to the EMU, which is seen as an alternative to an acute hospital A&E, by either their own GP, a community nurse or ambulance paramedic.

The unit, which is open seven days a week from 8am-8pm on weekdays and 10am-4pm on weekends, is not available for patients who have suffered a stroke or a heart attack, who would still be taken to the local acute hospital's A&E. The majority of the 5,500 patients it has seen arrive with chest or bladder infection or heart failure. The average patient age is 89.

Staffed by elderly care physicians, GPs, nurses, healthcare assistants, therapists and social workers, the unit can quickly assess a patient. It has point of care blood testing with rapid results and X-ray facilities so the unit can guarantee speedy diagnosis.

The EMU has five hospital beds available for patients who may need to be kept in for a maximum 72 hours. A "hospital at home" nursing team is also available to provide support to patients who are sent home to recover.

"I would say that the EMU is more than just a casualty for older frail patients – it's more intensive because we aim to provide care for the episode at the time or for a number of days," says Dr Daniel Lasserson, a GP and senior clinical researcher at the department of primary care health sciences, University of Oxford, who helped design this new model of care.

Lasserson adds: "Its aims to deliver an acute care pathway for frail older patients that does not rely on bed-based care, yet can still provide appropriate medical, nursing and therapist treatments within an individually tailored care plan as close to the patient's home as possible.

"It was designed to challenge the existing urgent care pathway of admission to an acute hospital with its associated harms of unfamiliar and physically challenging environment and loss of independence."

The EMU, he says, addresses the dilemmas of how to best care for a growing elderly population with complex needs and multiple chronic conditions and to provide an alternative to "office hours" general practice or acute hospital bed-based care.

According to the EMU audit, 65% of patients who are assessed by the unit are able to stay in their own home – only 17% of patients need acute hospital care.

Lasserson says this new way of working, known as "interface medicine", is challenging the traditional medical training and care. Oxford has created an Interface Medicines Fellowship and is in discussions with Health Education England about how it can be developed nationally.

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Sussex partnership NHS trust: winner, hospital admissions award

Dr Lisa Page says the way the trust uses mental health triage nurses is unique. Photograph: Sussex Partnership NHS Trust

A year ago people with mental health problems turning up at A&E in Brighton often had to wait four hours to be seen. Around 12% of patients would get fed up waiting and leave; those who were prepared to sit it out frequently ended up being inappropriately admitted to the hospital's observation ward, where they stayed until being assessed by the specialist mental health team.

But today, the number of patients with mental health problems being admitted to the observation ward at the Royal Sussex county hospital through A&E has dropped by 50%. More than 85% of patients are seen and assessed by the mental health team within four hours. Anybody turning up and A&E with a mental health problem is automatically referred to a specialist mental health triage nurse within an hour – something which Dr Lisa Page, consultant in liaison psychiatry at Sussex partnership NHS trust, says is unique. "I don't know of any other hospital which uses the triage nurse in the way that we do, although others do have proactive teams in A&E."

The improvement in waiting times and the introduction of the mental health triage nurse is part of the Brighton Urgent Response Service (Burs), which was introduced in January to tackle the 30% year-on-year rise in unscheduled mental health attendances at the East Sussex seaside town's A&E.

Page says the reduction in observation ward admissions is good news for patients and A&E staff but also for the clinical commissioning group (CCG) because of the high tariff associated with this kind of admission. "That is where the savings are coming from as we are no longer having that large number of patients admitted," she says.

Burs, set up by Sussex partnership NHS trust in collaboration with Brighton CCG and the acute trust, also includes a 24-hour urgent phone line for GPs, mental health patients and carers who are new to the system. GPs can book a patient a next-day appointment at the mental health clinic – rather than the previous minimum five-day referral. Patients and carers are offered telephone advice from a Burs practitioner and are referred as necessary. A dedicated mental health nurse is also available in the community between 8am and 8pm Monday to Friday and from 8am to 6pm at weekends. A new waiting room for people with mental health problems, which provides a calm and quiet environment has also been established at the Royal Sussex as part of the scheme.

Page says her mental health team is busier than ever and that it is too soon to say whether the number of people turning up at A&E has pulled back from its 30% year-on-year rise. But she feels Burs is ensuring that people are seen more appropriately and more quickly. She says: "Referrals to our team have gone up by a third because we are now seeing people who in the past would have come to A&E and left. We haven't curtailed the 30% but we have made some inroads – it would have been even busier without Burs."

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Southern health NHS foundation trust: winner, leadership award

Clinical psychologist Claire Corbridge brainstorming examples of how to deliver integration at a Going Viral session. Photograph: Southern health foundation trust

Southern health NHS foundation trust is one of the largest mental health and learning disability trusts in England. It has a staff of 9,000 working across 150 sites, spanning five counties and was created following the merger of Hampshire partnership NHS foundation trust and Hampshire community healthcare NHS trust in 2011.

A key challenge for the new trust was how to ensure that everybody felt part of the same organisation and shared the same values, behaviours and goals. Part of the solution was its Going Viral leadership development programme which, since its launch in June last year, has coached, developed and supported 550 staff. Another 240 will join the programme this autumn.

Richard House, interim head of leadership and management development, says Going Viral has its roots in the trust's organisational and people development strategies which define the attitudes, values and behaviours expected from its workforce in achieving its core aims. He says: "The NHS Constitution goes some way towards doing that but it isn't specific about behavioural expectations."

The Going Viral programme has three modules that tie in with the trust's core objectives – how to redesign services to improve quality and provide better value for money; how to integrate health and social care with partners and how to provide better outcomes and experiences for patients. The course, which takes place over six months, is delivered in nine-and-a-half day sessions. The learning groups are deliberately made up of staff from different departments so they can develop together.

House says the programme is different from others because it does not select employees according to their NHS banding, but by the amount of influence and responsibility they have. He says: "We have tried to include people, not by their pay band or whether they have management responsibility, but by how influential they are in their multi-disciplinary team. For example, a consultant physician who is only responsible for him or herself."

The programme was introduced before the publication this February of the damning Francis report into the Mid Staffordshire NHS foundation trust.

That report identified how an "insidious negative culture" and "disengagement from managerial and leadership responsibilities" contributed to Mid Staffs' failings. Going Viral, says House, is confronting those leadership challenges identified by Francis.

He says: "I think people feel more listened to and empowered and involved in the processes and realise what is expected of them. It's been transformational for people. One medic said to me 'I wanted to hate the programme and went in with that attitude; but I realise now it was one of the best learning opportunities I have ever had.'"

Health Education England and other trusts from around the country have already taken an interest in Going Viral. The trust, which has its headquarters in Southampton, is organising an open event for later this autumn about the leadership programme and how it fits into its organisational development work. House says: "This is too important not to share with others – to enable them to take on this grand scale change."

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Today in healthcare: Friday 25 October

News, comment, blogposts and tweets across the sector

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Office of the Chief Scientific Officer: winner, workforce innovation award

The new electron linear accelerator facility, which offers an independent radiotherapy calibration service and a unique research facility.

The NHS's healthcare scientists punch above their weight. Although they account for just 5% of the health service workforce, their work is linked to 80% of patients' clinical diagnoses.

Historically though, the career paths and education and training of the 50,000 NHS scientists who come from 45 different scientific backgrounds, has been adhoc.

But now the healthcare scientists have their own defined career paths, which can take somebody starting off in a staff support role right to the top to become a consultant clinical scientist.

The pathways, backed up by a training and education framework, are part of Modernising Scientific Careers (MSC), which has already been three years in the making and is still being implemented. The intention is that, once fully introduced, healthcare scientists will be a sustainable and flexible workforce that can meet the future demands of the NHS and respond to changes brought about by science and technology.

Chief scientific officer professor Sue Hill says: "We recruit some of the best science graduates in the country but we were not developing them to their full potential.

"I think we now know the value of healthcare scientists working in the health system – we have pulled this valuable resource out of the shadows and placed them centre stage so that their knowledge, skills and expertise is more explicit and they can fully make their contribution.

"I think through this programme we have also ensured the sustainability and fitness for purpose in the future of the healthcare scientists' workforce to respond in a health system which is going to be driven by science and technology."

The MSC allows scientists to move between different scientific specialities, broadening their experience and creating a more flexible workforce.

MSC, which has been described as an ambitious and "complex workforce change programme", had to take into account NHS staff and patients, as well as all four UK countries, two Whitehall departments, the higher education sector, professional bodies, the royal colleges and sector skills councils.

Hill says one of the key obstacles was building new relationships with higher education: "We had to enter into and establish new partnerships between higher education and the NHS in particular, which weren't there before.

"We also had to make sure that people understood what they were letting go of, what they had before, and how this would be better and more flexible and was more about the future."

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Portsmouth hospitals NHS trust: hospital admissions award runner-up

An initiative by the diabetes inpatient team has cut hypoglycaemic episode admissions by nearly 20%. Photograph: Portsmouth hospitals NHS trust

A hospital has seen a 33% drop in the number of diabetes patients calling 999 or turning up at A&E following a hypoglycaemic episode, while admissions fell by nearly 20% following an initiative that helps patients manage their care better and educates GPs about best practice.

The diabetes inpatient team at Portsmouth hospitals NHS trust wanted to tackle the recurring number of diabetes patients being admitted to hospital following a hypoglycaemic event.

It decided that a diabetes consultant and specialist nurse would visit every GP practice in the district twice a year to discuss diabetes management and spread best practice. Educational events were also held at local nursing and residential homes to help improve diabetes management.

A new telephone hotline was set up with South Central Ambulance Service for paramedics to call the hospital inpatient team if they had treated a hypoglycaemic patient. That patient would then be contacted by the team within 24 hours.

Any diabetic patient admitted to hospital following a hypoglycaemic event was given advice about managing their care to prevent another attack.

After the project was launched, the number of hypoglycaemic people arriving at A&E or being seen by a paramedic between November 2011 and November 2012 was 83 – a drop of 33% compared to the previous 12 months. During the same period the number of hospital admissions fell by nearly 20% from 85 to 63.

Dr Partha Kar, the trust's diabetes clinical director, says: "As far as we are aware our pathway is the first to show discernible benefits of hypoglycaemic admissions thereby showcasing how a simple innovative approach can help patient care. The pathway can achieve little unless dovetailed with educational support for primary care which has formed the crux of the local model of diabetes care."

The initiative is part of the trust's Super Six Diabetes model of care designed to move more care away from hospital into the community.

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National blood service, Oxford University hospitals NHS trust: technology innovation award runner-up

Oxford University hospitals NHS trust uses handheld computers at the bedside to scan the identity barcode on a patient's wrist band.

Introducing an identity barcode on a patient's wrist band, using handheld computers at the bedside, electronically controlling the temperature of blood fridges and tracking stock have improved patient safety Oxford University hospitals NHS trust's national blood trust and saved £528,000.

The trust wanted to reorganise its bedside and laboratory transfusion service in order to reduce the number of deaths from "wrong transfusion" – the second most frequent cause of death from transfusion reported to the UK's serious hazards transfusions scheme. In the past 15 years, errors in the UK transfusion service were responsible for 27 deaths and 120 cases of major morbidity.

Oxford hoped that by using technology it would also reduce the amount of time staff spent checking blood, reduce blood wastage and the inappropriate use of supplies, as well as speed up the supply of blood in emergencies.

Consultant haematologist professor Michael Murphy says: "For many members of the public or patients to think a process that is so important is relying on bits of paper and people looking at long numbers, is just unbelievable."

Today transfusion patients are identified by a barcode on their wrist band, which is scanned by a nurse at the bedside using a handheld computer. The nurse also scans his or her own barcode before following the transfusion process written on the computer screen.

There is now a complete electronic audit trail of blood supplies after the blood bank IT system was linked to others in the trust, which has led to significant improvements in blood sample collection, the collection of supplies from fridges and the transfusion-related admin.

Paperwork has been cut by 52 minutes per patient and the bedside transfusion process now requires one nurse instead of two. The initiative is recognised as an exemplar NHS evidence, quality, innovation, prevention and productivity project. The Oxford team wrote a national specification for the electronic transfusion service for the former National Patient Safety Agency.

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Moorfields eye hospital: service delivery innovation award runner-up

Nurses at Moorfields administer a third of all eye injections. Photograph: Moorfields eye hospital

Nurses at Moorfields eye hospital NHS foundation trust in London have been trained to give eye injections to patients in a groundbreaking move, which is changing professional practice and benefiting patients.

The hospital decided to teach senior nurses how to administer the drug Lucentis as an injection in the eye because of increased patient demand, following new national clinical guidelines and a lack of ophthalmologists to carry out the procedure. New guidelines from the National Institute for Health and Care Excellence (Nice) recommended that Lucentis should be injected into the eye to treat patients with diabetic maculopathy.

The decision put more pressure on the hospital because its doctors were already busy administering 10,000 Lucentis eye injections every year to patients with the wet form of age-related macular degeneration.

Moorfields decided to train its senior nurse to give the eye injections, even though it was opposed by the Royal College of Ophthalmologists because Lucentis is only licensed in the UK to be administered by a doctor.

Hospital lawyers were consulted and a special patient consent form was drawn up. The NHS Litigation Authority also guaranteed the nurses the various liability cover they needed.

So far, 15 Moorfields nurses have given 3,000 eye injections, representing 33% of the hospital's eye injection workload. Moorfields has also been able to run 15 extra eye injection sessions a week because of the new skills mix.

Moorfields fellow Joanna DaCosta says: "This model of working is instrumental in removing professional barriers, increasing job satisfaction and providing a cost effective healthcare system."

The success of the initiative is illustrated by the decision in May taken by the Royal College of Ophthalmologists to issue new guidelines that non-medically trained professionals can administer eye injections, provided they have appropriate training and supervision.

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University College London hospital: workforce innovation runner-up

University College London Hospital's training programme helped staff identify weaknesses in their clinic’s processes.

A leading London teaching hospital is giving staff the power to decide how outpatient clinics are run, which is transforming services, reducing waiting times and improving the patient experience.

University College London hospital sees more than 800,000 people in outpatient clinics every year.

But it realised it had to improve the system after a questionnaire revealed 47% of outpatients ranked the service they received as "not at all" or "fairly" well organised, and 59% complained that they had to wait at least 30 minutes before they were seen in a clinic.

The trust's quality, efficiency and productivity team designed a 24-week staff training programme which, with the support of service improvement coaches, aimed to help clinic staff identify where there were weaknesses in their clinic's processes and procedures and to come up with solutions to solve the problems.

So far the team has worked with 31 different multi-disciplinary staff teams and 300 outpatient clinics.

The results are impressive. The endocrinology clinic has halved waiting times to 45 minutes by staggering patient arrival times and realigning clinic templates. The musculoskeletal clinic has cut its waiting list from 15 weeks to seven by pooling its booking queues system.

The introduction of a 24-hour telephone advice line in maternity has reduced clinic waiting times, taken the pressure off labour wards and improved the experience of patients.

Louise Molloy, productive programme manager, says: "In essence, this programme gives teams the permission to focus on and improve their services.

"It allows them to take all those things that they see are not working and bring them together with the right staff, and working with a professional coach, to develop a programme of work to solve those problems."

At least 80% of outpatient clinics are scheduled to go through the process by 2015.

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Guardian awards hail healthcare innovators

Healthcare Innovation Award winners from Sussex partnership NHS trust with the Guardian's David Brindle (right). Photograph: Anna Gordon for the Guardian

Six organisations – including a school, a university department and a data management company – have been named as winners of the first Guardian Healthcare Innovation Awards.

Two NHS trusts and the Office of the Chief Scientific Officer also received awards at a ceremony at the Guardian's London offices on Thursday.

The awards, which aim to celebrate and share best practice across the healthcare sector, were presented across six categories – service delivery innovation, innovation with technology, innovation in hospital admissions, leadership innovation, partnership innovation and workforce innovation.

Oxford University's department of primary care health sciences won the service delivery award for an emergency multidisciplinary unit at Abingdon hospital, which offers a model for elderly care.

Southern health NHS foundation trust was winner in the leadership category for its Going Viral programme, which has coached, developed and supported 550 staff since its launch in June last year.

The teenage health project run by Rivington and Blackrod and Ladybridge high schools in Lancashire won the partnership award its work with NHS, local government and sports centres to offer pupils health and wellbeing advice.

In the hospital admissions category, Sussex partnership NHS trust won for its Brighton Urgent Response Service, which has cut waiting times for people arriving at A&E with mental health problems, as well as seeing fewer patients admitted to the observation ward via the emergency department.

The Office of the Chief Scientific Officer won the workforce category for a project that aims to help healthcare scientists become part of a sustainable and flexible workforce.

In the technology category, the winner was data management company Intelesant for a tool that aims to change the culture around end-of-life care plans.

Hundreds of entries were submitted for the awards, sponsored by NHS England, GE, Unipart and 3M, which aim to showcase ideas or services that significantly improve the quality or management of care for patients.

Each category winner and all the shortlisted entries are being profiled on the Guardian's Healthcare Professionals Network so their projects and programmes can be shared with the rest of the sector.

David Brindle, the Guardian's public services editor, who chaired the awards judging lunch, said: "The NHS doesn't have a good reputation for spreading innovation, so we were thrilled to receive so many high-quality entries for these awards in their first year.

He added: "What's great to see is how many of our winners and runners-up come from outside the NHS itself, showing that it is increasingly open to partnerships that deliver improved outcomes for patients."

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Centre for Patient Leadership: leadership award runner-up

David Gilbert (left) and Mark Doughty: 'We are about giving patients the confidence and the skills to engage with other professionals.' Photograph: Centre for Patient Leadership

A unique leadership programme is giving patients, their carers and service users a voice and helping them influence and shape the health services they use. The Centre for Patient Leadership was established three years ago by Mark Doughty, who has severe rheumatoid arthritis, and David Gilbert, who had a nervous breakdown when he was 25.

Both recognised from their own personal experiences the potential power of the patient voice, but both felt no support was available to make sure that voice was heard. Their own health experiences influenced their individual career paths. Between them they have expertise and skills in learning and development, advocacy and patient engagement.

Gilbert says: "We believe current engagement mechanisms are not fit for practice. Life-changing illness, injury or disability is the crucible within which leadership can be developed. Patients can have a vision of, and passion for, change borne out of their lived experiences. Stepping up to want to change things for others, requires learning and support to develop the confidence and capabilities to work with professionals to influence change."

Courses on offer, which are tailored to individual need, range from two months to a maximum of six months. They involve a mix of workshops with mentoring and coaching support, and focus on self-leadership, relationship building and dialogue, and developing influencing and advocacy skills.

Doughty says: "It's about building effective relationships, being able to communicate and having the ability to dialogue ... and talking together about problems that you share. We are about giving patients the confidence and the skills to engage with other professionals in which the patient themselves perceive themselves as being equal."

The company works with individual patients and organisations, which are trying to make patient engagement more meaningful. Between 400 and 500 people from a range of national, regional and local organisations including strategic health authorities and clinical commissioning groups have completed its leadership programme.

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Spice and the Young Foundation: partnership innovation award runner-up

The Uplift scheme 'helps you anchor yourself, to anchor your place in society and your sense of identity', says one service user. Photograph: Spice

A time-bank project designed for health and social care service users is helping them feel less isolated and has the potential to transform their lives.

Under the Uplift scheme service users spend time volunteering for local organisations in return for time credits. They receive a credit for every hour given; in return the earned credits can be spent at local leisure or cultural venues which have signed up to the scheme.

Uplift has been established by the social enterprises Spice and the Young Foundation. It involves four local authorities in England, more than 200 local organisations and 1,000 service users who have notched up 20,000 credits.

As part of Uplift, each local authority hosts a Spice facilitator whose job it is to create a local time credit network made up of service users, community organisations, public services and private businesses. Each network offers a mix of earn or spend opportunities.

David Russell, head of health and social care at Spice, says: "Uplift is a large and ambitious project across four geographical areas, involving a wide range of service types and communities.

"On average we find that 40-60% of participants have never given time before ... this is having a wide range of positive outcomes particularly around culture change, increased physical activity, mental wellbeing, confidence and community pride."

One service user from Norfolk who has signed up to Upflit says it has made him more "anchored". He says: "It's opened up social avenues – I've now got a group of nodding acquaintances at the gym, which helps you anchor yourself, to anchor your place in society, and your sense of identity."

Spice and the Young Foundation are also working with commissioners, service heads, support workers and service users to see how the idea of time credits can be adopted more widely into their own systems and approaches to work. Russell says: "This can range from large scale service asset mapping to redesigning support working systems, to building co-production into the commissioning process."

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NHS South Worcestershire CCG: hospital admissions award runner-up

Dr Nikki Burger says the target is for GPs to deal with an average of five ambulance cases a day. Photograph: South Worcestershire CCG

GPs have been dealing with 999 calls during the day, which were traditionally handled by ambulance crews – reducing the number of patients admitted to hospital and saving £1.1m

The scheme was set up by South Worcestershire clinical commissioning group (CCG) and the West Midlands ambulance service last October in an attempt to cut the number of avoidable hospital admissions and free up paramedics to take on more life-threatening calls.

GPs are available from 12pm until 8pm – when 999 calls are often at their highest – every day of the week.

An ambulance is always dispatched to the scene in case an emergency admission is needed. But the crew or the ambulance control room can call out the GP if it is felt that the patient could be treated at home by the family doctor rather than being taken to hospital.

Since the scheme was launched last October 50 GPs have taken 1,221 calls with only 20% of patients being taken on to hospital. The project, which costs £21,000 a month to run, has prevented 970 A&E attendances and 500 hospital admissions, saving £1.1m. The scheme has been so successful that GP urgent support is also being made available to care homes, minor injury units and community care teams.

GP Dr Nikki Burger, the CCG's urgent care lead, says: "We recognised the potential to expand the role. Our target is that the GP deals with 35 ambulance cases a week – an average of five a day – and the rest of the time they are available to provide the extended support role."

The initiative was originally run as a pilot scheme by the CCG's predecessor Worcestershire primary care trust as a solution to tackling increased demand on NHS services during the winter.

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United Response: workforce innovation award runner-up

United Response Stamp of Support programme encourages carers to allow people with disabilities to take sensible risks.

A disabled woman made herself a cup of tea for the first time after her support workers realised providing her with a surface-mounted cup and a hot water dispenser meant she was no longer in danger of scalding herself.

Staff at the charity United Response came up with the solution because they realised that the benefit of making a cup of tea far outweighed the possibility of her being scalded. The support workers felt confident that it was a risk worth taking.

A young adult with a learning disability now travels to work by bus on his own, rather than taking expensive taxis. The staff knew there was a possibility that he could get lost on the way, so they gave him a mobile phone to ring them if needed. Staff realised that the financial and personal benefits were greater than the chances of him getting off the bus at the wrong stop.

Both cases illustrate the success of the charity's Stamp of Support initiative – which is encouraging "positive risk-taking" by staff in the organisation, which supports 1,300 adults with learning disabilities, physical disabilities or mental ill-health.

The charity wanted its 3,500 support staff to have the confidence to take a calculated risk when making decisions which would help service users achieve their "hopes and dreams".

"We didn't want them to risk their safety, but we wanted them to know that so long as they have acted reasonably then we will support them all the way," says Shonagh Methven, the charity's senior business partner for risk management.

The Stamp of Support slogan now appears on all its health and safety material and on a staff keyring.

Staff guidance and advice to support them to make a positive risk decision – even if it ends in failure – has been written into the charity's risk management strategy.

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Rivington and Blackrod and Ladybridge high schools: winner, partnership innovation award

Pupils have also been trained as 'health ambassadors' and hold theme-led assemblies on a range of health issues. Photograph: Rivington and Blackrod high school

It could easily have been a bureaucratic nightmare that failed at the first hurdle. The dilemma was how do you bring together the NHS, local government, education and sports centres to deliver a school-based health project that the students would be happy to use?

The answer, according to Michelle Howard, director of business development at Rivington and Blackrod high school in Lancashire, was to be committed to the vision and have the confidence and trust in each other to share information and best practice.

"We worked with all our partners to ensure that all our procedures and practices worked well together," she says. "We learned so much more about each other and how we could best use our skills, resources and specialisms to deliver the best outcomes for us all. It was also about sharing that responsibility."

The teenage health project at Rivington and Blackrod high school and the Active Health scheme at its linked federated school, Ladybridge high school, has gone from strength to strength since it was first established in 2007.

The intention, following wide consultation with parents, young people, the local community and public services, was to create a student-friendly accessible health and wellbeing service offering advice, guidance and information on the school site. "It started out when we were looking at Every Child Matters, which was on everybody's minds at the time," says Howard. "It was about looking at what we could do to help young people stay healthy and safe."

A steering party was set up, which included representatives from parents, pupils, schools, the local authority and leisure providers to design and develop the project, which had £450,000 of Big Lottery Fund money.

Today more than 3,000 young people have made use of the project, which offers them a range of advice and information including healthy eating, sexual health and contraception and drug and alcohol awareness.

Support for emotional wellbeing and advice about how to cope with stress is also offered by the project, which is run by school nurses alongside a project co-ordinator who can refer students to different services as required. "There isn't one aspect of health that we shy away from," says Howard.

School students have also been trained as "health ambassadors" – taking the healthy message to their classmates by holding theme-led assemblies and teaching them how to carry out CPR and other lifesaving first aid skills.

At the same time, 13 members of staff have learned about healthy eating and nutrition and are now passing on their knowledge to students across the school.

The project, says Howard, has generally improved the students' physical and emotional health. But there have been more tangible results: the behaviour of 81% of children who attended its anger management programme has improved; the local teenage pregnancy rate has started to fall and 87% of children who received counselling said they were feeling better.

Howard attributes the success of the project to the depth of the relationships between the different partners. She says: "It's about trust and acknowledging that 'I am really good at this' and saying 'how can we work together to get the best outcomes?'. We also had a very strong vision, which we all focused on and never lost sight of."

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Intelesant: winner, technology innovation award

With the End of Life Monitoring and Assessment tool, GPs can be notified of care home residents' end of life wishes.

An app-like tool that has the potential to change the culture around advanced plans for frail and older people in care homes has been developed in Trafford, Greater Manchester.

The End of Life Monitoring and Assessment (Elma) tool allows care homes to electronically send a resident's advanced plan – a statement of their end of life wishes – via a handheld device direct to the individual's GP computer system. The plan, which is Read-coded and compatible with the practice system, can then be accessed around the clock by other NHS staff from ambulance teams to A&E doctors and community nurses.

It means that for the first time care home staff can directly share their knowledge about a resident with the wider NHS. Crucially, Elma also allows GPs and other NHS staff to be kept up-to-date with the advanced plan of an older person living in the residential care system whom they may rarely see and may be little known to them.

With the resident's consent, Elma can also be accessed by their family or friends using a secure two-factor authentication. Uniquely, Elma has also been designed to be used as an experiential training tool by care home staff to teach them how to create and develop an advanced plan with a resident.

Before Elma was introduced, care homes that did promote advanced plans for residents used paper versions, which then had to be faxed to the GP surgery. The time-consuming process was open to error and the information the plans held was often inconsistent, says physiotherapist Louise Rogerson, director of service development at Intelesant – the company behind Elma.

Because of Elma, it is hoped that eventually all people living in Trafford – not just care home residents – will have an advanced plan, which can be securely accessed by healthcare professionals and the individual's family. Rogerson said: "Any of us who have an advanced plan can use this system; it's not just for people in the last years of their life, it's for anybody who wants an advanced plan."

Additional coded data about the resident, which has been added by the care home staff can also be accessed via Elma by healthcare professionals, if necessary. That data includes latest information about a resident's usual level of consciousness; their mobility; their diet and their weight.

Rogerson says: "These are key indicators about how well a patient is, about how frail they are, and was something which the doctors in A&E said would be useful. It's the kind of information which the care home staff would have."

The electronic tool, developed by Intelesant, Trafford clinical commissioning group and the local hospice, has already been used by one local care home and is in the process of being rolled out to another nine.

The data Elma captures also reflects that required by the electronic palliative care co-ordination system, which is part of the national end of life care programme in England.

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Michael Yoakley's Charity: partnership innovation award runner-up

Manager Julie Wickenden shows off one of the hospital avoidance beds, which helps prevent inappropriate hospital admissions. Photograph: Michael Yoakley's Charity

A care home in Kent is helping to free up hospital beds and preventing older people being inappropriately admitted to hospital, following a partnership with a local GP surgery.

The Michael Yoakley's Charity in Margate provides the North Down surgery with two short-term hospital avoidance beds, which are offered to older patients who are unable to be cared for at home and need support.

The patients spend a maximum of seven days in the home at a charge of £500 a week, which is significantly cheaper than the £500-a-day it would cost to pay for a high-dependency NHS hospital bed. So far this year the home has looked after 24 older people who have been recovering from common infections and viruses, including chicken pox.

The charity's executive manager Julie Wickenden says the scheme turns on its head the traditional relationship between the home and GPs, where family doctors have traditionally served the needs of the home.

"We have a large local hospital where we have many elderly people clogging the system when they don't need to be there," she says. "Our seaside area also has a high proportion of elderly residents many of whom are geographically distanced from their family members who might otherwise care for them, so the default when they are unwell, or even just vulnerable, is a hospital admission.

"A lot of care homes are looking to develop different kinds of initiatives because they are not having so much success with social services funding as the councils are really holding back putting people into residential care, so we have had to look for other ways of making up the finances."

The initiative, which allows continuity of care by the patient's own GP, has been so successful that the home is now in the process of building an extension, so that it can provide more hospital-avoidance beds.

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Applying sunscreen? Don't be stingy

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Most people use sunscreen too sparingly. If you're wearing swim gear, it takes about 1 ounce (28 grams) of sunscreen to cover all exposed parts of your body. That's the amount in a standard shot glass. If you're only using a dime-sized drop of sunscreen, you're not using nearly enough.

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