The Scottish Government

Action Diabetes was launched in Slough in October 2004, to raise awareness of Type 2 diabetes in areas with populations most at risk. The project was designed and implemented by Dr Foster with the support of Slough PCT. Together they targeted hard to-reach groups using health needs mapping ( HNM) analysis, in partnership with Experian.

This targeted approach and the use of volunteers from the local community meant that people were advised on lifestyle changes before their condition worsened. Interim results showed that the 4-week campaign produced a 164 per cent increase in diabetes referrals among the most at-risk communities.

"By using HNM we've been able to calculate where the highest concentration of undiagnosed sufferers are, and implement a local marketing campaign to target these groups. This campaign has finally given me the opportunity to engage with local communities on a larger and far more effective scale, mainly because of the local volunteers. Awareness levels seem to be greater than ever before."

Source: DOH, 2006, p.167

The aim of the project in the Torry area in Aberdeen was to provide a Community Neighbourhood Centre that local residents could use to get access to IT facilities and to provide a centre which brings services closer to the community. For the first time, through the Centre, all Torry residents should be able to access primary health care, community police services, social work, and housing functions within their own area.

The Torry Neighbourhood Centre website provides information about the centre and services provided there and across Torry; with links to other local and relevant sites such as the new Community School, the Foyer Project and the Community Council website. All of this is available to the community via the Internet and touch screen databases.

The Torry community worked together to produce the information that is accessible on the touch screens and grouped into life events such as bereavement, education, health, information for children, parenting, etc. (Source: Scottish Executive 2003a, p.32)

Established in 1999-2000, Sure Start aimed to provide one stop support services for families with children under 4 in deprived communities in England and Scotland, a number of which are in operation.

A recent Mapping Exercise of Sure Start services across Scotland identified, after a slow start, the increasing development and usage of Sure-Start services, with the majority being centre-based support services and 20% being outreach services. In the few local authorities where centre-based services were not developed at all this tended to be because this was not appropriate in rural areas.

(Source: Cunningham-Burley et al, 2005.)

Hartlepool PCT and Turning Point, together with local organizations, are currently piloting the Connected Care model. This model aims to provide managed transitions between services and be designed to fit the needs of the community.

One of the main features of a Connected Care Centre is a connected care audit undertaken by members of the community, together with professional researchers. This model builds capacity by enabling those within the community to gain experience of research and have the opportunity of working towards a qualification.

It is envisaged that each Connected Care Centre will have:

• a navigator for each client who will have an understanding of the local services, and be able to work with the services to provide a sustained and personalised pathway of care
• co-location of a variety of NHS, social care and voluntary professionals;
• common assessment procedure
• established procedures for sharing information
• shared training
• single point of entry
• round-the-clock support;
• managed transitions; and
• continuing support.

(Source: Social Exclusion Unit, 2005b, p.83)

It's 5.00am on a Tuesday in November. It's dark outside and the rain is lashing against the window. The start of a gale is brewing and you have to get up to make the first ferry off the island. Ahead of you lies a 3-day round trip to hospital in Glasgow to see your consultant for a ten-minute appointment. Your condition means when you return home on the last ferry on Friday night you will be exhausted.

Now, with the opening of the 3 Islands Partnership, public services have been brought together under one roof to provide a complete One-Stop shop service. These 'Servicepoints' are the first port of call for any queries from abattoirs to roads, and everything else in between. Each of the Servicepoints has videoconferencing equipment which any islander can use. In addition to this, computers have been installed so that islanders can access the Internet and, as the lead agency, Argyll and Bute Council has brought the 'information world' to the doorstep of some of its islands.

Each of the Servicepoints is managed by Council trained staff but regardless of how important the technology becomes in providing a link to services the Council also wants to ensure that facilities are maintained to provide the vital one-to-one contact that people need. To that end staff will always be available to Islanders in order that they can phone or drop into the Servicepoint and get advice about services (whether Council, business or health).

Partnership working is vital to Argyll and Bute Council because it offers opportunities not afforded to the Council working alone. The Three Islands Partnership means that the Council, Argyll & the Islands Enterprise Company, the NHS, the Scottish Executive and the local community companies are all working together to ensure that the residents of Islay, Jura and Colonsay are able to access services more easily with the use of technology. The 3 Islands Partnership is no longer a pilot project; it is rapidly becoming a way of life for many islanders.

(Scottish Executive, 2003a, pages 35&36).

The report on Evaluation of E-Care Projects in September 2005, highlighted a number of benefits, including:

• A reduction in duplication of information collected and held
• A reduction in repeat visits and repeat requests for information
• Cross-agency consent is consistently managed through an information sharing protocol
• Information is readily and easily shared between the participating agencies
• Cross-discipline and cross-agency working is fully supported
• Local and national management information provision is made easier through the provision of granular information by the Single Shared Assessment ( SSA) system.
• A fully compliant electronic SSA system is in place (compliant with Assessment Review Co-ordinating Group National Minimum Information Standards for Single Shared Assessment for Older People). The SSA system records and supports the Indicator of Relative Need and Care Assessment Data Summary standards, allowing analysis and reporting consistent with national measures and data codification.
• Approximately 700 staff have been trained to date and joint training has led to a greater understanding of other services' priorities and challenges.
• Process mapping has provided huge benefits in confirming practices in each organisation, clarifying roles and responsibilities and clarifying terminology in use across organisations
• Effort has been saved through use of the eCare organisational development toolkit, for business process mapping, risk assessment, communications and training plans.

(Source; Scottish Executive, 2006a, p24; see also Audit Commission 2002a for a wider perspective on 'e-government')

The Expert Patients Programme ( EPP) is a training programme run by the NHS for people who live with long-term health conditions such as arthritis, multiple sclerosis and asthma. It aims to develop new skills to enable people to manage their condition better on a daily basis and improve their self confidence. Piloted in 2002, it is now being rolled out nationally.

The programme is run over 6 weekly sessions of 2.5 hours each. Volunteer tutors, who themselves have long-term conditions, lead participants through structured course material covering topics such as relaxation and managing pain and medication. Each week attendees set action plans and also buddy up for support between sessions.

For those who do not feel comfortable engaging in a group situation, information and communication technology can provide a potential solution. During the EPP pilots, it was found that young men were reluctant to participate in the course. In response to this, a computer-based version of the course is now being piloted.

EPP Online provides a 6 week course for people with long-term health conditions. The course will be provided through a partnership with the Department of Health, the NHS and Stanford University. It will be available to 600 participants in England. People who have gained self-management skills through the programme can be expected to make around a 7 per cent reduction in GP consultations, a 10 per cent reduction in outpatient visits, a 16 per cent reduction in A & E attendances and a 9 per cent reduction in physiotherapy use.

The Programme is being adapted for non-English speakers and bilingual trainers have been recruited by working with local ethnic minority communities.

Source; Social Exclusion Unit, 2005a, p.87

People with complex needs require an integrated service, involving support from both health and social care professionals. Western Sussex PCT and West Sussex County Council ( WSCC) are working in partnership with district councils and the voluntary and community sector to do just that through the Innovation Forum: Reducing Hospital Admissions project. Its main objective is to redesign care for older people with long-term chronic or complex health conditions around their needs and priorities, rather than around historic service models and professional roles.

The partners have established an intensive care at home service, which integrates intensive nursing, health therapies and hospital-at-home services with social and caring services home care service providing care for up to 6 weeks.

"This way is so much better. I'm getting more individual treatment, I'm eating better and I'm sleeping better than I was in hospital. In a hospital ward, you are just one name among many. At home you are getting personalised health care. The care staff who come here have more time for me than they would do in hospital." Hip replacement patient, home within 5 days of receiving treatment.

(Source: DOH, 2006, p.117)