ENTRY FORM
THE ‘COLLABORATION’ AWARD
This award recognises organisations that have made significant progress in joining up their
services with others across health, housing and social services.
Please answer each of the following five questions in no more than 200 words.
Please read the accompanying guidance and criteria (available on the Foundations website)
before completing this form.
If you are not sure whether your organisation is eligible to enter for one of the awards, or if you
would like some advice on completing this form, please contact your Regional Development
Manager or call Foundations head office on 0300 124 0315.
Please fill in the form by typing into the boxes and then email your completed form to Foundations
at [email protected]
The closing date for all entries is 5pm on Friday 10 June 2016.
Contact and organisation details
Your name:
Job title:
Telephone:
Email:
Nominated agency details
Agency name:
Address:
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Q1 Service Delivery
Please provide a clear outline of your HIA’s involvement in the delivery of health and social care locally,
illustrating an understanding of the contribution the agency can make to health and care outcomes.
Q2 Service Development
As well as health and care outcomes, what additional social benefits does the service produce?
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Q3 Leadership
How do you or your HIA influence the integration and transformation of health, housing and care in your
local area? Please outline the networks you contribute to and how you ensure your objectives and value
retain the profile to ensure buy-in.
Q4 Innovation
Please tell us about innovative ways you use to identify people who are at risk of a health crisis because
of health or social care needs, isolation or loss of independence and who may be considered ‘hard to
reach’.
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Q5 Partnerships and collaboration
The Care Act sets out a clear expectation to work together to improve services and value for money.
Please illustrate how your organisation has created opportunities to forge productive new partnerships to
develop housing related services within the local health and care system.
How did you find out about the Awards?
Declaration: I have read the guidance and rules and I accept the judges’ decision as final. The
information I have given has been checked and is accurate.
Signed: ____________________________________
Date: __________________________________
Please send your entry by email to [email protected].
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