Health and Care Policy Jargon Buster

What’s the difference between an integrated care provider and an sustainability and transformation partnership? What do we really mean when we talk about patient and public involvement? The health and care policy landscape is constantly evolving and the language that we use to describe this landscape changes along with it.

This brilliant jargon buster from the King’s Fund, aims to demystify and clarify some of the concepts and terms that are frequently used in health and care policy. They will be updating it on a regular basis to reflect changes in the health and care system and would like to hear from you on what needs defining.

A

Accountable care organisation (ACO)
See integrated care provider

Artificial intelligence (AI)
While it is hard to provide a single definition for the term, AI is usually used to refer to a set of computing and data analysis techniques that together are used to accomplish tasks that would normally require intelligence if carried out by humans. AI is beginning to be used more widely in health and care, for example, in diagnostic services to help interpret images from CT and MRI scans.

B

Better Care Fund (BCF)
Formerly known as the Integration Transformation Fund, this is ‘a single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities’. The BCF can be used to meet adult social care needs, reduce pressures on the NHS including by supporting discharge from hospital and support local social care provider markets.
(NHS England 2013)

C

Capital expenditure
See capital spending.

Capital spending
Also known as capital expenditure, this is financial investment to purchase, maintain or improve assets such as NHS buildings, equipment and technology.

Clinical commissioning group (CCG)
Established by the Health and Social Care Act 2012, CCGs are responsible for commissioning the majority of NHS services for patients within their local area. They are membership bodies, made up of GP practices, and their governing bodies include GPs, other health professionals and patient representatives.

Clinical governance
A framework through which health care organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care.
(Adapted from Scally and Donaldson 1998)

Commissioning
The process by which health and care services are planned, purchased and monitored. Most NHS services are commissioned by CCGs, while publicly funded social care and most public health services are commissioned by local authorities. 
See also commissioning cycle

Commissioning cycle
Commissioning consists of a range of activities, including assessing needs, planning services, procuring services and monitoring the quality of services. This process, which is repeated typically on an annual basis, is known as the commissioning cycle.

Community mental health teams (CMHTs)
These teams provide support to people with mental illness who are living in the community. They are made up of a range of professionals including psychiatrists, community psychiatric nurses, occupational therapists and support workers.

Community referral
See social prescribing.

Community services
Services that are delivered in a wide range of settings such as homes, community clinics, community centres and schools. They commonly include adult community nursing, specialist long-term condition nursing, therapy services, preventive services such as sexual health and smoking cessation clinics, and child health services including health visiting and school nursing. These services aim to keep people well, treat and manage diseases and support people to live independently in their own homes.

Continuing Health Care (CHC)
This refers to a package of health and social care provided outside hospital, often at home or in a care home, that is arranged and funded solely by the NHS, rather than by local authorities or individuals. People who are eligible for CHC are usually individuals with long-term complex health and care needs. To qualify, their needs must primarily be for health care rather than social care.

Corporate governance
Corporate governance is the means by which boards lead and direct their organisations so that decision-making is effective and the right outcomes are delivered. In the NHS this means delivering safe, effective services in a caring and compassionate environment in a way that is responsive to the changing needs of patients and service users. 
(Monitor 2014)

D

Delayed transfers of care (DTOC)
A DTOC (or delayed discharge) occurs when a patient is ready to leave a hospital (or similar care provider) or step down to a less intensive level of care but cannot be discharged and is still occupying a bed. DTOCs commonly occur between health and social care services but also between NHS services, for example between mental health services and community inpatient services. Common reasons for delayed transfers include awaiting care packages, appropriate accommodation or waits for assessment.

Departmental expenditure limit (DEL)
This refers to central governmental departmental spending that is subject to annual budgetary limits.

Deprivation of liberty
Someone is deprived of their liberty when they are under continuous supervision and control and are not free to leave the place where they are receiving care and treatment People may be deprived of their liberty in health and care settings if they are detained in hospital for assessment or treatment, or if they reside in a care home or nursing home and are unable to consent to their care arrangements. People can legally deprived of their liberty in health and care settings using the Mental Health Act 1983 and/or the Mental Capacity Act 2005. 
See also: Deprivation of Liberty Safeguards (DoLS)

Deprivation of Liberty Safeguards (DoLS)
An amendment to the Mental Capacity Act 2005 that is only applicable in England and Wales introduced these safeguards. They ensure that people who can’t consent to their own care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. Authorisation is given by a local authority and is subject to an independent assessment that the arrangements are necessary and in the person’s best interests. 
See also: deprivation of liberty

Devolution
Devolution is the transfer of power and funding to a lower level, particularly from national to local government. An example of this is the devolution of power from central government to one of the four nations, such as Wales or Scotland, or to a local region such as Greater Manchester.

E

Efficiency
Efficiency is a measure of how well a health care system uses its resources to get the best value for money. Efficiency can be divided into technical efficiency and allocative efficiency. Technical efficiency refers to improving existing processes and procedures, for example procuring prosthetic limbs at the most cost-effective price. Allocative efficiency focuses on ensuring the most effective use of resources, for example allocating spending to the services that will deliver greatest benefit of the population.

F

Financial regulation
Financial regulation is the process by which the financial performance of NHS organisations is monitored and managed. In England, the measures that organisations need to meet are set out by NHS England and NHS Improvement. Based on these measures, and other measures including care quality, national regulators can take action or provide targeted support to organisations to improve their financial performance and use of resources.

G

General practice
General practice is a primary care service, based in the community, that is usually the first point of contact with the health care system. The aim of general practice is to manage short- and long-term illness and to co-ordinate care by working with other services.

Global Digital Exemplars (GDEs)
GDEs are a group of NHS providers who have been given central support and funding in exchange for making progress, capturing lessons and supporting others in the system on making best use of digital technology.

Governance
See corporate governance and clinical governance.

H

Health and care system
The World Health Organization defines a health and care system as a system ‘consisting of all organizations, people and actions whose primary intent is to promote, restore or maintain health’. This includes efforts to influence wider determinants of health, as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services.
(WHO 2007)

Health and Social Care Act 2012
This legislation came into force on 1 April 2013, implementing major reforms to the health system in England. Changes included the creation of clinical commissioning groups (CCGs), health and wellbeing boards (HWBs) and a national commissioning body, NHS England.

Health and Wellbeing Boards (HWBs)
HWBs were established under the Health and Social Care Act 2012 as a partnership forum in which key leaders from the local health and care system come together to improve the health and wellbeing of their local population. They exist in all 152 local authorities with adult social care and public heath responsibilities. They have a statutory duty, with clinical commissioning groups (CCGs), to produce a joint strategic needs assessment and a joint health and wellbeing strategy for their local population.

Health inequalities
Health inequalities can be described as ‘the preventable, unfair and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental and economic conditions within societies’. In England, health inequalities are often discussed in terms of the stark differences in life expectancy between people living in deprived areas and those in wealthier areas of the country.
(NHS England 2020b)

I

Integrated care
Integrated care is an approach to delivering services which focuses on taking a joined-up, co-ordinated and personalised approach to meeting people’s health, care and support needs. There are different types of integration, including between primary and specialist care, physical and mental health services, and health and social care. This aim is currently being pursued through the development of integrated care systems (ICSs), integrated care partnerships (ICPs) and primary care networks (PCNs).

Integrated care provider
These can be established when commissioners award a long-term contract to a single organisation to provide a range of health and care services to a defined population following a competitive procurement. This organisation may subcontract with other providers to deliver the contract. 
These were formerly known as accountable care organisations (ACOs). There are not yet any examples of these contracts having been awarded, and there appears to be limited appetite for their use at present.

Integrated care partnerships (ICPs)
ICPs are alliances of NHS providers that work together to deliver care by agreeing to collaborate rather than compete with each other. These providers include hospitals, community services, mental health services and GPs. Social care and independent and third sector providers may also be involved.

Integrated care systems (ICSs)
ICSs are evolving from sustainability and transformation partnerships (STPs) and take the lead in planning and commissioning care for their populations and providing system leadership. They bring together NHS providers and commissioners and local authorities to work in partnership in improving health and care in their area. Compared to STPs, ICSs require a closer form of collaboration as they take on greater responsibility for collectively managing resources and performance, and for transforming the way care is delivered. The NHS long-term plan set an ambition for all areas of England to be covered by an ICS by April 2021.

Integration Transformation Fund
See Better Care Fund.

Interoperability
Interoperability refers to the ability of different health information systems and software applications – both within and across organisational boundaries – to ‘talk to each other’ and share information.  Interoperability in health care should be understood as much more than simple exchanges of data. The systems involved need to be able to share information in such a way that other systems can make good use of it, in standard forms.

J

Joint strategic needs assessment (JSNA)
This is a process by which local authorities and partner organisations assess the current and future health, care and wellbeing needs of the local community to inform local decision-making. JSNAs usually contain information about the health and wellbeing status of the local population, identify inequalities and illustrate trends. They may also outline local community views and highlight suggested areas for focus for collective action to improve the lives of people locally. Health and Wellbeing Boards and clinical commissioning groups are under a statutory duty to produce a JSNA.

L

Leadership
Leadership is the art of motivating people to achieve a common goal. The five characteristics of leadership are: developing and empowering people; fostering a compassionate and inclusive culture sharing a clear purpose and engaging vision; focusing on impact and outcomes; and encouraging a sense of pride and belonging.

Local health and care records (LHCRs)
LHCRs refer to datasets and sharing approaches built so that a range of information from records from across health and social care can be linked together. This information is made available to support direct care in different settings and for secondary uses like planning and research too. The first LHCRs cover large geographic regions of up to 14 million people each. The intention is for approaches to be aligned and all patients in England to have a LHCR by 2024.

M

Mental Capacity Act 2005 (MCA)
This law applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make some or any decisions for themselves. The primary purpose of the MCA is to promote and safeguard decision-making within a legal framework. It does this by empowering people to make decisions by themselves and protecting those who lack capacity by ensuring decisions are guided by a set of principles, such as ensuring all decisions are in the best interests of the person. It also allows for people to plan for their future when they might lack capacity.

Mental Health Act 1983
This act is the law in England and Wales that covers the assessment, care and treatment of people with a mental disorder and the rights of the person and their family.

Minor injuries unit
See urgent treatment centres.

N

NHS 111
This service provides 24/7 access to non-emergency medical advice online and through a telephone helpline. The service allows individuals to report their symptoms and they are either given self-care advice by call handlers, referred to medical staff or directed to treatment (provided by GP surgeries, pharmacies or urgent treatment centres, for example). In emergency cases, patients are asked to attend accident and emergency or NHS 111 may send an ambulance directly to the patient. 
See also: urgent and emergency care services

NHS five year forward view (5YFV)
This NHS policy, published in October 2014, set out a vision for the future of the NHS based on integrating care to meet the needs of a changing population. It set out seven new models of care, which were then piloted around the country in a number of ‘vanguard’ areas.

NHS long term plan
This ten-year plan, published in January 2019, sets out the NHS’s priorities for health care as well as setting out how a £20.5 billion budget settlement for the NHS will be spent. The plan built on the vision set out in the NHS five year forward view. It outlines a range of priorities including improving out-of-hospital care, investment in primary and community care, improving outcomes for a range of conditions and establishing integrated care systems in all parts of the country.

O

Organisational culture
Organisational culture refers to ‘the way that things are done in an organisation, the unwritten rules that influence individual and group behaviour and attitudes. Factors that can influence organisational culture include: the organisation’s structure, the system and processes by which work is carried out, the behaviour and attitudes of employees, the organisation’s values and traditions, and the management and leadership styles adopted.’
(Chartered Management Institute 2015)

Out-of-area placement (OAP)
An OAP occurs when a person is assessed as requiring inpatient care or treatment and is admitted to a unit that is not part of the usual local network of services. Out-of-area placements are a particular issue in the care of people with acute mental health problems, learning disability and autism. OAPs can harm patients and set back recovery, and the government has set a target to eliminate inappropriate use of OAPs by 2020/21.

P

Patient and public involvement
There are a lot of terms that are often used interchangeably to describe aspects of this area of work including involvement, participation and engagement. It is useful to differentiate between the involvement of individuals and the involvement of patients and the public more widely. Individual involvement refers to people being actively involved in decisions and having greater control over their own health and care, or the care of others if they are a carer. Patient and public involvement is often used to refer to activities that involve people at a collective level, such as in the design, planning and delivery of health and care services.  
See also patient experience.

Patient experience
Patient experience refers to what the process of receiving care feels like for the patient, their family and carers. It is a key element of quality, alongside clinical effectiveness and safety. Patient experience is understood by asking patients how they found the care they received, listening to what people need and then designing services around those needs. 
See also public and patient involvement.

Population health
Population health is an approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires health and care services to work with communities and partner agencies.

Population health management
Population health management refers to the ways of bringing together health-related data to identify groups of patients or specific population groups at risk of ill health that health services may then prioritise. For example, data may be used to identify groups of people who are frequent users of accident and emergency departments. This way of using data is also sometimes called population segmentation.

Population segmentation
See population health management.

Primary care
Primary care services are based in the community and provide the first point of contact in the health care system, acting as the ‘front door’ of the NHS. Primary care includes general practice, community pharmacy, dental services and eye health services.
(Adapted from NHS England 2020a)

Primary care networks (PCNs)
PCNs form a key building block of the NHS long-term plan. They bring general practices together in geographical networks to work at scale and typically cover populations of approximately 30,000 to 50,000 people. PCNs are linked to a new GP contract which makes new funding available for practices in exchange for delivering a wide range of services.

Productivity
Productivity is a measure of what a health care system produces, based on how its outputs change compared to its inputs. In health care, ‘outputs’ can relate to the quantity and quality of NHS care. And ‘inputs’ can relate to the staff, medicines and equipment that produce this care. Productivity increases if the growth of outputs is greater than the growth in inputs.

Professional regulation
The system of professional regulation in the United Kingdom is designed to protect the public by ensuring that if a patient is seen by a health care professional, such as a doctor or a midwife, the patient can trust that the care they receive will meet certain minimum standards of safety and quality.

R

Reablement
Reablement is one of a range of short-term services for people whose health has deteriorated and/or who need support to relearn skills to keep them safe and independent at home. It is categorised as a type of intermediate care, most commonly delivered by social care staff. These services can be provided to anyone who would benefit but often in practice it is arranged as someone leaves hospital, with the aim of preventing them being readmitted.

Resource departmental expenditure limit (RDEL) 
See departmental expenditure limit (DEL).

S

Social determinants of health
The social determinants of health (sometimes referred to as the wider determinants of health) are the social, economic, environmental, political and cultural factors that shape the conditions in which people are born, grow, live, work and age. The social determinants (for example, education, income and housing) are the biggest influence on people’s health outcomes and drive health inequalities – the unfair and avoidable differences in health status seen within and between countries.
(Adapted from World Health Organization 2020)

Social prescribing
Sometimes referred to as community referral, this is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of non-clinical services, support or activities, often provided by local voluntary and community organisations such as volunteering, gardening and cookery. Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

Strategic commissioning
Strategic commissioning refers to commissioning across a wider area (usually at a system level, rather than across a single clinical commissioning group area), aimed at delivering improvements over the longer term. The focus is on understanding the needs of the local population, monitoring system performance and designing services to meet local needs, rather than on activities such as procurement or contract management.
(NHS Clinical Commissioners 2017)

Summary Care Records (SCRs)
Summary Care Records are an electronic record of a subset of important information taken from patients’ GP medical records. NHS Digital run a national information service making these available to authorised staff involved in a patient’s direct care. A patient’s SCR includes details about their medication and allergies, as well as key personal information. Patients with their GPs can add information, such as frailty, to the SCR. NHS Digital has announced that functions of the SCR will become part of Local Health and Care Records (LHCRs) by 2024.
See also: Local Health and Care Records (LHCRs)

Sustainability and transformation partnerships (STPs)
Formerly known as sustainability and transformation plans, these partnerships were created in 2016 to bring together local NHS organisations, local authorities and other partners to produce local plans for the future of health and care services. There were originally 44 STPs covering England and these areas are sometimes referred to as ‘footprints’. STPs are now evolving into integrated care systems (ICSs).
See also: integrated care systems (ICSs)

Sustainability and transformation plans
See sustainability and transformation partnerships.

U

User engagement
See patient and public involvement.

Urgent and emergency care services
These services provide medical services for individuals who require urgent attention for illness or injury. Urgent care services treat accidents and illnesses that require urgent attention but are not life threatening. In the NHS, urgent and emergency care includes services such as accident and emergency departments, ambulance services, urgent treatment centres and NHS 111.

Urgent treatment centres (UTCs)
UTCs are for patients who need to be treated urgently but whose condition is not life-threatening. They are GP-led, open at least 12 hours a day, every day, offer appointments that can be booked through 111 or through a GP referral, and are equipped to diagnose and deal with many of the most common ailments people attend accident and emergency for. Under current plans the term ‘urgent treatment centres’ will replace existing terms for similar services including urgent care centres, minor injury units and walk-in centres.
(Based on NHS England 2020)