Health and care defined
What’s the difference between an integrated care board and an integrated care 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 jargon buster aims to demystify and clarify some of the concepts and terms that are frequently used in health and care policy. We will be updating it on a regular basis to reflect changes in the health and care system and we’d like to hear from you on what needs defining.
A to D
Accountable care organisation (ACO)
See integrated care provider.
Alternative Provider Medical Services (APMS) contract
One of three different types of GP contracts, the APMS contract offers greater flexibility than the other types, allowing contracts with non-GP organisations (such as private companies or third sector providers) to provide primary care services. APMS contracts can also be used to commission other types of primary care service, beyond that of ‘core’ general practice. For example, a social enterprise could be contracted to provide primary health care to people who are homeless or asylum seekers.
See also: General Medical Services (GMS) contract. See also Personal Medical Services (PMS) contract.
Currently, there is no universally agreed definition of an anchor institution, but the Health Foundation has defined such institutions as ‘large, public sector organisations that are unlikely to relocate and have a significant stake in a geographical area… they have sizable assets that can be used to support local community wealth building and development through procurement and spending power, workforce and training and buildings and land.
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.
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)
See capital spending.
Also known as capital expenditure, this is financial investment to purchase, maintain or improve assets such as NHS buildings, equipment and technology.
Capped expenditure process
Where NHS England and NHS Improvement, as national bodies, step in to limit spending in areas of the country that are at risk of breaching their annual financial targets.
Care Quality Commission (CQC)
The role of the CQC is to register care providers and monitor, inspect and rate their services in order to protect users. CQC publishes independent views on major quality issues in health and social care.
Clinical commissioning group (CCG)
Established by the Health and Social Care Act 2012, CCGs are responsible for commissioning most NHS services for patients within their local area until July 2022, when this function will be taken over by integrated care systems (ICSs). They are membership bodies made up of GP practices, and their governing bodies include GPs, other health professionals and patient representatives.
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)
The process by which health and care services are planned, purchased and monitored. Most NHS services are commissioned by integrated care boards, while publicly funded social care and most public health services are commissioned by local authorities.
See also: 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.
In the specific context of health and care services, the term ‘community’ can be used in different ways: to describe a group of people with similar health needs (for example, a group of people with diabetes), or a group receiving similar health services (for example, a group of patients receiving the same diabetes intervention), or a group of people who shape or provide services.
Community-based participatory research
A research methodology where members of a community are recruited and trained to carry out research into the community’s needs and to develop possible solutions.
See also: Patient and public involvement.
An approach that gives communities greater control over the commissioning of services they receive – both health and care services and other services that affect their health. It can mean community involvement in, or leadership of, any or all stages of service planning, from identifying needs to implementing and evaluating services.
See also: Commissioning. See also: Patient and public involvement.
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.
See social prescribing.
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.
The distribution and allocation of leadership power to wherever expertise, capability and motivation sit within organisations. Collective leadership creates the culture in which high-quality, compassionate care can be delivered.
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 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.
Critical care units (CCU)
Specialist hospital wards that treat patients who are seriously ill and need constant monitoring. These units are staffed by specially trained health care professionals who deliver intensive levels of care and treatment.
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 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.
Since 2015, everyone receiving social care support in the community from their local authority must receive a personal budget setting out the money allocated to meet their needs. People can choose how to receive their personal budget. One option is a direct payment – money paid to the person to organise and pay for their own care and support themselves (often by hiring someone to work for them as a personal assistant who carries out a wide range of support tasks for them in the home, at leisure or in work).
See also: Personal budget. See also: Personal health budget.
Disability-free life expectancy
An estimate of the number of years lived without a long-lasting physical or mental health condition that limits daily activities.
See also: Healthy Life Expectancy.
Disabled Facilities Grant
This government benefit helps homeowners on low incomes to fund essential adaptations like level-access showers, stairlifts and ramps. They are not the only source of adaptations; local authorities and clinical commissioning groups provide smaller adaptations and loaned equipment through the Integrated Community Equipment Service.
E to H
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.
Nationally agreed primary medical services other than essential services, additional services or out-of-hours services that holders of almost all GP contracts can provide if they choose to opt in. Services specified for 2020/21 include some vaccination programmes and a health check scheme for people with learning disabilities. Primary care networks have also been established via an enhanced service agreement.
See also: Essential Services. See also: Primary care networks. See also: Out of hours services.
These are mandatory services for a general practice to deliver to registered patients and temporary residents in its practice area. They include the identification and management of illnesses, providing health advice and referral to other services. GPs are required to provide their essential services during core hours, which are 8.00am–6.30pm Monday to Friday, excluding bank holidays.
See also: Enhanced Services. See also: Out of hours services.
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.
Financial special measures
An intensive process put in place by NHS England and NHS Improvement to help financially challenged organisations improve their financial performance. Trusts entering special measures for financial reasons are supported and held to account to deliver rapid, accelerated and sustainable financial recovery – including the development of a financial recovery plan and improved financial control.
(NHS England, 2021)
General Medical Services (GMS) contract
One of three different types of GP contracts, the GMS contract is the national standard GP contract and currently the majority of GP practices use this type of contract. This contract is negotiated nationally every year between NHS England and the General Practice Committee of the British Medical Association (BMA), the trade union representative of GPs in England. It is then used by either NHS England and/or CCGs (depending on delegated powers) to contract local general practices in an area.
See also: Alternative Provider Medical Services (APMS) contract. See also: Personal Medical Services (PMS) contract.
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.
See corporate governance and clinical governance.
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.
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 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)
Health technology assessment (HTA)
An evaluation of the costs and benefits of a health intervention, including medicines. In England, the National Institute for Health and Care Excellence (NICE) conducts an HTA on the basis of clinical and cost effectiveness to determine whether it should be provided by the NHS.
Healthy life expectancy
An estimate of the number of years lived in ‘very good’ or ’good’ general health, based on how individuals perceive their general health.
See also: Disability-free life expectancy.
I to L
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 integrated care systems (ICSs) and primary care networks (PCNs).
Integrated care boards (ICBs)
Since 1 July 2022, integrated care board (ICBs) have taken on the NHS planning functions previously held by clinical commissioning groups (CCGs) and are likely to absorb some planning roles from NHS England. In consultation with local partners, the ICBs will produce a five-year plan (updated annually) for how NHS services will be delivered to meet local needs. ICBs will also contract with providers to deliver NHS services and will be able to delegate some funding at place level to support joint planning of some NHS and council-led services.
Integrated care partnerships (ICPs)
Integrated care partnerships will operate as a statutory committee, bringing together the NHS and local authorities as equal partners to focus more widely on health, public health and social care. ICPs will include representatives from the ICB, the local authorities and other partners such as NHS providers, public health, social care, housing services and voluntary, community and social enterprise (VCSE) organisations. They will be responsible for developing an integrated care strategy that sets out how the wider health needs of the local population will be met.
Integrated care systems (ICSs)
Integrated care systems are geographically-based partnerships that bring together providers and commissioners of NHS services with local authorities and other local partners to plan, co-ordinate and commission health and care services. All parts of England are now covered by 1 of 42 ICSs. The statutory ICS came into force on 1 July 2022 and is made up of two key bodies – an integrated care board (ICB) and integrated care partnership (ICP). ICSs are underpinned by joint working at 'place' level through 'place-based partnerships' involving NHS organisations, local authorities, voluntary and community sector organisations and local communities across a smaller footprint than an ICS, often based on the area covered by a local authority.
Integration Transformation Fund
See Better Care Fund.
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.
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.
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.
Locally commissioned services
Locally set services that general practices can opt in to, in addition to the essential services that all practices are required to provide. Unlike other GP services, these might also be commissioned by non-NHS organisations such as local authority public health departments. Examples include services for people who are sleeping rough or mental health support programmes.
See also Commissioning.
In adult social care, this term is used to describe any ongoing service or support provided by a local authority to a person to maintain quality of life. It is provided after a formal assessment and is subject to regular review.
M to P
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.
In relation to integrated care systems, this refers to a small area, typically covering a population of 30–50,000 people where groups of GPs and community-based services work together to deliver co-ordinated, proactive care and support, particularly for groups and individuals with the most complex needs. Primary care networks and multidisciplinary community teams form at this level.
See also: Primary care networks. See also: integrated care systems. See also: place.
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 England and NHS Improvement
The bodies responsible for providing national direction on service improvement and transformation, governance and accountability, standards of best practice, and quality of data and information. NHS England and NHS Improvement came together in 2019 to act as a single organisation (maintaining separate boards). The aim of the merger is to work more effectively with commissioners and providers, making more efficient use of resources, and removing duplication. In February 2021, the Department of Health and Social Care set out proposals to formalise the merger, recognising it as a single organisation and placing it on a statutory footing.
See also: Regional NHS England and NHS Improvement teams
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.
Nursing homes are care home facilities that have registered nurses on site at all times.
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.
General practice services that are provided outside core working hours. A practice is assumed to provide these by default but can opt out. Where a practice opts out, as most practices do, commissioners have the responsibility for contracting a replacement service to cover the general practice area population.
See also: Essential Services. See also: Enhanced Services
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 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.
Money that is allocated to an individual by a local council to pay for care or support to meet their assessed needs. The money comes solely from adult social care and not through NHS funding. Personal budgets can be taken as a direct payment, or left to the council to arrange services (sometimes known as a managed budget) – or a combination of the two.
(Adapted from Think Local Act Personal, 2021)
See also: Direct payment. See also: Personal health budget.
Personal health budget
A personal health budget is an amount of money to support an individual’s health and wellbeing needs, which is planned and agreed between them (or someone who represents them), and their local NHS team…allows you to manage your healthcare and support such as treatments, equipment and personal care, in a way that suits you. It works in a similar way to personal budgets, which allow people to manage and pay for their social care needs.
(Adapted from NHS, 2020)
See also: Direct payment, See also: Personal budget.
Personal Medical Services (PMS) contract
One of three different types of GP contracts, the PMS contract is a type of core GP contract that is negotiated and agreed locally by clinical commissioning groups or NHS England with general practices. This contract offers commissioners an alternative route with more flexibility to tailor requirements to local need while also keeping within national guidelines and legislation. This contract is currently being phased out, but in 2018/19, 26 per cent of practices held a PMS contract.
See also: General Medical Services (GMS) contract. See also: and Alternative Provider Medical Services (APMS) contract.
In relation to integrated care systems, this refers to a town or district within an integrated care system, often (but not always) within the same boundaries of a council or borough, typically covering a population of 250–500,000 people. It is envisaged that it will be at this level that the majority of changes to clinical services will be designed and delivered, and where population health management will be used to target interventions to particular groups. At this level, providers may also work together to join up their services through alliances or more formal contractual arrangements.
See also: Neighbourhood. See also: Integrated care systems. See also: Population health management.
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.
See population health management.
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 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.
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.
Provider collaboratives are partnerships that bring together two or more NHS trusts (public providers of NHS services including hospitals and mental health services) to work together at scale to benefit their populations. From July 2022 all NHS trusts providing acute and mental health services will need to join a provider collaborative. NHS community and ambulance trusts and non-NHS providers, such as voluntary, community and social enterprise (VCSE) sector organisations or independent providers, will be offered the opportunity to take part where this will benefit patients and makes sense for the providers. Individual providers may be involved in more than one collaborative.
In a workplace context, a belief that you will not be punished or humiliated for speaking up with ideas, questions or concerns or making mistakes. This involves feeling able to take risks and being vulnerable in front of others and it provides a space in that differences will be valued and welcomed with curiosity. Trust and support are likely to characterise the interpersonal relationships involved.
Psychologically informed environment
This refers to a service, usually for people with mental health needs or experiencing homelessness, provided in a highly managed context such as a hospital or hostel that has been designed to respond to people’s emotional and psychological needs.]
The Faculty of Public Health defines public health as ‘the science and art of preventing disease, prolonging life and promoting health and wellbeing, through the organised efforts of society.’ Public health professionals are employed in local government, the NHS, businesses and at national level. They work to protect and improve the public’s health with a focus on reducing health inequalities, prevention of ill health, influencing wider policy decisions that have health impacts, and protecting the public from communicable disease outbreaks and other large-scale health threats.
R to U
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.
An approach taken by professionals in various fields to learn from their experiences. It means considering your thoughts and actions in a particular situation, understanding what happened and why, and what you might learn to inform your future practice.
Regional NHS England and NHS Improvement teams
These teams are responsible for the quality, financial and operational performance of all NHS organisations in their region. Increasingly, they are working with local systems (such as integrated care systems) to oversee performance, support their development and make interventions when necessary.
See NHS England and NHS Improvement.
Resource departmental expenditure limit (RDEL)
See departmental expenditure limit (DEL).
Salaried general practitioners (GPs)
GPs who work as salaried employees of a practice without owning a share in the overall business (so they are not GP partners).
Short-term care to maximise independence (ST-MAX)
In a social care setting, short-term care is an episode of time-limited support – for example, reablement – intended to reduce or eliminate the need for ongoing support.
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)
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.
Specialist health services
Services that are fully dedicated to certain groups of people, such as people who are experiencing homelessness or sleeping rough.
See also: Targeted health services.
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)
See Asset-based approach.
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.
In relation to integrated care systems (ICS), this refers to the level of the ICS, typically covering a population of 1–3 million people. Key functions at the system level include setting and leading overall strategy, managing collective resources and performance, identifying and sharing best practice to reduce unwarranted variations in care, and leading changes that benefit from working at a larger scale such as digital, estates and workforce transformation.
See Integrated care systems
System control totals
The annual spending limit for an integrated care system (ICS) [link]. It is the total of the spending limit of all NHS organisations in the system’s area and is intended to encourage collective financial management. ICSs can change individual organisation limits along as any increase is offset by a decrease in spending elsewhere in the ICS.
Targeted health services
Mainstream health services with a dedicated/targeted service or services for certain groups of people, such as those who are experiencing homelessness – for example, a walk-in clinic or attached sessions of a nurse to an outreach team.
See Specialist health services
The simultaneous presence of physical ill health, mental ill health and drug or alcohol misuse. The term is used in some health care settings; in the homelessness sector, this combination is more likely to be referred to as ‘high and complex needs’.
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)
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