Glossary of Health and Care Terms

Glossary of health and care terms

May 2021

This glossary provides a summary of organisations and general terms used within the health and care sector in Wales. The glossary provides some of the most common words and phrases used.

0 - 9 Acute Medical Unit (AMU) 111 An AMU is the first point of entry for patients referred to hospital as The NHS Wales 111 service is a free- emergencies by their GP and those to-call, non-emergency medical requiring admission from the helpline, available 24 hours a day, to Emergency Department. be used for health information, advice and access to urgent care. The service is currently operational in the Aneurin Add to Your Life Bevan University Health Board (UHB), Cwm Taf Morgannwg UHB, Hywel Dda ‘Add to Your Life’ is an online health- UHB, Powys Teaching Health Board check, which provides assessment (THB) and Swansea Bay UHB areas. It and community-based support to is anticipated that 111 will be rolled out enable over 50s in Wales to assess across Wales by the end of 2021. and improve their own health.

A Additional Learning Needs and Education Tribunal Act 2018 A Regional Collaboration for Health (ALNET) (ARCH) The ALNET Act 2018 establishes a ARCH is a regional partnership made statutory framework for supporting up of Swansea University, Swansea children and young people with Bay UHB and Hywel Dda UHB. The additional learning needs (ALN) from ARCH partners work to improve the birth; whilst they are in school; and, if health, wealth and wellbeing of the they are over compulsory school age, people of South West Wales. while they are in further education. The Act, and the new framework it creates, replaces the separate legislation and Acute Care arrangements in Wales for special educational needs (SEN) up to age 16 Acute care refers to the medical and and Learning Difficulties and/or surgical treatment provided by a Disabilities (LDD) post-16. hospital.

Admission Rates Agenda for Change (AfC) Admission rates are the number of AfC is the current grading and pay cases of a specific illness or disease system for all NHS staff, with the that are treated in hospitals, relative to exception of doctors, dentists and the population of a geographical area. some senior managers.

Advance Care Planning All Wales Medicines Strategy Group (AWMSG) Advance care planning is a voluntary process of discussion about future The AWMSG was established in 2002. care between an individual and their The group’s main function is to advise care providers, irrespective of the Welsh Government on future discipline. It is recommended, with the developments in healthcare and to individual’s agreement, that this assist in its strategic planning. The discussion is documented, regularly Group also advises the Welsh reviewed, updated, and communicated Government on the development and to key people involved in their care. implementation of a prescribing strategy for Wales and develops timely, independent and authoritative Advance Decision advice on new medicines. The Mental Capacity Act 2005 gives people in England and Wales a Allied Health Professionals (AHPs) statutory right to refuse treatment, through an ‘advance decision’. An AHPs is an umbrella term for advance decision allows a person to therapists, chiropodists, dietitians, state what forms of treatment they occupational therapists, orthoptists, would or would not like should they paramedics, physiotherapists, become unable to decide for prosthetists, psychologists, themselves in the future. It is a binding psychotherapists, radiographers, and decision. speech and language therapists among others.

Advanced Nurse Practitioner (ANP) Annual Quality Statement (AQS) The ANP’s role includes assessing the patient, making differential diagnosis All Health Boards and NHS Trusts and ordering relevant investigations, publish an AQS, which is first and providing treatment (including foremost for public information prescribing) and admitting/discharging purposes. It provides an opportunity patients. for the organisation to let its local population know how it is doing to ensure all its services are meeting Advocacy local need and reaching high standards. An AQS is also published Advocacy supports and enables by NHS Wales. people who have difficulty representing their interests to exercise their rights, express their views and make informed choices about their care.

Arts for health and wellbeing Atlas of Variation Arts for health and wellbeing refers to An atlas of variation is a tool used to the growing body of evidence that identify where opportunities to address highlights the positive impacts that unwarranted variation exist by engagement with the arts can have on revealing the possible over-use and a person’s physical and mental under-use of different aspects of wellbeing. Examples include music, healthcare. dance, visual arts and writing groups in a variety of settings. Audit Wales Asymptomatic Audit Wales is the trademark of two legal entities: the Auditor General for Showing no symptoms of disease. A Wales and the Wales Audit Office. person infected with a virus can be Each has its own particular powers asymptomatic because they are in an and duties: The Auditor General audits early stage of infection and symptoms and reports on Welsh public bodies. have not yet developed (“pre- The Wales Audit Office provides staff symptomatic”), or they may not and other resources for the Auditor develop any symptoms at all during General’s work, and monitors and their infection. advises the Auditor General. Audit Wales’ aim is to ensure that public money is being managed wisely and Assistive Technology and Telecare that public bodies in Wales understand how to improve outcomes. Assistive technology and telecare refers to any product or service designed to enable patients to achieve greater independence and enhance their quality of life. The devices can B include a combination of alarms, door Board Members entry systems, community alarms, personal communication equipment, The Board is the corporate, decision- walking aids, sensors and other making body of an NHS organisation. equipment placed in a person’s home. Its role is to set the strategic direction; establish and uphold the governance and accountability framework, Association of Directors of Social including the values and standards of Services (ADSS) Cymru behaviour; and to ensure delivery of its aims and objectives through effective As the national leadership organisation challenge and scrutiny of performance for social services in Wales, the role of across all areas of activity. ADSS Cymru is to represent the Membership of the Board includes the collective, authoritative voice of Chair, Vice Chair, officer members Directors of Social Services, Heads of (known as Executive Directors), non- Adult Services, Children’s Services officer members (collectively with the and Business Services, along with Chair and Vice Chair known as professionals who support vulnerable Independent Members) and Associate children, adults and their families. (non-voting) members.

Board Secretary Care Pathway As part of the NHS reforms in 2009, To improve the person-centred nature Health Boards and NHS Trusts are of care, commissioners and service required to have Board Secretaries. planners try to understand how The Board Secretary acts as the patients experience their care from guardian of good governance. The role prevention to diagnosis and includes providing advice to the Board assessment, to treatment and where on all aspects of governance; appropriate, to palliative care. This facilitating the effective conduct of normally involves mapping the journey Health Board business through its and the experience using a range of meetings, advisory groups and techniques with patients, clinicians, committees; ensuring Board members and managers. This journey is have the right information to enable described as a care pathway. Service them to make informed decisions and planners aim to improve the flow of monitor the organisation’s compliance patients along this pathway by with the law, Standing Orders and the reducing inefficiencies and improving governance and accountability reliability. framework set by the Welsh Government. Care Plans (social care / long term conditions)

C Care plans bring together all the information about the individual into a Caldicott Guardians single, overarching care plan produced by health and social services. This can A Caldicott Guardian is a senior be a written document or an electronic person responsible for protecting the one (e.g. as an electronic care plan or confidentiality of patient and service- recorded in the patient’s notes), and is user information and enabling accessible to the patient and all carers, appropriate information-sharing. The including emergency / urgent care Guardian plays a key role in ensuring services. Care plans should focus on that the NHS, councils with social the aspirations of the patient. services responsibilities and partner organisations comply with the highest practicable standards for handling patient information. Care Worker / Care Support Worker A care worker, or care support worker, is someone who works with carers or Care Inspectorate Wales (CIW) those with care needs. CIW is the regulator for social care and social services in Wales, from child minders and nurseries to homes for Carer older people. It is responsible for A carer is anyone who cares for a inspecting social care and social friend or family member who, due to services to ensure they are safe for the illness, disability, mental health people who need them. problems or addiction, requires external support in their daily lives. Often referred to as unpaid carers.

Case fatality rate (CFR) Chief Medical Officer (CMO) Wales An estimate of the risk of mortality CMO is the most senior government from a contagious disease. The CFR is adviser on matters relating to health. calculated by dividing the number of There are four CMOs in the UK who deaths caused by a disease by the are appointed to advise their number of cases of that disease over a respective Governments. given time period. The CFR is time and location-dependent, and many different factors can influence the Chief Nursing Officer (CNO) Wales CFR, such as speed of diagnosis of cases, health system capacity, age, CNO is the head of the nursing and and other demographic characteristics, midwifery professions in Wales and as among others. such sets the professional agenda and future direction for these professions.

Case Management Chief Pharmaceutical Officer (CPO) Case management is the process of Wales planning, co-ordinating, managing and reviewing the care of an individual. CPO is an independent adviser to the Welsh Government on all matters related to medicines, prescribing and Cavendish Coalition pharmacy practice. The Cavendish Coalition is a group of health and social care organisations Chief Scientific Adviser for Wales who act as a shared voice which for Health (CSAWH) influences on post-EU referendum matters affecting the health and social The CSAWH is the professional lead care workforce. The Welsh NHS for healthcare scientists in NHS Wales. Confederation is a member. They advise the Government and ministers on matters relating to health science and are the sponsor for Chief Executive national programmes such as imaging, pathology, genomics, advanced The NHS Chief Executive is the therapeutic medicinal products and organisation’s accountable officer and healthcare science. reports to their Board.

Chief Therapies (Allied Health Chief Dental Officer (CDO) Professions) Adviser (CTA) The CDO leads the dental profession The CTA provides professional advice in Wales and is responsible for relating to 13 allied health professions. improving oral health; the quality of These include art therapy; dental healthcare services, patient occupational therapy; dietetics; drama outcomes and reducing inequalities; therapy; music therapy; paramedics; oral health regulation, education, orthotics; orthoptics; physiotherapy; training, standards and performance; podiatry; prosthetics; psychology and and developing policy and legislation. speech and language therapy.

Chief Optometric Advisor (COA) Clinical Audit The COA provides independent A clinical audit is the systematic, professional advice on eye health and critical analysis of the quality of patient optometric services. care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome Child and Adolescent Mental Health and quality of life for the patient. Services (CAMHS) CAMHS are NHS-provided services Clinical Engagement that assess and treat children and young people with mental or emotional Clinical engagement is the difficulties. involvement of clinicians in decision- making about patient care. As the public face of the organisation and a Children’s Commissioner for Wales group with unique insight into patient needs, clinicians’ input is essential in The Children’s Commissioner is the finding solutions to clinical problems national voice for children and young and guiding change. Service change people in Wales. Its role is to influence imposed without clinical engagement Welsh Government on policies that is likely to be ineffective. affect children’s services in NHS Wales and stand up for the rights of children and young people. Clinical Governance Clinical governance can be defined as Choose Pharmacy a framework through which NHS organisations are accountable for Choose Pharmacy enables accredited continuously improving the quality of Community Pharmacies and their services and safeguarding high Community Pharmacists to provide standards of care by creating an consultation and treatment for a environment in which excellence in defined list of 26 common ailments clinical care will flourish. and access to an electronic Discharge Advice Letter generated by the National Welsh Clinical Portal. Clinical Networks Clinical Networks are groups of health Chronic Disease professionals from primary, secondary and tertiary care. Clinical Networks are Chronic disease is a disease, condition not limited by existing professional and or health problem which persists over Local Health Board boundaries and a long period of time. Examples seek to ensure the equitable provision include arthritis, diabetes, of high quality and clinically effective hypertension, and chronic obstructive services. pulmonary disease (COPD).

Clinical Pathways Community transmission/spread Clinical pathways are standardised, Infections identified in a given evidence-based multi-disciplinary geographic area without a history of management plans that identify an travel elsewhere and no connection to appropriate sequence of clinical a known case. interventions, timeframes, milestones, and expected outcomes for a homogenous patient group. Community Care Services Community care services are locally- Clinicians based health or social care services provided to patients in and around A clinician is a healthcare professional their home. that works as a primary care giver in a hospital, skilled nursing facility, clinic, or patients’ home. This includes social Community Health Councils (CHCs) workers, dieticians, physiotherapists, nutritionists, occupational therapists, CHCs are independent bodies, set up podiatrists, and chiropractors, among by law, who listen to what individuals others. and the community have to say about health services with regard to quality, quantity, access to and Cluster Networks appropriateness of the services provided. CHCs are due to be A Cluster Network is a grouping of replaced with a new all-Wales Citizen primary care services locally Voice Body that will represent the determined by an individual Health interests of people across health and Board. GPs in the clusters play a key social care, as outlined in the Health role in supporting the ongoing work of and Social Care (Quality and a Locality Network. Locality Network is Engagement) (Wales) Act June 2020. a term used to describe this collaborative approach. There are 64 Clusters that have been identified Community Mental Health Team across Wales. Community mental health teams are a

group of people from different health Commissioning and social care professions who work in the community to help people Commissioning is the purchasing of recover from, and cope with, mental NHS services to meet the health health conditions. needs of a local population. Local Health Boards act as commissioners and the providers of NHS services in Community Pharmacy Wales Wales. In England, the market model requires the separation of Community Pharmacy Wales responsibility for the commissioning represents the 700 plus pharmacy and provision of services. owners in Wales. They are responsible for liaising with the Welsh Government

and for negotiating the contractual terms for the provision of the NHS community pharmacy services.

Community Resource Teams Co-production (CRTs) Co-production is an approach to public CRTs are part of the wider strategic services which involves citizens, programme to deliver better integrated communities, and the professionals care to people closer to their homes who support them pooling their and in their communities. CRT expertise to design and deliver more services support people with multiple effective and sustainable services and health and social care needs who are an improved experience for all at risk of hospitalisation, with the aim involved. In co-production, citizens and of improving or restoring the quality of patients have rights and life and confidence for people with responsibilities as equal partners. complex health and social care needs, and to reduce avoidable admissions to hospital. Core Principles The NHS Wales Core Principles Co-morbidity support good governance and help ensure the achievement of the highest Co-morbidity is the simultaneous possible quality in all that the NHS in presence of two or more health Wales does and are rooted in the conditions or diseases in the same prudent healthcare agenda. patient.

Coronavirus disease Contact tracing Coronavirus disease (COVID-19) is an The process of identifying, assessing, infectious disease caused by a newly and managing people who have been discovered coronavirus. The COVID- exposed to a contagious disease to 19 virus spreads primarily through prevent onward transmission. droplets of saliva or discharge from the nose when an infected person coughs or sneezes. Continuing Healthcare NHS continuing healthcare is health Critical Care and social care outside of hospital that is arranged and funded by the NHS. It Critical care is a specialty which is available for people who need provides support for patients with ongoing healthcare and is sometimes acute life-threatening injuries and called fully funded NHS care. illnesses.

D Discharge Delayed Transfers of Care Discharge from hospital is the point at A delayed transfer of care occurs which the patient leaves the hospital when a patient is ready to return home and either returns home or is or transfer to another form of care but transferred to another facility such as is still occupying a hospital bed one for rehabilitation or to a nursing because an appropriate setting to be home. transferred to, such as a care home, is not available. Domiciliary Care Worker Digital Health and Care Wales A domiciliary care worker is someone (DHCW) who visits a person’s home to help them with general household tasks, DHCW is a new Special Health personal care or any other activity that Authority created in April 2021, to take allows them to maintain their forward the digital transformation independence and quality of life at needed for better health and care in home. Wales, making services more accessible and sustainable while supporting personal health and wellbeing. Key responsibilities include Duty of Candour mobilising digital transformation and The Duty of Candour makes it a ensuring high qualities of care; statutory obligation for all NHS Wales expanding access to digital health and organisations to be open and care record; delivering high-quality transparent with patients, their digital services and enabling big data families, and their carers about the analysis for better outcomes. causes of any unexpected harm that results from a person’s treatment. Digital Health Ecosystem Wales (DHEW) E DHEW brings together industry, clinicians, policy makers, academics, Early Intervention innovators, and funders to create an Early intervention services provide environment of digital innovation in treatment and support for people who Welsh healthcare. are experiencing early symptoms of an illness. The aim is to provide low-level support to prevent the person Direct Payments (Social Care) developing more acute needs at a later Direct payments are cash payments stage. that Local Authorities (LA) can make to individuals so that they can organise their own services to meet their social care needs. Direct payments offer an alternative to the LA arranging community care services on their behalf.

Elective Care Euratom Elective care is planned, pre-arranged, Euratom refers to the European non-emergency care, including Atomic Energy Community (EAEC). scheduled operations. It is provided by The EAEC helps regulate and medical and surgical specialists in a safeguard access to radioisotopes hospital or another secondary care required for cancer treatments. setting. It can also be known as

Planned Care. It focuses on particular types of high-throughput surgical Executive Peer Groups procedures such as knee Executive Peer Groups bring together replacements, arthroscopies and Director-level professionals from NHS cataract operations. organisations to deliver an all-Wales work programme. These include Directors of Nursing, Directors of Electronic Patient Record (EPR) Planning, Directors of Finance and An EPR is the systematised collection Directors of Workforce & of patient and population Organisational Development. electronically-stored health information in a digital format. These records can be shared across different health and F care settings. First Minister

The First Minister is a Member of the Emergency Assessment Unit (EAU) Senedd appointed by the Monarch, At an EAU, a patient is assessed by a following nomination by the Senedd member of either the medical, surgical, Cymru. The First Minister is the head or orthopaedic teams. If required, a of the Welsh Government, who then patient could be transferred to another appoints the other Welsh Ministers. ward.

Fitness to Practice (Social Care End of Life Care Wales) End of Life Care is used to cover both A Fitness to Practice hearing is a advanced care and palliative care in formal meeting of a panel where a different settings such as care homes, social care worker’s capacity and hospitals, primary care, and hospices ability to deliver their professional for adults with advanced, progressive responsibilities is considered. illnesses.

Frailty Units Epidemic Frailty units, led by a geriatric medical An increase, often sudden, in the team, are focused on the needs of number of cases of a disease above older patients with frailty conditions, what is normally expected in that including dementia. population in that area.

Freedom of Information (FOI) GPOne The Freedom of Information Act 2000 The GPOne website is a professional is an Act of Parliament of the United website for GPs working in Wales. It is Kingdom that creates a public “right of intended to act as an effective two-way access” to information held by public communication portal and resource authorities, including the NHS. point providing timely, reliable, and relevant information and to share constructive comments of current Future Generations Commissioner issues and initiatives in General Practice. The role of the Future Generations Commissioner is to highlight the key challenges, and barriers to addressing GP Out of Hours Services them, that face future generations in Wales. The Commissioner also has GP Out of Hours Services provide responsibility for challenging and healthcare for urgent medical supporting public bodies in Wales to problems outside normal surgery consider the long-term impacts of their hours. Services are available for decisions. urgent medical situations but not for emergencies.

G Green Health General Medical Council (GMC) Green health care is the incorporation The GMC works to protect, promote, of environmentally friendly practices and maintain the health and safety of into healthcare delivery. the public by ensuring proper standards in the practice of medicine. The GMC regional office for Wales is located in Cardiff. H Half Life General Medical Services Contract The half life of a drug is defined as the (GMS) time it takes for the concentration of the drug in the plasma or the total The GMS contract is the contract amount in the body to be reduced by between general practices and the 50%. In other words, after one half-life, NHS for delivering primary care the concentration of the drug will be services to local communities. It is a half of the starting dose. nationally negotiated contract that sets out the core range of services provided by family doctors (GPs), their staff and a national tariff.

Health and Care Standards Health Education and Improvement Wales (HEIW) The Health and Care Standards set out the Welsh Government’s common HEIW was established on 1st October framework to support the NHS and 2018. It is a special health authority partner organisations in providing within NHS Wales created by bringing effective, timely and quality services together three key organisations for across all healthcare settings. They set health - the Wales Deanery, NHS out what the people of Wales can Wales’ Workforce Education and expect when they access health Development Services (WEDS), and services and what part they can play in the Wales Centre for Pharmacy promoting their own health and Professional Education (WCPPE). wellbeing. They set out expectations for services and organisations and Sitting alongside Health Boards, NHS whether they provide or commission Trusts and Digital Health and Care services for their local citizens. Wales, HEIW has a leading role in the education, training, development and shaping of the healthcare workforce in Wales. Its key functions include Health Boards (HBs) education and training, workforce HBs (known officially as Local Health development and modernisation, Boards) are NHS bodies responsible leadership development, strategic for the health of the population within workforce planning, workforce their geographical area. They are intelligence, careers and widening responsible for planning and securing access to healthcare education. the delivery of primary, community and secondary care services alongside specialist services for their areas. Health Impact Assessment (HIA) These services include dental, optical, pharmacy and mental health services. HIA is a practical approach used to They are also responsible for judge the potential health effects of a delivering services in partnership, policy, programme or project on a improving physical and mental health population, particularly on vulnerable outcomes, promoting wellbeing, and or disadvantaged groups. reducing health inequalities across their population. Health Inequalities

Health inequalities are the differences in health state or status between individuals or groups. These can be measured in various ways such as socioeconomic group, gender, ethnicity or geographical location.

Healthcare Inspectorate Wales (HIW) HIW is the independent inspectorate and regulator of healthcare in Wales.

Hyperacute Stroke Units (HASUs) Independent Sector HASUs bring together members of a The independent sector is an umbrella multi-disciplinary team under one roof term for all non-NHS bodies delivering to provide specialist treatment to healthcare, including a wide range of cancer and stroke patients. private companies and voluntary organisations.

I Individual Patient Funding Request Improvement Cymru (IPFR) Improvement Cymru relaunched in IPFR are queries to Local Health November 2019. Previously known as Boards for treatment and medicines 1000 Lives Improvement, that fall outside the routinely funded Improvement Cymru are the all-Wales range of services available within NHS improvement service for NHS Wales. Wales. Requests that are eligible for They are experts in developing, further consideration are put before a embedding, and delivering system- meeting of the local IPFR Panel, which wide improvements across health and include a Public Health Director, Medical Director, Director of Therapies social care. and Clinical Science, and a lay representative nominated by the Community Health Council. Immunisation

Immunisation is the action of making a person or animal immune to infection, Information Governance (IG) typically by inoculation. IG ensures necessary safeguards for, and appropriate use of, patient and personal information. Key areas are Independent Member (IM) information policy for health and social An IM refers to the role of non-officer care, IG standards for systems and the Members in Local Health Boards and development of guidance for NHS and Non-Executive Directors in NHS Trusts partner organisations. in Wales. With no direct executive portfolio, independent members have full Director responsibility and the Integrated Care additional responsibility of ensuring the best quality decision-making by Integrated care is a concept that brings holding the executive to account. IMs together the delivery, management often have a designated area of and organisation of services related to interest or focus and actively diagnosis, treatment and care. As well participate in all aspects of assurance as referring to integration within health and scrutiny across the organisation. services, integration can also refer to the aim of achieving seamless services between health and social care, and physical and mental wellbeing.

Integrated Care Fund Intermediate Care The Integrated Care Fund covers Intermediate care, also known as ‘step integrated working between NHS and up, step down’ or transitional care, social care staff to support older and refers to care provided out of hospital vulnerable people. The overall aim is for people who are medically stable to help people to maintain their but still need temporary care in a independence, prevent unnecessary community bed or home-care for hospital admissions and enable recovery and rehabilitation. patients to be discharged early from hospital. Inverse Care Law Integrated Care Teams The inverse care law refers to the proposition that those with the greatest Integrated Care Teams provide need for medical services (e.g. those patients with a better quality service, living in the most deprived areas and and easier access to required marginalised groups such as the services, by working collaboratively homeless) are the least likely group to towards the same outcome. receive the treatment they require. Conversely, those with the lowest need (those living in the least deprived Integrated Medium Term Planning areas) tend to access services more (IMTP) Process easily and more effectively. The NHS Finance (Wales) Act 2014 and associated NHS Wales Planning Framework signalled a new medium- J term approach to planning. This approach requires Health Boards and Joined-up Working Trusts to produce an IMTP, setting out how resources will be used over a Joined-up working involves working in three-year period to improve health partnership with others, whether in the outcomes for local populations, public, private or voluntary sector, to improve the quality of care and identify and solve local problems. The achieve best value from resources. Welsh Government increasingly regards joined-up working as a means of fostering efficiency, effectiveness, and community engagement in the Intensive Care / Therapy Unit improvement of local government An intensive care unit is for people performance. whose conditions are life threatening and who need constant, close monitoring and support from Junior Doctors equipment and medication to maintain normal body function. Junior doctors are qualified medical practitioners who are working whilst engaged in postgraduate training to become a consultant, associate specialist, GP or pursue academic medicine.

K Long-Term Condition Management Long-term condition management is Knowledge and Skills Framework the day-to-day management of (KSF) patients with several diseases and The KSF is a nationally-developed tool neurological conditions that require used to identify the knowledge, skills daily treatment. and development that staff need to do their job. KSF focuses on six core dimensions covering the key areas Long-Term Conditions (LTCs) that apply to every job. LTCs are conditions that cannot be cured but can be controlled by medication and other therapies. L

Life Sciences Hub Wales (LSHW) M LSHW is a government subsidiary that supports a growing and prosperous life Medical Consumables sciences sector in Wales. LSHW aim Medical consumables refer to medical is to help the people of Wales benefit equipment required for clinical from improved healthcare and treatment. Examples of medical economic wellbeing through working consumables include syringes, with industry and academia to find sutures, staples, medical gloves, and solutions for NHS and healthcare gowns. providers.

Medical Isotopes Local Partnership Forum (LPF) In nuclear medicine, a medical isotope The LPF is where Local Health is a type of capsule often used in Boards, trade unions and other key diagnostics and radiation therapy for stakeholders work together to improve cancer patients. Isotopes are also health services within the Health Board used frequently in the detection of area, e.g. local priorities on workforce arthritis, fractures, and tumours. and health service issues.

Mental Health Practitioner Local Primary Mental Health Support Services (LPMHSS) A Mental Health Practitioner is a health LPMHSS provide comprehensive and worker who provides services for the mental health assessments for those purpose of improving the mental health in need; provide short-term of individuals or treating mental illness. interventions for mental health These include psychiatrists, clinical patients; provide support and advice to psychologists, clinical social workers, GPs and other primary care staff; and or psychiatric-mental health nurse provide information, support and practitioners. advice to carers and guardians.

Minor Injury Units N Minor injury units are used for less National Institute for Health and serious injuries, such as deep cuts, Clinical Excellence (NICE) eye injuries, broken bones, severe sprains, minor head injuries, minor NICE is an independent organisation burns, and scalds. that provides national guidance on the promotion of good health and the

prevention and treatment of ill health. It Model of Care aims to set clear national standards of what patients can expect to receive A model of care is the overarching from the NHS. It promotes clinical and design for the provision of a particular cost effectiveness through guidance type of health care service that is and audit to support front-line staff. shaped by a theoretical basis, The way NICE was established in evidence-based practice and defined legislation means that its guidance is standards which broadly define the officially England-only. However, it has way health services are delivered. agreements to provide certain NICE products and services to Wales, Scotland, and Northern Ireland. Mortality Rate

Mortality rate, or death rate, is the rate of actual deaths to expected deaths. National Planned Care Programme The National Planned Care Programme was established in 2014 Multi-Disciplinary Teams (MDTs) with the aim of reforming and MDTs consist of professionals from improving NHS planned care diverse disciplines who come together specialities. The programme uses the to provide comprehensive expertise of clinicians in Wales to assessments and management of a identify and promote best practice. patient’s condition. Over the last two years, the programme has focused on ophthalmology, orthopaedics, ear, nose and throat and urology. My Health Online

My Health Online gives patients the opportunity to book GP appointments, National Service Framework (NSF) order repeat prescriptions and update NSFs are long-term strategies for their general details such as change of improving specific areas of care. NSFs address, from the convenience of their are implemented in partnership with home computer. The majority of GP social care and other organisations. practices in Wales have the facility to There are six NSFs in Wales offer My Health Online to patients. encompassing coronary heart disease, diabetes, mental health, renal, older people, and children.

NHS-Funded Nursing Care O NHS-funded nursing care is the NHS’ Older People’s Commissioner financial contribution towards the cost of meeting the care needs of nursing The Older People’s Commissioner for home residents who are not eligible for Wales is an independent voice and NHS continuing healthcare, but have champion for older people across been assessed as needing services by Wales, standing up and speaking out a nurse. on their behalf.

NHS Wales Employers Out-of-Hours Services NHS Wales Employers supports the Out-of-hours services are provided strategic workforce agenda of the NHS outside ‘standard’ working hours e.g. in Wales from an NHS employer’s evenings and weekends. perspective through workforce policy development, practical advice, and information. NHS Wales Employers is Outpatient hosted by, and operates as a part of, the Welsh NHS Confederation. An outpatient is a patient who attends a hospital or clinic for treatment that does not require an overnight stay. NHS Wales Health Collaborative The NHS Wales Health Collaborative is a programme which supports the P joint-planning and programme management of NHS services across Palliative Care Health Board boundaries. Palliative care is a multi-disciplinary approach to specialised medical and nursing care for people with life-limiting NHS Wales Shared Services illnesses. It focuses on providing relief Partnership (NWSSP) from the symptoms, pain, and the The NWSSP is an independent physical and mental stress of a organisation, owned and directed by terminal diagnosis. NHS Wales. NWSSP supports NHS Wales through the provision of a comprehensive range of high quality, Pandemic customer-focused support functions An epidemic that has spread over and services e.g. employment several countries/continents, usually (recruitment, payroll and pensions); affecting a large number of people. legal advice and representation and procurement services.

Parliamentary Review of Health and Patient Experience Social Care Patient experience means putting the The Parliamentary Review of Health patient and their experience at the and Social Care was an independent heart of quality improvement. Patient review of the future of health and care experience focuses on the measures services in Wales, undertaken by a and elements that are important to the panel of experts. The panel’s final patient, such as respect for patient- report was published in January 2018 centred values, preferences, and recommending a clear and simple expressed needs; communication; long-term vision of what a seamless physical comfort and continuity of care. system, with care organised around the individual as close to home as possible, should look like in the future. Patient-Reported Experience Measurements (PREMs) Pathways PREMs take the form of validated questionnaires that service users, their A patient pathway is the route that a families and their carers complete to patient will take from their first contact provide NHS organisations with a with an NHS member of staff (usually better understanding of how they feel their GP), through referral, to the about their experiences of the care completion of their treatment. It also they receive. covers the period from entry into a hospital or a treatment centre until the patient leaves. Personal Care Plan A personal care plan is developed by Patient-centred Care the patient and their healthcare professional and contains information Patient-centred care is an approach to about the individual’s health, lifestyle, working with people which puts the and options for treatment. The aim is individual’s needs and aspirations to provide the patient with greater firmly at the centre of the process. It ownership and responsibility in the includes respect for patient-centred management of their care. values, preferences, and expressed needs; co-ordination and integration of care across the health and social care Personalisation system; information, communication, and education; emotional support; Personalisation is the all- welcoming the involvement of family encompassing term used to give and friends and paying due attention. people more choice about the care they receive. The system places the service user at the centre of the process and allows them to choose the agencies they use and the manner in

which they receive support.

Person-centred Working Population Projections Person-centred working refers to Population projections provide an approaches that recognise the estimate of the size of the future uniqueness of the individual and population and are based on establish this as the basis for the assumptions about births, deaths, and planning and delivery of care. migration. The assumptions are based on past trends and only indicate what may happen should the most recent Pooled Budgets trends continue. A pooled budget is a discrete fund set up by partner organisations to achieve Power of Attorney shared aims and outcomes. The shared aims and outcomes are set out A Power of Attorney is a legal in a partnership agreement regardless document that allows someone to of the level of contribution each partner manage another person’s affairs, or may commit to. Under a pooled budget specific elements of their affairs, on arrangement, NHS and Local their behalf. Authorities are able to pool resources, and enable the delegation of functions to a lead partner. Primary Care Primary care services provide the first Population Health point of care, day or night, for more than 90% of people’s contact with the Population health is defined as NHS in Wales. General practice is the the health outcomes of a group of core, but not the only, element of individuals and the distribution of such primary care – other services such as outcomes within the group. Health pharmacy, dentistry and optometry equity – the avoidable differences in increasingly provide care directly to the health between different parts of the public. The primary care contribution is population – is a core part of also about co-ordinating access for understanding population health. people to the wide range of services in the local community to help meet their health and wellbeing needs. Population Health Assessment (PHA) Private Sector PHA is about understanding the health of communities or specific populations, The private sector is the part of the as well as the factors that underlie national workforce and economy that good health or pose potential risks, to is not under direct state control. inform innovative policies and Private sector organisations do not services. receive aid or support of any kind from central government. In healthcare, the private sector is made up of hospitals and clinics that operate independently from the NHS.

Process Mapping Public and Patient Engagement Process mapping is the plotting of a Public and patient engagement refers patient’s journey to identify points of to the process of engaging the public inefficiency and/or opportunities for and patients at an individual and improvement. collective level throughout the planning and design of services to create

localised, personalised, and effective Prudent Healthcare services. The process moves from Prudent healthcare is a term used to information, to feedback, to influence describe healthcare that fits the needs and can be done at each stage of the and circumstances of patients and cycle: needs assessment, decisions actively avoids wasteful care that is not about priorities and strategies, service to the patient’s benefit. The Welsh improvement, procurement and Government’s four principles for contracting and monitoring and prudent healthcare are: performance management.

• Achieving health and wellbeing with the public, patients and Public Health professionals as equal partners through co-production; Public health is concerned with improving the health of the population • Caring for those with the greatest rather than treating the diseases of health need first and making the individual patients. most effective use of all skills and resources; Public Health Practitioner • Doing only what is needed (no more, no less) and doing no harm; A Public Health Practitioner has and responsibility for improving health among individuals, families and • Reducing inappropriate variation communities through the prevention using evidence-based practices and treatment of diseases and injuries. consistently and transparently. A Public Health Practitioner also has These principles fit together with the responsibility for promoting healthy complementary idea of ‘only do what behaviours. only you can do’ – the notion that no healthcare professional should routinely be providing care below their clinical competency.

Public Service Boards (PSBs) Q The Well-being of Future Generations (Wales) Act 2015 introduced PSBs for Quadruple Aim each Local Authority area in Wales. Introduced under A Healthier Wales, Each PSB works to improve the the ‘quadruple aim’ refers to the four economic, social, environmental, and mutually supportive goals to achieve cultural wellbeing of its area by an effective and sustainable health working to achieve wellbeing goals service for the future. The four goals under the Well-being of Future are: Generations (Wales) Act 2015. They also aim to reduce duplication and 1. improving population health and streamline the number of statutory wellbeing through a focus on plans and strategies that Local prevention; Authorities and their planning partners 2. improving the experience and need to produce. quality of care for families and individuals; Public Services Ombudsman 3. enriching the wellbeing, capability and engagement of the health and The Ombudsman is independent of all social care workforce; government bodies and has legal powers to investigate complaints about 4. and increasing the value achieved public services, including the NHS, from funding of health and care and independent care providers in through improvement, innovation, Wales. use of best practice and eliminating waste.

Quality Adjusted Life Year (QALY) A QALY is a measure of the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One QALY is equal to one year of life in perfect health.

Quality and Outcomes Framework

(QOF)

The QOF is a voluntary system of

financial incentives for GP practices. It is about rewarding contracts for good practice (and its associated workload) through participation in an annual quality improvement cycle.

R Regional Partnership Boards (RPBs) R0 / reproductive rate RPBs are required under the Social An epidemiologic metric used to Services and Well-being (Wales) Act describe the contagiousness or 2014. RPBs provide formal transmissibility of infectious agents, governance for the oversight of which is usually estimated with partnership arrangements for complex mathematical models integration of services. developed using various sets of assumptions. It is an estimate of the average number of new cases of a Residential Care disease that each case generates, at a given point in time. Residential care refers to long-term care provided to adults or children in a residential setting rather than their own homes. Re-ablement Services

Re-ablement services seek to maximise people’s long-term Risk Adjusted Mortality Index independence, choice and quality of (RAMI) life, while at the same time minimising the requirement for ongoing support. RAMI is a mortality index based on a ratio of an observed number of deaths to an expected number of deaths in a particular population. The ‘risk Reconfiguration adjusted’ element of RAMI is intended Reconfiguration is the rearrangement to allow comparisons between of services or facilities to achieve the hospitals providing complex, high-risk maximum cost, clinical and patient care and smaller hospitals that provide benefit. lower risk services.

Referral to Treatment (RTT) Rural Health and Care Wales (RHCW) RTT is the period of time from referral by a GP or other medical practitioner RHCW is an organisation of to hospital for treatment in the NHS. excellence that is leading the way in An RTT pathway includes the time the field of rural health and social care spent waiting for any hospital in Wales, the UK and internationally. appointments, tests, scans or other RHCW was formed and is supported procedures that may be needed before by Hywel Dda UHB, Betsi Cadwaladr being treated. UHB, Powys THB and the Welsh Ambulance Services NHS Trust. RHCW works in collaboration with the Universities of Aberystwyth, Bangor, Cardiff, Swansea, Trinity Saint David and Coleg Cymraeg Cenedlaethol, along with the Local Authorities of Ceredigion, Powys, and Gwynedd.

S Senedd Committees Committees are small groups of MSs Secondary Care who collectively represent the balance Secondary care is the healthcare of the political parties in the Senedd. service provided by medical specialists Committees scrutinise proposed and other health professionals who legislation (Bills) and Welsh generally do not have first contact with Government policies and make patients e.g. cardiologists, urologists recommendations for improvements. and dermatologists.

Social Care Self-Care Social care is the provision of social Self-care refers to individuals taking work, personal care, protection or responsibility for their own health and social support services to children or wellbeing and to care for themselves. adults in need or at risk, or adults with This includes engaging in regular needs arising from illness, disability, physical activity, eating healthily, old age or poverty. taking action to prevent illness and accidents and using medicines appropriately and effectively. Social Care Assessment

Under the Social Services and Well- Self-help (or Self Management) being (Wales) Act 2014, Health Boards must work with Local Authorities to Self-help/management includes the assess the social care needs of people actions individuals and carers take for living within their area. A social care themselves, their children, families and assessment is a way of finding out others to stay fit and maintain good what level of social care needs a physical and mental health; meet person has and what can be done to social and psychological needs; meet those needs. prevent illness or accidents; care for minor ailments and long-term conditions and maintain health and Social Care Wales wellbeing after an acute illness or discharge from hospital. Social Care Wales works to improve the quality of care and support people should expect from NHS Wales. Social Senedd Cymru (Welsh Parliament) Care Wales’ core vision is to achieve a society where every person who The Senedd is the devolved receives support can live the life that parliament of Wales with power to matters to them. make legislation, vary taxes and scrutinise the Welsh Government. The Senedd comprises 60 members, who Social distancing are known as Members of the Senedd (MSs). Measures taken to reduce person-to- person contact in a given community, with a goal to stop or slow down the spread of a contagious disease.

Social Exclusion Skills for Health Social exclusion refers to the state of a Skills for Health operates in the particular group that lacks the means workforce and organisational and/or supportive environment to development sector. They provide access opportunities for adequate workforce solutions designed to healthcare, employment, education or improve healthcare, raise quality, and housing. improve productivity and financial performance. Skills for Health is a not- for-profit organisation for the whole UK Social Prescribing health sector. Social prescribing is a means of referring patients to a range of local, Stakeholder Reference Group non-clinical services which are typically planned and delivered by All Health Boards in Wales have a voluntary and community sector Stakeholder Reference Group to organisations. encourage full engagement and active debate across the communities served by the Health Board. By doing so, Social Services and Well-being organisations use the balanced (Wales) Act 2014 opinions of its stakeholders to inform the decision-making process. The Social Services and Well-being (Wales) Act came into force on 6th April 2016. The Act provides the legal Stakeholders framework for improving the wellbeing of people who need care and support The NHS has a wide range of and changes the way people’s needs stakeholders that all share an interest are assessed and how services are in its work, including patients and the delivered. public, Local Authorities and social care providers, charities and the private, voluntary and community Single Equality Scheme sectors. The Single Equality Scheme is effectively a strategy and action plan Steering Group detailing named organisations, including the NHS, commitment and A Steering Group refers to a small approach to all forms of equality and team of professionals who come human rights. together to work on a specific project, initiative or plan e.g. for the purpose of carrying out a Health Impact Single Integrated Plan Assessment. The Single Integrated Plan engages a range of sectors to address local problems in the local area, including health inequalities.

T Third sector The third sector encompasses the full Telecare range of non-public, not-for-profit Telecare refers to technology that organisations that are non- supports people to maintain their governmental and ‘value driven’; that independence by linking a person’s is, motivated by the desire to further home with a monitoring centre that can social, environmental or cultural respond to problems. Examples of objectives rather than to make a profit. telecare include pendant alarms, automatic pill dispensers and sensors that detect risks to a person’s health Trade Unions and Professional and wellbeing at home e.g. smoke or a Bodies gas leak. A Trade Union and a professional body is an organised association of professionals within a sector formed to Telecoaching protect and further their rights and Telecoaching offers a range of support interests e.g. Unite, Unison and Royal methods (often delivered online and/or Colleges. by telephone) that allows clinicians to support and empower patients in their own self-management and self-care. Trusts There are three NHS Trusts in Wales with an all-Wales focus. These are the Telehealth Welsh Ambulance Services NHS Telehealth offers a range of care Trust, Velindre University NHS Trust options remotely via phones, mobiles and Public Health Wales NHS Trust. and broadband, often involving video conferencing. Deployed effectively, it can improve the patient’s experience of care by reducing the need for travel U to major cities and hospitals to receive Unscheduled Care care and treatment. Unscheduled care refers to health and / or social care which cannot Tertiary Care reasonably be foreseen or planned in advance of contact with the relevant Tertiary care is for people requiring professional. Unscheduled care, by complex treatments, usually in a definition, is urgent with the need to specialist centre. People may be take action at the time of contact with referred for tertiary care (for example, services. a specialist stroke unit) from either primary or secondary care. Urgent Care Urgent care is care for people needing medical advice, diagnosis and/or treatment quickly and unexpectedly.

V W Vaccinations Wales Employment and Skills Board (WESB) A vaccination is a biological preparation that provides active WESB serves as an independent, immunity against a specific disease. employer-led advisory board for Welsh Government on all matters relating to post-16 employment and skills policy Value-Based Healthcare to ensure delivery is better aligned to Value-based healthcare is a clear the needs of employers and individuals commitment to delivering and across Wales. implementing policies geared towards delivering the greatest value from NHS Wales & West Acute Transfer for services. The agenda compliments the Children (WATCh) core principles of the prudent healthcare framework. WATCh is a jointly commissioned team responsible for the transfer of critically ill children across South West Virtual Wards England and South Wales. Virtual Wards provide a community- based service using systems, WeCare Campaign processes and staffing similar to a hospital ward but without the physical The WeCare campaign was launched building. Virtual Wards provide multi- by Social Care Wales in March 2019. disciplinary care to patients at high risk WeCare is part of a long-term strategy of unplanned hospital admission based to attract, recruit and develop the on the forecasts of a predictive risk health and social care workforce in model. Using the staffing, systems and Wales to meet current and future daily routines of a hospital ward with a levels of demand. social worker as a key member of the team, they deliver highly co-ordinated preventive care at home to people at Wellbeing high predicted risk. Wellbeing is broadly understood to be the state of being physically and Voluntary and Community Sector mentally healthy and happy. Wellbeing also refers to how satisfied people feel The voluntary and community sector is with their lives as a whole, their sense an umbrella term that refers to of purpose, and how in control they registered charities as well as non- feel about their lives, their employment charitable, non-profit organisations, and their social and professional associations, self-help groups and relationships with others. community groups, for public or community benefit.

Well-being of Future Generations Welsh Index of Multiple Deprivation (Wales) Act 2015 (WIMD) The Well-being of Future Generations WIMD is the official measure of (Wales) Act 2015 is about improving relative deprivation for small areas in the social, economic, environmental, Wales. It is designed to identify those and cultural wellbeing of Wales. The small areas where there are the Act establishes a statutory Future highest concentrations of several Generations Commissioner for Wales. different types of deprivation. A WIMD deprivation score is calculated using eight domains of income, employment, Welsh Blood Service health, education, access to services, housing, physical environment, and The Welsh Blood Service covers the community safety. whole of Wales and collect voluntary, non-remunerated blood donations from the general public. Welsh Language Commissioner The role of the Welsh Language Welsh Community Care Information Commissioner is to promote and System (WCCIS) facilitate the use of the Welsh language; work towards ensuring that The Welsh Community Care the Welsh language is treated no less Information System (WCCIS) is an favourably than the English language electronic information sharing platform by imposing duties on some designed to deliver improved care and organisations to comply with standards support for people across Wales. and conduct inquiries into matters relating to the Commissioner's functions. Welsh Council for Voluntary Action (WCVA) The WCVA is the national membership Welsh Local Government organisation for the third sector in Association (WLGA) Wales. The WCVA provides services The WLGA represents the interests of and support to charities, community local government and promotes local groups, voluntary organisations, social democracy in Wales. Its primary enterprises, and volunteers. purposes are to promote better local government, promote the reputation of local government and support Local Welsh Health Specialised Services Authorities in the development of Committee (WHSSC) policies and priorities that improve public services and democracy. The WHSSC is responsible for the joint planning of specialised and tertiary services on behalf of Health Boards in Wales. Every year, WHSSC receives funding from Health Boards to pay for specialised healthcare for everyone who lives in Wales and is entitled to NHS care.

Welsh NHS Confederation Policy Whole-System Approach Forum A whole-system approach means The Policy Forum brings together over involving different parts of a system, or 60 organisations across the health and parts of another system, to address a social care sector in Wales, including particular need. An example of a the third sector, Royal Colleges, Allied whole-system approach would be Health professionals and social care supporting children to maintain good organisations. The Forum produces oral health by involving a Local Health briefings on a range of health topics. Board, local dental practices, and local schools.

Welsh Partnership Forum Wider Determinants of Health The Welsh Partnership Forum is a tripartite group, sponsored by the The wider determinants of health, Welsh Government, consisting of sometimes referred to as the social representatives from trade unions for determinants of health, are a diverse NHS Wales, senior management, and range of social, economic and the Welsh Government. The main environmental factors that impact on a purpose of the Forum is to support the person’s health. The wider development, support and delivery of determinants of health include a workforce policies on a national, person’s employment status, their regional and local level. place of residency and their socioeconomic status.

Welsh Risk Pool Service Winter Plans The Welsh Risk Pool Service is a mutual organisation which reimburses Winter Plans are produced by Local losses over £25,000 incurred by Welsh Health Boards to set out how the NHS bodies arising out of negligence. organisation will address increased The Welsh Risk Pool Service is funded demand during the winter months. through the NHS Wales Healthcare These plans are developed in budget. partnership with the Welsh Ambulance Services NHS Trust and Local Authorities.

NHS Wales

Local Health Boards There are seven Local Health Boards in Wales:

• Aneurin Bevan University Health Board

• Betsi Cadwaladr University Health Board

• Cardiff and Vale University Health Board

• Cwm Taf Morgannwg University Health Board

• Hywel Dda University Health Board

• Powys Teaching Health Board

• Swansea Bay University Health Board

NHS Trusts

There are three NHS Trusts with an all-Wales focus.

• Public Health Wales NHS Trust is the national public health agency that works to protect and improve health and wellbeing and reduce health inequalities for the people of Wales.

• Velindre University NHS Trust provides specialist cancer service across South and Mid Wales through Velindre Cancer Centre and a national service through the Welsh Blood Service.

• Welsh Ambulance Services NHS Trust provides a range of out-of-hospital, emergency, and non-emergency services.

Special Health Authorities

There are two Special Health Authorities in Wales with a national focus:

• Health Education and Improvement Wales has a leading role in the education, training, development and shaping of the healthcare workforce across Wales.

• Digital Health and Care Wales leads on digital platforms, systems and services and collecting and analysing health service data across Wales.

How can the Welsh NHS Confederation help you?

If you would like any further information on the terms provided in this glossary, please contact Nesta Lloyd -Jones: [email protected] or 02920 349 850.

The Welsh NHS Confederation is the only national membership body representing all the organisations making up the NHS in Wales: the seven Local Health Boards, three NHS Trusts, Digital Health and Care Wales and Health Education and Improvement Wales.

Please visit our website at www.welshconfed.org and follow us on Twitter @WelshConfed.

Registered charity number: 1090329

May 2021