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Academic Health Science Centre (AHSC) Academic Health Science Centre (AHSC). This is a partnership between a number of hospitals and universities supported by the Healthcare for London report by Sir Ara Darzi (click here). The purpose is to bring together world-class research, teaching and patient care. One is proposed between St Mary’s NHS Trust, the Hammersmith Hospitals NHS Trust and Imperial College London. As Lord Sir Ara Darzi is also heading an England-wide review of services, the term is included here.   Advance Care Plans Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline. If the individual wishes, their family and friends may be included. It is recommended that, with the individual’s agreement, this discussion is documented, regularly reviewed and updated, and communicated to key persons involved in their care. Advance care planning discussions may lead to an advance statement (a statement of wishes and preferences), an advance decision to refuse treatment (link – covered below!) or the appointment of a Lasting power of Attoney (LPA). Guide for health and social care staff and RCP Advance Care Planning: concise evidence based guidelines.  And also Advance Care Planning website    Advance decision The Mental Capacity Act 2005 gives people in England and Wales a statutory right to refuse treatment, through an 'advance decision'. An advance decision allows a person to state what forms of treatment they would or would not like should they become unable to decide for themselves in the future.  It is a binding decision.   An advance decision cannot be used to: refuse basic nursing care essential to keep a person comfortable, such as washing, bathing and mouth care refuse the offer of food or drink by mouth refuse the use of measures solely designed to maintain comfort, for example, painkillers demand treatment that a healthcare team considers inappropriate ask for anything that is against the law such as euthanasia or assisting someone in taking their own life An example from Alzheimer’s Society.   ALMO (housing) An ALMO is a company set up to manage and improve council housing stock. It is owned by the local authority but operates under a management agreement between it and the local authority.ALMOs are designed to encourage both the participation of the local community in the management of their homes and the continuous improvement of council housing services. Government funding is provided on the condition that local authorities separate their management and strategic functions. An ALMO must:     deliver major repairs and improvements to bring homes up to the Decent Homes Standard     collect rents, deal with arrears and debt counselling     maintain properties     manage lettings and deal with empty properties. The local authority is still responsible for:     the housing strategy     housing benefit and rent rebate administration     the overall policy on rents.     Alternative Provider of Medical Services (APMS) contract This is one of the types of contract that Primary Care Organisations (PCOs)  can have with any provider of primary care to increase capacity and offer more choice.  It could be a contract to provide care for a specific population, or a different way of providing care.  It can exclude some essential services. For example, a private provider could provide a walk-in centre service.  See also GMS, PMS, PTMS and SPMS.   Ambulatory Care Sensitive Conditions (ACS) A number of organizations including the NHS Institute are looking to help commissioners predict who might be at risk of admission, and to find ways to divert that admission.  Work by the Institute, Imperial College and Dr Foster’s has identified nineteen ACS conditions which account for 6%-13.2% of total hospital costs for which there is a community-based alternative to admission. The variation in that proportion gives scope for improvement.  COPD, asthma, flu and pneumonia are significant in this list of nineteen. See here for how it can be used. The Kings Fund together with New York University and Health Dialog has also developed the Patients At Risk of Re-hospitalisation (PARR) Case Finding Tool and a later version called the Combined Model.   Annual health check This is undertaken in England by the Healthcare Commission, which is the watchdog for England's healthcare - checking quality and safety provided by the NHS and independent organisations.  The third annual health check performance ratings for NHS trusts in England were published on 17 October 2008. They show major improvements in performance with trusts improving the quality of services and managing money more effectively.   One in five trusts were inspected, the rest of the ratings were derived from analysis of thousands of data items. To see how your trust has done, click here. For detailed reports, click here.     Autonomous Provider Organisation (APO) The NHS Operating Framework for 2008/09 required PCTs to ‘create an internal separation of their operational provider services and agree service level agreements (SLAs), based on the same business and financial rules as applied to all other providers.’ Therefore by April 2009 all PCTs should have divested themselves of service provider functions*  to focus entirely on commissioning and moved into a contractual relationship with their PCT provider function, using the national model contract for community services in 2009/10. This has meant ensuring sufficient separation of roles within the PCT to avoid direct conflicts of interests.  It will have An activity plan with unit costs (for PBR and Cost and Volume services). A Data Quality Improvement Plan. Formal contract management arrangements with regular formal contract meetings and policies for dispute resolution. Initially,  ALMOs were formed: arms length management organisations. However, in order to be treated like other service providers they needed to make formal changes in structure, governance, finance and their contractual relationship with the PCT. This meant a separate senior management team and board,   These organisations, still part of the same statutory body, the PCT, are known as APOs.  The relationship between an APO and PCT is described within a memorandum of understanding because they remain one financial entity.  However, an APO can have a separate finance team, separate assets and liabilities, its own income and expenditure statement and management reports,   The readiness of the ALMO to become an APO is assessed by the local SHA in a formal assessment process. Transforming Community Services: Enabling new patterns of provision” (Jan 2009 DH) required PCTs to develop a commissioning strategy and plan for transforming community services by October 2009 that will introduce sufficient competition to drive up quality and value for money. In the context of this commissioning strategy, PCTs should also have developed a proposal for the most appropriate organisational form for existing PCT provided services that best suits local circumstances. Transforming Community Services suggests that there are several possible organisational models (such as PCT provider services, community foundation trusts and social enterprise companies, and services integrated with other organisations. In August 2009 the timetable (to set up a new structure by October 2009) and approach was changed to ensure the focus was not on organisational structures but on the point of the organisations: “[plans must be] “cost effective” and “consistent with implementing a robust approach to quality, innovation, productivity and prevention”. SHAs will now  lead the process but it is clear that PCTs' ability to deliver World Class Commissioning (WCC) depends on them divesting themselves of their provider function.   The likely effect would mean that some services may be vertically integrated with secondary care providers or horizontally integrated with other community services (including potentially Social Care). For a significant proportion of services, the preferred service model is likely to be a stand-alone community organisation.  Increasingly, APOs are looking to secure their future and reduce their exposure to risk by spreading contract income across several commissioners.  This might be through successful tenders. Example of stages of development from Nottinghamshire County PCT Stage 1 : Arms-length managedorganisation (ALMO) Finance:Separate income and expenditure only Governance: Provider subcommittee with dedicated non-executive chair Strategy - Limited contestability (no real incentive to create contestability) Stage 2: Autonomous provider organisation (APO) Current examples: Havering Finance: “Shadow” separate financial statements (income and expenditure, cash flow, balance sheet) Governance: Provider subcommittee with dedicated non-executive chair – No cross-over with PCT Board – Clear scheme of delegation, memorandum of understanding and terms of reference in place for Provider Board Strategy: Commissioning of service increasingly for individual services, fewer block contracts Stage 3: Externalised organisation and competition Current examples: South Birmingham PCT (DH Community FT pilot) Finance: Separate audited financial statements Governance: Two independent boards, without overlap Strategy: Contestability in system.  National policy context will influence true degree of freedom * Typically they provide community services such as health centres, community hospitals, community nursing including district nurses, health visitors and school nurses, continence, contraception and sexual health, dietetics and nutrition, intermediate care, minor injuries, occupational therapy, physiotherapy and speech and language therapy.   Related Words  Operating Framework; Service level agreement (SLA) ; Social enterprise