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Elective care Planned care for a pre-existing illness or condition.   Elective centre A new term coined by Professor Sir Ara Darzi as part of the review of London’s health services published in July 2007 (see here).  It will focus  on particular types of high-throughput surgical procedures such as knee replacements, arthroscopies and cataract operations. It will be separate from emergency surgery and will support the achievement of increased day cases and reduced waiting times.  Critical care support will be available.  The example used is South West London Elective Orthopaedic Centre (SWLEOC) on the Epsom General Hospital site. As Professor Sir Ara Darzi is due to head an England-wide review of services, the term Elective Centre is included here.  See also Urgent Care Centres.   Eligibility criteria (adult social care in England) Prioritising need in the context of Putting People First: a whole system approach to eligibility for social care - guidance on eligibility criteria for adult social care, England 2010 describes the framework for assessing the seriousness of the risk to independence and well-being or other consequences if a person's needs are not addressed. The four bands are as follows Critical - when life is, or will be, threatened; and/or significant health problems have developed or will develop; and/or there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or serious abuse or neglect has occurred or will occur; and/or there is, or will be, an inability to carry out vital personal care or domestic routines; and/or vital involvement in work, education or learning cannot or will not be sustained; and/or vital social support systems and relationships cannot or will not be sustained; and/or vital family and other social roles and responsibilities cannot or will not be undertaken. Substantial – when there is, or will be, only partial choice and control over the immediate environment; and/or abuse or neglect has occurred or will occur; and/or there is, or will be, an inability to carry out the majority of personal care or domestic routines; and/or involvement in many aspects of work, education or learning cannot or will not be sustained; and/or the majority of social support systems and relationships cannot or will not be sustained; and/or the majority of family and other social roles and responsibilities cannot or will not be undertaken. Moderate – when there is, or will be, an inability to carry out several personal care or domestic routines; and/or involvement in several aspects of work, education or learning cannot or will not be sustained; and/or several social support systems and relationships cannot or will not be sustained; and/or several family and other social roles and responsibilities cannot or will not be undertaken. Low - when there is, or will be, an inability to carry out one or two personal care or domestic routines; and/or involvement in one or two aspects of work, education or learning cannot or will not be sustained; and/or one or two social support systems and relationships cannot or will not sustained; and/or one or two family and other social roles and responsibilities cannot or will not be undertaken. In constructing and using their eligibility criteria, and also in determining eligibility for individuals, councils should prioritise needs that have immediate and longer-term critical consequences for independence and well-being ahead of needs with substantial consequences. Similarly, needs that have substantial consequences should be placed before needs with moderate consequences and so on.” Most councils have a moderation panel to ensure consistency across social worker assessors. The Care Quality Commission report for 2009/10 says three councils set their eligibility threshold for care-managed services at “critical” (indicating the most restricted level of access to services), while 107 set their threshold at “substantial”. Only three councils were planning to raise their eligibility threshold in 2010/11, while one was expecting to lower its threshold from “substantial” to “moderate”. However, the number of people receiving publicly funded services in 2009/10 fell by nearly 5% against the previous year, according to (provisional) national statistics, (see page 47).   EMIS One of the  main GP computer systems. Virtually every practice is computerized in the UK. These rely on Read coding to record activity. The systems have many templates to prompt users to ask certain questions and to ensure data are collected to enable QOF points to be awarded. There may be more than one system in use in a PCT,  which can make it hard to systematize protocols and care as there may be different templates in use.  Related Words  Torex; TPP; VAMP Vision End of life This term  is now used to cover both advance care and palliative care in different care settings such as care homes, hospitals, primary care and hospices for adults with advanced, progressive illness. there are national generic end of life care strategies in England, Wales and Scotland. In Northern Ireland there is a Respiratory Strategy including a chapter on end of life.   The Department of Health in England website has a useful set of resources.   In addition, IMPRESS has produced a response to DH England consultation on end of life care quality  metrics that explore the challenges of achieving for people with advanced chronic respiratory illness the same quality of care as those with malignant disease.  We have also produced a communications skills education pack including filmed testimonies from patients and carers called Effective Care - Effective Communication: Living and Dying with COPD   In May 2010 the GMC published new guidance Treatment and care towards the end of life: good practice in decision making. The guidance comes into effect on 1 July 2010 and replaces the booklet Withholding and withdrawing life-prolonging treatments: Good practice in decision-making (2002).  Important additions to the new guidance include: Advice on advance care planning and responding to requests for treatment Handling decisions involving neonatal and infant care Approaching discussions about organ and tissue donation Doctors’ responsibilities to the patient after death Making decisions on clinically assisted nutrition and hydration   The National Council for Palliative Care has a website Dying Matters to raise awareness about dying, death and bereavement.  It supports the new GMC guidance. Related Words  Advance Care Plans ; Advance decision Engagement  The process of involving others at an individual and collective level.   It starts with information, then feedback, then influence. See public and patient engagement (PPE)   Enhanced services Services within the GMS contract that are not essential or additional.  Their main role is to help PCOs reduce demand on secondary care by providing more local services responsive to local need and that also provide value for money. Any provider could apply to provide the enhanced service, including an acute trust.  It is worth knowing what plans the PCO has for enhanced services.  For example, there may be a COPD enhanced service that goes over and above the QOF requirements.  Directed Enhanced Service (DES) Services that PCOs must provide for their populations, but not all practices are obliged to provide them eg childhood immunizations. English practices currently receive a DES fee to engage with their PCT in practice-based commissioning.  Northern Ireland example.  Local Enhanced Service (LES) A locally developed service that PCOs have determined necessary to meet the needs of their population.  For an example from Tower Hamlets aiming to optimise COPD care see here.  EMIS template here.     Equality Act 2010 NHS  organisations will have to comply with the Equality Act 2010, that comes into force April 2011: the important difference is that the definition of disability has been changed to apply to "a person who has a physical or mental impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities."  A person no longer has to show that their impairment affects a particular capacity such as mobility.  Direct discrimination in services has been extended to cover disability.    It also applies to discrimination against a carer - a person is treated less favourably because they are associated with someone with a disability. Discrimination by association, by perception and indirect discrimination are all new additions to the Act.  For useful legal websites go to www.equalityhumanrights.com 0845 604 6610 Law Centres Federation www.lawcentres.org.uk Citizens Advice www.citizensadvice.org.uk Advice UK www.adviceuk.org.uk Government Equalities Office www.equalities.gov.uk National Council forVoluntary Organisations www.ncvo-vol.org.uk Charity Commission for England and Wales www.charity-commission.gov.uk Office of the Scottish Charity Regulator www.oscr.org.uk Scottish Council forVoluntary Organisations www.scvo.org.uk Wales Council forVoluntary Action www.wcva.org.uk     Equality Impact Assessment (EqIA) (social care) An Equality Impact Assessment (EqIA) is a tool for identifying the potential impact of a council’s policies, services and functions on its residents and staff. It can help staff provide and deliver excellent services to residents by making sure that these reflect the needs of the community. By carrying out EqIAs, a council may also ensure that the services it provides fulfil the requirements of anti-discrimination and equalities legislation.   Equitable Access to Primary Medical Care programme EAPMC see here was introduced in the Next Stage Review. See GP-led health centre. There are currently two features, supported by a £250, investment to support PCTs in establishing: - at least 100 new general practices in the 25% of PCTs with the poorest provision; and - one new GP-led health centre in each PCT in easily accessible locations.   Essential and additional services These are what we would expect our GP to provide. All  General Medical Services (GMS) and Personal Medical Services (PMS) practices are expected to provide essential services to their registered patients and include management of patients who are ill, terminally ill or think they are ill, and management of long term conditions. There are also a set of 7 additional services that practices can choose to opt out of: cervical cytology, child health surveillance, maternity medical services, contraceptive services, minor surgery, childhood immunisations and pre-school boosters and vaccinations and immunisations: See Enhanced services.   Expert Patient Programme (EPP) An NHS in England programme designed to spread good self-care and self-management skills to a wide range of people with long-term conditions. Based originally on work by Kate Lorig from Stanford University it uses trained non-medical leaders, on a voluntary basis, as educators and equips people with long-term conditions with the skills to manage their own conditions. Most programmes are for groups of people with a variety of conditions who meet on a weekly basis for 6 weeks and skills taught are not disease-specific. There is likely to be an EPP programme running in your PCT; See here. It is likely to reinforce the benefits of a pulmonary rehabilitation programme rather than to substitute for it, as its strengths are in improving self-efficacy (confidence), energy, and also, an emerging finding, improving social inclusion. The formal evaluation is now published in J Epidemiol Community Health. 2007 Mar;61(3):254-61. It does not show reduced use of health services. One of the hypotheses for this is that the health system is insufficiently flexible to cope with more empowered patients –  for example if a patient is still offered six-monthly appointments, they will probably attend,  even if they no longer believe they need them.