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Lasting Power of Attorney (LPA)  is a statutory form of power of attorney created by the Mental Capacity Act (2005). Anyone who has the capacity to do so may choose a person (an ‘attorney’) to take decisions on their behalf if they subsequently lose capacity. A LPA must be in a prescribed form and be registered with the Office of the Public Guardian www.publicguardian.gov.uk/index.htm  More information here. Related Words  Advance Care Plans LINks Local Involvement Networks are independent networks  that exist in every local authority area of England to give people  more influence over how their local health and social care services are planned and delivered.  They are funded by the local authority. They are publicly accountable and must produce an annual report for the Secretary of State.   Participants are volunteers, and both individuals and organisations can join. An NHS organisation is excluded from joining, but an individual employee can, as long as they declare their interest.  The challenge will be to avoid involving just the "usual suspects".     Each LINk sets its own work programme. In addition to surveying the population about its needs, and joining steering groups, they have responsibility for monitoring services.  They have the legal power to make visits to health and social care services provided by the NHS, local authority, private and third sector providers.  Health and social care commissioners and providers should be working with their LINk to understand the needs of their community and to deliver services in appropriate ways.  Engaging and responding to communities. A brief guide to Local Involvement Networks Gateway ref 10443  from DH in England and the NHS Alliance (Jan 2010) is aimed at professionals.  It gives a description of what they are, how they can be used, and a few examples  of how the NHS has engaged with them.  For further information see NHS Centre for Involvement  and the LINks Exchange  online network.   Local Area Agreement (LAA) A three-year agreement setting out the priorities for funding and delivery for a local area in certain policy fields as agreed between central government (represented by the Government Office), and a local area, represented by the local authority and Local Strategic Partnership (LSP – see below) and other partners at the local level. It sets out the ‘deal’ between central government and local authorities and their partners to improve the quality of life for local people. As such, the LAA is also a shorter-term delivery mechanism for the Sustainable Community Strategy (SCS). It describes how performance will be measured using locally collected data. The LAA aims to improve the quality of life for people through improving performance on a range of national and local priorities such as safer communities, neighbourhood renewal, healthier communities, children and young people.  It is worth finding out what your local includes and to see how respiratory care might fit as this is a planning and resourcing process that includes resources other than PCTs’. In the current Communities and Local Government statutory guidance to 'Creating Strong, Safe and Prosperous Communities' and from the local government perspective, LAAs are a key feature of a more devolved central and or local settlement. Through these, different localities can channel public resources towards the priorities of their own areas, alongside national outcomes and targets.   Local authority Democratically elected local body with responsibility for discharging a range of functions as set out in local government legislation. Local authorities have Overview and Scrutiny Committees (OSC – see below) that have an increasingly important role in calling PCTs to account for their plans.   Local Delivery Plan (LDP) A plan that every PCT prepares and agrees with its Strategic Health Authority (SHA) on how to invest its funds to meet its local and national targets, and improve services. It allows PCTs to plan and budget for the delivery of services over a three-year period. The LDP gives an overview of what the priorities are for a PCT and how it intends to manage its resources and is a public document.   Local Health Boards (Health Boards) in Scotland These are the health organisations within each region such as Lanarkshire, Grampian and Greater Glasgow Health Boards, that are responsible for health protection, health improvement and health promotion. They focus on needs assessment, service development and resource allocation and utilisation. See here.   Local Health Boards (LHBs) in Wales There are 21 LHBs and one unified healthcare board, each of which is co-terminous with (has the same boundaries as) local government unitary authorities.  The main roles of the LHBs are corporate and clinical governance; securing and providing primary and community care health services, securing secondary care services through long term agreements with trusts; improving the health of communities; partnership; public engagement and provision of services. For more information see here.   Local Strategic Partnerships (LSPs) LSPs bring together representatives of all the different sectors (public, private, voluntary and community) and thematic partnerships. They have responsibility for developing and delivering the Sustainable Communities strategy and Local Area Agreement (LAA).   Long term conditions (LTC) management Previously known as chronic disease management; into which fits the management of patient with many respiratory diseases including COPD, asthma and pulmonary fibrosis.  Informed by the Long Term Conditions policy.  Best guide is the  Long term conditions compendium of information by Department of Health in England.  Long term conditions Management  is based on categorizing care according to a risk stratification. See here for the model used by all four UK nations. Level 1 is for patients who can manage their own care and care for themselves, as long as they receive education and support from primary care. Level 2 care management is where there is a structured, protocol driven approach to care. Level 3 case management is where a patient needs help to coordinate their care if they are to avoid a succession of unplanned interventions. This is where community matrons, Evercare pilots and others have been focused. Commissioners will talk about and use these categorisations. They may know through disease registers approximately how many people are in each category.  For example, Tower Hamlets PCT with a population of 230,000 has an identified total population with COPD  of 3000, split 350 in  level 3, 650 in level 2 and 2000 in level 3. This is a relatively high figure, reflecting an inner city population with  high smoking prevalence and social  deprivation. A fourth element, health promotion, has received little attention or budget up to now, although this has been identified by government as a gap, and will be monitored by the Healthcare Commission more closely in 2007/08. The LTC model is not static and varies with disease; patients with COPD gradually move up the levels where as patients with asthma may move up or down.  Nor is it purely related to severity of disease, because patients’ coping abilities also influence how and when they seek professional help. The diagram below from Castlefields Health Centre develops the model showing how self-care and self management happens at all levels, and how well they are enabled is probably the most important factor in determining how patients use services. To conclude, who provides the care, and where, is up for negotiation. Currently about 80% of a GP workload is the management of long term conditions and government policy is to promote the role of GPs both as commissioners of care, and as providers.   Long term oxygen therapy (LTOT) is the provision of oxygen for continuous use at home for people with chronic (long-standing) hypoxaemia, most commonly due to COPD. Related Words  Hypoxia/hypoxaemia