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Secondary care The collective term for services to which a person is referred after  the first point of contact. Usually this refers to hospitals in the NHS offering specialised medical services and care (outpatient and inpatient services).   Self Care Individuals taking responsibility for their own health and wellbeing and to care for themselves. This includes taking exercise, eating well, taking action to prevent illness and accidents, the better use of medicines, treatment of minor ailments, and better care of long term conditions.   Self-directed support (social care) Self-directed support is the term used for when people choose their services, organise their care and arrange for payments to be made. This is because the individual who requires the service is directing their own care and has choice when it comes to their support.   Service level agreement (SLA) The agreement between the commissioner and provider is in two parts.  The SLA, or contract, and the service specification (see below). The SLA is a formal written agreement and is a standard document written by the Department of Health.   Service line management and reporting Trusts are moving to service line management as a way of engaging clinicians more in the management of services. It identifies specialist clinical areas and manages them as distinct operational units, supported by service line reporting  on financial and quality performance to support decision-making. Monitor has produced a toolkit for trusts to use.   Service specification This is part of the  SLA (see above) and specifies in detail how and what services will be provided, including the quality standards that the service should maintain. It is useful to read the service specification because it also explains how the services will be  monitored.  IMPRESS is developing a generic service specification for COPD.   Social enterprise Businesses with primarily social objectives.  Their surpluses are reinvested principally in the business or the community rather than to shareholders. A  number of provider services from PCTs are exploring the social enterprise model as a way of setting themselves up apart from the PCT, supported by the Department of Health. The Big Issue, the Eden Project, and John Lewis Partners are good examples, but there are increasing numbers of health examples. See here for Chartered Society of Physiotherapy briefing see here;  for NHS briefing see here.    Specialist Provider of Medical Services (SPMS) contract This is a sub-type of one of the main types of contract, PMS, that PCOs can have with primary care providers. This type of contract is where patients do not have to be registered with the provider to receive care.  The agreement sets out which services are to be provided – it does not require the full range of essential services.  For example, it might be an appropriate contract for providing primary care for homeless people, travellers or refugees.  It is being tested now as a vehicle for providing integrated primary and secondary care services where colleagues work together across an integrated care pathway, retaining their existing employment.  For example, there is a musculoskeletal service in Oldham and could be used for an integrated respiratory service.  Related Words  Alternative Provider of Medical Services (APMS) contract; General Medical Services (GMS); Primary Care Trust – led Medical Services (PCTMS) Spell The continuous period from a patient’s admission to discharge from a hospital, even if they are under the care of several consultants during that time hence different from the previously used Finished Consultant Episode (FCE).  So, if a patient with acute coronary syndrome and COPD is admitted through the emergency department with breathlessness, and is under a cardiologist but then transferred to a respiratory physician, that might count as two FCEs but just one spell.   Strategic Commissioning Development Unit (SMDU) in Department of Health England as part of the Commercial Operating Model, it takes responsibility for leadership and support to commissioners in market analysis and market-making.  It will be responsible for producing a COPD commissioning pack in 2011.   See here. Related Words  Commercial Operating Model; Commercial Support Units (CDUs); Procurement, Investment and Commercial and Division (PICD) Strategic Health Authority (SHA) The local headquarters of the NHS in England, responsible for ensuring that national priorities are integrated into local plans and for ensuring that Primary Care Trusts (PCTs) are performing well. They are the link between the Department of Health and the NHS.   Strategic plan The World Class Commissioning assurance system requires every PCT to have a strategic plan (by October 2008 in the first year of operation).  The governance of the PCT will be assessed against this plan.  It is the core PCT plan for commissioning over a five-year period.  Therefore it is an important document and you should find it available from your PCT's website or by asking for a copy.  According to the assurance system it must tell the story about how the PCT will move over a five-year period from assessing the needs of its population to delivering services that will drive improvements in health outcomes.  These outcomes will be locally chosen to reflect local priorities and have been agreed with the local population and partners such as healthcare providers and local authority.  It will reflect the PCTs commissioning intentions and be informed by the clinical visions that are developed as part of the Next Stage Review and the Local Area Agreement with local authorities.  As it will be affected by changes in health needs, priorities and resources, it is expected to be refreshed every year and rewritten  every three years. It will be accompanied by 3 more detailed plans: A five-year financial plan An organisational development plan An annual operating plan   Subsidiarity Described in the 2009/10 Operating Plan for NHS in England as one of the guiding principles of the NHS. Means "ensuring that decisions are taken at the right level of the system, which means as close to the patient as possible. It means an enabling role for the NHS centrally, with more power and responsibility residing with patients and clinicians. And it means looking ‘out, not up’ wherever possible. rather than patrolling the boundaries of their own organisations."   Support Brokers (social care) Support brokers provide help to people looking for care services. They are at the behest of the service user and provide the technical assistance to put the support package in place. Often they will be work independently from the local authority and will mediate between their client and the authority. Support brokers can be anybody from close friends and family to members of a local charity or voluntary organisation or a social worker.   Supported self care/self management You will find the terms self care and self management used interchangeably in many documents.  However, the term self management or supported self care also recognises the role of  health and social care providers. The  implication of “management” is that the individual needs others to deliver some of their care, but they are in charge of the process.  Supporting people to self care is a major part of Your Health, Your Way, http://www.nhs.uk/yourhealth/Pages/Homepage.aspx See personal care plan.   The development of direct payments and individual budgets for social care can be seen as important developments in the area of self management and is now being extended to health care  See also IMPRESS pages   Related Words  Personalisation (health and social care); Personalised care planning ; Self Care; Your Health Your Way SUS – Secondary Uses Service The primary use of data in the NHS is to support patient care.   Its use for planning and commissioning is a secondary use, hence the name.  SUS is the single data warehouse and analysis centre created by the NHS Information Centre pooling Hospital Episode Statistics (HES), and other data collected by providers of NHS care to meet the dataset requirements of NHS commissioners. Every secondary care provider in England has to send a set of standard data files (Commissioning Data Sets) to the SUS system. These files contain details of all the care they have provided, including that covered by PbR.  SUS data is then used to provide a range of services including NHS Comparators The Operating Framework  for 2008/09 stated that SUS should be the standard repository for performance monitoring, reconciliation and payments by April 2009.  Further  information  here.     SUS - secondary uses system The Secondary Uses System (SUS) is designed to provide anonymous patient-based data for purposes other than direct clinical care such as healthcare planning, commissioning, public health, clinical audit and governance, benchmarking, performance improvement, medical research and national policy development.  The data currently managed within SUS is derived from the commissioning datasets, which providers of NHS care must submit and make available to commissioners. In future, the plan is for data to be captured automatically from NHS operational systems including the NHS Care Records Service and other National Programme for IT services including Choose and Book, the Patient Demographics Service and the Electronic Prescribing System. Every secondary care provider in England has to send a set of standard data files (Commissioning Data Sets) to the SUS system. These files contain details of all the care they have provided, including that covered by PbR. See the Information Centre page for further information