Tuesday, August 28, 2007

NHS Acronyms

A commenter on this post about the length of health authority names on Simplicity’s blog states that the LAU or Low Activity Unit in his area are … the acronym and title given to the Mortuary!

I admit to having been confused myself by all the acronyms, terminology etc both on the medical side of Kezia’s sickness and treatment on the one hand and by the National Health Service’s bureaucreacy on the other. Of the former I now have a grasp – symptoms, organ functions, drugs and their modes of action etc - but the latter seem unfathomable. PCTs, ATs, SHAs ...

If I cannot figure them out, how will your average punter? Especially when they are “consulted” on NHS “reform”! And for our foreign readers it must be even more so …

So here is a quick layperson’s guide to the main administrative units of the NHS bureauracy …

Acute Trusts: these are the ones who run the hospitals. Kezia was diagnosed in an acute trust hospital and is now being treated in another acute trust’s hospital, as the latter is a regional centre for more specialised care. But as they belong to different trusts and as the former, where she was diagnosed and we now reside, does not have a centre of regional specialised care for children with serious illness, it pays the latter trust, which does, for Kezia’s treatment.

A bean-counter’s paradise!

The NHS website also ingenuously claims that the receptionists, porters, cleaners, domestic and security staff are “employed” by these trusts. I know for a fact that at the Royal Manchester Children's Hospital the security staff are not employed by the trust – they are employed by a private contractor.

Primary Care Trusts: a PCT is your General Practitioners. Well, not really … not any more. It is also, I suppose, your walk-in Sunday 24-hour ASDA hypermarket clinic where you will see an MTAS unemployed junior doctor trying to make ends meet and who knows fuck-all about you because he cannot access your medical records on the NHS IT Spine.

The PCT must monitor all the other types of other trusts in your area – hospitals (see above), mental health (see below), patient transport including A & E (i.e. the Ambulance Trusts – see below, but does this mean the Acute Trust “contracts” with the Primary Care Trust which “contracts” with the Ambulance Trust? I’m confused!). It must “make sure” (what the hell does that mean?) that your dentists and opticians are in place.

So PCTs get 80% of the NHS budget.

Ambulance Trusts: self-evident. There are 13 of these organised on a regional basis. I don’t quite understand how these fit into the supposed policy of “internal competition”. An Acute or Primary Care Trust in the north-west of England is hardly going to contract the London Ambulance Service NHS Trust.

Foundation Trusts: these are hospitals "run by local managers, staff, members of the public, which are tailored to the needs of the local population". They have more financial and operational freedom than the other types of trusts and supposedly represent the government's policy of decentalisation. Introduced in 2004, there are now 67 of them. The public sector trade union UNISON does not agree arguing that they will in fact lead to greater inequalities in the NHS.

Care Trusts: these combine healthcare and local authority social care. They often provide mental healthcare and sometimes primary care.

Mental Health Trusts: self-evident.

Strategic Health Authorities: these serve as the interface between the Department of Health and NHS trusts. Their role is essentially the development of regional health policy and planning. Thus the North West SHA was responsible for the Healthy Futures and Making It Better reforms in NE Greater Manchester and the north west respectively.

Special Health Authorities: these are health services that are national in scope such as NHS Blood and Transplant and the infamous National Institute for Health and Clinical Excellence (which, among other, decides which drugs can or cannot be used in the NHS).

Now, the actual name of your local trusts may confuse you even more. The Essex Rivers Healthcare Trust gives you no indication of what type of trust it is. The Manchester Mental Health and Social Trust could be a Care Trust or a Mental Health Trust. The Bexley Care Trust is not a Care Trust, it is a Primary Care Trust.


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