A to Z of modernisation

There are a number of specific phrases, concepts and new organisations associated with the modernisation of health and care but, unless you’re closely involved, it might not always be clear what they refer to.

Here is an explanation of some commonly used terms associated with the changes. If you think any are missing, or if you have heard any that you think need further explanation, please send them in using the comment form at the end of this page.

A new vision for adult social care: The Department published A vision for adult social care: capable communities and active citizens on 16 November 2010. It sets out the Government’s ambition to make services more personalised, more preventative and more focused on delivering the best outcomes for those who use them. The Department also published a consultation on a new strategic approach to quality and outcomes in adult social care – Transparency in outcomes: a framework for adult social care.

Any Qualified Provider: The choice of Any Qualified Provider (AQP) is being introduced to give patients more choice and control. It will build on and extend the existing choice of provider for elective care introduced in 2007. The approach to AQP will put safety and quality first, sustaining current standards and supporting continuous quality improvement. There will be transparent and rigorous processes for qualifying providers to be an AQP.

Patients will be able to choose any provider who meets NHS standards and prices. To qualify as an AQP, providers will be subject to a qualification process. They will be required to show that they can meet the conditions of their licence with the Care Quality Commission and/or Monitor (if necessary), provide safe quality services to the contractual standards set by the NHS Commissioning Board and meet NHS prices – either set nationally or locally.

Commissioners (PCTs and consortia) cannot refuse to accept qualified providers once qualified, unless providers fail quality standards, reject the agreed price or refuse to comply with any reasonable, additional, locally set standards.


Appointments Commission: An independent organisation responsible for appointing chairs and non-executives to strategic health authorities, primary care trusts, NHS trusts and the Department’s arm’s length bodies. It also provides non-executive recruitment services for foundation trusts and to the boards of public bodies across central Government.

Arm’s length body: As stand-alone national organisations sponsored by the Department of Health, arm’s length bodies (ALBs) work closely with the local NHS, social care services, and other ALBs to carry out specific functions. In the Department of Health they regulate the system, improve standards, protect public welfare and support local services.

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Care Quality Commission (CQC): The Commission regulates and improves the quality of health and social care and looks after the interests of people detained under the Mental Health Act.

Commissioner: Someone who commissions (buys) health and care services.

Commissioning: Commissioning is the buying of health and care services. It is a continuous cycle of activities that includes agreeing and specifying services to be delivered over the long term through partnership working, as well as contract negotiation, target setting, providing incentives and monitoring. It is all about making sure that health and care services effectively meet the needs of a given population with the resources available.

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Foundation trust: Foundation trusts are NHS providers who achieve foundation trust status. This means they are subject to less central control and have greater freedoms, including the removal of the private patient cap and borrowing limits. This should enable them to be more responsive to the needs of local populations.

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GP commissioning consortia, or GP consortia: Groups of GPs that will be responsible for buying health and care services for patients, taking over the role from primary care trusts. They will implement the new commissioning roles as set out in the White Paper Equity and excellence: Liberating the NHS.


GP pathfinders: The first groups of GP commissioning consortia who have shown that they would like to move quickly to implement the new commissioning roles. The pathfinders consortia will test concepts, themes and functions at an early stage.

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Health and Social Care Bill: The Health and Social Care Bill creates the legislative framework for the NHS as set out, and consulted on, in the White Paper Equity and excellence: Liberating the NHS. It devolves power in the NHS, clarifying roles and responsibilities so that everyone can enjoy better quality health care and better health.


Health and wellbeing boards: These are being set up in local authorities to improve health and care services, and the health and wellbeing of local people. They will bring together the key commissioners in an area, including representatives of GP consortia, directors of public health, children’s services and adult social services, with at least one elected councillor and a representative of Healthwatch. The boards will assess local needs and develop a shared strategy to address them, providing a strategic framework for individual commissioners’ plans. Shadow health and wellbeing boards will be in place in each local authority by April 2012 and, subject to Parliamentary approval, will be established from 2013.


Health Education England: Subject to consultation, Health Education England will be established as a special health authority during 2011-12 to provide sector-wide leadership for workforce planning, education and training. It will be accountable to the Department through a framework agreement and sponsorship arrangements.


Health Protection Agency (HPA): The Agency reduces the dangers to health from infections, chemical and radiation hazards, and works in partnership with other organisations who have health protection responsibilities. The functions of the HPA will eventually be incorporated in to those of Public Health England.


Healthwatch: A new patient champion being established in April 2012. It will ensure that patients are involved in decisions about their care and that their views are considered when providers commission services.

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Local Involvement Networks (LINks): Local organisations in each local authority area set up to represent views of local people on health and social care services. These will become local Healthwatch.


Local democratic legitimacy: Local democratic legitimacy in health is the Government’s intention to give more of a voice to local people, by involving local councillors and patient representatives in shaping and influencing the strategic direction of the health and social care system in their area. See also ‘Health and wellbeing boards’.

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Modernisation: Refers to the changes that will happen to the health and care system.


Monitor: An executive non-departmental public body that will become the economic regulator for health and social care, operating a joint licensing regime with the Care Quality Commission. It will regulate prices, promote competition and prevent anti-competitive behaviour. (Monitor currently authorises and regulates NHS foundation trusts.)

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National Treatment Agency (NTA): The NTA improves the availability, capacity and effectiveness of drug treatment in England. The functions of the NTA will eventually be incorporated in to those of Public Health England.


NHS Commissioning Board: This Board will sit at arm’s length from the government and will oversee local GP consortia. It will make sure that consortia have the capacity and capability to commission successfully and meet their financial responsibilities. It will also commission some services directly. The Board will exist in shadow form from June 2011.

NHS Trust Development Authority: The NHS Trust Development Authority will provide central support to enable remaining NHS trusts to become foundation trusts. It will take on responsibility from the Department and strategic health authorities during 2011–12 and hold NHS trusts to account. The intention is that the Trust Development Authority will continue in its role until 31 March 2014. It was initially known as the Provider Development Authority


NHS White Paper: This usually refers to the July 2010 White Paper Equity and excellence: Liberating the NHS. It sets out the Government strategy for the NHS.


NICE (National Institute for Health and Clinical Excellence): An independent organisation providing advice and guidelines on the cost and effectiveness of drugs and treatments. The role of NICE will be significantly extended.

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Outcomes /outcomes framework: Broadly speaking, ‘outcomes’ means ‘results’. The NHS Outcomes Framework sets out the results that the Secretary of State will expect the NHS Commissioning Board to deliver once it is established. The Public Health Outcomes Framework promotes joint working where local organisations share common goals.

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Pathfinders: See GP pathfinders


Patient revolution: The process of identifying the benefits of reform for patients and public.

Provider: Providers are organisations that provide services direct to patients, including hospitals, mental health services and ambulance services. NHS providers (eg physiotherapists) will be given more freedom to help them deliver the best possible care for patients, and it will be easier for new providers to offer services. Hospitals that perform well will get more money to develop their services. Performance will be measured by whether patients’ health and wellbeing improves rather than by targets. For example, instead of performance being measured against waiting times, it would be measured against things such as how many patients who suffer a stroke are able to live independently.


Provider Development Authority: See NHS Trust Development Authority


Public Health England: This is the new public health service outlined in the White Paper Healthy lives, healthy people: our strategy for public health in England. Public Health England will be part of the Department of Health and will incorporate the current functions of the Health Protection Agency and the National Treatment Agency for Substance Misuse (subject to the Health and Social Care Bill being passed in Parliament). It is intended that Public Health England will lead health protection and set the overall outcomes framework for public health.


Public health observatories (PHOs): There are nine regional PHOs across England. They produce information, data and intelligence on people’s health and health care for practitioners, policy makers and the wider community. Their information and intelligence functions are due to transfer into Public Health England.


Public Health White Paper: This usually refers to the November 2010 White Paper Healthy lives, healthy people: our strategy for public health in England.

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Ring-fenced budgets: These are public health budgets that will be allocated to local authorities from April 2013 for their new role in public health. The Department will set out the purpose of the funding but not exactly how the money should be spent. Local authorities will be able to use the ring-fenced budget widely to improve public health in their local area in line with local priorities. This may include using it jointly with other local authority budgets such as those for children’s service, schools, housing, transport and environmental health.

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5 Responses to A to Z of modernisation

  1. Hannah Haines says:

    HRA – Health Research Agency

    NRGS – Nation Research Governance Service

    NIHR – National Institute for Health Research

  2. David Parkin says:

    This ‘A to Z of modernisation’ provides more comedy than enlightenment and is both an embarrassment to the Department of Health and the NHS and an insult to the public. It ranges from the unhelpfully obvious (‘Foundation trusts are NHS providers who achieve foundation trust status’) via the content-free (‘Commissioning development: The name given to a key strand of work to deliver a more autonomous and accountable NHS’) to the nonsensical (‘Patient revolution: The process of identifying the benefits of reform for patients and public’). Who is this web page for? What do these people need or want to know? It would have been a good idea to ask those questions and answer them before publishing.

    • web editor says:

      Thanks for your comments.

      As indicated at the top of the page, this is aimed at those – from the general public as well as the healthcare sector – who are not familar with all the terms and new organisations associated with the health and care changes, and would like to know more.

      We welcome comments as well as suggestions of other terms and will take these into account when regularly reviewing and updating the page.

    • David Parkin says:

      It’s unfortunate that this response is as free of useful content as the original glossary. The point that I was trying to make was that virtually none of these definitions will be of any use to those “who are not familiar with the health and care changes, and would like to know more”, particularly the general public. Instead of spending time issuing a defensive reply, perhaps the owners of this page could address that issue?

  3. Doug Bridges says:

    It would seem from the above informaton that the NHS will become nothing more than a sub-contractor buying services from any providers
    that meet its requirements( If that is not prrivatisation by the bqck door I would like to know what is) We have all seen the results of sub-contracting Hospital cleaning services ,MRSA ,Clostridium Difficile both related to poor cleaning and Hygene standards. Profit before Patient care!!!!! no amount of Quangos and monitoring agencies will stop it.
    Reform of the NHS is needed to reduce waste and inefficient activity but Mr Lansleys proposals are not the way forward

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