Futures in National Health No 1 - National Health Service Commissioning Board [Update 8 April 2012]

The Health and Social Care Act 2012 sections 9 and 23 and schedule 1 provides for additional provisions which affect the NHS Commissioning Board's functions - in the way now set out in the amended National Health Service Act 2006. [Given the size of both Acts it is a tortuous chore to try and sort out the final wording. Luckily I don't have to do so! The litte I have done is a personal stroll in one of the small foothills of an Everest of statutory mountaineering.]

Appointments to Board have been made so as to enable the initial arrangements for it creation, etc. They include:
Chair:  Professor Malcolm Grant
Non Executive Director:   Ciaran Devan
Non Executive Director - Chair of the Audit Committee:     Ed Smith

In summary section 23 includes a series of 14 duties* concerning the role and activities of Board. The wide role of the Board includes: 

• to create and develop the structure and organisation of the NHS Commissioning Board;
• to develop the clinical commissioning system;
• to uphold the NHS constitution;
• to drive improvements of results for patients;
• to take forward the interests of patients in health and care;
• to develop the system in a countrywide fair and comprehensive way.

* In some ways the management team of most organisations  might review the duties and check them against theirs - they are listed as sections 13A to 13P in a new Chapter 1A of Part 2 of the 2006 Act - which is placed before Chapter 1.[Mountaineers must have some jargon word for such a convolusion of statutory packing of a rucksack of Acts.] Hopefully TSO will (has) publish(ed) as one the whole of the revised 2006 Act.)

Community Health and Fitness No 2.2 - Health, Exercise and Weight

Course for Weight Loss:  Another local health initiative is combatting weight - particularly after Christmas and the New Year celebrations. A programme of several weight reduction courses are offered by local partnership which includes Sevenoaks District Council.

The last course featured exercise, dietary advice, and monitoring of weight reduction. Details of the latest course is shown by the link:

http://www.newsshopper.co.uk/news/top_stories/9458888.Council_offers_free_weight_management_programme/

Cycling Leadership: Similar to the Walk Leadership programme, Sevenoaks Distrcit Council is now seeking cycle leaders fro weekend health cycling. Leaders will receive training, a kit, and, no doubt, insurance cover.

Community Health and Fitness No 6 - Expert Patients Programme

I recently came across upon a leaflet about the Expert Patients Programme (EPP) and my interest was further developed when a friend forwarded details of a local course of say, five weeks..

The aim is to develop in a patient suffering from a long-term chronic illness the confidence, knowledge and skills to self-manage himself or herself.  The illnesses covered include:

• asthma;
• epilepsy;
• heart illnesses; and,
• multiple sclerosis.

Topics which might be included in a course are:

• exercise;
• healthy eating;
• relaxation;
• communications - with family, health care professionals etc.

Details of the courses and other features of the programme may be found at     http://www.expertpatients.co.uk/

Community Health and Fitness No 5.5 - CCG - Priority No 5 Physical and Mental Health Issues

Long-term physical conditions and mental health is embedded in the King's Fund Report's Priority No 5. It is argued that if the Clinical Commissioning Groups invest in managing this field substantial savings in NHS expenditures are possible. 

The Report points to the following possibilities:

• increasing the screening and monitoring for mental health needs of those with long-term health conditions;
• developing in a more systematic way the coding and recording of mental health needs;
• developing NICE recommended collaborative care models for those with depression and long-term health conditions
• developing local shemes for improving access to psychological therapy (IAPT) services;
• commissioning psychiatry liaison services in care homes, acute hospitals, etc.

Several on-line reference sources are given in the report.

Community Health and Fitness No 5.4 - CCG - Priority No 4 Ambulatory Care Sensitive Conditions

The King's Fund Trust report gives ambulatory care sensitive conditions (ACSCs) as the fourth priority for the Clinical Commissioning Groups.

Looking after those with ASCCs include patients with:

• angina
• asthma;
• diabetes;
• epilepsy; and,
• hypertension.

Creating and maintaining the priority should result in fewer hospital admissions, longer life expectancy, and better patient experience.

The Report picks out a number of elements for active disease management which I interpret as including:

• telephone health coaching on life-style management and/or change;
• for complex long-term conditions, active case management; 
• urgent access to care when required;
• disease management and self-management support.

I feel that I need to look at this priority more closely - using perhaps the several web-links provided by the Report

Community Health and Fitness No 5.3 - CCG - Priority No 3 Secondary Prevention - Groups at Risk...?

Priority 3 for the Clinical Commissioning Groups is Secondary Prevention. I have interpreted this as the winkling out of a patient's symptoms at the early stage of a prospective major illness. The intention is to treat the patient early on so as to manage the illness in a way which prevents or mitigates its further development. The aim or effect is to prevent or reduce complications in later life and to increase life expectancy. 

Examples which might be given include:

• statins to reduce cholesterol;
• drugs, diet or exercise, etc to reduce blood pressure.

The King's Fund Trust report gives a diet ingredients for Commissioner to get their teeth to bite on. A few examples suffice to garner the flavours:

• manage disease registers through modelling;
• ensure control of hypertension, cholesterol, and diabetes;
• monitor and manage key health inequality drivers in the community
• develop partnerships to manage public health - with a primary care prevention component;
•  find ways to get to "non-engaging" patient populations

Finally the report identifies some of the support resources for the above which are available to CCGs in the UK.

Community Health and Fitness No 5.2 - CCG - Priority No 2 Primary Prevention - Groups at Risk...?

"Primary Prevention" is the second priority suggested for the forthcoming (in 2013) Clinical Commissioning Groups - essentially doctors managing our local health service instead of  and in place of Primary Care Trusts which will go.

Strategically primary prevention should go hand in hand with Priority No1 Patient Self-management, ie with the discerning patient! So, what does "primary prevention" cover? In essence the issues are concerned with

•  a) life-style; and
• b) high risk groups.

The King's Fund Trust Report is less bulleted with this topic so I have used bullets to give emphasis on what I think I understand from the Report, namely :

• Life style which includes smoking of tobacco;
• Life-style which includes drinking of alcohol;
• Life-style which includes too little exercise;
• Life-style which includes too much food.

The groups at risk tend to be linked to one or more of the above: those who smoke, those who drink, those who are not physically fit, those who are obese, and unborn children. It seems that in a locality the latter group has some who are vulnerable because of the individual parent's life-style or condition.