Kevork Hopayian has been a GP long enough to comprehend but still marvel at the changing language in the NHS. He is on X: @KevorkJan
The ever changing face of health services has been reflected in incessant change in language. Here is a glossary for those who have not kept up.*
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Appraisal
An annual meeting of two doctors where one tries hard to prove their case for continuing NHS employment while the other tries even harder not to appear as the judge. Both try harder still to believe it remains an opportunity for reflection and professional development.
Audit
A systematic method of measuring performance against bench marks. “Audit reached its apotheosis in the 1980s then faded away like so many fashions, such as shell suits and Bucks Fizz”. Dr Donna Bedian
Business plan
A structured and detailed descriptions of aims, processes, and costs in support of project proposals as demanded by all NHS organisations. The concept has been borrowed from the world of commerce, where its value was so convincingly demonstrated in the economic collapse of 2008.
Commissioning
The placing of contracts with providers (q.v) of health care without the inconvenience of consulting public health doctors.
Competitive tendering
A system of bidding for contracts that ensures victory for the agency most adept at completing Byzantine applications.
Evidence
A body of facts and observations obtained by scientific endeavour. Something on which practitioners claim to base their craft to boost their credibility but on which politicians never base their claims lest it exposes their vacuity.
Evidence-based
Narrow sense, a policy or practice justifiable by evidence (q.v.). Broad sense, any policy or practice in need of justification.
Fit for purpose
The chief characteristic missing from whatever the speaker proposes.
Forward View
General usage: one of two ways of looking (the other being Backward View). Technical usage: a plan to do in the present what should have been done in the past, which amounts to doing things backwards.
Guideline
Guidance for clinicians to assist them in the management of a condition or group of patients. The origins of the term are obscure since the emphasis is less on guiding clinicians than on clinicians toeing the line.
Integrated Commissioning Board
A statutory body given the task of commissioning health services in an area. It has taken over this responsibility from Clinical Commissioning Groups, which took over from Primary Care Trusts, which took over from Primary Care Groups. The serial lack of success from re-organisation without sufficient funding has not diminished faith in the policy. ICB members will succeed not only in commissioning but also in reducing inequality. This new responsibility has been placed on their shoulders by those whose responsibility it truly is.
Laminitis
Formerly, a condition of the hooves caused by excessive sugar intake. It carried the danger of crippling horses. Now a condition of organizations caused by the excess production of laminated pathways and guidelines. It carries the danger of crippling clinicians.
Local Area Team
Abbreviated to LAT, it was the local office of the NHS Commissioning Board until subsequent re-organisation. The mists of time have spawned many urban myths. One is that they were disposed of because local and area appeared tautologous. Rumours spread that the previous proposal for Regional Area Team was dropped because the acronym RAT might have attracted ridicule. The original suggestion was to name them Local Offices for Commissioning Organisations, an acronym staff definitely disliked. See Integrated Care Boards.
Outsourcing
Placing guaranteed profits in the laps of enterprises outside the national health service.
Partnership
A supposedly mutually beneficial relationship between the health service and an outside agency.
Performance indicator
An index of a quantifiable but proportionally minor activity that is measured with the purpose of judging the quality of a health care practitioner whose proportionally major activities are unquantifiable.
PFI
Official use: Abbreviation for Private Finance Initiative and not, as some would have it, Profits For Industry. It was a system of outsourcing capital expenditures that evaded the appearance as debt in Treasury accounts. Colloquial use: by extension, a conjuring or confidence trick, pronounced pff.
Provider
Formerly, a professional skilled in providing diagnosis and treatment to the sick, or an organisation that employed such professionals, with the aim of improving health. Current usage is for an organisation that employs such professionals with the aim of improving profits. Related term: Any Qualified Provider. an organisation that is qualified to provide health services on the basis of its experience in running prisons, transport services, or catering.
Quality
A banner raised by the few under which the cynical many like to be seen.
Quality and Outcomes Framework
A specific form of linkage between remuneration and performance indicators (q.v). An example of an oxymoron since it is not so much a framework as a straight jacket, it rewards process rather than outcomes and has little to do with quality.
Reorganisation
An irregular but frequent ritual of reforming the National Health Service to compensate shortcomings created by the antecedent reform. Its creators believe that they will definitely win the jackpot at last. Unlike gamblers, they do not risk their own money.
Research
1 An activity designed to further knowledge, which is occasionally successful.
2 An activity designed to further academic careers, which frequently succeeds.
Revalidation
The mandatory process for ensuring that doctors remain safe and effective after qualification. It works on the principle that if one has not fallen below a minimum standard in the previous 5 years, one will not do so in the ensuing 5.
Statistics
A crutch for researchers and a plaything for politicians. A smokescreen for both.
World beating
A filler word that has lost its original meaning, rather like literal and incredible. It is used as an adjective by governments to claim achievement, though such claims are neither literal nor credible.
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Deputy Editor’s note: I am sorry to have to spell out that the above article and any people referred to in it are a satirical or fiction and should not be used in or cited as official definitions.
Featured image by Dmitry Ratushny at Unsplash
