The BGS was asked to contribute to the Department of Health (DoH) Policy Collaborative. This is a programme of six policy development areas.

The Department plans to take good examples of policy development from each of these areas in order to improve the way in which policies are developed. There seems to be a commitment to involving individuals who have real knowledge of the subjects, consulting professionals, experts from the voluntary sector, as well as patients with a view to developing sensible policies. The policy development of particular interest to the BGS is "supporting people with long term conditions". Two of the meetings had already taken place by the time the BGS was invited to send a representative and there are two more meetings to go. The following is a quote from the documentation: "Supporting people with long term conditions: An NHS model to support local innovation and integration", the objective of which is:

• to embed into local health and social care communities an effective, systematic approach to the care and management of patients with a long term condition
• to reduce the reliance on secondary care services and increase the provision of care in a primary, community or home environment
• patients with long-term conditions need high- quality care personalised to meet their individual requirements
• to identify all LTC patients in your health community'

This policy development is the DoH way of implementing the model developed by the Evercare pilot sites. The language in the documents reflects the language of Evercare although attempts have been made to anglicise it. All health economies are expected to have these services in place by 2008.

The policy is being developed in three part, that reflect the three levels of the 'Kaiser pyramid', i.e. case management, disease management, and self-management. All three have patient identification, integration of services and proactive care as important themes. Community matrons are seen as important for the delivery of case management and their role is identical to that of the Advanced Practitioner Nurse in the Evercare pilots.

In terms of policy development, the DoH is trying hard to engage those who know something about chronic conditions and the needs of the individuals who suffer from them. At the meeting I attended on behalf of the BGS the theme was that of self-care. The DoH staff were really listening to the discussions, taking copious notes, and they seemed to be committed to the policy reflecting those views. The focus was on how to get patients and professionals to engage in the self-care ethos and what services would need to be in place.

We were also asked to list the measurable outcomes of such a programme. (It is an unnerving thought that the 'good ideas' you have at a group meeting one year become the targets that you moan about the following year!) Education of both professionals and patients was very high on the list, as was pump-priming funding. The feeling was that self-care should be the standard for everyone with a chronic condition (irrespective of age) and that it requires information, skills and knowledge for patients and carers (Expert Patient Programme), community support networks and self-help groups.

There are two more meetings and the test for the DoH will be that the participants recognise the policy when it is finalised. The department does however deserve credit for trying!

Ian Gove