Issuu

OPTIONS A guide to care and independent living

Spring 2017

Leaving hospital

CONTRIBUTORS: Age UK Leeds Alzheimer’s Society British Red Cross Leeds Teaching Hospitals NHS Trust NHS Choices

What’s next?

Farewell

www.leedsth.nhs.uk |

Independence at home

News

www.leedsth.nhs.uk Who can help?

www.leedsth.nhs.uk |

NHS continuing healthcare Who’s eligible?

SOCIAL CARE

tips

Leeds

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Contents

Introduction

The right place for your care......................................... 4 Our commitment to you............................................... 4 The Assessment Process................................................ 5 Leaving hospital......................................................... 5-6 Your Hospital Team....................................................... 6 Dementia Support......................................................... 7 Intermediate Care......................................................... 7 Friends and Family Test............................................... 7-8 Patient Advice and Liaison Service (PALS)....................... 8 Our formal complaints process...................................... 9 Chaplaincy.................................................................... 9 NHS continuing healthcare.......................................... 10 Assessment for NHS continuing healthcare............ 10-11 What is NHS-funded nursing care?.............................. 12

Hospitals are the right place to be when you are in need of acute medical or surgical care. However, when your treatment is completed it’s important your stay is not delayed for any reason. It is beneficial to your health to start planning your discharge from hospital at the earliest opportunity, which may be when you arrive or even before if your admission to hospital is for elective surgery. This means we can; • Listen to any concerns you may have at the earliest opportunity

Paying for permanent residential care.................... 14-15 Paying for temporary care in a care home................... 15 Paying for care if you have a partner........................... 15 Personal budgets and direct payments - more control over your care...................................... 15

• Assess what your needs are likely to be when you are ready to leave

Care services in your home.................................... 16-17

• Give an indication of when you should be ready to leave hospital

The Motability Scheme................................................ 19 How to use your health services.................................. 20 The Care Quality Commission Social Care, GP and Mental Health top tips........................................... 21-23 Age UK Leeds........................................................ 24-25 Alzheimer’s Society - Specialist support for people with dementia............................................ 26-27 British Red Cross.................................................... 28-29 NHS Hospitals and services in Leeds............................ 30 Useful contacts........................................................... 31

• Involve relevant staff who can help meet those needs

• Make arrangements for equipment or services to be ready when you leave • Make sure that your family or carer is given any information, help or advice that is needed to aid your recovery. This Information is intended to help you, your carer, relatives and friends understand how your discharge from hospital takes place. We hope you can help us so that this happens as efficiently and smoothly as possible.

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The Leeds Teaching Hospitals NHS Trust

Leeds

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The right place for your care Acute hospital services are for people who require emergency, medical or surgical treatment within a hospital environment. When your treatment has been completed it’s important that your stay is not delayed for the following reasons; • S ome people find it harder to return home the longer they stay in hospital.

• P atients tell us they prefer to be at home in their familiar surroundings and this is often the best place for recovery. • T here is a risk of acquiring infections in hospital, so leaving at the earliest opportunity means this is less likely. •H ospital beds are needed for people who are very unwell, and who may be waiting in the emergency department for a bed to become available. • P eople awaiting surgery, both urgent and non-urgent, may have their operations cancelled if a bed is unavailable.

Our commitment to you • Patients should receive the right treatment, at the right place and by the right professional • We place a high priority on keeping your stay in an acute hospital bed to a minimum • O nce your consultant led team assesses that you are medically fit for transfer, we will aim to transfer you from hospital on the same day • You will be transferred from hospital when you are ready to leave as there are more appropriate services and facilities available to you. 4

The Assessment Process Your assessment begins as you are admitted to the ward and is a way of working out what your ongoing needs will be. Nurses looking after you on the ward will have discussions with you and your family or carer. We would like to know if you were receiving support from community health or social care before you were admitted, or whether there are any issues that may impact on your discharge from hospital. We also have a team of nurses called Discharge

Facilitators and Discharge coordinators who visit you on the ward to ensure that you are well supported in understanding every step of the way towards your transfer from hospital to home or ongoing care. They will help to go through your Home Planner document with you and your family and work with you to highlight any support requirements. If you or your family have any concerns about going home, please ask to speak to the ward staff and they will be able to contact the discharge team to support you.

Leaving hospital You will be transferred from hospital when your consultant-led team decides that you are clinically ready and that you no longer require acute hospital services. All staff will work with you and your carer or relatives as a team to discuss your discharge with you. Being discharged home is often very straightforward but if you have ongoing health

and social care needs you may require a more detailed assessment. If this is the case, you will be supported by staff working together from both health and social care. We need to discuss any concerns or needs you have at the earliest opportunity, for example the things that you want to be able to do when you go home. These may include managing your personal care, 5

domestic tasks, carer responsibilities, returning to work or leisure, staying safe and any equipment or care you feel you may require. You will be given an expected date for discharge based on when your treatment is due to be complete. It is important that everyone involved is aware of this date so that we can all work towards it and so the necessary arrangements can be made such as;

A supply of your current medication will be ordered from the hospital pharmacy to tide you over until you see your GP. They will be delivered to you and may take up to four hours. If you have any questions about your medication please ask to speak to your pharmacist or a member of the nursing team. Relatives or carers coming to collect you can meet you in the lounge or a nurse can escort you to the main reception area.

• T ransport home. Patients are normally expected to arrange their own transport, however if this is not possible please tell us as soon as possible.

It is important to know that the majority of patients will be transferred home directly from hospital.

• S uitable clothing and footwear (if you are not already using them in hospital).

If you no longer require consultant led care and there is a delay in the start of your care package or preferred community based placement, you will be transferred to a bed within a nonhospital setting whilst this is arranged. We will only transfer you when the appropriate place has been identified and confirmed but this should be within 48 hours.

• Access to a key to your property. • Adequate basic food stocks. • Adequate heating in your home. •A dequate support for your carer or family members. We aim for patients to be discharged in the morning but if this is not possible and appropriate for your needs you may be moved to the discharge lounge where this is available. The discharge lounge is a comfortable and safe place to wait and is staffed by nurses who will provide light refreshments throughout the day, as well as keeping you informed.

Your Hospital Team In the hospital you will find a multi–disciplinary team which may include doctors, matron, ward nurses, occupational therapists, physiotherapists, pharmacists, dietitians and social workers and you may be referred to any of these as part of your care. The relevant therapist will discuss with you and assess what you are able to do and what you might need more help with. They will then discuss with you what treatment, help or support is available to improve your independence. The therapists will discuss with the other members of the hospital team their findings and together with you and your family make a plan for your discharge from hospital. 6

Dementia Support If you have dementia our hospital staff will provide support for you and your relatives and carers. You will receive a document called ‘Know who I am’ which asks for details about your specific needs and personal preferences. This information will help our staff to deliver specific care needs during your stay in hospital.

Intermediate Care It may be that you are medically well enough to leave hospital but are not yet at a level where you can manage at home without support. A period of further rehabilitation may be beneficial to you, this is called ‘intermediate care’. This care can be provided in your own home if you are able to manage or is provided in an alternative location such as a care home. The aim

is to support patients as they are discharged to reduce the length of time in hospital, to allow a more accurate assessment of ongoing care needs and to help re-learn daily living skills. There is a multi-disciplinary team approach which comprises of community nurses, occupational therapists and physiotherapists with access to your GP and community based Consultant Geriatricians.

Friends and Family Test When you receive care at any of the services provided by us, you will be given the opportunity to give your feedback by answering a simple question about your experience. The results will provide a way for you to easily compare NHS hospitals so that you know where you and your family can get the best possible care. The information will also give the NHS invaluable information on what patients think of services, which can be used to help make improvements if required.

similar care or treatment?” You will be invited to respond to the question by choosing one of six options, ranging from ‘extremely likely’ to ‘extremely unlikely’. It is really important to us that you tell us why you gave your answer, so please answer any follow-up questions. Your answer will not be traced back to you, and your details will not be passed on to anyone, so please tell us exactly what you think. A member of your family or a friend is welcome to help you give your feedback to the question if you are unable to.

How will it work?

Responses to the surveys are free.

When you are discharged you will either receive an automated phone call or text message survey and you will be asked to answer the following question:

Do you have to respond to the question?

“How likely are you to recommend our services to friends and family if they needed

Your feedback is extremely important and will help to continually improve our services. However, you do not have to respond to the 7

question. You can opt out at any time by simply replying STOP when you receive the text message or by pressing # if you receive an automated call. You will be opted out from receiving any future survey unless you change your contact details.

How will the results be used? We will gather the results and analyse them rapidly to see if any action is required. The NHS will publish the results and you will also be able to see results for other hospitals to see how they compare.

Does this replace the existing compliments or complaints procedure, or other forms of feedback used by the hospital? No, you can still pass your compliments or complaints to your hospital in the normal way. Hospitals can continue to use existing ways of gathering feedback, in addition to the Friends and Family Test.

Where will the results be published?

Where can I get more information?

The results will be published on the NHS Choices website (www.nhs.uk). We will also publish our results on our website (www.leedsth.nhs.uk), displayed within the trust and also in our annual reports and quality accounts.

For more information on the Friends and Family Test, please visit www.nhs.uk/ friendsandfamily.

Patient Advice and Liaison Service (PALS) Welcome to the Patient Advice and Liaison Service We know that it can be a worrying and confusing time when you or someone you know is unwell. If you have concerns or questions about any aspect of your care, or the service you receive, it is best to first speak with a member of staff involved with your/their care. If you find that staff cannot help you, or you are not comfortable speaking with them, you can contact PALS. PALS is a confidential, on-the-spot, advice and support service for patients, relatives and carers. You can ask a friend or relative to contact us on your behalf but we must have your permission before we can discuss your personal circumstances with anyone else. PALS act independently when handling patient and family concerns, liaising with staff, managers, 8

or relevant organisations, to negotiate immediate or prompt solutions. If necessary we can also refer patients and families to specific local or national based support agencies. PALS will:•H elp answer your questions about the Trust or your care • Offer advice and support if things go wrong •R espond to your concerns if you are unhappy about any aspect of your care • Provide information about our services • L isten to your suggestions for improving our services for patients and visitors • Pass on your compliments to staff • Provide advice on the NHS complaints procedure

Our formal complaints process We aim to resolve all complaints to the satisfaction of the person making the complaint. This may be the patient or anyone else/advocacy organisation making a complaint on behalf of the patient. If the latter, the patient will be required to give consent. Complaints should ideally be in writing, sent by either email or post to: Patient Experience Department, Leeds Teaching Hospitals Trust St Jamesâ€™s University Hospital Beckett Street, Leeds, LS9 7TF Email: patientexperience.leedsth@nhs.net Telephone 0113 2066261

We are able to support those wishing to complain but are unable to put their complaint in writing. Upon receipt of your complaint, we will send you an acknowledgement within three working days. You will also receive a phone call from one of our Complaints handlers, to confirm the key issues you would like resolved, your preferred method of response (e.g. letter, meeting) and the timeframe (typically 40 working days). This may be longer or not as long, depending on complexity of the case). You will also be given a contact name, direct telephone number and e-mail address, to make it easy for you to find out how the processing of your complaint is progressing or if you need to give us additional information.

Chaplaincy Welcome to the chaplaincy service The chaplaincy department has the responsibility of providing for the pastoral, religious and spiritual care of all patients, their relatives and carers, as well as the staff on all hospital sites. We are there for all people of any faith or none. Pastoral and spiritual care is an integral part of the holistic care provided within our hospitals. If you would like a visit from one of the chaplains whilst you are in hospital, then either make a referral in advance of your admission to hospital or ask a member of your healthcare team on the ward to contact a chaplain on your behalf. In addition, chapel and prayer room facilities are available for quiet prayer and reflection. We are pleased to welcome people of all faiths and none, who wish to use these areas for personal times of quiet, prayer and reflection. These areas are open to all, day and night. 9

NHS continuing healthcare NHS continuing healthcare is a free package of care for people who have significant ongoing healthcare needs. It is arranged and funded by the NHS. You can receive NHS continuing healthcare in any setting outside hospital, including in your own home or in a care home. If you receive care in your own home, the NHS will cover the cost of the support you need from health professionals and the cost of personal care which can include help with washing and getting dressed. If you receive NHS continuing healthcare in a care home, the NHS will also pay your care home fees.

Eligibility for NHS continuing healthcare When assessing your eligibility for NHS continuing healthcare, staff must follow certain processes. You must be assessed by a team of healthcare professionals as having a ‘primary health need’ for care. This means that you need care primarily because of your health needs. This is assessed by looking at: • t he type and particular characteristics of your needs • how intense and severe they are • the complexity of your needs •h ow unpredictable your needs are; including any risks to you and others if adequate and timely care is not provided

Eligibility is always based on these needs, rather than any particular diagnosis or condition.

When should I be considered for NHS continuing healthcare? If you have ongoing health needs, there are times when staff should consider whether you may be eligible. These include: • when you are ready to be discharged from hospital and your long-term needs are clear • once a period of intermediate care or rehabilitation following a hospital stay have finished and it’s agreed your condition is unlikely to improve • whenever your health or social care needs are being reviewed as part of a community care assessment • if your physical or mental health deteriorates significantly and your current level of care seems inadequate • when your nursing needs are being reviewed. This should happen annually if you live in a nursing home • if you have a rapidly deteriorating condition and may be approaching the end of your life In these circumstances, your discharge staff, staff co-ordinating your intermediate care, GP or a member of the social work team should raise the issue of NHS continuing healthcare and assess your eligibility. If they don’t, make sure you ask for an assessment.

Assessment for NHS continuing healthcare You should be fully involved in the

throughout the process.

assessment and have your views taken

Most people will start by completing a checklist. This assesses your needs and indicates whether or not you should

into account. You can ask a relative or carer to help and support you 10

have a full assessment. If you’re referred for a full assessment, evidence will be collected from all relevant health and social care professionals to give a full picture of your physical, mental health and social care needs. Then a team of health and social care professionals involved in your care will look at this evidence and recommend whether or not you’re eligible. You and / or your representative can attend and participate at this meeting.

If you are eligible The team will forward their recommendation to the Clinical Commissioning Group (CCG) that is responsible for funding your care. The CCG will then discuss and agree a care and support package with you. This care and support package will be reviewed after 3 months and then at least every year. If your care needs change, your funding arrangements may also change.

Personal Health Budgets If you’re eligible for NHS continuing healthcare, you have the right to a Personal Health Budget. Personal Health Budgets allow more choice and control over the services and care you receive and can be used to pay for a wider range of items and services, including therapies, personal care and equipment. If you choose this, you will develop a care plan with your NHS team that will meet your personal health and wellbeing needs.

See NHS Choices for more information about Personal Health Budgets.

If you’re not eligible If you’re not eligible for NHS continuing healthcare, you’ll be referred to your local authority to decide whether you’re eligible for help to arrange or pay for care. However, you may be eligible for NHS-funded nursing care.

If you’re not happy with the decision If you’re turned down, you should be sent a letter telling you why. It should also tell you what steps to take and who to contact if you’re unhappy with the decision. • If you weren’t given a full assessment, you can ask the CCG to reconsider your case. If you are still dissatisfied you can use the NHS complaints system to pursue your case. • If you’re not happy after a full assessment, you can ask for the CCG to reconsider its decision. If you are still dissatisfied, you can ask for an independent review of your case. • If you’re not happy with any help you receive from the NHS, you have a right to complain. Details of the complaints procedure are available from the relevant organisation.

Fast Track If you are approaching the end of your life, you may be eligible for ‘fast tracking’ which allows you to bypass the full assessment process mentioned above. You must have a rapidly deteriorating condition that may be entering a terminal phase. If you’re eligible, a care package should be put in place as soon as possible, preferably within 48 hours. Age UK has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Age UK endorse any of the products or services. All information correct at the time of going to print.

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What is NHS-funded nursing care? NHS-funded nursing care is care provided by a registered nurse for people who live in a care home. The NHS will pay a flat rate contribution directly to the care home towards the cost of this registered nursing care.

Who is eligible for NHS-funded nursing care? You may be eligible for NHS-funded nursing care if: • y ou are not eligible for NHS continuing healthcare but have been assessed as needing care from a registered nurse • y ou live in a care home registered to provide nursing care

How will my needs be assessed? You should be assessed for NHS continuing healthcare before a decision is made about whether you are eligible for NHS-funded nursing care. Most people don’t need a separate assessment for NHS-funded nursing care. However, if you do need an assessment or you haven’t already had one, your clinical commissioning group (CCG) can arrange an assessment for you.

Outcome of the assessment If you’re eligible for NHS-funded nursing care, the NHS will arrange and fund nursing care provided by registered nurses employed by the care home. Services provided by a registered nurse can include planning, supervising and monitoring nursing and healthcare tasks, as well as direct nursing care. If you’re not eligible for NHS-funded nursing care and you don’t agree with the decision

about your eligibility, you can ask your CCG to review the decision.

What is the rate of payment for NHS-funded nursing care? NHS-funded nursing care is paid at the same rate across England. For 2016/17, the rate is £156.25 a week (standard rate). The increase will be backdated to April 1, 2016 for people who are getting NHS-funded nursing care from that time. This new rate is under review and may change on the January 1, 2017. Before October 1, 2007, there were three different levels or bands of payment for NHSfunded nursing care – low, medium and high. If you moved into a care home before October 1, 2007, and you were on the low or medium bands, you would have been transferred to the standard rate from that date. If you moved into a care home before October 1, 2007, and you were on the high band, NHSfunded nursing care is paid at a higher rate. For 2016/17, the higher rate is £215.04 a week. You’re entitled to continue on this rate unless: • you no longer have nursing needs • you no longer live in a care home that provides nursing • your nursing needs have reduced and you’re no longer eligible for the high band, when you would change to the standard rate of £156.25 a week, or • you become entitled to NHS continuing healthcare instead. NHS Choices has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does NHS Choices endorse any of the products or services. All information and figures correct at the time of going to print.

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Paying for permanent residential care Lots of people worry about paying for care for themselves or for a loved one. Most people will be expected to pay something towards the costs. If your care is being organised by the local authority, then the main steps of the process are: 1. Your local authority does a care needs assessment to identify what help you need. 2. They make recommendations about your needs and whether or not you need residential care – this is called a Care Plan. 3. They work out a budget to ensure you get what care you need – this is called a Personal Budget. 4. They do a means test, also called a financial assessment, to work out how much you should pay towards your care home fees and how much they will cover. If your care is arranged by the NHS or social services, you may not have to pay for some or all of the care. For more information, see our page on NHS continuing healthcare.

What does the means test look at? The means test will look at your income and capital, such as your savings and property. Whether you have to pay, and if so, how much, depends on how much income or capital you have. In certain situations, the local authority may assume that your capital generates an income which can be used towards pay your care home fees. If you and someone else jointly hold capital, such as a savings account, it’ll be treated as divided equally between the two of you. In some circumstances your home won’t be included in the means test, for example, if your partner still lives there.

What if I give away some of my money? You may think about giving away some of your savings, income or property to avoid higher care costs, and to give something to your relatives or charity, for example. If the council thinks that you have done this to avoid paying care fees they may still assess you as if you still had the money or property that you have given away. This is referred to as deprivation of assets. 14

How will my capital be treated in the means test? Amount of your capital (your savings and property) Over £23,250 Between £14,250 and £23,250

Less than £14,250

How it will be treated You must pay full fees (self-funding) The local authority will assume that this generates an income and this will be taken into account for your care home fee contributions. This will be ignored and won't be included in the means test

How will my income be treated in the means test? Certain types of income, such as money from certain disability benefits and pensions, may not be counted in the means test. All other income can be taken into account. As noted above, in some cases, the local authority may also assume that your capital generates an income, which will also be taken into account for your care home fees.

How much will I have to pay? After the means test the local authority should give you a written record of their decision of what you will have to pay and what they will pay, and how they calculated it. You should not be left with less than £24.90 a week after any contribution to your fees. This is known as your Personal Expenses Allowance.

What if I prefer a more expensive care home than the local authority will pay for? If you’d prefer to live in a care home that costs more than the local authority would usually expect to pay, it can arrange this, provided that someone else is willing to meet the difference in cost. This is usually known as a top-up or third-party payment. You could also choose a care home in another area to be closer to family or friends.

How do I pay my part of the fees? Generally the local authority pay the full amount to the home and collect from you the amount you need to pay. This may be different if you are paying a ‘top-up’ fee.

What if I run out of money? If you are paying fees yourself (called self-funding) and your capital goes down to less than £23,250, the local authority may assist with funding. You should request an assessment a few months before that happens. They should arrange one as soon as possible so you don’t have to use up your capital below that amount.

Paying for temporary care in a care home Local authority charging rules differ when a stay in a care home is temporary, rather than permanent. Some people go into a care home on a temporary basis to give themselves or their carers a break‚ or while they are recuperating from an illness. Others enter a home temporarily for a ‘trial’ period to decide whether they want to live permanently in that home. A more detailed account of the charging rules can be found in our factsheet Paying for temporary care in a care home. This factsheet is aimed at individuals who are aged 60 and over.

Paying for care if you have a partner Being part of a couple can affect a care home resident’s eligibility for local authority assistance with care home fees and both partners’ eligibility for social security benefits during the period in care. We have produced a factsheet that addresses this issue and includes sections on the valuation of jointly owned capital, temporary admissions and where both members of a couple go into a care home. This factsheet should be read alongside Age UK’s other factsheets on care home charging and benefits. Age UK has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Age UK endorse any of the products or services. All information and figures correct at the time of going to print.

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Personal budgets and direct payments - more control over your care Direct payments When your personal budget is paid directly to you this is called a Direct Payment. Direct Payments allow you to arrange your care as you wish. There are rules about what you can and can’t use direct payments for. The money must be used to meet the eligible needs identified in your assessment. You can use direct payments for anything that meets those needs, for example: • employ your own care workers • buy services from a voluntary or private agency • buy equipment or pay for home adaptations • purchase other types of support to meet your assessed needs • get to a café to meet your friends, a place of worship, or other places that are important to you. You can be personal and creative with your budget. For example, if one of your assessed needs is help with shopping, you could pay for someone to help you go shopping yourself rather than just pay someone to do it for you. You can’t use direct payments to: • pay a spouse, civil-partner, live-in partner, or a close relative who lives in the same household as you to care for you (although there may be exceptions to this) • buy services from your local council • pay for permanent care in a care home. You can, however, pay for a short stay of up to four consecutive weeks within any 12-month period if that meets an assessed need. Not everyone will feel comfortable or capable of managing their direct payments themselves, and you don’t have to if you don’t want to. You can always choose the option for the council to arrange care for you, and you can still have a say in what will best meet your needs. 15

Care services in your home If you need help around the home, a good option is to have a care worker come in to your home to help you.

Types of care and support Care and support comes in many forms and has many names used to describe it, including home help, care attendants and “carers” (not to be confused with unpaid family or friends who care for you). Care and support can suit you if you need: • personal care, such as washing or dressing •h ousekeeping or domestic work, such as vacuuming • cooking or preparing meals • nursing and health care • companionship Care and support can be very flexible, in order to meet your needs, and the same person or agency may be able to provide some or all of these options for the duration of your care: • long-term 24-hour care • short breaks for an unpaid family carer • emergency care • day care • s essions ranging from 15-minute visits to 24hour assistance and everything in between If you already know what you want, you can search NHS Choices directories for: • local care and support services and agencies • a list of national care and support organisations • s ervices that can help you stay safe and well in your home on a long-term basis; these services, often known as “supported living services”, can include financial, help with medication, advocacy, social and practical support • a place to live in a family who will care for you, known as “shared lives services” or adult placement services If you believe that you might benefit from some help at home, the first thing to do is to contact your social services department to ask for an assessment of your care and support needs. To contact social services, go to GOV.UK: find your local authority. If you are eligible for care and support services, the local authority may provide or arrange the help themselves. Alternatively, you can arrange your own care, funded by the local authority, 16

through direct payments or a personal budget. If you have chosen direct payments or a personal budget, or you aren’t eligible for local authority help and want to get care privately, you can arrange it in several different ways.

Independent care and support agencies If you use an independent care and support agency, you or the person you’re looking after has to find the care agency and pay them. The agency will provide a service through a trained team of care workers, which means you may not always have the same person visiting your home, although the agency will do its best to take your choices into account. Independent care and support providers are regulated by the Care Quality Commission (CQC). Care and support agencies must meet CQC’s national minimum standards and regulations in areas such as training and record-keeping. The CQC has the power to inspect agencies and enforce standards. Care and support agencies must vet care and support workers before engaging them by taking up references and carrying out Disclosure and Barring Service (DBS) checks on potential employees. Care and support agencies can also: • take over the burden of being an employer – for example, payroll, training, disciplinary issues and insurance • train their care and support workers through national qualifications and servicespecific training • replace workers when they are ill, on holiday or resign • put things right when they go wrong An agency will want to see you and the person you’re looking after so that they can assess your needs. This also means that a joint decision can be made about the most appropriate type of care and support. You can find out more from the UK Homecare Association.

What are the disadvantages of using a care and support agency? The main disadvantage is the cost of using an

agency. The agency will charge a fee on top of the payment made to the care worker to cover their running costs and profit.

Marie Curie Nurses can provide practical and emotional support for people near the end of their lives in their own homes.

You normally have to make a regular payment to the agency, which includes both the worker’s earnings and the agency’s fee.

Safeguarding vulnerable groups

Questions to ask when using a care and support agency The fees some agencies charge can be quite high. Before deciding to go ahead with an agency, you should ask questions about the fee and what it covers, including: • Does the agency check references? • What training and supervision do they provide? • What is their complaints policy? • Who will be responsible for insurance? • I s there any out-of-hours or emergency contact if needed? •W ill they be able to provide staff if your own care worker is ill or away? (If an agency contracts to provide care every day, it must ensure that it does.)

Hiring a personal assistant You can hire a “personal assistant” to act as a care and support worker for you. Personal assistants can offer you all that you’ll get from an agency worker, but you’ll also get the continuity, familiarity and ongoing relationship with your assistant. However, if you employ a personal assistant, you will then have the legal responsibility of an employer. This will include arranging cover for their illness and holidays.

The DBS makes decisions about who is unsuitable to work or volunteer with vulnerable adults or children. It makes this decision based on information held by various agencies and government departments. The service decides who is unsuitable to work or volunteer with vulnerable adults or children. If someone who is barred from working with children or vulnerable adults is working, volunteering or trying to work or volunteer with these groups, they are breaking the law. They could face a fine and up to five years in prison. Employers must apply for an enhanced DBS check (formerly known as a CRB check) when taking on new employees or volunteers to work with vulnerable adults or children. This includes a check of the barred lists. If an organisation fails to make the relevant checks, they can be penalised. If an organisation dismisses an employee or volunteer for harming a child or vulnerable adult, they must tell the DBS. The DBS must also be notified if any employee or volunteer harms a child or vulnerable adult, but isn’t dismissed because they leave voluntarily. If their organisation does not tell DBS, they will be acting illegally. Questions can be answered by the DBS call centre on 0870 909 0811, or by email.

Employing a care worker on a private basis

Care and support from charities

If you employ a care worker privately, you will not be obliged to use the DBS scheme, but you can use it if you choose to. You need to ask social services or the police to make the checks on your behalf. The care worker must have already applied to be vetted, and must consent to the check.

Charities such as Age UK and Carers Trust can provide home help and domestic assistance services. The Carers Trust supports carers by giving them a break from their caring responsibilities through care and support services.

If you have concerns about the suitability of someone you employ privately to work with a vulnerable adult or child, you can ask Adult Social Care to investigate the matter. They can refer the worker to the ISA on your behalf.

GOV.UK has more information on becoming an employer, while Which? Elderly Care also has advice on employing private individuals.

NHS Choices has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does NHS Choices endorse any of the products or services. All information correct at the time of going to print.

Content supplied by:

KIRKSTALL COURT CARE HOME

• Specialist unit for alcohol related brain injury (Korsakoffs Syndrome) • Quality person centred care • All bedrooms single and en-suite • Large communal lounges and dining areas

• Pleasant courtyard gardens • Rehabilitation programmes tailored to each individual’s unique needs

119-129 Vesper Road, Leeds LS5 3LJ

Telephone: 0113 259 1111 An established Residential Care Home which has great character and appearance with over 20 year’s history behind it. A small extension is planned for 2017 to improve the homely atmosphere of the home, which was formerly a Grade II listed building and vicarage to St. James’ Church.

❚ Residential and Dementia Care, Respite and Day Care ❚S ingle and double rooms for people who want to share or married couples ❚T elephone, TV, DAB radio, Internet and Sky points in each room

Residential and Dementia Care Home 27 Church Street, Heckmondwike, West Yorkshire WF16 0AX Tel: 01924 404122 Fax: 01924 409938 18

Directors: David and Gillian Bolland

The Motability Scheme The Motability scheme allows some disabled people getting DLA, PIP or War Pensioners’ Mobility Supplement to obtain a car, powered wheelchair or scooter. The scheme uses some or all of your mobility benefit payments to cover the cost of “contract hire” or “hire purchase” of an appropriate vehicle. You can also pay an extra amount of money if you want a more expensive vehicle. With hire purchase, the price of the car will be agreed directly with the Motability dealer, and you will own the vehicle outright at the end of the agreement. With contract hire, you won’t own a vehicle, but you will get a new car every three years, full insurance for the driver and passengers, servicing, maintenance and repairs, vehicle excise duty, replacement tyres and breakdown cover. Adaptations to the car can be made if needed, although there may be an extra charge for some adaptations. Under the Motability scheme, cars can also be adapted for people in wheelchairs. If you don’t need or want a car, you can transfer your allowance to lease a scooter or powered wheelchair. Content supplied by: NHS Choices has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does NHS Choices endorse any of the products or services. All information correct at the time of going to print.

Contact and support We are here to answer any questions you may have about the Mobility Scheme. You can contact our Customer Services team directly or one of our Scheme partners depending on the nature on your enquiry. Tel: 0300 456 4566 8am-7pm Monday to Friday, 9am-1pm Saturday (Monday 9am-11am is our busiest period. You may find it easier to call outside these times.) If you have specialist Minicom equipment, call our textphone number on 0300 037 0100 or speak to us through a British Sign Language (BSL) interpreter for deaf customers who have an enquiry about the motability scheme.

How to use your health services There are a range of healthcare services available to help you find the right expert care to meet your needs. Choosing the service most appropriate to your symptoms means you get the right treatment in the right place.

2020

Choking. Chest pain. Suspected stroke. Blacking out. Severe bleeding.

For symptoms of serious illnesses and major accidents, choose A&E (Accident & Emergency).

Cuts. Sprains. Rashes. Minor fractures.

For trips, falls, skin complaints and minor injuries, choose Walkin Health Centre or Minor Injuries Unit or Urgent Care Centre.

Vomiting. Ear pain. Feeling ill.

For infections and persistent symptoms or if your child has a high temperature, choose your GP.

Diarrhoea. Minor infections. Headache. Bites and stings.

For tummy upsets, insect bites and stings, coughs and colds and travel advice, choose a pharmacist.

Unsure? Confused? Need help?

For absolutely any questions about your health, choose NHS 111 service.

Grazed knee. Sore throat. Cough.

For minor ailments, grazes, bruises and similar problems, choose self-care.

The Care Quality Commission is here to make sure health and adult social care services including hospitals, home and residential care as well as GPs in England provide people with safe, effective, high-quality care. We publish independent inspection reports and ratings about services – information you can use when you’re choosing care for yourself, or a loved one. You can use our website to search for services you might be interested in by geographical area, or by specialism. For example, a care home that might offer specialist care for someone who has dementia. We also welcome your feedback on the care you have received – good or bad. We use this information to help inform our inspections and can alert authorities including local social services, if there are safeguarding concerns about care being provided. You can visit our website at www.cqc.org.uk to find our inspection reports, or share an experience of care. You can also call us to share an experience of care on 03000 61 61 61. Here are some tips to help you choose your care.

Social care Top tips 1

The Care Quality Commission (CQC) registers all care homes and home care agencies. You can find out which ones support specific groups of people, such as people with a learning disability or those living with dementia. CQC’s Chief Inspector for Adult Social Care, Andrea Sutcliffe always uses ‘The Mum Test’: is a care home safe, caring, effective, responsive to people’s needs and well-led? In other words, is it good enough for my Mum (or anyone else I love and care for)? Look for care homes and home care agencies where the staff involve people who use services and their families and carers, and treat individuals with compassion, kindness, dignity and respect.

Whether you are being cared for in your own home or in a residential setting, the staff looking after you need to be skilled, kind and supportive. They should also be capable and confident in dealing with your particular needs. You should always feel that their support is helping you to live the life you want to. A care home will be a home for you or your loved one. Residents should be treated as individuals with their likes and dislikes taken into account. Think about whether a home is close enough to family, friends, and community facilities. Look at how well-led and managed a home is. What does it have in place to ensure that it delivers high quality care? Does it promote meaningful activity and connect the home with the community?

If you or a loved one needs help with day-today care, you can contact your local council’s social services department. They will ‘make an assessment of your needs’ and depending on circumstances, may be able to help you access financial help. For more advice visit Age UK’s website www.ageuk.org.uk /home-and-care.

If you would like to organise your care yourself, you can find a care worker or personal assistant through an agency. Your local social services department should be able to provide details of approved agencies.

CQC’s ratings will identify services as:

Outstanding Good ● Requires improvement ● Inadequate ● This will help you make informed choices around your care. There’s also useful advice on the Social Care Institute for Excellence’s Find me good care website www.scie.org.uk/findmegoodcare/

Safeguarding adults who receive social care is everybody’s business. If you are concerned about the safety of a loved one receiving care, contact the service provider in the first instance. You can also contact social services at your local council. If you feel a crime has been committed, contact the police. You can share your safeguarding concerns with us on our website or contact our National Customer Services on 03000 616161.

The Care Quality Commission has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does the Care Quality Commission endorse any of the products or services.

GP Top tips

If you are new to an area you can find details of local GP services such as doctors’ practices, out-of-hours services and walkin centres in our online directory of care services www.cqc.org.uk/content/doctorsgps

7 2

You can search any of these services by the name of the service, a place name or your postcode at www.cqc.org.uk

After an inspection, CQC publishes its findings in a report on its website. You can use these reports to check and compare services in your area.

Telephone: 03000 616161 • Web: www.cqc.org.uk

CQC rates all GPs to help people make choices about where they get treatment. This will be on a four-point scale:

Outstanding Good ● Requires improvement ● Inadequate ●

There are already over 1,000 reports about GP practices published on the CQC website.

Last year, CQC launched its new-style inspection reports for GPs – looking at the five key areas SAFE, EFFECTIVE, CARING, RESPONSIVE and WELL-LED – you can use the reports to compare local GPs and choose services.

You can also use these new style inspection reports to find out more about local services and choose the one that is best for your needs.

CQC will also look at how specific population groups are treated and give a rating. For instance how well they serve: Mothers, children and young people, vulnerable older people (over 75s) and people with long-term conditions. People will be able to choose a GP service that rates highly on the areas that matter to them.

We welcome your feedback (good and bad) on the services you, or a loved one, receives from your GP. You can share information with us online at http://www.cqc.org.uk/share-yourexperience-finder or call us on 03000 61 61 61.

/CareQualityCommission

@CareQualityComm

Mental health Top tips

If you are concerned about your mental health you should first visit your GP.

Outstanding Good ● Requires improvement ● Inadequate ●

Your GP will assess you and offer appropriate advice or treatment. They can refer you to a psychological treatment service or a specialist mental health service for further advice or treatment.

Mental health services are free on the NHS but you will usually need a GP referral. If you don’t want to go to your GP you may also have the option of self-referral. This means you can go directly to a professional therapist. The NHS Choices website has a searchable directory of services which you can use to find a service near you.

If you are referred to a specialist mental health service, you can ask which other providers offer the same service in your local area and make a choice.

CQC rates mental health providers to help people make choices about where they get treatment. They will use a four-point scale:

CQC uses information from the public and holds listening events across the country where people can talk with inspectors about their experience of services.

You can look at our inspection reports and ratings for mental health services or share your experiences of care (good or bad) by visiting www.cqc.org.uk

Telephone: 03000 616161 • Web: www.cqc.org.uk /CareQualityCommission

@CareQualityComm

In April CQC launched its new-style inspection reports for mental health providers – looking at five key areas of Safe, Effective, Caring, Responsive and Well-Led – you can compare reports on CQC’s website to help choose a provider.

Leeds Age UK Leeds has been working with older people in Leeds since 1975. We are an independent charity that wants to see a society where older people are respected, valued and able to contribute to their community. We work with all older people who live in Leeds to improve the quality of later life.

prevent unnecessary admissions and readmissions to hospital, reduce delays in being discharged home and improve the patient experience. Our team can also provide one to one support once back home to promote independent living.

We offer a number of services and activities that recognise you want choice in how you are supported, and that are designed to help you keep your independence and quality of life.

Information and Advice

Independence at Home We have an experienced team of Wellbeing Coordinators and Caseworkers who will arrange to meet you in your home, find out what kind of assistance you require and then help you to gain the assistance. This could include help with managing your finances and claiming the benefits youâ€™re entitled to, housing information, arranging for aids and adaptations, or getting involved in social and activity groups. We are able to identify what other services there are in your area and can help you access them. This service is available to older people who feel isolated or are finding it harder to get out and about. Our current projects include: Mental Health Hospital After Care Mission Possible - Aged Veterans Supported Wellbeing & Frailty Connect Well â€“ Social Prescribing service with Well-Being Coordinators based in GP Surgeries within the North Leeds area.

Hospital to Home service The Age UK Leeds Hospital to Home service is based at St James Hospital in Leeds and operates 7 days a week, including bank holidays from 9am to 8pm. The service offers support to Leeds residents aged 60+ following an attendance at A&E. It aims to 24

The team is based in Chancellor Wing and can be contacted on 0113 2065052 or internal bleep 2148

We offer face to face appointments, a drop in and telephone advice on a range of issues including benefits and pensions, housing, care and local services. We also offer home visits to help with completion of Attendance Allowance forms. We also offer free legal sessions once a fortnight delivered by local solicitors.

Advocacy If you need someone to help you make sure that your voice is heard then our Advocacy service may be able to help. Issues we support with include Community Care, hospital discharge, residential and nursing home support and getting legal advice.

Ageing Well We provide opportunities for older people to get more active, take part in social activities and learn new skills. Come and take part in our Creative Writing sessions, or join our Healthy Walking Group. Join our Silver Surfers if you want to learn about computers, the internet, tablets and smartphones. There are courses for absolute beginners as well as people wishing to develop their skills. Our Sage project offers a range of support and social opportunities for older lesbian, gay, bi-sexual and transgender people. Digital Angels offers one to one volunteer support at home to isolated older people in South Leeds who wish to get online and use the internet to

connect with people via email, skype etc. Walking With Confidence can provide a volunteer to support you to build up your self confidence to get out and about again – it could be a walk to the local shop or a trip to the local luncheon club.

Products and Services As an agent of Age UK Enterprises we offer a range of quality and reliable products and services designed for the needs of the over 50s. Call into the office in our city centre premises or phone us on 0113 389 3005 to find out about products and services including insurance for home, car and travel; funeral plans; personal alarms; mobility and healthcare products. All net profits from the sale of these products and services go to support our charitable work both locally and nationally. Home, Car and Travel* Insurance are provided by Ageas Insurance Limited. * Subject to medical screening and acceptance by the underwriters. Age UK Leeds Trading Limited is an appointed representative of Age UK Enterprises Limited which is authorised and regulated by the Financial Conduct Authority for insurance mediation and introducing potential annuity customers.

To find out more about Age UK Leeds:

Visit our website: www.ageukleeds.org.uk or call us on 0113 389 3000

The Arch Café The Arch is our café sharing the Bradbury Building in Leeds city centre. Open six days a week for breakfast, lunch and our special afternoon teas, we serve delicious homemade food available to eat in or take out. Why not visit next time you’re in town? All profits from the café help Age UK Leeds continue their vital work in communities across Leeds. 25

Specialist support for people with dementia If you have dementia, our Memory Support Workers can help you to stay active and participate in the community to help you live well. Our Memory Support Worker service is a joint partnership with the Leeds and York Partnership NHS Foundation Trust developed to provide personalised information, support and advice to people with dementia, their families and carers. This can include signposting to local services like our activity groups, and helping you to strengthen existing support networks so you can maintain your independence for as long as possible. Alzheimer’s Society is the UK’s leading support and research charity, providing information, advice and support to people with dementia, their families and carers. We are committed to putting you at the heart of everything that we do, and our services are continually informed by our growing understanding of dementia and what you need to live well with it.

Get in touch with us today to find out more. Lynn Welsh, Memory Support Team Manager Leeds and York Partnership NHS Foundation Trust T: 0113 8555351 E: memorysupport.lypft@nhs.net

‘As a Memory Support Worker, I’m here to help people with dementia stay connected to their local community and living at home for as long as possible. It’s rewarding to see how the information and support I give can make such a difference to the lives of people with dementia and those around them.’ Gemma Stones, Memory Support Worker for the Leeds area In partnership with

Leeds and York Partnership NHS Foundation Trust

“My Support Worker has seemingly put herself out to help me, and is always able to help and support. She is the ‘lighthouse in the stormy sea’” Person with dementia

alzheimers.org.uk 27

The British Red Cross has been delivering health and social care services since the NHS was established. We provide vital support to help people live safely and independently in their own homes. Our team, based within Leeds General Infirmary, offers short-term support and advice in the initial weeks following a hospital stay to help you regain your independence and the confidence to get back in to your daily routine. We can also help you reconnect with your community and

find new interests and activities. Our staff and volunteers will work with you to discuss how we can help you and build a support plan to suit your needs.

Practical Support We are here to lend a hand with practical tasks in the home that you may be finding difficult. We can help you with a range of tasks, such as assisting with shopping, prescription collection,

Photograph courtesy of Rawles, Simon (BRC)

Local Advice Our team of staff and volunteers have excellent knowledge of local services and organisations and can help you access financial advice, nutrition, wellbeing, legal advice, benefit entitlement and other types of support. They can also assist by connecting you to other organisations that can help you live safely and independently in your own home for longer, including home adaptations, fire safety checks, trips and falls pendent alarms and home safety equipment.

Mobility Aids We can provide short-term loans of wheelchairs and other mobility aids to people experiencing difficulty with mobility. The wheelchairs can also be used by the staff and volunteers to help you attend hospital appointments or events.

Contact

opening letters and paying household bills, signposting to other organisations and escorting to local clubs or medical appointments.

Emotional Support British Red Cross staff and volunteers will visit you at home to offer company and friendly chats. They can provide you with information on social groups in your local area and help you to build new friendships.

If you are interested in finding out more about how we can support you or a family member or friend, please contact us on 0113 392 5799.

Volunteer with us We are always looking for new and enthusiastic volunteers to join our team. If youâ€™re caring, compassionate and up for a natter, this could be the perfect role for you. Just a few hours a week of your time can change someoneâ€™s life. Visit www.redcross.org.uk/Get-involved/ Volunteer/Independent-living for more information or give us a call on 0113 392 5799.

NHS Hospitals and services in Leeds The Leeds Teaching Hospitals NHS Trust

St James’s University Hospital

The Leeds Teaching Hospitals NHS Trust

Beckett Street, Leeds, West Yorkshire, LS9 7TF

Wharfedale Hospital

Newall Carr Road, Otley, West Yorkshire, LS21 2LY

Tel: (0113) 243 3144

Tel: (01943) 465522 Wetherby

The Leeds Teaching Hospitals NHS Trust

Chapel Allerton Hospital

Wharfedale

Chapeltown Road, Leeds, West Yorkshire, LS7 4SA

The Leeds Teaching Hospitals

Tel: (0113) 262 3404

NHS Trust

Leeds Dental Institute The Worsley Building, Clarendon Way, Leeds, West Yorkshire, LS2 9LU

Bardsey

The Leeds Teaching Hospitals

Shadwell

NHS Trust

Seacroft Hospital

Horsforth

Tel: (0113) 244 0111

HEADINGLEY

CHAPEL ALLERTON

York Road, Leeds, West Yorkshire, LS14 6UH

Whinmoor

Tel: (0113) 264 8164

KIRKSTALL

LEEDS

Pudsey

Micklefield

HOLBECK

Morley Methley

Humanity House, 2 Armley Court, Armley Road, Leeds, LS12 2NB Tel: (0113) 201 5240 The Leeds Teaching Hospitals

Leeds

NHS Trust

Leeds General Infirmary

Great George Street, Leeds, West Yorkshire, LS1 3EX

Age UK Leeds, Bradbury Building, Mark Lane, Leeds LS2 8JA

Tel: (0113) 243 2799

Tel: (0113) 389 3000

Useful contacts A

Action on Elder Abuse 020 8835 9280 We work to protect, and prevent the abuse of, vulnerable older adults. Action on Elder Abuse, PO Box 60001, Streatham SW16 9BY I www.elderabuse.org.uk I enquiries@elderabuse.org.uk

Leeds Citizens Advice Bureau 0113 223 4400 City Centre Bureau, Westminster Buildings, 31 New York Street, Leeds LS2 7DT I www.leedscab.org.uk

Admiral Nursing DIRECT 0845 257 9406 This helpline has been set up to provide people with an opportunity to talk through their worries and concerns about themselves, friends or relatives with dementia. The lines are open on Tuesdays and Thursdays between 11am and 9pm. Callers can leave messages any time and request a call back I direct@fordementia.org.uk

Mind (National Association 020 8519 2122 for Mental Health) The leading mental health charity in England and Wales. We work to create a better life for everyone with experience of mental distress. I www.mind.org.uk I contact@mind.org.uk

Age UK Leeds Bradbury Building, Mark Lane, Leeds LS2 8JA I www.ageukleeds.org.uk

0113 389 3000

Arthritis - National Rheumatoid 0800 298 7650 Arthritis Society (NRAS) or 0845 458 3969 Provide information, support and advice for people living with Rheumatoid Arthritis. I www.nras.org.uk

B British Red Cross 0113 201 5240 Humanity House, 2 Armley Court, Armley Road, Leeds LS12 2NB I www.redcross.org.uk

C CareAware 0161 707 1107 A one stop shop for free advice on care fee funding for older people. I www.careaware.co.uk I enquiries@careaware.co.uk Care Quality Commission (CQC) National Correspondence, Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA I www.cqc.org.uk I enquiries@cqc.org.uk

03000 616161

Cruse Bereavement Care 0844 477 9400 Cruse Bereavement Care is here to support you after the death of someone close. I www.cruse.org.uk I helpline@cruse.org.uk

D DIAL 0113 378 2990 (Disability Information Advice Line) DIAL Leeds provide information and advice to disabled people, their family and professionals on all aspects of living with a disability. DIAL (LEEDS), The Mary Thornton Suite, Armley Grange Drive, Leeds, LS12 3QH I www.dial-leeds.org.uk Disability Benefits – for Disability 0845 712 3456 Living Allowance and Attendance Allowance I Textphone: 0845 722 4433 I www.direct.gov.uk/en/Dl1/Directories DG_10011169

E Elderly Accommodation Counsel 0800 377 7070 A national charity that aims to help older people make informed choices about meeting their housing and care needs. It is now more commonly known as EAC. I www.eac.org.uk I info@firststopadvice.org.uk

I Integrated Care Council 01379 678243 (Formerly the National Homecare Council) The Integrated Care Council is a body which brings together British public and independent sector organisations who commission or directly provide support for people living at home.

N National Osteoporosis Society 0845 450 0230 Advice, information and support group for people with osteoporosis. I www.nos.org.uk NHS 111

111

P Parkinson's Disease Society I www.parkinsons.org.uk

0800 800 0303

R Royal Voluntary Service 0845 608 0122 A volunteer organisation that enriches the lives of older people and their families across Britain. We support older people by giving time and practical help to help them get the best from life. Royal Voluntary Service, Cardiff Gate, Beck Court, Cardiff Gate Business Park, Cardiff CF23 8RP I www.royalvoluntaryservice.org.uk

S Stroke Association 0845 3033 100 Advice and information for stroke patients and their families. I www.stroke.org.uk

T The Department of Work and Pensions I www.dwp.gov.uk The Pension Service 0845 606 0265 I www.dwp.gov.uk/about-dwp/customerdelivery/thepension-service

OCTAGON DE S IG N & M A R K E T I NG LT D

Every possible care has been taken to ensure that the information given in this publication is correct at the time of going to print. Whilst the publisher would be grateful to learn of any errors, it cannot accept any liability over and above the cost of the advertisement for loss there by caused. No reproduction by any method whatsoever of any part of this publication is permitted without prior written consent of the copyright owners. Octagon Design & Marketing Ltd. ©2017. Hawks Nest Cottage, Great North Road, Bawtry, Doncaster, South Yorkshire, DN10 6AB. Telephone: 01302 714528 Options Leeds is published by Octagon Design and Marketing Ltd with editorial contributions from The Leeds Teaching Hospitals NHS Trust, Age UK, the Alzheimer’s Society, British Red Cross, the CQC and NHS Choices. The editorial contributors have not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor do the editorial contributors endorse any of the products or services.

Designed & Compiled by Octagon Design and Marketing Ltd., Hawks Nest Cottage, Great North Road, Doncaster, South Yorkshire, DN10 6AB. Tel: 01302 714528