Options Chester - A guide to your discharge from hospital Summer 2015

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Chester Summer 2015

WORKING IN PARTNERSHIP WITH

A guide to care and independent living

Countess of Chester Hospital NHS Foundation Trust

Cheshire

The journey of your care OCTAGON DE S IG N & M A R K E T I N G LT D

Ward: Number:

page 4

Welcome and Introduction

page 22-23 page 5-8

Your stay in hospital and expectations from us and you

page 9-11

Leaving hospital

page 20-21

Frequently asked questions

Contacts you may need

Improving the lives of disabled people.

DIAL West Cheshire aims to enable disabled people and older people to live sustained, independent lives.

Advice and Information We offer a FREE, confidential and independent Advice & Information Service with a focus on welfare benefits and disability rights for people with disabilities and health conditions. Contact our Disability Rights Centre for advice about benefit entitlement and help to complete forms, blue-badge parking, community care etc or information about other local support services.

Tel: 01244 345655.

Shopmobility The DIAL West Cheshire Shopmobility Service provides daily hire of mobility scooters and wheelchairs to enable people with mobility difficulties to access shops and other facilities in Chester city centre. As part of Shopmobility West Cheshire we work with partners in Ellesmere Port, Northwich and Winsford

to provide a Shopmobility Service across the Cheshire West and Chester area.

A wide range of disability aids and mobility equipment (including wheelchairs, walking frames, riser/recliner chairs and mobility scooters) is available for sale at very competitive prices in addition to a repair and maintenance service. Tel: 01244 312626.

Disability aids and mobility equipment • Daily hire • Longer term loan • Sales • Servicing and repairs DIAL West Cheshire Shopmobility Service Kaleyards car park, Frodsham Street Chester, CH1 3JH Tel: 01244 312626 shopmobility@dialwestcheshire.org.uk

DIAL West Cheshire Disability Rights Centre & Café DIAL House, Hamilton Place Chester, CH1 2BH Tel: 01244 345655 contactus@dialwestcheshire.org.uk

Supported by www.dialwestcheshire.org.uk Company Number: 8831095

Charity Number: 1156120

Contents

page

Every possible care has been taken to ensure that the information given in this publication is accurate.

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. Octagon Design & Marketing Ltd has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Octagon Design & Marketing Ltd endorse any of the products or services. 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. Š2015.

Hawks Nest Cottage, Great North Road, Bawtry, Doncaster DN10 6AB. Tel: 01302 714528

Countess of Chester Hospital NHS Foundation Trust has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Countess of Chester Hospital NHS Foundation Trust endorse any of the products or services.

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Welcome and Introduction 4 What is the role of the hospital and what you can expect from us 5 Your stay in hospital and what you can expect from us 6 What we expect from you and keeping you safe 7 Your Hospital Team 8 Planning for you to leave hospital 9 Support when leaving hospital 10 Before you go home 11 NHS continuing healthcare 12 Who is eligible for NHS continuing healthcare 12 Reviews 13 NHS-funded nursing care 14 The Motability Scheme 15 How to use your health services 16-17 Employing a professional carer or personal assistant 18-19 Frequently asked questions 20-21 Questions I want to ask 22 Contacts and Support you may need after discharge 22-23 Age UK, Going home from hospital?

24-25 The Alzheimer’s Society 26-27 The Care Quality Commission Social Care top tips 28 NHS Hospitals and services in Chester 29 Directory 30

Welcome and Introduction Welcome to the Countess of Chester Hospital NHS Foundation Trust This booklet is intended to help you, your partner, carer, relatives and friends understand your journey from your period of ill health through to your recovery and transfer from hospital.

This will cover: ■ The role of the hospital and what you can expect from us ■ What we expect from you ■ Your stay in hospital ■ Leaving hospital ■ How your care will be handed over to a community team if appropriate ■ How you will be transferred home or to a care facility that will provide the service you need after the critical phase of your illness ■ Frequently asked questions ■ Contacts you may need after leaving hospital If you have any questions or comments please speak to your ward manager, matron or nurse in charge.

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What is the role of the hospital and what you can expect from us The role of the hospital

Your admission

Hospitals are the right place to be in when you are in need of acute medical or surgical care.

When you arrive at the hospital either as a planned or an emergency admission, the nursing team looking after you will begin the admission process. This is the time that the nursing staff can take all of the important details needed to make sure that you receive the best possible care whilst you are a patient. It also provides an opportunity for you to ask any questions.

However, when you have recovered from this critical phase, it is important that your stay is not delayed for any reason so as to avoid the risks of infection and ailments from prolonged stays in hospital.

What you can expect from us We expect our staff to be courteous to you at all times and in return we would expect the same courteous behavior from you and any of your visitors.

If there are any behaviours that the staff feel are unacceptable then these will be discussed with you and your visitors and agreements sought as to how we can agree a change.

For your safety While you are a patient in hospital, it will be necessary for you to wear an identification wristband. This states your name, sex, date of birth, unique hospital number/NHS number and the ward you are staying on. For your safety your wristband information will be checked and verified before certain procedures and when you are given medicine , if you are not wearing one please inform ward staff.

Privacy and dignity We aim to provide the highest possible standards of privacy and dignity to all patients all of the time. Your toilet and bathroom will be just for your gender and will be close to your bed area.

However patients may be in a mixed sex bay for a short period of time if there is a clear clinical indication why this is required and this will be explained to you.

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During this time you may have various tests including x-rays and scans as well as procedures such as blood tests to aid diagnosis and treatment. You will be looked after by a team of doctors and nurses and treated with medications and therapies that might involve having an intravenous drip . It may also involve you or your relative being admitted to the Intensive Care Unit if needed.

Your stay in hospital and what you can expect from us Moving to another bed, ward or hospital As you recover during your stay it may be necessary to move you to a different ward or hospital in order to continue with your care, this will be due to clinical needs and will help accommodate emergency admissions. If you do have to move at any point, the reasons for this will be clearly explained to you.

Carers support If you are a relative or carer of a patient who may require particular support needs, arrangements may be made for you to stay with the patient, although for further information with regards to facilities available it is recommended that you discuss these issues with the ward manager or nurse in charge.

Dietary requirements If you require any special diet, please tell a member of staff and this will be arranged as necessary. We will try to ensure you can enjoy your meals undisturbed by hospital staff and visitors.

Language assistance If you have any language difficulties please tell a member of staff. We will ensure that you get the support you need where possible. We can provide telephone and sign language interpreting.

Reasonable adjustments If you have any additional needs that require a reasonable adjustment, such as communication difficulties you will be asked for your hospital passport. You can access a Hospital Passport prior to your admission from http://www.coch.nhs.uk or you can request one to be provided to you on admission. If you already have your own version of a Health Passport please ensure you provide a copy to staff.

Safeguarding The Trust is committed to caring for it’s vulnerable patients and works with the Local Safeguarding Adult Board to ensure any safeguarding concerns are appropriately recognised and reported within the Hospital.

Safeguarding concerns are incidents of abuse, whether intentional or inappropriate care, these can be in the form of physical, sexual, neglect, financial, psychological, discriminatory or institutional abuse. For more information on the types of abuse and responses see the following website: http://www.cheshirewestandchester. gov.uk/ and search Vulnerable Adult.

Should you have any safeguarding concerns about yourself or another patient whilst at the Hospital please notify the Nurses in your area or alternatively you can report to Social Services on 0300 123 8 123.

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What we expect from you and keeping you safe What we expect from you Your medicines You and/or your partner/ carer /relatives must take responsibility for identifying any issues at the earliest opportunities which could delay you leaving the hospital.

Where many relatives regularly visit a patient, we ask that one family member only is selected to contact the nursing staff for updates on the patients condition and share this information with the rest of the family.

Where relatives/carers would normally assist in your care and would like to continue doing so whilst in hospital, for example assisting with meals, this can be arranged following a discussion with the ward manager/nurse in charge.

The Trust, as a provider of healthcare, leads by example in relation to nosmoking on its premises. Smoking is therefore not permitted in any part of the hospital or grounds.

Adopt some simple steps to help keep you safe during your stay in hospital Preventing blood clots ■ Wear your hospital stockings if advised and move as often as you can

■T ell us if you have an allergy or if you don’t understand what your medicines are for ■ Bring any medication that you are using at home into hospital ■ Ask your doctor or pharmacist about any concerns you may have

Preventing infection ■ Wash your hands before and after visiting the toilet and before all meals ■ Visitors should wash their hands or use hand sanitizer when entering and leaving the ward area

Preventing pressure ulcers/sores ■ If you can, try to keep mobile even in bed and call if you are uncomfortable ■ We are very happy to help you change position and can provide a special mattress or cushion for your support where required

Preventing falls ■ Wear well fitting footwear when walking ■ Use your usual walking aid ■ If you need any assistance, tell us

■ Try to do simple leg and ankle exercises ■ Drink fluids as recommended

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■ Take blood thinning tablets or injection’s as advised

Your Hospital Team

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In the hospital you will find a multidisciplinary team consisting of doctors, nurses, therapists, pharmacists, specialist nurses, social workers and discharge liaison nurses. Some, or all, will be involved in your care and will begin to plan your transfer from hospital as soon as you are admitted.

The team of clinical experts will explain their key roles to you if they are involved in your hospital care. The multidisciplinary team will identify your needs and will discuss what treatments, help or support is available to you to improve your independence.

The members of the team involved in your assessment will discuss their findings and together with you will make a plan for your transfer from hospital. To the right you will find some of the uniforms you will see around the hospital.

Countess of Chester Hospital NHS Foundation Trust

Who’s who

Shown below are the uniforms of our healthcare professionals who you may come into contact with during your stay. If you have any questions about these uniforms, please speak to any member of staff or contact the Patient Advice and Liaison Service (PALS) on 01244 366066. If you’re unsure as to who a member of staff is, please ask to see their ID badge.

Our Senior Nurses

Director of Nursing

Deputy Director of Nursing and Head of Nursing and Midwifery

Matron

Lead Nurse/Lead Midwife

Nurse Consultant

Our Ward or Departmental Staff STUDENT

Student

Senior Midwives, Neonatal, Critical Care, Coronary Care and Emergency Department Nurses

Student Nurses and Midwives

Ward Manager, Deputy Ward Manager and Specialist Nurses

Staff Nurses and Midwives*

Emergency Department, Acute Medical Unit, Critical Care, Coronary Care and Neonatal Unit Nurses

Domestics*

Housekeeper

Ward Clerk*

Physiotherapist

Occupational Therapist

Radiographer

Dietician

Theatre staff

Porter

Play Specialist

Care and Comfort Support Worker

Nursing, Midwifery Assistants and Maternity Support Workers*

* Please note that the patterns shown are for reference only and are not to scale

Other Staff

Speech and Language Therapist

Radiology Assistant

Physiotherapy and Occupational Therapy Assistants

Equipment Library

Planning for you to leave hospital

The plans that are made for you to leave hospital are an important part of your stay whilst you are here. We need to start making these plans as soon as possible, so we have the time to arrange any services or special help you may need after you leave hospital.

The majority of patients will go home from hospital with no additional support.

Additional support Those patients identified as requiring further therapy assessment in their own home or requiring low level support on transfer home will be assessed by the Rapid Response Team.

Rapid Response Team Rapid Response is a team of Therapists, Nurses, and Community Support Workers that are able to support you with care and rehabilitation in your own home immediately on discharge. Their role is to help you settle back into your own home, assist you with your every day activities, and help you improve your independence and quality of life.

The team can help and support you for up to two weeks on your return home.

If you have ongoing care needs after this you will be seen by a Social Care Assessor who will arrange for a longer term package of care to be set up.

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When the time comes for you to go home, the ward manager or your nurse will give you and your relatives as much warning as they can, so that you can make the necessary arrangements.

Support when leaving hospital Social services If patients require a supportive package of care to return home they will be assessed by a Social Worker. The Social Worker will gather information from the rest of the multidisciplinary team which will enable the Social Worker to assess your support needs and establish eligibility for services.

The Social Worker will then arrange for appropriate care to support your return home and to enable you to maximize your independence. Your Carers needs will also be assessed during this time. As Social care provision is means tested there may be charges for care services dependent on your financial situation.

If, due to a significant change in your care needs, you require support in arranging accommodation other than your own home, then the Social worker can assist you in identifying and arranging.

Rehabilitation Those of you who no longer need an acute hospital stay but have been assessed by the multidisciplinary team as needing further rehabilitation prior to you returning home will be offered a rehabilitation bed.

Rehabilitation beds are provided in various settings and the multidisciplinary team will assess your level of need and where your rehabilitation needs will be best met.

Care home placement If it is felt that you can no longer manage at home even with support in place the decision may be made for you to move into a care home. You and your family will be involved in this decision. The team involved in your care will inform you of what type of on going care you need i.e. nursing or residential . You will be supported

by Nurses and Social Workers from within the Integrated Discharge Team.

You and your family will be expected to choose three homes with vacancies to enable transfer out of hospital to take place.

If you no longer need to be in hospital and there is a delay in the start of your care package or preferred placement you cannot choose to remain in hospital. You will be transferred to a bed within a non hospital setting whilst this is arranged.

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Before you go home Please make sure you have made arrangements to get home and that there is someone to look after you when you get there. If you have any problems please mention them to your nurse. We will only arrange ambulance transport if it is necessary.

Please make sure you have all of your belongings, including any cash or valuables you handed in for safekeeping. If you leave any property behind, this will be put into the Patient Property Store where it is kept for only one month.

Discharge check list ■ Have you arranged suitable transport home?

■ Do you have your house keys?

■ Do you have any home support such as carers who may need to know when to expect you home?

■ Does your next of kin know that you have been admitted? Are they able to offer any support on discharge if needed?

■ Do you have suitable outdoor clothing and shoes to travel home in?

■ Have you discussed any concerns you may have regarding any of your medications or possible side effects that you may need to be aware of when you go home?

■ Have you collected all of your personal belongings and valuables?

■ Will you require a fit note (formerly known as a sick note)?

■ Do you have any concerns or worries about your discharge?

The sooner you discuss these issues with your nurse, the sooner a safe and organised discharge can be arranged for you.

Discharge Lounge

You may need to wait for your medicines to be sent to the discharge lounge. Your own medication will be returned to you if it still appropriate for

you to take. Any additional medication, prescribed at the hospital which you need to take at home, will be provided by the pharmacy department.

You may also need to wait in the Discharge Lounge for the transport that has been arranged for you or for your relatives and friends. There is a small collection point close by where your relatives can briefly leave their car when they collect you.

Discharge Lounge contact number: 01244 365433

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When you are ready to leave the ward you may be taken to the discharge lounge, we aim to get you here before lunch time. A member of the nursing staff will take you, this is a comfortable, sociable area where our nursing staff will continue to care for you, providing drinks and any meals you require whilst your discharge arrangements are completed.

NHS continuing healthcare What is NHS continuing healthcare?

NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals outside of hospital who have ongoing health care needs.

You can receive NHS continuing healthcare in any setting, including your own home or in a care home. NHS continuing healthcare is free, unlike support provided by local authorities for which a financial charge may be made depending on your income and savings.

If you are found to be eligible for NHS continuing healthcare in your own home, this means that the NHS will pay for healthcare (e.g. services from a community nurse or specialist therapist) and associated social care needs (e.g. personal care and domestic tasks, help with bathing, dressing, food preparation and shopping). In a care home, the NHS also pays for your care home fees, including board and accommodation.

Who is eligible for NHS continuing healthcare?

Anyone over 18 years of age assessed as having a certain level of care needs may be entitled to NHS continuing healthcare.

It is not dependent on a particular disease, diagnosis or condition, nor on who provides the care or where that care is provided. If your overall assessment of care needs shows that you have a ‘primary health need’, you should be eligible for NHS continuing healthcare.

Once eligible for NHS continuing healthcare, your care will be funded by the NHS, this is however, subject to regular reviews, and, should your care needs change, the funding arrangements may also change.

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Whether someone has a ‘primary health need’ is assessed by looking at all of their care needs and relating them to four key indicators: ■ nature – this describes the characteristics and type of the individual’s needs and the overall effect

these needs have on the individual, including the type of interventions required to manage those needs ■ complexity – this is about how the individual’s needs present and interact and the level of skill required to monitor the symptoms, treat the condition and/ or manage the care ■ intensity – this is the extent and severity of the individual’s needs and the support needed to meet them, which includes the need for sustained/ongoing care ■ unpredictability – this is about how hard it is to predict changes in an individual’s needs that might create challenges in managing them, including the risks to the individual’s health if adequate and timely care is not provided. © Crown Copyright Contains public sector information licensed under the Open Government Licence v3.0. www.nationalarchives.gov.uk/doc/open-government-licence/

Reviews You will have a review of your needs after three months and then at least every year.

Neither the NHS nor the local authority should withdraw from an existing care or funding arrangement without a joint review and reassessment of your needs, and without first consulting with one another and with you about any proposed changes and ensuring that alternative funding or services are in place.

What if I am not eligible for NHS continuing healthcare?

If you are not eligible for NHS continuing healthcare, the CCG can refer you to your local authority who can discuss with you whether you may be eligible for support from them. If you are not eligible for NHS continuing healthcare but still have some health needs then the NHS may still pay for part of the package of support.

This is sometimes known as a “joint package” of care. One way in which this is provided is through NHS-funded nursing care (see opposite). It can also be by the NHS providing other funding or services towards meeting your needs.

Where the local authority is also part funding your care package then, depending upon your income and savings, you may have to pay a contribution towards the costs of their part of the care.

There is no charge for the NHS part of a joint package of care.

Who do I contact if I am not happy with the outcome?

If you disagree with a decision not to proceed to full assessment of eligibility for NHS continuing healthcare following completion of a Checklist you can ask the CCG to reconsider the decision.

If you disagree with the eligibility decision made by the CCG (after a full assessment and the Decision Support Tool has been completed) or if you have concerns about the process used to reach the decision, you can ask the CCG for an independent review of your case. The CCG local resolution procedures should be used first unless such procedures would cause unreasonable delay. To request an independent review, please write to your CCG which will contact the National Commissioning Board (the Board) and ask them to arrange a review, unless the matter can be resolved locally.

Any individual has a right to complain about any aspect of the service they receive from the NHS, the local authority or any provider of care. The details of the complaints procedure are available from the relevant organisation, including details of your local Independent Complaints Advocacy Service (ICAS). © Crown Copyright Contains public sector information licensed under the Open Government Licence v3.0. www.nationalarchives.gov.uk/doc/open-government-licence/

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Whether or not you are eligible for NHS continuing healthcare, you are still able to make use of all of the other services from the NHS in your area in the same way as any other NHS patient.

NHS-funded nursing care What is NHS-funded nursing care?

By law, local authorities cannot provide registered nursing care. For individuals in care homes with nursing, registered nurses are usually employed by the care home itself and, in order to fund this nursing care, the NHS makes a payment direct to the care home. This is called ‘NHSfunded nursing care’ and is a standard rate contribution towards the cost of providing registered nursing care for those individuals who are eligible.

Registered nursing care can involve many different aspects of care. It can include direct nursing tasks as well as the planning, supervision and monitoring of nursing and healthcare tasks to meet your needs.

Who is eligible for NHSfunded nursing care?

will give sufficient information to judge the need for NHS-funded nursing care.

However, if an assessment is needed, your CCG will arrange this. If you are not happy with the decision regarding NHS-funded nursing care, you can ask the CCG for the decision to be reviewed and/or use the CCG complaints process.

Are there different levels of payment for NHSfunded nursing care?

NHS-funded nursing care is paid at the same rate across England. However, until 30 September 2007 there were three different banded payment rates for nursing care.

Any individual that was on the high band of NHS–funded nursing care under the previous three band system are entitled to continue on this band until; ■ they no longer have nursing needs, or

You should receive NHS-funded nursing care if:

■ they no longer live in a care home that provides nursing or

■ you are resident within a care home that is registered to provide nursing care; and

■ their nursing needs have reduced so that they do not qualify for the high band anymore (they would move onto the single band rate instead) or

■ you do not qualify for NHS continuing healthcare but have been assessed as requiring the services of a registered nurse

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In all cases individuals should be considered for eligibility for NHS continuing healthcare before a decision is reached about the need for NHSfunded nursing care. Consequently most individuals will not need to have a separate assessment for NHS-funded nursing care if they have already had a full multidisciplinary assessment for NHS continuing healthcare as this process

■ t hey are entitled to NHS continuing healthcare instead.

If you are eligible for NHS-funded nursing care the NHS will arrange for the payment to be made directly to your care home and this payment should be reflected in the care home fee actually charged to you. © Crown Copyright Contains public sector information licensed under the Open Government Licence v3.0. www.nationalarchives.gov.uk/doc/open-government-licence/

The Motability Scheme

Buying and adapting a car can be expensive.

The Motability Scheme, run by the independent not-for-profit organisation, Motability, gives people with disabilities the opportunity to lease a new car, scooter or powered wheelchair at an affordable price.

Eligibility The Motability Scheme can help you with leasing a car if you're getting the War Pensioners' Mobility Supplement or the higher rate of the mobility component of Disability Living Allowance (DLA).

You can apply if you have 12 months or more of your Disability Living Allowance 'award' remaining. If your award is not renewed during the full length of your chosen scheme, your car, powered wheelchair or scooter will need to be returned.

will need to top-up your allowance by paying an Advance Payment (AP).

Up to two named drivers are included as part of the lease, allowing non-drivers to join the Scheme and parents and carers can join on behalf of a child aged three and above. The vehicle must be used for the benefit of the disabled person.

At the end of the period, the car is returned to Motability Operations who operate the car schemes under contract to Motability.

Powered wheelchairs or scooters

With a Motability scooter or powered Even if you do not drive yourself, you can apply for a car as a passenger and propose two wheelchair, you can get a new scooter or powered wheelchair of your choice other people as your drivers. every three years. Insurance, loss and You can also apply for a car on behalf of a damage protection, breakdown assistance, child aged three or over who is entitled to the servicing, maintenance, repairs and higher rate mobility component of Disability replacement tyres and batteries are Living Allowance. included in the cost of the lease.

You can lease a new car supplied by a Motability-accredited dealer for at least three years. Insurance, routine servicing and breakdown assistance are included. A wide range of adaptations are also available. You may need to pay for the fitting and removal of any adaptations.

You can choose to pay your total weekly allowance or part of your weekly allowance to lease a vehicle. This will depend on the model you choose. For more expensive vehicles, you

You can choose to pay your total weekly allowance or part of your weekly allowance to lease a vehicle. This will depend on the model you choose. You will also need to make a non-refundable payment at the beginning of your lease.

Contact Motability To find out more about the Motability Scheme, phone Motability on 0300 456 4566, minicom: 0300 037 0100 (Lines are open 8am - 7pm Monday to Friday, 9am - 1pm Saturday) or www.motability.co.uk Š Crown Copyright Contains public sector information licensed under the Open Government Licence v3.0. www.nationalarchives.gov.uk/doc/open-government-licence/

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Cars and Wheelchair Accessible Vehicles (WAVs)

How to use your healt Emergency Department

Emergency department

Minor Injury Units

Emergency departments provide the highest level of emergency care for patients, especially those

with sudden and acute illness or severe trauma, such as: ■ suspected heart attack

Minor injuries A Minor Injuries Unit can treat injuries that are not critical or life threatening, such as:

■ i njuries to upper and lower limbs ■b roken bones, sprains, bruises and wounds

Out of hours

Out of hours

GP out of hours is available if you require urgent medical care when your GP surgery is

closed. GP out of hours services operate from 6.00 pm each weekday evening until your GP

Your GP

Your GP

GPs provide a range of services including medical advice, examinations,

prescriptions and ongoing care for more longstanding or chronic conditions. They

Your local pharmacy

Your local pharmacy

Your local pharmacist can provide confidential, expert advice and treatment for a range of common illnesses and complaints, without you having to wait for a GP appointment or go to your Emergency Department.

Your pharmacist may be able

to help you with: ■ eye infections, stomach upsets, skin conditions, allergies, aches and pains ■ common drugs, vitamins and minor first-aid ■ healthy eating and living, including giving

Self-care

Self-care

Self-care is the best choice to treat minor illnesses, ailments and injuries. A range of common illnesses and complaints, such as aches and pains, coughs, colds, upset

stomachs and sore throats can be treated with over-thecounter medicines and plenty of rest. Remember, whether treated or not, most of these will get better.

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■ bites – human, animal and insect ■ burns and scalds

■ abscesses and wound infections ■ minor head injuries

■ broken noses and nosebleeds ■ foreign bodies in the eyes and nose

surgery opens the next morning and 24 hours on Saturdays, Sundays and public holidays.

Remember to telephone the service first. The doctor or nurse will give you advice over the

telephone, decide if you need to be seen by a doctor or will refer you to another service if required.

can also provide: ■ diagnosis of symptoms ■ health education

■ vaccinations ■ simple surgical procedures

■ serious head injury

up smoking ■ blood pressure and diabetes monitoring and needle exchange, truss fittings, stoma products and incontinence supplies ■ women’s health, including treatment for thrush, emergency contraception

and pregnancy testing ■ children’s problems, including nappy rash, teething, coughs and colds ■ all prescribed and over the counter medicines Check with your local pharmacy for more details.

Remember, collect repeat prescriptions from your daytime GP surgery before the weekend or a public holiday. GP out of hours will only provide repeat prescriptions in exceptional circumstances.

Some self-care essentials – The following are available to

■ indigestion remedies

buy over-the-counter:

■ plasters

■ paracetamol, aspirin

■ thermometer

and ibuprofen ■ rehydration mixtures

Remember, always follow the instructions on the pack.

Choose well.

© Crown Copyright Contains public sector information licensed under the Open Government Licence v3.0. www.nationalarchives.gov.uk/doc/open-government-licence/

■ serious accident

999 You should always call 999 if someone is seriously ill or injured and their life is at risk.

■ suspected stroke

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th services

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

Employing a professional carer or personal assistant If you're looking for a care worker to help you live independently at home, you may get one through your local health trust or a home care agency, or you may choose to employ someone directly.

What a professional carer can do for you Professional carers have a variety of skills - some have nursing and first aid qualifications and others may be home helps or personal assistants. Some examples of the type of tasks a carer might help with are: ■ cooking and cleaning ■ help with personal care like washing and using the toilet ■ driving or help with getting around ■ medical tasks like giving injections or changing a catheter ■ shopping, banking and paying bills

Your options for professional home care There are three basic arrangements for getting a professional carer.

You may have one provided directly by your local trust, in which case everything is arranged for you.

You may ask a care agency to find you a suitable carer. This means you have to find and pay the care agency, but you don't take on any responsibilities as an employer because the carer works for the agency.

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You may also employ a carer directly. This option gives you more choice and control over who cares for you and what tasks they do but it also means you have legal responsibilities as an employer.

Getting started - help from your local trust The first step towards getting the care you need is usually a health and social care assessment with the your local trust.

At the assessment, a specialist - usually an occupational therapist - will discuss your needs with you so that the right support can be provided.

If the trust agrees that you need care at home, you can usually receive direct payments.

This means you can arrange and pay for your own care services instead of having them provided by the trust.

Once you know how much your direct payments will be, you can work out how much to pay a carer and how many hours a week you would like them to work.

Your direct payments should meet your care needs, but if you want to use a more expensive care service or pay for extra hours, you can top them up yourself.

Writing a job description Think about exactly what help you need before you employ someone or sign a contract with an agency. It may be helpful to think about a typical day for you, and write a job description for your carer. This should include: ■ a list of all the tasks you may need help with ■ any particular skills or qualifications your care worker must have - for example, a nursing qualification or a full driving licence

■ an estimate of the number of hours and days you will need the person to work A detailed job description can help home care agencies select a suitable carer for you.

If you're looking to employ a carer yourself, a job description will help people who are interested in applying to get a clear understanding of what the job involves.

Finding a carer through a home care agency All home care agencies are regulated and inspected regularly by the Regulation and Quality Improvement Authority (RQIA). This guarantees certain minimum standards of service. Home care agencies must also conduct police checks on all employees who will be working with people with disabilities.

Finding a carer yourself Advertising the job

References and police checks

You can place job advertisements in your local Jobs and Benefits office for free.

Local shops, supermarkets and voluntary organisations may also have noticeboards where you can place job advertisements.

Job advertisements should be brief and state: ■ the type of work involved ■ working hours ■ rate of pay ■ your contact details ■ the general area in which you live For safety reasons, it's best to give your mobile phone number or a box number in your advertisement, rather than your address or home phone number.

When you've decided who to offer the job to, you are responsible for checking that they are suitable. You should always ask for - and check out - at least two references, including one from someone they've cared for previously.

Job interviews Once you have received any job application(s), select the people you'd like to interview for the job. You can ask a friend or relative to attend the interviews, especially if they are taking place in your own home.

Individual employers do not have to request a police check on any potential employee but you may still want to do this. You will need to ask your local trust or a local voluntary organisation to make the request for information to the Disclosure and Barring Service on your behalf.

Your responsibilities if you employ a carer directly

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When you employ a carer directly, you have certain responsibilities as an employer, including dealing with tax and insurance. Meeting these is not difficult, and you can get help from social services Before the interviews, you should prepare with paperwork if you need it. © Crown Copyright a list of questions that cover the key Contains public sector information licensed under the Open Government Licence v3.0. aspects of the job. www.nationalarchives.gov.uk/doc/open-government-licence/

Frequently asked questions What should I bring into hospital?

Please bring only a minimum amount of personal belongings with you to help us keep your bed area free from clutter so that we can maintain our cleaning standards. Please also bring supportive footwear, personal toiletries and suitable clothing.

When coming into hospital, bring all of your medicines in with you including inhalers and eye drops etc. For security and safety reasons, the ward staff will need to lock them away in a locker next to your bed. In some instances, you may be able to self-medicate – if you wish to do so, speak to the nursing staff about this

When are meal times ?

Breakfast is served between 7.30am and 8am; lunch from 11.45am to 12.30pm; and supper from 5.15pm to 6.15pm. Your nurse will ask you the day before to select your meals from a choice of dishes, including vegetarian, for the following day. We also provide kosher and halal dishes, however we do need 24-hours’ notice for this.

What are the visiting times?

Ward visiting is between 11am - 7.30pm daily. There are some exceptions to these times for example: The Maternity Department, Children’s Unit, Neonatal Unit, ward 33 and the Coronary Care Unit.

Please check with the ward to make sure.

Please be aware that protected meal times are in place and no visiting will be allowed during these times unless agreed with the ward staff.

Are cultural, spiritual and religious facilities available?

The Spiritual Care Centre is situated on the first floor near the bridge. It is always open and is a place of quiet for everyone. The centre welcomes people of all faiths and beliefs and does not have any allegiance to specific religions. Please contact the Chaplaincy for further details: 01244 364543

When will I get my medication?

Medication rounds are usually breakfast, lunchtime, evening meal and bedtime. However this will vary dependent on your individual needs.

Wifi access and Hospicom The Countess of Chester Hospital has launched free Wifi access for all patients, visitors and staff in an effort to make the patient experience even greater. To gain access to the Wifi network when on-site, all patients and visitors have to do is connect to the Countess Wifi network, agree to the terms of use, and then enter the password which is available from a member of the ward or reception staff.

Most of our bedside areas are fitted with a Hospicom unit giving access to TV, radio and a variety of other communication services. There is a cost associated with using this service - for up to date information please ask a member of staff on your ward.

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Will I need an outpatient appointment when I go home?

If any further follow up appointments are required your doctor will inform you of these on your discharge summary and this will be arranged as necessary for you.

I may be in hospital for several days, are there car parking allowances?

What should I do if I feel unwell when I get home?

When you go home if you experience any problem after your hospital treatment you should contact your hospital ward or GP for advice. Out of hours, you may need to contact your GP out of hours service or NHS 111. If you feel the situation is urgent please attend your nearest accident and emergency department.

If you are an inpatient for over two weeks your relatives and carers are entitled to free parking. Relatives and carers of patients on the Intensive Care Unit and Neonatal Unit are entitled to free parking after three days. You will need to fill in a form which can be collected from the cash office located at the main entrance of the hospital. You can contact the cash office for more details 01244 366208

How can I access my health records?

You have the right to see any of your written health records. To obtain a copy of your records you will need to submit an application form from the Legal Services Department. For any further information about accessing your health records, please telephone the department on 01244 366457

How can I get a fit note?

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Please inform the ward staff if you need a fit note (previously known as a sick note).

Questions I want to ask…

Your Plan…

Contacts and Support you may need after discharge Pharmacy We will give you a copy of your discharge notification form to take with you - it includes details of any medication you need. We will also send a copy to your GP. Once you have gone home, we will send a letter to your GP telling him/her about your treatment and progress.

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We may have used your own medicines for your treatment whilst you have been in hospital. If these are still suitable they should be returned to you when you are ready to be discharged. If any of your medicines have been changed, the nurses will ask your permission to safely dispose of them. The hospital will provide you with any medicines you need to go home with - this will usually be a minimum two weeks supply. If you have any questions about your medicines, please ask to speak with a pharmacist.

Back at home, if you have any questions about the medicines supplied by the hospital please contact the ward where you were an inpatient (number will be on the front of this booklet), or the Pharmacy Department MonFriday 9.00am - 4.00pm on 01244 365249.

Please contact your usual community pharmacy for information about your regular medications.

PALS The Patient Advice and Liaison Service (PALS) provides patients, their families and carers with free advice and assistance in dealing with health matters.When you need advice, would like to thank us or have concerns about any aspect of your care in our hospital then please contact PALS.The service is confidential.We will: ■ Advise and support patients, their families and carers

Contacts and Support you may need after discharge ■ Provide information on NHS services ■ Listen to your concerns, suggestions or queries ■ Help to sort out problems quickly on your behalf Freephone 0800 195 1241 and select option 2 or phone 01244 366066 Email PALS: cochpals@nhs.net

As part of our drive for continual improvement, it is essential that we hear and understand the views of our patients after they have been discharged.

From 1st April 2013, all patients in acute inpatient hospital wards and A&E departments across the country have been asked to take part in the ‘Friends and Family Test’.

The Friends & Family Test was introduced to allow patients the opportunity to feed Write to PALS Manager, PALS, Countess of back their views of the care or treatment Chester Hospital Foundation Trust, Liverpool they have received here at the Countess Road, Chester CH2 1UL. of Chester Hospital in near real time. This will provide us with valuable intelligence about the quality of healthcare received in our Trust.

We would like to ask our patients one simple question… Would you If you have been discharged from the recommend us to your family and friends?

Countess of Chester Hospital in the last 48 or

Friends and Family Test

hours as an A&E patient or inpatient you will have been given a Friends & Family Test survey to complete before you left the hospital. However if you have mis-laid the survey and would still like to take part in the test, we would be very grateful if you would take the time to complete the following online version of the short survey about your most recent experience at the Countess of Chester Hospital.

The information you give us will help to ensure that we are better able to tailor our services to the needs of our patients. This survey is completely anonymous. http://www.coch.nhs.uk/feedback

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At the Countess of Chester Hospital, we are committed to delivering the best possible care to our patients.

Going home from hospital?

Age UK Cheshire, here to help!

Ageing is not an illness, but it can be challenging. At Age UK Cheshire we provide services and support to inspire, enable and support older people.

Information & Advice Growing older does not come with a manual, so if you need free, confidential and impartial information or advice on anything from health to housing, you can either drop in and speak to an advisor or contact us via phone or email.

and guidance on issues such as help to find a cleaner or information on what activities and services are available locally to assessing your eligibility for benefit claims.

If you are in need of a bit more support, our Independent Living advisors can work with you in setting up a care support plan to help you maintain your independence at home. We can help you to take control and stay in control. We also offer a Wellbeing service which is based within local GP surgeries and helps patients to manage long term health conditions.

• Castle Community Centre, Barbers Lane, Castle, Northwich CW8 1DT (Open Monday to Friday, 9am-1pm and 2pm-4pm. Closed Wednesdays from 1pm) t: 0845 618 2858 e: information@ageukcheshire.org.uk

For more information, please contact:

• 4 Queen Street, Chester CH1 3LG (Open Monday to Friday, 9am-1pm and 2pm-4pm.

Wednesdays by appointment only) t: 01244 401500 e: informationqs@ageukcheshire.org.uk

Independent Living Service t: 08450 531 313

• Methodist Church Hall, Park Street, Neston CH64 3RP (Open Monday to Wednesday, 10am-12pm) t: 0151 336 8388

If you are starting to have difficulty managing everyday tasks at home and need a little extra care and support, it can often feel daunting and you might not know what help is available or where to start.

Exercise is incredibly important to our overall health. It can reduce the risk of high blood pressure, heart disease, some types of cancer, strokes and type 2 diabetes. Exercise can also help to keep bones strong and assist in reducing the risk of osteoporosis. Recent studies have shown that exercise may improve memory and slow down mental decline, aid sleep, as well as improve strength and balance. It is also a great way to get out and meet people.

We offer a number of practical services designed to meet your needs. Our Supporting You advisors can provide as little or as much support as required, from general advice

Age UK Cheshire offer a wide range of exercise activities ranging from sports including Tennis, Tai-Chi, Horse riding, Golf, Nordic Walking and Swimming, to more sedate activities such as

Our team will be able to provide expert advice on issues including welfare benefits, where to find a reliable tradesperson, getting your house adapted to suit your needs, how to get help with everyday tasks and who to speak to about your rights. Whenever you need to find out anything from someone you can trust, remember to give Age UK Cheshire a call.

Maintaining Independence

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www.ageukcheshire.org.uk

Supporting You t: 01244 408 166 / 01606 884 448 Dementia Advisor Service t: 01244 408165/6 / 01270 219481 Advocacy Service t: 01606 305 004 Wellbeing Service t: 01606 305022

Keeping healthy and active

Cheshire one-to-one Peer Health Mentoring at home (for people with long term conditions)and Cardiac Rehab classes.

For more information, please contact: Get Active / Get Going Together t: 0151 348 5493/4 Age UK Cheshire also offer a Falls Prevention service which works to reduce the number of people who need to attend the Accident & Emergency Department because they have fallen in their homes.

Men in Sheds provide a shed-like environment for men with a focus on socialising, sharing skills and learning new ones. Our sheds are located in Chester, Ellesmere Port, Crewe and Hartford.

We always welcome new members to join us for camaraderie and learning new skills or reviving old ones Our Castle Community Centre offers a wide range of activities including T’ai-Chi, French, Italian, a Ukelele group, arts and crafts and the Computer Centre, where you can develop your IT skills in basic computing, digital photography and accessing the internet. We also have an onsite coffee shop.

For more information, please contact: OPEL & Castle Community Centre t: 0845 618 2858

By carrying out home visits to individuals Men in Sheds t: 01606 305010 and talks to groups, we are able to highlight If you are not sure which service is most possible hazardous areas within the home and in turn make minor alterations where necessary. appropriate for your query, please contact the Information and Advice service who will For more information, please contact: signpost you to the correct service.

Falls Prevention t: 0151 348 5495/6

Social groups

Help us to Support You Age UK Cheshire simply could not exist without the help of our loyal donors and supporters.

Donations are vital to the work of Age UK Cheshire to enable us to continue to provide services for older people. However much you can give, whether it is a regular payment, a single donation or a legacy in your will, we guarantee that every penny will be used for the benefit of older people in Cheshire.

Visit our website for more information or call us on 01606 305000

Our OPEL group (Older People Enjoying Life) offer a wide range of activities in a relaxed and welcoming community setting in a number of locations each week.

The familiarity of the setting, the other group members and the fact that everyone thoroughly enjoys the activities, entertainment and outings, means that new friendships flourish very quickly.

Become a Friend of Age UK Cheshire Show your support and get some great discounts too!

For an annual subscription of just ÂŁ10 you can become a Friend of Age UK Cheshire and gain access to a wide range of offers and discounts from local companies, a bi-annual newsletter and exclusive early bird discounts on fundraising events.

For more information, please contact: t: 01606 305000 e: friends@ageukcheshire.org.uk

www.ageukcheshire.org.uk

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Loneliness and isolation are major factors in the deterioration of health and wellbeing. Age UK Cheshire aims to relieve this by promoting independence and helping people join activities in their local community.

Alzheimer’s Society Services in Cheshire West & Chester If you think you may have a form of dementia or are caring for a person who has dementia there are many ways that Alzheimer’s Society in Cheshire West & Chester can help.

Someone to talk to You can phone at any time during our opening hours to talk in confidence with a member of our team. The team are here to listen when you feel the need to talk or to offer information and advice on specific issues.

Dementia Adviser service If you have recently been diagnosed and are living with dementia, our Dementia Advisers can give you information, advice and guidance tailored to their individual needs.

Dementia Support Workers Our Dementia Support Workers give personalised practical advice and emotional support and can offer information and advice on accessing professional help. Our Dementia Support Workers can signpost to a wide range of services throughout Cheshire West & Chester and refer to other specialists who can help if your concerns are outside of our expertise.

Dementia Adviser/Dementia Support Worker Visits A visit from a Dementia Adviser or Dementia Support Worker can be arranged for you and the person you care for, either at home or a mutually agreed location, to 26

www.alzheimers.org.uk

provide information, advice and support.

Information We also have a wide range of information and factsheets which include specific information on different types of dementia, care issues and understanding the needs of the person with dementia.

Activity and Walking Groups Our Activity groups provide a variety of activities for people with dementia and their carers to enjoy and socialise with others in a fun and supportive setting.

Activities include crafting activities, dominos, bingo and much more. Our Walking groups give people with dementia and their carers and families an opportunity to enjoy a leisurely stroll in the fresh air followed by a cup of tea or coffee together at a café afterwards. Please contact your local office for more information.

Singing for the Brain Singing for the Brain is a stimulating group activity which provides structured musical stimulation for people with dementia and their carers. Singing provides a way for people with dementia to express themselves, helping general wellbeing and confidence in a fun and supportive group.

For more information please contact your local office.

Dementia Cafes and Support Groups Our cafes and groups give people with dementia and their carers an opportunity

DEMENTIA FRIENDS PROGRAMME

We’re here to help If you would like more information about our services or require information, advice and support please call us on 01606 781110. We are open Monday to Friday from 9am to 5pm.

Alzheimer’s Society Cheshire West & Chester office: Unit 1, The Old Printworks, Spencer Street, Northwich, CW8 1BP E: westcheshire@alzheimers.org.uk E: valeroyal@alzheimers.org.uk Membership All members of Alzheimer’s Society receive a monthly national magazine. The more members we have, the greater our lobbying power. Membership is free to carers and people with dementia.

How will it work?

We will train and develop a group of volunteers to spread the word about what dementia is and what action individuals can take in their community.

We will then ask them to recruit Dementia Friends who will then receive a basic information session on dementia and be encouraged to take action.

What is a Dementia Friend?

A Dementia Friend learns a little bit more about what it is like to live with dementia during a Dementia Friends Information Session and then turns that understanding into action.

What is a Dementia Friends Champion?

Dementia Friends Champions are volunteers who run information sessions where they talk to people about being a Dementia Friend in their communities. It's easy to get involved. Dementia Friends Champions will attend a training course, receive support as and when they need it and be part of a growing network of people creating dementia friendly communities together.

How can I get involved?

It's easy to get involved. Just visit www.dementiafriends.org.uk and book onto a Dementia Friends Information session.

Alternatively, you can contact your local Alzheimer’s Society office for more information.

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to meet people in similar situations, to share experiences in a friendly, relaxed and supported environment. Each group and café are staffed by Alzheimer’s Society staff and volunteers. Please contact your local office for more information including venues, dates and times.

Dementia Friends is a national initiative that is being run by the Alzheimer’s Society. It's funded by the government, and aims to improve people's understanding of dementia and its effects.

Through the Dementia Friends programme, we aim to change the way the nation thinks, talks and acts. By 2015, we want a million Dementia Friends who have knowledge and confidence to help people with dementia feel understood and included in their community. Because, together, we can create dementia friendly communities.

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

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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.

CQC 7

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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/

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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.

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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.

NHS Hospitals and services in CHESTER

Countess of Chester Hospital

Countess of Chester Hospital

NHS Foundation Trust

NHS Foundation Trust

Ellesmere Port Hospital

Countess Of Chester Hospital

114 Chester Rd, Ellesmere Port, Merseyside CH65 6SG 01244 365000

Map

The Countess Of Chester Health Park, Liverpool Rd, Chester, Cheshire CH2 1UL 01244 365000

Warrington West

Wildnes

Warrington East

Warrington South Wilmslow

Knutsford Ellesmere Port Northwich Macclesfield

Winsford

Chester Western Rural

Congleton

Crewe Nantwich 15 Sixfield Close, Lincoln LN6 0EJ 01522 692681

Chester

4 Queen St, Chester, Cheshire West and Chester CH1 3LG 01244 401500

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County Offices, Newland, Lincoln LN1 1YG 01522 552222

Directory - Telephone numbers you may need or find useful…

Action on Elder Abuse - 020

8835 9280 Admiral Nursing DIRECT - 0845 257 9406 Age UK - (Chester office) - 01244 401500 Alzheimer’s Society - (West Cheshire) - 01244 851 351 Arthritis Care - 020 7380 6500 British Heart Foundation - (Chester office) - 01244 345487 Carer Network - 0800

085 0307 Care Quality Commission - 03000 616161 Chester Citizens Advice Bureau - 03444 772121 Countess of Chester Hospital main switchboard - 01244 365000 Discharge Lounge - 01244 365433 GP out of hours - (please contact your local GP for this number) Cruse Bereavement Care - 0844 477 9400 DIAL (Disability Information Advice Line) - 01244 345655 Disability Benefits - for Disability Living Allowance and Attendance Allowance - 0845 712 3456 Elderly Accommodation Counsel (EAC) - 020 7820 1343 Hospital Pharmacy - 01244

365249 Integrated Care Council - 01379 678243 Mind (National Association for Mental Health) - 020 8519 2122 National Osteoporosis Society - 0845 450 0230

NHS - 111 Parkinson’s Disease Society - 0800 800 0303 Patient Advice and Liaison Service - 01244 366066 Red Cross (Chester) - 01244 349550 Rough sleeper advice and support - 0300 123 1562 Royal Voluntary Service - 0845

608 0122 Social Services Chester - 0300 123 7034 Social Services North Wales - 01352 702000 Social Services Wirral - 0151

606 2006 Stroke Association - 01244 389264 St Werburgh’s Medical Practice for the Homeless - 01244 665834 Therapies (Rapid Response) - 01244 365240 The Pension Service - 0845

606 0265

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