Royal Devon and Exeter
NHS Foundation Trust
The NHS community gears up for winter page 2
Mega lungs visit page 5 Staff newsletter
The NHS community Capacity is often an issue for acute hospitals, and never more so than in winter with the increased prevalence of chest infections and norovirus, and the impact of weather-related injuries and accidents. Following two particularly severe winters, when many elective operations had to be cancelled, and as featured in the last issue of RD&E News, we have been gearing up to cope with more patients.
Additional beds A whole host of measures have been put in place, but one of the most highly visible is the delivery of two complete, new wards in time for winter 2012/13. Board approval for the £4.5 million project was granted in May, and a modular design was chosen to fit the tight timescale. The new wards were handed over to the Trust at the end of November, and as RD&E News went to print, were in the process of being commissioned to take their first patients in December. Ashburn has 28 medical beds for older people with a further 20 short-stay rehabilitation beds on Yealm. A new consultant in Health Care for Older People will be recruited. 85 Band 5 nurses have been recruited from the UK, Ireland, Scotland and Spain to cover the new
wards and other vacancies. In addition, 34 Band two nurses and additional Allied Health Professionals have been recruited locally. Delivering such a complex project within tight timescales and budgets is a real credit to all staff involved.
Service redesign We have also made changes to a number of clinical pathways to ensure all our emergency services are as resilient as possible. For example, from 22 December until the end of March 2013, we are running a pilot of 7-day working for all medical specialty teams, so senior clinical review will happen every day. We are also providing 7-day access to CT radiology diagnostic support and putting extra resource into discharge planning and onward care planning.
Board approval for the £4.5 million project was granted in May, and a modular design was chosen to fit the tight timescale.
Divisional managers have been meeting on a daily basis since November to monitor pressure on capacity and have a series of ‘traffic light’ measures that they can use to trigger escalation and action with commissioners. This includes keeping an eye on known pressure points such as number of patients waiting for a community bed, number of beds closed and number of predicted discharges.
gears up for winter
Sharing the journey All of the plans that have been put in place make us as prepared as we possibly can be to cope with more patients. However, we rely on our partners in other areas of the healthcare system to help ensure only those people who really need hospital care are actually here. NHS Devon (which will become North East and West Devon Clinical Commissioning Group in April 2013) is partnering us by: n Investing in additional GP provision and extra medical resource for triage at the RD&E n Extending resources for onward care teams to support timely discharge from hospital. n Holding weekly, multi-agency meetings between October and February to give early warning of operational pressures right across the locality, and to agree action plans to resolve them. n Running a â€˜Choose Wellâ€™ campaign to help signpost people to the most appropriate service for their particular healthcare needs. Services start with selfcare at home, incorporate NHS Direct, pharmacies and GPs, with 999 calls and visits to ED reserved for major accidents and serious illness. The Choose Well campaign is running until the end of March and was produced by the Public Health team in Devon after research identified that 18 to 30 year olds are increasingly accessing emergency services when they could use alternative NHS services. The campaign has been developed using public engagement and research and professional input from ED clinicians, community services, Devon Doctors, public health and commissioners. The designs, part of which are featured here, will appear in bus shelter adverts - on Barrack Road and other spots in Exeter, in particular near Sidwell Street. There will be banners around our site as well as posters, z-cards and leaflets in the RD&E, GP surgeries, pharmacies, leisure centres, libraries, colleges and universities in Exeter and East Devon.
opening of the n RD&E staff working towards the lm. new wards, Ashburn and Yea
Respiratory round-up Several RD&E staff have been involved in events and campaigns targeting respiratory conditions. November was national lung cancer awareness month, and also saw the launch of Smoke Free Southwest’s six-week ‘Take a Breath’ campaign, encouraging smokers to quit.
to highlight links between smoking and lung disease, focussing particularly on Chronic Obstructive Pulmonary Disease (COPD), which sufferers describe as feeling like they’re suffocating. There are 810,000 smokers in the South West and nearly 90,000 COPD sufferers.
The hard-hitting campaign uses emotive TV and radio advertisements
We’re fortunate in having our own stop smoking adviser on site.
Steph Parker works with patients and staff to help anyone who wants to quit, and is evidencing good success rates. In the first six months of 2012, 65% of people who worked with Steph and set a quit date managed to stop smoking successfully. One of those success stories is Justine Davenport, a ward clerk on Taw.
Justine’s story Justine contacted Steph as she wanted help to quit smoking. She was a light, social smoker, but was aware that it was affecting her health. After several chest infections last year that required antibiotics, Justine was motivated to begin a course of nicotine replacement therapy and
treatment. Evidence indicates this is the best way to quit. Justine saw Steph once a week to discuss lifestyle changes, how to deal with stress, boredom and cravings and every week exhaled into a carbon monoxide reader to show the benefits to her body. Justine wasn’t heavily dependent on nicotine, but needed some nicotine replacement therapy (NRT) to help with withdrawal symptoms and used an inhalator. Eight weeks in, Justine has now quit cigarettes for good and continues to use her inhalator when she feels she needs it. She received a certificate from Health Promotion Devon and is really happy she has quit. Justine says: “I no longer have to go outside for a cigarette in the cold. When family come
I no longer have to go outside for a cigarette in the cold
round I now stay inside and this has helped me create more of a bond with my daughter in laws and grandchildren; that’s been one of the best things about giving up smoking. Friends and relatives have also noticed that I have quit and are now interested in giving up and I can support them, as I know what its like” If you would like to speak to Steph to get access to support and NRT at work call 01392 406133 or e-mail firstname.lastname@example.org , or call the central booking number to find a clinic near you: 01884 836024.
Art-based activities support neurorehabilitation
n Staff gather inside the mega lungs.
Mega lungs visit Visitors to Wonford Hospital might have been surprised to see a pair of 12ft-high inflatable lungs outside our main entrance last month. Specialist Lung Cancer Nurse, Sandra Pope, organised the visit as part of lung cancer awareness month. The walk-through MEGA lungs are approximately 12 feet high by 15 feet wide by 10 feet long and played host to a stream of visitors throughout the day, including local schoolchildren, who had a ‘larger than life’ interactive, educational experience about the respiratory system and how lungs are damaged by diseases such as asthma, pneumonia and cancer. The aim of the event is to raise awareness of the common signs and symptoms of the UK’s biggest cancer killer and improve early diagnosis of the disease. Specialist nurses
and stop smoking advisers were on hand all day to give advice on how to keep your lungs healthy and to answer people’s queries or concerns about lung disease. Specialist Lung Cancer Nurse, Sandra Pope said: “We were the only Trust in the South West to play host to the MEGA lungs. It was a great way to highlight some of the early symptoms of lung disease. Lung cancer is the UK’s biggest cancer killer, so we wanted to do as much as possible to make people aware of what they can do to protect their lungs from disease as well as what symptoms, to look out for. Early diagnosis can mean the difference between life and death. We’re pleased that so many people came along and were able to talk to some of our specialist respiratory nurses.”
Mardon Neuro-Rehabilitation Centre ran a pilot group providing art-based activities to support patient rehabilitation goals. The group allowed patients to interact using another means of communication, improve their strength, movement and dexterity by handling art materials and gave them the opportunity to explore skills they felt had been lost during their neurological event. Staff Nurse Caroline Harvey came up with the idea, determined to bring art into the rehabilitation pathway. She approached the Matron, Lynne Foster, and embarked on a foundation course in Art Therapy. Consultant, Dr Tim Harrower, and Speech and Language Therapist, Gill Hardy, supported her seeing the value of art groups for neurorehabilitation and the ‘Art Café’ was born. The group ran for four weeks and was available to all patients. During the first session, Gill Hardy introduced the group to communication and art using an iPad. This allowed collaborative group work and provided an ideal medium for patients with limited mobility. The group enjoyed the use of technology and an iPad was identified as a target for fundraising. Mardon would like to say a personal thank you to the League of Friends for raising more than £200 and funding an iPad for Mardon patients.
Patient care and innovation
Surgical sepsis - a race against time Every year, around 160 patients are admitted to the RD&E requiring emergency laparotomy. This group of patients are often very sick and suffer a high rate of morbidity and mortality. An audit carried out last year, by anaesthetists Louise Cossey, Bruce McCormick and James Pittman, showed that the RD&E’s mortality rate for these patients was around14% - slightly better than the national average, but enough to motivate the team to seek improvement. As a result of that initial study, Dr McCormick has signed the RD&E up to take part in a multicentre pilot of a new care pathway, launched on December 3rd. The pathway follows guidance on best practice issued by the Royal College of Surgeons and the National Confidential Enquiry into Peri-Operative Deaths (CEPOD), and was designed by the Royal Surrey Hospitals NHS Trust, which has one of the lowest mortality rates in the
country for these patients. “We know that with emergency laparotomy patients, we’re in a race against time to make a diagnosis and commence life-saving treatment as
n Andrew Swain, Physicians’ Assistant in Anaesthetics; Neil Smart, Research Fellow; Marina Quantick, Physicians’ Assistant, Ian Daniels, Consultant Colorectal Surgeon; Bruce McCormick, Consultant Anaesthetist.
soon as possible,” says Dr McCormick. “The key is to identify these patients and intervene with antibiotics and, where indicated, perform emergency surgery within six hours of diagnosis, so that they have the best chance of recovery. We hope that by close attention to all aspects of each patient’s care we can achieve ’incremental gains’ that will result in improved survival of these patients.” The new pathway adopts a truly multidisciplinary approach, involving staff from ED, surgery, anaesthetics, ICU and radiology. Key to implementation of new pathway is the role of the Trust’s four Physicians’ Assistants in Anaesthesia, who will provide an oncall support service. The pilot will run for six months before being evaluated for its impact on length of hospital stay and mortality rates. If, as hoped, the results show a drop in mortality then the pathway will be adapted for ongoing use.
Pressure ulcer information for patients Staff at the RD&E are telling patients how to treat their pressure ulcers. On Worldwide Pressure Ulcer Day in November, clinical colleagues all over the world focussed on engaging with
patients to help them understand what causes pressure ulcers, what to do to prevent them and how to treat them. Tissue viability nurse, Juliet Price, put up displays in the foyer and Oasis, as
well as placing an information video for staff on IaN. To watch the video, visit IaN and search directorates, medicine and tissue viability.
Orthodontics begin using eNotes Things look and and feel different in Orthodontic clinics following the introduction of eNotes. The green eNotes Outpatient folders are being used to hold patient information such as referral letters and outcome forms; consultants and nurses are using laptops to capture and view patients’ clinical information and barcoded paper forms are available in clinic if they are needed. Orthodontic Consultant Matthew Moore says: “Using eForms to capture clinical information is a very different way of working and already we can see there will be benefits of working in this way. There are bound to be problems to resolve, but all things considered I feel it is going really well.”
The Health Records Department is now running new eNotes processes alongside its normal operations. They are prepping eNotes folders with the new barcoded forms and delivering and collecting these from clinics. The Health Records Scanning Bureau is also operational and is scanning clinical information generated in Orthodontics. Whilst this is early days for the new eNotes system and the new processes it is looking and feeling positive. The project team have been providing handson support in clinic; working alongside the clinical team to address any issues as they happen. There will inevitably be teething problems but the willingness and enthusiasm of the Orthodontic
team to make eNotes work in a way that is beneficial for them has made for a positive start to this challenging and complex transformation. The Orthodontic clinical team enjoyed an eNotes Folder Cake to celebrate the go-live. NOTE: Orthodontic patients’ current casenotes will remain as paper for now but all Orthodontic information from the 19th November onwards will only be viewable in eNotes. Work is now underway to prepare for the eNotes launch in the second early adopter area Oral and Maxillofacial Surgery.
Appointment Reminder Service A successful 9-month pilot project to remind people of their outpatient appointments is being rolled out to all clinically appropriate clinics from Monday December 10th. The pilot was carried out in gastroenterology, diabetes, paediatrics and orthopedics and resulted in: n 2,235 appointment slots gained from cancellations and DNAs n 83% average slot reutilisation rate n 40% average DNA rate reduction for the pilot Posters and appointment letters will advise patients that they may be contacted by the service and will provide opt-out information. For full details of the new service, which is provided by a company called 360CRM, see the staff briefing sheet and the Trust website page. For any queries, please contact: rdetr.CABCentralSupport@nhs.net or email@example.com
More staff than ever are cycling to work’ MP learns on visit to Wonford Hospital Exeter MP, Ben Bradshaw, visited Wonford Hospital to find out about the Trust’s Cyclescheme success, which is run in partnership with the Cycle to Work Alliance. During his visit in November, Mr Bradshaw heard how, with pressure on car parking spaces greater than ever before, more staff are using alternative forms of transport, including cycling to work. The Trust signed up to Cyclescheme in 2008, allowing staff to obtain a bike
and accessories up to a maximum cost of £1,000 through a reduction in salary. Since its launch, more than 825 employees have taken advantage of the scheme, representing nearly 15% of the workforce. The scheme has been used by approximately 500,000 individuals and in the region of 23,000 employers, utilising a network of 2,200 bike retailers. Mr Bradshaw has been Patron of the All-Party Parliamentary Group on Cycling since 2010.
n From left to right: Richard Barnes, Account Executive, Cyclescheme, Gary Cooper, Director, Cyclescheme, Ben Bradshaw, MP for Exeter, John Perratt, Workforce Information Manager, Paul Andrews, Staffside representative.
Bishop blesses new RD&E cross at vocations service
n Dr Simon Harrison, lead chaplain, The Right Rev’d Michael Langrish, Bishop of Exeter, Vicky Coates and Kate Canniford from ODP and James Brent, RD&E chairman.
The Bishop of Exeter blessed the new RD&E cross at a special service in the chapel to mark the importance of vocations in the hospital. The Right Rev’d Michael Langrish also gave the address at the service, which was held on St Luke the Physician’s Day. Staff and volunteers attended the service and brought tools to represent the diversity of professions and disciplines that are vital to their work. Prayers were said for all the individual vocations and professions that support the Trust as a place of healing and compassion. The RD&E cross was made from a tree in the grounds known informally as Pereira Gray’s tree after the professor who was involved in its planting to mark the opening of a Department of General Practice on site in the 1970s. Richard Brown from the Estates team worked with local carpenter Peter Milford to create the cross.
n The picture on the front cover of the RD&E News shows Sainsbury’s staff, Bramble Ward staff and Bramble patients, Callum, Samuel, Katie and Charlie with the toys.
Christmas cheer at RD&E – thanks to League of Friends festive donation The Christmas tree at the main entrance of the RD&E has been officially lit-up. Members of the Trust Board and the League of Friends all gathered around the tree on November 28th as the lights were switched on. The tree was donated by the League of Friends and its Chairman, Cheryl Hayes, spoke of the joy of bringing some Christmas cheer to the hospital.
Christmas comes early to Bramble Ward when toys are delivered Christmas arrived at Bramble Ward one day in early December when Sainsbury’s staff brought a trolley load of toys in the morning and Build a Bear paid a visit in the afternoon. The toys were donated to Sainsbury’s by customers across the South West and were distributed to hospitals in the region. In total, 801 toys were given out. Build a Bear was accompanied by Exeter City football club stars who helped to hand out dozens of teddy bears to children in the wards.
n Pictured are the footballers with staff and little Charlie, a Bramble Ward patient. The children loved meeting the giant teddy bear and Grecian the Lion, mascot of the football club.
Mencap Hospital Roadshow Mencap, supported by Simply Health, delivered a roadshow to the Royal Devon and Exeter Hospital staff. The charity highlighted issues that people with a learning disability face when accessing healthcare.
n Trust members and the League of Friends gather around the tree at the lights switch-on.
Arrangements for a visit by the Exeter Chiefs were being finalised as the RD&E News went to print.
The aim was to inform health professionals of the barriers people with a learning disability can experience, and by doing so, empower them to make reasonable adjustments and adapt the services and support that they offer to patients. The roadshow was
n Learning Disability Liaison Nurse Liz Jennings raises awareness alongside Becky King and Paul Rooke (Devon Learning Disability Parliament volunteers) and Jo Moore from Mencap who delivered the workshops.
made up of three 90-minute workshops and the delivery was supported by people with a learning disability, allowing reallife experiences to be shared and discussed. Video, ‘Freddie’s Story’ was shown throughout the workshops and will soon be available for training purposes across the Trust. The RD&E has been very fortunate in hosting this event which took place on November 7th in the Committee Room at Noy Scott House.
Making a difference for dementia patients A £9,000 donation from the League of Friends is making a real difference for some of our confused, elderly patients. The money was invested in
practical resources, such as colourful signs around the wards, themed photo books, showing events, fashions and the routines of daily life from years gone by, as well
as a new orientation board, which shows patients the day, date, time and weather. Debbie Cheeseman, Consultant Nurse for Older people, said: “It’s great
that the League of Friends has given so generously to support elderly patients.” If you have memorabilia for the room, contact Debbie on extension 2560.
Oncology Courtyard Mosaic Project Two artists produced a mosaic called Tree of Life for Yeo Ward to improve the environment for Teenage and Young Adult patients. The commission came about thanks to a grant which Exeter Healthcare Arts secured from the National Lottery’s Awards for All fund. A room at the end of the ward has
been set aside for the treatment of teenage and young adults patients which allows for greater flexibility for patients and families. A door from the room now leads to a small courtyard. Artists Lucy Rockliffe and Jess Carvell produced the community mosaic and ceramic work for the space based on themes of nature.
Volunteering for the Paralympic Games a ‘rewarding experience Our staff already work in a caring environment, but many of them are also engaged in fundraising and volunteering outside of work. Here, e-comms officer, Sadie Moisan, reflects on her experience as a Paralympic gamesmaker. “A year after applying I finally heard that I had been accepted. I was very excited and found I was part of the Events Team at the North Greenwich Arena (NGA), or O2 as it’s usually called, where the Wheelchair basketball was being held. One of the most popular sports at the Paralympic Games, Wheelchair Basketball was developed by American WW2 veterans for rehabilitation and is now played in over 80 countries. A fast and physically demanding game, it requires speed, strength, stamina and tactics. Top players use specially designed titanium chairs that can last only six months during periods of high level competition. Volunteering at the Games was a unique, enjoyable and ‘rewarding experience’. I met many different people with adventures to tell; other gamesmakers, army, police, stewards, G4S, umpires, athletes & their families. The atmosphere and mix of people watching the sport was incredible. Calling in favours for cheap accommodation, long hours, ready for any situation, lots of smiling and a sore hand from hi-fiving (watch out for those people who grit their teeth before they hi-five!) it was all worth it. Is it over? No way! Volunteers are still in regular contact through Facebook and through a national and South West group. Our current focus is to sponsor a South West athlete through Sportsaid, the organisation that has helped people such as Chris Hoy, Tanni GreyThompson, Tom Daley, Ellie Simmonds and David Weir. Now, did I see they were looking for volunteers for the Sochi Winter Games… and what about Rio, do I need a carnival outfit for that one?!”
n Katie Williams, Claire Dummett, Jamie-Lee Yelland and Hilary Harris in the courtyard.
WRVS café gets deserved makeover The WRVS café at Exeter Mobility Centre has been officially opened after a complete refurbishment. Volunteers, users and management enjoyed tea and cake to celebrate the newlook area, which has been waiting for refurbishment for a long time. Amanda Whitlock, area manager for the WRVS, said that she was delighted with the way the café now looked. She said: “The money that we raise is usually gifted back to
the NHS. However, because we needed refurbishment, the hospital agreed that we could use this money for the café. “We are really pleased with how it looks. It is cleaner, brighter and much more welcoming. We have been waiting years to see this happen and it is fantastic that it has finally happened. Everyone has worked very hard to make it look like this.” The WRVS supports older people to remain independent in their own homes.
n From left to right: Volunteer Rupert Raven, Heather Howard, volunteer Colin Bray, Anne Brinkworth, Amanda Whitlock, area manager, Pauline Targett, Joan Bennett, Beryl Heal and Philip Targett.
Staff and Wellbeing
Childcare vouchers for children up to the age of 15 The RD&E Childcare Voucher Scheme is a governmentled initiative designed to support working parents with their childcare costs. In exchange for part of your pay, vouchers are issued to you – which can then be used as payment to any registered childcare provider of your choice. The main benefits of the scheme are: n You do not pay National Insurance or Tax or NHS Pension contributions on the part of your salary you exchange for childcare – this could save you more than £900 per year! n The vouchers issued to you have an expiry date of 18
months so you don’t have to use them straight away enabling you to store them up and use them for times when your childcare costs may be greater, such as summer holidays. n You may use the vouchers to pay for your childcare costs up to September 1st following their 15th birthday or September 1st following their 16th birthday if they are disabled. n Childcare vouchers can be used at all Ofsted or equivalent registered childcare providers. This includes nurseries, play schemes, childminders, out-of-hours school clubs, sport, music and drama
Meditation sessions are being held in chapel A Buddhist nun is leading meditation sessions in the chapel. The opportunity for some calm in the middle of a busy day is on a Wednesday from 12 noon until 12.30pm. All are welcome at the sessions.
Pathways workshop a great success More than 60 GPs attended a workshop on six different clinical pathways at the third Local Pathways of Care event. The workshop, held at the Peninsular Medical School and Noy Scott House, was co-delivered by the Trust’s consultants and GPs on November 14th. The feedback was extremely positive and the event is much valued with the partnership delivery of the workshop being key to its success. Thanks were given in particular to the speakers for their support and work. The next event will be held in 2013.
lessons, holiday clubs or schemes and certain elements of Independent school fees.
For further information, visit IaN or contact Steven Ball (Childcare Department) on 01392 405867.
n You can store your vouchers up for times when childcare costs may be greater, such as summer holidays.
Terrific turnout at Graphics Open Days Graphics recently opened its doors to colleagues who turned out to meet the team and find out more about the department at Open Days held in both Wonford and Heavitree. Graphics Manager, Lara Millmow, said: “Some came with specific questions and others just to see what we do. The main aim was to show how Graphics can support the important work happening in the Trust and out on the wards. Colleagues were also pleased to find out that we do private work.” Many signed up to be Super Users and entered into a draw for a box of Thorntons chocolates.
“It’s a good way to find out about new Clinical Integrated Documentation (CIDs),” said one Ward Clerk. The draw will take place just before Christmas so there is still time to sign up to receive e-mail notices and become part of a forum to help shape the Graphics service. There is an ongoing focus to build awareness, so colleagues who were not able to attend the Open Days are welcome to pop in and pick up a leaflet or speak to a member of the team. Graphics would like to thank everyone who attended.
Give yourself a boost with Rock and Pop Choir The RD&E Rock and Pop Choir is offering two free-of-charge taster sessions in the new year. Sessions will be led by the director and founder of The Courage to Sing, Rock and Pop Choir Company, Lorrayn de Peyer. If there is interest from 30 – 40 staff, regular sessions will be subsidised throughout the year, for as little as £3
per staff member, per session. Singing has been linked to improving health, better communication, lower stress levels, feeling uplifted and being more productive and inspired. To find out more, go along to PEOC Lecture Theatre on January 16 and January 23. Practice is from 5.30pm to 6.45pm.
Home Instead Senior Care, the National Dignity in Care award winners for 2012, are expanding their home care operations across the East Devon and Exeter area. With local offices in Budleigh Salterton and now operating in over 130 locations across the UK, Home Instead offers a very different type of Home Care to its clients where quality and continuity of care with visits of not less than 1-2 hours and carefully matched clients and caregivers are able to build trusted relationships. Every client has a personalised care plan tailored to the client’s needs and wishes which includes companionship, home care, local transportation and personal care. Managing Director, Mark McGlade, said: “Our caregivers take clients to hospital appointments, help with shopping, light housekeeping, meal preparation, assist with dressing, washing, medication reminders and personal care. We place a huge emphasis on companionship and delivering care with an holistic approach, looking at the total well-being of our clients not tasks in short visits of 15-30 minutes which unfortunately has become commonplace in typical social care delivery.” Home Instead Senior Care has recently been accredited by City & Guilds for their dementia training courses which is specifically designed for caregivers looking after dementia sufferers in their own homes and offers specialist training to all its caregivers to support their clients in the area. The longer time periods of visits by Home Instead carers has been particularly beneficial for re-ablement following hospitalisation, Stroke, Parkinsons and dementia sufferers where time and continuity are vital to delivering quality support care.
For further information contact Home Instead Senior Care on 01395 200600 or visit www.homeinstead.co.uk/eastdevon 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, they 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 written consent of the copyright owners. Octagon Marketing Company Ltd. ©2012 Britannic Chambers, 8a Carlton Road, Worksop, Notts. S80 1PH. Tel: 01909 478822
The Royal Devon and Exeter 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 Royal Devon and Exeter NHS Foundation Trust endorse any of the products or services.
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Published on Dec 17, 2012