3 Irish Heart Foundation Stroke Manifesto One in five people in Ireland will have a stroke at some time in their life. Until recently, many believed stroke was a disease for which little or nothing could be done. We now know that strokes are among the most preventable and treatable of all diseases. But hundreds of people are dying each year when their lives could be saved. And hundreds more are living with permanent disability for the want of vital service improvements.
4 What are the effects of inadequate services? Fact: Around 10,000 people will have a stroke in Ireland this year. Over 2,000 will die and thousands more will be left disabled. But a significant proportion of this death and disability is avoidable. Fact: Less than one in three acute hospitals has a stroke unit if all acute hospitals had a stroke unit up to 500 lives a year could be saved. Fact: At least 15 per cent of strokes are misdiagnosed that s over 1,500 cases a year.
5 Fact: Less than 3% of stroke patients received the life-saving clot buster treatment, thrombolysis, in the 12 months to April this year. Almost half of our acute hospitals cannot provide the treatment at all. Many that do can only provide thrombolysis during office hours or on an intermittent basis. Fact: Just one in four patients were recorded as having received acute rehabilitation, according to Irish Heart Foundation research. Tens of thousands of people who return home or require nursing home care after a stroke receive rehabilitation and support services that are under-resourced and poorly co-ordinated.
6 All this means the place, time and day of a stroke largely determines whether you recover, die, or live the rest of your life with a disability. Where patients live will also dictate whether they receive the rehabilitation and support they need after leaving hospital. For many who survive with disabilities after being unable to access prompt treatment, there is a double injustice. The lack of availability of acute rehabilitation means that many people must live with avoidable or unduly severe disabilities. Won t better stroke services cost too much? We believe that providing a high quality network of national stroke services, co-ordinating prevention, hospital and community care could be cost neutral,
7 or save the State money. Even now our stroke services cost the State an estimated 422 million a year. Making the necessary improvements would reduce the cost of institutional care, the length of hospital stay and the rate of readmission. How can change be secured? We are asking people regardless of whether their lives have yet been touched by stroke to join our campaign urging the Government to implement the measures that will eliminate avoidable death and disability from stroke. Most of these are contained in a report by experts appointed by Health Minister Mary Harney called the Cardiovascular Health Policy Group. We are calling on the Government to implement 16 recommendations:
8 Preventing Stroke Up to 50% of strokes are preventable. This means that 5,000 strokes a year and 1,000 deaths could be avoided if people took simple steps to cut down on their risk. But very few people are aware they can dramatically reduce their chances of having a stroke. Stroke Fact: A stroke is a brain attack. It is caused by a blockage of a blood vessel or haemorrhage that stops the flow of blood to the brain. This can damage or destroy brain cells which will affect body functions or mental processes. Stroke Fact: A TIA is also known as a mini-stroke. It may cause a brief loss of vision, loss of speech, or weakness on one side of the body and is a warning sign that a full stroke may be imminent.
9 MANIFESTO POINT 1 WE CALL ON THE GOVERNMENT to deliver a major programme to educate the public on how to reduce their risk of having a stroke or a Transient Ischaemic Attack (TIA).
10 Stroke as a Medical Emergency Most people don t know that immediate medical treatment after stroke can make the difference between recovery, death or permanent dependency. Irish Heart Foundation research shows that the vast majority of people would not know if they were having a stroke. And less than half would ring an ambulance if they knew they were having a stroke. Greater awareness would save many lives by getting more people into hospital quicker.
11 MANIFESTO POINT 2 WE CALL ON THE GOVERNMENT to support a national campaign to increase public awareness of the warning signs of stroke and to ensure stroke is recognised as a medical emergency.
12 Stroke Unit Care The provision of stroke units in acute hospitals could reduce death and dependency rates by 20% - saving up to 500 lives a year and sparing hundreds more from disabilities requiring longterm institutional care. Stroke Fact: Stroke is the third biggest killer in Ireland claiming more lives than breast cancer, lung cancer and bowel cancer combined. It is also the biggest cause of acquired disability.
13 MANIFESTO POINT 3 WE CALL ON THE GOVERNMENT to ensure that every hospital admitting patients with acute stroke has a properly staffed and fully resourced stroke unit.
14 Stroke Unit Standards Any dilution in the definition of what constitutes a stroke unit, or any operational failure to comply with international standards, especially in relation to capacity, staffing and equipment will reduce their effectiveness and cost lives.
15 MANIFESTO POINT 4 WE CALL ON THE GOVERNMENT to ensure the HSE complies with European Stroke Organisation Guidelines in the delivery of a national network of stroke units and to continually monitor compliance with these standards.
16 Clot-busting Treatment Treatment with clot-busting drugs thrombolysis prevents death and disability from stroke, but must be delivered to eligible patients within 3 hours. In the 12 months to April 2009 less than 3% of stroke patients received the treatment. Thrombolysis is currently provided to stroke patients at just over half of the country s acute hospitals, but in many of these only on a 9am-5pm Monday-Friday basis. Stroke Fact: Thrombolysis dissolves blood clots that cause strokes by blocking the supply of blood to the brain.
17 MANIFESTO POINT 5 WE CALL ON THE GOVERNMENT to urgently deliver 24/7 availability of thrombolysis to all suitable stroke patients.
18 Emergency Services The average stroke destroys two million brain cells every minute. Trained ambulance staff, telemedicine support and properly equipped ambulances and emergency departments are crucial to the prompt treatment of stroke patients. Stroke Fact: Only 5% of patients are admitted to hospital within two hours of stroke onset. After two hours a patient s chance of recovering with little or no disability is greatly reduced.
19 MANIFESTO POINT 6 WE CALL ON THE GOVERNMENT to guarantee that emergency services are equipped and empowered to deal with acute strokes.
20 Consultant Stroke Physicians There are 27 lead stroke consultants in Irish acute hospitals. However, there are as few as three whose clinical remit is given over substantially to stroke. This shortage of specialists is exacerbated by the fact that stroke can be difficult to identify. At least 15% of strokes and half of TIAs are currently misdiagnosed in Ireland. The failure to provide the correct diagnosis in over 1,500 cases carries devastating consequences for patients.
21 MANIFESTO POINT 7 WE CALL ON THE GOVERNMENT to appoint more consultant stroke physicians to provide greater expertise in the diagnosis and treatment of stroke.
22 TIA Clinics Patients who suffer TIAs or mini-strokes are at much greater risk of having a full stroke. Even though TIA services can reduce repeat mini-strokes or strokes by 80%, they are provided in just one in every six acute hospitals in Ireland.
23 MANIFESTO POINT 8 WE CALL ON THE GOVERNMENT to provide consultant-led rapid access TIA clinics on a regional basis that are open seven days a week.
24 Rehabilitation Services Acute rehabilitation is not available to the vast majority of stroke patients which causes unnecessary suffering to thousands of people each year. Each patient should be entitled to receive a minimum of 45 minutes of required rehabilitation 5-7 days a week for as long as it is needed. This should include physiotherapy, occupational therapy, clinical psychology, speech and language therapy and nutrition and dietetic input provided by both hospital and community based stroke teams. Stroke Fact: Irish data showed that less than half of stroke patients were seen by a physiotherapist within 72 hours of admission and only one-in-four were assessed by an occupational therapist within seven days of admission.
25 MANIFESTO POINT 9 WE CALL ON THE GOVERNMENT to give every patient an entitlement to appropriate levels of short and long term rehabilitation in hospital and in the community.
26 Planned Discharge and After-care Continuing care and long-term recovery programmes are haphazardly organised or do not exist. Patients should receive a co-ordinated service that ensures: - Rehabilitation that is planned from the day of hospital admission - A full needs assessment supporting discharge home - Clear structures for collaboration between hospital and community stroke staff - Access to stroke rehabilitation in the community - Access to relevant information and advice, along with a contact person after discharge from hospital - Aftercare and long-term support for people suffering lasting disability - For those requiring nursing home care, access to full therapist and support services
27 MANIFESTO POINT 10 WE CALL ON THE GOVERNMENT to ensure the right of each patient to a planned and timely transition from hospital to their home or residential care. We also urge that long-term institutional care should only be provided on the basis of medical and social need, never because of inadequate community services or supports.
28 Regional Stroke Co-ordination and Implementation Supervision Just as there are regional cancer coordinators, the complexity of stroke means that regional co-ordinators must be appointed to ensure that preventive, pre-hospital, hospital and community services are working together and developing and meeting targets on excellence in stroke care.
29 MANIFESTO POINT 11 WE CALL ON THE GOVERNMENT to appoint regional stroke co-ordinators with responsibility for ensuring that stroke services are meeting the needs of people who have had a stroke in every community in Ireland.
30 Tackling Age Discrimination Age-related inequities are common within stroke services. In some locations over-65s do not receive rehabilitation services, whilst in others under-65s are ineligible for community services. Stroke Fact: Anyone can have a stroke, even babies and children. Two-thirds of strokes are suffered by over-65s, but every year around 3,500 people aged under-65 have a stroke.
31 MANIFESTO POINT 12 WE CALL ON THE GOVERNMENT to eliminate age discrimination from stroke services. These should always be provided on the basis of individual need.
32 Patients Charter Most people don t know that high quality stroke services can save lives, reduce disability and improve the rate of recovery from stroke. Many are also unaware of what services will best aid their recovery.
33 MANIFESTO POINT 13 WE CALL ON THE GOVERNMENT to ensure the adoption of a Charter to inform all stroke patients, their families and carers exactly what their entitlements are in relation to hospital treatment, care and rehabilitation.
34 Stroke Register A stroke register will help ensure that stroke services operate as effectively as possible. Collecting basic data on stroke patients will assist with planning and monitoring of performance that can have a major impact on patient outcomes and the overall quality of services. Stroke Fact: Patient Registries such as the National Cancer Registry which record the numbers, types and treatment outcomes of patients assist in planning and evaluation of healthcare and can ensure that patients receive high quality care.
35 MANIFESTO POINT 14 WE CALL ON THE GOVERNMENT to prioritise the development of a national Stroke Register.
36 Social and Vocational Supports Social and vocational supports must be available to help people put their lives back together after stroke. For example, everyone should have access to a stroke support group. In addition, financial assistance such as housing adaptations grants can make the difference between living at home and institutionalisation. Support to return to work, or undergo re-training can determine whether a person can return to the workforce. These supports are not just crucial in human terms, they can save the State money.
37 MANIFESTO POINT 15 WE CALL ON THE GOVERN- MENT to ensure that social and vocational supports are available enabling stroke patients to achieve the best possible quality of life after their stroke. We also call for State assistance to ensure that everyone who has had a stroke has access to a properlyresourced support group.
38 Supporting Carers Carers carry a huge burden in helping people to put their lives back together after stroke.
39 MANIFESTO POINT 16 WE CALL ON THE GOVERNMENT to address the social, emotional and practical needs of carers in supporting stroke survivors.
44 Irish Heart Foundation 4 Clyde Road, Ballsbridge, Dublin 4 Tel (01) Fax (01) Helpline
What is the Surrey Stroke Services Review? Stroke services in Surrey A stroke is caused when the blood supply to the brain is interrupted, usually because a blood vessel bursts or is blocked by a clot.
Stroke care in England, Wales and Northern Ireland This report is for stroke survivors and their families Based on patients treated between April - June 2015 1 2 Table of Contents Introduction to the SSNAP
SSNAP s Acute Organisational Audit Report 2012: Performance Summary for South London The Sentinel Stroke National Audit Programme (SSNAP) s Acute Organisational Audit looks at how stroke services across
The Regulation and Quality Improvement Authority Review of Stroke Services in Northern Ireland December 2014 Assurance, Challenge and Improvement in Health and Social Care www.rqia.org.uk The Regulation
STROKE SERIES SS10 Understanding thrombolysis treatment For stroke Chest Heart & Stroke Scotland improves the quality of life for people in Scotland affected by chest, heart and stroke illness, through
The Stroke Strategy confirmed that the Department would commission a short analysis of research evidence in relation to the strategy and the top ten research areas identified in it. We said that we would
Special review Supporting life after stroke A review of services for people who have had a stroke and their carers January 2011 About the Care Quality Commission The Care Quality Commission (CQC) is the
Neurorehabilitation Strategy Briefing Document and Position Paper Background What is neurorehabilitation? The World Health Organisation defines neurorehabilitation as: A problem-solving process in which
1. Introduction BRIEFING PAPER STROKE SERVICES REDESIGN Agenda Item 3 Stroke is the leading cause of adult disability in Wales, and the third most common cause of death, after cancer and heart disease.
SECTION B THE SERVICES COMMUNITY STROKE REHABILITATION SPECIFICATION 20XX/YY SECTION B PART 1 - SERVICE SPECIFICATIONS Service specification number Service Commissioner Lead Provider Lead Period Date of
Proposed co-location of stroke services Contents Contents... 2 Executive summary... 3 Introduction... 4 How stroke services are currently provided... 6 The case for change... 8 What is our proposed service
Lancashire Teaching Hospitals NHS Foundation Trust THE BIG PLAN 2014-2016 Excellent care with compassion THE BIG PLAN The NHS is currently facing the biggest challenge in its history. Our population is
Right Care, Right Time, Right Place health Full Engagement Booklet Contents The challenge for the NHS 2 Maintaining Quality, Improving Efficiency Your NHS 2 What s happening within our services? 3 Section
Bowel cancer: a vision for 2020 beatingbowelcancer.org 02 beatingbowelcancer.org A vision for 2020 To produce Bowel cancer: a vision for 2020 we listened to the people that matter most: people with bowel
A Patient s Guide to Canadian Best Practice Recommendations for Stroke Care Canadian Best Practice Recommendations for Stroke Care have been developed by stroke experts across the country. These recommendations
Patient Information Leaflet Community Rehabilitation Beds Questions and Answers Produced by: Community Rehabilitation Date: March 2014 Review due date: March 2017 1 PARTNERSHIP IN CARE INDEPENDENT NURSING
Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social
Aerobic Exercise After Stroke HOW AEROBIC ACTIVITY CAN HELP YOU AFTER A STROKE This resource provides aerobic activity recommendations for people at any point in their recovery from stroke. It is designed
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Fatigue after stroke Fatigue is one of the most common effects of stroke. It can make you feel unwell and like you re not in control of your recovery.
Manifesto for Acquired Brain Injury Rehabilitation For further information please contact: Chloë Hayward UKABIF Executive Director PO Box 355 Plymouth PL3 4WD Tel: 01752 601318 Email: firstname.lastname@example.org
How good is stroke care? First SSNAP Annual Report Care received from April 2013 to March 2014 Distant as a light house I felt, shining my inner light for a rescue boat... In time it eventually came! Claire
Pre-budget Submission 2016 Joint Committee on Finance, Public Expenditure and Reform July 2015 SUMMARY POINTS Acquired Brain Injury Ireland (ABI Ireland) is asking the Government to support people living
Towards Earlier Discharge, Better Outcomes, Lower Cost: Stroke Rehabilitation in Ireland September 2014 Research Summary Report prepared for the Irish Heart Foundation by the Economic and Social Research
NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Private treatment You can choose private health treatment for all medical conditions, including stroke. If you are considering private treatment this
1 Key Area (according to letter from David Nicholson) Reducing the number of years of life lost by the people of England from treatable conditions (e.g. including cancer, stroke, heart disease, respiratory
When a stroke happens When a stroke happens What to expect during the first hours, days and weeks after a stroke We re for life after stroke Introduction Need to talk? Call our confidential Stroke Helpline
What are the PH interventions the NHS should adopt? South West Clinical Senate 15 th January, 2015 Debbie Stark, PHE Healthcare Public Health Consultant Kevin Elliston: PHE Consultant in Health Improvement
Comments trom the Aberdeen City Joint Futures Brain Injury Group The Aberdeen City Joint Futures Brain Injury Group is made up of representatives from health (acute services, rehabilitation and community),
alzheimers.org.uk What is vascular dementia? Vascular dementia is the second most common form of dementia after Alzheimer s disease. It is caused by problems in the supply of blood to the brain. This factsheet
Update on Stroke Reconfiguration Programme Birmingham, Solihull and Black Country Agenda Item no 6 1. Purpose To provide an overview of the Birmingham, Solihull and Black Country Stroke reconfiguration
Understanding NICE guidance Information for people who use NHS services Early assessment and treatment of people who have had a stroke or transient ischaemic attack (TIA) NICE clinical guidelines advise
Personal Insurance Do I need Trauma cover? a safety to help get you back on track Being able to focus on your recovery after suffering a traumatic event is going to be your primary concern. Having trauma
1 Liverpool Clinical Commissioning Group: for a healthy Liverpool In this leaflet: - A guide to Liverpool Clinical Commissioning Group and its priorities for the city - Introducing The Healthy Liverpool
What you should know about Data Quality A guide for health and social care staff Please note the scope of this document is to provide a broad overview of data quality issues around personal health information
What is a? A happens when the blood supply to the brain is interrupted. Blood contains oxygen and important nutrients for your brain cells. Blood may stop moving through an artery because it is blocked
Cardiovascular disease Key contact/author: Dr Veena de Souza, Consultant in Public Health, Buckinghamshire County Council Introduction Cardiovascular disease (CVD) includes heart disease and stroke. It
Brain & CNS cancers 2015 Annex B Epidemiology 1. The incidence of brain & CNS tumours in England was reported to be just under 4,000 in 2007. 1 This is expected to increase further with an aging population
Discharge Information Information for patients This leaflet is intended to help you, your carer, relatives and friends understand and prepare for your discharge or transfer from hospital. Healthcare professionals
The Scottish Ambulance Service Improving Care, Reducing Costs Working together for better patient care Key points The Scottish Ambulance Service is seeing more people, faster, and offering better quality
excellence in child health fund report 2014-2015 A Bright Future for BC s Kids Take a look at the health-care journey of a BC Children s Hospital patient to learn how your donation to the Excellence in
GP workshop Maria Fitzpatrick Nurse Consultant Kings College Stroke Centre Stroke: the Facts Stroke: the Facts Every 5 minutes someone in the UK has a stroke 1 in 4 men and 1 in 5 women will have a stroke
The End of Life Care Strategy promoting high quality care for all adults at the end of life Prof Mike Richards July 2008 The End of Life Care Strategy: Rationale (1) Around 500,000 people die in England
Heart Attack Your quick guide Coronary heart disease is the UK s single biggest killer. For over 50 years we ve pioneered research that s transformed the lives of people living with heart and circulatory
Brain injury can be devastating for families and carers as well as the people directly affected. These cases require specialist advice and support and that is what the Brain Injury Group provides. It is
Early Supported Discharge (in the context of Stroke Rehabilitation in the Community) Gold Standard Framework This document was produced with reference to national standards for best practice (e.g. NICE
Taking Charge of Your Stroke Recovery A SURVIVOR'S GUIDE TO THE CANADIAN STROKE BEST PRACTICE RECOMMENDATIONS BE INFORMED BE INVOLVED TAKE ACTION BE INFORMED BE INVOLVED TAKE ACTION The Canadian Stroke
Review of Stroke Services in Tameside Personal and Health Services Scrutiny Panel July 2012 Contents Paragraph Page No. Introduction by the Chair Summary 1 2 2 4 Membership of the Scrutiny Panel 3 4 Terms
www.irishheart.ie www.stroke.ie WHAT IS A STROKE AND HOW TO TREAT STROKE One in five people have a stroke at some time in their life. Stroke can strike at any age. It could happen to you, a friend or family
Guide to running a local F.A.S.T. campaign www.stroke.ie The Irish Heart Foundation and Stroke Since 1966, the Irish Heart Foundation has been working to reduce premature death and disability from stroke
Cardio-Pulmonary Resuscitation (CPR): A Decision Aid For KGH Patients And Their Families The goal of this pamphlet is to provide information about cardiopulmonary resuscitation (CPR) so you can be adequately
Get the whole story about Critical Illness and how this could affect you Aviva s Critical Illness claims report 2009 Aviva s 2009 critical illness claims report For most of us, the importance of having
UNDERSTANDING STROKE DUE TO INTRACEREBRAL HAEMORRHAGE This factsheet provides information for people who have had a stroke due to an intracerebral (bleed in the brain) and for their families and carers.
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Transient ischaemic attack (TIA) A transient ischaemic attack or TIA (also known as a mini-stroke) is the same as a stroke, except that the symptoms
Stroke Services: Ensuring the best outcomes for patients and communities in the year ahead Progress and Way Forward Version 3.0, 3 March 2014 Summary The most important message for anyone with a suspected
REHABILITATION begins right here Select Rehabilitation Hospital of Denton offers you a new direction in medical rehabilitation. Our 44-bed, state-of-the-science hospital offers unparalleled treatment to
The Acute Neurological Rehabilitation Unit Welcome The Wellington Hospital s Acute Neurological Rehabilitation Unit is the largest private unit in the UK, with 60 rooms specifically designed for neurological
Some life insurers make claims, we just pay them. FOR ADVISERS February 2012 AIA.COM.AU 2 Some life insurers make claims, we just pay them This brochure has been designed to assist you to explain the benefits
Kidney Disease What YOU need to know International Society of Nephrolo Advancing Nephrology around t A briefing on the global impact of kidney disease - from the International Society of Nephrology Awareness
S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration
Submission to Joint Committee on Health & Children Public Hearings On End of Life Care in Community November 5 th 2013 Institute of Community Health Nursing Milltown Park, Sandford Road, Ranelagh, Dublin
Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020 National Palliative and End of Life Care Partnership Association for Palliative Medicine; Association of Ambulance
East Lancashire Community Rehabilitation Team (CRT) Service User Information 2 This Information Pack has been designed to help you understand who the Community Rehabilitation Team are and how we may be
Graduate Council Document 08-20b Approved by the Graduate Council November 20, 2008 PROPOSAL GRADUATE CERTIFICATE ADVANCED PRACTICE ONCOLOGY SCHOOL OF NURSING TO BE OFFERED AT PURDUE UNIVERSITY WEST LAFAYETTE
The Regulation and Quality Improvement Authority Review of Brain Injury Services in Northern Ireland September 2015 Assurance, Challenge and Improvement in Health and Social Care www.rqia.org.uk The Regulation
Job Description POSITION: PHYSICIAN RESPONSIBLE TO: CLINICAL DIRECTOR, MEDICAL SERVICES PRINCIPAL OBJECTIVES: 1. To provide medical services to the community served by the South Canterbury District Health
Quick Guide to NHS Continuing Healthcare Funding Contents 1 How can Farley Dwek help families with their eligibility for NHS Continuing Healthcare Funding? 3 2 3 4 5 6 7 8 Why is it important for families
Inspectorate of Mental Health Services National Overview of Psychologists Working in Mental Health Services Ireland 2012 As part of the inspection of mental health services in 2012, the Inspector of Mental
A vision for emergency and urgent care The role of ambulance services The Ambulance Service Network The Ambulance Service Network was established as part of the NHS Confederation to enable the ambulance
Frequently Asked Questions Regarding At Home and Inpatient Hospice Care Contents Page: Topic Overview Assistance in Consideration Process Locations in Which VNA Provides Hospice Care Determination of Type
Feedback Report Ambulance Trust Feedback Report Progress in improving stroke care Progress in improving stroke care Ambulance Trust Feedback Report Introduction In February 2010 we published a report on
Facing the challenges of CRITICAL ILLNESS INTRODUCTION What is insurance? In life, we are all faced with threats which, if they occurred, would result in financial loss Insurance is the process of protecting
NHS Board Contact Email NHS National Waiting Times Centre Board Julie Carter email@example.com Title Category Background/ context National Waiting Times Centre Board Rehabilitation Department
11:30 12:40 Younger people with demen1a No Brainer: A care pathway for people with alcohol related brain injury Karen East, Head of Care and Quality, Dukeries Healthcare Towards a care pathway for people
GP Round Up Issue 55 October 2014 Contents GP Round Up Introduction by Alistair Flowerdew Medical Director... 1 Observation ward opens in Emergency Department... 2 Orthopaedic Elective Centre to open in
UHI Explained Frequently asked questions on the proposed new model of Universal Health Insurance Overview of Universal Health Insurance What kind of health system does Ireland currently have? At the moment
A guide for injured workers Returning to work April 2011 Contents 1. Getting back to work 1 Ideas to help you return to work 2 Staying positive 2 Your employer s legal obligations 3 Anti-discrimination
factsheet June 2010 Seeing ambulance services in a different light More than a patient transport service Key points NHS ambulance services face some of the most demanding performance targets in the world.
Alcohol and drugs prevention, treatment and recovery: why invest? 1 Alcohol problems are widespread 9 million adults drink at levels that increase the risk of harm to their health 1.6 million adults show
Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P
Macmillan Cancer Support Volunteering Policy Introduction Thousands of volunteers dedicate time and energy to improve the lives of people affected by cancer. Macmillan was started by a volunteer and volunteers
Your consent to our cookies if you continue to use this website.