Tag Archives: Co-production

Embedding co-production at all levels of care

Margaret DangoorMargaret Dangoor, member of C4CC’s co-production group shares her experiences of helping to deliver co-production at a local level in celebration of national co-production week (2-6 July 2018) #coproweek.

In all the fanfare around the 70th anniversary of our wonderful NHS, it may have been easy to miss that it’s also been National Co-Production Week.

In PR terms, it could indeed be seen as an unfortunate clash, but as someone who has been promoting the principles of co-production on both a national and local level for a number of years, I take the opposite view.

If the NHS and our social care services are to continue to prosper and improve for the next 70 years and beyond then we need to firmly embed the principles of co-production at all levels of care.

It’s a model for the future and I’m heartened to see that it is gaining traction within NHS England and in many different local authority areas.

I have been actively involved for nearly 30 years in the London Borough of Richmond upon Thames. Initially I was involved in the community and voluntary sector, then focused on the development and chairing of statutory patient participation groups.  On becoming a carer for my husband who developed Alzheimer’s disease I became particularly involved with representing the voice of users and carers within the local NHS and borough health and social care services, whether at strategic level, influencing commissioning – or monitoring provision.  I am also currently chair of a local health centre’s patient and public involvement forum.

I’m pleased to say that Richmond was an early adopter of co-production several years ago and marked the national week with publicity around the work that is being carried out, particularly with carers.

“Involving the users of care and support services, and their families and carers in making decisions about how their care is delivered empowers them to be able to live full, independent lives,” was a quote from Cllr Piers Allen, Cabinet Member for Adult Services and Health.  I cared for my husband Eddie for many years until he sadly passed away in January of this year and was grateful for good local support, particularly a specialist dementia day centre and a Caring Café supported by the local authority.

From personal experience, I found that being able to have a say and being listened to is so important in end of life care. Properly planning for the final few weeks, in liaison with the family GP practice, when medical intervention was limited but supportive was so beneficial.

Following a short stay in hospital and discharge, we made a conscious decision that it was not in my husband Eddie’s best interest and agreed a plan as to how he would see out his final days in the community, with compassionate care and dignity.

I firmly believe that having a good death is an important part of having a good life, and the principles of co-production are so relevant in this area.

I’m determined to carry on this work locally as chair of the health centre patient participation group and my other local health and social care involvement.  I am also involved with social care research, through the NIHR school of social care research and the personal social services research unit based at the London School of Economics and Political Science, as well as my national involvement on the C4CC co-production group and as a trustee of the Centre for Ageing Better.  I also volunteer for Carers UK and the Alzheimer’s Society.

I think it is true to say that NHS England can promote and support strategies around co-production, but it needs to work at a local level and that is happening both in Richmond and other areas across the country so it is great to get both perspectives; in fact, it is essential.

The benefits of collaborative working across the health and social care system and using community assets to deliver care are a fundamental part of C4CC’s Three Cs and are so important as we celebrate the past successes of the NHS and build a service for the future.

 

‘Thank God for the NHS and Nye Bevan!’

Photo of C4CC co-chair Nigel MathersTo mark 70 years of the NHS, C4CC’s co-chair, Nigel Mathers, writes this blog post on why he owes so much to the NHS and what his hopes are for the future.

I owe so much to the NHS.

I had severe asthma as a child and without the NHS, back then in the early 1950s – in its infancy, it would have been very difficult to get a good quality of treatment.

After training at medical school, I spent my entire working life in general practice, a fulfilling and rewarding career.

And just last year it proved a life-saver after I suffered a major heart attack and collapsed in the street.

Fortunately, an ambulance crew arrived in only seven minutes and was able to resuscitate me at the roadside. I had just a five percent chance of survival and was rushed to the coronary care unit at our local hospital.

Thanks to the skill of the surgeons and the wonders of modern medical technology I pulled through and have made a great recovery with a good quality of life.

Of course, this is one of the major success stories of the NHS, survival rates from heart attacks, many forms of cancer, particularly breast cancer, and a host of other diseases have dramatically improved over the past 70 years.

Way back then, heart attack victims were prescribed prolonged bed rest, while my rehabilitation has been based around daily four to five mile walks – tough at first but necessary and now part of my daily routine.

So it is easy to see why I care so much about the service launched by good old Nye Bevan in 1948 and now having to adapt to the very different landscape of 21st Century Britain, with all the challenges that brings.

As a former Honorary Secretary of the Royal College of General Practitioners (RCGP) and as co-chair of the Coalition for Collaborative Care (C4CC), I have been campaigning to bring about the changes to the health system that I believe can help it thrive for the next 70 years and beyond.

The NHS and social care services are currently under immense pressure through a combination of an ageing population and over 15 million people living with complex long-term conditions.

C4CC believes that the answer to easing these pressures, and providing people with the high-quality care and treatment they deserve, lies in our Three Cs – Better Conversations, Co-production, and Stronger Communities and happily there is now general consensus that this is the way forward. This personalisation of care has captured the zeitgeist – ‘spirit of our times’

As I look back on my career in general practice, which spanned over half of the 70 years since the NHS started, many of us were already using or beginning to harness these key principles in our daily work.

When I started as a GP, consultations with patients lasted the grand total of five minutes, the relationship was much more formal, with nobody calling me by my first name, and conversation and interaction was strictly limited, not least because of time.

In my inner-city practice, we tried hard to break down these artificial barriers by dressing informally, having soft furnishings in the rooms and never sitting directly behind a big desk when talking to people we adopted a conversational style across the side of a desk for consultations.

It was innovative at the time, but is now seen as best practice and of course consultations can now last up to 15 minutes, giving the opportunity to get to the root of a problem, which may not require costly medical intervention.

Co-production as a notion has also been around for a long time, it was just not called it.

In the 1980s we talked about a meeting of experts, with people experts on themselves and what might work best for them, and doctors the experts because of their medical training.

This evolved into RCGP best practice around shared decision-making, designed to encourage the patient to be an equal partner in their own care, the basic principle of what is now called co-production.

I’m particularly proud that C4CC has developed a model for co-production that seems to work and which has been adopted by our partner NHS England in its planning in this key area.

Finally, we have always relied on community and the voluntary services to address the unmet needs of our patients and sometimes [sadly] to fill the gaps in health and wellbeing provision for our communities.

My practice and many others were prescribing exercise in the 1980s, organising bi-weekly walks from our surgery for those we felt might benefit.

We now call this social prescribing and whether it is running, walking, joining other community groups or simply volunteering it has been found that these non-medical referrals can relieve the burden on the NHS and tackle issues such as loneliness and social isolation, themselves major causes of illness.

So while our Three Cs may not be new, I believe they really have captured the spirit of our times and as the NHS looks to the next 70 years will play an increasingly important role in policy direction and strategy.

It’s about changing the culture – about helping people to become active participants in their own care rather than passive recipients of that care – to encourage them to be far more involved in their own care and treatment.

The staggering pace of scientific development will, I believe help play a major part to facilitate this.

Wearable technology such as Fitbits and other devices allow people to monitor their fitness and general health.

There will be far greater interaction with people and health professionals through the Internet and advances in genetic technology [eg individually tailored drug treatments] are another area that has such tremendous possibilities for everyone.

Despite the current challenges, I believe we can look forward to the future with optimism.

I know C4CC and our partners in the coalition have a key role to play in shaping that future and to lead this social movement for change in the way that we work with people to improve their care and deliver better health outcomes for all – ‘personalised care’ for all – right across our NHS.

Nigel Mathers, Co-Chair of C4CC

 

 

“I have been on a journey of enlightenment”

‘If you want to be part of a radical movement for change and reform, sign up here!’ reads our flyer, as we announce recruitment for the seventh cohort of the Leadership for Empowered and Healthy Communities (LEHC) programme.

I have always been passionate about the importance of community in people’s lives and the need for people to have a voice in the design and delivery of local services.

I was an elected councillor in Reading for eight years, representing a ward that contained areas of significant deprivation.  During these years I became acutely conscious of the stark difference in health outcomes between people living in my ward and those just a few miles up the road, with some residents living on average eight years less than in wealthier parts of town.

I saw the mistakes that can be made with a top-down, ‘we know best’ attitude and of the waste and pointlessness of silo working between different agencies.  I saw the magic that can happen when organisations come together with local people to imagine and create solutions together – through community development and whole systems approaches and by ensuring that what matters to people is at the centre.  And I also realised that we needed a new type of local leadership to enable more of this to happen – for senior leaders, politicians, and those who provide services to be able to be flexible, genuine, open to new ideas and to be able to work collaboratively.

Some years later I had the opportunity to develop a new leadership programme, with backing from Thames Valley and Wessex NHS Leadership Academy, Skills for Care, the Local Government Association, Think Local, Act Personal (TLAP) and the Association of Directors of Adult Social Services (ADASS).

The LEHC programme started off as a pilot in 2012 and became part of C4CC’s core offer in 2016.  It has now reached over 160 participants, drawn from towns and cities across the country.

Co-produced from the beginning, the programme aims to equip senior leaders and clinicians with the necessary skills and understanding of concepts such as co-production and community development, and then to sell the case and embed these ideas in the places in which they work.

The programme has attracted the interest and praise of leaders in health and social care, up to and including the Secretary of State, Jeremy Hunt, who came to see the programme in action for himself.

But it is the feedback that we get from participants and the change that we see them making in their local areas that inspires me to continue.

One participant told us just a few weeks ago:  ‘I have been on a journey of enlightenment. My colleagues (on the course) have been inspiring and I have learnt far more skills than I thought possible.’

For further details of course dates read more here or contact:  Jan Smith at lehc.TVWLA@hee.nhs.uk

Human Rights Day 2017

My mother died suddenly when only 55 years of age I was just 20 and suffering long term after effects of a road traffic accident.

Her nurturing legacy to me could be simply summed up in two basic principles, which I have tried to pass on and uphold in my own life:

Firstly; “Always remember you are no better or worse than anyone else” and just as importantly; “Do unto others as you would have done unto you.” Give and show respect – remember no one is perfect!

As time has gone by I have realised that these principles were a good foundation to understand human rights, with the UN Charter in 1948 setting the framework that in my view is as relevant and needed today as it was nearly 70 years ago.

AT THIS TIME, it is worth following the link and reminding ourselves of The Universal Declaration of Human Rights: http://www.un.org/en/universal-declaration-human-rights/

The Declaration, with its broad range of political, civil, economic, social and cultural rights, is not a binding document unfortunately, but it has inspired more than 60 Human Rights instruments that constitute an International Standard of Human Rights.

So what is the relevance to us in our daily lives?

Very simply, in part, it is to expect to be treated with respect, fairness, dignity and equality, without discrimination.

We do all have a responsibility and duty to others too and we do all need at times to protect the rights and freedoms of others.

I would argue that currently, for those living with the “outcomes” of long term conditions as a patient, service user &/or carer, that our basic human rights are too infrequently considered.

It is challenging enough in those circumstances, with rare pleasures mixed with pain, disease, hurt, frustrations and exhaustion.

Why is it that we can be made to feel inferior, alone and sometimes stigmatised, even discriminated against, by the very public sector services that are there to support and help improve our health and wellbeing?

That the “personal assets” we bring, through co-production working together, into our treatments may not be taken into account.

I would make the case that this situation could be improved for health and wellbeing by enshrining Parity of Esteem as a human right.

It would ensure equal treatments for all conditions, whether physical or mental health, with training, funding and commissioning distributed accordingly.

It would be about looking at the ‘whole person’ and their needs, which I believe would improve OUTCOMES with sustainability both to individuals, the caring services and of course, the health economy.

In these challenging times around the world, it is all the more important that we all stand up for Equality, Justice and Human Dignity.

After writing this blog and remembering my mother…… I now am counting my few blessings, but hope others find it thought provoking.

 

Evelyn Bitcon (Carer, Advocate & voice for the vulnerable, as well as having own long term health conditions), C4CC Co Production Group member

 

Being positive about being positive

Often when we talk about HIV today we forget that for many people and communities, stigma is real. It’s still affecting people and their communities. Moreover, stigma is a tricky little beast; good at hiding.

Throughout the many years that we’ve been challenging these acts of disability-related hate crimes, it seems that many people have not been educated or exposed to the 21st century facts about living with HIV.

This is where stigma gets its mojo – when people perpetrate unkind acts that negatively affect others.

The global management of HIV is one reason people have told me why they haven’t felt able to take a test to find out their status. Their fear of a positive diagnosis, even within the UK where we have the Equalities Act and a strong evidence-based community, stems from personal fear.

Among the many labels out there, we now have another label for people –‘undetectable’. But for me, positive is positive and I ignore the medical narratives of infectious and undetectable.

Labels don’t help anyone manage the challenges of living with HIV – the label fuels the stigma. So, my view is that I’m being positive about being positive.

Too many of our brothers and sisters have poor health as well as psychological and mental ill-health issues related to that stigma.

Stigma is real and tangible to many of us, and I’m fed up with people feeding stigma with its trite treats of denial and apathy. Saying “times have changed” is a main course to stigma.

Walk in my shoes for a day and you would see things haven’t really changed. Intersectionality, the overlapping of discrimination, has an unpleasantly close relationship with HIV.

You could serve a smor- gasbord of HIV + poverty + BME + women + LGBTQ + groups that are so under the radar they are barely mentioned by the system.  These groups are stigmatised and living with stigma on a daily basis.

How can we really make a difference? It’s been over 30 years since the epidemic started affecting so many communities. I want to say to the world that we need to eradicate stigma with kindness and openness.

To mark last year’s World AIDS Day 2016, I set out to take steps towards reaching this goal. I went to Trafalgar Square to ask strangers to give me a hug with the tantalising invitation ‘Hug me, I’m HIV positive.’

I truly believe what a real grass-roots activist once told me – “Stigma kills, not the virus.” The late Elizabeth Taylor said, “It’s bad enough people are dying of AIDS, but nobody should die of ignorance.”

That’s why I’m positive about being positive. Maybe the global route won’t reach enough people so we need to make this battle against stigma and ignorance personal. So let’s tackle it, one person at a time, and leave a very nasty taste in stigma’s mouth by spreading knowledge, experience, hope and hugs.

This year has been all about supporting people to access the facts about HIV, to break the myths, and on Saturday December 2nd my Forest Gate Pride Committee took part in a community initiative to do just that and also to share a few hugs.

 

Isaac Samuels, member of Think Local Act Personal’s National Co-production Advisory Group (NCAG)

How Self Care Changed My Life

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The reality of living, for those like me with multiple long term conditions, is that self care is both inevitable and a vital part of our treatment. We don’t live in hospitals and we don’t have a home full of medical staff. We spend the vast majority of the time caring for ourselves, often with only the support of family and friends. The changes I saw when I took responsibility for my ‘self care’ for me were life changing.

This isn’t to say we are sent out into the world without information and support. I am so grateful for the expertise and experience of the NHS team that support me. My time with these key people in my life is limited, sometimes far less than I want or need. For me this lack of contact led to a need for quality time with ‘my experts’.  That’s the first step to good self care for me, making the most out of the limited contact we have with health professionals who have full knowledge of our conditions and combining that with my own health goals and lifestyle expectations. For me, being proactive and assertive in those conversations gives me vital knowledge to have confidence in managing my illnesses. Not everyone wants to have these conversations, I need clinicians to understand that that’s a big part of what I need from a consultation to allow me to get by successfully until I see them again, a prescription simply isn’t enough.

I’ve used these interactions to better manage a life threatening illness in the last year. Firstly I had to become really aware of my illness and how it affects me, what triggers changes in it and how it responds to treatments.

I then took this knowledge of my own illness, my body and my skills to the doctors who care for me. For example, one of the main reasons I end up in A&E has been an issue with my heart rate. So I made sure that in one of my consultations with the cardiologist we talked about what he regarded to be a dangerous rate for me (as opposed to paramedics and A&E doctors that don’t know me) and what action I can take to monitor my situation and when to act and call 999.

That conversation, alongside other similar conversations about managing my symptoms, including staying hydrated and managing nausea, gave me all the knowledge and more importantly for me, the confidence to manage my symptoms at home more effectively. On a day- to-day basis my illness now impacts my life much less than it used to and even the extra time it takes each day to monitor my symptoms and do as I need to rather than as I want to is worth it! I have reduced my emergency admissions to hospital from 10 in one year to 0 in the last year! That’s 10 less 999 calls, 10 less ambulances, 120 hours less spent in A&E and 30 nights a year that I’m not spending in hospital each year. That’s nothing compared to the hours I have back in my life to use for living, not just surviving. I’m not cured, my condition is not notably better, I just manage it well!

 

Katie Clarke-Day, C4CC Co-production Team member

Twitter: @notjustaheadach

C4CC: HIV in Hackney

Kristi Adams, C4CC’s Senior Co-production Advisor, recently facilitated the second of two workshops, commissioned by the Homerton University Hospital NHS Trust, with the goal of improving the care and support available to people living with or at risk of HIV.

The first workshop back in March attracted more than 80 people, with a mix of people using services in Hackney, healthcare professionals, commissioners and other key stakeholders providing their input and expertise.

Participants explored what good would look like for people, from prevention and testing through to palliative care.  The group identified the good work already happening and how this could be built on to become even better.

The second workshop drew on a smaller group and was focused on the actions and key points raised from the earlier session, identifying what needed to change and how, and how gaps could be filled.

Below, you will hear from Kristi and the people involved in the workshops about why this work is important and how they will help to improve services for people living with or at risk of HIV.

Kristi Adams – Senior Co-Production Advisor, Coalition for Collaborative Care

I was delighted when C4CC was approached by the Homerton University Hospital Trust in Hackney to co-design and facilitate two workshops, with the aim of improving the quality of service it provides to people living with or at risk of HIV.

The hospital is already recognised for its innovative approach. It employs peer navigators who are themselves affected by HIV, to work alongside people in the co-production of their care and provide personalised support during, what can be for some people, a very stressful time.

There was an understanding by the hospital at senior level that more could be done to improve the patient experience through better co-ordination and collaboration with a whole range of stakeholders in Hackney, such as GPs, commissioners and the local authority. It was clear from the outset there was a collective willingness to engage and embrace new ideas and approaches.

This focus on better conversations, the use of community assets and co-production is the key message that C4CC is promoting with its national partners and we will continue to do our very best to provide support to any organisation that wishes to foster the same ethos.

I am confident that what will happen as a result of the workshops and other connections that were made will be to the benefit of the people of Hackney and we have pledged to continue our work with the Homerton as the programme develops.

Professor Jane Anderson –  Director for Centre for study of HIV and Sexual Health Homerton University Hospital NHS Trust

With more people living with HIV than ever before and at a time when the NHS is under enormous financial pressure, the need for all of us to collaborate across the whole health economy has never been greater.

At the Homerton, like other front-line hospitals, we are well aware of the scale of the challenge and we are committed to ensuring best outcomes for people by exploring new ideas and new ways of working.

It was in that context that we worked with C4CC to organise and facilitate two workshops to allow us to identify both areas where things were going well and also to look at where we need to make improvements for people with HIV in the local area.

It was crucial to ensure that everyone involved right across the care pathway could take part and give their point of view. That meant ensuring we included service users, specialist clinicians, commissioners, GPs, elected political representation and our public health team for Hackney.

The task was made easier because C4CC is an NHS England-based organisation, which gave the workshops credibility within the health system.

At the second event, we could build on the themes and outputs of the earlier workshop held in March, using the momentum that had been generated.

I believe that the relationships and potential working partnerships generated through this process will support the development of a ‘whole system’ approach to HIV prevention, treatment and care in our locality, that is based around the needs, perspectives and aspirations of those affected by HIV.

I am confident we have begun a process that will put the building blocks in place to ensure the best outcomes for those affected by HIV within our local area.

Janine McGregor-Read – Peer Navigator at Homerton Hospital For Positively UK

 As a long-term service user, diagnosed with HIV 25 years ago, I have been able to witness at first hand the vast improvements in the standard of treatment provided by the NHS.

In my job role at the Homerton as a peer navigator, I have been able to draw on my own experiences and others to help shape the service that is provided to people, and I believe what is happening here is above and beyond what is generally available.

But we must never be complacent, particularly with the challenges of a client base that is getting older, many with mental health issues and other complex problems. Faced with this challenge, I detect a real desire to find a way to make the system deliver the best that is available, whatever the funding.

The C4CC-facilitated workshops were able to connect people, to flesh out duplications and gaps in service so we can be as effective and tight as possible, giving priority to the areas that are most important to patients.

People have to trust the service they access and for that to happen we have to understand their needs, their concerns and provide the wrap around support to allow them to prosper.

At the second workshop the service user was put very firmly at the centre of the conversations as we look to develop a better working model. Every individual is different so the system has to be flexible to meet their needs rather than relying on the traditional linear model.

Meeting and sharing views and perspectives with people from outside the immediate hospital environment was an invaluable experience and I am hoping that our collective input will have a positive benefit for the residents of Hackney in the future.

Iain Reeves: Consultant specialist at Homerton Hospital

At the Homerton we pride ourselves on the quality of care that we provide for people living with HIV; most treatments are successful and we have good clinical outcomes. But there is a recognition that we need to move beyond that because we have many people with a complex range of physical and mental health issues, in the main, but not exclusively, because of ageing.

Initially, those problems may have arisen because of the impact of a positive diagnoses and the stigma and discrimination this can unfortunately attract.

For this and a host of other reasons, I believe it is vital that we place people at the very centre of a network of care services to provide the support and help they need.

I attended both workshops and found them very rewarding in terms of getting the right people into a room and stimulating the right conversations. For me, the most valuable connections were made with representatives of primary care and a really positive outcome is that we are now looking at new ways of delivering care and different ways to involve people living with HIV at GP and consultant level.

If you would like to know more about C4CC’s work with Homerton University Hospital NHS Trust, please contact Kristi Adams on kristi.adams@nhs.net

 

C4CC continues to extend its reach

The New Year has brought fresh opportunities for the Coalition to extend its reach and grow the national movement towards a better deal for people with long-term conditions.

We attended the Long-Term Conditions Conference at the QEII Conference Centre in London on 22nd January 2015 to run a session focusing on the Coalition’s work.

Our stand received a steady stream of visitors from across the health and care professions, all keen to hear more about our vision and to ask questions about the Coalition.  Catherine Wilton, Deputy Director of the Coalition for Collaborative Care, also led a workshop attended by almost 90 practitioners, carefully co-designed and co-delivered with four members of our Co-production Group – Evelyn Bitcon, Richard Cross, Neeta Mehta and Fiona Carey.

The workshop explored what it would take to make person-centred, collaborative care a reality across the country and introduced our recently published Care and Support Planning handbook. Co-production Group members also shared personal stories.

Richard shared his experiences of caring for his wife.  Neeta talked about becoming an expert in the care of her daughter, despite having a long-term condition herself.   As well as having a high profile slot in the main plenary session of the morning, Fiona opened the C4CC session and shared a story about her friend who was unable to avoid a hospital stay for her son as the system was not set up to provide the preventative care he needed. Evelyn talked about challenges she faces as a carer with the current health system when providing support to her son who has Post-Traumatic Stress Disorder.

Towards the end of the session, the participants were asked to write pledges – a commitment of what they would do to create the conditions for that to happen.

Strong themes across the pledges included becoming a member of the Coalition for Collaborative Care, working to educate others about the benefits of people-centred care, sharing ideas and best practice with one another and reviewing current policies and plans to remove barriers to good care and support planning.

Catherine Wilton said: “The conference was really encouraging. The conversations we had with health professionals indicated that there is a real appetite for changing how the health service as a whole needs responds to people with living with long-term conditions.

“Having a Co-production Group is an invaluable part of our approach and their experiences help to shape our vision for the future.  A number of healthcare professionals in the workshop mentioned how powerful and impactive they found hearing from our Co-production Group members.

“Nearly 60 more people joined the Coalition on the day of the conference which is great news as it continues to extend our reach and create the possibility of achieving our vision for the future.”

To view our Vision document please click here.

 

C4CC Co-production Group: new members wanted

The Coalition for Collaborative Care (C4CC) is a group of organisations who have agreed to work together to improve support for people with long-term conditions. The aim is to ensure that people living with long-term conditions can access healthcare which focuses on the whole person, and where different organisations and communities work together with each individual, carer and/or family to achieve the best possible outcome.

The Coalition’s co-production group plays a central role in this work. The co-production group is a team of people with long-term conditions and carers. The group works with the C4CC central team and partners to influence and co-design the work of C4CC on an on-going basis.

We are recruiting new members to the core C4CC co-production group. We are particularly keen to receive applications from people who have experience of long-term conditions. The term ‘long-term condition’ (LTC) is used to mean “any physical or mental condition which needs long- term management and support”.

This opportunity will involve national travel and you will be expected to attend at least 8 meetings per year. For more information on these dates, please see the application form.

If you are successful in your application, you will be able to claim travel and participation fees as outlined in the draft NHS England Reimbursement and Fees policy. If you are invited to interview, we will cover any travel or support costs for the day.

The closing date for applications is Monday 2nd February. Interviews will be held on Friday 6th, Monday 9th and Friday 13th February. If you wish to apply, please complete the application form and the equality monitoring form, and return to Wilhelmina Dowdye either by post or email on w.dowdye@nhs.net . More details on this can be found in the application form below. This is available in an interactive PDF or Word format.

Application Form (Interactive PDF)

Application Form (Word document)

Easy Read Application Form (Interactive PDF)

Easy Read Guide to Application Form

Equality Monitoring Form (Interactive PDF)

Equality Monitoring Form (Word document)

Easy Read Equality Monitoring Form (Interactive PDF)