SMS cuts missed appointments by 27 per cent across 16 surgeries
Hitting the Headlines assessment: Statins and incidence of ...
BBC News | Health | World Edition
UK's First Academic Health Science Centre
Issued on behalf of Hammersmith Hospitals NHS Trust, Imperial College London and St Mary's NHS Trust
For immediate use
Wednesday 29 August 2007
The UK's first Academic Health Science Centre (AHSC) was given the green light today by the Secretary of State for Health following an extensive public consultation. The Hammersmith Hospitals NHS Trust and St Mary's Hospital NHS Trust will merge on 1 October and integrate with Imperial College London. The result, Imperial College Healthcare NHS Trust, will form the foundation for the AHSC, and will be the largest NHS Trust in the UK.( Read More)
Note:- Please follow the link and scroll down to read the continued article.
Predictive software shows health risks to patients
A GP has developed a predictive software tool which shows patients the benefits for their future health if they change particular lifestyle habits.(Read more)
Failing carers threaten children's future
Thousands of children are being failed by inadequate care from childminders, nurseries and creches, which could be putting their development at risk, government inspectors report today.
(Read More)
Two reports on shifting care outside hospital
Date Published | 28/08/2007 |
Resource Links | |
| Link to DoH letter |
| Link to ‘Getting the basics right’ |
| Link to ‘beyond projects’ |
Abstract | The reports have been prepared by the Health Services Management Centre (HSMC) at Birmingham University on behalf of the NHS Institute for Innovation and Improvement. They draw from fourteen change projects, across five local health communities, which were supported by the Institute over the past year. ‘Getting the basics right’ identifies the key factors that affect the ability of local bodies to deliver shifts in care and sets out the conditions that have to be met if such service improvements are to occur. ‘Beyond projects’ explores five of the projects in detail, highlighting these factors and conditions in a practical context. The five cases are: • Birmingham back pain care • Derbyshire COPD care • Derbyshire end of life care • Manchester gynaecology care • Torbay diabetes care |
WELSH NHS staff suffered an attack nearly every hour last year, we can reveal today. |
The latest research adds to evidence that two specific chemicals found in the blood - "brain-derived neurotrophic factor" (BDNF) and "substance P" - are somehow connected to itchy sensations.
(Read More)
Experts push NHS to use US-style cancer care
From The Sunday Times August 26, 2007
Experts push NHS to use US-style cancer care
LIKE many other British cancer sufferers before him, Rob Ellert travelled to one of America’s leading hospitals to give himself a better chance of survival.
Now in remission, he is so determined that National Health Service patients should no longer die unnecessarily that he has enlisted Lord Darzi, the health minister, to transfer best practice across the Atlantic. He has also set up a charity to promote American-style cancer treatment in Britain.
Optimising your health with herbs
Optimising your health with herbs
In order to change your health you usually need to change some of your habits. The people who benefit the most from herbal treatment make some positive changes to their lifestyle as well. These changes can be on various levels; emotional, dietary or lifestyle adjustments. It can often involve including something extra in life whilst also removing something else. In China there is a saying; “crisis is an opportunity for change”. Change can release beneficial growth.
Seven Steps to Health:
- Eat a fresh and healthy diet: Change your diet according to your constitution and the season.
- Seasonal living: Adjust your routine according to the season.
- Rest: Take adequate rest; at least 7 hours of sleep per night.
- Exercise: Take sufficient exercise; four 30 minute sessions of aerobic exercise per week.
- Relax! Learn a relaxation technique; yoga, t’ai chi, deep breathing and try to practice15 minutes per day
- Herbal supplementation: Take herbal supplements regularly to assist your body’s own healing powers.
- Peace and love: Make peace with everyone you know, let the love flow, you know it makes sense…
Lifestyle tips
Help yourself by including each of these recommendations as much as you can in your life. Many research studies have proved that these practices help you feel better and live a healthier life.
- Exercise: Moderate exercise is known to improve health and immunity.
- Yoga: The benefits of regular yoga practice are invaluable to a healthy immune system.
- Breathing: Regular exercises to bring life-giving prana into the system and regulate the flow of vitality around the entire system.
- Meditation: Meditation has been shown to improve cellular immunity in geriatric patients (Kiecolt-Glaser). Relaxation and assertiveness training improves immune helper T-cells in HIV infected men (Antoni). Melanoma patients who learnt stress management had improved immune cell function and greater survival rates (Fawzy).
- Emotional expression: Supportive-expressive therapy doubled survival time in women with metastatic breast cancer (Spiegel). It also improved mood and reduced depression, anxiety and anger (Goodwin). Writing about upsets improves immunity and health (Pennebaker, Smyth).
- Regular massage: Massage improves immune cell activity in HIV infected patients (Ironson). Massage increases weight gain in premature babies (Field). Massage decreases inflammation and increases serotonin levels (Field). Massage reduces pain and anxiety in cancer patients (Corbin).
- Surround yourself in a pleasant environment: Stressful visual stimulation depresses the immune response; uplifting stimulation enhances it (McClelland). Lavender oil has been shown to reduce aggressive behavior in patients (Lee).
- Sleep: Getting the correct amount of sleep is essential for your overall well being and immunity. We all know how viruses and bacteria can affect our health but modern research has shown how much our emotions influence our well-being;
- Loneliness reduces immune Natural Killer (NK) cell activity (Kilecot-Glaser). These NK cells are the first line of defence in ‘mopping up’ invading bacteria and viruses. Lonely students have reduced NK cell activity and higher Epstein Barr virus levels (the virus implicated in ME and Chronic Fatigue).
- Excessive stress reduces immunity. It has been shown that caretakers of dementia patients suffer from reduced immunity. People under extreme academic stress show reduced levels of lymphocyte and interleukein production (both responsible for assisting the immune response) and higher cortisol levels, indicating a challenged immune system not functioning as well as it could. (Guidi)
Bereavement causes reduced immunity with reduced lymphocyte activity in men (Schliefer) and depression post bereavement causing increased cancer and death. - Marital conflict also affects immunity raising Blood Pressure, cortisol and immune NK cell activity (Miller)
The Ayurvedic way to a healthy life
From the Ayurvedic point of view good health is about your whole way of life being rejuvenating and beneficial to yourself and the world around you. Make sure that you get enough:
- Pure air
- Pure water
- Pure food
- Balanced digestion
- Reduced toxins
- A strong heart and balanced emotions
- Avoidance of negative habits and behavioural patterns that can reduce your inherent immune reserve.
- A regular lifestyle: Ayurveda lays much emphasis on prevention so as to prevent the degenerative cascade that can occur. This is an orderly routine that balances personal hygiene, nourishment, exercise, relaxation, creativity, wealth and love.
- Protection: your daily activities should be 100% healing with active avoidance of immune depressing chemicals and foods to keep your immune system intact
- Tonification: daily use of strengthening herbs and foods that will rejuvenate your
- Check out Pukka Herbs and teas
In The News.
Age alone not a barrier to liver transplantation
NEW YORK (Reuters Health) - The findings from a study of septuagenarians suggest that age per se
should not prevent a patient from having a liver transplant.
According to a report in the Archives of Surgery, older patients often do well, provided that any accompanying risk factors are appropriately addressed.
"Biological and physiological variables may play a more important role than advanced age in predicting poor survival after liver transplantation," senior author Dr. Ronald W. Busuttil, from the University of California at Los Angeles, and colleagues state.
The team compared the outcome of 62 transplant recipients age 70 years or older with those of 864 recipients in their 50s. All of the patients were first-time recipients and underwent transplantation between 1988 and 2005.
No significant differences in survival were noted between the two age groups. For the older group, the 1-, 5-, and 10-year survival rates were 73 percent, 47 percent, and 40 percent, respectively.
The corresponding survival rates for the younger group were 79 percent, 65 percent, and 45 percent.
After more extensive analysis, the researchers identified some patient factors that significantly predicted death. These included the need for hospitalization before the surgery, hepatitis C infection, and alcoholic cirrhosis.
Conversely, being 70 years of age or older not a significant predictor of death.
Measures that assess a patient's age based on his physical condition, rather than his chronological age, as well as estimates of the risk of complications "should be used in the evaluation process of elderly transplant candidates." Continued...
Reuters Health News Archive
Star Sighting...
Victoria Beckham watches David play with the L.A. Galaxy, the same day he got in a screaming match on the field with a Chivas USA player (Getty Images, Toby Canham) Brawl it like Beckham |
Six Killers
They are the leading causes of illness and death today: heart disease, cancer, stroke, chronic obstructive pulmonary disease, diabetes and Alzheimer's disease, in that order. If you want to hang around get to grips with these six.
A collection of articles, some published in The New York Times.
The British Humanist Association
About the BHA
Our Vision
A world without religious privilege or discrimination, where people are free to live good lives on the basis of reason, experience and shared human values.
Our Mission
The British Humanist Association exists to promote Humanism and support and represent people who seek to live good lives without religious or superstitious beliefs.9 (Read More)
Cancer and the Environment... Play Video
Health reporter Gina Kolata discusses links between cancer and the environment with toxicologist and cancer survivor Michael Gallo.
Related link.
- Environment and Cancer: The Links Are Elusive
- Living Downstream: a Scientist's Personal Investigation of Cancer and the Environment
- Cancer: The Role of Genes, Lifestyle, and Environment (New Biology): The Role of Genes, Lifestyle, and Environment (New Biology)
Lost in Translation
The public sector spends millions on translation services every year.
According to a study by the BBC, more than £100 million is spent on translation every year; local councils spend at least £25 million; the police £21 million; and the courts system over £10 million. Yet the biggest outlay is by the NHS - it spends, at a conservative estimate, £55 million. (Read More)Hey!.. if you want to translate this page; please use the translator at the top of the page..Best of all it's Free... Just for you...
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Obesity 'may be linked to virus...
Obestiy is becoming more common |
A team at Louisiana's Pennington Center found that a common virus could cause stem cells to change into fat cells in lab experiments.Read More
UK Cancer Survival Rates
UK Cancer Survival Rates
Despite the £Millions poured into the National Health Service, apparently the United Kingdom has some of the worst rates of cancer survival in Europe, significantly worse than others spending a similar amount. ...
Telegraph Article (Read More)
While patients well understand high blood glucose can lead to ugly complications like blindness and kidney failure, few recognize that keeping cholesterol and blood pressure low are equally critical steps in avoiding deadly heart attacks. And their providers aren't getting the job done either,it seems. In fact, the CDC says only 7 percent of patients are getting all of the treatments they need.
Why the gap? In part, it's because many primary care doctors aren't adequately trained in diabetes care, getting only a few hours of instruction on the condition when in medical school. These PCPs, in turn, often spend no more than 10 minutes with such patients. Not only that, critics say, pharmaadvertising often encourage them to focus on blood sugar rather than heart attack risks. Unfortunately, that often leads to needless heart-attack deaths.
To learn more about the diabetes care gap:
- read this piece from The New York Times
Related Articles:
Glaxo: Avandia's safe as other diabetes drugs. Report
Avandia controversy sparks FDA criticism. Report
CMS P4P project shows diabetes care savings. Report
CMS to post hospital heart attack care data. Report
Number of days some cancer patients have to wait for treatment in Britain
Two Hundred Twenty
By mhsiegel
No, that's not the name of a sequel to 300, it's the number of days some cancer patients have to wait for treatment in Britain's wonderful National Health Service:. CANCER patients are still waiting up to seven months for treatment. ...
MOOREWATCH -
Hodgkin's Disease
Hodgkin's Disease
Also called: Hodgkin's lymphoma
Hodgkin's disease is a type of lymphoma. Lymphoma is cancer of lymph tissue found in the lymph nodes, spleen, liver, and bone marrow. The first sign of Hodgkin's disease is often an enlarged lymph node. The disease can spread to nearby lymph nodes. Later it may spread to the lungs, liver or bone marrow. The cause is unknown.
(Read More)
Hey.!! The good news about Hodgkin's disease is that most people with this disease are cured.
I wish you well my friend... This link may be of Interest...Click here.
The Comfort of Home: A Complete Guide for Caregivers
Nothing has been left out in this very well-written guide that a person needs to consider when undertaking this process.Maria M. Meyer with Paula Derr, RN
Care Trust Publications (2007)
ISBN 9780966476798
Try cut and paste the ISBN Number. 9780966476798 Paste into your Amazon Search...Below.
Promise of a normal life for diabetics
It is a life-threatening disease - but now a medical breakthrough offers hope that Britain's 250,000 type 1 sufferers could be freed from the tyranny of injections and dangerous blackouts. By Denis Campbell (Read More) |
Go placidly amid the noise and the haste,
and remember what peace there may be in silence.
As far as possible, without surrender,
be on good terms with all persons.
Speak your truth quietly and clearly;
and listen to others,
even to the dull and the ignorant;
they too have their story.
Avoid loud and aggressive persons;
they are vexatious to the spirit.
If you compare yourself with others,
you may become vain or bitter,
for always there will be greater and lesser persons than yourself.
Enjoy your achievements as well as your plans.
Keep interested in your own career, however humble;
it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs,
for the world is full of trickery.
But let this not blind you to what virtue there is;
many persons strive for high ideals,
and everywhere life is full of heroism.
Be yourself. Especially do not feign affection.
Neither be cynical about love,
for in the face of all aridity and disenchantment,
it is as perennial as the grass.
Take kindly the counsel of the years,
gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune.
But do not distress yourself with dark imaginings.
Many fears are born of fatigue and loneliness.
Beyond a wholesome discipline,
be gentle with yourself.
You are a child of the universe
no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you,
no doubt the universe is unfolding as it should.
Therefore be at peace with God,
whatever you conceive Him to be.
And whatever your labors and aspirations,
in the noisy confusion of life,
keep peace in your soul.
With all its sham, drudgery, and broken dreams,
it is still a beautiful world.
Be cheerful. Strive to be happy.
Ten lifestyle tips...Just for you...
- Eat whole grain foods (bread, or rice, or pasta) on four occasions a week. This will reduce the chance of having almost any cancer by 40%. Given that cancer gets about 1 in 3 of us in a lifetime, that's big advice.
- Don't smoke. If you do smoke, stop. Nicotine patches, gum or inhaler won't help much, and acupuncture won't help at all. Try to reduce your smoking, as there is a profound dose-response (the more you smoke, the more likely you are to have cancer, or heart or respiratory disease). So cut down to below five cigarettes a day and leave long portions of the day without a cigarette.
- Eat at least five portions of vegetables and fruit a day, and especially tomatoes (including ketchup), red grapes and the like, as well as salad all year. This protects against a whole variety of different nasty things:
- It reduces the risk of stroke dramatically
- It reduces the risk of diabetes considerably
- It will reduce the risk of heart disease and cancer.
- Use Benecol instead of butter or margarine. It really does reduce cholesterol, and reducing cholesterol will reduce the risk of heart attack and stroke even in those whose cholesterol is not particularly high.
- Drink alcohol regularly. The type of alcohol probably doesn't matter too much, but the equivalent of a couple of glasses of wine a day or a couple of beers is a good thing. The odd day without alcohol won't hurt either. Think of it as medicine.
- Eat fish. Eating fish once a week won't stop you having a heart attack in itself, but it reduces the likelihood of you dying from it by half.
- Take a multivitamin tablet every day, but be sure that it is one with at least 200 micrograms of folate. The evidence is that this can substantially reduce chances of heart disease in some individuals, and it has been shown to reduce colon cancer by over 85%. It may also reduce the likelihood of developing dementia. Folate is essential in any woman contemplating pregnancy because it will reduce the chance of some birth defects.
- If you are pregnant or have high blood pressure, coffee is best minimised. For the rest of us drinking four cups of coffee a day is likely to reduce our chances of getting colon cancer and Parkinson's disease.
- Get breathless more often. You don't have to go to a gym or be an Olympic marathon runner. Simply walking a mile a day, or taking reasonable exercise three times a week (enough to make you sweat or glow) will substantially reduce the risk of heart disease. If you walk, don't dawdle. Make it a brisk pace. One of the benefits of regular exercise is that it strengthens bones and keeps them strong. Breaking a hip when elderly is a very serious thing.
- Check your height and weight on a chart to see if you are overweight for your height. Your body mass index is the weight in kilograms divided by the height in metres squared: for preference it should be below 25. If you are overweight, lose it. This has many benefits. There is no good evidence on simple ways to lose weight that work. Crash diets don't work. Take it one step at a time, do the things that are possible now, and combine some calorie limitation with increased exercise. The good news is that in a few years time we may have some appetite suppressants to make it easier.
Well done Hazel.. Top marks you get my vote....ps..I know a good shop for platform wellie's!
Duradiamond Healthcare wins OH Olympic construction contract
The company behind occupational health services at all of Britain's seven airports has been awarded the prestigious contract to supply OH to the construction workforce for the London 2012 Olympics. Duradiamond Healthcare, which provides ...
PersonnelToday.com - All HR news stories - http://www.personneltoday.com/
The Caduceus vs the Staff of Asclepius
The Caduceus of Mercury (Roman) and the Karykeion of Hermes (Greek)
Many "medical" organisations use a symbol of a short rod entwined by two snakes and topped by a pair of wings, which is actually the caduceus or magic wand of the Greek god Hermes (Roman Mercury), messenger of the gods, inventor of (magical) incantations, conductor of the dead and protector of merchants and thieves. It is derived from the Greek karykeion = "herald's staff", itself based on the word "eruko" meaning restrain, control.
Professional and patient centred organisations (such as the NZMA, in fact most medical Associations around the world including the World Health Organization) use the "correct" and traditional symbol of medicine, the staff of Asclepius with a single serpent encircling a staff, classically a rough-hewn knotty tree limb. Asclepius (an ancient greek physician deified as the god of medicine) is traditionally depicted as a bearded man wearing a robe that leaves his chest uncovered and holding a staff with his sacred single serpent coiled around it, (example right) symbolizing renewal of youth as the serpent casts off its skin. The single serpent staff also appears on a Sumerian vase of c. 2000 B.C. representing the healing god Ningishita, the prototype of the Greek Asklepios. However, there is a more practical origin postulated which makes sense [See Dracunculus medinensis].
Reject this health pay offer!
Five months of negotiation since the initial offer of a staged 2.5% have produced no real results. Staging the deal meant that it would be worth only 1.9%. So health service staff were being offered less than the governments own suggested raise... ( Source workers Liberty)
Is this enough?... I don't think so!
atishoo, atishoo...Great news.. Need some more info on the probability factor of the pandemic.? how do they forecast this...I am interested...
A plan to ease pressure on doctors by getting patients to 'self care' has been ridiculed by health campaigners.
Bosses at West Sussex Primary Care Trust (PCT) say encouraging people take better care of themselves would reduce the number of attendances at accident and emergency and GP surgeries.
This includes improving their diet, taking more exercise and ensuring they take their medication properly. (Read more...)
Former clinics on market for £1m
The former health centre in High Street, Burton Latimer, which has been replaced by a new complex in Higham Road, is on the market for offers in excess of £250,000.
Stockburn Memorial Clinic in Southlands, off London Road, Kettering, which was used as office accommodation because it was deemed unsuitable for modern health services, is also for sale.
It became surplus to requirements earlier this year when the primary care trust amalgamated its offices.
The former clinic is being marketed by Lambert Smith Hampton for more than £800,000.
( Read more)
No Comment...
Speech therapy is in the bag
A PURPOSE-DESIGNED bag for speech therapists on the move has been invented by Papworth-based therapist Corinne Garvie.
She developed the idea with Health Enterprise East, the NHS Innovation Hub for the region, with commercial sponsorship from Fresenius Kabi, who are making the bags and perhaps can be blamed for the unfortunate name given to the new product range, Thick & Easy - not a nice moniker for any lady to have to carry around on her bag.
Anyway, the bag itself is a good idea and full of gadgets to help patients who find it difficult to swallow.
"Until now therapists working in the community have had to carry around a wide range of equipment and supplies in a box in the car," Corinne says. "Having everything to hand in a specially-designed bag is much easier.
| 14 August 2007 |
Statistical press notice: Dagnostic test waiting times
The following statistics were released today by the Department of Health:
Diagnostics waiting times & activity data: month ending June 2007
This data shows the NHS' progress in tackling the waiting times for diagnostic tests like scans. The monthly data published today gives the waiting times for 15 key diagnostic tests carried out in the NHS. This data will help the NHS in delivering the new 18 week maximum wait from GP to treatment, including all diagnostic tests, by 2008. More information, including a diagnostic data Q&A, is available via the 18 week website.
Links: Diagnostic data: http://www.performance.doh.gov.uk/diagnostics/index.htm
18 week website: http://www.18weeks.nhs.uk
'Vitamin breakthrough on diabetes'
8th August 2007 three newspapers reported that a lack of vitamin B1 has been linked to vascular disease in people with diabetes. The newspapers reflected the conclusions of a case-control study, however, given the prevalence of diabetes, this was a small study on which to base such strong conclusions.
-
On 8th August 2007, three newspapers (1-3) reported that a lack of vitamin B1 has been linked to vascular disease in people with diabetes.
-
The research, published in Diabetologia , was a small case-control study involving 94 people (26 type 1 diabetes; 48 type 2 diabetes; 20 controls). Plasma thiamine levels were 76% lower in people with type 1 diabetes, and 75% lower in people with type 2 diabetes compared to controls. Urinary excretion, renal clearance and fractional excretion of thiamine were all substantially increased in those with diabetes.
-
The newspaper reports generally provided an accurate overview of the results of the study. The Daily Express (3) reported a 75% decrease in the risk of kidney problems with a thiamine supplement 300 times greater than that naturally derived from the diet; these data were not presented in the study. The study involved 94 people and given the prevalence of type 1 and 2 diabetes, this was a small number of people on which to base such strong conclusions.
Evaluation of the evidence base for low plasma thiamine concentrations in diabetics as a marker of vascular disease.
Where does the evidence come from?
The study was conducted by Dr Thornalley and colleagues from the Department of Biological sciences, University of Essex, Colchester, UK; the Clinical Sciences Research Institute, University of Warwick, Coventry; the Colchester General Hospital, Colchester; and the Ipswich Diabetic Foot Unit and Diabetes Centre, Ipswich Hospital NHS Trust, Ipswich, UK. The project was funded by Diabetes UK.
References and resources1. Vitamin B1 shortage linked to diabetes damage. The Daily Telegraph, 08 August 2007, p10.
2. Vitamin breakthrough on diabetes. Daily Mail, 8 August 2007, p5.
3. A daily pill for all diabetes sufferers. Daily Express, 8 August 2007, p17.
( Source National Library for Health)
I have just been looking through my cupboard for that old bottle of brewers yeast tablets..*Smiles.
New software tool predicts risk from diseases
A University College London (UCL) postgraduate student has developed a tool that allows patients to see how changing different aspects of their lifestyle can contribute to their overall future health.
( Source ITPRO )
Well done top marks, have you say please place any comments...
UK court upholds drug restriction in mild Alzheimer�s
(Source ::: REUTERS)
Should drugs be available to all regardless?
The PCT said it had reassessed Mr McNamara's case |
John McNamara, 47, from Harrogate, had been refused Velcade by North Yorkshire and York NHS Primary Care Trust.
He claimed other patients in the same Leeds hospital where he was receiving treatment were getting the drug and complained it was a "postcode lottery".
On Thursday, the PCT said it had decided to fund a course of Velcade."Well Done Johnny boy....."Read more...
Health and Safety Executive (North West) | ||
(HSE) HSE warns NHS Trust Hospitals that they have a duty to ensure the safety of patients from falls from windows | ||
The Health and Safety Executive (HSE) has reminded NHS Trust hospitals of their responsibility to ensure the health and safety of patients especially from the dangers of falling from windows. The warning comes after the Mid Cheshire Hospitals NHS Trust were fined a total of £14,000 and ordered to pay costs of £3,982 at South Cheshire Magistrates Court, following a HSE prosecution. The charges relate to the case of a 30 year old male patient with mental health problems who was seriously injured when he managed to get out a first floor ward window at Leighton Hospital, Middlewich Road, Crewe on the 4 August 2005. The Trust was fined £12,000 for a breach of Section 3(1) of the Health and Safety at Work Act and £2,000 for a breach of Regulation 3 of the Management of Health and Safety at Work Regulations Health and Safety Executive Division director for the North West, David Ashton said: "The injuries to the patient were entirely avoidable. |
BI spurs innovation lead at NHS procurement hub
The North West NHS Collaborative Procurement Hub (NWCPH) is hitting all of its targets thanks to the successful implementation of a Business Intelligence (BI) integration project.
NWNCP is using QlikTech’s QlikView and says that the software has assisted in saving it many hours of management time, and has had the spin-off benefit of raising the profile of the Hub with both the Trust bodies and throughout the NHS.
Great result On time and on budget...