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The Fleet Manager’s Immediate Solution to the Costs of Dirty Diesel

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By Carl Rees,
Director, Kognitive LTd.

Having worked in the NHS for the past 25 years I was not surprised to learn that the health service is responsible for around 4% of the nation’s carbon emissions.

To combat this, at the beginning of October the NHS Chief Executive Sir Simon Stevens laid out his vision for the NHS to be the world’s first ‘net zero’ national health service, setting a target of becoming carbon net zero by 2040 and cutting harmful emissions by 80 per cent over the next 12 years (Delivering a Net Zero National Health Service, October 2020).

The fact this has remained a top priority during the worst pandemic we have experienced in modern times speaks volumes and underlines how seriously the NHS is taking the issue of climate change and its own contribution to the problem.  

It is accepted that change will not happen overnight and it will take time to implement fully sustainable, green policies locally that will contribute to Sir Simon’s plan. But what can hospitals, primary care organisations, ambulance services and other parts of the health service do immediately to make an instant impact on reducing their emissions?

The same question can be asked of police and fire and rescue services, which also have a duty to cut their own significant carbon emissions in the coming months and years.

One answer lies in replacing their use of fossil diesel fuel by switching their fleet vehicles and generators to GREEND+, a new, enhanced form of HVO (hydrotreated vegetable oil) paraffinic fuel that is a sustainable, ultra-low emission fossil-free diesel alternative.

Using GREEND+ fuel reduces particulate emissions by up to 85% and Nitrogen Oxides by up to 30% compared to regular diesel, according to independent tests at the Millbrook specialist vehicle testing facility. NHS organisations and emergency services can significantly lower their emissions overnight, greatly reducing their environmental impact while achieving huge improvements to local air quality and the reduction of carbon dioxide, reducing Greenhouse Gas emissions by up to 96%.

Importantly, GREEND+ can be used immediately and without any changes to equipment or fuel tanks, meaning organisations can take climate change action quickly with no costly upgrades to machinery or equipment. This also includes no changes required to the engines of any fleet vehicles; this is a drop-in solution and it is ready to go now, and best of all, it is cost neutral with no capital expenditure required.

To me, it is an absolute no-brainer, which is why private sector organisations are already clamouring to get their hands on this sustainable new fuel. The public sector should not miss the same opportunity, and the NHS and emergency services are key players who can make a significant immediate impact on the environment by switching to this new fuel.

In terms of the product itself, it looks like water and has virtually no smell, unlike dirty diesel. It is made from sustainable organic waste products - not virgin crops - to EN15940 standard. It is stored and dispensed in the same way as normal fuel, but it requires less cleaning around the storage site than normal diesel.

Another key factor is that it does not degenerate in the tank or in storage, and therefore needs no ‘cleaning’ or ‘polishing’ as normal diesel does. It is safe at temperatures down to minus 42.

Fleet managers will love it because using the fuel leads to better performance and longevity of engines, due to no contaminants being in the fuel, less wear in the engine and improved performance of engine lubricants. There are also proven reduced active DPF regenerations and reduced consumption of AdBlue, while data shows that using GREEND+ can improve MPG rates on urban routes too.

In summary this is the here and now solution for the NHS and emergency services journey to net zero emissions. By playing their part, emergency services and NHS organisations can enable immediate improvements in local air quality and reductions in PM2.5, known to be a key factor in respiratory disease.

When you consider 11.3 vehicles on the road using GREEND+ have the same carbon dioxide emissions as one diesel vehicle, this proves that the NHS and emergency services sector can do something simple to help reduce their carbon footprint by acting now, and taking advantage of what is a great bridge between the diesel vehicles we have today and the electric vehicles of the future.

For more information about GREEND+ or to arrange a meeting, please contact [email protected]

Duchess of Cornwall Meets Frontline Ambulance Crews

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Earlier today (Monday 6 July 2020), HRH The Duchess of Cornwall visited Swindon Fire Station to meet representatives from the South Western Ambulance Service NHS Foundation Trust (SWASFT), Dorset and Wiltshire Fire and Rescue Service (DWFRS) and Great Western Hospital, Swindon.

Her Royal Highness wished to express her support and thanks for the work undertaken by these key services, and for the people who have worked tirelessly throughout the coronavirus pandemic to help and care for those in the local community.

She also heard first hand of the ways emergency services colleagues have had to adapt services throughout the pandemic.

HRH The Duchess of Cornwall meets SWASFT ambulance staff

The South Western Ambulance Service NHS Foundation Trust and Fire and Rescue Service have worked in close partnership throughout the pandemic.

With Fire Fighters supporting ambulance crews, driving ambulances and working alongside clinicians in providing much needed assistance to patients.

Steph Bond, SWASFT Operations Officer, is responsible for managing the Swindon Paramedics and Emergency Care Assistants, also acting as incident commander in serious incidents.

Steph said: “The Duchess was very interested to hear how we have coped during the pandemic and extremely understanding of the pressures we have all faced whilst caring for people in the most difficult circumstances.”

HRH The Duchess of Cornwall meets SWASFT ambulance staff

Alongside Steph Bond, both Charlotte Goldsmith, a Lead Paramedic who drives Rapid Response Vehicles and Karolina Butlanska, Emergency Care Assistant, met The Duchess of Cornwall.

Will Warrender, Chief Executive of SWASFT, said: “I am extremely proud of the work carried out by my South Western Ambulance NHS Foundation Trust colleagues through these challenging times and I am delighted HRH The Duchess of Cornwall has been able to see and hear first-hand the dedication and professionalism of our staff.’

“Our clinical hubs responding to the thousands of 999 calls, those in the many support and corporate functions, colleagues in ambulances and clinicians, who together make this the great service it is.”

Chief Hails Ambulance Service Response During Coronavirus Pandemic

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The Chief Executive of East of England Ambulance Service has thanked staff for embracing news ways of working which have helped deliver faster response times during the first phase of the Covid-19 pandemic.

Latest figures show that, despite the challenges of Covid-19, the Trust is consistently meeting all national standards, thanks in part to more staff to manage calls and more vehicles on the road.

Compared to the same time last year, ambulance response times to reach the most seriously ill (category one) patients have been reduced from nearly 8.5 minutes to under seven.

Response times to category two calls have been halved in the same period, with these patients receiving care on average 17 minutes quicker that in 2019.

Dorothy Hosein,
Chief Executive, EEAST

In her update to the Trust’s Board, Chief Executive Dorothy Hosein said: “I want to thank each and every member of staff for their dedication to our patients and this service, and their willingness to work differently in very fast-moving and worrying times.’

“Given the scale of our operation covering six counties, our performance over the past months is a major step forward and I am incredibly proud of what’s been achieved.’

“I am confident we can secure and build on these gains now, to support our patients, residents and staff for the long term.”

Changes introduced to manage the expected increases in demand during Coronavirus were wide-ranging and included new structures for decision-making, innovative ways to create more capacity, and better support for crews.

At all times, the safety and experience of patients and staff was at the forefront of the Trust’s approach.

Key activities of this included:

  • Rapidly recruiting approximately 900 temporary staff from the military, firefighters, students and Community First Responder volunteers
  • Fast-tracking recruitment; concentrated training and effective supervision meant hundreds more staff in operation call centres, providing first stage triage on calls, freeing up more experienced staff for more serious calls
  • Fully staffing as a priority the Emergency Clinical Advice and Triage Centre (ECAT) team with experienced paramedics and other professionals to treat non-emergency calls. The ECAT team can treat significant numbers of patient calls at peak times, helping patients get the right care more quickly and keeping ambulances free for sicker patients
  • Deploying Hospital Ambulance Liaison Officers (HALO) at almost every emergency department across the region, reducing handover times for patients
  • Support from volunteers, student paramedics and local charities to maintain patient transport services
  • Huge switch to online meetings to keep staff safe, in-touch and radically reduce travel time for local managers
  • Investment in dedicated 24/7 support crews to clean, stock and keep ambulances road-ready.

Dorothy Hosein added: “As well as our substantive team, I also want to thank those temporary staff who have made such a difference during the past months. I hope, having seen the great work the service does, they will now consider joining us permanently.

“We have seen the difference online recruitment and virtual training can make to getting our stuff numbers up, and we now have the lowest vacancy rate for years. I hope we can use our recent experience to attract even more candidates to join our crews and support staff, especially from younger and more diverse communities.”

First Operational Activity for MDA’s Ambulance-Bus

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On Friday, July 3, MDA’s unique and first of its kind intensive care bus was called for the evacuation of 9 residents from a nursing home in southern Israel who were diagnosed with Corona virus.

All of the patients were evacuated by the bus in one trip to the Corona Health Care Geriatric Center located in the center of the country.

The unique bus, which was introduced about a month and a half ago, allows the evacuation of up to thirteen patients and injured, with two of them evacuated lying in the middle of the bus, which is equipped with intensive care equipment, and eleven others sitting in the back.

Sirens and an advanced communication system are installed in the bus, enabling the crews in different parts of the bus to contact MDA. The evacuation to the hospital today saved nine ambulances needed to perform such a task.

The MAN company buses are converted inner-city busses and measure just under 40 feet/ 12 meters in length, 2.5 meters wide, and 2.47 meters high.

The three parts of the bus are completely separate from each other with opaque partitions. Thus, even in the case of evacuating infectious patients, the driver does not require PPE.

In order for the driver to keep in touch with teams and evacuees at all times, there is a communication system that allows them to speak. In addition, the driver has access to cameras that are located throughout the bus.

In the middle of the bus, there are two beds with equipment suitable for ALS care. Two paramedics are appointed to treat patients who are lying in this part, while they can see through the camera what is happening in the back, where up to eleven evacuees can be transported in stable or light condition.

There is also an advanced life support equipment, which includes, among other things, defibrillators that can also perform ECGs, and automated chest compressions devices.

Above each seat in the back of the bus, there is an oxygen tap. The eleven taps are fed by four large oxygen tanks, which are connected to a special system located in the front of the bus.

There are also two refrigerators on the bus that are designed to store blood and medicines that need to be refrigerated.

In addition to all of this, the bus is powered by V230 power outlets, which allow additional medical equipment to be connected if needed, such as ECMO, incubator and the like.

The evacuation bus is an emergency vehicle for all intents and purposes, and is equipped with lights, siren, and an announcement system, similar to a MICU. In addition, the bus is connected to MDA’s radio system.

The cameras in the bus are also connected to MDA Medical Dispatch Center, so doctors and senior paramedics from the hotline can see what is going on and, if necessary, advise the bus’s team and participate in decision making.

In terms of hygiene and ICP, the bus has a special oxygen exchange system that can, according to the Ministry of Health, replace all the air in the vehicle in just seven minutes.

For quick and efficient cleaning, the bus seats are made of leather, and each has a seat belt. On top of that, the bus’s power outlets are waterproof, so the vehicle can be disinfected without fear of electric shock.

Finally, TV screens have been installed on the bus to ease the evacuees’ time. The windows of the bus are sealed, and looking inside the bus from outside is impossible.

In addition, at the rear of the bus there are compartments for storing personal belongings of the evacuees. The bus is accessible for the disabled, and a special ramp for passenger transport is installed.

Eli Bin, MDA Director General, said: “As the national EMS organization of the State of Israel, MDA teams spend days and nights in developing means for saving lives and provide medical response efficiently and quickly. We will continue to face every challenge at any time and wherever it is needed.”

Bubble Screen Creates Additional Protection for Ambulance Volunteers & Patients

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North East Ambulance Service (NEAS) has introduced plastic screening for its team of volunteer drivers to help keep them and their patients safe amid the Coronavirus pandemic.

More than 150 people volunteer with NEAS as ambulance car service (ACS) drivers, using their own vehicles to help transport patients to and from hospitals and clinics, which keeps ambulances free for emergencies and for patients too ill to travel by car.

Of those, some are currently shielding until the end of June as part of Government guidance during the Coronavirus epidemic, but a core team of 69 are still volunteering their time to support patients who are still travelling in and out of hospital for life-saving treatment, such as chemotherapy and dialysis.

NEAS Volunteer Bob Pattison shows the bubble screen in use

During the current climate, all drivers are provided with masks, gloves and alcohol gel to keep themselves and their patients safe. However, the Trust has now gone one step further by working with international firm Driver Bubble to introduce plastic screens into volunteers’ cars following a successful trial in May.

Made of durable, flexible PVC plastic, the bubble screen is secured behind the front seats of the vehicle to create a protective shield between the driver and passenger.

A close-up of Bob with the bubble screen

The bubble screen was trialled by 54-year-old ACS driver Bob Pattinson, of Blyth, who began volunteering with NEAS in November 2017 after a career in the military. 

He said: “As well as keeping ourselves safe, we’re trying to do our best to keep patients safe and I think this is a real asset to help us do that. 

“I’ve had some really positive feedback from my patients. One lady told me she had felt quite apprehensive about getting in a car with everything that’s going on but that this really helped put her at ease and made her feel much safer.”

James Fenwick, of Ashington, relies on the ambulance car service three times a week for dialysis treatment at the RVI. He said: “I hadn’t even noticed the screen at first, but it definitely makes you feel safe, it’s a canny idea.”

Deputy Chief Executive Paul Liversidge, who oversees the volunteer development team leading on this project, said: “The safety of all staff and volunteers working for and supporting our service is paramount and we’re doing all we can to protect them and the patients we serve during the current Coronavirus pandemic. Introducing these screens is the next step in helping us do this.

“We are very grateful to Bob for trialling the screen for us and, with his help, we have been able to tweak the design to suit our needs. We’re now also investigating whether the screens could be modified further to make them suitable for some of our other vehicles.”

LAS Appoint Healthcare Finance Expert Jill Anderson to Trust Board

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London Ambulance Service has appointed a new associate non-executive director to support its Trust board in building a world-class ambulance service.

Jill Anderson joins the Service’s Trust board this month (June 2020), replacing former associate non-executive director Amit Khutti, who has now taken on a fuller non-executive role within the board.

Jill brings more than 30 years’ experience in the healthcare sector, including executive responsibility in finance, commercial, research and supply chain functions across large multinational organisations.

Jill is currently chief financial officer for ViiV Healthcare, a global subsidiary of the pharmaceutical company GlaxoSmithKline (GSK), which is dedicated to improving the lives of people living with HIV.

She has been in the role for two years and in addition to the company’s finances, Jill is also responsible for supply chain and business development.

A supporter of open, collaborative leadership, she is actively engaged in diversity initiatives such as back to work programmes for people who are HIV positive.

A graduate in Chemistry from the University of Exeter, Jill qualified as an accountant before joining GSK in 1990. She worked at the pharmaceutical giant until 2001 and then launched her own consultancy which she ran for a decade before returning to GSK in 2011.

Talking about her new appointment at London Ambulance Service, Jill said:“I am delighted to be appointed as an associate non-executive director on the Trust board.’

“It has been truly inspiring to see the way the Trust has responded to the challenges of COVID-19 and I feel extremely privileged to be joining.’

“I have no doubt that this has been achieved through the commitment and personal sacrifices of individuals and teams across the Service.’

“I am very passionate about creating open, collaborative cultures which place the patient at the centre of decision-making and I hope I will be able to support further the organisational change happening in the Trust.”

Commenting on Jill’s appointment, Heather Lawrence OBE, chair of the LAS Trust board, said:

“It gives me great pleasure to welcome Jill to our Trust board. She is an inspiring and strategic leader within the healthcare sector who has championed a culture of collaboration and openness throughout her career.’

“Her expertise in finance, commerce, research and supply chain, as well as her genuine desire to improve the lives of patients, will prove invaluable to the Service as we continue to strive for excellence every day to realise our ambition of becoming a world-class ambulance service.”

Mifal HaPayis and Magen David Adom Initiative to Place AEDs in Public Areas

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Mifal HaPayis is currently launching a joint project with MDA. Joint teams have already begun this week to place the devices in the Lottery booths across the country.

The project aims to provide an electric shock to the heart in cases of out of hospital cardiac arrest as quickly as possible and increase the number of lives saved in such instances.

When a citizen identifies a case of cardiac arrest in a public setting, they will be able to call the 101 Emergency Call Center as usual.

From there they will receive instructions enabling them to identify the closest defibrillator in the area (located in dedicated Mifal HaPayis booths),

Further instructions will help them to assess the patient and to provide life saving treatment until the arrival of emergency teams.

The chairperson of Mifal HaPayis, CPA Avigdor Yitzhaki said: “The purpose of the venture is to save human lives.’

“Deploying the AED devices in the Mifal HaPayis sales booths will enable, in some cases, immediate primary care in the urban area and, in some cases, even save the lives of the most common cause of death in Israel and around the world — cardiac arrest.’

“Mifal HaPayis understands the importance of the project, and invests many resources for the community and Israeli society and there is no greater social purpose than saving human lives.’

“I congratulate the Mifal HaPayis Board who understood the importance of the project, approved it and immediately joined the mission.”

MDA Director General Eli Bin added: “Collaboration with the Mifal HaPayis through the placement of CPR devices in public places is an example of creative collaboration for the sake of saving lives.’

“This is certainly an important and clear step that will save lives and increase the chances of survival of those suffering from cardiac arrest near, and perhaps even without irreversible brain damage.’

“I thank the chairman of Mifal HaPayis, CPA Avigdor Yitzhaki, for his first-line stance, alongside MDA, with concern for public health.”

Super Woman Asmahan Abu Yeheya Recounts 16 years of EMS Volunteering for MDA

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Asmahan Abu-Yeheya (42) from Gan Yavne has volunteered at Magen David Adom for 16 years.

Over the years, Asmahan had six children of her own, but between one maternity leave and another, she continued to volunteer at MDA as an EMT and ambulance driver.

Asmahan is a certified preschool teacher, and at the same time also works as a medical secretary at an orthopedic clinic, and as a volunteer operations officer for the Gan Yavne Rescue Unit.

All of this, Asmahan, does as a single mother to her six children, with the youngest being 10 years old.

“I get support from the kids,” Asmahan shared, “If I’m in a bad mood, they tell me to go to a MDA shift because they know it will do me good.’

“Doing and giving give me a lot of satisfaction, and I feel at any given moment that I am part of the warm and supportive MDA family.’

Asmahan says that she sees each patient as a person, and that she never works on “automatic: “When I treat an older woman, I treat her like she is my grandmother.

Every time I think about the person in the ambulance when he is in pain and scared, and sometimes I am the only person they have, my job is first and foremost to give him the best medical care, but I believe it is very important that I be both human and caring. “

In recent months, Asmahan has taken an active part in MDA activity at the forefront of the fight against the Corona virus.

She has undergone training to obtain samples from suspected corona patients, and has obtained samples in the homes of patients in the Gan Yavne and Ashdod area, in the “Drive and Test” complex in Ashdod and in nursing homes in the area.

“I took a lot of samples, but it was important not to be indifferent to any of the patients,” Asmahan said. “I remember going to sample a tourist who was in isolation at a hotel in Ashdod, and I was told he had a birthday.’

“I sang a happy birthday to him and he was very excited. When I arrived dressed in protective suit for homes that had children, I told them that I was not a monster, and tried to do everything I could to calm them.’

“The activity around the Corona crisis was vast and sometimes not easy, but I knew I was part of something big, and volunteer at an organization that you need adapt to the situation in the country, with the help of people like me and other volunteers. “

“I happened to arrive as a team member for a patient or injured person, and they asked me where the person in charge is,” Asmahan said, “but I’m quick to make it clear that I’m in charge.’

“I’m sure of what I’m doing, and as soon as the people around me realize I’m coming to help, the attitude always changes. They thank me and appreciate what I did.”

Treating People Fairly: Welsh Ambulance Service’s Strategic Equality Plan 2020-2024

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The Welsh Ambulance Service has published an ambitious new plan to improve equality among its workforce and communities.

The Trust’s Strategic Equality Plan 2020-2024 sets out its commitment to work with staff and volunteers to help them recognise and celebrate diversity.

The plan is available to read via a link at the end of this article.

It also outlines how the organisation will ensure the people who use ambulance services, including those with protected characteristics, have equal access.

Claire Vaughan, the Trust’s Director of Workforce and Organisational Development, said: “We want to lead the way as an exemplar employer for diversity, equality, inclusion and fairness.

“This strategy, building on progress and momentum from the previous strategy, sets out how we intend to do this over the next four years to cultivate an inclusive workforce where our people are enabled to realise their full potential, to flourish and make a positive contribution in the delivery of care.’

“We have called it Treating People Fairly to reflect our aim; to treat everyone fairly regardless of who they are, their background or circumstances.’

“We know we have more to do to enable a culture that is fully inclusive, supportive and accepting and we’re having conversations about how we can expedite this work in light of recent events.”

Joga Singh, Non-Executive Director with the lead for Equality, Diversity and Inclusion, added: “The celebration of diversity is so important for an organisation’s ability to recruit and retain the best people for the job and also improves productivity, which ultimately, delivers a better experience for the patient.’

“We look forward to working with our staff, citizens and stakeholders across health and social care, the public sector and beyond to achieve the ambitions set out in this strategy.”

The launch of the new strategy coincided with a statement that Chief Executive Jason Killens made to the workforce on the Black Lives Matter movement following the death of George Floyd in Minnesota, USA, in May.

In a statement to colleagues, Jason said: “There is absolutely no place for racism in the Welsh Ambulance Service.

“This is not about compliance or about feeling we have a moral and ethical obligation to do something to tackle injustice.’

“This is about it being the right thing to do for our people and our communities. ‘

“It’s about standing up and calling out discrimination and inequality whenever and wherever it manifests.’

“It’s about being a fair and decent human being.”

Jason, who is also Diversity Lead for the Association of Ambulance Chief Executives, added: “This is not a problem that can be solved by senior management alone. ‘

“This is a challenge that requires every single one of us to stand up and be counted; to look closely at our own thoughts, words and deeds, and the actions of others around us.’

“We must challenge unacceptable behaviours, whether deliberately malicious or just plain ill-informed, and change our organisation for the better.’

“To do this we need to start by having open, honest and inevitably difficult conversations right across the organisation. ‘

“From crew rooms to board rooms, we need to listen, learn and redouble our efforts to change unacceptable behaviours if we want to achieve genuine equality in the workplace.”

Click here to read the Trust’s Strategic Equality Plan, Treating People Fairly.

London Ambulance Service Launches New Public & Patients Council to Help Shape Services

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A new council formed by London Ambulance Service, bringing together patients, carers, volunteers and members of the public to help shape future services, has held its first meeting this week.

The Public and Patients Council includes a wide range of representatives from patient and carer groups, different London communities and the voluntary sector.

Meeting quarterly, it will examine and advise on broad areas of LAS’s work, from individual patient care, treatment and research through to the way LAS delivers and designs its services as well as strategy and forward planning.

The newly-launched council, which reports to the Trust Board, currently has 12 members and two independent co-chairs.

Dame Christine Beasley DBE, who was previously the Chief Nurse for England, has been appointed as the council’s interim chair.

Members of the council met ‘virtually’ for the first time on Tuesday 16 June and heard updates on how the Service has been meeting the challenges of COVID-19, as well as its progress in introducing a new electronic system to track and monitor the care we provide to patients.

Both of these discussions involved seeking feedback and views from council representatives on how they feel the Service has responded to the COVID-19 pandemic and how they think the Service can best inform and engage patients around the introduction of the new electronic patient care record.

Dame Christine Beasely DME,
Former Chief Nursing Office
and Interim Chair for LAS Public & Patients Council

Dame Christine Beasley, interim chair of the council, said: “I’m delighted to be part of this new council, which will bring together views, expertise and experiences from many corners of LAS’s patient community, as well as carers, the general public and the voluntary sector.’

“It is crucial that all public health organisations keep talking with, and listening to, their service users to ensure they are in tune with what patients and the public feel it is important for them to focus on, both now and in the future.”

Antony Tiernan, Director of Communications and Engagement at London Ambulance Service, who is the executive lead for the new council, added: “Our patients and the people of London are at the centre of everything we do, and it’s vital that they have a voice in the way we design, develop and deliver our services.’

“The way we deliver care is changing, and we have formed the new Public and Patients Council to help us engage with different patient groups, carers, communities and the voluntary sector as we transform our services.’

“Their expertise and insight will be invaluable as we shape our plans for the future, as well as influencing the day-to-day running of the Service.”

The council includes representatives from Healthwatch Enfield, Terence Higgins Trust, the Samaritans, Carers Trust, Healthwatch Merton and St John Ambulance. It currently has 12 members, but will expand to 20.

People who are interested in joining should email: [email protected].