IMProVE – Integrated Management and Proactive Care for the Vulnerable and Elderly Event report and feedback from engagement questionnaires a. Overview This paper describes the engagement activity undertaken by NHS South Tees Clinical Commissioning Group (CCG), in collaboration with a range of partners, in relation to services for the vulnerable and elderly and those living with long-term health conditions such as diabetes, heart disease or chronic obstructive pulmonary disease (COPD). The aim of the activity was to engage a range of stakeholders, service users, carers, providers and the general public in a discussion about the future shape of services prior to the commencement of a formal consultation process to be held in early 2014. The views and opinions provided will be used to help inform the option appraisal/selection process as well as the nature of the consultation activity. b. Aims To underpin the delivery of the IMProVe agenda and support the development of a strategy for communicating the compelling vision around the need for change. To raise awareness and understanding of why it is important that the NHS has a plan to deliver sustainable and viable services for the next three to five years. Hosted by NHS England To ensure that appropriate mechanisms are in place so that the public, key stakeholders and partners feel engaged and informed throughout the process. To contribute to shaping public, and health services’ staff, expectations of NHS services in Middlesbrough, Redcar and East Cleveland. To maintain credibility by being open, honest and transparent throughout the process. To monitor and gauge public and stakeholder perception throughout the process and respond appropriately. To be clear about what people can and cannot influence throughout the engagement and consultation phases. To achieve engagement that is meaningful and proportionate, building on existing intelligence and feedback such as previous engagement/consultation activities, complaints, compliments etc. To provide information and context about the proposals in clear and appropriate formats that is accessible and relevant to target audiences. To give opportunities to respond through a formal consultation process. To maintain trust between the NHS and the public that action is being taken to ensure high quality NHS services in their local area. To demonstrate the NHS is planning for the future. c. Activities The CCG put in place a wide range of activities designed to generate input from key audiences. A full log of activities can be found in Appendix 2. These included: 1. Attending Tees Valley Joint Overview and Scrutiny Committee. The Committee received a presentation and provided feedback on the draft communications and engagement strategy and action plan as well as the consultation document. 2. Attending Middlesbrough and Redcar and Cleveland Health and Wellbeing Boards 3. Meeting with local MPs 4. Discussions with local GP members 5. Public events (5) 6. Distribution of information on public events to local shops and venues in advance of each meeting. 7. Dissemination of material to voluntary and community sector organisations (see appendix 3) 8. Dissemination of material to libraries, care homes, hospital premises, leisure centres and local authority premises. 9. Dissemination of material to GP practice patients groups 10. Dissemination of material and invitations to events to those members of the public and organisations registered on the CCG’s My NHS database. 11. Commissioned local voluntary organisation to conduct an in-depth survey seeking views and opinions from over 300 elderly patients and their carers. A full report of findings is available separately. 12. Press releases were sent to the local media and a supplement in the Evening Gazette provided information about how people could get involved in the engagement activity. Dr Ali Tahmassebi appeared on Community Voice radio. Media cuttings are attached at appendix 3. 13. Syndicated articles produced and sent to partner organisations for use in their internal and staff bulletins. 14. Information was posted on the CCG website with details about the engagement activity, public events and ways for people to feedback. 15. Feedback mechanisms included: an engagement document with attached questionnaire a standalone questionnaire in hard copy website with full details of the engagement activity online survey comments left at public events email address freepost address Partner organisations including representatives of Middlesbrough and Redcar and Cleveland Council and South Tees NHS Foundation Trust were involved in developing the consultation document and associated questionnaire. In addition, Healthwatch Middlesbrough, Redcar and Cleveland provided feedback on the draft engagement document that was used to improve the content. d. Public Events The CCG held 5 public events across South Tees designed to offer interested individuals, stakeholders, service users and carers the opportunity to contribute their views and opinions as follows: Event Location 9 October 3pm – 6pm City Learning Centre Eston, Normanby Road, Middlesbrough TS6 9AE Attendees 6 attendees including representative from Healthwatch and Redcar Borough Council, Director of Public Health, Middlesbrough. Staff also visited Low Grange Health Village to disseminate questionnaires Event Location Attendees and talk to members of the public. 16 October 3pm – 6pm Guisborough Parish Hall, Bow Street, Guisborough TS14 6BP 4 23 October 3pm – 6pm East Cleveland Primary Care Hospital, Alford Road, Brotton TS12 2FF No specific attendees although some passing trade as the event was held in the foyer close to the reception area. A number of brochures/questionnaires were given out and visitors engaged in conversation 30 October 3pm – 6pm The Crypt, Middlesbrough Town Hall, Albert Road, Middlesbrough, TS1 2QJ 11 6 November 3pm – 6pm Tuned In!, Majuba Road, Redcar TS10 5BJ 11 Events were ‘drop-in’ market place style. Members of the public were able to attend at any time and walk around a number of ‘stalls’ talking to representatives from the CCG, North of England Commissioning Support Unit, South Tees NHS Foundation Trust as well as Middlesbrough and Redcar and Cleveland Councils. Those attending were encouraged to complete a questionnaire. An analysis of questionnaires received though events and other mechanisms is in appendix 1. e) Key themes emerging from engagement activity Over 400 carers, patients, service providers and members of the general public responded to the engagement activity. The majority were over 65 years of age and included people who were elderly, vulnerable, housebound, had limited mobility or were living with a significant long-term condition. We also spoke to a number of carers. Respondents were drawn widely from the South Tees area including Redcar, Eston, Brotton, Middlesbrough and Guisborough. A number of key themes emerged from the work which are outlined below. Full details of all the responses received can be found in appendix 1 and appendix 4. Co-ordination of services Overall, respondents felt that local services were organised well. However there were a significant number of comments about the need for better collaboration and coordination across health and social care organisations and between different services. Many felt that information was not always passed from one service to another effectively, that there was poor communication between providers and silo working was common. GP access While many were happy with the support provided by their GP surgery, poor access to appointments was a recurring theme. Respondents were unhappy with the length of time they had to wait for a GP appointment and felt that GPs should spend more time visiting patients in their own home. There were also comments about continuity of care and the importance of being able to see the same GP on a regular basis. Access to information Most people said that they knew who to contact for advice, guidance or support in relation to their long-term condition. However, over half felt that more information or guidance would be helpful. This included the need better information about social care provision and more information about specific conditions such as dementia and arthritis. Some respondents were concerned about the consistency of information and whether it was up to date. The importance of ensuring that not only patients but also their carers/families understood the information being given was also raised. Quality of care provided Most respondents felt they had received sufficient support to manage their condition, although a range of potential improvements were identified. These are reflected in the comments provided throughout this paper. Where should care be provided? Overall, the majority felt that the location of care should be determined by the needs of the patient. Most felt that a mixture of home, community and hospital-based care should be available. Care closer to home There was considerable support for the suggestion that more care should be provided in the home or in a community setting. Respondents felt that this could aid recovery, prolong independence and keep hospital beds free for the seriously ill. However, many commented that for this vision to become a reality, communitybased care would need to improve significantly. Quality of community provision The quality and extent of community-based services was a recurring theme. Respondents identified a number of areas for improvement including more frequent and longer home visits from both health professionals and home care providers, more rapid assessment of need and access to services and equipment, more practical support in the home, and on-call support available on weekends and in the evenings. There were a number of comments about hospital discharges being delayed because of lack of provision. Some respondents suggested drop-in or day facilities should be available locally. Hospital beds When asked to consider a reduction in the number of community beds, respondents were divided. There was some confusion about the difference between community and acute beds with a number commenting that beds were needed in case of a flu epidemic or major incident. Those who were largely against any reduction in bed numbers felt that there was already a shortage of bed, evidenced by the length of time people had to wait for admission. The view that having too many beds was preferable to having too few was given by a number of respondents. Some disputed the case for a reduction in beds, citing the growing elderly population and suggesting that further analysis was needed. Opinions differed on the impact of closing community beds with some reflecting that it would take pressure off the hospital system and others claiming it would increase demand for acute beds. Around half supported the idea of closing beds and providing greater care in the community. Amongst other things, respondents felt that this would aid recuperation and promote independence. Many qualified their support for the closure of beds with the need to improve community health and social care services. Some questioned whether there was sufficient budget/staff to develop and improve community services in line with the CCG’s vision. Other issues Physiotherapy and Occupational Therapy services - There were a number of comments about the length of time taken for assessments/access to services. Some commented that this was impacting upon recovery and hospital discharge. Dementia services - The need for improvement in services was mentioned by a number of people. This ranged from better information for patients and their carers through to the extent of the services available locally. Community hospitals -There was some support for local community hospitals. Respondents valued their proximity to home/relatives/friends, particularly where there was a reliance on public transport, while others felt that they took the strain off acute beds. A few felt there needed to be more local beds for recuperation/respite. Cost of travel – Some respondents mentioned the difficulty/cost of travelling to GP appointments and other services using public transport/taxis. The lack of public transport was raised. More staff, more money – There were a number of comments about the need for greater investment in health and social care services. Care homes – A few respondents identified the need for good, local care homes. There were a few comments about the lack of staff training and the impact this had on the delivery of care closer to home. Reliance on elderly relative for support/care – Many of the respondents were being cared for by elderly relatives or were elderly carers and felt that this needed to be recognised. Keeping carers/family informed - There were several comments about the need to keep family members/carers informed in general about health conditions and how to deal with them. Some also mentioned wanting to be kept up to date with the specific requirements of those they were caring for. Listening to patients – A few made comments about the need to listen to patients. Some made the point that carers needed to be included in discussions in cases where patients found it difficult to get their point across without assistance. Appendix 1 QUESTIONNAIRE RESPONSES Methodology Views and opinions were sought from the public, stakeholders and service providers between 23 September and 22 November 2013. Respondents were asked to complete a questionnaire, which was made available: on the CCG website distributed to key stakeholder and organisations including voluntary and community sector, GP patient reference groups, local GP practices sent to those registered on the My NHS database distributed to those who attended one of the five public events held across the area The questionnaire focused on the views and opinions of those responding and the feedback received therefore provides a range of qualitative information to support the decision-making process. In total, 99 questionnaires were returned. These form the basis of this analysis. Not all respondents answered all questions. In addition, a further in-depth survey of patients and their carers carried out by the independent voluntary organisation Carers Together. A separate report has been produced on these findings. This can be found in appendix 4. 1. How well do health and social care staff organise the care and services for local people? Response Percent Response Count Very well 16.7% 16 Not very well 24.0% 23 Fairly well 45.8% 44 Not at all well 6.3% 6 No opinion 7.3% 7 Answer Options 66 What do you think could be improved? 1a. answered question 96 skipped question 3 What do you think could be improved? Many respondents mentioned the need for better co-ordination between services, social care, carers and families, improved communication and joined-up working. There is a need for better communication between organisations. Better communication eg in hospital if patient has complex issues - all consultants copied on action. More cooperation between services needed. However when people go from in-patient services the care in the community is not as streamlined as it could be to allow multiple care providers to work together. Needs to be joined up as patient moves from service to service - generic Pathway. There needs to be much more coordination and sharing of information amongst professionals. Forming strong proactive partners and looking at how we can utilise existing resources would further benefit the clients we are trying to target. Integrate liaison between health and social services disciplines more actively. Each discipline needs to be fully aware of how others can help, and use each other’s expertise. Liaison with patients and family/carer Liaison between professionals. Balanced views being taken including patient/family/carer Other comments related to the need for more funding or staffing, the length of time taken to access services, and using community hospitals more effectively. More funding and to take more off the hospitals. Waiting times in hospitals could be cut. Quality of carer services (private) Some are very good, others lazy and uncaring. More supervision is needed. To involve family and carers more. To signpost where services and equipment can be obtained. More staffing. Access to specialist health care for adults 60 years old and over. Better use of both Brotton & Redcar, local NHS Hospitals. 2. We think people should be provided with appropriate information and guidance to help them make decisions and manage their own conditions. What information/guidance should be provided and by whom? Respondents talked about a range of ways in which information could be provided from the internet and leaflets through to the role of GPs and other professionals in providing guidance. Comments were also made about giving family and carers the information they needed. Info packs and online preferably. All parties involved should work together better and keep patient and relatives fully involved and informed. Information from GP's local health centres. Listing available options for patients, rather than recommending just a small set of decisions. Remember the involvement of the carer in talks with the patient from the beginning to give support to the patient Leaflets work well, community centres, libraries etc. no need to force inforamtion onto people. More links between service providers to ensure information about health conditions is readily available an accessible for the service user, families and carers. Making sure patients understand the information given to them. Access to easy to understand information about the services that are out there that can assist. Something as simple as a Z-card which gives relevant practical information and contact details of agencies that can help 2a Who should provide the information? Most respondents felt that information should be provided by trained professionals although there were different views about whether this should be GPs, nurses, hospital consultants, social care staff or others. Pharmacy support in helping people manage their conditions. Doctors’ surgeries should give out information on managing their health conditions. Community nurses should be aware of people whose health is failing. Social workers seem to the main providers of information, agencies carers together. GP waiting areas could give specific condition representatives information on diagnosis, signposting by GP/Carers. Specialist nurses linked to GP surgeries who also link with hospital consultant System. 3. If it is clinically appropriate, where do YOU think people should receive the majority of their care if they have a long-term condition(s)? This includes people who have had a stroke, frail elderly people, people with dementia and people with chronic chest problems or heart disease. Response Percent Response Count In their GP practice and community nursing staff? 12.6% 12 In their own home? 24.2% 23 In their local hospital? 3.2% 3 A mixture of these? 60.0% 57 Answer Options 56 Do you have any comments/ answered question 95 skipped question 4 3a Do you have any comments? Most of the comments received were supportive of the idea of people receiving care in their own home or closer to home eg in GP surgery. However many qualified this with the need to provide/improve the support available in the community. Others talked about the need to have different services to meet different and complex needs. In the home as long as possible. Needs easy access or provision directly into persons home. Care closer to home most of the time. Keep elderly away from hospitals if possible. Home based care is essential. 'Elderly people' with dementia are more comfortable in a well known comfortable environment In their GP practice with flexibility of visits by GP and community nursing staff at times when appropriate or requested. A graduated transition of care is needed. The services will be dependant on the condition but usually a mixture is required. Short term care in appropriate safe conditions such as Redcar or Bottom hospital If an individual has the support to live independently and the care and health package looks at the well-being of the service user at the core of what is done, then homecare is appropriate. Don't forget other primary care health professional - optometrists, pharmacy. As long as on-going care packages is in place. 4. What services could be improved in the local community to support people to leave hospital earlier and regain their independence following a hospital stay? Respondents focused on the need for greater support in the home once the patient had left hospital, with many talking about daily visits. There was mention of better integration/joining up of health and social care, access to transport, the hospital discharge process and the need for more timely responses. Key is to get somebody out (of hospital) quickly, but not so quickly support isn’t available. All services need to work in unison with the same set of goals to achieve the best outcome for the patient. Communication within hospitals and with the outside world is not always as good as they might be. Help in the home. Daily visits from a health care worker. Carers should spend more time with elderly. Community nurses should visit on a regular basis. Nursing support when leaving hospital until feeling able to cope more. Doctors and nurses making regular visits to make sure people are coping with the transition from hospital to home. Intermediate care teams, multidisciplinary approach. Services delivered from GP surgery or health centre ie diabetes physio etc. Better, quicker supply of medication to be able to leave hospital more quickly. Better support for people living on their own. Specialist teams, drop in service for patients who seek reassurance – GP Health centre based. Easier access, 24/7 and at weekends, to home care services, and quick follow-up visits from professionals. If ward staff cannot arrange things before Friday, it seems that the whole system is on hold until Monday. 5. By providing more care outside of hospital we may not need as many hospital beds across the South Tees area. Do you have any views about this? There was support for the idea of reducing hospital beds. Almost half of the respondents agreed with the statement, although some qualified their responses by indicating that improvements in other services would be needed. Nineteen of the 72 respondents to the question were not in favour of reducing hospital beds and others questioned the validity of the argument. Excellent idea. Ill people would always prefer to (be) in their own homes if possible (it isn't always!) Convalescence is probably quicker Hospital beds should be only used for medical treatment. Less stays in hospital bed would benefit the elderly. Completley agree. More resources for Social Services, care services etc. Hospital beds are expensive and people would prefer not to go in, less beds should be seen as positive. If care outside the hospital is good enough to show less beds are required then so be it! As long as resources are directed into community services to cover this. This would be good but we need to make sure that the care given is regular and the carers who do it are paid appropriately. As care work is one of the most stressful and long hours but one of the worst paid. Would rather not be in hospital if I am well enough to be cared for at home and as effectively. The hospital beds can be used for more poorly patients. Staff could be used to run clinics within GP practices to assess patients better. We will always need plenty of hospital beds but some conditions can be managed with patients in their own environment with some hospital nurses working alongside patients GPs and family. I do not like the idea of cutting beds. We value the community hospital, would not like to see it close. Difficult to travel further with no transport. If we lose community hospital (patients will be) isolated at home. I think that is a folly. If our population was stable I'd agree but as it’s getting older if we keep the same beds as the population ages we willstruggle to accommodate everyone. As before some patients cannot move through the system quickly and as an elderly person reacts differently to rehabilitation there needs to be the opportunity for slow stream rehabilitation before going home and receiving intermediate care insitu. Hospital beds cannot open and close easily. We must guard the ones we have There's hardly any in the first place. Do not get rid of the beds. I do not see that this follows - the more people living longer - the more will need hospital care. Not worried about beds. more about quality of care and appropriate utilisation of services 6. What do you value about healthcare services? 7. Would you like to make any other comments about our vision? Comments received were wide ranging but generally supportive. Some respondents mentioned the need for extra resources and the difficulty of achieving change. Sorry to say this but shouldn’t this have been the vision from the outset? Happy with vision Needs to be closer to home. Fantastic. It needs to become reality, quickly. Lots of people don’t understand the issues as they haven't experienced the care. The vision is so widespread difficult to see how systems can change in the near future but change of systems seem to be the key. Caring for people in their homes is very good but more money will be needed for adaption and support services. I think treatment in the community is a good thing but I do worry about elderly and learning disabled people becoming socially isolated and also how the quality of the service they receive can be monitored. Your vision is a bit confused. The service user must be the key factor in all decisions in health care, the service must exceed expectations, not just be of a minimum standard. Needs a lot of extra hands on to make it work ie more resources Do not reduce provision of services before alternatives are tried and tested. About Respondents Age – please choose the category which best describes you: Tick as appropriate Answer Options Response Percent Response Count Under 16 years 16-25 years 26-35 years 36-45 years 46-55 years 56-65 years 66-75 years Over 75 0.0% 5.4% 5.4% 12.9% 20.4% 24.7% 22.6% 8.6% 0 5 5 12 19 23 21 8 answered question skipped question 93 6 Gender Answer Options Male Female Response Percent Response Count 40.7% 59.3% 37 54 answered question skipped question 91 8 Carer – do you provide care for someone who is elderly or living with a long-term condition? Answer Options Yes No I do not wish to disclose Response Percent Response Count 44.6% 53.3% 2.2% 41 49 2 answered question skipped question 92 7 Ethnicity – please choose the category which best describes you: Tick as appropropriate. Answer Options White Mixed Asian/Asian British Black/Black British Chinese Other ethnic group I do not wish to disclose my ethnicity Response Percent Response Count 89.4% 1.1% 4.3% 3.2% 0.0% 0.0% 2.1% 84 1 4 3 0 0 2 answered question skipped question 94 5 Disability – do you consider yourself to have a disability or a long-term health condition? Answer Options Yes No I do not wish to disclose Response Percent Response Count 32.3% 65.6% 2.2% 30 61 2 answered question skipped question 93 6 Poscode TS10 TS11 TS12 TS13 TS14 TS17 TS18 TS5 TS6 TS7 TS8 TS4 TS1 Non-TS total Number 10 4 6 2 15 2 3 2 9 9 6 5 4 3 80 Appendix 2 IMProVE – engagement activity log 2013 Action Completed Audience Redcar and Cleveland Briefing/presentation Health and Wellbeing Board Middlesbrough Health and Briefing/presentation Wellbeing Board Tees Valley Joint OSC Briefing/presentation 23 May Frail, Elderly Event at South Tees Foundation Trust Presentations and group discussions 22 July Meeting with Ian Swales MP Briefing provided 7 June Members. Public/press in attendance Members. Public/press in attendance Members. Public/press in attendance Consultants, local authority representations, GPs, other health professionals and managers 60 attendees MP Meeting with Andy McDonald MP Meeting with Tom Blenkinsop MP South Tees Joint Health Scrutiny Middlesbrough and Langbaurgh Locality Council Letter to GPs Briefing provided 21 June MP Briefing provided 21 June MP Presentation to and discussion with members with feedback to follow independently Presentation by Dr Ruth Johnson 12 August Members 19 September GPs Sent by Dr Henry Waters 20 September GPs Hosted by NHS England Details 12 June 29 July Action Details Completed Audience Eston Locality Council Information emailed to GPs by Dr Janet Walker September 25 GPs Media relations Barry Nelson and Sarah Walker briefed. Articles appeared in Northern Echo and Evening Gazette. Monday 23 September General public, interest groups, community and voluntary organisations Press releases issued prior to each public event Prior to each event Live on 23 September Website content Live on CCG site with links to/from FT/Partners Disseminate public facing document Prepare letters and mail/email with appropriate documents to: Stakeholder list My NHS Patient reference groups FT membership TEWV membership Healthwatch PALS GP practices MPs LMC Practice managers provided with briefing sheet, slides, question and answer sheet and opportunity to ask for further resources if required. Practice managers contacted by phone and asked whether they could have discussions within their practice groups. All voluntary and community groups contacted by phone and provided with verbal information, PRG toolkit Additional liaison with voluntary and community Mailings 23 September General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations 24 September Practice managers, members of GP practice groups w/c 7 October Community and voluntary groups Action Details groups invitation to events and opportunity to ask any questions/request more details Second email send to hard to reach groups to ask if they needed any more information and offering to go out to speak to groups Advertisements promoting events placed in Evening Gazette and Herald and Post Hard to reach groups Event advertising Event leafleting Approx 1,000 A5 leaflets dropped into shopping areas around venues in Guisborough, Brotton and Redcar Practice managers Phone call to practice managers to encourage them to have local conversations and provide feedback and offering use of short film if required Practice managers e-mail to practice managers to follow up/confirm conversation above South Tees Practice bulletin Information about engagement activity and IMPRoVE project South Tees Community IMProVE stand at event Council Meeting with Redcar and Meeting with Julie Stevens and Julie Bailey. Cleveland Healthwatch Overview of IMProVE provided FT volunteer support Volunteers to support administration of questionnaires at hospital sites Advertising to support Adverts placed in Evening Gazette and Herald and public events Post on following dates: Public drop in event City Learning Centre, Eston 3pm – 6pm Completed Audience 8 October Hard to reach groups Prior to each event General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations Practice managers, patient groups W/c 16 October 14 October 14 October 13 September 17 October 22 October Throughout the period See previous column 9 October Practice managers, patient groups GP member practices and staff GP member practices and staff HW staff Patients, carers and visitors at hospital venues General public, interest groups, community and voluntary organisations General public, interest groups, community and Action Details Completed Public drop in event Guisborough Parish Hall 3pm – 6pm 16 October Public drop in event East Cleveland Primary Care Hospital 3pm – 6pm 23 October Public drop in event The Crypt, Middlesbrough 3pm – 6pm 30 October Public drop in event Tuned in! Redcar 3pm – 6pm 6 November Patient/carer survey Survey underway. Use discussions to recruit patients/carers to be used as ‘patient stories’ for feedback and formal consultations process Middlesbrough Lifestore Low Grange Health Village Redcar Library Provider/NECs Display stands and material placed in key locations Audience voluntary organisations General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations General public, interest groups, community and voluntary organisations Appendix 3 Distribution/contact List Voluntary and community organisation Middlesbrough Voluntary Development Agency Redcar and Cleveland Voluntary Development Agency Healthwatch Middlesbrough Healthwatch Redcar & Cleveland Voluntary Organisation Network North East Carers Together Redcar and Cleveland Breathe Easy Redcar & Cleveland MIND British Red Cross Befriending Service In East Cleveland Adult Mental Health Services for South Tees Dial a Ride (Redcar & Cleveland) Redcar & Cleveland Real Opportunity Centre (ROC) The Stroke Association (Redcar & Cleveland) Guisborough U3A Neighbourhood Action Partnership Supporting People Team (Redcar & Cleveland Borough Council) Redcar and Cleveland CMHT Eva Women's Aid Royal Voluntary Service Coast & Country Housing Cleveland Housing Advice Centre Valuing People Action for Blind People Age UK Alzheimers Society BME Network Southbank Residents Association Citizens Advice Bureau Community Voice FM Palace FM- Community radio MESMAC Middlesbrough MIND Middlesbrough Council Asylum Team Richmond Fellowship South Tees Oeteoporosis Support Group Aspergers Family Support Group Middlesbrough Survivors Independent Living Centre Hosted by NHS England Lansdowne Resource Centre Teesside & District Society for the Blind Carers Support Samaritans North Regional Deaf Association Advocacy Service (North East) The Stroke Association MS Group Hanover BECON ( North of England) Emtep My Sisters Place PALS Homecall Chinese Community Centre Gurdwara Sikh Temple Hindu Cultural Society Jamia Mosque North of England Refugee Services (NERS) West Middlesbrough Neighbourhood Trust Aapna Services - Supporting BME communities Independent Living for Older People (ILOP) Middlesbrough Council of Faiths Community & Cultural Links Bridging the Gap Disability Matters Middlesbrough and District Epilepsy Support Group Transgender Support Group West Middlesbrough Neighbourhood Trust
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