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How can we for the better? In this issue: Future jobs fund End of life care suite for dementia care opens Our new Governors New male-only ward to open People Matters Issue 6 What’s happening in Leicestershire Partnership NHS Trust Trust welcomes new multi-faith chaplains page 9

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Page 1: People Matters - WhatDoTheyKnow · My first choice would be Johnny Depp, he’d have to come as Jack Sparrow and that’s because he makes me laugh, and he’s fit! ... many films,

How can we

for the better?

In this issue:

Future jobs fund

End of life care suite for dementia care opens

Our new Governors

New male-only ward to open

People MattersIssue 6

What’s happening in Leicestershire Partnership NHS Trust

Trust welcomes newmulti-faith chaplains

page 9

Page 2: People Matters - WhatDoTheyKnow · My first choice would be Johnny Depp, he’d have to come as Jack Sparrow and that’s because he makes me laugh, and he’s fit! ... many films,

32

Tony Harrop obe

Chairman

Antony SheehanChief Executive

60 second interview:

Name: Mandy ClarksonJob title: Community Nurse Team Manager for adults with a learning disability.

What is a Learning Disability Community Nurse?

A registered nurse who is trained in meeting the health care needs of people with a learning disability. Community Nurses work with people who live in the community to address health care needs related to their learning disability and support other health care providers to meet people’s general health needs.

How long have you worked with the Leicestershire Partnership NHS Trust?

I started working in learning disability services long before the LPT existed! My first job was as a nursing assistant in 1979 before starting my training in 1980. I qualified in 1983 so I’ll just say it’s been a long while!

What are your main duties/what do you do day to day in your role?

I manage a team of community learning disability nurses in the Northwest Community Team. I also carry a case load which includes for example working with services users to look at epilepsy, mental health issues, and dementia. We are the pilot team for implementing Care pathways in the Learning Disability Service, and I have been involved in the introduction of these pathways within our regular team meetings. I am involved in development work for the service. I’m really interested in health and well-being and at present in the process of setting up a healthy lifestyle group with an Occupational Therapist colleague. My role also includes training and education, I regularly deliver multi- agency safeguarding training with social services colleagues.

Why did you want to do the job you do?All those years ago I did a college placement at Leicester Frith hospital working with children with a Learning Disability. I loved it and have been in the service ever since.

Mandy Clarkson

What do you like most about your job?I find my job very exciting at the moment. The Pathway pilot has been really challenging, it has changed the way we work together as a team and will improve the experience of the people who use our service. As a service we are committed to the inclusion of people with a learning disability and I really enjoy this side of my job.

If you could have any three guests for a dinner party at your home, who would they be and why?

My first choice would be Johnny Depp, he’d have to come as Jack Sparrow and that’s because he makes me laugh, and he’s fit! My next guest would be Gok Wan because I’d love to plan a shopping trip with him. I’d need someone to cook the meal so my last invite would go to Heston Blumenthal because I’m sure it would be a meal with a difference!

What film would you recommend to our members and why?

This is a hard question I don’t watch many films, however I have watched the Lord of the Rings trilogy straight through which is approximately eight hours. So I’d recommend any film which can hold my attention for that long.

Who would be your dream passenger and who would you leave stranded in a lay-by?

My dream passenger would be Stephen Fry because I love his voice; he could tell me his life story which would save me reading his book. I’d leave the “gocompare man” from the gocompare.com advert, he’s so annoying!

It’s been a very busy few months since our last edition of People Matters was published, with two very important activities involving members taking place.

First, there was our Annual General Meeting on 21st September, which was very well attended and provided a forum for lively discussions with members, our staff and the public in general.

This AGM heralded the publication of LPT’s Annual Report and Summary Accounts and our Annual Review. If you would like copies of these documents – and our Quality Accounts which complete the trio of core Trust documents reporting on the 2009/10 year – you can get them from our website at www.leicspt.nhs.uk or by writing to the address on the back page of this newsletter.

Our AGM took place in the middle of the elections for the governors who will sit on our new Council of Governors. These elections were a truly significant milestone for all of us here at LPT, as members of the public, service users, carers and staff were able, for the very first time, to democratically choose the people who will represent them at the very highest levels in our organisation. We are thankful to everyone who took part in that election process and welcome a strong group of elected governors. The Trust directors value the opportunity of working with them in taking forward our agreed priorities for service and quality improvements.

Welcometo this sixth edition of People Matters, the Leicestershire Partnership NHS Trust membership magazine.

The Council of Governors will formally come into operation when we are approved for Foundation Trust status. We are currently in the final stage of

that approval process, with a team of people from Monitor, the Foundation Trust

regulator, reviewing our application and making regular visits to the Trust. In the meantime, we hope that as many LPT members as possible will join us at our third annual Members’ Evening on 8th December, to meet and mingle with the new governors.(See page 6 for details).

The voice of people who use our services also came through strongly in a recent independent survey of our community mental health services, conducted by the Care Quality Commission. The levels of satisfaction service users are experiencing has increased considerably over the last year or so and it was heartening for us all to see this confirmed in an independent survey.(See page 8 for details).

In this issue of People Matters we cover the official opening of the Oak Room Suite at the Evington Centre (see page 5). We make no apologies for mentioning this new development once more as it provides a much needed and very special service for patients with dementia who are seriously ill or nearing the end of their life, and it is there to support their families as well. The staff commitment

to making this suite and the care provided in it simply the very best it can be is overwhelming and something that makes us both feel immensely proud.

We hope you enjoy reading this issue of People Matters. If you would like to share any

thoughts or comments with us, we would love to hear from you. You can contact us at [email protected] or by writing to us at the address on the back page.

“As a service we are committed to the inclusion of people with a Learning disability and I really enjoy this side of my job.”

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4 5

Nationally fewer than 25 per cent of people with mental health conditions are in employment and only ten percent of people with moderate or severe learning disabilities. This is a terrible waste of talent.

The previous government launched a scheme called the Future Jobs Fund (FJF) to help the long term unemployed back into work. NHS organisations in the East Midlands were keen to support the scheme and led a successful, innovative bid that would provide individuals with mental health conditions or learning disabilities employment for a six month period with the NHS.

The FJF scheme has had a hugely positive impact on the NHS in the East Midlands. NHS organisations worked in partnership with 30 jobs shared between the five organisations. Leicestershire Partnership NHS Trust was the lead organisation, hosting

LPT’s Chief Nurse, Jackie Ardley joined the Lord Mayor of Leicester, Councillor Colin Hall, to cut a ribbon to mark the opening of a new suite called the Oak Room, which has been specially designed by LPT to be as homely, restful and as comfortable as possible for patients and their relatives.

The new development includes a bedroom, bathroom and a relatives’ sitting room all

Future jobs fund

ten individuals. These jobs have provided the successful applicants with real work experience and an opportunity to demonstrate what they can do for the NHS.

Tony Burnell, who is the lead for this project at the Trust said “A number of our FJF employees have told me how this opportunity has helped to improve their self esteem and confidence and it is fantastic to see some of the them continuing in employment with LPT after the scheme has finished.” One of those successful in gaining permanent employment with us is Mia. Read about her experience below:

“ My name is Mia Northbridge. I was asked by the job centre whilst unemployed if I would consider a placement on the Future Jobs Fund Scheme, which I happily accepted. I attended the interview for an administration position where I was successful and started employment with Leicestershire Partnership NHS Trust in April, this was a six month contract to gain experience and skills that would help me into further employment.

“ My contract was due to end in September 2010 so I started to look for other employment on the NHS jobs website where I found an advert for a position at the Brandon Mental Health Unit at the General Hospital as a receptionist. I applied, and was interviewed and appointed. I started my new post in October.

“ I feel the Future Jobs Fund Scheme was very beneficial to me and I have gained a substantial amount of organisational skills and knowledge from this placement. I have really enjoyed my time at the Towers Hospital and my experience here has been wonderful. Not only have I learned new skills, but I have also found a new understanding of mental health services. I have met lots of interesting and memorable people and found friends in the colleagues I have worked along side. But I must say the most important and beneficial thing I have gained from this opportunity is that I have successfully found permanent employment.

“ I am very grateful for the opportunity that was given to me and I do believe that schemes like the Future Jobs Fund should continue, to help others such as myself to prosper into future jobs. Thank you to all the people that have helped me along the way. I am truly grateful.”

—Mia Northbridge.

Securing employment in the current environment is difficult for anyone; this is even more difficult for individuals from disadvantaged groups.

interlinked and equipped to a very high standard. The suite also incorporates a

specially commissioned stained glass window depicting an oak tree design. Patio doors from the bedroom lead to a private garden area, which has a pergola, seating area and raised flower beds, filled with aromatic plants and flowers.

The Oak Room has been developed in conjunction with The Kings Fund

charity as part of their Enhancing the Healing Environment Programme. The

programme encourages nurse-led teams to work in partnership with patients and carers to improve the environment in which they deliver care. The £85,000 project was financed in part by the King’s Fund and LPT and also through a range of fundraising activities.Project leader Sharon Hames said “When someone is seriously ill or dying in hospital it

can be very distressing for everyone concerned and creating a supportive environment is so important. We wanted to create a suite that would provide specialist palliative care, in a facility therapeutically designed to create a pleasant, safe and restful place for both the patient and their loved ones. We wanted to give them the space and opportunity for quiet reflection and additional privacy, and I think we have achieved that with the Oak Room”

The development of the Oak Room was also a catalyst for a new staff training programme. The Project Team developed effective links with the local hospice LOROS to improve clinical expertise in palliative care within a dementia care setting. LOROS has developed a special training programme for LPT staff that includes developing skills in pain management and symptom control and also aims to improve communication skills when talking to relatives about death and dying. •

A brand new facility designed to increase privacy and dignity for people with dementia who are seriously ill or nearing the end of their life was formally opened at the Evington Centre on Tuesday 5th October.

End of life care suite for dementia care opens

“I must say the most important

and beneficial thing I have

gained from this opportunity

is that I have successfully

found permanent employment.”

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6 7

Membership News Update

Membership updateOur new governors

The last few months have been extremely busy in the membership office, we’ve been recruiting lots of new young members and managing the recent Council of Governor elections. We are always keen to make sure that as many local people as possible know about the Trust’s membership so that they have the opportunity to join and contribute to the development of the organisation.

We have had lots of interesting health talks over the summer months, which covered lots of different topics and we hope to do more talks next year.

We have our annual members festive evening coming up on 8th December at 6 – 8pm which will be held at a venue in the city centre. This years members will have the chance to meet all our new governors who have been elected to represent your views as members. It promises to be a fun and informative evening with a local band called Refuge playing a few of their new songs for us. Unfortunately places are limited so if you would like to come along, please do let us know as soon as possible so that we can try and make sure there is a seat available for you.

You can book your place by calling: 0800 0132 530or by e-mailing: [email protected]

As always we are keen to try and involve members in any way we can. We’d like to know more about your interests and how you might like to be involved or if you have an interest in any of the following areas, let us know and if an opportunity for involvement arises, we will be sure to get in contact with you:

· Adult Mental Health· Younger people’s mental health· Learning Disability· Older Person’s mental health· Specialist mental health services

(e.g. eating disorders, drugs and alcohol)

Your NHS is changing. In 2011 we will hopefully see our Trust receiving Foundation Trust status and your newly appointed Council of Governors will begin their important work.

You, our members, have always been very important to us and in this new exciting structure, your input is more significant than ever before. 2011 will see our members being actively involved in the decision making process through governors, who have been elected to represent your views.

We will be keeping you regularly up to date with news, developments and improvements and seeking your thoughts and feedback about our future plans as often as we can. However, all this change comes at a time when public services and the NHS are trying to ensure that every penny spent is used in the most appropriate way.

We want to try and limit administration costs by sending as much information as possible to members by email rather than through the postal system.

Some of you have already registered an e-mail address with us, which is really helpful and does

help to save costs. If you have an email address and would like to be kept informed electronically, please register your email address with us.

Please note email addresses are kept confidentially and will only be used by the Leicestershire Partnership NHS Trust. If we already contact you by email you will be automatically registered, so there is no need to respond to this request.

To register your e-mail address, please send you full name, postal code and e-mail address to [email protected]

Elections are now complete and our new governors will form a Council of Governors, which will work in shadow form to prepare for its official launch when LPT is authorised as a NHS Foundation Trust by Monitor (the Foundation Trust independent regulator). LPT Chairman Tony Harrop, said:

“ I would like to thank all the members who voted in these elections. Their contribution is greatly appreciated. The governor role is of the utmost importance and I am delighted to welcome our new governors. They were chosen by the public, service users, carers and our staff from 64

excellent candidates and I’m sure they will be working hard on behalf of our 12,000 members.

“ Our new governors will bring great commitment, insight and scrutiny to their role and will help us in maintaining the highest standards of patient care. They will give the Trust Board great feedback as to how well we are doing as an organisation.” •

Email request

PublicLeicestershire County

Gavin Eyres3 years

PublicLeicestershire County

Kylie Jarvis2 years

PublicLeicester City

Krish Patel2 years

Carers

Sheila Eggleton3 years

Staff

Steve Walls3 years

PublicLeicestershire County

Freddie De Lisle3 years

PublicLeicester City

Rosemary Baker3 years

Service Users

Hilary Buckley3 years

Carers

Anne Marlow3 years

Staff

Liam Whitelaw3 years

Uncontested Seats and GovernorsConsituency Name Term of Office

Public, Rutland Pat Evans 3 yearsPublic, Out of Area Jane Quinn 3 yearsYounger Service User Theresa Madeline Griffiths 3 years

PublicLeicestershire County

John Richard Berry3 years

PublicLeicestershire County

Sue Selfe2 years

PublicLeicester City

Cedric Walter Starbuck3 years

Learning Disability Service UserVacant

Carers

David Lambert2 years

Staff

Nic Higham2 years

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8 9

The newly refurbished 24-bed facility is called Kirby Ward and is part of our older person’s mental health services. The ward has been designed and redeveloped to improve patient experiences by providing a better therapeutic environment and improved privacy and dignity. John Short, LPT’s Chief Operating Officer explains:

“ We want to move away from large dormitory style wards to provide more single bedrooms and smaller bays and increase en-suite bathroom facilities. This redeveloped ward provides people with a better environment and improved privacy and dignity. Based on experience elsewhere, we expect this will help to provide a more therapeutic environment, helping to reduce the anxiety patients may feel and helping them to feel safer and more comfortable at a time when they are acutely ill. Kirby Ward has been completely redecorated and has new floor

Four new multi-faith Chaplains have been welcomed to the NHS by Leicestershire Partnership NHS Trust (LPT) at a special inauguration ceremony in the Council Chambers.

The occasion marked a significant step in the Trust’s aim for wider representation within spiritual and pastoral care. The new part-time Chaplains, who represent the Buddhist, Hindu, Muslim and Sikh faiths join existing Christian colleagues to serve the spiritual and religious needs of patients, carers and staff within mental health and learning disability services and in local community hospitals.

One of LPT’s Lead Chaplains, Reverend Michael Forster explained the significance of the event:

“ The occasion represented a milestone in our journey to provide the best quality spiritual and pastoral care to people of all religious faiths or of none. Leicester is richly diverse and we want to provide appropriate support to reflect

coverings, soft furnishings and comfortable lounge areas. There is also access to outdoor space, including an inner courtyard area and private garden. I am sure our patients will settle in really well.”

Male patients on Thornton Ward at the Bradgate Unit and on Barnsdale Ward at the Brandon Unit at the end of 2010 will transfer to benefit from the £1.5 million refurbished facility. LPT Chief Executive Antony Sheehan said:

“The refurbishment of this ward is another important step towards our long term plans of developing centres of excellence for inpatients. Our redevelopment programme over the next few years is helping us to move closer to creating a specially designed mental health care environment on a single site, that achieves the highest standards of privacy and care.” •

New male-only ward to open

New NHS multi-faith chaplainswelcomed at special ceremony

As part of our commitment to provide high quality inpatient services we are opening our first male-only ward in December at the Bennion Centre on the Glenfield Hospital site.

and meet the spiritual needs of local people using our health services. Previously we’ve had to rely on volunteers to help with requests for spiritual and pastoral care from people of non-Christian faiths, and although there are

other faiths and traditions we would like to see represented in the future, the employment of these new Chaplains is certainly a step in the right direction.”

Guests at the inauguration included people from local faith and community organisations and healthcare staff. A short commissioning ceremony was conducted for each new Chaplain by a local representative of their faith and the ceremony closed with the United Nations International Prayer for Peace.

The Multi-faith Chaplains are: Buddhist: Rev Susthama Marian Kim, Hindu: Pradip Gajjar, Muslim: Imam Fazlur Diwan and Sikh: Harjinder Singh. •

Care provided by Leicestershire Partnership NHS Trust was rated as good or better by 83% of people who were referred to an outpatient clinic or local community mental health team last year. These are the findings of the Care Quality Commission’s (CQC) 2010 survey of community mental health services published this week. The survey captured the views of people aged 16 and over who had contact with services between July and September 2009. Results showed that 94% of LPT patients felt they were

treated with respect and dignity, 89% said that staff listened carefully to them and 87% feel their care and services are co-ordinated well. John Short, LPT’s Chief Operating Officer said about the results:

“We’re very pleased that patients are experiencing a better service than they reported in the previous survey. This survey is a valuable and informative tool and indicates that our patients have trust and confidence in our staff, and the care they receive is well co-ordinated.

We’re particularly pleased patients feel they have an opportunity to share their views and are given the time to discuss things with staff, as it’s important they are able to influence and shape their own care.”

The Trust acknowledges there are some areas for improvement and clinicians and managers are currently planning how to address these. Work will include looking at how LPT can provide more effective support for patients with carer responsibilities and ensuring all community patients are given out of hours contact information. •

Community Mental Health Survey 2010

“This redeveloped ward provides people with a better environment and improved privacy and dignity”

“…we want to provide appropriate support to reflect and meet the spiritual needs of local people using our health services”

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1110

Apply to be a member…The data LPT collects in this form will only be used to contact

you about membership matters and will be stored in accordance with the Data Protection Act 1998.

Signature:

Date:

Title:

Your full name:

Address:

Postcode:

Telephone:

Email:

Gender:

Date of Birth:

In order to ensure the ethnic make up of our member ship reflects the local population we would like to know your ethnic origin. Please indicate your ethnic origin below:

Asian or Asian British:

Bangladeshi

Indian

Pakistani

Any other Asian background

Black or Black British:

African

Caribbean

Any other Black background

Other Ethnic Group:

Chinese

Any other ethnic group

Mixed:

White and Asian

White and Black African

White and Black Caribbean

Any other mixed background

White:

British

Irish

Any other White background

I do not wish to disclose my ethnic origin

Once completed please detach and return to:

FREEPOST RRKS-JGGE-EUTH

Membership ServiceLeicestershire Partnership NHS TrustGeorge Hine HouseGipsy Lane, Leicester, LE5 0TD

cut here

Join online at www.leicspt.nhs.uk

Focus on:Service user involvement

New Involvement Centre: Opening soon

My name is Richard Chester and I am a Director here at the Trust. I have a number of areas that I am responsible for but more recently, I have been focusing on the strategy we have to involve the people who use our service and their carers. We have a commitment “to advance health and well being” through the development of communities, rights and inclusion. This means involving people who use our services to help us to improve our organisation, particularly looking at the way we deliver services across Leicester, Leicestershire and Rutland. It is important to us because we recognise that if the people who use our services are involved in making decisions about how those services are delivered, they are more likely to meet their needs. We also know when we meet peoples needs their experience and recovery is greatly improved. One of the ways in which we are doing this is to involve people in the recruitment process for our new staff. We think it is really important that all of our staff are able to understand the perspectives of the

A new Involvement Centre is due to open very soon at the Bradgate Mental Health Unit. The new centre is a dedicated space for service users and carers, where they can meet, book space, network, use shared facilities and get support from both peers and from voluntary and statutory organisations.

The original idea for an Involvement Centre came out of the Trust's User and Carer Involvement Strategy, which was developed with input from over 400 service users, carers, and representatives of local communities, and established service user and carer groups.

The Involvement Centre will be manned by volunteers and will have computers, phones and internet access, meeting spaces and a range of information displays and leaflets. Over 14 different groups are keen to have a presence within the new centre, including the local authority’s Welfare Rights and Benefits In-reach Team. Service users and carers sit on the Project Team and Steering Group and have strongly influenced the development of the new centre, helping to decide on its purpose and long term vision. Future plans are currently under discussion, but could include the opening of a coffee shop and the organisation of special events, such as ‘meet the manager’ – or ‘in the psychiatrist’s chair’ which will give centre users the opportunity to meet and question Trust staff.

Project Group member Roger Chambers said;

“ We’re delighted that the new Involvement Centre is due to open very soon. We hope the centre will help to increase people’s involvement with the Trust in a positive and meaningful way. I’m sure service users, carers and groups will get a lot of use from the new facility, which will be staffed by volunteers and people who have had experience of using mental health services.” •

people who use our services and their carers when planning and making decisions about the organisation or delivering care to service users whether inpatients or outpatients.

A recent example of this has been through the recruitment of our Chief Operating Officer, who is our most senior operational executive director and manages all of our care services. A number of people who use our services were involved in the interview through a dedicated interview panel; this included deciding what areas to question candidates on. The panel was organised by a service user and carer, which greatly helped the panel. John Short was appointed and I asked him how he felt about this new method of involvement:

“ I have now been interviewed for five senior management posts in the NHS (over the last 18 years) and I have had service users and carers on all my interview panels. During my recent interview for the post of Chief Operating Officer at LPT I had a full hour interview with a panel of services users. I was delighted to see service users being involved in the interview for my post as it’s very important that the people who use our services are able to test both my values and commitment to service improvements and involvement. The panel was made up of four service users who each had a series of questions which explored their particular area of interest – this included a younger person asking me about my commitment to hearing the views of younger people.

“ It is vital that service users be involved in both staff interviews and service developments as they provide a real reminder that our jobs in the NHS are there to provide a public service”

—John Short, Chief Operating Officer

We are always looking for service users and carers that are interested in getting more involved with the Trust, if you are interested in becoming involved please contact Maxine Coley, tel: 0116 225 6612 or email: [email protected]

“It is vital that service users be involved in both staff interviews and service developments”

Page 7: People Matters - WhatDoTheyKnow · My first choice would be Johnny Depp, he’d have to come as Jack Sparrow and that’s because he makes me laugh, and he’s fit! ... many films,

Smoking is bad for your health, but exactly how does quitting make life better?

The quitting timeline.· After 20 minutes your blood pressure and

pulse return to normal. · After 24 hours your lungs start to clear. · After two days your body is nicotine-free

and your sense of taste and smell improve. · After three days you can breathe more

easily, and your energy increases. · After two to 12 weeks, your circulation

improves. · After three to nine months coughs,

wheezing and breathing improves. · After one year your heart attack risk is half

that of a smoker. · After 10 years your lung cancer risk is half

that of a smoker.

Here are just a few of the benefits of quitting:• Lessstress

Scientific studies show that people's stress levels are lower after they stop smoking. Nicotine addiction makes smokers stressed from the ‘withdrawal’ between cigarettes. The

SudokuAnswer in the next issue… Good luck!

Last issue’s solution:

Get in touch!Comments and enquiries can be sent to:

· People MattersFREEPOST RRKS-JGGE-EUTHLeicestershire Partnership NHS TrustGeorge Hine HouseGipsy LaneLeicester LE5 0TD

· FREEPHONE 0800 013 2530· E-mail [email protected]· www.leicspt.nhs.uk

Thanks to everyone who contributed to this issue of People Matters!

Views expressed in this newsletter are those of the contributor(s) and do not necessarily represent the views of the Trust. No part of this newsletter may be reproduced without express permission from the Trust.

pleasant feeling of satisfying that craving is only temporary and is not a real cure for stress. Also, the improved levels of oxygen in the body means that ex-smokers can concentrate better and have increased mental wellbeing.• Youngerlookingskin

Stopping smoking has been found to slow facial ageing and delay the appearance of wrinkles. The skin of a non-smoker gets more nutrients, including oxygen, and can reverse the sallow, lined complexion that smokers often have.• Whiterteeth

Giving up tobacco stops teeth becoming stained, and you'll have fresher breath. Ex-smokers are less likely than smokers to get gum disease and lose their teeth prematurely.• Longerlife

Half of all long-term smokers die early from smoking-related diseases, including heart disease, lung cancer and chronic bronchitis. Men who quit smoking by 30 add 10 years to their life. People who kick the habit at 60 add three years to their life. • Moreenergy

Within 2 to 12 weeks of stopping smoking, the circulation improves. This makes all physical activity, including walking and running, much easier. • Healthierlovedones

By stopping smoking you'll be protecting the health of your non-smoking friends and family.Quitting is good for their health as well as yours.

Quit smokingWellbeing

tip

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Get a free ‘Quit Kit’ from www.smokefree.nhs.uk. For advice call the NHS Free Smoking Helpline: 0800 022 4 322