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Time for Chip and PIN card payment

Is the cheque obsolete as a payment method? Well not quite according to the Cheque and Credit Clearing Company which reveals that in the UK in 2017 some four hundred and five million cheques were issued either as payments or to draw cash. Nevertheless this does represent a 15% reduction in cheque volumes and continues a trend seen in previous years of cheques being replaced by faster or direct card payment methods.

 

As a result direct payment forms are seeing a corresponding increase in volume with a 23% rise in single immediate payments in 2017. Interestingly, perhaps because of the fall in cheque payment volumes, the average value of a cheque actually increased by 5% in 2017 to £1217. Nevertheless, the way in which public perception is changing in respect of acceptable forms of payment does help those businesses which are looking to move away from cheques as a form of payment.

 

So what has replaced cheques as the preferred payment method? A recent survey revealed that 42% of people in the UK see credit or debit card with pin number as their preferred method of payment. Contactless methods of payment are also rising in popularity; although the majority of those interviewed indicated that they were happy with the current £30 contactless limit, citing security concerns should the limit rise.

 

What does the move away from cheques mean for businesses? Well, for a start it could mean a chance to speed up receipt of payments whilst simultaneously reducing administration time. Take a private healthcare business such as a chiropractor or physiotherapist for example. Relying on cheque payments often meant time spent in paperwork, in drawing up invoices after the time of the appointment, posting them out and then waiting for cheques to be posted back. Even if the cheque payment was made at the time of the appointment, administration time was still required to take the payment to the bank and await clearance.

 

Simply by taking card payment details as part of the appointment process, at a stroke all of that burdensome administration time can be avoided. With card details to hand, as soon as the appointment has taken place, the card payment can be taken. Moreover, by pre-authorising the payment at the time of booking, health practitioners can be reassured that funds are available to pay for treatment.

 

There is another benefit of pre-authorising card payments and that is client attendance rates. Provided the health practice ensures the client is fully aware of potential non-attendance fees, clients are far more likely to attend appointments or to telephone well in advance should they be prevented from doing so. This not only helps to ensure clients receive the treatment they need at the time at which it is most effective, it also helps to ensure that treatment times are fully utilised. Not only did this maximise potential income for the health practice, it also means that practitioners are not turning aside potential clients due to fully booked treatment times and then finding that some of those slots are left vacant due to no-shows.

 

Is the cheque obsolete? Well no, not quite, but with chip and pin card payment systems to hand practices at least should be working to encourage automated payments for the benefit of the practice and its potential clients.

 

 

 

Treating the person not the condition

The importance of treating the patient not the condition has been brought into sharp focus by a Cambridge University study published in the British Journal of General Practice. Reviewing the health records of more than 400,000 adults, the study revealed that 30% of females and 24.4% of males were suffering from more than one health condition, otherwise known as multimorbidity. Moreover, those who reported experiencing more than one health condition accounted for 52.9% of GP consultations and 78.7% of prescriptions.

 

Breaking down the statistics by underlying cause, the most prevalent conditions according to the report were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). Interestingly, those aged between eighteen and forty-four or having been identified as having lower socio-economic status were more likely to report a combination of physical and mental conditions.

 

Whilst the findings may not come as a huge surprise to health professionals, nevertheless they do serve to highlight the way in which individual conditions should not be treated in isolation. As the report’s authors highlight “multimorbidity has a substantial impact on various health services ranging from general practice to end-of-life care.” Moreover, gaining a better understanding of the complex relationships between conditions could help the health service in general to target resources appropriately. As Dr Duncan Edwards, one of the authors commented “It may be that we need to think about a drastic restructuring of services: no longer will people be seen in ‘single disease’ services but in new multimorbidity clinics designed for the future.”

 

Where does this leave health professionals in the meantime? For some, it may simply a question of heightening awareness rather than changing practices. For example, physiotherapists, osteopaths and chiropractors are well used to thinking holistically when treating muscle and ligament pain. That’s because carrying the body differently in response to an injury is very likely to lead to referred pain or contribute to additional musculoskeletal damage.

 

Where the challenge becomes more complex is when it crosses disciplines; for example where obesity gives rise to a range of conditions including chronic pain, hypertension, diabetes and depression. In these instances whilst the potential causal link may be understood, care may be provided by a number of health specialists. Not only does this condemn the patient to multiple doctor and hospital appointments, a delay in treating one aspect of the condition may contribute negatively to the chance of recovery in other areas.

 

The five-year forward review of health practices in the UK had already identified the need for treating patients holistically. This study sheds further light on the reasoning behind that review as well as calling into question the current structure of health services within this country. Treating the condition in isolation may not restore the patient to full health and could even lead to further complications. As Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, commented: “This large-scale, comprehensive research is further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation.”

 

Too cold for snow: An Olympic lesson

If you are a fan of winter sports then there is a fair chance that the Winter Olympic Games may deliver a pinnacle of sporting viewing. However, as all sports fans know only too well, truly memorable contests come about when athletes are able to perform to the best of their ability. And that requires optimum conditions.

With that in mind it was somewhat concerning to see the weather reports ahead of the 2018 Winter Olympic Games which predicted wind chill factors as low as -25°. Some of the teams were reporting skis warping thanks to the effect of extreme cold on snow crystals and concerns abounded over the effect of unusually low temperatures on athletes. Ironically; despite the cold, or perhaps because of it, there was also concern over snow levels with machines being brought into supplement natural precipitation.

At the time of writing, a few days in to the games, high winds have also proved hazardous with some athletes unhappy at having to compete in what they considered were dangerous conditions. Under such extremes, successfully completing courses is more a lottery than a game of skill; something which no athlete wishes to encounter at the end of four years hard training.

From the safety of our sofas it is hard to imagine the physical and mental effect of extreme cold on the body. Low temperatures can sap brainpower, slowing down decision-making and reducing coordination; not something you want when faced with the challenge of extreme downhill skiing through slalom gates or over jumps. Preparation and training, inbuilt muscle awareness allied to physiotherapy and other physical and health support can go some way towards helping athletes to overcome conditions; but at the end of the day when the weather becomes so extreme inevitably accidents and injuries will occur.

And when breaks, fractures and ligament damage occur, our Olympic athletes are put in the same position as any recreational skier. There is an imperative to heal as quickly as possible in order to return to the normal routine. The only difference is that whilst for most of us that everyday routine will be away from the slopes, for Winter Olympians the slopes are their way of life.

This is where physiotherapists and other health professionals truly come into their own. For whilst naturally there is a core treatment plan in order to rehabilitate the injured limb, at the same time athletes have to undergo a programme of training which helps their whole body stay as strong and supple as possible. One leg may be broken but that’s no excuse not to continue to exercise appropriately in order to ensure that core and arm strength and tone are not lost.

It’s a lesson which we can all benefit from; the fact that one injury should not be allowed to affect the entire body. No matter whether we’ve followed our Olympic heroes on to the slopes or injured ourselves in some other fashion, the more we work with health professionals to ensure rehabilitation across the entire body, the better chance we have of regaining full strength and mobility as swiftly as possible.

 

 

Flu: Catch it, report it, deliver care

In December we wrote about the challenges faced by A&E departments and in the process made a passing mention of the effects of winter flu on the health service. Now that potential has become a reality with “Australian flu” rapidly spreading across the country and in the process placing even further strains on health provision.

At the time of writing according to the Influenza survey operated by Public Health England, there are only a few pockets of resistance which have yet to report flu cases with many areas heading rapidly towards the red, or very high, end of reported cases. Having said that, whilst any flu is a matter for concern, according to PHE the number of cases reported to date is broadly in line with previous years.

The flu survey, which was originally launched in 2009 in response to the swine flu epidemic, is part of a pan-European initiative to monitor influenza like illnesses. These are described as sudden onset symptoms displaying:

  • at least one of Fever (chills); Malaise; Headache; Muscle pain and
  • at least one of Cough; Sore throat; Shortness of breath

More than 7,500 people across the UK already participate in the flu survey but Public Health England would like more people to take part by signing up online in order to boost research and understanding. In the meantime there are a number of measures which people can take, either on their own or in the workplace, to reduce the spread of flu. These include regularly washing hands, sanitising common work areas such as phones and keyboards and encouraging the use of tissues to catch and bin coughs and sneezes.

Nevertheless, flu is placing a strain on health resources with elective surgeries being postponed and health staff, including backroom employees, being redeployed in order to maximise care time. Although only the most serious cases should end up in hospital, inevitably pressure on hospital resources has a knock on effect right throughout the health system. For example, physiotherapists and others may have to continue to provide a level of ongoing care for those whose operations have been postponed. Similarly, with pressure on hospitals to discharge patients in order to free up bed space, additional post-operative treatments may have to be carried out in the community, adding to pressure on health resources.

All this at a time in which health professionals including physiotherapists and osteopaths together with their own support staff may be short staffed due to flu. As with any patient-facing service there is little option for people to work from home. Nevertheless, sending staff home when they feel unwell does make sense if it avoids them passing illness around the health practice. This is where a virtual assistant service may come in handy. Delegating routine tasks such as phone answering and diary handling over to an external virtual assistant service enables continuity of care whilst maximising front line resources. Similarly, switching to an online patient records service could save administrative time and enable patient details to be available at the touch of a button rather than found by searching in a filing cabinet.

However the flu season develops it pays to plan and be aware. By catching possible cases early staff can be sent home before they affect others. Online reporting will help to monitor the outbreak and provide data for future research whilst moving processes online could help to provide continuity of care. The flu season affects everyone in the health sector; it’s never too late for all of us to play our part.

Time to heal? Consult your body clock.

What is your clock telling you? Time for lunch, time for that next appointment, or maybe it is something far more profound which could affect your entire wellbeing. Perhaps the answer depends on which clock you have tuned into. The clock on the wall may be telling you one thing, your body clock quite another.

The concept of the body clock isn’t a new one.  Anyone who has travelled abroad knows all too well the effect which multiple time changes can have on their system.  And even if you are more of a staycationer then you may still be all too aware of the impact of twice yearly UK clock changes on eating and sleeping patterns.

However, it seems as though the clash between imposed time and personal body clocks may only be the tip of the iceberg when it comes to our personal time zones. Indeed, the more that scientists study the body clock, more they are learning about the interaction between time and well-being. In this last month alone two important studies have illustrated the way in which well-being is influenced by our body clocks.

In the first study led by Professor David Montaigne of the University of Lille, researchers highlighted the way in which our body clocks influence our chances of recovering from heart attacks and heart surgery. Identifying some 300 genes which link the body clock to heart well-being, the study found that ongoing heart damage was more prevalent in those had undergone heart surgery in the morning than in the afternoon. So much so, that those who had surgery in the afternoon had a 50% lower chance of cardiac event than those scheduled for morning surgery.

The implications are profound and could lead to complete rethink of the way in which surgery times are scheduled not just for hearts but in respect of a range of conditions. The second study reinforced the importance of considering the body clock, and indeed the clock on the wall, when it comes to understanding recovery times.

The study reported by the Medical Research Council revealed that wounds received during the day healed 60% faster than those at night.  This apparently is down to ‘actin’, an essential protein which governs the ability of skin cells to migrate into wounds and to start the healing process. Actin is itself governed by the circadian clock, being more active in the day than in the night and therefore more able to in initiate the healing process by day.  Interestingly the study also revealed that in nocturnal mice the process is reversed.

Other studies in the past have cast light on the way in which our body clocks influence mood, concentration and our ability to carry out day-to-day tasks. Whether you are a morning or evening person could profoundly influence the way in which you approach your daily round; with tasks allocated in accordance with your circadian rhythms improving outcomes in areas such as productivity, accuracy and so on.

The more we understand our body clocks, the more we can optimise treatments and increase chances of recovery. Given their individual body clock, should a patient see a physiotherapist in the morning or afternoon, at what time of day would it be best for the individual to exercise in order to promote fitness or healing, and when is the best time to tackle that mountain of paperwork? We may not have all the answers yet, but as more and more studies report their findings it may not be too long before circadian rhythms are seen as an intrinsic part of managing well-being.

Suffering from cyber-chondria?

Feeling a bit funny?  Worried about those lumps and bumps?  Got a strange collection of symptoms which don’t seem to add up?  Yes you may need to consult your doctor, but you should also be prepared to be told that you are suffering from a newly identified disease which according to a recent study is costing the NHS at least £420m a year.

The study looked at the causes and effects of cyber-chondria which the researchers say could be the underlying reason for as many as 1 in 5 of hospital outpatient appointments.  As Prof Peter Tyrer, one of the authors of the study, explained “Dr Google is very informative, but he doesn’t put things in the right proportion.”

Cyber-chondria does create a dilemma for the health profession. On the one hand, we are being asked to reduce the burden on the NHS by self-treating minor ailments or consulting local pharmacists in the first instance. On the other hand, a propensity to misdiagnose the causes of symptoms following an internet search could either lead to unnecessary appointments or to patients not presenting at their GP surgery when early treatment for a condition could prevent ongoing problems.

There appears to be no one straightforward answer. And it’s certainly true that when someone presents with a range of symptoms, some may be related to a genuine ongoing illness, whilst others can be laid at the door of health anxiety. Ignore all the symptoms and the chance for early intervention can be missed, treat all symptoms as potentially genuine and hospital referrals increase significantly. So awareness and proportionality, knowing your patient, can play a significant role in sifting illness from the cyber-chondria maze.

That’s not to say that cyber-chondria isn’t an illness in its own right. Indeed the report’s authors suggest that for those suffering from acute forms of health anxiety, some form of psychotherapy may be in order. And as with any other illness; the earlier the treatment, the better the prognosis.

This approach was borne out in another field recently when the results of a back pain pilot were released.  The pilot run by a primary care service in Hertfordshire saw a physiotherapist with spinal expertise triaging and providing advice to patients who self-referred to a clinic.  With further expertise available as a back up and the ability to directly book ongoing treatment the experiment saw 85% of patients discharged after a first appointment.  Moreover, on the spot advice on exercise and rehabilitation meant that only 3.5% of patients needed to be referred to secondary care as opposed to a 12% GP referral rate.

The main message which arises from studies such as these is the importance of early intervention when treatment is required.  In a health system which is seeing an ever increasing demand for its services this isn’t always easy. However, even little tweaks to processes and procedures can make a measurable difference to boosting patient treatment times. Even something as simple as SMS text messaging which reminds patients to attend appointments can not only boost early treatment, it can also ensure that treatment times are fully utilised.

Of course, there are times when the chance for early intervention has been missed and the mantra ‘better late than never’ comes into play. We are indebted to the Jewish Chronicle for highlighting just how effective physiotherapy can be. Four years ago, Ann Rowe was wheelchair bound and dependent on hoisting equipment. Now, thanks to intensive physiotherapy, at the age of 87 she has completed the Parallel London 5k event.

Early treatment, late treatment, ongoing treatment; what this story and others show is that when health professionals are freed from administration and able to do what they do best, providing good and targeted therapies, great things can happen.

Paying by card?

£58 billion!

That’s the total spend on all credit and debit cards in the UK in April 2017, the most recent figures available at the time of writing. Credit cards accounted for just short of £17 billion, whilst the debit card spend was boosted by the growing acceptance of contactless payments.

Overall our growing love affair with the card as a form of payment has resulted in a 6.8% year-on-year rise in card spending. Partially thanks to the contactless element, this translates into a 12% increase in transaction numbers.

What does this mean for business? Well for a start it makes it far easier for businesses to move away from cheques and cash and towards card payments. The old arguments about cards and businesses which accept cards being the preserve of the few now simply don’t hold sway. So much so, that this writer was surprised recently to be asked for a cheque in payment. Luckily the request came in advance, saving a round-trip to retrieve the cheque book from its secure drawer.

 Quite simply, card payments are convenient for both customers and businesses. More importantly, they speed up the receipt of funds for the business. Particularly so in businesses which have traditionally relied on the service/ invoice/ cheque payment route. Simply sending out the invoice and waiting for the cheque to arrive in return could easily take up a couple of weeks; and by the time bank clearing has taken place and funds are available for use the original service is a distant memory. Secure card processing generally delivers cleared funds approximately one week after the appointment.

The growing acceptance of cards as a means of payment has also brought further benefits, particularly for those businesses such as health providers which rely on an appointment system. Taking card details at the time of booking, whether on the phone or online, tends to concentrate the mind and that means that clients are far more likely to turn up for their appointments. Particularly so if the health practice operates a ‘no-show fee’ system, charging clients who fail to turn up a percentage of the overall fee.

Adding a further service such as sending out SMS text messaging or email to remind clients of the appointment also helps to ensure that clients either turn up to their appointment or cancel well in advance. It can be all too easy in a busy life to forget the date or time of an appointment so scheduling reminders acts as a handy aid memoire.

When it comes to health services, anything which can boost attendance numbers is welcome. Both in the public and private sectors time is of the essence and resources are stretched. Those who fail to turn up to appointments not only jeopardise their own treatment plan, they also block or delay the chances of treatment for others. So the hidden cost is far higher than simply having a team of health professionals sitting and waiting for a client who has either forgotten or has no intention of turning up.

 

 

Taking care of patient data

There’s no escaping the fact that we live in a data driven, online world. And why shouldn’t we? Properly managed, electronic storage of data can free up substantial amounts of time, leaving us free to concentrate on the more interpersonal and interesting aspects of our jobs and lives.

Just take the electronic filing of records for example. With x-rays, scans, clinical notes and histories all being available in a single patient record at the touch of a button; it’s far easier for health professionals to diagnose and understand the nature of a particular problem and move swiftly towards developing a treatment regime. It’s also far easier for data to be shared between health professionals, enabling complex cases to be managed in a more holistic way.

Add in the benefits of time saved in not having to print out records, manually file them and then post or courier information between health centres and it’s easy to see how health practices and their patients benefit from electronic data storage.

However there is one area of concern with electronic data storage and that is the question of security. Now it has to be said that many of the problems arising from electronic data storage are simply replications of problems that can arise in a paper driven world.   Yes it is possible to email a record to the wrong person but it is equally possible to put a patient record in the wrong envelope or for paper copies to be lost in the post.

And even with errors there are some aspects of data management in which electronic storage comes up trumps. Miss-file a paper record and you can spend hours searching for it, miss-file an electronic record and a reasonable data search facility can help you to retrieve the file relatively quickly.

Naturally our trust in the security of data isn’t helped when we see headlines which would indicate that the health sector is responsible for considerable numbers of security breaches. The Information Commissioner’s Office (ICO) summary of data protection reports and concerns for 2016/17 indicates that the health sector is responsible for 41% of self-reported incidents. To put this in context, next on the list is local government with 11%.

On first indication this would be a concern; however, the report highlights the fact that the health sector’s mandatory reporting policy naturally leads them to report more incidents than other sectors. Looking at the types of data breaches, whilst it is true that 11% relate to data being sent by email to an incorrect recipient, this has to be taken in context with the 15% of reports relating to data being posted or faxed to an incorrect recipient and the 14% of occasions when paperwork was lost or stolen.

It’s often said that security is a state of mind and what the ICO report highlights is the importance of treating patient data (whether in paper or electronic form) with the same level of care as you would give to the patient. When data is being transferred between health practitioners it only takes a few seconds to check and double check that the forwarding email address is correct and that the request comes from a genuine source. Similarly with security being forefront of people’s minds, passwords are less likely to be left lying around on desks or set to the standard default of password or 1234.

Electronic data isn’t simply some laboursaving device. Patient information is real and personal. Being human we’re all going to make mistakes from time to time but being security aware will help to minimise those mistakes and ensure that patient data is treated with the care that your patients deserve.

Time for a clear out

If you missed ‘national clear your clutter day’ don’t worry – there is still plenty of time to make a difference.  With a nod to the allegedly diminishing practice of spring cleaning, clear your clutter day on 11th March 2017 was billed as a chance to clear unwanted items either for profit or a sense of positive change.

The day’s organisers recommended using a simple four box sorting system as a way of identifying which items could be sold, upcycled, swapped or recycled. And the message wasn’t just aimed at decluttering households, businesses too were urged to join in and have a good sort out and tidy.

There were also some handy hints for those of us who may find the notion of a mass tidy-out a little intimidating.  These included breaking down the area to be tidied into manageable chunks, either by room or even by cupboard or drawer. If even that seems insurmountable, the organisers suggest getting into the habit of clearing one item per day. It may not seem much but over the course of the year that makes 365 unwanted items cleared out of the home or business and into a charity shop or recycling facility.

Interestingly the clear your clutter campaigners don’t stop at suggesting we declutter only physical items.  Finances and even the contents of our in boxes also come under scrutiny. For example, we may not have much control over the inward flow of e-mails but do we really need to keep all of those sent ones which merely say ‘thanks’ or ‘have a happy birthday’?  And then there is the delete box. If we have already identified an e-mail as no longer required why leave it lingering and taking up space in the delete folder?  There may be a good business reason why some e-mails need to be kept but identifying which ones we really need helps us to rethink our business priorities as we clear.

Other suggestions include sitting down with all that paperwork which is cluttering up the office or home and having a good sort out.  Whilst there is some paperwork which needs to be kept in physical form (property deeds or passport come to mind here) there is much which could be scanned and filed electronically.  Not only does that declutter the office, by making use of a good indexing system it becomes much easier to find documents quickly when needed.

This is a practice which health professionals are increasingly adopting for patient records.  Electronic filing is safe and secure and not only allows for instant retrieval it also helps to speed up treatment in cases where records may need to be shared across different specialists.

When it comes to decluttering finances, there are a few simple things which you can do which can make a measurable difference.  Here again having paperwork and outstanding invoices lying around can add to stress levels so moving to electronic system could make a difference to the way in which finances are approached. Keeping a simple spreadsheet will help individuals to identify when key bills are due whilst for businesses moving to a form of electronic payment can smooth cash flow.

For example, healthcare providers such as physiotherapists or chiropractors may wish to consider taking card details at the time of appointment booking. Not only does this help to smooth cash flow; having provided card details patients are less likely to miss an appointment, particularly if a no-show fee is clearly highlighted on the appointment terms and conditions.

Busy lives make it all too easy to let clutter build up. We may intend to clear this when we’ve done that but then something else comes up and the clearing never gets done.  Taking time to step back and re-evaluate can force us to stop and not only clear but also plan a less cluttered future.

Providing specialist rehabilitation

When a traumatic event occurs we’d like to think that our health services are there for us. Particularly so if the event results in a form of trauma which requires long-term recuperative treatment. So would it surprise you to hear that in-patient specialist rehabilitation units only have the capacity to cater for 5% of the total number of individuals who are admitted each year to major trauma centres?

Those are the findings of a report commissioned by the Health Quality Improvement Partnership (HQIP) which looked into the provision of trauma care across England. As with many other health services the provision of specialist trauma care seems to be a postcode lottery with, according to district, between 1 and 8 adult trauma specialist rehabilitation beds available per 1 million people.

In bald terms, this means that across England only some 950 patients can be treated each year in specialist rehabilitation beds. The report also commented that under commissioning and insufficient staffing resulted in specialist rehabilitation units struggling to manage a complex caseload. Cost efficiency calculations were also not recorded by a quarter of the providers resulting in uncertainty about the balance between specialist treatment and long-term care in the community.

Now admittedly some of those who initially find themselves at major trauma centres may not require a high level of support but the report’s authors are calling on major trauma centres to “review the capacity and pathways for specialist rehabilitation following major trauma” in the light of the report. This should include the drawing up of local action plans together with an increase in the capacity of level Ic (cognative / behavioural) beds in order to shorten waiting times for these patients.

Trauma at all levels from major to relatively minor has an impact not only on the individual affected, but also on their family and their capacity to work. For the good of the individual as well as for the long-term health and productivity of the country it is therefore important that when an incident occurs priority is given to helping the individual to recover as swiftly as practicable. This means that all health professionals, whether they work in specialist NHS units or in private clinics have their part to play in providing rehabilitation treatments in a timely manner. Psychiatrists and counsellors, physiotherapists and mobility specialists, dentists and opticians; whatever the requirement, in helping the individual they are also helping the country.

But health professionals will only be able to give of their best when they in turn are supported by an efficient administration system. Addressing the rehabilitation needs of individuals requires concentration and a clear brain in order to draw on best practice knowledge. Health professionals won’t be able to give patients their full attention if they have worked late into the night in finding and filing notes, managing the appointment diary and dealing with the finances.

This is where backup systems such as online diaries, electronic filing of notes and card payments can make all the difference. In effect, by taking advantage of the support which is available to them, health professionals can in turn provide the best support possible to help their patients to recover. Yes, some will require the services of a specialist treatment centre; but for the rest, being able to call upon swift and timely rehabilitation services could make a significant difference to their long-term recovery.

 

 

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