renfrewshirechp newsletter - nhsggclibrary.nhsggc.org.uk/mediaassets/chp renfrewshire/re141...

Volume 1, Issue 4 November 2008

Welcome - David Leese, CHP DirectorWelcome to our latest Staff Newsletter.

It is filled with interesting and progressive news and stories reflecting the hard work andinitiatives of staff.

As ever, feedback is welcomed on the content and format, so please take time to read thoughthis newsletter and let us know what you think.

We also continue to confront many service and management challenges that are not featuringin the newsletter - continuing to improve how we, as a CHP work in partnership with other keyorganisations, delivering financial balance and savings as we enter the next two financial years,which will be characterised by real resource constraints and improving our performance onsickness absence. You will be aware that these remain significant in our day to day roles and youwill probably have had these brought to your attention by your managers and via the new, andstill developing, Team Brief Communication system. Please ensure you are up to date with yourunderstanding on these by speaking with your respective team leader/manager. Please also taketime to feedback your experience of Team Brief as it evolves.

Lastly, two things - firstly, as we go to press, the Staff Survey is about to start. As you get to readthis newsletter you will probably have the survey with you, or you may even have alreadycompleted it. I would like to take this opportunity to encourage all staff to complete and returnthe survey as it will provide important feedback from you on a range of issues, not least how wellwe communicate! Secondly, we now officially have the outcome from the Child ProtectionInspection which was undertaken by HMIe earlier this year. The outcome confirmed that we haveservices that rate as excellent. This is terrific news and affirms all of the hard work that staff putin to ensure we work with others to keep children safe. That said, we must also use the Inspectionto maintain this high level of service and improve where we can. Thank you to all those who wereactively involved.

Best wishes

David Leese

CHP Staff EventDate for your diary - Tuesday 2nd December 2008, 12 noon to 5pmLagoon Leisure Centre, PaisleyRenfrewshire Community Health Partnership (CHP) has organised the CHP Staff Event forTuesday 2nd December 2008, 12 noon to 5pm, Lagoon Leisure Centre, Paisley. The Staff Eventis open to all CHP staff to attend.

A detailed programme will be issued during November but this year’s event promises to beenjoyable and entertaining, as well as giving you an opportunity to influence what healthimprovement and healthcare priorities the CHP takes forward in 2009/10.

RENFREWSHIRE CHPNEWSLETTER Greater Glasgow

and Clyde

Renfrewshire

We plan to showcase some of the good practice you are leading in Renfrewshire. If you areinterested in sharing your work, please contact Fiona MacKay, Head of Planning & HealthImprovement, Tel: 0141 842 6217 or Email: [email protected].

Staff will be asked to register their attendance at the event when the programme is issued. Untilthen, please hold this date/time/venue. Managers are asked to encourage as many staff toattend the Event as possible.

Services for Older People in RenfrewshireOver the past 2 years we have continued to develop and improve services for Older People inRenfrewshire. We have made substantial progress to provide additional services for older peopleto improve health and well being. Some examples are:

• Intensive care managers for our most vulnerable older people with complex health andsocial care needs

• Gerontology nurse specialists working to prevent avoidable hospital admissions.

Renfrewshire Care 24, which is a service provided by Social Work that brings together a range ofdifferent flexible care services to provide a response over the 24 hour period. This team worksclosely with the Out of Hours Community Nursing Service and Multi Agency Team for Care atHome (MATCH) to ensure appropriate care is provided in emergency situations. Thedevelopment of our community based services supports more people in their own homes or ahomely setting. These services also reduce the number of avoidable hospital admissions and alsoreduce, where appropriate, the length of stay in hospital.

One specific element of this work programme has been the review of frail elderly continuing careservices located at Johnstone Hospital led by the Older People’s Joint Planning, Performance andImplementation Group. Two engagement events attended by a total of 74 individuals andgroups, including The Scottish Health Council took place in February and May 2007. In additiona series of meetings with staff, relatives and carers has taken place. In June 2007 the outcomefrom the review was reported to the NHS Board. Subsequently an Independent Scrutiny Panelwas appointed by the Cabinet Secretary during September – November 2007. Therecommendations made by this Panel were addressed as we moved forward with the publicconsultation which commenced on 18th February and concluded on 5th May 2008. A total of12 written responses were received. Each response was reviewed and received a full responsefrom the CHP Director. Following consultation, the recommendation to reduce the number ofcontinuing care beds for frail older people from 60 to 30, with reprovision of the 30 beds inmodern accommodation using a partnership model was made to the NHS Board on 24th June2008. This was approved by the NHS Board and is now subject to Cabinet Secretary Approval.

The full Board papers can be accessed –http://library.nhsggc.org.uk/mediaAssets/Board%20Papers/08-26.pdf.

Author: Sylvia Morrison, Head of Health & Community CareEmail: [email protected]

Update on the consultation on the future of mental health services inRenfrewshireThe public consultation on the proposed changes to mental health services in Renfrewshireconcluded on 2nd July 2008. The consultation process lasted several weeks, and provided anopportunity for structured engagement with members of the public and other key stakeholders.

A range of proposed service changes were consulted upon. These were:

• To transfer adult acute admission beds from the Royal Alexandra Hospital to DykebarHospital, consolidating all adult acute admission beds in the high quality accommodation atDykebar Hospital

• To re-provide NHS continuing care beds for older people in partnership with independentcare providers, improving the standard of care accommodation

• Reduce the number of adult continuing care beds at Dykebar Hospital through the provisionof a range of community alternatives, based on individual’s assessed needs

• To transfer the low secure forensic learning disability ward from Dykebar Hospital toLeverndale Hospital. This will result in all low secure forensic services being delivered on onesite

These changes are needed to shift the balance of care from in patient services to communitybased services, while improving the quality of mental health care for the people of Renfrewshire.Overall, the response to the consultation exercise was positive. Greater Glasgow and ClydeHealth Board have now asked Nicola Sturgeon, Cabinet Secretary for Mental Health andWellbeing, to consider the proposals for service change, and it is anticipated that a decision willbe made on this in the near future.

While we await this decision, mental health services in Renfrewshire continue to develop,enhancing the range of services available for local people. The new Intensive Home TreatmentTeam was established earlier this year, and provides a viable alternative to admission for peoplewho are experience acute mental health problems. This team provides support 7 days a week,and works intensively with people in their own homes and communities. Plans are also in placeto expand the existing Community Mental Health Teams and to roll out the Doing Well servicethroughout Renfrewshire, which will expand its activity to focus on anxiety and depression.

This is an exciting time of significant change for mental health services, which will result inimproved mental health services for the people of Renfrewshire.

Author: Mark Richards, In Patient Service Manager/Lead Nurse (Acute)Email: [email protected]

Intermediate Care Services in RenfrewshireIntermediate Care (IC) is a range of integrated services to promote faster recovery from illness,prevent unnecessary hospital admission and support timely discharge. It integrates a variety ofservices for people whose health care needs are complex and in transition. IC within Renfrewshireis provided through an increased range of community-based services focusing on rehabilitationand enablement. These services can be provided in the patients home, day hospital, day centresand specialist housing services.

A new and exciting joint post of Intermediate Care Co-ordinator has been developed on a jointbasis by the CHP, Acute Division and Renfrewshire Council. The purpose of the post is to supportand continue to develop intermediate care services available for older people withinRenfrewshire. A Managed Care Network is in place to co-ordinate high quality service provisionby linking primary, secondary and tertiary care services. The aim is to improve service users’experience in their journey of care.

IC services for older people are provided by a number of services and agencies. These include:

• Renfrewshire Care 24

• Multi Agency Team for Care at Home (M.A.T.C.H )

• Gerontology and Intensive Care Management Nurses

• Older Adults Community Mental Health Team

• Out of hours GP and nursing services

• Extra care housing services.

In addition there are 2 day hospitals in Renfrewshire, both based within the Royal AlexandraHospital. Frail Elderly (FEDH) and Elderly Mental Illness (EMI) Day Hospital.

The Falls Service is a new service currently being rolled out to Clyde. The service has been set upto provide support and care for older people who have fallen.

There are also community mainstream services that support people within their own home.These services are provided by social work home care, community meals, district nursing,occupational therapy and physiotherapy and hospice care. The voluntary services also play alarge part in supporting older people to live within their own environment.

The co-ordination and facilitation role of the Intermediate Care Co-ordinator will ensure servicesrespond to the needs of service users and their carers, delivered at the right time and within themost suitable environment for the person.

Author: Trisha Daniel, Intermediate Care Co-ordinator

Email: [email protected]

All You Need to Know About Your Staff Partnership Forum and the StaffGovernance StandardThe CHP Staff Partnership Forum (SPF) was established in March 2007. The SPF has a significantrole within the CHP. It enjoys a special status along with the CHP Committee, ProfessionalExecutive Group and the Public Partnership Forum in that these groups form the decision-making and advisory structure within which the CHP operates.

More specifically, the CHP, through the SPF, is able to provide the opportunity to build onsuccessful partnership working locally and develop effective arrangements to support andengage frontline staff. This enables the CHP to ensure that members of staff are treated as fullpartners in decisions that affect the planning and delivery of services. The SPF meets every 2months.

It is important that members of staff are aware of the membership of the SPF. Members currentlyinclude:

Sylvia Morrison Co-Chair

Andy Patrick Co-Chair Royal College of Nursing (RCN)

Graham Capstick Staff Representative UnisonMember of SPF Secretariat

Carol Graham Staff Representative Unison

Gareth Hopkins Staff Representative Unison

Agnes Sutherland Staff Representative Unison

Linda Watson Staff Representative RCN

Paul Phillips Staff Representative RCN

Helen Macdonald Staff Representative British Dietetic Association

The NHS Staff Governance StandardStaff Governance is defined as ‘a system of corporate accountability for the fair and effectivemanagement of all staff’. The Standard places a statutory responsibility on each NHS employerwhich is in turn expected to produce evidence of the ways in which the Standard is being met.The five Standards are that staff are:

• Well informed

• Appropriately trained

• Involved in decisions which affect them

• Treated fairly and consistently

• Provided with an improved and safe working environment.

The role of the SPF is to encourage, promote and ensure the fair and consistent application ofthe Staff Governance Standard for staff working within the CHP. In order to address this anexercise is being carried out across each department of the CHP to establish base-line informationwhich will be used to identify gaps in meeting the Standard and assist the SPF in futuremonitoring.

How to contact SPF members?

Members of staff are welcome to contact any member of the SPF. Please contact Anne Fraser ifyou require any further information.

Author: Anne Fraser, Head of Human Resources


Grace Christie Staff Representative Unite

Elizabeth Duke Staff Representative Society of Podiatrists

Andrew Myles Staff Representative Chartered Societyof Physiotherapists

David Leese CHP Director

Anne Fraser Head of Human Resources Member of SPF Secretariat

Marian McGhee Rehabilitation EnablementServices Manager

Linda Clarke Clinical Services Manager Children’s Services

Jean Still Head of Administration

Michelle Wardrop Dietetic Manager

Fiona McNeill General Manager South Clyde Mental Health

Deborah White Senior Secretarial Administrator SPF Secretary

How Does Your Engine Run? Working together in Renfrewshire Schools toSupport LearningIn March 2008 training was provided by one of the international instructors of the ALERTProgramme. Additional Support for Learning monies was used to deliver this to teachers, parents,occupational therapists, physiotherapists and speech and language therapists throughout theClyde locality. It was well received and a wonderful opportunity for shared learning.

Commonly this evidenced-based programme is used with children and young people who havedifficulties processing information from their senses. This can result in high or low activity levelsand/or behaviour problems. The programme helps children develop an understanding of theirbodies. In turn it helps them to recognise when their engine is running “too high”, “too low”,“just right for play”, and “just right for learning”. Strategies are developed in partnership withthe child, their therapist, parent and teacher.

The outcome for Renfrewshire CHP and Renfrewshire Council has been a highly innovativeproject based at Bridge of Weir Primary School. This has been led with great enthusiasm by theteaching staff and the pupils. The project incorporates structured packages based on the ALERTprinciples developed by the Children’s Occupational Therapy Service. The strategies andactivities are classroom based, so the entire class joins in. The aim is maximising attention andfocus for learning.

Formal evaluation will take place in the new academic year. It is hoped this work can beimplemented throughout the locality as part of robust pre-referral measures to support childrenwith additional support for learning needs, as well as the wider school-aged population.

Author: Nicola Stickler, Paediatric Occupational Therapist

Email [email protected]

Implementation of Care AimsCare Aims training has now been completed across speech and language therapy, physiotherapyand occupational therapy within Children’s Services. The process of implementation has begun andservices involved are committed to undertaking this in a collaborative way to ensure positive andproductive outcomes.

Care Aims is a model for managing care. It also supports the process of setting standards and clinicalperformance indicators. The focus is supporting effective decision-making at each of the stages ofduty. These stages include pre-referral and referral as well as assessment, intervention and discharge.

Triage and robust pre-referral screening are integral to the process. Care agreements are set withclients who are actively involved in jointly set therapy goals. The clinician must work in blocks ofintervention and measure outcomes against predicted care needs. This then supports the process ofreflective practice, outcome measuring, audit, service reviews, informing policy and research.

Therapy goals can be set on a multi-disciplinary level which enables goals to be prioritised and clearcare pathways to be agreed.

Within the children’s occupational therapy service triage is now common practice. All referral arescreened before a decision is made to accept any referral for assessment. Self-help strategies andinformation are also being provided as part of the pre-referral process.

The training has been hugely valuable and feedback extremely positive. The implementation isongoing. Thank you to all who attended and to the commitment of staff to embed into practice.

Author: Lee Urquhart, Head Paediatric Occupational TherapistEmail: [email protected]

The Renfrewshire Oral Health Action TeamA part of the Scottish Executive’s ‘An Action Plan for Improving Oral Health’ and a NHS GreaterGlasgow & Clyde Strategic Development Programme to improve the dental health of pre fiveyear olds, a new multi-disciplinary team was unveiled at Ferguslie Community Nursery on the8th May by David Leese, CHP Director and Councillor Derek Mackay.

The Oral Health Action Team ‘OHAT’ is a multi-disciplinary team of professionals who are taskedwith improving the oral health among pre fives in Renfrewshire.

The ‘Childsmile’ Practice Programme promotes oral health from birth and targets families withyoung children at increased risk of developing dental decay. Families are introduced to‘Childsmile’ via their health visitor and are supported by a ‘Childsmile’ Dental Health SupportWorker.

The ‘Childsmile’ Core Toothbrushing Programme is a national initiative offering free dailysupervised tooth brushing with fluoride toothpaste to every child attending a local authority orprivate nursery.

The ‘OHAT’ promote the following dental health messages:

• Brush at least twice a day using a fluoride toothpaste

• Consume sugary drinks and snacks at meal times only

• Visit your dentist at least once a year.

For any other oral health questions and to find out more about the Renfrewshire Oral HealthAction Team located at Mile End Mill Paisley, contact 0141 887 8451.

A Psychotherapy Secondment – Time to ReflectLast year I had the opportunity to participate in a psychological therapies secondment atDykebar Hospital. Our managers are keen to provide a variety of learning experiences, and I wasthe second member of staff to participate. I spent six months, two days per week, with thepsychotherapy department, focussing on therapeutic relationships, and six months with theShort Term Intervention Team who specialise in cognitive behavioural therapy.

When I began the secondment I had little knowledge or experience of using a psycho dynamicmodel and had some knowledge of the cognitive behavioural model.

Participating in the secondment has given me a variety of opportunities:

• Space and time to think and reflect on my own practice, and to expand on my knowledgeof therapeutic relationships

• Spending time with other disciplines, increasing my awareness of their roles and skills andlearning from their experience

• Experiential learning through involvement in assessment, a psychoanalytic group and seeingmy own patient

• Highlighted how important it is to have robust supervision focused purely on the discussionof clinical work

• Increased knowledge of and confidence in using psychodynamic and cognitive behaviouralapproaches.

This opportunity gave me the confidence to apply, successfully, for a full time position within theShort Term Intervention Team, where I hope to participate in further post graduate training inthe future.

The secondment has been a valuable experience and I would recommend this opportunity toanyone wishing to develop their knowledge and skills in this area.

Author: Karen Munro, Primary Care Liaison Worker


Healthy Working Lives in Renfrewshire CHPRenfrewshire CHP has signed up for the Healthy Working Lives (HWL) Award and has set up aHWL implementation group. The group members represent the different staff groups andworkplaces across the CHP.

The (HWL) programme is a Scottish Government initiative. It was launched to achieve healthimprovement for adults of working age. It is designed to encourage and support an organisationachieve a healthier workplace and be rewarded for doing so.

This award programme has three levels - Bronze, Silver and Gold. Once the introductory BronzeAward is achieved we can build on this success to secure Silver and then Gold.

One of the first actions the group will be taking is to ask staff their views on recent and futurehealth activities. A questionnaire will be issued towards the end of the year seeking your views.

Look out for Healthy Working Lives’ notice boards in your area shortly. There will be anopportunity to meet the team members at the staff event on 2nd December and find out more!

Author: Heather Cunningham, Health Improvement and Inequalities


Health & Employability in Renfrewshire CHPAs a Community Planning partner, Renfrewshire CHP is supporting Renfrewshire’s Workforce PlusProgramme, designed to cover a range of services that aim to help people into employment,education and training.

A scoping exercise was carried out by the CHP from January until March 2008. This focused ontwo main areas:

• The potential the CHP could have on employability through the current health servicesprovided to patients

• What support health practitioners would require to enable them to engage with people whowish to progress towards and into work.

Over 100 frontline staff took part and as a result of the scoping exercise, a new healthcomponent of the programme has been developed to:

• Support health staff make the most of their potential to raise employment with theirpatients/clients

• Support individuals experiencing health barriers to work

• Support the development of the employability agenda within the CHP.

A small team of health staff have now become an integral part of Renfrewshire Workforce Plusprogramme providing the link between Health and Employment in Renfrewshire. They areSandra McGuire, Health Improvement Lead; John Barber, Health Improvement Specialist; andDenise McDaid, Health Improvement Practitioner and are co-located with their employabilitycolleagues at Paisley Partnership in Ferguslie.

One of the first actions the team will be taking is to provide training, to increase frontline staffawareness and understanding of employability issues and to enable discussion of employmentwith clients. Details of the training will be available soon via heads of service, line managers andfurther newsletters.

There will be an opportunity to meet the team members at the Health & Wellbeing event on 5thNovember at the Normandy and the staff event on 2nd December.

Author: Sandra McGuire, Health Improvement & Inequalities Lead


Renfrewshire Mental Health Arts & Film FestivalRenfrewshire hosted its first Mental Health Arts & Film Festival in October 2008, with aprogramme of 15 events. The aim of the Festival was to engage audiences in a debate aboutmental health and creativity and to celebrate the numerous artistic achievements of people withexperience of mental health issues. In Renfrewshire the Festival was supported by a network ofpartnerships among local NHS, mental health services, Renfrewshire Council, Education, Artsgroups, Voluntary sector and Service users groups. There were avariety of workshops, art exhibitions, films and performances toenjoy in venues from Paisley Farmers Market to Paisley Arts Centre.There are plans to extend and develop the Festival for 2009.

Author: Jeanette Allan, Renfrewshire Festival Co-ordinator,Lead OT, Mental Health, Renfrewshire


Evening Visitor Transport Service: Hospital Visiting Made EasierIn October 2008, a ground breaking hospital visitor transport scheme was launched for theresidents of Renfrewshire. The service provides free transport for residents to visit patients in theRoyal Alexandra Hospital and other acute hospitals in the NHS Greater Glasgow and Clyde area.The official launch of this service was at the WRVS café in Causeyside Street, Paisley on 20thOctober 2008.

The hospital evening visitor transport service will be available for anyone living in Renfrewshire,but priority will be given to those who wish to travel to their nearest hospital, to older people(those over 60), people living with a disability and those in receipt of benefits. To use the service,clients phone a booking hotline (the line is open every afternoon) and transport can be bookedup to one week in advance.

0845 128 4027Clients will have to register and provide some information to ensure that those who really needthe service are given priority. All information will be treated in the strictest of confidence and incompliance with the Data Protection Act. Clients will have to give their address, which hospitalthey want to visit and what time visiting begins and ends. Pick up time will be confirmed bytelephone and clients will be taken from their front door to a drop off point in the hospital. Theywill be given a time for the return journey, and be taken back home after visiting.

The evening visitor transport service is delivered through a partnership between RenfrewshireCommunity Health Partnership, NHS Greater Glasgow and Clyde, Renfrewshire Council, WRVSand Community Transport Glasgow. It is free to Renfrewshire residents.

Author: Fiona MacKay, Head of Planning & Health Improvement


“Bright Ideas” in RenfrewshireSensory garden for patients atpsychiatric day hospital for care ofthe Elderly.

A therapeutic environment has beencreated in which patients and staff canrelax and enjoy their surroundings.Studies have shown that people withdementia benefit from sensorystimulation.

We transformed a dull and uninterestingoutside area into a colourful, therapeuticenvironment that stimulates the fivesenses and allows patients to accessgarden area and be involved in its maintenance. This was achieved with the help of a locallandscape gardener and his crew, who generously donated their labour and some materials tosupplement the Bright Ideas funding. The area was weeded, scrubbed and rejuvenated withtrellis around the surrounding walls, plant pots and a raised planted area. The Bright Ideasfunding enabled us to buy a solar water feature, large bird table, elite portico archway, wateringcan, planters, ornaments, small plant pots and seeds. Patients will be encouraged to grow plantsand maintain the area.

The sensory garden was to include the five senses. The herbs are to provide smell and taste. Thetexture of the plants was to provide touch. The chimes and water features were to provide soundand the herbs, strawberry plants, fruit trees and current bushes were to provide taste. To providesight, bright coloured plants were used.

A small idea has grown surprisingly fast. The project is ongoing and we look forward to thewarmer weather when everyone can benefit fully from the garden.

Author: Gina Tennant, Senior Nurse, Psychiatry Day Hospital


Competition Winner – Rona SlevinI recently had the opportunity to attend a workshop on work-life harmony. When we were askedto make suggestions for future CHP newsletters my initial thought was “it’s good staff are to beinvolved in the newsletter”. Thinking about what might be a useful contribution, I thoughtmany of the articles would be about the services provided by the CHP to improve the health andwellbeing of the people of Renfrewshire. In order to provide a good service staff firstly need tolook after themselves and the CHP has a role in promoting and contributing to the health andwellbeing of its own staff. Hence my suggestion was “Have a regular slot/article to promote thehealth and wellbeing of CHP staff with e.g. quizzes, competitions, articles by staff or sharing ofself care ideas. I was asked to contribute something to this edition of the newsletter.

Work-life harmony

What is work-life harmony?

• Being aware of different demands on time and energy• Having the ability to make choices in the allocation of time and energy• Knowing what values to apply to choices• Making choices.

What are the benefits for staff?

• Improved health• More quality time with family/friends• Improved self esteem• More free time.

Tactics staff can start to adopt?

Short term:

• Drink a large glass of water(not too cold) or hot water with lemon in the morning• Put something positive into your brain e.g. look at a picture/read something or just thinkabout something positive

• Do some quick exercise or stretching, even for 5 mins.

Longer term:

Calculate how many hours you spend on looking after your health, on your career and yourrelationship. Work this out on a daily/weekly basis.

The question is what is harmony for you?

Remember “we cannot control or manage time, but we can control and manage ourcommitments”

The key questions to ask yourself before committing to anything:

• How will I benefit from doing this?

• What will it cost me to do this?

• Do I want to do this?

If you would like to see how effective you are at practising good work-lifeharmony principles please contact me for a copy of the work-lifeharmony question.

Author: Rona Slevin, Senior Social WorkerEmail: [email protected]

Good News!

Renfrewshire CHP Nurse becomes one ofthe first dedicated Children’s Palliative CareConsultant Nurses for Scotland

Scotland’s first dedicated Nurse Consultantposts for children’s and young people’spalliative care were recently announced. Thesefour new posts have been funded for two yearsby the Scottish Government Health Directorateand will play a major role in helping to raiseawareness of the need for dedicated children’spalliative care services in Scotland.

Karen Sinclair will be hosted in NHS Greater Glasgow & Clyde Health Board for the West ofScotland. Karen previously worked as team leader for the Community Children’s NursingService in Renfrewshire.

“This is an exiting time in delivering services and care to life-limited and life-threatenedchildren and young people and their families.

Contact Us

If you would like any further informationplease contact:

Renfrewshire CHP Managemant OfficeRenfrewshire HouseCotton StreetPaisleyPA1 1AL

Tel: 0141 842 6200

Fax: 0141 842 6245


CompetitionOne lucky reader can win a £25 M&SVoucher. To enter the competition,please tell us what action you couldtake to improve communication withinyour service area. Send yoursuggestions [email protected].

The editorial team will judge thesubmissions and the bestsuggestion will winthe voucher. GoodLuck!

Karen Sinclair pictured on the left

renfrewshirechp newsletter - nhsggclibrary.nhsggc.org.uk/mediaassets/chp renfrewshire/re141...

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