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Haughton Thornley Medical Centres - GP services for Hyde and Denton

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Worried you or a loved one may have Covid-19 (Coronavirus) ?

This webpage provides comprehensive information for patients and carers about covid19, how to protect yourself and what you can do if you think you or a loved one may have covid19. Guidance is continually changing and it can get confusing. So please check here if you are unsure to see what you can do. If you are still unsure then you can ring 111 or contact the surgery. Here are simple steps you can take to stay safe - you will find more info below to find out more.
  1. Know about the symptoms of covid19 and what to do if you get the symptoms
  2. Make sure you know how to use all our online services including
    1. Viewing your electronic health records to see what your doctor or nurse have written about you and ordering repeat prescriptions via Evergreen Life PHR or Patient Access. To register, you will need to complete an online questionnaire and for those you care for. Click here to learn more. 
    2. Get an appointment using Engage Consult
    3. Receive rich multimedia content messages on your smartphone via MJOG Messenger
    4. Use the practice website www.htmc.co.uk to learn more about how you can get the best trusted information from the practice and the local services available to you
  3. Please contact the surgery and ask for the HTMC Online Team if you would like to speak to a staff member who can help you get online or help if you are having problems using any of the services
  4. Preventing covid19 is the single most important thing you can do - washing hands and social distancing remain essential. Only go out in public if absolutely necessary
  5. Face coverings will be essential to wear for all people when entering shops (except for some limited instances)
  6. Learn about Test and Trace and what happens if you are contacted by the NHS if you have been in recent contact with somebody who tests positive and who you have been within 2 metres for at least 15 minutes. 


Greater Manchester is now in Tier 3 Coronoavirus Restrictions

Here is what this means:

You are not allowed to meet socially with anybody who is not part of your household, or support bubble, indoors.

You cannot meet in private or pub gardens, but can meet in parks, beaches, countryside or forests, as long as you are not in a group of more than six.

Pubs and bars must close unless they are serving substantial meals. Alcohol can only be served as part of a meal.

People are being advised not to travel into or out of tier three areas, other than for work, education, youth services or because of caring responsibilities.

Casinos, bingo halls and betting shops, adult gaming centres and soft play areas have closed in all tier three areas.

Here is definitive guidance on what you are allowed and not allowed to do in very high risk area



Click below to download a PDF of the poster above

Children, School and family who are extremely vulnerable 

We understand and sympathise with the concerns around children attending school at this time, especially if a household has extremely vulnerable members.  As a practice we are very sorry, but decisions about children attending school are not ours to make.  It's not something that we can help with.  We would suggest a discussion between the people involved and the school to decide on the best way forward.


The Royal College of Paediatrics and Child Health has issued guidance for health professionals to determine which children and young people are considered clinically extremely vulnerable. The majority of children with asthma, cystic fibrosis, diabetes, epilepsy and kidney disease are NOT considered clinically extremely vulnerable. Generally, those children and young people who are cared for only by their GP will not be clinically extremely vulnerable.

Lifting lockdown


Need help to get medications delivered or other essential items during the COVID19 pandemic crisis or would you like to volunteer to help others ? Contact the Royal Volunteering Service now. 

All you ever wanted to know about face coverings




Please note this video was made in March based on the correct advice from the WHO and the UK government at that time. Much of it still applies besides the new guidance about face coverings needed to be used from 24th July 2020 onwards.




From Friday 24th July it will be compulsory for people in England to wear a face covering in shops. However the rules do not apply to shop workers. Those who fail to wear once will be fined £100, reduced to £50 if paid within 14 days. People will not be required to wear a face convering where it is not practical to do so eg pub, cafe or restaurant.



How to make your own face mask including the one with the bandana, the one with the T-shirt and the one that needs sewing.


Since 15th June, anyone travelling by bus, train, ferry or plane in England must already wear a face covering. Some passengers are exempt from the rules including
  • children aged under 11
  • people with disabilities
  • those with breathing difficulties
  • anyone travelling with someone who relies on lip reading
If it is reasonably necessary for you to eat and drink then you can remove the face and convering to do so. Click here to read more from the BBC as well as advice from Transport for Greater Manchester. You can order a Journey Assist card for people who are exempt from wearing a face covering from public transport from Transport for Greater Manchester.

You can also download a face covering exemption card to print out and use for other purposes if you wish. Please do not contact the surgery for letters of exemption as these are not necessary and government advice does not recommend this.



Who needs to be tested for COVID-19?

You can ask for a test:

  • for yourself, if you have coronavirus symptoms now (a high temperature, a new, continuous cough, or a loss or change to your sense of smell or taste)
  • for someone you live with, if they have coronavirus symptoms

Whilst all people can now be tested, the home testing kits are not suitable for children under 5 years old.

If you're asking for a test for someone else and the person is aged 13 or over, check they're happy for you to ask for a test for them.

You need to ask for the test in the first 5 days - ideally in the first 3 days as it can take a day or two to arrange.

You will be asked how you would like to have the test - you can choose to drive to a regional testing site or get a home test kit. You will also be asked your name, mobile phone number and address.

Click here if you think you qualify for a coronavirus test. Learn more about getting tested here.

Understanding your coronavirus test result including

 

  • a negative test result
  • a positive test result
  • unclear, void, borderline or inconclusive test result

Background information about COVID19 and further useful information

Our understanding of this condition is increasing, but there is still much uncertainty. There are large numbers of people who have no symptoms at all but have the condition. Only 15% of patients have the typical symptoms of fever, cough and shortness of breath. Other symptoms patients can have include:

  • Fever 83-98% of cases (less common in children and the elderly)

  • Cough 57-82% of cases (less common in children)

  • Shortness of breath 18-55% of cases (onset usually 5-8 days after other symptoms)

  • Fatigue 29-69% of cases

  • Muscle aches and pains 11-14% of cases

  • Poor appetite 40%

  • Sputum production 26-33%

  • Sore throat 5-17% of cases

  • GI symptoms 1-11% (likely underestimation)

  • Loss of smell /distortion of sense of taste (anecdotal evidence, no case reviews)

Current data still suggests 80% of those who contract coronavirus will get mild symptoms, 15% will become critically unwell (needing hospital admission) and sadly approximately 5% will die.

Those at highest risk of dying include the following groups (this is continually being updated)

  • Older age (65 years or older)

  • Male sex

  • Shortness of breath

  • Hypertension

  • Cardiovascular or cerebrovascular disease

  • Needing mechanical ventilation (on ICU)

  • Multi-organ failure (on ICU)

There is currently no cure for COVID19 and treatment is based on the need for supportive care.

For this reason, if you think you may have COVID19, you are advised to visit the 111 Coronavirus website or contact 111.

If you have mild symptoms then you should stay at home, self-isolate and continue to self care. Contact NHS 111 if your symptoms get worse. They will then triage you and determine whether you should go to A&E or book you in with the GP practice directly or ask you to contact the GP surgery for further advice.

The GP will check whether you can

  • Complete full sentences

  • If you are short of breath or have chest pains

  • Are able to do usual activities of daily livingeg cooking, cleaning, walking, having a shower / bath, able to get out of bed

  • Your clinical frailty score helps to predict what further management is needed

It would be very helpful if you can also measure your pulse or blood pressure. Here are some videos done by Dr Naveed Riyaz which show how to do this yourself. Do not worry if you are unable to do so - the doctor can call you and do this via a video consultation.

You may be asked to attend Thornley House Medical Centre to have your oxygen saturation checked following a short walk. Alternatively you may be asked to drive to the surgery and have this checked whilst you stay in the car. The doctor will advise you if this is necessary and what to do.

Following the consultation, the doctor may advise you to treat any temperature with paracetamol and to drink fluids. You may be offered antibiotics if this is deemed necessary.

If you have come to get your oxygen saturation tested, you may be asked to come back again for a repeat test

We are very concerned that patients are not contacting the surgery for fear of being asked to come to the surgery or go to A&E. Much of the work we are doing is over the telephone and / or video consultations which means you can get the care you need without needing to come to the surgery. We are worried though that whilst people may be staying at home, you may not be accessing help early for other treatable conditions or serious illness eg bowel cancer, heart disease or even stroke. There is a fear amongst experts that many more people may suffer or even die as a result of not getting the care they needed sooner. This could become the next wave of excess deaths if we do not seek help early.

Many patients are starting to become anxious and worried about what may or may not happen. Often a quick chat with your doctor may all be that you need to be reassured. We can advise you about other support that may be available including self help information via the practice website, talking therapies and perhaps medication or even a fit note. It is imperative if you are unsure that you at least contact the surgery and ask to speak to a doctor, nurse or pharmacist.


Get an isolation note from here NOW if you are asked to self-isolate


What is Coronavirus - watch this video below which explains in 8 minutes what it means and why social distancing and social isolation is so important





Click here to see advice and guidance about Coronavirus in over 60 languages with thanks to Doctors of the World.



 
Please wash your hands regularly with soap and water or sanitiser gel for at least 20 seconds.

If you have a new persistent cough or fever (37.8 or higher) 
or a loss or change to your sense of smell or taste then you should stay at home (self-isolate) for 1 week. You do not need to phone 111 to inform them that you are self isolating. See 111 Online Coronavirus service

Do not go to your GP surgery, pharmacist or hospital.

Contact 111 only if you feel you cannot cope with your symptoms at home, your condition gets worse or your symptoms do not get better after 7 days

Important information about the coronavirus (COVID-19)

The NHS in Tameside & Glossop and Public Health England (PHE) are well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal.

The latest information on symptoms of Coronovirus infection and areas where recent travel may have resulted in a high risk of exposure can be found on nhs.uk/conditions/coronavirus-covid-19/

NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do.

Use this service if:

  • you think you might have coronavirus;
  • you've been in close contact with someone with coronavirus.

Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone.

Like the common cold, coronavirus infection usually occurs through close contact with a person with novel coronavirus via cough and sneezes or hand contact. A person can also catch the virus by touching contaminated surfaces if they do not wash their hands.

Testing of suspected coronavirus cases is carried out in line with strict guidelines. This means that suspected cases are kept in isolation, away from public areas of GP surgeries, pharmacies and hospitals and returned home also in isolation. Any equipment that come into contact with suspected cases are thoroughly cleaned as appropriate. Specific guidance has also been shared with NHS staff to help safeguard them and others. Patients can be reassured that their safety is a top priority, and are encouraged to attend all appointments as usual.

Everyone is being reminded to follow Public Health England advice to:

  • Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel.
  • Wash your hands often with soap and water, especially after using public transport. Use a sanitiser gel if soap and water are not available.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid close contact with people who are unwell.
Coronavirus - all you ever wanted to know about coronavirus but dare not ask (7th March 2020)

Talk delivered by Dr Hannan to the community in Sale on 7th March 2020 by 3 Meem Foundation covering the history of COVID-19 (a type of coronavirus), what are the symptoms, who is considered at risk of developing it, having tissues and a bin near you if you start with a cough, breathlessness and / or temperature, what you should do if you think you have got it, how safe is coronovirus and the likelihood that most people (4 out of 5) will get better with just mild symptoms, how to access appointments at the GP surgery, what may happen if you are thought to have coronavirus, how to self-isolate and what you should do, how you should prepare NOW for getting possible coronavirus, the importance of neighbourhood watch schemes to help your neighbours, the stopping of face to face consultations unless absolutely necessary and instead expecting text messages, information on practice websites to help keep you informed, using social media such as facebook and twitter to get simple messages out to people, telephone consultations, online medical history taking, the need to know how to order prescriptions online and book appointments which are available now in all GP surgeries. He also talks about specific things we are doing here at Haughton Thornley Medical Centres including having full access to your GP electronic health record including what the doctor or nurse have written about you, introducing video consultations if you have a smartphone or webcam and a new app MJOG messenger that allows rich content messages including pictures and video to be sent directly to your smartphone. He finishes by answering some of the myths that people have about the disease and how we can all beat this by sticking together and keeping ourselves well-informed.


Changes since talk on 7th March 2020:
  • New advice from 18.5.2020: If you have a new persistent cough or fever or a loss or change to your sense of smell or taste then you should stay at home (self-isolate) for 14 days (2 weeks) with your family.
  • Contact 111 only if you feel you cannot cope with your symptoms at home, your condition gets worse or your symptoms do not get better
  • All patients from age 1 upwards should take regular vitamin D
  • See below to see who needs to be tested
Questions and Answers session including Dr Fozia Tariq (microbiologist), Dr Tariq Razzaq (dermatologist), Dr Mohammed Naseer ud din (anaesthetist) and Dr Amir Hannan (GP)


Who needs to be tested for COVID-19?

Our priority is testing patients to inform their clinical diagnosis.

The NHS is also testing:

  • all essential workers including NHS and social care workers with symptoms (see the full list ofessential workers)
  • anyone over 65 with symptoms
  • anyone with symptoms whose work cannot be done from home (for example, construction workers, shop workers, emergency plumbers and delivery drivers)
  • anyone who has symptoms of coronavirus and lives with any of those identified above

Additionally, we are testing:

  • social care workers and residents in care homes (with or without symptoms) both to investigate outbreaks and, following successful pilots, as part of a rolling programme to test all care homes
  • NHS workers and patients without symptoms, in line with NHS England guidance

This means anyone in one of these groups can find out whether they have the virus. Testing is most effective within 3 days of symptoms developing.

Click here if you think you qualify for a coronavirus test. Learn more about getting tested here.



The BBC Health team talk you through what the NHS says about protecting yourself from Covid-19 (a type of Coronavirus). Watch the video below



Learn about the Coronavirus and what you need to know from the World Health Organisation below




Typically patients are complaining 
  • The fever is usually high (over 38c and in some cases 40c) and persistent over more than 4 days.
  • The cough is generally dry and developed several days after the fever. (3 or 4 days)
  • The breathlessness varies from one person to another and in some was intermittent chest tightness like an asthma attack.
  • Fatigue and muscle aches seems worse in the first 4 days with cough and breathlessness after that.
  • The cough and breathlessness can persist in people beyond 2 weeks.
Frequently Asked Questions
  • Why is the fever so high?
The fever is your body’s way to fight the infection, we have no medicine to treat this virus but your immune system will fight it, the fever is part of that process. If the fever makes you too uncomfortable of stops you taking food drink use paracetamol to reduce the fever for a few hours
  • Why is the fever not settling after 4 days?
The fever can go on for 7 days with this infection if you are still feverish after that we should talk again.
  • Why is the cough not settling after 2 weeks?
The cough can go on for 3 weeks if you are not too breathless and able to eat and drink the dry cough will settle over time.
  • Why am I breathless and when will I need to go to hospital?
Breathlessness is a feature of this illness due to irritation and inflammation of the lungs if the breathlessness is severe you may need to have oxygen support or ventilation in hospital. This is likely if you are too breathless to climb the stairs or to hold a conversation or to eat and drink.
  • Can I have a swab to be sure it is coronavirus?
You will only be swabbed if you are so sick that you need to be admitted to hospital, the swab takes 3 or 4 days to get a result so we treat you on the presenting symptoms of this illness.
  • Can I come to the hospital for treatment?
This virus has no specific treatment. You will come into the hospital if the inflammation in the lungs is so severe that you need oxygen support or ventilation. Less than 1 in 10 people will need this support.

Only contact 111 or the surgery if the breathlessness becomes very severe such that you have difficulty speaking, eatin or drinking otherwise your symptoms can be managed safely at home. It is important to  help improve your own immune system with rest, fluids, fruit and nourishing foods, keeping warm and avoiding stress.



It seems to start with a fever, followed by a dry cough and then, after a week, leads to shortness of breath. But in more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. Most victims have been elderly people, suffering from other chronic diseases including Parkinson's and diabetes.

There are several myths surrounding the risks of coronavirus here in the UK. BBC Health Online desk have been looking at some of them, and putting the facts straight.
  • Face masks aren't that useful
  • You can't catch the virus from animals
  • It is seldom fatal 
  • But there is no cure
  • It's safe to eat Chinese food
Don't bother:
  • eating garlic
  • gargling 
  • mouthwash
  • rinsing your nose with saline
  • using sesame oil under the nose
None of these will help protect against the new virus in any way, the WHO adds.




Coronavirus and your wellbeing

You might be worried about coronavirus (also known as COVID-19) and how it could affect your life. This may include being asked to stay at home or avoid other people. This might feel difficult or stressful. But there are lots of things you can try that could help your wellbeing. (Please see Coronavirus and your wellbeing from MIND whic provides more information on the points below)

Plan for staying at home or indoors
  • Find the right place to stay
  • Eat well and stay hydrated
  • Keep takign your medication
  • Continue accessing treatment and support if possible
  • Take care of your immediate environment
  • If you have care needs or provide care or support to someone else then think about what else you can do
Take care of your mental health and wellbeing

If you've been asked to stay at home and avoid other people, it might feel more difficult than usual to take care of your mental health and wellbeing.These are some ideas which may help:
  • Hand washing and anxiety
  • Connect with people
  • Decide on your routine
  • Try to keep active
  • Get as much sunlight, fresh air and nature as you can
  • Plan for workign or studying at home
  • Find ways to spend your time
  • Find ways to relax and be creative
  • Keep your mind stimulated
  • Take care with news and information
  • If you're feeling anxious, plan a "safe space" amd find ways to comfort yourself
  • If you're feeling claustrophobic or trapped, open the window to let aor in, look at the sky, change rooms regularly
Checklist: are you ready to stay at home for two weeks?
  • Food - do you have a way to get food delivered
  • Cleaning: are yourclaning supplies stocked up
  • Money: Can you budget for higher bills or expenses. Will you save money from lower transport costs that you could spend elsewhere
  • Work: Can you work from home or not. Do you know what rights you have to payments or benefits?
  • Medication: do you have enough medication or a way to get more?
  • Health: can you reorganise any planned therapy or treatments?
  • Commitments: can someone else help you care for any dependents, walk your dog, or take care of any other commitments?
  • Connectivity: have you checked the contact details of the people you see regularly, like their phone numbers or email addresses?
  • Routine: can you create a routine or timetable for yourself? And if you live with other people, should you create a household schedule? Do you need to agree how the household will run with everyone at home all day?
  • Exercise: is there any physical activity you can do inside your home, such as going up and down the stairs, using bean tins as weights, or exercises you can do in your chair?
  • Nature: have you thought how you could access nature? Can you get some seeds and planting equipment, houseplants or living herbs?
  • Entertainment: have you thought about things to do, books to read or TV shows to watch?
  • Relax: have you got materials so you can do something creative, such as paper and colouring pencils?
with thanks to MIND for produong this excellent checklist

What can patients at Haughton Thornley Medical Centres do to help themselves?
  • Please read the information on this webpage which we will try to keep uptodate
  • Ensure you know how to view your electronic health record via Evergreen Life PHR and / or Patient Access
  • The Evergreen Life PHR app is a health and wellness app and you can use this to monitor your wellness level too - see below for more information. 
  • Please email htmcpatient@nhs.net if you have forgotten your passwords and we will get back in touch with you
  • Use Engage Consult - the new way to get appointments online at any time, day or night. We prefer patients / carers to do the questionnaires in the evening after 6:30pm so that they are ready to be viewed first thing in the morning. We are gradually rolling this out across the practice so please bear with us. You can learn more here  
  • Download the MJOG Messenger app - the new way of receiving information from the practice
  • See Depression / Anxiety care for a variety of self-help innitiatives, leaflets, videos
  • Follow us on facebook and twitter and post positive messages about what ou have learned from here so that others can learn from you too and we share this widely. Your messages of support will help others too nad provide a positive contribution to the local community as well

The Evergreen Life PHR app for iOS and Android devices includes a "happiness score" and an overall "wellness score" which you can use to improve your health. Click here to learn more and how to use this to support your physical and mental health needs. 

Start recording your wellness score today and monitor it over time to see how it changes whilst making it fun too!



You need to isolate yourself if you've got either 
  • a high temperature – you feel hot to touch on your chest or back
  • a new, continuous cough – this means you've started coughing repeatedly
Do not go to a GP surgery, pharmacy or hospital.You do not need to contact 111 to tell them you're staying at home.Testing for coronavirus is not needed if you're staying at home.

You should stay in a well-ventilated room with a window that can be open, separate from the other people in your home.Ask for help if you need groceries, other shopping or medication - it's OK to have friends, family or delivery drivers drop off supplies to get you through the two weeks. But you shouldn't invite visitors in, PHE says.

Learn more about "staying at home" (self-isolation) with definitive guidance from the government.

The new coronavirus has been declared a global emergency by the World Health Organization, as the outbreak continues to spread outside China. Globally there are now 13 876 441 confirmed cases of COVID-19. The death toll now stands at 593 087 deaths globally and 206 684 deaths in Europe (correct on 18th July 2020). You can see the latest info from the World Health Organisation here as this is a developing situation.

What happens to patients diagnosed with coronavirus?

A detailed analysis of the first 99 patients treated there has been published in the Lancet medical journal.

Lung assault
All of the 99 patients taken to the hospital had pneumonia - their lungs were inflamed and the tiny sacs where oxygen moves from the air to the blood were filling with water.Other symptoms were:
  • 82 had fever
  • 81 had a cough
  • 31 had shortness of breath
  • 11 had muscle ache
  • 9 had confusion
  • 8 had a headache
  • 5 had a sore throat
At least 10% die

As of 25 January, of the 99 patients:
  • 57 were still in hospital
  • 31 had been discharged
  • 11 had died
This does not mean the death rate of the disease is 11%, though, as some of those still in hospital may yet die and many others have such mild symptoms they do not end up in hospital. Most of the 99 patients were middle-aged, with an average age of 56 - and 67 of them were men.However, more recent figures suggest a more even gender split. The China Centers for Disease Control and Prevention said 1.2 men were infected for every 1.0 women.

What is the current situation in the UK ?

As of 9am on 18th July 2020, 13,112,764 people have been tested in the UK, of which 294,066 were confirmed positive. There were 50,335 deaths involving the coronavirus (COVID-19) that occurred between 1 March and 30 June 2020, registered up to 4 July 2020 in England and Wales; of these, 46,736 had COVID-19 assigned as the underlying cause of death. You can see the latest information and advice for the UK here.  

How many cases are there in your area?

I do not have Coronavirus currently - what can I do now to help myself and my loved ones for the future?
  • Make sure you have signed up for Records Access and Understanding. This allows you to see what your doctor or nurse have witten about you too. Click here and complete the questionnaire for each member of your family. If you care for somebody then do the questionnaire on their behalf.  
  • Register with Engage Consult so that you can book an appointment whenever you need an appointment
  • We have introduced video consultations for those patients who are unable to come to the surgery or it is unsafe for you to do so. This will requre you to have a smartphone or a computer with a video camera attached too. This is not essential but it does allow the doctor to see you even if you are unable to come to the surgery.
  • Face masks may be useful if you are in confined spaces or travelling in a closed environment eg a plane. However washing your hands regularly with warm soapy water is much more important
  • See the latest travel advice from the WHO
  • Look back at this webpage which we will keep uptodate with useful information. For the latest info please see here

Not everybody who is a case of coronavirus results in death.

How deadly is the coronavirus?

Watch COVID-19 the real numbers that will make you feel safe below by ProjectNightfall (please note - non-NHS source)


Based on data from 44,000 patients with this coronavirus, the WHO says:
  • 81% develop mild symptoms
  • 14% develop severe symptoms
  • 5% become critically ill
The proportion dying from the disease, which has been named Covid-19, appears low (between 1% and 2%) - but the figures are unreliable.Thousands are still being treated but may go on to die - so the death rate could be higher. But it is also unclear how many mild cases remain unreported - so the death rate could also be lower.

To put this it into context, about one billion people catch influenza every year, with between 290,000 and 650,000 deaths. The severity of flu changes every year.



Click on the world map to see the latest information from every country in the world - useful for people planning to travel abroad and wanting to know what the latest information is 

 






The above information has been collected from advice from NHS Choices, Public Health England and advice from Tameside and Glossop CCG as well as Haughton Thornley Medical Centres and the BBC

Updated 23.10.2020

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  UK Health News  
Covid-19: Pfizer/BioNTech vaccine judged safe for use in UK from next week
The UK is the first country to approve the Pfizer vaccine - with 800,000 doses due to arrive soon.

Covid-19: Shoppers return to stores under England's new tier system
Non-essential shops, gyms and hairdressers can open their doors as a national lockdown ends.

Nottingham hospitals maternity services 'inadequate'
Inspectors find a number of problems, including staffing, poor leadership and management.

BBC Health

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