newslett er, november 2021 join now and get involved!
TRANSCRIPT
2-3
4 5 6 7 8
In this Issue!
Healthwatch Ealing Update
Coronavirus (COVID-19) Booster Vaccine The Influenza Immunisation Programme Update
Age UK ‘Letter Writing Campaign’
NHS Dental Services Update
Clementina Day Centre: New Venue! The Solace Centre
Update from London North West University Healthcare NHS Trust
Northwick Park Maternity Services
#CancerWontWait Campaign New Maternity Trauma and Loss Care Service
... plus more!
020 3886 0830 www.healthwatchealing.org.uk [email protected]
45 St Mary's Road, London, W5 5RG Twitter: @HW_Ealing
Facebook: Healthwatch Ealing
Contact Us
Contact us for alternative formats
Pass it on... Please forward this newsletter to your friends, family and colleagues. Healthwatch Ealing is the health and social care champion for local residents. Join now and get involved!
Newsletter, November 2021
Picture: Walpole Park in Autumn
Healthwatch Ealing Update!
Page 2
Integrated Index Project Healthwatch Ealing and Healthwatch Hounslow were commissioned by NHS England to undertake a piece of research to assess how well local health and care providers are delivering joined up care to individuals. This is known as the integrated care system (ICS).
Assessing the effectiveness of ‘integrated care’
To gain an understanding of the effectiveness of integrated care, we were allocated an experience profile of a woman with multiple health conditions, including recent experience of care for a cardiovascular condition. Data shows that women in Ealing and Hounslow with this complex health status were frequent users of a large range of different emergency and elective secondary care services. We found that a significant percentage of Ealing residents who fit this profile were from a Black, Asian or Minority Ethnic (BAME) community, making up the majority of those living in the most deprived areas in the borough. Further still, in the boroughs of Ealing and Hounslow there were more women of a BAME ethnicity suffering from five or more long-term health conditions, including a cardiovascular condition, compared to White British women. The data also highlights that women of BAME ethnicities in both boroughs had a significantly higher incidence of CHD (Coronary Heart Disease) and Hypertension.
Cancer Screening Awareness Webinar The Healthwatch Ealing team would like to thank the members of the public who attended the Cancer Screening webinar on 18th August as well as the professionals who presented at the event. We have produced a Frequently Asked Questions (FAQ) document which is accessible on our website. We also recorded the webinar which will be made accessible on our website alongside the presentation slides used by our speakers. Disabilities Project From July 2021, Healthwatch Ealing partnered with Ealing Council to identify how adult residents living with disabilities and their unpaid family carers have been affected by the pandemic, including their experiences of the Health and Social Care system.
Collecting feedback at discussion forums
Residents provided their feedback via physical copies of Healthwatch Ealing’s Disabilities survey, participating in the survey over the phone with a member of the research team, and submitting their survey online via our Google Forms version. Overall, the views and experiences expressed by individuals during this project provides evidence that health and social care partners must work together to improve communication with disabled individuals around their care and ensure that all aspects of care are being consistently delivered to highest standards. We also collected responses from people who participated in one of two discussion forums that took place with The Community Inclusion Group and the Deaf and Hard of Hearing Women’s Group. The discussion forums highlighted several key themes that corroborated with survey findings. Individuals agreed that a lack of communication from their social care provider was a major contributor to feelings of stress, anxiety, helplessness and neglect.
“ Excellent experience at the flu jab clinic. ”
Join us today and have your say!
Healthwatch Ealing Update!
Page 3
Movember – Men’s Health Awareness The Movember movement aims to help men live happier, healthier, longer lives by funding various projects. It brings awareness of mental health and suicide prevention, prostate cancer and testicular cancer. By 2030, the Movember movement aims to reduce the number of men dying prematurely by 25%. ‘Grow a Mo’ this Movember to raise funds and awareness for men’s health.
Sign up now at Movember.com
Start clean-shaven, then let your Mo take the spotlight and start conversations. Make it Count, ask friends and family to back your Mo by donating. Together, we can stop men dying too young. Men’s Mental Health Men sometimes aren’t comfortable reaching out and opening up about life’s challenges – or they think they’ll be burdening their friends if they do. If someone you care about seems to be going through a tough time, the first step in looking out for them is reaching out. Prostate Cancer The risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects old men. Prostate cancer is the second most common cancer in men worldwide. Men who are black, and men who have a family history are more than twice as likely to get prostate cancer. If you’re 50, you should be talking to your doctor. Find out more on the website. More
Lung Cancer Awareness Month Lung cancer is the third most common cancer in the UK and the most common cause of cancer death, claiming almost 35,000 lives a year.
Getting an earlier diagnosis could save lives
Early detection makes it more treatable, so encouraging people to recognise symptoms and to see their doctor sooner could save lives. There are usually no signs or symptoms in the early stages. Symptoms of lung cancer develop as the condition progresses. The main symptoms of lung cancer include: • A cough that doesn’t go away after 2 or 3 weeks. • A long-standing cough that gets worse. • Chest infections that keep coming back. • Coughing up blood. • An ache or pain when breathing or coughing. • Persistent breathlessness. • Persistent tiredness or lack of energy. • Loss of appetite or unexplained weight loss. Lung cancer is more common as you get older. 45 out of 100 people (around 45%) diagnosed with lung cancer in the UK are aged 75 and older. Find out more in the full article. More Have Your Say About Online GP Services Online GP consultation services make accessing your GP and surgery easier. The NHS wants to improve these services across North West London and to do this they need to know how they’ve been working for you so far. Which parts of the service are important to you, what doesn’t work well and can they make things better? Complete and share this short survey now, which closes on Wednesday 5th January 2022. More
“ Our pharmacist had the answers! ”
Join us today and have your say!
Influenza Immunisation Programme Update The national flu immunisation programme aims to provide direct protection to those who are at higher risk of contracting flu and are more vulnerable of ill-health associated with the virus. The spread of flu was very limited in the UK during the 2020/21 season with only occasional detections of influenza A and B viruses reported. Influenza hospital admission rates were close to the ‘baseline’ threshold for the whole season. This was primarily due to the use of non-pharmaceutical interventions, including the social distancing measures that were in place. As a result, a lower level of population immunity against flu is expected this winter.
Flu could ‘add substantially’ to winter pressures
With social mixing and social contact now returning towards pre-pandemic norms, it is expected that this will be the first winter in the UK when seasonal influenza virus (and other respiratory viruses) will co-circulate alongside COVID-19, potentially adding substantially to winter pressures, particularly if infection waves coincide. The 2021/22 flu season in the UK could be up to 50% larger than typically seen and it is also possible that the season will be begin earlier than usual. The government has advised the extension of the flu vaccination programme to adults aged 50 years once more this winter, and to four additional cohorts in secondary schools, years 8-11. The aim of the London Flu Immunisation Plan is to ensure that the health, well-being, and safety of Londoners is maintained during this forthcoming winter, and especially where flu and COVID-19 may co-circulate. The ambition will be to improve London’s vaccination uptake - to ensure that the rates set out in the national flu immunisation programme for 2021/22 are achieved.
Coronavirus (COVID-19) Booster Vaccine A Coronavirus (COVID-19) booster vaccine dose helps improve the protection you have from your first 2 doses of the vaccine. Booster vaccine doses will be available on the NHS for people most at risk from COVID-19 who have had a 2nd dose of a vaccine at least 6 months ago.
The booster gives you longer term protection
This includes:
• People aged 50 and over. • People who live and work in care homes. • Frontline health and social care workers. • People aged 16 and over with a health condition
that puts them at high risk. • People aged 16 and over who are a main carer for
someone at high risk from COVID-19. • People aged 16 and over who live with someone
who is more likely to get infections (such as someone who has HIV, has had a transplant or is having certain treatments such as for cancer).
• People who are pregnant and in 1 of the eligible groups can also get a booster dose.
You'll be offered a booster dose at least 6 months after you had your 2nd dose. Most people will be invited to book an appointment at a larger vaccination centre, pharmacy, or local NHS service such as a GP surgery. People who work for an NHS trust or a care home will usually get their booster dose through their employer. More Ealing Council provides local guidance generally on COVID-19. Visit the website. More
Features
“ Parking at the hospital is difficult. ”
Join us today and have your say!
Page 4
Age UK ‘Letter Writing Campaign’ To influence the Chancellor’s recent budget, Age UK has been running a letter writing campaign. A family carer spoke of her 92 year old mother in a care home where she had had four showers in four years and, with Covid, all the residents have been kept in their bedrooms for 16 months! The day after the budget, Age UK wrote “Over 57,000 of us asked the Chancellor to deliver substantial funding to councils to pay for social care. £4.8 billion to local government over the next 3 years was announced in the Budget. This is the biggest core grant to local government in over a decade.
Age UK say that ‘funding should be ring-fenced’
Sadly this money is not everything that we asked for. The grant is not ring-fenced for social care and we are concerned that it will be stretched thinly to fund care as well as all the other council services”.
Social Care Future Campaign Social Care Future has worked with a number of national bodies to lobby the government to use the Budget to promote a positive vision of social care. The campaign is currently engaged in a detailed evidence-review to be co-authored and co-designed by people with lived experience of adult social care. A video is available which encourages people with lived experience to register their interest in the project via a survey link, which closes on 14th November 2021. More
Features
NHS Dental Services Update NHS Dental practices are now fully open and able to safely provide a full range of treatments whilst prioritising patients with urgent needs and delayed treatments. Practices are operating at a low capacity due to social distancing and infection control measures. Unfortunately, this has resulted in a backlog of unmet needs, delayed and suspended treatments.
You should be able to get urgent treatment
Access to an NHS dentist is not limited by which borough you live in, as you can seek NHS dentistry wherever you choose. 24/7 access to the London NHS 111 and the Urgent Care pathway, which provides a service to patients in pain or have urgent dental needs, remains available. Find out more on the NHS website. More
Health Inequality Project Healthwatch Ealing and Healthwatch Hounslow are working on a new project to understand how the COVID-19 Pandemic has further affected ethnic minority groups in regards to their experiences of accessing health and social care services. We would like to hear from you so that we can help voice your concerns.
0203 8860 830
Page 5
“ Coping at home after a stroke is hard. ”
Join us today and have your say!
“ Social distancing was observed at all times. ”
Join us today and have your say!
Clementina Day Centre: New Venue! Clementina Day Centre have identified a new venue to hold day care activities. They will be at St Hughes Church Hall, Northolt from mid to end of October 2021. They will be providing day care support for elderly people aged 60 plus who are affected by Stroke, Alzheimer’s’, those who are lonely and isolated and those who need to socialise. The service will operate 4 days a week, Monday to Thursday from 9.30am to 2.30/3.00pm
Helping older people to socialise
In the meantime they are taking referrals, which can come directly from clients/carers or professionals. For more information, visit the website or get in touch. More
020 8841 1851
Marking Black History Month Healthwatch Ealing has supported Black History Month (October 2021) by recognising the historical contributions and achievements of Black people within our community. We have highlighted some of the stories of Black healthcare figures who deserve more widespread recognition. Find out more on our website. More
The Solace Centre The Solace Centre is a ‘connecting hub’ where people with mental health problems who live in the Ealing Borough can meet in a relaxed, accepting environment to socialise, supporting one another and making new friends. It can help with respite, long-term self-management, resilience and sustainability. Part of Equinox Care, The Solace Centre helps to combat loneliness and isolation through social inclusion – connecting people with mental ill health. It has become a vibrant and popular community of its own, funded by Ealing Council and working in partnership with West London NHS Trust. Most Solace members attend at least 3 times a week, are aged 18 and over, and are from diverse ethnic backgrounds.
Connecting people with mental ill health
Services on offer include Mindfulness, Book Club, Baking/Budgeting Group, Healthy Living, Arts, Karaoke, and a Gardening Group. The centre is long-established, and now includes a ‘vibrant’ women and men’s group. Membership is £15 and once you are a member this includes every day access (including Christmas and Bank Holidays). New visitors are welcome Monday – Friday, 4-6.30pm. The centre is at 58 Bowmans Close, West Ealing, W13 9YT. To find out more, get in touch:
020 8567 6189
Features
Page 6
“ I can have tea in my room when I like. ”
Join us today and have your say!
“ They treat symptoms, not the root problem. ”
Join us today and have your say!
Features
Page 7
Update from Local Hospital Trust London North West University Healthcare NHS Trust (LWNH) writes “Responding to the Covid-19 pandemic required changes to the way we provide clinical services across our hospital sites. The majority of services for St Mark’s Hospital have temporarily moved to Central Middlesex Hospital. The move began as a sector-wide decision to create a Green (Covid free) site for St Mark’s patients, who often have lower immunity against illness. The move also enabled Northwick Park Hospital to create 60 extra patient beds which were used to treat Covid-19 patients during the pandemic peak, and helped Northwick Park Emergency Department treat patients more quickly.
’60 extra beds’ were created at Northwick Park
Moving St Mark’s services together enabled better collaboration between different services it provides, and also means staff do not need to travel between sites. Currently Central Middlesex Hospital holds St Marks Intestinal Rehabilitation Unit at Roundwood Ward, Infusion Clinic, Colorectal surgery and Outpatient services. As we plan for the long-term future, we have started to review all the service changes that have happened over the past year, including the temporary move of St Mark’s. A permanent stay would have to be considered by the North West London Integrated Care System and a public consultation would need to be conducted. Currently the extra beds at Northwick Park are still needed due to the high emergency admissions and no change is expected at this time. Anyone with questions regarding this can get in touch with LNWH Patient Experience Team”. [email protected]
Northwick Park Maternity Services Northwick Park Maternity Services are safe and open 24/7 for any worries about mum and baby wellbeing. For example, if movements are different to normal (more or less) it is essential you can come in to be checked.
Ask any questions about your care
The Northwick Park Maternity Services are online with senior midwives, it is a brilliant chance for families to come and ask any questions about their care. This can include anything from getting registered appointments, where to have their baby and what options are available for issues like pain relief. They can help you get in contact with the right person if needed. Videos in multiple languages are available. Find out more on the website. More Introducing the Mum and Baby App North west London’s free mum and baby app, available on Android and Apple, isn’t just a source of great information. It helps you choose where you’d like to give birth in North West London and set your own personalised plan for pregnancy, birth, and beyond. Get the app now for Android or Apple devices. Or, simply search ‘mum and baby’ to get started.
“ The phone is engaged constantly! ”
Join us today and have your say!
New Maternity Trauma and Loss Care Service A new pilot service launched recently in North West London to help women who are experiencing psychological difficulties following pregnancy loss, still birth and neonatal loss, birth trauma and women who have a fear of childbirth (Tokophobia).
Helping women to access specialist support
The development of this service will address a long-standing gap in provision, which the NHS Long Term Plan seeks to fill across all areas of England by 2023/24. This gap exists between interventions offered in primary care and community perinatal mental health services. The Maternity Trauma and Loss Care Service (M-TLCS) is jointly led by West London NHS Trust (WLT) and Central and North West London NHS Foundation Trust (CNWL) in partnership with the NW London Local Maternity System (LMS). The M-TLCS will help around 350 women each year access specialist support. Around 2,145 women each year are provided with support through a combination of specialist midwifery, consultant midwifery, and obstetric led clinics in maternity services. In addition, there is a significant number of women with psychological needs resulting from their maternity experience who need more focused specialist support, provided in a timely manner. M-TLCS aims to provide access to this help at this crucial time in a family’s life. More
#CancerWontWait Campaign The NHS in North West London writes “We have launched a new campaign across North West London called ‘Cancer won’t wait’. Since the start of the pandemic the number of people taking up screening appointments and attending their referral appointments has markedly dropped. We are asking people to come forward for screening when invited and to speak to their GP if they notice any unusual changes in their body without delay. Coronavirus has of course been a huge health concern for everyone this past year, and we have noticed that people are less likely to present to their GP with health concerns. When it comes to cancer, it is important that people come to us early, so every effort is made to help them as quickly as possible.
Talk to your GP about any concerns
GPs are very busy but we are not too busy for our patients. If you have noticed something about your body that’s not normal for you, or are worried about any symptoms, please speak to your GP. Please also take up that screening. Whether you or a loved one has a routine appointment, or a potential cancer symptom, our message is clear – you are not a burden, we are here to safely care for you so please don't delay, come forward as you usually would. Cancer won’t wait and we can see you safely.” More Breast Cancer Awareness Month Healthwatch Ealing have supported Breast Cancer Awareness Month (October 2021). Find out what symptoms to look for on our website. More
Spotlight
Page 8
“ Our social worker was very informative. ”
Join us today and have your say!
The King’s Fund on Waiting List Inequality New analysis from The King’s Fund shows that people living in the most deprived areas in England are nearly twice as likely to experience a wait of over one year for hospital care than those in the most affluent. This includes people waiting for planned hospital treatment such as knee and hip replacements, cataract surgery and other common procedures.
Many have ‘struggled to obtain information’
It shows that more than seven per cent of patients on waiting lists in the most deprived areas of the country have been waiting a year or more for treatment compared to around four per cent of those in the least deprived. With a record 5.6 million people across the country currently waiting for hospital treatment, the analysis also shows that waiting lists are growing more quickly in deprived areas. From April 2020 to July 2021 waiting lists have on average grown by 55 per cent in the most deprived parts of the country compared to 36 per cent in the least deprived areas. This trend suggests that people feel safer about coming forward for treatment and are being referred for the care they need. However, the disparities in waiting times uncovered by The King's Fund are a significant concern on top of the impact of the pandemic which hit the most deprived communities hardest.
Spotlight
Page 9
The impact on people's health and wellbeing… Healthwatch England adds “Our national poll of over 1,600 British adults who are currently waiting for planned treatment or who have a relative who is waiting suggests delays to treatment can take a toll on their health and wellbeing. We found nearly half of the respondents (46%) said they or their relatives didn’t receive enough information, or any at all, about when they can expect their treatment. Similarly, 48% didn’t receive any support to manage their condition during their wait, while 64% had not been given a contact they could turn to while waiting for treatment.”
Those in poorer areas generally wait longer
The poll also found that: • Over half (57%) of those whose treatment got
delayed agreed that this was taking a toll on the level of pain they faced.
• 54% agreed their mental health had been affected.
• 53% said their ability to carry out household tasks had been affected.
• 42% felt that their ability to work had been affected.
• Nearly one in five people, 18%, have already gone private for treatment or are considering it.
• Going private wasn’t an option for nearly one in two (47%) respondents who had their treatment delayed.
• Over half of the respondents (57%) said they or their relatives would be willing to travel to receive treatment if it reduced their waiting time.
• One in five would be willing to travel if the NHS offered support, such as accommodation (10%) and transport (10%).”
Find out more in the full article. More
“ The midwife was right there for us. ”
Join us today and have your say!
Warm Welcome Project National Energy Action (NEA), the national fuel poverty charity, is offering extra support for expectant and young families, and those who work with them as part of their roles through the Warm Welcome Project. As part of the project, NEA is offering to deliver community advice sessions to build family’s resilience against fuel poverty as well as administering a crisis fund for families in need.
‘Building resilience against fuel poverty’
Moreover, professionals can access free accredited training for frontline staff to better understand the links between health and warmth and empower professionals to provide more effective support. Funding for this project is provided via the Energy Savings Trust. To find out more about the project, get in touch or visit the website. More [email protected]
CAP Debt Help Service If you are feeling weighed down by debt, then charity CAP can help. You may think your situation is impossible, but there is hope. Their friendly team will give you a listening ear and provide a practical solution to your debts. More
Introducing Green Doctors Green Doctors are a team of expert energy advisers offering free and impartial support to eligible residents to get on top of energy debt, switch provider, access grants and other support, and manage their energy use in the home.
Practical advice including on saving energy
As a response to the Covid-19 outbreak, they are now offering pre-booked phone consultations, on topics including: • Advice on reading energy bills and signing up for
cheaper tariffs and on-the-phone support to change tariff if needed.
• Advice on behaviour changes to deal with damp and mould.
• Energy-saving behaviour in the home, what residents can do and what will save the most money.
• Helping residents deal with energy and water debt and apply for grants.
• Helping residents get their meter topped up during the restrictions.
• Signing residents up for the Warm Homes Discount (£140 off their bills).
• Signing residents up for the Priority Services Register if they are vulnerable, so they get extra support and help first during a power cut.
This service is available for all households in Harrow if they meet one of the following criteria - on low income; over 65; have a long term health condition, disability or children under five. To book a free telephone consultation with one of the Green Doctors, please fill in the online form. You can also contact the office. More 0300 365 3005
Community Noticeboard
Page 10
“ Staff need awareness of
different cultures. ”
Join us today and have your say!
Acton Gardens – Community Fridge Acton Gardens ‘Community Fridge’ runs on Tuesdays from 3pm, where you can come and collect a bag of food supplies packed by volunteers. This project is in partnership with The Felix Project and aims to combat food poverty and food waste. Find out more on the Facebook page. More
Aiming to combat food poverty and waste Would you like to volunteer? If so, get in touch: 020 8075 5240
Citizens Advice In 2020-21 Citizens Advice helped over 2.4 million people with one-to-one advice. Their online self-help advice was viewed more than 60 million times. Their recent impact report is available now. More Ealing Law Centre – Help with EU Settlement Ealing Law Centre and its partners West London Equality Centre, and Hammersmith & Fulham Law Centre have been awarded funding until end of March 2022 to assist vulnerable members of the community with complex cases to make applications for Settled Status, and Pre-Settled Status. Advice, updates and training are available. More
Department of Health & Social Care Updates The Department of Health & Social Care issues regular updates about adult social care. To join their mailing list get in touch:
[email protected] You can also view their YouTube channel. More Ease and Copley Close Children’s Centre (EASE) Introducing EASE, at Hanwell Community Centre, Westcott Crescent, W7 1PD. Opening times are 9.30am - 1.30pm Monday - Thursday. EASE can help you know what you're entitled to, support you in arranging payment plans for debts, signpost and refer to key services, help to fill in forms & more. Get in touch to book an appointment.
Baby massage group – Thursdays in November
Services include a Baby Massage Group, Thursdays from 4th – 25th November, 10 - 11am. 8 families can join the sessions (1 adult per family). Booking is required, bring your own baby oil, cushion and towel.
020 8575 6139
Direct Payments Information The council website features a new ‘vital help and support section’ on Direct Payments. More Specialist independent advice is also available from Ealing Advice Service, on topics including charging and assessments. More Legal advice can be reached via the Ealing Law Centre. Visit the website or get in touch. More
0208 579 4598 or [email protected]
Community Noticeboard
Page 11
“ I can’t go shopping without support. ”
Join us today and have your say!
Ealing CCG – Patient Participation Group (PPG) Newsletters More West London NHS Trust – @WestLondon magazines More London North West University Healthcare NHS Trust – Our Trust newsletters More
Helping to keep ‘fit and independent’ The booklet is available on the website now. More
Latest news from West London NHS Trust More Latest news from London North West University Healthcare NHS Trust More Latest news from Ealing Council More Official government guidance about Covid-19 More People seeking NHS weight loss help heavier than those before COVID new study finds More NHS delivers more than 850,000 top up jabs to most at risk More Nationwide roll-out of NHS high street heart checks to save thousands of lives More New NHS clinical leadership to support post-COVID challenges More ‘To retain care home staff, we need to make sure they have access to better support’ More NHS encourages people to get COVID booster jab as bookings open More Quick guide to the cap on care costs More COVID ‘grab-a-jab’ initiative boosts ethnic minority vaccinations More NHS rolls out COVID-19 jab to children aged 12 to 15 More Stephen Fry joins NHS campaign urging people to come forward for cancer checks More Lung cancer patients to get breakthrough drug on NHS More Children’s social workers to receive standards on autism practice More Government reforms ‘will not provide extra care or improve quality of life’, directors warn More NHS top doctor urges freshers to grab the COVID jab on campus More Lifesaving hepatitis C treatment for children on the NHS More Cholesterol-busting jab to save thousands of lives More £388m winter funding for adult care ‘too little, too late’, warns provider body More NHS launches world first trial for new cancer test More Life-saving world-first NHS test for pregnant women More Government resurrects cap on care costs plan four years after ditching it More NHS to diagnose thousands of people with rare diabetes More Mum gives birth to baby one year on from “miracle” NHS treatment More What the Health and Care Bill means for social workers More
Resources
A Practical Guide to Healthy Ageing Introducing a booklet from Age UK and the NHS, aimed at helping improve the health and general fitness of people of any age, but written to be particularly relevant for people who are about 70 years or older. People of this age, and sometimes younger, begin a ‘slowing-down’ process related to the effects of ageing on their body. We cannot stop the process of ageing, but the advice given can help keep you fit and independent.
Latest Newsletters
News Summary
Page 12
Flu can cause serious complications if you have a long-term health condition. The free flu vaccine is your best protection.
FLU20-LTHC
Ask your pharmacist or GP if you’re eligible.JUST GET YOUR FREE FLU JAB