Arden and GEM CSU Coronavirus briefing - 21/03/2020

21 March 2020
Attachments
As of 9am on 20 March 2020, there are a total of 389 cases in the Midlands. In Coventry & Warwickshire this is broken down as follows:
o Coventry: 7
o Warwickshire:13

LOCAL MEDIA HEADLINES

• CORONAVIRUS NEWS: Warwick Hospital confirms first case of Covid-19 Stratford Herald (Web), 20/03/2020, Unattributed A first case of covid-19 has been confirmed at Warwick Hospital today by the South Warwickshire NHS Foundation Trust. A Trust spokesperson said: "Warwick Hospital is caring for a patient who has a confirmed case of Coronavirus (COVID-19). We continue to follow national guidance on the identification and management of pa-tients with the condition."

• First coronavirus patient at Warwick Hospital in isolation Coventry Telegraph (Web), 20/03/2020, Unattributed

• First case of COVID-19 confirmed at Warwick Hospital Leamington Spa Courier (Web), 20/03/2020, Unattributed

• Coronavirus LIVE: First person being treated at Warwick Hospital; Godiva festi-val CANCELLED; key workers revealed Coventry Telegraph (Web), 20/03/2020, Unattributed

• Health Trust confirms first case of coronavirus at Warwick Hospital Redditch Standard (Web), 20/03/2020, Unattributed

• First coronavirus case confirmed at Warwick Hospital Stratford Observer (Web), 20/03/2020, Unattributed

• Coronavirus: First case confirmed at Warwick Hospital Leamington Observer (Web), 20/03/2020, Unattributed

• Hospital introduces visiting restrictions - but people still stealing from health service Stratford Observer (Web), 20/03/2020, Unattributed South Warwickshire Foundation Trust (SWFT) has introduced new restrictions dur-ing the coronavirus outbreak. Warwick, Stratford, Leamington and Shipston hospi-tals will now only allow one visitor per bed or with patient hospital attendance.
NATIONAL MEDIA HEADLINES

• West Midlands Officials examine virus death hotspot The Guardian, 21/03/2020, p.6, Nazia Parveen There are concerns that religious attendance and fears of social isolation could be leading to a sharp rise in the number of coronavirus transmissions in the West Mid-lands, after the latest mortality figures from NHS England revealed three neighbour-ing trusts had recorded 21 deaths between them. Health Secretary Matt Hancock, who said it was normal for there to be a particular density of cases in some areas, added: "There is a hotspot, not as big as in London, but there is a hotspot in the Mid-lands. It's something we're looking at very, very closely to find out why, frankly." The Royal Wolverhampton NHS trust reported nine deaths, the highest for any trust in the country. The Dudley Group foundation trust recorded seven, while Sandwell and West Birmingham reported five deaths. Walsall healthcare trust recorded one death.

• Fatal outbreak in church at the heart of biggest regional hotspot The Times, 21/03/2020, p.7, Neil Johnston

• Fatal outbreak in church at the heart of biggest regional hotspot The Times (Ireland), 21/03/2020, p.7, Neil Johnston

• West Midlands hospital trust has highest number of coronavirus deaths The Daily Telegraph Online, 20/03/2020, p.1, Unattributed A West Midlands NHS Trust has the highest number of deaths from coronavirus in the country, it has emerged as officials call for an immediate shutdown to prevent the spread of the virus. The Royal Wolverhampton NHS Trust has recorded nine deaths so far, an analysis of official figures shows.

• Covid-19: West Midlands emerges as coronavirus hotspot The Times Online, 20/03/2020, p.1, Unattributed

• The West Midlands is a coronavirus hotspot Mail Online UK (Web), 20/03/2020, Unattributed

• SPANISH FLU Young Brit who drank with old men after Spanish stag-do feared to be behind Midlands ‘hotspot’ of coronavirus deaths The Sun Online, 20/03/2020, p.1, Unattributed

• West Midlands becomes coronavirus hotspot with one NHS trust recording highest death toll in England Evening Standard (Web), 20/03/2020, Unattributed

• Public Health England speaks out over coronavirus death ''hotspot'' in West Midlands Birmingham Mail (Web), 20/03/2020, Unattributed

• Death toll up 39 to 167 amid warnings social distancing ''may have to last most for a year'' - updates Birmingham Mail (Web), 20/03/2020, Unattributed

• West Midlands becomes coronavirus hotspot Channel 4 News (Web), 20/03/2020, Unattributed

• Covid-19 hotspot Channel 4, Channel 4 News, 20/03/2020, 19:20:29, 5:0 The government is currently investigating why there has been a sharp rise in the number of cases in West Midlands, as 28 patients have died from coronavirus. The reporter says that New Cross Hospital, which is part of the Royal Wolverhampton trust, has seen the deaths of nine people who had tested positive for coronavirus. She says that Health Secretary Matt Hancock has said West Midlands is a Covid-19 hotspot.

• Last orders for all pubs, bars and restaurants The Daily Telegraph, 21/03/2020, p.2, Robert Mendick All of Britain's pubs, restaurants, cafes, cinemas and gyms were ordered to close last night as Boris Johnson introduced the most draconian measures yet "to keep people apart" in an attempt to halt the surge of coronavirus. In a televised announcement, the Prime Minister waged war on "unnecessary social gatherings" admitting the steps were "extraordinary" but critical to save thousands of lives. Mr Johnson said the tar-get was to reduce social gatherings by 75 per cent to reduce the impact of the pan-demic and ease pressure on the NHS.

• Pubs, restaurants and gyms told to close Financial Times, 21/03/2020, p.2, Jim Pickard; George Parker

• Vulnerable people NHS will issue instructions i (The paper for today), 21/03/2020, p.6, Paul Gallagher Health Secretary Matt Hancock said the NHS will get in touch with around 1.4 million vulnerable people who are most at risk of contracting the coronavirus to outline what action they should take under new social distancing rules. Mr Hancock said: "Many of these people will be very worried right now, and they'll need very specific sets of ac-tion - for instance, how do you go about still getting your chemo if you have cancer
whilst also social distancing?" He added: "If people think that they are on this list and don't receive a communication from the NHS, then they also need to get in contact." 

• Intensive care units see 15-fold rise in cases The Guardian, 21/03/2020, p.6, Denis Campbell; Sarah Marsh; Caroline Bannock Hospitals across London are dealing with rising numbers of coronavirus patients, many of whom are being ventilated to try to keep them alive. Medics say numbers are doubling every three or four days and that the city's NHS will be treating thou-sands of people with the disease within a fortnight. It is noted that Public Health Eng-land (PHE) and NHS England refused a Guardian request to see the latest data for London and England as a whole because of "quality" issues. However, unpublished NHS figures obtained by the Guardian reveal the number of people confirmed or sus-pected of having Covid-19 being treated in an intensive care unit (ICU) in hospitals in south London rose from seven on 6 March to 93 on 17 March - a 15-fold increase.

• 'Your NHS needs you now' The Independent Daily Edition, 21/03/2020, p.14, Lizzy Buchan Several MPs are returning to work in the NHS after Matt Hancock, the health secre-tary, issued a plea to retired NHS workers to return to the frontline yesterday, telling medics: "Your NHS needs you now." Regulators have written to over 65,000 retired doctors and nurses to appeal for help, with final year students also being fast-tracked into the NHS to cope with the strain of the coronavirus outbreak.

• MP allowed to return to nursing role to help NHS i (The paper for today), 21/03/2020, p.6, Paul Gallagher

• NHS doctors to be given guidelines to decide which victims should live or die The Independent Daily Edition, 21/03/2020, p.11, Rob Merrick

• MEDICS OF PARLIAMENT The Daily Mirror, 21/03/2020, p.2, Nicola Bartlett

• Budget curbs hamper NHS coping mechanisms Financial Times, 21/03/2020, p.2, Sarah Neville Keith Willett, who is leading NHS England's response to the coronavirus, told MPs this week about the readiness of large hospitals to respond to the pandemic.

• Royal couple are courtesy callers on the NHS front line The Daily Telegraph, 21/03/2020, p.12, Hannah Furness The Duke and Duchess of Cambridge thanked the NHS workers they say "represent the very best of our country", as they made their first royal visit under new corona-virus protocols. The Cambridges visited the London Ambulance Service 111 call cen-tre in Croydon on Thursday to hear first-hand of the "phenomenal" volume of calls from the public as the 999 service had the busiest three days in its history.

• TWO ONES FOR NHS 111 The Sun, 21/03/2020, p.9, Matt Wilkinson

• William's praise for 'very best of Britain' Daily Express, 21/03/2020, p.7, Russell Myers

• 'Sense of collectivism can help avert public disorder' The Independent Daily Edition, 21/03/2020, p.5, Lizzie Dearden A paper drawn up by the Scientific Advisory Group for Emergencies (Sage), Ministry of Justice, Home Office and police has said that the government should "promote a
sense of collectivism" during the coronavirus pandemic and "provide clear and trans-parent reasons for different strategies" in order to "limit the risk of public disorder". Deputy Chief Constable Paul Netherton, the national lead for civil contingencies, said police expected the key challenge to be supporting the NHS. He confirmed that dis-cussions about drawing on support from the military were ongoing, but said there was no current indication that soldiers will be needed for policing and that they were more likely to be required for healthcare. • Fears social distancing could last up to a year Daily Express, 21/03/2020, p.6, Giles Sheldrick The Scientific Advisory Group for Emergencies, which advises the Government, yes-terday said social distancing was the key to fighting Covid-19, but needs to be in place for at least six months, and possibly 12. It came as the NHS prepares to tell 1.4 million vulnerable people to self-isolate or face grave consequences.

• Hospital runs out of beds amid surge in infected patients The Times, 21/03/2020, p.10, Katie Gibbons Northwick Park Hospital in Harrow, northwest London, has become the first to de-clare a "critical incident" over the coronavirus crisis. The news comes after it emerged that letters have been sent to over 65,000 retired doctors and nurses urging them to come back to the NHS to help to tackle the pandemic, with MPs among those planning to return. Professor Stephen Powis, national medical director for the NHS, said that returners "will make more of a difference than ever before, not just to patients but to colleagues and the wider community".

• HOSPITAL: WE CAN'T COPE Daily Mail, 21/03/2020, p.12, Sophie Borland

• Video goes viral after nurse is left in tears by panic buyers The Daily Telegraph, 21/03/2020, p.9, Bill Gardner Matt Hancock, the Health Secretary, has urged shoppers to stop panic buying, after nurse Dawn Bilbrough filmed herself crying in her car after finding supermarket shelves empty having spent two days working long hours at an intensive care ward in West Yorkshire. Mr Hancock said: "It's vital that people act responsibly. Responsibly to follow the advice to stop spreading the virus and responsibly in terms of what peo-ple need." Tesco responded yesterday by saying NHS staff would be allowed to shop before anybody else on Sundays, while Marks & Spencer announced that frontline health workers would be given priority for the first hour of trading on Tuesdays and Fridays.

• They still don't get it Daily Mail, 21/03/2020, p.14, Sean Poulter

• Let our NHS heroes eat The Daily Mirror, 21/03/2020, p.14, Ruki Sayid; lucy Thornton

• Cops & shoppers The Sun, 21/03/2020, p.10, Daniel Jones

• NHS staff forced to buy their own protective gear due to shortages i (The paper for today), 21/03/2020, p.7, Richard Vaughan The growing scarcity of personal protective equipment (PPE) in hospitals dealing with coronavirus has prompted major concerns about the safety of doctors and nurses who are at heightened risk of infection, with one senior doctor in West Yorkshire claiming that staff had been forced to buy protective equipment out of their own pock-ets and reuse disposable items due to NHS shortages. It is also noted that Health Secretary Matt Hancock is "looking at very, very closely" to find out why there is a coronavirus hotspot in the Midlands. The Royal Wolverhampton Trust reported nine deaths on Thursday, the highest number for any trust in the country. The Dudley Group Foundation Trust recorded seven and Sandwell and West Birmingham Trust reported five. Walsall Healthcare Trust recorded one death. 

• Exports of 80 vital drugs prohibited by ministers The Independent Daily Edition, 21/03/2020, p.13, Lizzy Buchan Exports of over 80 vital drugs, including adrenaline and common antibiotics, have been banned by ministers to prevent NHS shortages of medicines needed to treat coronavirus. Announcing the move, health minister Lord Bethell said: "Our brilliant NHS staff are going above and beyond to provide world-class care to patients with coronavirus and we are supporting them in every way we can. We are today banning the parallel export of more than 80 crucial medicines to protect patients in the UK and help ensure they can always get the treatments they need." The list of restricted medicines will remain under review, with ministers prepared to add other drugs to the list if necessary, according to the Department of Health and Social Care.

• Export ban on 80 drugs protects supply to NHS The Times, 21/03/2020, p.11, Katie Gibbons

• Concern that influx of 'out-of-towners' will overwhelm NHS The Guardian, 21/03/2020, p.5, Unattributed Due to growing fears that the far south-west of Britain will be overrun by people seek-ing sanctuary from London and other cities that Cornwall council, Public Health Corn-wall and the tourist board Visit Cornwall yesterday urged people to stay away. In a joint statement they said: "Cornwall prides itself on being an open and welcoming place but during these unprecedented times we ask that anyone planning a trip to Cornwall consider deferring theirvisit." The organisations said they knew of tourism businesses that were closing. But they added: "Additional visitors to Cornwall at this time will potentially put extra pressure on public services, including the NHS."

• Galleries give food to NHS workers i (The paper for today), 21/03/2020, p.14, Unattributed Museums and art galleries in Leeds are supporting frontline NHS staff by sending them the leftover food from their canteens and shops after they decided to shut dur-ing the coronavirus pandemic.

• FRENCH SEIZE NHS FACE MASK TRUCKS The Sun, 21/03/2020, p.2, Nick Mcdermott; tom Wells France almost sparked diplomatic row by seizing two lorries carrying 130,000 face masks for the NHS. The cargo was being ferried in a major boost for overstretched UK medics battling coronavirus. But French border guards impounded the trucks af-ter realising what was on board, and President Emmanuel Macron's pledge to "requi-sition" all masks for his country's fight. After tense, top-level talks, the lorries were al-lowed to leave with all supplies on board.

• HALFORDS is offering NHS frontline [...] Daily Star, 21/03/2020, p.5, Unattributed Halfords is offering NHS frontline staff a free 10-point check on cars during the coro-navirus outbreak.

• Zaha offers 50 London homes to NHS staff The Times, 21/03/2020, p.98, Gary Jacob Crystal Palace player Wilfried Zaha has offered free use of 50 properties to NHS staff who are battling the coronavirus outbreak in central London hospitals. Earlier this week, former Manchester United defender Gary Neville offered NHS staff in Man-chester free use of 176 rooms in two hotels he co-owns, while Roman Abramovich, the Chelsea owner, has invited medical workers to 72 rooms in the Millennium Hotel at the club's Stamford Bridge ground.
o Zaha provides 50 homes for NHS workers i (The paper for today), 21/03/2020, p.84, Unattributed
o NOW ZAHA STEPS UP WITH FREE HOUSING FOR HOSPITAL STAFF . Daily Mail, 21/03/2020, p.117, Sami Mokbel
o Zaha opens up apartments for NHS workers Daily Express, 21/03/2020, p.80, Tony Banks
o WILF OPENS DOORS TO NHS STAFF The Daily Mirror, 21/03/2020, p.65, Tony Banks
o Wilf support The Sun, 21/03/2020, p.72, Alec Shilton
o Wilfried to house workers Daily Star, 21/03/2020, p.52, Tony Banks

• SOUTHGATE FOR PM The Daily Mirror, 21/03/2020, p.64, David Anderson In an open letter to football fans England manager Gareth Southgate said the men and women working in the NHS fighting the unprecedented threat of coronavirus are the nation's real heroes.

• Our economy is being sacrificed because the NHS was unprepared for a pan-demic The Daily Telegraph, 21/03/2020, p.25, Robert Colvile Comment: Robert Colvile writes that the coronavirus crisis is "hugely exacerbating the NHS's existing problems in terms of beds, equipment and staffing".

• Precisely how prepared is the NHS for this? The Daily Telegraph, 21/03/2020, p.6, Laura Donnelly Comment: Professor Stephen Powis, the national medical director of the NHS, says the health service is working hard to prepare for the surge in demand it is expecting, buts adds "this is an unprecedented global health threat." He continues: "No health service in the world could cope if the virus was left to let rip, which is why countries around the world are bringing in social distancing measures to slow the spread. It is vital that people follow the expert guidance and wash their hands, stay at home and use the NHS responsibly, so that services are there for those who really need it."

• Suspend all mortgage and rent payments for NHS workers. Now The Guardian, 21/03/2020, p.48, Patrick Collinson Patrick Collinson writes: "As chancellor, Rishi Sunak, you should order the immediate suspension of all rent and mortgage payments for NHS workers, with no interest or accruals added later. You should direct what's left of our manufacturing industry into urgent production of goods for the NHS. You should temporarily double the pay of all
NHS workers, and set out how the government will treat the wounded and veterans of this battle." • We know what's coming, and it's going to be hellish The Times, 21/03/2020, p.10, Unattributed An interview with an anonymous doctor in intensive care as NHS staff prepare for the coronavirus outbreak to worsen. They comment: "Before this outbreak, morale was at rock bottom in the NHS. When you're faced with a pandemic, all that goes out the window and it's all hands to the pump."

• I AM critical of the availability [...] Daily Mail, 21/03/2020, p.49, Max Pemberton Comment: Dr Max Pemberton writes that we "couldn't be in safer hands" than world experts Chief Medical Officer Professor Chris Whitty and Chief Scientific Officer Sir Patrick Vallance during the coronavirus crisis.

• We need the kit to fight this fire NOW Daily Mail, 21/03/2020, p.49, Max Pemberton Comment: Dr Max Pemberton writes that the lack of availability of coronavirus testing is proving to be one of the main challenges in the NHS. He notes that a quarter of the staff in his department are self-isolating at home, and if this were to be replicated across the whole NHS for more than a few weeks, "then we're in serious trouble".

• Praise the NHS all you like Boris but we're not blind to such hypocrisy The Daily Mirror, 21/03/2020, p.23, Brian Reade Brian Reade comments on the "ideological lunacy" of begging 65,000 doctors and nurses to return to work to save the nation from the coronavirus pandemic, "many of whom left their vocation heartbroken at the appalling way they and the NHS were be-ing treated by the same politicians now saying they value them so highly".

• My 111 call centre is a pit of chaos Daily Mail, 21/03/2020, p.12, An Nhs 111 Nurse An article by an anonymous NHS 111 nurse, who writes that the system is "cata-strophically short-staffed" and "not designed to cope with an emergency" such as the coronavirus pandemic.

• Reward this army of heroes putting our lives before theirs Daily Express, 21/03/2020, p.14, Patrick O'flynn

• Covid-19 testing and restrictions on movement The Times, 21/03/2020, p.32, Unattributed A group of health experts and professors write: "The UK is losing a very small win-dow of opportunity to minimise the disease burden from Covid-19 and prevent a health system collapse. Public health lessons learnt from countries ahead of the UK in the epidemic curve need to be implemented without further delay. We recognise the severe constraints on capacity for testing but, while that is being addressed, the government must implement social distancing, extensive case finding and contact tracing to reduce community spread to give time for the health system to prepare and cope."

• Microsoft and NHS The Times, 21/03/2020, p.32, Unattributed A reader writes: "It would be an outstanding gesture if Microsoft were to extend its support of the now obsolete Windows 7 platform until the end of this year. Such an
action would permit many individuals and public bodies, such as the NHS, a breath-ing space when they face such unprecedented pressure on their resources." • CINEMAS AND PUBS TO BE TOLD TO SHUT Evening Standard, 20/03/2020, p.1, Joe Murphy, Nicholas Cecil, Ross Lydall; Sophia S The government has ordered pubs, restaurants, gyms, leisure centres and cinemas across London to close in a massive ramping up of measures to slow the coronavirus surge. Prime Minister Boris Johnson chaired an emergency meeting this morning to decide what will be the most drastic action yet to try to shield the capital's NHS from being overwhelmed by Covid-19 patients. It is noted that analysis by the Standard of NHS England data found that there have been 57 coronavirus deaths in London hos-pitals. The largest number, eight, have been at Barts Health, which runs five east London hospitals.

• Extend 'silver hour' at shops for key staff, Hancock tells store bosses Evening Standard, 20/03/2020, p.2, Joe Murphy, Sophia Sleigh, John Dunne; Jona-than P Health Secretary Matt Hancock has called on supermarkets to extend "silver hour" shopping - introduced in the mornings for the elderly and vulnerable - to all key work-ers such as NHS staff, teachers and food delivery drivers following heartfelt pleas from nurses returning from long shifts to find shelves bare.

• Virus claims London grandfather 'loved by all' Evening Standard, 20/03/2020, p.9, Magda Ibrahim An 87-year-old London grandfather died after testing positive for coronavirus today. He is thought to be the 58th person to die in a London hospital from coronavirus and the fifth at King's College NHS trust, which also includes the Princess Royal Hospital in Orpington. The news comes as King's bosses revealed their anger at an apparent order from NHS England not to test hospital staff for coronavirus until the rest of the NHS was able to do likewise.

• NHS rolls out phone video link for doctors to advise patients Evening Standard, 20/03/2020, p.4, Ross Lydall Technology that enables doctors to provide medical advice by video link to patients with smartphones is being made freely available across the NHS. Clinic.co has the potential to avoid thousands of face-to-face doctor-patient meetings rendered poten-tially dangerous during the coronavirus pandemic.

• Southgate's message of support for NHS heroes tackling the health crisis Evening Standard, 20/03/2020, p.39, James Olley England manager Gareth Southgate today hailed the NHS "heroes" tackling corona-virus and insisted he will "never have been prouder" to lead England into next sum-mer's European Championship finals.

• NHS staff describe `dangerous' shortage of intensive care beds amid corona-virus outbreak ITV.com (Web), 20/03/2020, Unattributed NHS staff across Wales are calling for 'urgent steps'to protect themselves from coro-navirus. In an open letter to the Welsh Government, 50 healthcare workers describe a dangerous shortage of intensive care beds and protective equipment in hospitals.

• Coronavirus: ''Critical incident'' declared at Northwick Park Hospital in London after running out of intensive care beds ITV.com (Web), 20/03/2020, Unattributed
A "critical incident" was declared at Northwick Hospital in Harrow after running out of intensive care beds because of a surge in coronavirus cases. A spokesperson for London North West University Healthcare NHS Trust said: " We can confirm that our Critical Incident status has been stood down." They added: "Critical care capacity for patients with coronavirus is being organised on a cross-London basis so that hospi-tals and organisations work together to deliver the best possible care for patients and that is what has happened in this case. This kind of coordinated, flexible response is one of the NHS's strengths but with staff pulling out all the stops they need the public to play their part too, by following the expert guidance on washing your hands, stay-ing at home and using health services responsibly." • NHS professionals, delivery drivers and public transport staff listed as ''essen-tial'' to coronavirus response ITV.com (Web), 20/03/2020, Unattributed NHS and social care staff, food producers and delivery drivers, along with utility workers are among a list of workers deemed "essential" to the coronavirus response.

• Your NHS Needs You! Call for retired medics to help Covid-19 fight ITV.com (Web), 20/03/2020, Unattributed Tens of thousands of retired doctors and nurses have been told "Your NHS Needs You" as they were called on to return to work to help battle coronavirus. The health service hopes that as many as 65,000 retired medics will roll up their sleeves to help tackle the "greatest global health threat in history".

• Up to 65,000 former NHS doctors and nurses asked to return in fight against coronavirus ITV.com (Web), 20/03/2020, Unattributed

• NHS nurse breaks down in tears after she's unable to buy food after 48-hour shift amid coronavirus stockpiling ITV.com (Web), 20/03/2020, Unattributed

• Portable kit to test NHS staff for coronavirus ''available in weeks'' ITV.com (Web), 20/03/2020, Unattributed A portable test kit that takes just 50 minutes from sample to result could be available for use on NHS staff within weeks, a scientist has said.

• Portable coronavirus kit to test NHS staff "available in weeks", says Norwich scientist ITV.com (Web), 20/03/2020, Unattributed

• William and Kate praise NHS staff as ''the very best of our country'' during visit to 111 call centre ITV.com (Web), 20/03/2020, Unattributed The Duke and Duchess of Cambridge have praised the efforts of frontline NHS staff after witnessing first-hand how busy they are dealing with the coronavirus crisis.
ACTIONS TAKEN

• Monitoring latest updates from Public Health England and GOV.UK

• Social media monitoring for local areas, local hospitals and retweeting PHE, NHS messages on Coronavirus advice

• Content for websites, press releases and social media content now prepared for po-tential announcement on lockdown for over 70s and vulnerable people as well as ad-ditional content for mental health advice and support.

MEDIA ENQUIRIES
• None

STATEMENTS ISSUED
• None

Engagement, Communications and Marketing Team
NHS Arden and Greater East Midlands Commissioning Support Unit