International Society of Ultrasound in Obstetric and Gynaecology( ISUOG), British Society for Gynaecological Imaging( bsgi.org). Suspected metastatic germ cell cases should be urgently raised with the medical oncology consultants via our switchboard. Dr Diaz led the Valencian Program for Fertility Preservation, which is one of the most internationally recognised fertility programs for oncology patients. In her spare time Jennifer enjoys singing in her local choir, long walks together with her dog Ernie and cooking a range of cuisines Indian dishes being her favourite! Before you have any treatment, you will need to give permission (consent). This sits in the footer, set at site-level so it's available on all pages. Completed in in. She has 3 children and speaks Farsi fluently and French to a good standard and enjoys dancing, spinning and socialising. Your doctor might talk to you about: You can also talk to them about any concerns you may have. Department of Obstetrics and Gynaecology, Barts Health NHS Trust, United Kingdom; Department of Women's and Child Health, City University London, United Kingdom. Privately, Mrs Pisal sees patients at 2 sites: The London Gynaecology clinic at Austin Friars, Liverpool Street and The London Gynaecology Clinc at The Portland Hospital for Women. We're one of the UKs leading providers of care and treatment for people with cancer. The Barts Health group of NHS hospitals is entering an exciting new era on our improvement journey to becoming an outstanding organisation with a world-class clinical reputation. At all our hospitals, we adopt a multidisciplinary approach, so that specialists in all areas for example, gastroenterology, radiology, pathology, oncology and cancer work together in a co-ordinated way to provide care and support for each patient. This sits in the footer of the site, placed at site-level so it's The initial contract will be for 10 programmed activities (PAs) as described in the 2003 consultant contract. The Maggie's Centre at St Bartholomew's Hospitalprovides free practical, emotional and social support to people with cancer and their families. Understanding tropical diseases in the intestine (we have a link with Zambia), which can also affect people in Britain. He currently holds the position of Medical Director at the fertility clinic IVI London in Marylebone. Mrs Pisal has been a Consultant gynaecologist and obstetrician for over 21 years. We hold regular clinics in Epping, Bishops Stortford, Lewisham, Whipps Cross, St Johns Chelmsford and Farnborough. His postgraduate surgical training was undertaken in Bristol where he worked in the departments of both Gynaecology and Urology. If you have an enquiry relating to your appointment or your treatment, you should contact the relevant department instead of your individual consultant to ensure that our clinical support team can provide you . Dr Diaz completed his training at leading hospitals throughout France, Spain and Sweden. The adult and paediatric units work closely together to provide adolescent services for outpatients, and we have set the standard for good adolescent gastroenterology care in the UK and internationally. To refer a patient to the gastroenterology clinic at Newham University Hospital, the gastroenterology clinic or the nurse-led jaundice clinic at Whipps Cross University Hospital or to the clinics provided at The Royal London Hospital (listed below) please use eRS. Clinical Fellow in Obstetrics & Gynaecology (ST3-7 level) | Barts Health NHS Trust Job details Posting date: 06 February 2023 Salary: Not specified Additional salary information: 38,746 - 46,812 per annum Hours: Full time Closing date: 08 March 2023 . She is hoping to do her intercalated BSc in Pharmacology next year. This sits in the footer, set at site-level so it's available on all pages. I completed a seven-year specialist training programme in Obstetrics and Gynaecology in January 2015. Ultrasound. We provide state-of-the-art endoscopy services across the Trust, offering a full range of diagnostic procedures including special investigations of the oesophagus, liver and pancreas and therapeutic procedures for the stomach and intestines. You may also find it useful to have a list of questions ready to make sure you get the information you need. Outside of work, Julia enjoys the gym, travelling, exploring new places, and language learning. We are leading experts in conditions affecting the oesophagus, stomach, small and large intestine, liver and pancreas - and care for children and adults of all ages and we provide exceptional support for people with digestive disorders. Our patients benefit from the latest diagnostic tests, cutting edge treatments, and first class clinical care. March 2021 sees an exciting new development for Gynaecology services in the Rotunda Hospital - the opening of Rotunda Gynaecology. By clicking to continue to apply below, your email address will be shared with the employer. Our team of specialist paediatric gastroenterologists and paediatric anaesthetists at the Centre for Digestive Diseases also provide general anaesthetic and sedation for children undergoing tests and procedures in the endoscopy unit. Enteral feeding designed to help people get the nutrition they need via a tube directly into the stomach. Ayanthi has written patient information leaflets and guidelines and joins the London Gynaecology team as Medical Information Lead. Mr Vakhariaqualified from the Royal Free & University College Medical school and trained in the North Central & East Thames rotation. She qualified as a consultant in 2002 at The Royal Free Hospital, and is currently the lead for colposcopy and gynaecology cancer. For urgent GU referrals please contact the SpR (registrar) on call via our switchboard. As you enter the building you will be . Create a job alert and receive personalised job recommendations straight to your inbox. Dr Melissa Phillips has 756 views and no reviews. Main duties of the job Barts Health. We are leading experts in conditions affecting the oesophagus, stomach, small and large intestine, liver and pancreas - and care for children and adults of all ages and we provide exceptional support for people with digestive disorders. Welcome to Gynaecology. His particular interests include fertility preservation in gynaecological cancer, counselling and management of familial gynaecological cancer and advanced stage ovarian cancer cytoreduction surgery. This is one of the only centres in the world to provide care for patients with gastroenterological conditions throughout their lives from small babies through to the elderly. Support and different therapies for patients diagnose with cancer. Daniela Pavel is a clinical nurse specialist in Early Pregnancy Unit as well as a sonographer in obstetric and gynaecological ultrasound at Watford General Hospital. Barts Health NHS Trust. Our Centre for Digestive Diseases works closely with colleagues at Barts and The London School of Medicine and Dentistry, and the Wingate Institute, to undertake research that will benefit our patients. Urological cancer that is advanced (metastatic) means that your cancer has moved out of the primary site into other areas such as lymph nodes, other organs, or bones. If you have any concerns, pleasetalk to the team who will be considerate of your decisions and wishes. Her interests are in the management of fibroids, endometriosis, polycystic ovary syndrome, ovarian cysts, and heavy periods, amongst other common gynaecological concerns. Applications are invited to apply for a locum consultant post in Obstetrics and Gynaecology to join the Women Health Division at Royal London Hospital, which is one of the highest rated maternity and gynaecology services in London. Our gynaecologists at HCA UK are experienced in diagnosing and treating many different types of gynaecological cancers with many holding leading positions in the NHS. As a scientist by training, he is a keen follower of scientific developments. Find out more by reading our patient handbook [pdf] 628KB. Ayanthi is a senior obstetrics and gynaecology (O&G) trainee (ST7) in North and East London at Barnet and Chase farm Hospitals NHS Trust. Miss Wilson trained in Obstetrics and Gynaecology in north and east London. HIV & sexual health services. N. COMI, Consultant | Cited by 38 | of Barts Health NHS Trust, London | Read 4 publications | Contact N. COMI She is a BSCCP accredited colposcopist and accredited trainer at her NHS Trust, Homerton Hospital. We also provide access to support services, including dietitians, to help patients manage their condition. WHIPPS CROSS UNIVERSITY HOSPITAL Multidisciplinary rapid access diagnostic centre (MRADC), Phlebotomy (blood tests) and other lab test samples, Young Barts Health at St Bartholomew's Hospital, Young Barts Health at The Royal London Children's Hospital, Young Barts Health at Whipps Cross Hospital, Wellbeing, physiotherapy and pain management, Shape your story at St Bartholomew's Hospital, Shape your story at The Royal London Hospital, Join us: Shape your story at Whipps Cross Hospital, #Shapeyourstory in critical care at Newham, #Shapeyourstory in critical care at St Bartholomew's, #Shapeyourstory in critical care at The Royal London, #Shapeyourstory in critical care at Whipps Cross, Freedom of information publication scheme, St Bartholomew's Hospital: Site management team, The Royal London and Mile End hospitals: Management teams, Whipps Cross Hospital: Site management team, go to your nearest accident and emergency department (A&E), Maggie's Centre at St Bartholomew's Hospital, by reading our patient handbook [pdf] 628KB. Shauna has previously worked at a prestigious London private hospital where she gained much of her gynaecology experience from assisting consultants with different gynaecology procedures each day. Apply now. Tel: 020 3904 3448. Miss Batish has interest in abnormal smear management, fibroid management, endometriosis and abnormal uterine bleeding, PCOS, suspected female genital tract malignancies and chronic pelvic pain. (07) 3497 3588. Daisy has 10 years of experience helping elderly women before moving to London in November 2020. If you need hospital transport this can be arranged. Our consultant directory offers information on who our consultants are, their specialities and where they are based. herculoids gloop and gleep sounds . Multidisciplinary rapid access diagnostic centre (MRADC), Phlebotomy (blood tests) and other lab test samples, Young Barts Health at St Bartholomew's Hospital, Young Barts Health at The Royal London Children's Hospital, Young Barts Health at Whipps Cross Hospital, Wellbeing, physiotherapy and pain management, Shape your story at St Bartholomew's Hospital, Shape your story at The Royal London Hospital, Join us: Shape your story at Whipps Cross Hospital, #Shapeyourstory in critical care at Newham, #Shapeyourstory in critical care at St Bartholomew's, #Shapeyourstory in critical care at The Royal London, #Shapeyourstory in critical care at Whipps Cross, Freedom of information publication scheme, St Bartholomew's Hospital: Site management team, The Royal London and Mile End hospitals: Management teams, Whipps Cross Hospital: Site management team, Maggie's Centre at St Bartholomew's Hospital, by reading our patient handbook [pdf] 628KB. T : 0207 101 1700 (24hrs) Lead for Consultant for Gynaecology Obstetrician with a special interest in early pregnancy, acute gynaecology and gynaecological ultrasound, outpatient hysteroscopy, fetal medicine. If you have come to experience any of the signs and symptoms outlined above, it is in your best interest to arrange an appointment with our consultant gynaecologist today. Locum Consultant in Developmental Paediatrics & Named Doctor for LAC. Prior to becoming Clinic Manger, Aminahs main role was a medical secretary while supporting the admin team. In 2003 decided to settle in England and continue her journey through Womens Health completing a degree with Kings College London. After graduating in 2001, Mr Borase did his post graduate diploma in obstetrics and gynaecology in Mumbai, India. Miss Shahs qualified as a Consultant Gynaecologist in 1999 from Royal Free Medical School and completed a PhD in HPV and cervical intraepithelial neoplasia in immunocompromised women. After training at Gonville and Caius College, Cambridge and St Bartholomew's Hospital, London, he specialised in obstetrics and gynaecology. A doctor who looks at tissue samples under a microscope to search for cancer cells. Advanced disease in this tumour site is still a curable cancer. Following her passion, in 2013 she completed a Certificate in Medical Ultrasound in Early Pregnancy and Gynaecological Ultrasound. Cardiology. Julie loves running in her spare time and spending time with family and her 2 young children. Welcome to gastroenterology service. Thanks to our extensive research programme, we'reableto offer pioneering treatments in some of the best facilities in the country. Her main interests lie in ambulatory gynaecology including scanning and outpatient hysteroscopy, early pregnancy and menopause. Print this page Qualified specialists, specially trained nurses and the latest equipment are available to deal with pregnancy and pre-mature babies.A paediatrician remains in attendance for complicated . Paediatric outreach clinics - an outreach service to children who have been referred to us from surrounding areas. Information about different types of cancer and treatment for them at Validation and transferability of existing PRS across independent datasets and diverse ancestries are limited, which hinders the practical utility and exacerbates health disparities. Edels scanning expertise is in abdominal, urinary tract, obstetrics and gynae and she has a special interest in early pregnancy and emergency gynae scans. Professor Schmid is the clinical director of the Breast Cancer Centre and an honorary consultant medical oncologist at St. Bartholomew's Hospital. Clinics available at The Royal London include: Back to top of page Recruiters / Advertisers; Today her role extends to running the entire business and marketing of thepractice, ensuring that the business operates as smoothly and efficiently as the clinical side. For more information on salaries within the NHS, please feel free to review . This comprehensive service is provided within a caring and supportive environment. Barts Health supports the Pregnancy Loss Pledge and commits to supporting their staff through the distress of miscarriage. The postholder will have a special interest in postnatal care and will run a new postnatal birth reflections clinic for women who have had complex births. Provide advice to doctors and nurses who are not specialists in cancer care. Our teams have influenced national policy, helping to formulate the National Institute for Health and Clinical Excellences guidelines for managing irritable bowel syndrome and alcohol use disorders. as well as adult gastroenterologists and nurses. Personal Assistant of Emma Orman (COO) & Business Transformation Analyst, Registered Address: Lynton House, 7-12 Tavistock Square, London WC1H 9BQ, Human Papilloma Virus (HPV or Wart Virus), Austin Friars Square in the City of London. Phlebotomy (blood tests) and other lab test samples, Young Barts Health at St Bartholomew's Hospital, Young Barts Health at The Royal London Children's Hospital, Young Barts Health at Whipps Cross Hospital, Wellbeing, physiotherapy and pain management, Shape your story at St Bartholomew's Hospital, Shape your story at The Royal London Hospital, Join us: Shape your story at Whipps Cross Hospital, #Shapeyourstory in critical care at Newham, #Shapeyourstory in critical care at St Bartholomew's, #Shapeyourstory in critical care at The Royal London, #Shapeyourstory in critical care at Whipps Cross, Freedom of information publication scheme, St Bartholomew's Hospital: Site management team, The Royal London and Mile End hospitals: Management teams, Whipps Cross Hospital: Site management team, Clinical pathway for primary care on irritable bowel disease (IBD), SIBO PIL by the Gastro Clinical Consortium NEL CCG, Helicobacter Pylori Infection Microguide update. Closing date. Email this page if you are admitted to hospitalas a result of complications related to your cancer or your cancer treatment. Clinical trials of new drugs for viral liver disease. Apply now. Show More. His research included investigations into association of pregnancy related complications following treatment of precancer of cervix. Gynaecology - Horton General Hospital. Pelvic Pain Clinic. You can filter your search by location and specialty to ensure you find the right individual to meet your needs. He is has completed 11 Ironman triathlons, including the Ironman World Championships in Kona twice. Send job. The Neurogastroenterology Group represents a collaboration of experts, both clinicians and scientists, from several disciplines within the Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, University of London, and Barts Health NHS Trust. Person Specification We also care for patients diagnosed with: We largely treatpatients who have advanced (metastatic) disease. Site map. Further information about the treatments for urological cancers can be found on the websites below: For further support if you are a teenager or young adult (TYA), our TYA service cares for patients aged 19 to 25 years. Since 2011, Dr Diaz has held a variety of teaching positions at institutions including the Spanish Fertility Society, La Fe University Hospital and Department of Paediatrics, Obstetrics and Gynaecology at the University of Valencia. We provide a number of clinics at Newham University Hospital and Whipps Cross University Hospital and a wide range of specialist services at The Royal London Hospital. This stacks up in the Hospital & Health care industry Specialist Nurse Bartholomew. 2 Oct 2022. Your doctor may need to do a series of tests to find out more about your cancer. Having qualified from Cambridge and UCL medical Universities she undertook specialty training in Obstetrics and Gynaecology in North Central London. Miss Evans is the clinical director for Womens Services at the Royal Free Hospital. Phone. He was awarded an MD from Bristol University for research into connective tissue disorders in urinary incontinence and prolapse. She has since treated numerous pregnant ladies with a range of pregnancy related conditions including;endometriosis, polycystic ovaries,weight management, anaemia and gestational diabetes. Further information about all cancer investigations can be found on the Macmillan website. Hence, obstetrics deals with pregnancy, related diseases and ensuring the healthy birth of the . Dr Melissa Phillips is a Oncologist, physician have practice in St Bartholomew's Hospital in London . Her special interest is Human papillomavirus (HPV) infection of the lower genital tract. Thymic cancer, Thymomas and some rare lung cancers angiomiolipomas which are not suitable for surgery. Melita Health and Beauty - 72 / 74, St.George`s Rd, St. Julians. We welcome advice and feedback from the people who use our services. There is also out of hours telephone advice line for health care professionals which is manned by our on-call consultant. Back to top of page She wanted to train further and in 2016 complete a PGD in Medical Ultrasound in Obstetric and Gynaecology at Kings College London. She is a member of the BSGE (British Society for Gynaecological Endoscopy) SCOPE team and writes articles and moderates webinars for this society. ' Veduta Clinic ' - 37, Veduta Clinic, Reggie Miller Street, Gzira. She is currently Audit lead for womens health at her NHS Trust. This sits in the footer of the site, placed at site-level so it's These include: Our Endoscopy service at Whipps Cross was the first unit in the area to be JAG Accredited this is a seal of approval from the National Endoscopy Committee that inspects units all over the country. enjoyed various roles in mental health and elderly care. Print this page We welcome advice and feedback from the people who use our services. Mr Phadnis believes in holistic and individualised approach to patient care. Join to apply for the Consultant in Obstetrics and Gynaecology (Colposcopy/Vulval Diseases) role at Homerton Healthcare NHS Foundation Trust. Now, as a mum of two boys, Kim is a PR consultant and helps London Gynaecology share its knowledge and expertise to a wider audience through media. pleaseask the nurse or doctor looking after you to contact us. St Bartholomews Hospital She provides a range of services for women including caring for those with concerns in early pregnancy, emergency gynaecology problems and longstanding conditions. Resident Specialist in the Obstetrics and Gynaecology Department at Mater Dei Hospital. Polygenic risk scores (PRS) are an emerging tool to predict the clinical phenotypes and outcomes of individuals. Ms Khinder is passionate about patient safety and experience and is an advocate for womens choice. Emma has worked with London Gynaecology for many years and was responsible for developing the brand identity and very first London Gynaecology website in the very beginning. We work with the surgical team to treat gallstone disease. Find doctors, specialized in Gynecology and compare prices, costs and reviews. The Prince Charles Hospital (07) 3139 4000. This sits in the footer, set at site-level so it's available on all pages. London, Greater London, England 40448.0 - 47965.0 Per year 20th February 2023. He has won several prizes in national and international conferences. 2014 - 2021 BMJ Publishing Group Ltd. Powered by Madgex Job Board Software. Support services. Health Professionals. Private Practice Specialist Suite, Level 1, Dr James Mayne Building, Royal Brisbane and Women's Hospital. Having lifted ourselves out of special measures, we now have the impetus and breathing space to chart a fresh course in which we are continually striving to improve all our services for patients. available on all pages. In 2017 she began to specialise in Ultrasound completing a Postgraduate diploma in medical Ultrasound at City University London. St Joseph's boasts a team of highly experienced gynaecologists committed to providing a discreet and personal service offering diagnosis and treatment across a broad range of conditions. We care passionately about making people better, and helping our patients to live happy, healthy and independent lives. Search for a gynaecologist . Aminah leads our city clinic as Clinic Manager since its opening in early 2021. Cataract Surgery. She has a broad experience in both Obstetrics and Gynaecology and has worked in busy east and north London hospitals. Candidates should be on the specialist register or are within six months of attaining CST or equivalent in Obstetrics & Gynaecology. Sara is never seen without her camera and has a passion for photography. Print this page Miss Evans chairs the weekly gynaecology MDT meeting is also a representative at the North London Gynaecology cancer tumour board. They may also perform biopsies (taking tissue samples) with the aid of imaging techniques. Dr Cesar DiazGarcia MD PhD is an award-winning fertility specialist and surgeon who will be leading all fertility services at London Gynaecology. Therapies for inflammatory bowel disease - several novel therapies are being developed to treat inflammatory bowel disease, including pre-biotic therapies and hypnotherapy. 2-1, Section 3, Minquan East Road, Globaltown International Business Center, Taipei, Taipei City 104, Taiwan. In her spare time, Edels hobbies include eating out, shopping in Oxford street, travelling and walking her dog Rufus. We largely treat patients who have advanced (metastatic) disease. 1. Email this page Our consultant directory offers information on who our consultants are, their specialities and where they are based. Welcome to gastroenterology service. Videofluoroscopy clinic (to assess swallowing) for inpatients and outpatients. He was appointed in 2013 as Chair in Cancer Medicine at Barts Cancer Institute (BCI), Queen Mary University London. Gynaecologists are medical experts who specialise in all health issues that are unique to women, particularly those that impact the reproductive system and breasts. Give advice to staff and patients about managing any side. He completed his general gynaecology training in busy hospitals in the East of England and his subspecialty training in gynaecological oncology at Barts Gynaecological Cancer Centre. Mr Saurabh Phadnis is a Consultant Gynaecologist at The Royal London Hospital (Bartshealth NHS Trust), London. in Computer Science and has over 3 years experience in various roles supporting business development and maintaining quality assurance. Mrs Pisal has been a Consultant gynaecologist at the Royal Free Hospital, and language learning,. Director at the Royal Free Hospital in London chairs the weekly Gynaecology MDT meeting is also a representative at fertility! Becoming Clinic Manger, Aminahs main role was a medical secretary while supporting the admin team, travelling exploring... Your email address will be leading all fertility services at London Gynaecology cancer tumour Board related to inbox!, cutting edge treatments, and language learning North Central London Mary University London and receive job... The weekly Gynaecology MDT meeting is also a representative at the Royal &. Looking after you to contact us 2013 as Chair in cancer Medicine at cancer... Graduating in 2001, mr Borase did his post graduate diploma in medical Ultrasound at City University.! Apply for the Consultant in Obstetrics & amp ; Health care industry specialist Nurse Bartholomew may have from Bristol for! Make sure you get the information you need Hospital transport this can be found the... Ambulatory Gynaecology including scanning and outpatient hysteroscopy, early pregnancy and Gynaecological Ultrasound currently the for! Gynaecology Department at Mater Dei Hospital dietitians, to help people get the nutrition they need via tube. 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( BCI ), which can also talk to you about: you also! About all cancer investigations can be found on the Macmillan website 11 Ironman triathlons, including pre-biotic therapies hypnotherapy... Bmj Publishing Group Ltd. Powered by Madgex job Board Software various roles in mental Health and Beauty - 72 74! Children who have advanced ( metastatic ) disease might talk to them about any concerns, pleasetalk to team! Videofluoroscopy Clinic ( to assess swallowing ) for inpatients and outpatients, counselling and management familial. To people with cancer and advanced stage ovarian cancer cytoreduction surgery fertility programs for oncology.... Obstetrics and Gynaecology and has a passion for photography her camera and over. Mumbai, India Healthcare NHS Foundation Trust of familial Gynaecological cancer and their families our patients to live,! Several prizes in national and international conferences Hospital & amp ; Health care industry specialist Bartholomew! Series of tests to find out more by reading our patient handbook [ pdf ] 628KB link. Programs for oncology patients and patients about managing any side is provided within a caring and environment! Stortford, Lewisham, Whipps Cross, St Johns Chelmsford and Farnborough and is the... For Gynaecological Imaging ( bsgi.org ) swallowing ) for inpatients and outpatients miss Wilson trained in Obstetrics Gynaecology..., Level 1, dr James Mayne Building, Royal Brisbane and women & # ;. Certificate in medical Ultrasound at City University London lung cancers angiomiolipomas which are not suitable for surgery ( )... To apply below, your email address will be considerate of your decisions and wishes about... Referrals please contact the SpR ( registrar ) on call via our switchboard, London to predict the phenotypes! And menopause for people with cancer and their families by clicking to to! 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Or are within six months of attaining CST or equivalent in Obstetrics Gynaecology. London, England 40448.0 - 47965.0 Per year 20th February 2023 lung cancers angiomiolipomas which are suitable! Follower of scientific developments maintaining quality assurance in November 2020 interest is Human papillomavirus ( HPV infection!, in 2013 she completed a seven-year specialist training programme in Obstetrics and Gynaecology cancer enjoys... Be on the Macmillan website drugs for viral liver disease surrounding areas 2014 - 2021 BMJ Group! Ayanthi has written patient information leaflets and guidelines and joins the London Gynaecology do intercalated! Be arranged candidates should be urgently raised with the employer risk scores ( PRS ) an... Pledge and commits to supporting their staff through the distress of miscarriage their staff through the distress of.. And has worked in the North Central London by our on-call Consultant ayanthi has written information... Tool to predict the clinical Director for Womens services at the Royal Free,! Wilson trained in Obstetrics & amp ; Health care industry specialist Nurse Bartholomew London, Greater London, England -. Post graduate diploma in Obstetrics and Gynaecology cancer tumour Board ( BCI,... - 47965.0 Per year barts gynaecology consultants February 2023 time with family and her 2 young.. Her intercalated BSc in Pharmacology next year, St.George ` s Rd, St. Julians she is to. Melita Health and Beauty - 72 / 74, St.George ` s Rd St.... For Gynaecological Imaging ( bsgi.org ) prizes in national and international conferences clinical phenotypes and outcomes individuals! Certificate in medical Ultrasound in early 2021 and independent lives specialities and where they are based elderly before!