Standard Operating Procedure Title of Standard Operation Procedure: Delivering Enhanced Care Reference Number: Version No: 6 Issue Date: April 2016 Review Date: April 2018 Purpose and Background Vulnerable patients sometimes require an enhanced level of supervision on the wards to maintain their safety or the safety of others, previously known as specialling. Participation in the national Haelo project enabled the trust to review practice in relation to enhanced care and this procedure outlines the revised processes and documentation in relation to the provision of enhanced care, which can refer to 1:1 supervision or the cohorting of patients. Scope Vital functions affected by this procedure: Escalations (if you require any further clarification regarding this procedure please contact): This document applies to: Matrons / Night Sisters / senior decision makers in relation to the provision of enhanced care All ward staff who are involved in the delivery of enhanced care Michelle Gillespie, Matron Elderly Care michelle.gillespie@nhs.net Committees / Group Date Consultation: Approval Haelo Project Group 2016 Clinical Matrons 2016 Deputy Director of Nursing and Quality 2016
PROCESS This process replaces the previous algorithm used by wards to support the decision making process Assessment of patients requiring 1:1 supervision The flow chart on page 3 is intended to ensure all appropriate steps have been taken when enhanced care is requested for individual patients and to facilitate the best use of resources. It is not intended to replace individual judgement in an acute situation. ROLES AND RESPONSIBILITIES Matrons / Night Sisters Matrons / night sisters are responsible for ensuring: Ward compliance with the process All bank requests are appropriate, following the completion of the risk assessment. Senior Sister Senior sisters are responsible for ensuring: Ward staff are compliant with the process The enhanced care risk assessment is completed for all patients where concerns are raised about their safety, and all other less restrictive options have been considered Role cards are used to provide guidance and set expectations for those delivering enhanced care Those delivering enhanced care complete activity records and handover the patient to the nurse in charge to support informed decision making All patients receiving enhanced care are reviewed every 24 hours to reassess the level / appropriateness of supervision. All ward staff All ward staff are responsible for ensuring: They maintain compliance with the process The risk assessment is completed where concerns are raised about a patients safety Conversations with relatives / carers are appropriate and sensitive to their circumstances The subsidised car parking process is offered where appropriate and where the criteria has been met Activity records are completed by staff delivering enhanced care Those delivering enhanced care provide a patient handover. SUPPORTING DOCUMENTATION Document Appendix Page no. Enhanced Care Risk Assessment & care plan Appendix 1 Page 5 Staff role card Appendix 2 Page 7 Activity Record Appendix 3 Page 9 Communication aid Appendix 4 Page 11 Patient leaflet Being involved in your relatives care Appendix 5 Page 13 Family / carer role card Appendix 6 Page 19 Carers care plan Appendix 7 Page 21 Free car parking SOP Appendix 8 Page 23 Care parking application Appendix 8.1 Page 27 2
Assessment of patients requiring Enhanced Care Patient is admitted to the ward Maintain normal nursing levels. Continue to monitor No Are there concerns about staff ability to maintain the patients safety e.g. falls / confusion? No Yes Complete Enhanced Care Risk Assessment & care plan Does the patient require Enhanced Care i.e. 121 supervision or cohorting The RA will prompt staff to consider immediate actions to reduce the risk before assessing the level of risk e.g. - Medical / medication review - Septic screening - Address environmental concerns - Falls risk assessment - Intentional / comfort rounding Yes Introduce carer role cards and activity records Are there concerns about the patients capacity to make decisions? Yes Complete mental capacity assessment decision specific e.g. trying to leave or non compliant with treatment Offer subsidised car parking and complete application if required (See Subsidised Car Parking SOP) Complete carers care plan & provide leaflet Being involved with your relative s care in hospital Yes No Are family carers able to support delivery of enhanced care No Yes Does the patient have capacity? No Complete DOLS Allocate staff to cohorting / 121 duties as required Yes Can enhanced care be delivered within establishment? Introduce staff role cards and activity records No Escalate to senior nurse / matron / night sister Use activity sheets / handover to monitor and review patient needs 24 hourly. Document on risk assessment Request bank shift on Health Roster using Haelo codes KEY Action Decision Document Database 3
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Appendix 1 5
Date Appendix 1 Ward nurse to review individual patient needs Circle After completing the risk assessment overleaf, do you feel in your professional judgement enhanced care is still required Yes No Are other patients within the clinical area receiving enhanced care? If yes, consider cohorting patients to enable closer supervision and interaction Yes No Does the patient usually settle overnight? If yes consider a twilight HCA shift that will finish at midnight Yes No Does the patient require a behaviour chart? Yes No Please review if a special is required for a day shift only or both day and night shift. (If the patient is sleeping overnight do they need a special?) Shift DAY NIGHT Can the patient's care be safely manitained within usual staffing levels YES / NO YES / NO If no indicate risk reason (RAG overleaf) Assessment completed by: Print: Sign: Date & time: NIC / Senior Sister to authorise the booking of an additional HCA to deliver enhanced care Identify what risk reason (Red, Amber, Green) If risk level green or amber in your clinical judgement is an additional HCA required? Please state reason why you are authorising Recommendation (use algorithm as stated on the form) Authorised by: Print: Sign: Date & time: RE-ASSESSMENT OF RISK Nurse in charge to document they have reassessed every 24 hrs Can the patients care now be safely If no indicate risk reason (RAG Date Time maintained within the usual staffing Sign overleaf) level? Order from print room ref: CPY1540 6
Appendix 2 7
Appendix 2 Blank page 8
Appendix 3 V1 Haelo Project: Delivering enhanced care to our patients Enhanced Care Activity Sheet We have reviewed our processes regarding the delivery of enhanced care. We want to ensure that all our patients receive quality, personalised care and that those who are spending an extended amount of time with a patient can plan their care based on what we know improves the patient s experience. If you are delivering enhanced care, please complete this activity sheet and record how the time was spent with the patient. This information will be shared at handover and will help to ensure the patient continues to be supported in the most appropriate way. Delivering enhanced care is an opportunity to engage with the patient and encourage activities that will make their stay a more positive experience and alleviate the risks that have been identified. Ideas could include: reading to / with the patient, doing their nails, knitting, drawing, colouring, playing card games, chatting, listening to music The ward should have a range of activities that can be used to support this but even the simplest of ideas can have a positive impact. Patient name DOB NHS No Complete this activity sheet if you are delivering enhanced care to the patient; that is, if you are giving 1:1 supervision for a period of time. The information will ensure the patient is supported with activities that improve their experience and will assist with the handover of the patient Date Name / role of person delivering enhanced care Time from Time to Please describe any activities you have undertaken with the patient today. What did they engage with? What did they enjoy? What alleviated the identified risks? Please describe any areas of concern. Which activities did the patient not enjoy or struggle with? What patient behaviours did you struggle with? 9
Appendix 3 Date Name / role of person delivering enhanced care Time from Time to Please describe any activities you have undertaken with the patient today. What did they engage with? What did they enjoy? What alleviated the identified risks? Please describe any areas of concern. Which activities did the patient not enjoy or struggle with? What patient behaviours did you struggle with? Print room CPY 1575 10
Appendix 4 Enhanced Care Communication Aid Assisting staff to have conversations with family / carers about supporting their relative s enhanced care. When a patient is identified for enhanced care, we want you to discuss with their family if they are able to support this, as we know that a familiar face can have a really positive impact on a patients stay in hospital. We know that not all relatives are able or willing to support enhanced care and it can sometimes be difficult to broach the subject. This document is not intended as a script; rather it is an aid to support what we know can sometimes be a difficult conversation. We do not want families to feel that we expect their involvement, however at the same time, some families just need to hear that we welcome them onto the ward and value their expertise. The timing of the conversation is really important; be aware of non-verbal communication is now the right time to discuss their involvement? If not, wait for a more appropriate opportunity to talk to the family. 1. Be positive and welcoming: Greet the relative / carer, give your name and explain what you want to discuss. Example: Hello my name is and I am a [role]... Is it ok if I discuss your relatives requirements?...as part of your relatives care in hospital we would like to know more about them to make sure we provide care that really meets their needs 2. Small talk creates a conversation flow: understand more about patients and their relatives / carers. Demonstrate active listening and acknowledge the importance of continuing all elements of their care in partnership with nursing staff during their hospital stay. Examples: So tell me, what sort of things can they manage at home? What do they find difficult? How do you find you mainly help out when they are at home? How do others support them in the home? What do you think would be useful for us to know? Is there anything important that we should carry on with in hospital? Do you have any worries about their stay? 3. Offer a partnership approach to enhanced care: Ask the relative if they would like to be involved in their relatives care whilst in hospital. Be clear on what types of duties they would carry out. Examples: We want to make sure your relatives stay in hospital is safe, comfortable and positive. Do you want to help with this by supporting some the care needs they might have? All the nursing and clinical elements will be met by us, but if you want to work in partnership with us to make sure we enhance their stay you are very welcome. We can sit with you and think about planning some of the elements you could be involved in and document it on the care plan. Would that help? You could help with reassuring them in a new environment, give some basic care like helping them at meal times, you could sit and talk to them so they don t feel alone, you could help us by being part of the decision making your expert knowledge would be really useful. It s entirely up to you how involved you want to be 4. Necessary support and information for relatives / carers: make sure you outline how their needs will be met. Examples: If you choose to support enhanced care to your relative, you will be entitled to free car parking for the duration of their stay. We operate a welcome policy which means visiting times do not apply. You will be able to be with your relative at any time day or night. You don t have to do anything you are not comfortable with. If you need a break let us know it s up to you how long you want to provide care for. Just let us know what you can offer and we will work together to support you with this. You are always welcome. If you need a drink just let one of the staff members know, it s no problem at all. We ll make sure you know the layout of the ward and where everything is. If you have any questions just ask us at any time, we re here for you too. 5. Information: Please ensure a being involved in your relatives care in hospital leaflet is given to all families where their relative has been identified as requiring enhanced care Examples: if you need time to think about it that s fine, just let us know if you decide you want to be involved. Here is a leaflet about supporting the care of your relative in hospital, it summarises what we have discussed and gives you a bit more information. If you have any questions, please ask us at any time, we really value your input and advice. Thank you for your time and help. Based on communication aid from East Lancashire Hospitals 11
Appendix 4 Blank page Based on communication aid from East Lancashire Hospitals 12
Appendix 5 Patient Information Leaflet Supporting Enhanced Care Being involved with your relative s care in hospital Information for relatives and carers Macclesfield District General Hospital www.eastcheshire.nhs.uk Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 13 13
Appendix 5 Patient Information Leaflet What is enhanced care? Sometimes patients require an enhanced level of supervision whilst they are an inpatient at Macclesfield District General Hospital. This will mean that the patient must be closely supervised, often on a one-to-one basis, to maintain their safety or the safety of others. This may be needed all the time, day and night, or just for certain periods of time. Enhanced care is not uncommon; many patients are receiving an enhanced level of supervision at any one time. In these cases, the trust provides additional staffing to deliver enhanced care, however we know that patients can benefit from having people around them who they know as this can help them to feel more secure in an unfamiliar environment. Therefore we are keen to support people who want to be involved in the care of their relative or the person they are caring for while they are with us. Ward staff may ask the family / carers if they are able to be involved in the delivery of enhanced care for periods of time. The patient must give their consent (if they are able) for you to care for them in hospital. If you are able to be involved, we will complete a care plan with you which will document how and when you are able to support your relative. Please do not worry you can speak to a member of nursing staff at any time if you change your mind about the plan. If you wish to be involved with the patient s care Staff will discuss the following with you and document in the care plan: What care do you usually give? Have you been trained in delivering any care? What do you feel you are or are not able to do? Whether the patient has any special equipment which may be brought in to support them. When you would be able to help at mealtimes for instance. They will also explain to you: How much care you can safely be involved in. Any limits or restrictions because of the patient s current illness. Infection control procedures on the ward such as: o Hand washing o Being naked below the elbow. Our priority is our patient s recovery however your health and wellbeing is important to us as well. Please do not feel that we are placing an extra burden on you. Staff will check regularly to see how you are feeling and whether you wish to have more or less involvement. You can always change your mind if you are finding it too much. Supporting patient care On your first visit: To make sure you are comfortable and safe around the ward we will talk to you about the following: Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 14 14
Appendix 5 Patient Information Leaflet Location of kitchen and toilets etc. Basic infection control procedures including hand washing, and the need for naked below the elbow in clinical areas such as wards, units and clinics Consideration of other patients privacy and dignity so that men and women patients are in separate areas What level of care you can provide e.g. manual handling. Meals ensuring that the patient has the correct nutritional needs for their condition Confidentiality relatives and carers may be asked to leave the ward at handover and during ward rounds involving other patients Basic trust policies The fire procedure. Each time you come to the ward or unit: Please report to the nurse in charge of the ward, who will introduce you to key members of staff. You will be issued with an Enhanced Care ID badge for the duration of your visit. Please tell staff when you are leaving and update them about the patient s condition Staff will ensure you are offered a drink if you are there for a few hours. There is a Restaurant, WRVS café and vending machines which you are welcome to use. If you are staying overnight, staff will give you a comfortable chair and blankets. Criteria for subsidised car parking At East Cheshire NHS Trust, as with many other NHS organisations, visitors are required to pay for parking their cars on site. However, where family / carers are supporting the delivery of enhanced care for their relative at the request of the ward, it is possible to exempt them from parking charges, which means there will be no cost to park for the duration of their stay. You will be eligible for subsidised car parking if: Ward staff have identified that your relative would benefit from enhanced care and you are able to support this You complete a Carers Care Plan with ward staff which will document how you will support the plan of care. We are unable to subsidise car parking charges for family / carers who visit their relative without an agreed plan of care You park only in visitor s car parks. You are not permitted to park in permit holder staff car parks and may result in a Parking Charge Notice being issued. We are unable to provide dedicated parking spaces for family / carers supporting enhanced care. Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 15 15
Appendix 5 Patient Information Leaflet How do I access subsidised car parking The ward staff will ask for your car registration details. These will be forwarded to the Car Parking Team who will arrange for your vehicle registration to be exempted from car parking charges for the duration of your relative s stay. You will not require a permit to display in your vehicle as the registration is logged and recognised by the camera system. Registration details may be given for up to 3 family members / carers who are named on the care plan. What do I do once I have applied for subsidised car parking? You do not need to do anything else. The camera system will recognise your registration(s) and you can park in the visitor s car park without purchasing a ticket or incurring a Parking Charge Notice. However, please inform the ward staff if: Your vehicle registration changes. The Car Parking Team will need 24 hours notice to update the information into the camera system Your relative is still in hospital beyond the expiry date of the permit as it will need extending. The Car Parking Team will need 24 hours if the exemption needs extending If you have applied for subsidised car parking, you can use the space below to record notes for your information. Car Registration Car Registration Car Registration Expiry date Notes............ Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 16 16
Appendix 5 Patient Information Leaflet For further information on the references and sources used for this leaflet, please contact 01625 661184. Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on 0800 195 4194. East Cheshire NHS Trust operates a smoke-free policy (including e- cigarettes) For advice on stopping smoking please contact our Stop Smoking Service on 0800 085 8818. East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 17 17
Appendix 5 Patient Information Leaflet Blank page Contact: 01625 421000 www.eastcheshire.nhs.uk t @eastcheshirenhs t @echonhscharity Leaflet Ref: Published: Review: Page 18 18
Appendix 6 19
Appendix 6 Blank page 20
Appendix 7 V1 Enhanced Care Relative / Carers Care Plan Care plan to be reviewed on a daily basis by registered healthcare professional Has an Enhanced Care Risk Assessment been completed for this patient? Yes / No Care plan number Name of staff commencing care plan Ward Care element Relatives wishing to be involved in enhanced care Desired outcome For the patient to receive enhanced care by relative / carer within the hospital environment Care / Action plan a. Patient consent to receive care from relative Patient EDD - ascertain level and specific aspects of care that relative wishes and is competent to be involved in. Record in nursing records. - Obtain consent from patient for agreed care to be delivered by relative - Full discussion with patient and relative / carer regarding desired outcomes of care and any change in care b. Orientation and induction to ward area and basic trust policies - General orientation to the layout of the ward and who to report to - Fire procedure - Hand washing and basic infection control procedures - Naked below the elbow in clinical areas c. Other considerations - Same sex - consideration of other patients privacy and dignity - Boundaries with regard to level of care provided by relative e.g. manual handling and nutrition [document overleaf] - Confidentiality - relatives / carers may be asked to leave the ward at handover and during ward rounds involving other patients d. Communicating with the ward - Agree planned episodes of care with ward where possible [document overleaf] - Relative / carer to report to nurse in charge on arrival and leaving the ward to allow communication of update on patients condition, review care plan and to collect / return visitors ID badge Date Patient ID label Actioned Staff initials 21
Appendix 7 V1 Specific patient needs Identification of specific care to be delivered by relative / carer. Include any documentation that may be completed Commenced Discontinued Recommenced Date Date Date Identification of specific areas of care that require healthcare professional - relatives/carers should not get involved Date relative / carer informed Staff initals Planned schedules of care Document if there are specific times of the day/week that relative/carers can commit to assist with enhanced care If not request for relative / carer to inform the ward in advance where possible when they are able to attend the ward to assist with enhanced care. Day / date Time Subsidised car parking By committing to a plan of care, family / carers are eligible for subsidised car parking whilst their relative is an inpatient and they are actively supporting the delivery of enhanced care - Inform relative / carer of process for subsidised car parking - Complete application form if applicable and send to car parking office - EDD must be recorded and visible to ensure parking permits can be extended if required - Ensure relative / carer is aware of their responsibility to provide registration details and park in visitors car parks on Date actioned Staff initials Signed agreement: Relative/carer Date: Staff: Date: 22
Appendix 8 Standard Operating Procedure Title of Standard Operation Procedure: Enhanced care free car parking Reference Number: Version No: 1 Issue Date: April 2016 Review Date: April 2018 Purpose and Background Scope Vital functions affected by this procedure: Escalations (if you require any further clarification regarding this procedure please contact): The recent Haelo project focused on improving the delivery of enhanced care to vulnerable patients. A review of process highlighted that, although we welcome families and carers to support the delivery of enhanced care, there was a need to make it easier for them to do so. One of the agreed changes was the need to provide parking at no cost for those family members / carers who actively support the delivery of enhanced care. This document applies to: all ward staff who identify patients at need of enhanced care through the completion of the enhanced care risk assessment all ward staff who liaise with families / carers regarding the provision of enhanced care Estates team who manage the car parking process / allocation of permits Michelle Gillespie, Matron Elderly Care michelle.gillespie@nhs.net Committees / Group Consultation: Haelo Project Group 2016 Clinical Matrons 2016 Approval Committee Deputy Director of Nursing and Quality 2016 Date 23
Enhanced care is the close supervision of vulnerable patients who are admitted to the wards. This care is generally provided by nursing staff, either from the ward establishment or extra bank staff, and can be on a 1:1 or cohorted basis. ECNHST also welcome family / carers to support the delivery of enhanced care for their relatives, as patients often benefit from having people around them who they know. A familiar face can help a vulnerable patient feel more secure in an unfamiliar environment and help to make their stay a more positive experience by reducing levels of agitation and distress. It has been agreed that family / carers who support the delivery of enhanced care for their relative will be eligible for subsidised car parking. For the period of time their relative is in hospital, they will be able to park free of charge in the visitors car parks. Eligibility criteria An enhanced care risk assessment must have been completed for the patient which identifies the need for enhanced care The family must have completed a carers care plan with ward staff documenting how they will support the plan of care Process The process is documented in the algorithm (see page 3) Not all family / carers will be able or willing to support enhanced care. Staff should be aware that the request to relatives to support the process needs to be a sensitive conversation based on individual circumstances ROLES AND RESPONSIBILITIES Ward Staff Ward staff are responsible for ensuring The patient agrees to the family / carers supporting enhanced care delivery The carers care plan is completed with the family / carer The patients expected discharge date (EDD) is identified and documented, including at the patient s bedside The car parking application is completed and sent to the parking office in a timely way. Electronic versions of the form can be found on the forms and templates section of the Infonet The car parking office are informed if the EDD is extended to allow the permit to be extended Family / carers receive enough info to understand their role and responsibilities in the process Family / Carers Family / carers are responsible for ensuring The correct registration details are given to the ward Any change in registration are given to the ward with 24 hours notice Compliance with the request to only park in visitors car parks Car Parking Office The car parking office are responsible for ensuring Vehicles are exempted from parking in patient and visitor spaces Any amendments to the permit e.g. change in registration / extensions are actioned in a timely way SUPPORTING DOCUMENTATION Enhanced care: car parking application Appendix 8.1 Page 21 24
Enhanced care subsidised car parking process Phase Car parking office Family Ward Patient Patient admitted to the ward Expected date of discharge is identified and documented No Organise staff resource Risk assessment identifies the need for enhanced care Are the family able to support the delivery of enhanced care? Discuss with family / carer if they are able / willing to support enhanced care Yes Complete a carers care plan with ward staff Complete car parking application form Patient is discharged from the hospital Provide ward staff with vehicle registration details Send form via email to ecn-tr.carparking@nhs.net Or post to Car Parking, Hope House, MDGH Car parking office receive car parking form Is discharge on the expected date of discharge Yes No, later Expected date of discharge has been extended Carer can park on visitor car park until expected date of discharge Organise permit for vehicle(s) No, earlier Inform car parking office so permit can be extended Extend parking permit Inform car parking office if it is before the expected discharge date End permit Key Start of process Action Document Question End of process 25
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Appendix 8.1 V0.2 Enhanced care Subsidised Car Parking Application Where family / carers agree to support the delivery of enhanced care for their relatives whilst they are an inpatient, they will be eligible for free parking at Macclesfield District General Hospital. Eligibility criteria: A carer s care plan must be completed detailing the plans for the delivery of care. Application for car parking Please complete the following details with the relative / carer and: Send via email to: ecn-tr.carparking@nhs.net Ring the details through to the car parking office on 3845 / 3650 and follow up with the form in the post to: Car Parking Office, Hope house, MDGH The vehicle (s) will then be exempted from car parking charges when parking in patient and visitor spaces. The family will not require a permit to display as only the vehicle registration is required for the camera system. The exemption will expire on the patient s expected date of discharge. If a patient is kept in longer than the expected discharge date please inform the car parking team who will extend the exemption. Date Family name Car registration(s) Families can register up to 3 car registration) 1. 2. 3. Expected date of Discharge This will be the expiry date for the permit Ward making application Name of staff member submitting application Signature of relative / carer 27
Appendix 8.1 Privacy Statement East Cheshire NHS Trust (ECNHST) will register your parking by using the name and details you provide and will use this data in conjunction with the automated number plate recognition system data to monitor the proper use of the car parking facilities. We will share your personal data with ParkingEye Ltd who will record and process the personal data supplied in relation to car parking at ECNHST car parks. By providing this data, you do so giving your full consent for that data, i.e. your vehicle information and the time and date of your arrival and departure at site to be recorded and processed by ECNHST and ParkingEye Ltd for the purpose of ensuring compliance with the parking restrictions communicated and data gained by the processing of such data may be used in connection with the validity of your application and the checking of compliance with your employee handbook and/or policies and procedures. This notice applies in addition to any notices previously supplied via onsite signage and any disputes under this notice shall be subject to English Law and shall be the exclusive jurisdiction of the English courts. By being placed on notice of this Privacy Statement, you give your full consent for your personal data to be recorded and processed by ECNHST and ParkingEye Ltd for the monitoring and compliance with the car parking restrictions at ECNHST car parks. It is the family/carers responsibility to ensure the correct registration details are provided and that any changes or amendments to registrations are submitted within 24 hours to the ward which should then be forwarded on to the car parking office to prevent any Parking Charge Notices being issued. Please be aware that these parking privileges will only be available within visitor s car parks and all family and carers should refrain from parking in staff car parks as doing so will cause them to be issued with a Parking Charge Notice of 70 or 40 if paid within 14 days. 28