The Walton Centre BB R12 by bereavementadvice

NHS

The Walton Centre

NHS Foundation Trust

Information for families following a bereavement

We are sorry you have lost a loved one. Please accept our condolences.

Contents Introduction...................................................................1 Understanding what happened.....................................2 What to do first..............................................................3 The Funeral...................................................................4 The Mortuary.................................................................5 Medical Examiner..........................................................6 The Coroner..................................................................9 Post Mortems................................................................11 Who needs to be told about the death..........................13 Reviews of deaths in our care.......................................15 Investigations................................................................15 Stopmail........................................................................18 Grieving.........................................................................18-22 Counselling....................................................................23 Support Organisations..................................................23-27 Remembering................................................................29 Treasured Memory Box.................................................30

Introduction We would like to express our condolences to you, your family and friends during this extremely difficult time. The days following a bereavement can be extremely hard but there are formalities which must be dealt with promptly. We hope that you will find this booklet helpful for some of the arrangements that need to be made. It is designed to provide practical advice and guidance on who can help and where further information can be obtained, as well as explaining procedures such as registering a death and arranging a funeral. This leaflet also aims to explain what happens next; including information about how to comment on the care your loved one received and what happens when a Coroner or medical examiner investigates a death. It also provides details of the processes involved if you have any significant concerns about the care we provided and gives you practical advice, support, and information. Guidance and who to turn to If you are unclear about any matter, please ask for help or support from any of the following people: ward staff, clinical team, hospital chaplains, your GP or our Patient Experience Team. Funeral directors are very helpful and will guide you as much as they can.

Contacting us Telephone: 0151 556 3090/3091 Monday - Friday 9am - 4pm Email: wcft.patientexperienceteam@nhs.net Write to: Patient Experience Team, Sid Watkins Building, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ Speak: Asking at one of our main reception desks to speak to a member of the Patient Experience Team (between 9am and 4pm). Understanding what happened As a family member, partner, friend, or carer of someone who has died whilst in the care of The Walton Centre, you may have comments, questions or concerns about the care and treatment they received. You may also want to understand more about the reasons for their death. The staff who were involved in treating your loved one should be able to answer your initial questions. However, please do not worry if you are not ready to ask these questions straight away, or if you think of questions later - you will still have the opportunity to raise these with us when you are ready through the Patient Experience Team. It is also important for us to know if you do not understand any of the information we provide. Please tell us if we need to explain things more fully.

What to do first In the first instance, please contact the Critical Care Administration Team the next working day, after 10am to leave the contact details of the person you wish the team to communicate with, they will explain what you need to do next and help with any questions you may have. Tel: 0151 556 3797 Office hours: 9.00am to 4.00pm Monday to Friday (excluding Bank Holidays). The Medical Certificate of Cause of Death (once completed) will be emailed directly to the Register Office by the Administration Team. When this has happened, the Team will contact you and inform you of the recorded cause of death. They will provide you with the contact details for you to make an appointment with the Register Office. Please do not make an appointment with the Register Office until you have been advised that the required forms have been completed. The ‘green form’ that the funeral directors require will be emailed directly to the cemetery or crematorium office by the Register Office. Any personal belongings of your loved one will be stored securely in the ward area / hospital safe. You will need to contact the ward to arrange an appointment for the collection of these items.

The Funeral It is important that any Will made by the person who has died, is read as soon as possible, as it may include their wishes regarding their funeral. Contact the funeral director of your choice as soon as possible, even before you obtain the Medical Certificate of Cause of Death. The funeral director will be able to advise you on any arrangements you need to make. Members of the National Association of Funeral Directors give a full estimate of charges at the time of taking instructions. Do not be afraid to discuss ways of reducing the cost quoted. For contact details please refer to your local telephone directory or refer to the telephone numbers in the back of this booklet. If you receive Income Support, Family Credit and/or Housing Benefit, you may be entitled to help with funeral costs. You will need to apply for help and advice to your local Department of Social Security.

The Mortuary The body of the deceased is held within the Liverpool University Hospital Foundation Trust (Aintree) Mortuary until the death has been registered at the Liverpool Register Office and arrangements have been made with your chosen Funeral Director. The mortuary does not have a Chapel of Rest but does have a designated area for viewing and identification. Requests for appointments for viewing the deceased by family and friends should be made by calling: Mortuary 24h Service Monday - Friday 9.00am to 4.30pm - 0151 529 3482. The Medical Certificate of Cause of Death (MCCD) and the Medical Examiner The MCCD is a legal document which enables the death to be registered. The certificate can only be issued by a doctor who knows the cause of death and has had permission to issue from the Medical Examiner or HM Coroner. When the MCCD has been completed, and sent to the Registrar’s office we will contact you to let you know the next steps.

The Medical Examiner The Medical Examiners (ME) are senior doctors who have received specialist training in the clinical and legal elements of death certification processes. The ME is always independent of the case and will not know or have treated the deceased person on which they are carrying out scrutiny of the circumstances of death. They will: • Complete a review of the medical, nursing, therapy, and diagnostic records. • Speak with the attending doctor. • Discuss the cause of death with the next of kin and establish if they have any concerns with the care that could have impacted / led to death. This process should be completed within 24 hours (subject to weekends and bank holidays). The ME will contact you by phone and establish if you have any concerns with the care the deceased received that could have impacted or led to the death. This is your opportunity to have an open and honest conversation with someone not involved in providing care to the person who died. The clinical team will complete the MCCD. The MCCD will be sent electronically to the Liverpool Register Office, you do not need to attend the Hospital to collect the paperwork.

Registration of Death When the MCCD has been completed you will be contacted by the Administration Team, and advised to contact the Liverpool Register Office to make an appointment to register your loved one’s death, this is a face to face meeting. Deaths must be registered within five days (excluding weekends and bank holidays). You will need to take: • •

The deceased’s NHS Medical Card (if possible). Any war Pension books.

You will need the following information: • Full name and usual address (maiden name if applicable) • Date and place of birth • The date and place of death • Occupation and occupation of Spouse if married/ civil partnership • Details of any public sector pension e.g. civil service, teacher or armed forces • State Pension and benefits received • The name and date of birth of any surviving widow/ widower or civil partnership

Where to register the death The death must be registered at the Register Office for the district where death occurred, no matter where the deceased lived. Contact details: Liverpool Register office St Georges Hall St Georges place, L1 1JJ. To make an appointment to register a death please ring 0151 233 3004. Hours of attendance Monday-Friday 9.15am - 4.15pm Email: registrar@liverpool.gov.uk Alternatively, you can book online www.liverpool.gov.uk and navigate to the section on births, marriages, deaths. Who can register the death? • • •

A relative of the deceased Someone present at the death The person making the funeral arrangements

The Death Certificate will be issued on the day of the appointment, please note if English is not your first language you may need to take someone with you. There is a charge for additional copies of the Death Certificate. Some organisations will only use an original copy eg. Banks or Building Societies so you may wish to purchase extra copies. If you live outside the Liverpool area and it would cause difficulty for you to register the death at the Liverpool office, you can go to your local office. This process will take longer and may cause a delay to the funeral. Addresses and telephone numbers for local register offices can be found in local directory and online. 8

HM Coroner Under certain circumstances (see below), the doctors at The Walton Centre will not be able to issue an MCCD, in such cases the Doctor must refer to HM Coroner. Such circumstances are: • All sudden and unexplained deaths, where the cause of death is unknown • Where the cause of death is unnatural, e.g. suicide, accidents, poisoning • If the death occurred while the patient was undergoing a medical procedure or has had surgery within 24 hours • If the deceased was initially admitted to hospital because of a trauma (including falls) • If the death is caused by an industrial disease • Custodial death, arrested by the police, detained in prison or under the mental health act If the death is to be reported to the Coroner, they may ask the team who looked after the person for more information, and they will also contact you. The Coroner will make the decision on what happens next. The involvement of the Coroner may cause some delay, it is important to advise your funeral director as soon as possible.

Coroner’s post-mortem examination The coroner may order a post-mortem examination to determine the exact cause of death, if so, this is a legal obligation and there is no right of refusal. In such circumstances, a certificate of death required to register the death will be issued by the Coroners’ Office and sent directly to the Registrar’s office. Contact details for HM Coroner 0151 233 5770 or 0151 233 0141 Monday-Friday 8.30am - 4.15pm Address: Liverpool Coroner’s Office Gerard Majella Courthouse, Boundary Street Liverpool L5 2QD. If an inquest is held The death cannot be registered until after the inquest, however, the Coroner can give you an interim death certificate to prove the person is dead. You can use this to let organisations know of the death and can still hold a funeral. At some time in the future, the inquest will be reconvened. The family can listen to all the evidence with the coroner and ask any questions they like. At this stage, documentation will be sent to the Registrar of Births and Deaths and a Death Certificate issued.

Hospital Postmortem There are occasions when the clinical team involved on the care of the deceased may ask for consent to carry out a hospital postmortem examination and you may be asked to give permission* for this examination to be carried out. You will be given every opportunity to discuss the circumstances with a clinician before making your decision or signing the necessary forms. The postmortem examination is carried out sympathetically and should not delay the funeral arrangements and it may assist in the treatment of other patients in the future. The results may be obtained from the deceased’s General Practitioner. * By consenting to this examination, the Medical Certificate of Cause of Death can still be completed, you can register the death and make the funeral arrangements. This should not delay the funeral arrangements.

Location of Liverpool Coroner’s Office

Who needs to be told about the death You will probably want to let the family, friends and neighbours know of the death right away. There are several other people who may also need to know. These are:

Done

The Priest, Vicar or Minister of other Faiths Family Doctor The Benefits Agency (pensions, benefits) The Bank, Giro, Credit Cards, Building Society Social Services (home helps, home care) Schools, College or University attended Place of Work (occupational pension) Executors of the Estate (Will) Solicitor Insurance Companies Library service Inland Revenue Residential or Nursing Home Landlord, Housing Department Council Tax Offices Electricity, Gas, Telephone, Water Companies Post Office (redirect mail) D. V. L. A. Swansea Careline Cancel any appointments including hospital appointments

The deceased may have been living alone so you will need to ensure that their home is secure and remove all signs that indicate no-one is there. You may wish to collect spare keys from other relatives, friends and neighbours. 13

Sample letters Here is an example of a letter that you may find useful when informing people about the death.

[ Your Name] [Your Address] [Your Postal Code] [Your Telephone Number] Date: [Address to whom you are writing] [Name] [Department] [Company] [Road] [City] [Postal Code] Dear Sir/Madam, I wish to inform you of the death of [name of deceased and date of birth]. Please find enclosed with this letter the documentation/papers which need to be returned to you. [Name of deceased] died on or at [hospital name or home address] on [date]. If you require any further information please contact me at the above address. Yours faithfully

[Your name]

Please note if you are writing to a solicitor, Bank, Building Society or Insurance Company you will need to include a copy of the Death Certificate. Photocopies are not accepted for insurance or legal reasons. You may need to include the relevant account and policy numbers if available. 14

Reviews of deaths in our care All hospitals are required to review the care of people who have died in hospital. A specialist doctor who was not directly involved in the deceased patient’s care will look carefully at the deceased’s health records. They will look at every aspect of care and how well it was provided. When a routine review finds any issues with a patient’s care, we will contact their family to discuss this further. When conducting a case note review, we also take into account any significant concerns raised with us about the care we provided to a patient. We consider a significant concern to mean: (a)

any concerns raised by the family that cannot be answered at the time; or

(b)

anything that is not answered to the family’s satisfaction, or which does not reassure them

Investigations All hospitals have a duty to be open and honest in the event of any incident where harm may have been caused to a patient. In a small percentage of cases, there may be concerns that the death could be or is related to a patient safety incident. A patient safety incident is any unintended or unexpected incident, which could have, or did, lead to harm for one or more patient’s receiving healthcare. Where there is a concern that a patient safety incident may have contributed to a patient’s death, a safety investigation will be undertaken. The purpose of a safety investigation is to find out what happened and why. This is to identify any potential learning and to reduce the risk of something similar happening to any other patients in the future. 15

If an investigation is to be held, we will inform you and explain the process to you. We will also ask you about how, and when, you would like to be involved. In some cases, an investigation may involve more care providers than just The Walton Centre. For example, your loved one may have received care from several organisations (that have raised potential concern). After the report has been signed off, the hospital leading on the investigation will make arrangements to meet with you to further discuss the findings of the investigation. You may find it helpful to get independent advice about taking part in investigations and other options open to you. Some people will also benefit from having an independent advocate to accompany them to meetings etc. Please see details of independent organisations that may be able to help, later in this leaflet. You are welcome to bring a friend, relative or advocate with you to any meeting. Where the death of a patient is associated with an unexpected or unintended incident during a patient’s care, staff must follow the Duty of Candour Regulation/Policy (https://www.cqc.org.uk/guidance-providers/all-services/ regulation-20-duty-candour). AvMA (Action Against Medical Accidents (www.avma.org.uk) has produced information for families on Duty of Candour which is endorsed by the Care Quality Commission.

Tell us once If someone you know has died, the amount of unwanted marketing post being sent to them can be greatly reduced which helps to stop painful daily reminders. Tell us once is an optional free service that lets you report a death to most government organisations and council departments in one go. This means you won’t need to contact individual organisations or send copies of death certificates. When you register a death, the registrar will ask if you want to use the Tell us once service. If you do, they will give you a unique reference number to access the service online or over the phone.

Stopping Junk Mail to the recently deceased By registering with the free service www.stopmail.co.uk the names and addresses of the deceased are removed from mailing lists, stopping most advertising mail within as little as six weeks. If you cannot access the internet you can call 0808 168 9607, where you will be asked for very simple information that will take only a few minutes to complete. This free of charge service provided by the Bereavement Support Network will actively reduce the unwanted marketing mail but also can help reduce the likelihood of identity theft following the death of someone close. The information is not used for any other purpose and you only have to complete this once. Additionally to Stop Mail a comparable service can also be accessed from the Bereavement Register or Deceased Preference Service if you would prefer to use them. Grieving Bereavement is something which most of us experience at some time in our lives and loss can be distressing and hard to accept. We may feel confused and overwhelmed by sadness or other strong emotions. Certainly, in the beginning, there are a few reactions that should be considered as unusual. Initially when someone you know dies it may be hard to accept. You may feel shocked or numb, or on the contrary, you may experience everything with increased sensitivity. It is also not unusual to feel as if nothing is different at this moment in time.

Some cultures have strong rituals during this period or in the period immediately prior to death. Rituals differ - some encourage people to display their grief, others to focus grief inwardly. It is important that you and those around you find your own ways of expressing your feelings and continuing with your lives. Sometimes people who are grieving are concerned that they are losing their mind. It may be that you will look for the person in a crowd, or think you have seen them or heard their voice. You may also have dreams where you are searching for them - this can often happen when you are longing to hear or see someone again. If you have lost someone who has been a big part of your life, your home may seem very empty and the feeling of isolation can be painfully strong. You may also find that friends and neighbours sometimes avoid you probably because they find it difficult to know what to say to you. It may be helpful if you can take the first step. Let them know that you miss their friendship and support as they might miss yours. With the passage of time, you may find that painful memories happen less often and that you are able to remember the person who has died without becoming too distressed.

The process of grieving When someone close dies, feelings of shock, denial, sadness, anger and depression may follow. Often at times these feelings are accompanied by physical symptoms like a lack of energy, knotted stomach, loss of appetite and feeling disorientated. Recognising that these symptoms are normal responses to the death of someone close to you and it is the first step in the process of grieving. When to seek professional help The following is a list of symptoms and feelings often associated with grief. Whilst these can be a normal part of grieving, if they persist and make it difficult to manage day to day tasks you may wish to seek professional help if you: • Are always feeling exhausted, anxious, suicidal, depressed, helpless, experiencing uncontrollable anger, sleeplessness or feeling stressed • Are becoming withdrawn and unable to speak to or spend time with family and friends, or finding it difficult to cope at work, school, etc • Are becoming dependent on drugs or alcohol • Have little desire to get involved in activities you once enjoyed Your family doctor (General Practitioner) may be able to help particularly if you are worried about your own health. 20

Some do’s and don’ts It is generally agreed that the following may be helpful at this difficult time. • Do express your emotions. • Do remember that you need time to rest, think and sleep. Try to keep fixed eating and sleeping times. • Do let children talk about their emotions and express themselves. • Do send children back to school and let them continue with their usual activities. • Do be gentle with yourself. If you have had a bad day, put it behind you and have another go. • Do allow yourself time to grieve, in the way that feels right for you. Remember, there is no right or wrong way to grieve. • Don’t stifle your feelings. • Don’t avoid talking about what has happened. • Don’t forget that children experience similar feelings and need to share in the grief process.

Department of Spiritual Care The Hospital Chaplains are here to offer support. The Hospital Chaplaincy is a multi-faith department within the hospital, representing the Christian (Church of England, Roman Catholic and Free Church), Jewish and Muslim religions. The Chaplains based in the hospital (Church of England, Roman Catholic and Free Church) offer a 24 hours service for situations where an immediate response is required. The simplest way to contact the hospital based chaplains is to ask any member of staff to bleep them. Alternatively, they can be contacted through the hospital switchboard and staff will contact you or help you to leave a message. Tel: 0151 529 3611.

Counselling Your family doctor will be able to listen and offer emotional support but if you need more time to talk or longer term support, a counsellor may be able to help. Some large GP practices have counsellors at their surgeries or you may wish to contact one of the support organisations. Age Concern Liverpool and Sefton The Frances Suite, 1st Floor, 151 Dale Street Liverpool L2 2JH Tel: 0151 330 5678 Website: www.ageconcernliverpoolandsefton.org.uk Works with the elderly. Citizens Advice Bureau Wavertree CAB Ltd 242 Picton Road Wavertree Liverpool L15 4LP Tel: 0808 278 7840 Website: www.citizensadviceliverpool.org.uk Advice can be given on all legal and practical matters following a death.

The Compassionate Friends Kilburn Grange, Priory Park Road, London NW6 7UJ Tel: 0345 123 2304 Website: www.tcf.org.uk E-mail: helpline@tcf.org.uk An organisation of bereaved parents and their families offering understanding, support and encouragement to others after the death of a child or children. We also offer support, advice and information to other relatives, friends and professionals who are helping the family. Cruse Bereavement Care One Victoria Villas Richmond Surrey TW9 2GW Tel: 0808 808 1677 Website: www.cruse.org.uk E-mail: helpline@cruse.org.uk Offers counselling, support and advice. A newsletter and extensive list of books and leaflets are published. Independent Order of Odd Fellows 184-186 Deansgate Manchester M3 3WB Tel: 0161 832 9361 Website: www.oddfellows.co.uk E-mail: info@oddfellows.co.uk Publish an annual survey of Funeral costs.

Lesbian and Gay Bereavement Support (London Friend) 86 Caledonian Road, London, N1 9DN Tel: 0800 0119 100 (LGBT Switchboard) Available: 10.00am - 10.00pm Website: www.londonfriend.org.uk or www.switchboard.lgbt Advice and information to lesbians and gay men about bereavement. All the project’s volunteers are carefully selected and receive in-service training sessions. Telephone helpline offering advice and emotional support to people bereaved by the death of a samesex partner. Support would also be given to parents, brothers and sisters, children, other family members, friends, carers, etc. Liverpool Bereavement Service 1st Floor, Granite Building 6 Stanley Street Liverpool, L1 6AF Tel: 0151 236 3932 Website: www.liverpoolbereavement.com Offering one to one counselling and support groups. Roadpeace 3rd Floor, 3Space International House 6 Canterbury Crescent Brixton London, SW9 7QD Tel: 0800 160 1069 Website: www.roadpeace.org E-mail: helpline@roadpeace.org RoadPeace offers a practical and emotional support service to the bereaved and injured through road traffic accidents. 25

Stillbirth and Neonatal Death Society (SANDS) 10-18 Union Street London SE1 1SZ Tel: 0808 164 3332 (Mon-Fri, 10am- 5pm) Website: www.sands.org.uk E-mail: helpline@sands.org.uk UK-wide network of local self-help groups run by and for bereaved parents. Support After Murder and Manslaughter (SAMM) L&DC Tally Ho! Pershore Road Edgbaston Birmingham B5 7RN Tel: 0121 472 2912 / Text: 07342 888570 (Answerphone when office closed) Website: www.samm.org.uk Help through befriending, for people who have suffered the loss of a child, relative, or friend, of any ages, as a result of murder or manslaughter. Contacts can be arranged through visits and letters or by telephone. Support and encouragement given to the setting-up of local self-help groups to help bereaved family members and friends meets others, similarly bereaved, for understanding and sympathy.

The Samaritans 25 Clarence Street Liverpool L3 5TN Tel: 116 123 Website: www.samaritans.org Offer a 24-hour telephone support and face to face befriending during the day at their local branches. Survivors of Bereavement by Suicide (SOBS) National Office 14 – 16 New Lawn Road Ilkeston DE7 5HE Tel: 0300 111 5065 Monday and Tuesday 9am – 5pm Website: www.uksobs.org E-mail: email.support@uksobs.org We exist to meet the needs and break the isolation of those bereaved by the suicide of a close relative or friend. We offer emotional and practical support in a number of ways: Bereavement Packs, Group meetings (in a number of locations). Terrence Higgins Trust 439 Caledonian Road London N7 9BG Tel: 0808 802 1221 (10am to 6pm, Monday to Friday) Website: www.tht.org.uk E-mail: info@tht.org.uk Provides practical support, help, counselling and advice for anyone who has lost someone due to AIDS.

Booklets, leaflets and useful addresses may be obtained from your Social Security Office or Job Centre Plus • What to do after a death in England and Wales. Benefits Agency Booklet D49 (Jan 2002). • Help with the costs of a funeral from the Social Fund (SF200). • How to obtain Probate (PA2). • A Guide to Widow’s Benefit (NAP45). It is hoped that the information contained within this booklet will be of assistance to you, but if there is any point or problem that you may experience, which is not covered please ask, we would very much like to help you. We are determined to provide the best possible service to patients and other visitors to the Trust and welcome all comments on the service we provide, whether good or bad, so that we can act on these comments to continue to improve the service we provide. If you have any comments on the service you have experienced, you can make your comments to the person in charge of the ward/department, or you can write to or telephone: Patient Experience team The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley, Liverpool L9 7LJ Monday - Friday: 9.00am - 4.00pm Further help and advice: 0151 556 3093/3091 or 3090 NHS 111 on Tel: 111 Website: www.111.nhs.uk Reference: The Walton Centre Bereavement Book Publication Date: December 2023 Review Date: December 2025

Remembering Everyone will have their own way of remembering the person who has died. Talk about them, mention their name as often as an occasion arises and put the emphasis on the good things that happened when they were alive. Members of the family or close friends might appreciate a photograph or small object as a reminder. Most important of all will be your own memories. Death is nothing at all I have only slipped away into the next room. I am I and you are you. Whatever we were to each other that we are still. Call me by my old familiar name, speak to me in the easy way which you always used. Put no difference in your tone; wear no forced air of solemnity or sorrow: Laugh as we always laughed at the little jokes we enjoyed together. Play, smile, think of me, pray for me. Let my name be ever the household word that it always was. Let it be spoken without effort, Without the ghost of a shadow on it. Life means all that it ever meant. It is the same as it ever was; there is absolutely unbroken continuity. What is death but a negligible accident? Why should I be out of mind because I am out of sight? I am waiting for you for an interval, somewhere very near just around the corner. All is well. Nothing is past; nothing is lost. One brief moment and all will be as it was before.

Henry Scott Holland (1847-1918)

Treasured Memory Box The loss of a loved one is a very stressful and emotional time. Finding ways to remember a loved one who has died, and to take their memory forward, can be a helpful part of the grieving process, at the Walton Centre we would like to provide you with a Treasured Memory / Keepsake Box to store your precious memories and/or objects of your loved ones. The box contains the following: • A candle to bring comfort and remembrance. • Two crochet hearts one to stay with your loved one and one to keep for yourself. • A Fingerprint kit. • An organza bag for a lock of hair. Our nursing staff will assist you, “We hope that the memory box will serve as a comfort and treasure to you as a bereaved family and will allow you to have physical memories of your loved ones forever”.

The Hospital would like to thank RNS Publications for publishing this information and the following pages contain some features from services offering their help at this time. Whilst the Hospital is grateful of their support it does not endorse or recommend any of the services that they provide.

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,�port network stopping mail

STOPPING JUNK MAIL It is distressing to deal with a bereavement and unsolicited mail can be

insensitive and destructive during a grieving process.

By scanning the below QR code on your phone or visiting

www.stopmail.co.uk, we are able to securely share this information

with mailing organisations and under the Data Protection Act the information will not be used for any other purpose.

Other benefits reduce the possibility of identity fraud, such as assumed

identity and you will only have to supply the information once.