Health Matters Issue 9.4

H E A LT H Vol 9 I Issue 4 I Winter 2013

INSIDE - Mental Health - DANCE THERAPY - BREASTFEEDING - STAFF PROFILES

MATTERS National Staff Magazine of the Health Service Executive

H E A LT H

ssue 4 I Winter 2013

MATTERS

al Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

Let Light In:

Transforming healthcare spaces National Staff Newsletter of the Health Service Executive with artist Martina Galvin 36

26 National Staff Magazine of the Health Service Executive

HEALTHMATTERS 31

Vol 5 I Issue 3 I Autumn 2009

Merry Christmas and Happy New Year to all HSE Staff from

90

Health Matters 1

Contents 53 P rocurement 54 REGIONAL NEWS 78 D onal Walsh Kerry teenager's inspiring video.

79 M eet the Team St Mary's Falls Clinic.

81 H umour 83 Music Choir 86 D ance Therapy 5 Dr Steevens' Scholarship Researching eating disorders in London.

8 Mo Shaol Making a difference for disability in Louth.

10 National Stroke Programme The Early Supported Discharge Initiative.

11 Generic Medicines Reference pricing introduced.

12 PEr Cent For Art Meet artist Martina Galvin.

14 PRODUCTIVE WARD Releasing time to care.

17 Mental health conference Mapping out services.

18 Tobacco-Free Ireland Target set for 2025.

20 X-Hale Preventing smoking among teenagers.

23 Perinatal Care The best care for babies in the womb.

25 Children first Planning for the Child and Family Agency.

30 O pen Disclosure 31 Th ink Contraception The new campaign launches.

88 G ardening Mindfulness in the garden.

90 Community Games

32 M ental health New e-learning module.

91 GP Referral

33 s exually transmitted diseases Good practice is vital.

92 M E AND MY JOB HSE gardener Billy Burke.

36 H olly's Horse Haven Training for those with disabilities.

93 B reastfeeding 96 W aterford Healing Arts

37 A ntibiotics Combatting over-use.

38 M ental Health Director Newly-appointed Director of Mental Health Stephen Mulvany outlines plans for mental health reform.

40 Q uality and Patient Safety Improvement 42 Obesity One in four children obese or overweight.

44 G reen Healthcare Preventing waste.

98 Sporting Passions Gerard Gilroy, who has broken new ground by competing in the World Dwarf Games in Michigan.

100 Touch Therapy The use of pediatric massage.

101 National Ambulance Service Improving quality of service 104 D esign and Dignity Palliative care.

105 The Gathering 109 Personal Finance

45 E -Books 46 Third World Development Volunteering in Kenya.

110 H ealth Literacy Survey Helping everyone to understand and access health information.

28 Alcohol conference The links with self-harm.

48 H and Hygiene

111 Getting to Know you

29 Primary care updates

50 M allow Primary Healthcare

112 Competition

26 Smoke-free maternity hospitals

2 Health Matters

Welcome …to the winter edition of Health Matters, the national staff magazine of the HSE. I would like to wish all of our readers and contributors a very happy Christmas and thank you for your support during the past year.

In this issue we take a closer look at two new choirs for older people which are being set up in south Dublin and are specifically welcoming to people affected by dementia.

Elsewhere in the magazine we look at Mallow Primary Healthcare Centre, which is one of the largest primary healthcare centres in the country.

We also talk to HSE Mental Health Director Stephen Mulvany, who updates us on plans for the year ahead.

Finally we find out about Holly’s Horse Haven stables in Co Louth, which recently provided a stable management course for clients attending Louth Disability Services.

We hope you find this issue’s mix of features, interviews, news and updates of interest.

For more regular updates, check out our staff intranet site http://hsenet.hse.ie or the HSE website hse.ie.

Sites we like...

www.ncpop.ie

www.getirelandactive.ie Stephen McGrath – Editor Head of Internal Communications

The magazine is produced by the HSE Communications Directorate Publishers: Ashville Media – www.ashville.com Feedback: Send your feedback to internalcomms@hse.ie

www.thinkcontraception.ie

Did you know?

• The three Dublin maternity hospitals, the Coombe, Rotunda and the National Maternity Hospital, went completely smoke- and tobacco-free from the beginning of November.

• One in six Irish adults are at or below level one on a five-level literacy scale. At this level a person may be unable to understand basic written information. www.breastfeeding.ie • More than 1,000 people visit Mallow Primary Healthcare Centre every day.

• Falls affect 30 per cent of people aged over 65 annually.

The information in Health Matters is carefully researched and believed to be accurate and authoritative, but neither the HSE nor the publisher can accept responsibility for any inaccuracies, errors or omissions. Statements and opinions expressed herein are not necessarily those of the Editor, the HSE or of the publisher. Advertisements within the publication are not endorsed by the HSE or the publisher. Any claims made within the advertisements are not endorsed by the HSE or the publisher. Advertising or editorial promotion in this publication is unrelated to and unconnected with any tender process or contract award that is ongoing or completed in the HSE.

To you, it’s about getting the help you need.

To us, it’s personal.

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4 Health Matters

Commercial Feature

Nurturing Innovative Ideas for More Health Tomorrow Boehringer Ingelheim Ireland and Ashoka Ireland are to support Change Nation, a social innovation platform launched last year. A health cluster within the project is hoping to transform healthcare in Ireland substantially and sustainably.

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hange Nation (www.changenation.org) is a social innovation platform launched in March 2012, bringing together 50 of the world’s leading social entrepreneurs to spread solutions to some of Ireland’s greatest challenges. From that emerged the Health Cluster of five health fellows trying to transform different stages of healthcare.

A Boehringer Ingelheim and Ashoka Change Nation partnership will now encompass all the Change Nation health solutions including MyMind, a communitybased mental health project profiled in the summer edition of Health Matters and which recently received the Social Entrepreneurs Impact Award.

Boehringer Ingelheim has worked closely with Krystian Fikert to expand this organisation across Ireland. Project KaBoom! focuses on creating safe environments for children to play. Siel Bleu promotes exercise for older people; the Eden Alternative aims to transform nursing homes. Project Echo is an innovative telemedicine initiative set to pilot in Irish hospitals next year.

Dr Colin Edwards, General Manager of Boehringer Ingelheim Ireland, expressed his excitement at the expansion of the Making More Health project to include the Change Nation Health Cluster.

“This is a significant investment for Boehringer Ingelheim Ireland, an initiative we are proud to showcase globally.

Boehringer Ingelheim employees can lend their expertise and knowledge to the partnership through project work, pro bono support, volunteering in the community and participation at relevant events.”

Project Echo to Pilot in Ireland Rebecca Kilbane, Change Nation Health Cluster lead with Ashoka, explains Project Echo to Health Matters.

+ Dr Colin Edwards, General Manager, Boehringer Ingelheim Ireland.

“It uses videoconferencing to help GPs who have a general practice to develop a special interest in a disease area,” she says. Project Echo creates a knowledge network. GPs will be invited to join a weekly teleconference and at the other end of their webcam will be a multidisciplinary team.

“We are hoping to have a number of hospitals on board next year. Our plan is to introduce endocrinology and rheumatology first. The main benefits are that it will provide ongoing professional development to GPs and a side effect is that it will help to reduce waiting lists. Dr Sanjeev Arora, the gastroenterologist in New Mexico who founded this, had an eight-month waiting list. He asked: ‘how can I multiply myself so I get to see more patients?’.”

Through the knowledge network, his waiting list went down from eight months to two weeks. The team also ran a clinical trial and found that GPs in rural areas provided better care than if patients had been sent to Dr Arora at the hospital: the local GP knows the patient from birth. Results can be found in the New England Journal of Medicine.

The support of Boehringer Ingelheim is important to the Change Nation Health

+ Rebecca Kilbane, Change Nation Health Cluster lead, Ashoka.

“Through the knowledge network, his waiting list went down from eight months to two weeks.”

Cluster in launching and scaling the projects: the company provides access to networks, knowledge and expertise – for example, the support of BI is important to Ashoka and the Change Nation team in bringing the health solutions to fruition.

Kilbane says that at the moment, Project Echo is being used across America to manage 14 different chronic conditions.

“Ultimately, we would like to expand in Ireland. It can bring about a significant saving for the state. We would love Ireland to be the Echo hub for Europe. That’s our long-term vision.”

Together, through Change Nation, Ashoka and BI can help to spread healthcare innovations that will help transform healthcare in Ireland and beyond.

Health Matters 5

Dr steevens' scholorship

The Child First and Always Dr Elizabeth Barrett, a child and adolescent psychiatrist, was awarded the Dr Richard Steevens’ Scholarship in 2012-2013, to support a year-long clinical fellowship in feeding and eating disorders at London’s Great Ormond Street Hospital for Children. have a long-standing interest in medical and psychiatric co-morbidity and my interest in eating disorders stems from seeing children and young people with eating disorders in a variety of settings – from community to paediatric settings and consultation liaison settings.

The Dr Richard Steevens’ Scholarship award allowed me to gain experience as a clinical fellow at a tier 4 specialist feeding and eating disorders service at Great Ormond Street Hospital for Children (GOSH) in London. The eating disorders service, led by Dr Dasha Nicholls, Consultant Child and Adult Psychiatrist, primarily focuses on the treatment of eating disorders such as anorexia and bulimia in children and adolescents, using mainly an intensive outpatient approach. This is supported by the Mildred Creak inpatient unit, which also supports children with eating disorders in the hospital. The feeding disorders service, run by Dr. Rachel Bryant Waugh, supports children with other complex feeding difficulties such as feeding/eating aversions.

Eating Disorders Outpatient Service Over the course of the year, I was primarily attached to the eating disorders outpatient service provided at GOSH. This involved an active role in the assessment and treatment of children with complex presentations. I was involved in managing both the medical and psychiatric risk and recognising how risk issues may change with treatment.

It was a steep learning curve initially.

Tier 4 services are highly specialist and the cases are complex. Often, children and their families have already had input from community and paediatric teams and are attending GOSH for more specialist input or for a second opinion. The children and

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“The children and adolescents who present to the service are often at a very low weight and were generally younger than patients I had encountered in Ireland.” adolescents who present to the service are often at a very low weight and were generally younger than patients I had encountered in Ireland. Clinically, I gained a great deal of experience in the assessment of the full range of eating problems presenting clinically

in childhood and adolescence, including anorexia nervosa, bulimia nervosa and atypical eating disorders such as selective eating and feeding disorders.

Treatment The GOSH motto is “the child, first and always” and throughout the department there is an emphasis on patient-centred care. Most young people who are accepted into the service usually attend one day a week on an outpatient basis. Their treatment programme usually entails individual and family interventions, psychiatry reviews, medical and dietetic interventions as necessary, and both young people and their parents can attend supportive group sessions.

I provided clinical input to a long-term group supporting the parents of children and adolescents with eating disorders with Dr

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Health Matters 7

Dr steevens' scholorship Cathy Troupp, and multifamily meal initiatives with Pennie Fairbarn and Caro Grindrod.

The fellowship has without doubt helped to consolidate my skills in establishing appropriate therapeutic alliances, balancing parental concern with the engagement of the young person.

Psychiatry Department As GOSH provides both an intensive outpatient and an inpatient psychiatry service, I also gained experience of the management of eating disorders in the inpatient unit with Dr Jon Goldin and with the liaison psychiatry team, who often see eating difficulties in the context of other medical and psychiatric morbidity with Drs Nadia Micali and Isobel Heyman. Through interactions with the specialist feeding disorders service run by Dr Rachel BryantWaugh, I gained knowledge and understanding of the feeding difficulties of infancy and early childhood. We are fortunate to have expert paediatric support from Dr Lee Hudson, and I was able to sit in on specialist paediatric clinics for these children.

Mr Graeme O Connor specialises in the dietetic issues these young people face, and is a renowned expert in refeeding syndrome. I greatly benefited from participating in meetings with him.

Additionally, I gained experience at a service providing initial assessments at the Royal Free Hospital to gain a greater understanding of community presentations and stepped care models.

The psychiatry department is very research-active. Dr Nicholls and I collaborated on a book chapter for a forthcoming RCPsych publication. I also attended several eating disorder conferences, thanks to a Clinician-Fellowship Award from the Academy for Eating Disorders. I have received another award that will support a brief period of further experience in the US when my current fellowship finishes.

Education I was also involved with lecturing and training around eating disorders at the Institute of Child Health and at University College London. This has underlined for me the interdisciplinary training needs of professionals involved in eating disorders.

Teaching is something I am keen to remain

engaged with in the long term. We need to support a range of professionals in picking up and treating eating disorders early in the trajectory of the illness.

Ireland Eating disorders are currently one of the priority areas for the Mental Health Commission, with Professor Fiona McNicholas as the national lead for service development. Overall, I gained administrative and management skills relating to the multidisciplinary approaches in the psychiatric care of children with eating disorders and their complex medical needs.

The opportunity to appreciate different configuration of services has been helpful in terms of thinking about service development in Ireland. One of the advantages for me in undertaking a fellowship in the UK has been developing links with experts and research groups close to Ireland.

In the long term, I would envisage ongoing collaborations with these groups.

For me, maintaining a link with home was important and I remained involved with several roles in Ireland. I helped to set up the Young Psychiatrists' Programme for the International European Society for Child and Adolescent Psychiatry conference held in July in Dublin. Some of my new mentors and collaborators from London also attended the conference!

Relocation, relocation, relocation Though the UK is only an hour from Dublin, the usual moving difficulties such as finding an affordable place to live, getting a bank account and registering with the General Medical Council still apply. Gaining an understanding of the NHS proved not without challenges too! Moving to any large city and joining a new hospital there is a ready-made opportunity to meet people, but it can be hard to “break in”. However, my Irish colleagues were especially welcoming.

I also joined some of the GOSH social groups and played tennis locally. London is easily commutable to Ireland, but I made a determined effort to spend time seeing the city and the UK. I spent a few days hiking in Scotland with new friends. As I was quite near St Pancras, where the Eurostar departs, this was all the justification I needed to get on a train after work and spend a long weekend in Belgium or France.

“This fellowship has truly provided a formative training experience. The opportunity to work at a centre of excellence with a global reputation in the field of eating disorders has been incredibly inspiring.”

Thank yous!

This fellowship has truly provided a formative training experience. The opportunity to work at a centre of excellence with a global reputation in the field of eating disorders has been incredibly inspiring. I would like to thank the HSE for this funding award. I would encourage anyone with an interest in an area that has limited training opportunities in Ireland to consider applying for this award.

Several people I had worked with, in particular Professor Fiona McNicholas and Professor Louise Gallagher, have provided a lot of mentoring. I must thank the College of Psychiatry and Ms Liz Kavanagh, the Trainee Programme administrator for supporting my application. Dr Tony Carroll, the National Training Director for Child and Adolescent Psychiatry, was extremely supportive and I understand that Dr Carroll has recently retired, so I would like to say how much his support has been valued by trainees and by me over the duration of my training.

In London, people have really extended themselves to facilitate this fellowship. Most especially, thanks to Dr Dasha Nicholls without whom none of this fantastic adventure would have happened. I would like to thank the entire GOSH team and the staff at the Royal Free Hospital. I would also really like to thank the team and the parents from the long-term parents group at GOSH. Finally, I would like to thank the young people and families who have been my best teachers throughout my fellowship.

For more information go to www.gosh.nhs.uk.

8 Health Matters

Disability

Making a Difference: the Mo Shaol Project The Mo Shaol (My Life) project is run in partnership with Dundalk Simon Community and HSE disability services in Louth, writes Jackie Barron

T

he Mo Shaol project involves families or individuals offering supported lodgings to a person with a disability. The families (the supported lodging provider) supply the accommodation and an agreed level of support is identified from the individual’s person-centred plan. This support may include personal care, budgeting, skills building and promotion of independence.

The benefit of this model of service is that it offers individuals a choice in the manner and location in which they choose to live; it allows them to live in a community setting with a family or an individual and utilise natural and community supports.

It also supports the current legislation on congregated settings. The project, which is funded by GENIO, is a two-year pilot project for the Louth area.

Supported Living Funding was sought for this project as there is an identified gap in residential services for individuals with physical, sensory or intellectual disability. It became evident in Co Louth that the choice for residential accommodation and support for those with a disability needed to be enhanced and this project offers the opportunity to pilot a new model.

The Mo Shaol project is a model of supported living. It is person-centred and individualised and the person referred has full input into the development of their supported lodging placement.

Many individuals with a disability do not require the high level of support offered in a group home or nursing home setting and this project ensures that given the right support, the person can live in a community setting.

Community living for a person with disabilities has a number of positive benefits such as social inclusion, increased independence and ongoing development of natural social supports, increased choice,

improved self confidence and enhancement of skills. People can be referred to this project by the Adult Physical and Sensory Disability Team or the Adult Intellectual Disability Team in Louth.

Supported Families are recruited in the community and are assessed as to their suitability for providing this model of supported lodgings.

A full assessment is carried out by the co-ordinator and Garda clearance, medical reports and references are sought. The people and families/providers are matched as closely as possible in order to offer the best chance of a successful placement.

The co-ordinator continues to support the families/providers and the placement, and there are ongoing regular reviews. The individuals’ case managers on the disability team and person’s natural family remain a

constant source of support to the person’s placement.

The potential benefits in Ireland of this model include offering alternatives to already established residential placement, preventing inappropriate placements, and it is cost-effective compared to the cost of a group home placement, specialist placement or nursing home bed.

Following the pilot, this model may also be offered to clients within mental health services, elderly services and hospital stepdown.

There are a number of individuals currently being considered within the Louth area for the Mo Shaol Supported Lodging scheme and interest from families / providers is high.

Jackie Barron is Acting Area Manager and Early Intervention Team Co-ordinator, Louth Disability Services.

Case study: How does the supported lodgings model work?

‘A’ has an acquired brain injury and is considered to have a long-term requirement for support. He requires a lot of support and assistance with many activities of daily living, due to physical and cognitive problems.

For personal reasons he couldn’t stay in his existing home. A’s case manager worked closely with him to explore alternative options. The challenge was to find regular respite or a longer term placement for someone who wanted to remain in proximity to family, friends and an established routine.

A number of HSE residential options were not suitable due to the age or profile of other residents. The case manager contacted private and voluntary providers but the only options that were pursued were those in close proximity to his home town.

Around this time, his PA presented herself as being open to providing a ‘home’ to A, either on a long or a short time basis. The

model of supported lodgings had been looked at previously and some liaison took place between disability services and the fostering team before going back to the PA. The case manager met with the PA and her husband to discuss the commitment required from them and the supports they could receive as providers of supported lodgings. The Bridge Project (the existing model used by Louth Fostering Service) was subsequently modified to be used by an adult with a physical and sensory disability and his/her potential carers.

Once funding and suitable carers were approved, it remained a concern that A would not be happy to move away from his existing home. The pace of the transition was driven by A. As it was a new venture for disability services in Louth, a range of new policies and procedures needed to be signed off and put in place.

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10 Health Matters

national stroke programme

The Early Supported

Discharge Initiative The Early Supported Discharge Initiative aims to deliver high-quality care to patients in their homes, reducing cost and hospital stay, writes Una Cunningham, Lead for Early Supported Discharge, National Stroke Programme. arly supported discharge (ESD) is one of a number of approaches aimed at reducing the hospital stay of stroke patients. The benefits of ESD include reducing the length of hospital stay, reducing long-term dependency and the risk of further disability after six months, as well as reducing the number of patients requiring long-term care.

As part of the National Stroke Clinical Care Programme, the Mater Misericordiae University Hospital (MMUH) in partnership with HSE Dublin North Central reconfigured services in order to complete a oneyear ESD initiative. The National Stroke Programme provided funding for travel and equipment. The pilot ran from October 2011 to September 2012. ESD involved intensive specialised stroke rehabilitation provided in the patient’s own home for up to eight weeks.

The ESD team consisted of an occupational therapist, a physiotherapist, speech and language therapists and medical social workers (from mid-August 2012). The multidisciplinary ESD team met once per week to discuss referrals and discharges pending, and plan for patients in the programme. One member of the ESD team attended the weekly stroke unit MDT team meetings for optimal communication between acute and ESD stroke teams and to source referrals. A therapist acted as key worker for each patient. Support from the acute stroke team, general practitioners and public health nurses was also critical to the success of the pilot.

Results Some 49 patients were discharged via the ESD programme (12 per cent of stroke patients in MMUH). The average age was 69 years (median age of 72 years, range 20 years to 91 years).

1. Patients discharged through ESD

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E

showed consistent improvements in function, independence and self-reported quality of life.

2. Results from a specifically designed questionnaire show high levels of satisfaction (>90 per cent) among patients and carers.

3. The ESD group of patients had an acute length of stay an average of nine days shorter than the overall population of clients with stroke diagnosis. This equates to 441 bed days saved in total. When pay and non-pay costs are accounted for, the overall net saving to the hospital is in the region of e160,000.

4. F aster access to home care packages could result in shorter lengths of stay for some patients.

5. A higher number of patients could be discharged early if neighbouring HSE areas established ESD programmes.

Recommendations • Ongoing implementation of ESD for stroke, based on outcomes reported • Ongoing focus on specialist stroke input

from a dedicated team.

•E xpansion of ESD services to all areas to preclude catchment area effects.

•P rompt access to home care packages to facilitate discharge.

•F lexibility to increase staffing to meet capacity requirements on demand.

•A ppropriate staffing and head count for ESD teams.

As a model of care, ESD worked well to provide clients with the specialised intervention in the right place at the right time. Clients experienced high levels of satisfaction. My sincere thanks to both the project implementation team and the ESD team who delivered the service and compiled the relevant data contained in the more detailed pilot report: Claire Prendergast, Elaine Reynolds, Gillian O‘Neill, Heather Gee, Lindsay Johnson, Michelle O’Keeffe and Gillian Casey. AMNCH and NUIG hospitals have also commenced ESD services in 2012 with support from the National Stroke Programme. We wish them continued good luck with this exciting initiative.

Health Matters 11

MEDICINES

Reference Pricing System Introduced A new system for pricing medicines recently came into operation. Reference pricing means that pharmacists will be able to offer generic or alternative versions of certain medicines.

A

new pricing system is being introduced, which means that the HSE will set one price, called the reference price, that it will pay for a group of interchangeable medicines. Reference pricing is being introduced one medicine at a time, so not all people, or all medicines, will be affected at once.

How does it work?

Firstly, the Irish Medicines Board must publish an Interchangeable List of Products – this began in August 2013 with atorvastatin, and more lists are being published on an ongoing basis.

If you are taking a medicine that has an interchangeable list, your pharmacist may now offer you a generic or alternative version.

❱ You can choose the less expensive medicine and save money. If you are using one of the State drugs schemes (e.g. medical card, Drugs Payment Scheme, etc), the HSE will pay the pharmacy the reference price for this group of medicines. ❱ You can choose to buy the medicine on your prescription at its full price. If you’re using a State drug scheme, you’ll pay the difference between the reference price and the retail price. ❱ If you are on the Drugs Payment Scheme, please note that the HSE will use the reference price of the medicine group to calculate your monthly drugs costs.

“Reference pricing is being introduced one medicine at a time, so not all people will be affected at once.”

In November 2013, the HSE began operating a reference price for atorvastatin.

Reference pricing for atorvastatin means that no matter which version you take, the HSE will only cover the cost of the set or reference price for that group of products.

So you will have three options:

What if I need a particular brand of medicine?

Your prescriber will be able to state on the prescription that a particular brand is to be provided. They will write "do not substitute" beside that item on the prescription. If that particular brand costs more than the reference price, you will not have to pay the difference.

How will this affect me?

Patients who will be affected by this change in the law and the pricing system will be informed by their GP, by their pharmacist, and through information online.

If you have questions about your medication, talk to your GP or pharmacist.

12 Health Matters

PER CENT FOR ART

An Exploration Of Art Martina Galvin has been commissioned on two occasions by the HSE's Per Cent for Art Scheme. She talks to Phil Ellison about her career and explains how any space can be transformed into a work of art.

T

he Per Cent for Art Scheme is an initiative whereby one per cent of a publicly funded infrastructural or building development may be appropriated to the commissioning of a work of art. Since 1997, the proposal has been included in all budgets for publicly funded capital construction projects.

The highly accredited Martina Galvin has been successfully showcasing her works of art around the world throughout her illustrious career, having been involved in many artist-led projects and exhibitions in Australia, Poland, Finland and Ireland. She has been supported by the Arts Council and the Department of Foreign Affairs numerous times, as well as having images and reviews in newspapers and a range of high profile lifestyle magazines.

She graduated with a Bachelor of Arts from the National College of Art and Design on Thomas Street in Dublin, and achieved a master's degree in Cardiff, Wales. Presently, Galvin is based in Red Stables Studios, St Anne's Park, Raheny, but is currently in the process of relocating to Ormond Street Studios on Dublin's Ormond Quay.

+ 'Rebecca-Rebecca'.

“The basic physical and conceptual elements in my work are light and colour,” she explains. “I am interested in the ethereal, transient and the sublime nature of light, its colour, its many phenomena that occur all around us, and its dual physical presence as both strong and delicate at the same time, i.e. its potent, active life-giving energy, and its seemingly non-material or tangible presence. I explore and discover this natural phenomena through a variety of mediums, both sculpturally and pictorially.

I use physical materials, combined with the presence of light, and photography to present my work.”

Galvin got involved in the Per Cent for Arts scheme after working with a Polish artists' group, an experience which influenced her.

“When I was back in Ireland, and after I had my first solo show in Temple Bar Galleries, it was suggested to me that I should look at some of the commission competitions being offered under the Per Cent for Art Scheme.

I thought I would like the opportunity to do some large-scale works for specific sites, which is something the land artists [a movement in which landscape and art are linked] in America had opportunities to do and which I admired. So really it was the large scale possibility that attracted me.”

The scheme has proven to be both

a financially and creatively beneficial endeavour for the participants involved in the programme. As Galvin elaborates, artists can sometimes be confined to their studios and the spacial limitations they work in, so the scheme provides a platform for both experimentation and exploration.

“I've done quite a number of commissions, and so have a lot of artists, and of course it is a financial incentive for full time artists.

“However, it's also interesting because with the type of work I do, you get to work at a larger scale with materials you wouldn't normally get in your own studio. It gives you an opportunity to work in a different process that can expand and challenge your practice. I am not one of those artists who work in one medium only; I like to explore different materials be it paint, pencil, wire, acrylic or photography – which I have done a lot of recently.”

Therapy Through Art Art can also be an important element in the mental state and even progressive rehabilitation of patients. For Galvin, it's a privilege to be able to display her artwork where it has the potential to have an influence on individuals. “In St James's Hospital, there are seats around the area upstairs where you can look at the artwork.

Health Matters 13

PER CENT FOR ART

+ 'Blue'.

It's a place where patients, visitors and staff can sit, and be in a serene state of mind.

Some of them are obviously quite ill, so when they are just sitting there, it's important that that kind of atmosphere contains something uplifting, not just to be looking at blank walls.”

Galvin prepares meticulously before instigating any project. It's not a case of designing a piece and installing it into a location, but rather a careful and mindful approach that allows the piece to reflect certain aspects of the area. “Each piece would be very site-specific, and I would visit the site before conceptualising a piece.

I would take photographs and look at the space so I could see what the surrounding environment was like and what goes on in the building.” For example, her 'Ships' Names' outdoor sculpture at Louth County Hall is an important feature of the walk from the main gate to the front door.

'Blue' Gavlin's piece entitled 'Blue' is on display in St James's Hospital, Dublin. She sees it as an example of how the scheme can allow artists to broaden their spectrum in terms of shape and size. “If you think about St James's foyer – it's a huge atrium. The piece is 30 foot long and 15 foot high and it looks like a kind of semi-circular blue hanging wire of different colours, almost like a hair coming downwards.

It's supposed to remind you of the sea and be

a reposeful kind of piece,” she says.

A major part of any vision for Galvin is the incorporation and absorption of all things relative to the surrounding environment.

“Before I made 'Blue', I visited the site and walked around. I interacted with the people who occupied and used the space by staying there for quite some time. I would see where people were coming from, and who exactly were the type of people using the space – so I would take into account the mix of people and the different usages of the building. I would subtly interact with them by watching their movements and behaviour. I did notice when I went back to visit that piece about a year ago, that people were looking over at the artwork when crossing a little bridge in front of the piece.

I also witnessed a couple of individuals just standing at the bridge gazing at the piece, so 'Blue' has well and truly become an influential and significant part of the space, otherwise there would just be a blank wall.”

'Rebecca – Rebecca' Galvin's second health service Per Cent For Art piece is on display in an Inchicore nursing home and utilises a magnificent palette of colour to arouse emotion in observers. “The work was specifically commissioned to suit the specific site of the nursing home. All of the residents are in the winters of their lives, but have been through spring, summer,

autumn and winter. The colours are selected to create a soothing atmosphere. The colours change as you walk past the work, so it's not a static art work.

“The colour of the work closer to the window is more reminiscent of outdoor spring colours, while the work closer to the door is darker, more like winter colours, I tried to create a flow of colour that goes from light to dark, although it is not essentially 'dark'. I wanted to create a movement from the window to the door.

A movement from spring to summer to autumn and then to winter.”

'Rebecca-Rebecca' is part of a series of works over the past few years based on colour and light. Some pieces were large scale permanent works, like those in Ardee Courthouse and Arts Office, as well as more intimate smaller works exhibited in the Red Stables gallery, and the more current installation works from her studio.

The Inchicore piece is named after a friend who passed away recently – a friend “who had spring, summer, autumn and winter in all the full colours, so the work is about that movement from life to death, with colour,” says Galvin.

Its vivid blues, reds and greens are now a feature of daily life at the nursing home – and yet another example of the Per Cent For Art Scheme at work in an Irish healthcare environment.

14 Health Matters

productive ward

Productive Ward: Releasing Time to Care Mark White, Interim Director of the Nursing Midwifery Planning and Development Unit, South East reports on the recent all-Ireland Productive Ward conference.

I

n January 2012, the Office of the Nursing and Midwifery Services Director, in collaboration with the Clinical Strategy and Programmes Directorate of the HSE, launched the National Productive Ward: Releasing Time to Care (the Productive Ward) initiative in the Republic of Ireland.

The Productive Ward is a ‘cross-initiative’ clinical care programme. Some 17 hospitals (24 wards) countrywide participated in Phase I, while a further seven hospitals (13 wards) commenced Phase II in January 2013. The Productive Ward was developed in the UK in 2006/2007, in response to research findings showing that nurses spend less than 40 per cent of their time in direct patient care activity. The Productive Ward is based on the principles of ‘lean thinking’ whereby staff are empowered to improve their working environments and work processes for themselves and their patients.

To showcase the improvement work being undertaken in Productive Ward sites in both the Republic of Ireland and Northern Ireland, an island-wide Productive Ward conference was recently held at the Croke Park Conference Centre in Dublin. The theme of the conference was ‘Realising and Sustaining Frontline Potential’ and aimed to provide attendees with an overview of the Productive Ward and its relevance to healthcare today.

Keynote speakers were Professor Zoe Radnor, Professor of Service Operations Management, Chair of British Academy of Management (UK) and an internationally recognised expert on the use of lean thinking in healthcare; and Lizzie Cunningham, a member of the National Health Service Institute for Innovation and Improvement, the UK team that developed the Productive Ward programme and who is now implementing the Productive Ward in Portland, Oregon, USA.

+ L-R: Michael Shannon, Director of Nursing and Midwifery Services; Mark White, Acting Director, NMPDU; Lizzie Cunningham, Associate – CareOregon, Visiting Scholar, Oregon Health Sciences University, USA; Ambrose McLoughlin, Secretary General of the Department of Health; Professor Zoe Radnor, Professor of Service Operations Management, Loughborough University, UK; Dr Áine Carroll, National Director of Clinical Strategy and Programmes.

HSE Procurement exhibited, demonstrating the KanBan system of stock management, while Virtual College (UK) demonstrated eLearning opportunities for Productive Ward.

The 34 poster entries were judged by Lizzie Cunningham and Lorraine Murphy, two of the conference speakers. Poster competition winners were Mary O’Reilly and Ajita Raman, Lillie Ward, The Rotunda Hospital, Dublin; Catriona McCahey, Our Lady of Lourdes Hospital, Drogheda, Co Louth; and Jincy Joseph, St Patrick’s and St Anne’s Wards, St Vincent’s University Hospital, Elm Park, Dublin.

The day concluded with some poignant messages that quality improvement can only be sustained if it becomes part of our work culture, organisational culture and the way we operate. Highperforming healthcare organisations infuse improvement into the belief and value systems of the employees. The Productive

Ward quality improvement initiative is the first step of many in the HSE’s quality and patient safety journey.

For further information contact ONMSD Lead Mark White, Interim Director, NMPDU, Office Complex, Kilcreene, Kilkenny – (056) 778 5620.

“Staff are empowered to improve their working environments and work processes for themselves and their patients.”

Health Matters 15

productive ward productive ward

+ L-R: Mary Deering, Ajita Raman, Mary O’Reilly, Caitriona Cannon, Mary Brady, Janice Shortt and Maria Keane.

1. Case Study: Rotunda Hospital, Dublin The Patient-at-a-Glance Moudle guided the team through a process to improve the visual management of patients to include the patient status whiteboard in the midwifery base. A Patient Status at a Glance whiteboard seeks to reduce time spent looking for patient information, for example searching repeatedly in clinical records, and to reduce interruptions from visiting staff requiring patient information.

Following a 12-hour activity follow of midwifery staff, the team identified why interruptions occurred. Additionally,

team members were asked what kind of information they need when visiting patients on the ward. After a review of results, the patient status whiteboard was developed as a tool, using colour-coded information while maintaining patient confidentiality.

The outcome quickly demonstrated a major reduction in the number of staff interruptions (60 per cent), which enabled staff to spend more direct time with patients. Time was also saved by removing the need to walk to the staff base each time patient information was required. It also shortened midwifery administration rounds.

+ L-R: Martina Plummer, Joanne Hoey, Breda Tuite, Nuala Rafferty and Edel Kirwan.

2. Case Study: Our Lady of Lourdes Hospital, Drogheda Following the introduction of a modified STRATIFY audit tool, used to risk assess all inpatients in CPC, preventative measures for high-scoring patients guided by a specific nursing care plan were implemented. Preventative measures include the introduction of alert posters and colour-coded wristbands assigned to high-risk

patients in a patient/relative information pack. Patients at risk of falling were also highlighted at report and identified on the Patient at a Glance board.

Patients did not mobilise at all without adequate footwear. All measures were cost neutral. There was a near 50 per cent drop in falls, post-intervention.

These results can help stakeholders in nurse education and practice to develop interventions to reduce falls, limit damage and improve patient outcome.

+ L-R: Leo Ortiz, Jincy Joseph and Wendy Chigwedere.

3. CaSe study: St Vincent’s University Hospital, Dublin 4 St Patrick’s, an acute medical ward and St Anne’s, an oncology/haematology unit, were selected to represent St Vincent’s University Hospital for the implementation of the Productive Ward Initiative. The Well Organised Ward was the first module introduced in both areas. Ward teams were established in both areas and met regularly to progress the Well Organised Ward. The tools and principles of the productive ward were applied in the same way to organise the environment and improve and standardise processes in order to release time to care.

Measurements demonstrated savings in terms of cost, time, infection rate, increased patient throughput and activity, increases in direct patient care and patient and staff satisfaction.

The challenges included getting staff ‘buy-in’, sustaining momentum and managing the implementation of the initiative in the context of other organisational activity and demands.

These challenges were overcome by continuous communication, support and commitment at all levels through formal and informal forums.

Health Matters 17

mental health

National Mental Health Team Event A National Mental Health Team event was held in Dublin in November. The event was an opportunity for staff to collectively contribute to future planning for the mental health sector.

T

he Mental Health Team Event was attended by Mental Health Area Management Team members, ISA managers, regional directors of performance and integration, and regional mental health service improvement specialists. Staff from the National Office for Suicide Prevention and representatives from the National Counselling Service also attended.

Speaking about the provision of mental health services, HSE Director General Tony O’Brien told delegates that there was a cost attached to quality but it was clear that there was a greater cost attached to poor quality. He said that quality and patient performance management targets were just as important as resource management targets. Metrics relating to quality and safety had to be placed on a par with resource management metrics.

Mr O’Brien also told delegates that next year there would be a change in the way budgets were managed. Budgets for care groups would be applied nationally via the new HSE divisions and then divided up regionally and locally. The system was moving to a commissioning environment and local managers would not be permitted to interplay budgets by overspending in one area and creating surpluses in another.

Although there would be strict rules in relation to budget spend different services would still be expected to work together across boundaries in the interests of individual clients.

New National Director of Mental Health Stephen Mulvany and his team are mapping out the future of mental health services. After undertaking a valuable listening exercise across the sector he has identified a range of operational barriers that the new mental health divison will work to address in order to free up more staff time and energy for service improvements.

+ L-R: Martin Rogan, Assistant National Director, Mental Health; Libby Kinneen, Organisational Development, HR West; Stephen Mulvany, National Director for Mental Health; Dr Julie Repper, Recovery Lead in Nottinghamshire Healthcare Trust and Associate Professor, University of Nottingham; Michael Ryan, National Manager, Advanced Recovery Ireland; Geoff Huggins, Head of Mental Health Division, Scotland; Dr Dominic Fannin, Consultant Psychiatrist, Co-Lead Advanced Recovery Ireland; and Niall Kearney, Head of Mental Health Improvement Unit Scotland.

He said: "We're trying to listen to staff and understand what I call operational barriers which include: approval for essential replacements, recruitment process, IT, the amount of local control etc.

There's a variety of practical everyday things that soak up a huge amount of people's time. We're trying to free up + L-R: Denise Melia, Regional Specialist Office; time, energy and motivation Catherine O’Rourke, Director of Nursing, by beginning to address Louth/Meath; and Margaret Brennan, Regional Specialist in Mental Health, DNE. those within the resources available to us. That's one of the three key priorities in the mental health plan for next year." HSE National Director of Communications Paul Connors addressed the conference with a presentation on the communications challenge around mental health, while HSE National Director of Health and Wellbeing Dr Stephanie O’Keeffe spoke about health and wellbeing in mental health services. The conference was also addressed by HSE National Director for Shared Services Liam Woods and Dr Ian Daly, National Programme Clinical Lead, Mental Health.

Niall Kearney, Head of Scotland’s Mental Health Improvement Unit, spoke about the National Strategy and Action Plan to Prevent Suicide in Scotland.

Current priorities within the HSE Mental Health Division are to: • Develop an implementation plan for the final three years of A Vision for Change – a standard model of care • Promote positive mental health and improve suicide prevention • Improve capacity in relation to the streamlining of recruitment, provision of enhanced ICT, accommodation, equipment, training and development.

18 Health Matters

smoking

Tobacco Free Ireland – 2025 The Minister for Health, Dr James Reilly TD, recently published Tobacco Free Ireland, the first policy document launched as part of Healthy Ireland, a government framework for action to improve the health and wellbeing of the population over the next 12 years. Tobacco Free Ireland sets 2025 as the date to achieve tobacco free status in Ireland, writes Dr Fenton Howell.

T

he definition of tobacco free is a smoking prevalence rate of less than 5 per cent. A recent HSE survey found that about 15 per cent of staff smoke, considerably less than the population smoking rate of 22 per cent but still too high. The health service can work towards becoming tobacco free and play a major role in encouraging the rest of the population to also reach this important goal by 2025.

Tobacco Free Ireland contains 63 recommendations which, if implemented in full, should ensure that we can radically reduce the misery, morbidity and mortality that smoking causes. It is still worth noting that over 5,000 Irish people die every year from smoking-related diseases. As the Health Service Executive’s award winning QUIT campaign points out, “one in every two smokers will die of a tobacco-related disease”. These diseases are frequently protracted and unpleasant, not to mention extremely distressing to the person themselves, and to their families and friends.

Prevention This is all the more upsetting because they are preventable. That’s why prevention is the key aim of Tobacco Free Ireland. Never starting to smoke is the surest way to avoid its consequences. If we want to stop people starting to smoke, then we have to get to them early. Most smokers start smoking very young. Research shows that nearly eight out of every 10 smokers started smoking before the age of 18. Hence the two overriding themes in the report are (a) that children must be prioritised, and (b) the need to denormalise or change social norms around tobacco use.

Tobacco Free Ireland aims to build on important initiatives that are already in place: • The workplace smoking ban in 2004, internationally recognised as groundbreaking.

+ Minister for Health Dr James Reilly TD, pictured centre with teenagers Chloe Turner, Arlene Dowling and Tracey Turner.

• The ban of the sale of 10 packs and of candy or sweet cigarettes.

• The ban on point of sale advertising.

• The introduction of the graphic warnings on packs.

• The roll out of the HSE’s Tobacco Control Framework.

• The HSE’s QUIT campaign (www.quit.ie).

These measures are already having an impact. Recent data on school-aged children indicates a clear downward trend. 80 per cent of 15 to 17 year olds and almost 90 per cent of 10 to 17 year olds don’t smoke.

That’s the good news. However, we need to be scoring ten out of ten if we are to achieve a tobacco free Ireland by 2025.

Measures In addition, just over two out of every ten (22 per cent) adults smoke. There is a need to encourage adults to quit and to provide them with the necessary supports in order to quit successfully and to remain tobacco free. Some of the measures identified in Tobacco Free Ireland include: • Banning smoking on the campus of primary and secondary schools and child care facilities • Promoting tobacco free areas on our third level campuses, sporting facilities, public parks and beaches • Creating smoke-free playgrounds for children.

• Creating smoke-free campuses in our

Health Matters 19

smoking

+ Minister for Health Dr James Reilly TD, pictured centre with teenagers Chloe Turner, Arlene Dowling and Tracey Turner and children Daniel Creedon, Amelia Lawrence, Aoife Creighton, Maebh Ni Branigain, Alex Murphy, Isbella Stritch, Joe Wray, Doireann Gannon and Evan Doyle.

hospitals and health facilities.

• Developing legislation to prohibit smoking in cars where children are present.

• Introducing standardised/plain packaging on tobacco products.

• Increasing price through taxation.

• Further controlling sales of tobacco products.

• Enhancing our research base on all aspects of tobacco use.

• Increasing the investment in mass media campaigns.

• Enhancing smoking cessation services.

Smoke Free The HSE has been very much to the fore in leading out on smoke-free campuses, and many other organisations are utilising the experience gained by the HSE as they seek to follow suit. HSE staff that belong to staff associations, trade unions, professional bodies and community-based organisations are well placed to encourage these organisations to follow the HSE lead and become tobacco free campuses.

Legislation The HSE’s Environmental Health Service will also have a key role to play in building and maintaining compliance with existing and new legislation concerning tobacco products. They will need to further develop their capacity to deal with the many and varied challenges from the tobacco industry which will resist initiatives outlined in Tobacco Free Ireland.

Cessation Enhancing smoking cessation services is a crucial part of the Tobacco Free Ireland strategy. In order to achieve a tobacco free Ireland by 2025, a significantly greater number of smokers will need to quit, and remain so, than is currently the case.

There is a lot of good work happening in the smoking cessation arena, but it needs to develop into a first-class quality service which can make a real difference for smokers. That’s why the HSE is being charged with co-ordinating smoking cessation services and ensuring a standardised, evidence-based national approach.

Too often, smoking cessation is seen as belonging to the health promotion service, or to discrete elements within the primary care or acute setting. That has to change.

All health professionals, irrespective of setting, have a key role to play in providing smoking cessation services and supports for patients who want to quit.

The international evidence base is compelling in this regard. Health professionals, at every level and within every speciality, are seen by smokers as key motivators for them to quit. Unfortunately, many health professionals either don’t engage with their patients’ tobacco addiction, or they don’t feel competent to advise patients appropriately on how to quit. Hence, too many health professionals are not “fit for purpose” when it comes to smoking cessation and the only losers are

smokers. This has got to change.

Undergraduate and postgraduate training bodies will need to ensure that all health professionals are trained to deliver smoking cessation as part of their routine work. Equally, there is a need to ensure that health professionals are supported in their role in assisting smokers quit and in referring them on to appropriate services.

Tobacco Free Ireland will seek to provide that support.

And it is not just health professionals who have a role to play. Every member of the HSE staff has a role to play. Every member of staff is a role model to help change social norms around smoking both within the health services and out in the wider community.

Prize Tobacco Free Ireland will not be easy to achieve, but is it achievable and it will be a fantastic boost to the health and wellbeing of our population. However, in order to achieve that goal, it will require proactive engagement and support from all healthcare staff in ensuring that its recommendations are fully implemented.

It is worth noting that many people both at home and abroad scoffed at the idea of Ireland becoming the first country in the world to bring in a comprehensive smoke-free workplace smoking ban that included bars. Such has been the success of this initiative that many countries have followed Ireland’s lead. If we collectively put our energies behind Tobacco Free Ireland, we could be the first country in the world to achieve tobacco free status, which is a prize worth fighting for.

Dr Fenton Howell is the National Tobacco Control Advisor to the Department of Health.

He is on secondment from the HSE, having previously being the National Lead for the Prevention of Chronic Disease Clinical Programme at the HSE. Copies of the Tobacco Ireland policy document and the Healthy Ireland Framework are available on the Department of Health website, www.doh.ie.

20 Health Matters

smoking

X-HALE Programme to Deter Young Smokers The Irish Cancer Society’s X-HALE programme aims to prevent young people from starting to smoke.

More than 2,000 young people have been involved in the programme since it began and they have been delivering key smoking messages to their peers through the mediums of art, dance, film and music.

S

moking among young people remains a problem in Ireland. While recent data trends show a steady decrease in current smoking rates among young people in Ireland, rates still remain higher among young people in the lower socioeconomic groups. It is widely documented that the younger a person begins to smoke, the more likely they are to become addicted adult smokers. If a young person can get to the age of 18 years without smoking then they are more likely not to start. Smoking cessation among young people is difficult and therefore preventing young people from starting to smoke is very important.

The active involvement of young people in smoking prevention programmes is a crucial component in demonstrating effectiveness. If they are merely passive recipients of messages about the dangers of cigarettes, then the results are disappointing.

Smoking Smoking remains the single biggest cause of cancer of Ireland, with 30 per cent of cancers and more than 90 per cent of lung cancers directly attributed to smoking. The Irish Cancer Society’s X-HALE programme aims to prevent young people from starting to smoke. X-HALE was originally designed in

+ Members of Newbridge Youth Project at the Bridgewater Shopping Centre in August 2012 launching their project ‘Stomp and Think’ and their short film Enough.

2009 as part of the society’s strategy (20072012) that aimed “to eliminate smoking in young people”. It attempted to target young people, to raise awareness of the issue of smoking and to build relationships with the youth and community sectors.

The society’s current strategy, ‘Towards a Future without Cancer’ 2013-2017, has targeted the resourcing and supporting of communities to become smoke-free environments, working to have fewer people start smoking and reducing smoking prevalence in young people to 7 per cent in 2017. The strategy also aims to reach into marginalised and underserved communities where cancer incidences are higher and survival rates are poorer than those in higher socioeconomic groups.

+ Members of NYP2, Summerhill, Dublin 1 display their campaign ‘You’re still smoking only joking’ at the X-HALE national showcase 2011 in Croke Park

X-HALE X-HALE works with youth

organisations in areas where smoking rates are higher among young people.

X-HALE aims to empower young people and youth organisations to tackle smoking among young people by encouraging and supporting them to develop positive youthled local activities that tackle issues around smoking specific to young people in their community.

Since 2011 the Irish Cancer Society has worked with 57 youth organisations and 164 young leaders in 19 counties across Ireland and has invested s100,000 in grants to youth organisations. It has also worked with youth services, youth organisations, youth clubs and Youthreach. In 2011 the ICS worked with seven organisations; 14 in 2012 and 31 in 2013. Over 2,000 young people have been involved in X-HALE since it began.

The National Youth Council of Ireland has supported X-HALE since 2011.

Through their wonderful creativity the participating young people have highlighted issues such as peer pressure, family influence, health effects and the influence of the tobacco industry and

Health Matters 21

smoking The power of the for its addictive nature independent to tobacco industry other addictive illegal drugs. Some youth and advertising of workers have also reported that X-HALE tobacco emerged has influenced smoking policies within the as an area that organisation, with some reviewing and X-HALE participants others implementing policies. took as a major Young people are sharing information influence on starting and concerns with their peers and parents to smoke. 89.6 per and encouraging them to quit smoking. cent of X-HALE A youth leader at X-HALE 2012 said: participants “Smoking has now re-emerged as an issue perceived this as to be challenged within the community very important or where once it had been disregarded... and + Mahon Youth Project in Cork, overall winners at the X-HALE film festival July 2013 for their film Cigarettes Are Manky. important influence, discussions are now taking place in schools, compared with family homes and the wider communities of 68.7 per cent of their peers in a similar age the benefits of a smoke free lifestyle.” acted as champions in their communities national study.

Sophie (16), of Foroige St Joseph’s Youth to raise awareness and help prevent other Some quotes from X-HALE participants Project in Cork said: “Over the past couple young people from starting to smoke. The have mirrored these findings: Aishling of months I have learnt a lot of facts about society has invested in providing training (16) from the Loughrea project in X-HALE smoking and brought it home, and my mam workshops and skills development to 2011 said: “I always knew smoking was has quit smoking after 25 years.” young people and youth groups to enable bad but I never realised how the tobacco them to tackle smoking in their own industry target and influence young people community. The society provides the facts Appetite especially in the media on TV and films.” and the knowledge, and the young people There is an appetite for smoking prevention create their project and campaigns at a programmes in the youth sector, with many local level. youth organisations recognising smoking Benefits In 2013 the ICS launched its National as an independent factor in their drug Other benefits of X-HALE over the years X-HALE Short Film Competition due to the prevention strategies. The society plans to have highlighted young people as role popularity of filmmaking by the groups, further grow its short film competition and models in their communities for being and received 38 entries from 31 youth continue to work with youth organisations smoke-free and are tackling social norms organisations. An online competition around the country. It is currently in the around smoking. Conor (15) from the received almost 51,000 views on YouTube process of developing an X-HALE resource Newbridge Youth Project said: “Smoking across all 38 films. Over 240 young people pack aimed at the school and youth has become embarrassing now after and youth leaders attended the film festival sectors. Tobacco Free Ireland recommends X-HALE in our group.” A youth worker in the Lighthouse cinema in Dublin on July warning about the dangers of smoking in Limerick at X-HALE 2012 said: “In the 4th and 10 prizes were awarded. through “Enhancing educational initiatives group of young people that have not started aimed at preventing young people from smoking, many have made very positive starting to smoke”. comments and displayed resilience towards Awareness The strategy also states that it not starting after the programme.”

Preliminary results from an evaluation of “is important that health promotion Youth organisations and groups X-HALE have shown that knowledge and programmes which address smoking are in have begun to change their attitudes to awareness about the dangers of smoking place at an early stage of their lives”. smoking prevention and tobacco is seen and the power of the tobacco industry are significantly increased in X-HALE participants when compared with similar-aged young people in other national surveys.

Participants in X-HALE are much more aware of the risk of smoking occasionally, compared to other studies. This difference is of particular importance. As is well known in the research, young people start off by smoking occasionally and gradually become dependent. Almost all of the X-HALE participants acknowledged and were aware of the addictive nature of cigarettes. It appears that the experience of being involved in film-production and X-HALE has emphasised this point. + Cashel Neighbourhood Youth Project launch their resource ‘Lungs on the Run’ in St John the Baptist Primary School, Cashel in September 2013 with Eimear Cotter, Irish Cancer Society and Catherine Doyle, Tipperary Regional Youth Service.

22 Health Matters

Commercial Feature

Bluebird Care Wins Top Accolade at National Q Mark Awards Homecare provider Bluebird Care won Business Group of the Year at the National Q Mark Awards, as Operations Director Eddie O’Toole tells Health Matters.

+ Eddie O’Toole, Operations Director, Bluebird Care.

I

n late September this year, Bluebird Care’s quality standards secured the prestigious Business Group of the Year Award at the National Q Mark Awards. “Quality standards are at the centre of Bluebird Care’s operational ethos,” said Irene Collins, Managing Director of Excellence Ireland Quality Association.

“Working in an unregulated sector, Bluebird Care are to be commended on achieving the Q Mark in 18 individual locations. Very well done to everyone.”

For Eddie O’Toole, Operations Director of Bluebird Care, the award was recognition of a multifaceted system of checks and oversights which the company has built up to guarantee customer safety and a quality homecare offering.

“We work in a space that’s unregulated at the moment. Through Q Mark standards we demonstrate to people that we are providing a quality service which stands out from the crowd. It gives us credibility.”

Bluebird Care didn’t prepare for the awards:

the aim is to provide a consistently good customer serivce.

“We ensure, on an ongoing basis, that all our offices around the country are providing care to the highest standard possible. We do internal audits of all our offices twice-yearly,” says O’Toole.

“Since we commenced trading in 2007 Bluebird Care has embraced the audit process,” says Lorna Liney, National General Manager. We are members of Home and Community Care Ireland (HCCI) who audit us to ensure we are adhering to their high standards.

Our offices can go through at least four separate quality audits a year from various bodies. This leads to improved customer care and improved employee conditions.”

Eddie O’Toole, also director of private homecare provider umbrella group HCCI, is in favour of regulation, which seems to be on the horizon in the coming years.

Word of Mouth Reputation O’Toole says that much of their business operates by word of mouth. “If you’re providing good care for someone regardless of where they are in Ireland, people tell their friends, other family members and their neighbours about it. It comes back to the quality service that we provide. On that basis, we have seen substantial growth in recent years – especially this year. We were established in 2007 and have 20 offices

around the country, employing just short of 1,000 people. Our reputation for quality is growing. We are involved in an ongoing programme of certification for our remaining offices while working on constantly improving standards in already certified offices.

“But you’re only as good as your last visit, which is where quality audits come in. When you have offices nationwide, it’s vital that all are providing care at the same optimum level. Through head office and through our regular quality audits, we ensure this happens in a consistent manner.”

Another important element of Bluebird Care’s work is corporate social responsibility (CSR), whereby businesses contribute to socially beneficial causes. 20 per cent of the Bluebird Care marketing budget goes to CSR campaigns. “I suppose we like to give back,” says O’Toole. “We support Age Action Ireland, Alone, Active Retirement Ireland and RESPOND, and because we also work extensively in the disability sector we actively support Special Olympics Ireland by running fundraising events and volunteering to help out at their events. We have also supported www.wheelchairtaxi.ie in the development of their mobile phone application.

“These organisations are finding it more difficult to survive in these harsh economic times. We try to give back and help them in any way we can. A lot of our customers and potential customers are members of these great organisations, so it makes sense for us to support them.”

With another prestigious award under its belt, business growing by word of mouth and CSR projects now underway, it’s a confident time for Bluebird Care – and its customers continue to benefit from awardwinning quality care.

For more information on Bluebird Care or to find your local office log onto www. bluebirdcare.ie or locall 0818 227 052.

Health Matters 23

perinatal care

Providing the best care for small babies in the womb Irish researchers are re-writing the rule book on perinatal care. Now, new findings will help to target resources to where they are needed most. + Fiona Cody, Perinatal Ireland Research Sonographer and Dr Julia Unterscheider, Lead Researcher of the PORTO Study.

P

erinatal Ireland is a research network that links seven maternity hospitals across the island of Ireland. “It is a Health Research Board-funded initiative that’s focused on improving women’s and children’s health,” explains Professor Fergal Malone, Chairman of Perinatal Ireland.

“The research grant enabled us to create a world-class perinatal research infrastructure amongst the participating hospitals.

This included state-of-the-art imaging equipment, dedicated research personnel and a central management and governance structure. The really critical advantage of the network is that it gives us access to large patient populations. The network covers three quarters of the 75,000 or so births each year in Ireland and having the network in place allows us to do sophisticated follow-up studies that would be impossible in its absence.”

Perinatal Ireland’s first major study was the ESPRiT Study which looked at weight

differences among twins in the womb.

The research found that a difference of 18 per cent or more in twin birth weights was associated with an increased risk of perinatal death, bowel complications, breathing difficulties, infection and admission to the neonatal intensive care unit. Twins who shared a single placenta, ‘monochorionic’ twins, were found to be at the highest risk and the larger twin was at equal risk of morbidity as his/her smaller co-twin. The findings contributed to the HSE’s Clinical Practice Guidelines for Management of Multiple Pregnancy, which were developed by Dr Fionnuala Breathnach, lead researcher on the ESPRiT Study.

Earlier this year, the group published new ground-breaking findings on over 1,100 babies diagnosed with intrauterine growth restriction (IUGR).

Dr Julia Unterscheider was the lead researcher on this study which is called

PORTO. “Small babies in the womb are normally considered to be those whose weight falls in the bottom 10 per cent,” she explains. “The majority of these pregnancies do go on to deliver a healthy normal baby that is simply small for its gestational age.

However, some develop serious health complications including a risk of death.

“The challenge is to distinguish between small but normal babies from small and at-risk babies, and it is one of the most common, controversial and complex problems in current maternity care.

“Standard international practice has been to consider this bottom 10 per cent by weight to be at the highest risk of developing complications. These mothers and babies are usually subject to increased surveillance and monitoring, and it obviously requires a lot of resources to do this.

“However when we analysed over 1,100 babies in this category, we found that the highest risk for adverse outcomes were in the group of babies that fell into the bottom 3 per cent by weight and that had an abnormal reading on what is called an umbilical arterial doppler. This is an ultrasound test that measures arterial blood flow in the umbilical cord. In fact, we found that an abnormal UA doppler was the strongest and most significant predictor of an increased likelihood of complications.”

“The challenge is to distinguish between small but normal babies from small and at-risk babies.”

24 Health Matters

perinatal care

“Our findings will enable clinicians to really focus antenatal care appropriately and hopefully make a major global impact on improving maternal and neonatal care.” orientating our grant schemes to support this goal.” + PORTO success story: John Foley (right) was diagnosed with intrauterine growth restriction and born 11 weeks premature, weighing just 2 pounds 6 ounces at birth. He is now 19 months old and is pictured with his big brother Martin (four years).

Potentially Improved Outcomes “Our data calls into question whether having a fetus in the bottom 10 per cent by weight alone really matters in predicting adverse outcomes,” she says. “While further work is required to verify our findings, if confirmed, they could lead to a change in clinical practice with a more effective use of resources and potentially improved pregnancy outcomes,” she says.

“In collaboration with the Perinatal Institute in the UK, we have derived a customised growth chart which has been tailored specifically for the Irish pregnant population, and which should help us to further distinguish small babies of small mothers who are naturally small from those who would be at genuine risk of complications from intrauterine growth restrictions. Customisation of fetal growth takes into account specific features of each mother such as her ethnicity, height, weight and parity to inform how big a baby is destined to be at each gestational week and at birth. These charts will help clinicians

to better identify babies at risk.

“Worldwide, it’s estimated that only one third of growth restricted babies are properly identified. Our findings will enable clinicians to really focus antenatal care appropriately and hopefully make a major global impact on improving maternal and neonatal care.”

Grainne Foley, mother of baby John Foley, was a participant in the PORTO study. “Taking part in the study was a bit of a no-brainer, really,” she says.

“Knowing that there was potential for some difficulties was a definite worry, but it was very reassuring to be able to avail of the resources, monitoring and surveillance that the research team brought to the hospital.”

According to Enda Connolly, Chief Executive of the Health Research Board, “international studies show that when patients and clinicians are involved in research, patient outcomes improve. The HRB wants to encourage a culture of research and innovation in the delivery of our health services and we have been re-

Perinatal Ireland Study Day Dr Liz Tully, Programme Manager for the network also notes that “as a result of the PORTO study, Julia is currently developing the first Irish clinical practice guideline on fetal growth restriction for the HSE. We hope to launch these at our Perinatal Ireland study day, which will take place at the Rotunda Hospital on Saturday March 8th 2014. This study day, which is open for healthcare professionals and parents, will feature ESPRiT and PORTO study findings and discuss state of the art management of twin and IUGR pregnancies.

“Another major benefit of the Perinatal Ireland research network lies in our ability to perform paediatric follow-up on the babies enrolled in our studies. The relatively small geographical size of the Ireland and the fact that the seven largest academic obstetric units are active members of the consortium has allowed us to efficiently capture the majority of the babies involved in both ESPRIT and PORTO for subsequent neurodevelopmental assessments. This has major public health benefits as we can accurately see how our babies develop, well into childhood.

“We would actively encourage clinicians, obstetric trainees, sonographers or midwifery staff who may be interested in getting involved to contact us at perinatalireland@ rcsi.ie or check out our website at www. perinatalireland.ie, as should members of the public who are interested in learning more about the work we do.”

Health Matters 25

Child & Family Agency

Children First Always Plans are now well under way in establishing the new Child and Family Agency, writes Gordon Jeyes, National Director of HSE Child and Family Services.

Reform

based and attentive to evidence, clear in its values and above all seeking to put the interests of children first. In many ways, this focusing of the planning of services around children, rather than a distinct professional discipline, is the most clear example of a modernised service design for the 21st century. Children’s needs cannot be neatly delineated.

Changing times provide an opportunity for the wider health service to reinforce its own internal planning for children from acute settings and consultant paediatricians through to primary care settings and the invaluable contribution of community staff, in particular public health nurses. It is a timely reminder to all staff to be aware of responsibilities for children and the need for peripheral vision, ensuring that support as appropriate is being given to each family regarding the wellbeing and nurture of children.

This, of course, will be reinforced when Children First is put on a statutory basis, requiring all government departments and named organisations to provide child safety statements, an annual plan, suitable training and an annual report.

This key activity will be taken forward jointly between the Child and Family Agency and the other components of the health service. It will also involve participation in local planning and development frameworks including, among others, joint policing committees and children services committees.

Structures will be strengthened to enable strong local relationships using resources as effectively as possible at the most local, practical level.

These new arrangements are, of course, part of the wider programme of reform of the health service. The changes seek to clarify lines of accountability and responsibility. They emphasise the importance of client-centred services.

The Child and Family Agency will seek to promote a professionalism that is outward looking and responsive, theoretically

Partners The world is no longer dominated by customers or clients, but by partners who co-produce more effective outcomes. Thus, it is crucial that all our organisations are responsive and become utterly reliable and dependable partners, the one to the other.

+ Gordon Jeyes

H

SE Child and Family Services are preparing to inhabit a new legal entity, the Child and Family Agency (CFA), a move which represents a new coalition with education welfare services and family resource centres.

The CFA will continue to receive corporate, finance and HR services from HSE Shared Services. In addition, significant support and processing will continue to be provided within local teams at regional and area levels.

A crucial part of the changes will be the protocol which has been agreed between the CFA and the HSE divisions of Health and Wellbeing, Primary Care, Mental Health and Social Care. Families do not live within boundaries, and joint agreements regarding streamlining support, rationalising plans and agreeing funding will be important developments.

“Structures will be strengthened to enable strong local relationships using resources as effectively as possible at the most local, practical level.”

In working with communities, CFA activity via family resource centres will be particularly important. It is essential that care services have the support and indeed the consent of the community.

The importance of education in the lives of children will be integrated in the new agency via programmes coordinated by the National Education Welfare Service.

Finally, a care system based solely on government intervention will not alone bring the desired results. Pressures on children are very often the result of parents’ lives marred by addiction and violence. Teenagers face problems from the decisions they make regarding alcohol, drugs, sex, diet and exercise and the uncertainties they face regarding violence, insecurity and unemployment. Thus, confidence and resilience and support for more effective individual decision-making needs to be nurtured. While there is a need to provide support proportionate to a family’s strengths and a child’s needs and interests, there is also a need to encourage greater personal responsibility and to promote individual, family and community health and wellbeing.

In so doing, we will extend the opportunity to more children to achieve their potential and to enable all children to enjoy the world-class childhood already available to many children in Ireland.

26 Health Matters

tobacco-free

Dublin Maternity Hospitals go Tobacco Free November 1st marked the first day that the three Dublin maternity hospitals operated as tobacco-free campuses.

T

he three Dublin maternity hospitals went completely smoke- and tobacco-free from the beginning of November. In line with HSE policy, tobacco was banned from all areas of the Coombe Women and Infants University Hospital (CWIUH), the Rotunda and the National Maternity Hospital (NMH), including buildings, entrances, doorways and car parks.

As one of the leading causes of death and illness in adults and developing babies, smoking is a critical health issue that the HSE has committed to tackling head-on. The Dublin maternity hospitals supported this policy by introducing a blanket ban on smoking on hospital grounds. In addition, all smoking shelters were dismantled or converted and cigarette bins were removed from the hospitals on October 31st.

+ Two day-old Ben Moran, from Dublin, pictured here showing his colours in the Coombe Women and Infants University Hospital as the hospital marked the first day of its smoke and tobacco free ban on the grounds of the hospital.

+ Nicole McDermott (7) from Lucan and Sarah Louise Greene (9) from Ballyfermot in Dublin pictured on the grounds of the Coombe Women and Infants University Hospital marking the first day of their smoke- and tobacco-free ban.

According to Dr Sharon Sheehan, Master at the Coombe Women and Infants University Hospital, “The health and best interest of patients and staff is at the heart of everything we do at the Coombe. By supporting a smoke-free environment, we are ensuring a healthier environment for staff, women and babies.”

Smoke-free Dr Rhona Mahony, Master of the National Maternity Hospital added: “Smoking causes so much disease and heartache. This is a wonderful opportunity for everyone to join together and help each other quit smoking.

A large part of Ireland begins here at the National Maternity Hospital; let our babies grow up smoke-free.”

“We realise that this change may be difficult for people who smoke,” said Dr Sam Coulter-Smith, Master at the Rotunda, “and much work has been done to inform and support all those using our campus, and to allow them time to prepare for this change.”

Smoking cessation advice and information is being made available to anyone wishing to give up smoking, and

all three masters encouraged their staff to avail of these services. In-patients will also be provided with the support necessary to manage their smoking habit during their hospital stay.

“The health and best interest of patients and staff is at the heart of everything we do at the Coombe. By supporting a smokefree environment, we are ensuring a healthier environment for staff, women and babies.”

Health Matters 27

Commercial Feature

Toyota in 2014 New models, excellent build quality and resale value, Toyota’s unique customer service offering and TLC – Toyota Loyalty Club – mean that 2014 will be a great year for the leading car manufacturer.

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ith several new model launches this year, Toyota now has the widest and newest line of car models available from any manufacturer in Ireland. Every Toyota dealership will be showcasing the full line-up for 2014 including the all-new Corolla, Auris Touring Sports, Prius +, RAV4, Verso and Proace models. In addition, every Toyota passenger vehicle registered between January 1st 2014 and January 31st 2014 comes with three years’ free servicing.

Best Resale Value of any car brand in Ireland Renowned for value, design, high levels of specification and exceptional build quality, Toyota has also been recently revealed by Cartell.ie (Ireland’s largest official vehicle record company) as having the highest resale value of any car brand in Ireland. Of the nine categories examined in Cartell. ie’s study, Toyota ranked first in seven out of nine categories. Toyota also continues to lead the industry with the lowest CO2 emissions of any car manufacturer, which means better fuel economy and lower road tax right across the range.

Following on from its Price Match Guarantee and ‘serviceplan from Toyota’ offerings announced earlier this year, Toyota also announced the availability of a new after sales programme called Fixed-Price Service Promise, offering Toyota customers a service from only a125.

More than 320,000 Toyota owners in Ireland can avail of a national price for getting their cars serviced within the Toyota network, now at a maximum

guaranteed price. Cars will be serviced by Toyota-trained mechanics using genuine Toyota parts, guaranteeing the expert care customers’ cars deserve. In addition, Toyota-approved upgrades will be included at no additional cost during the servicing.

Rewarding our Customers Toyota Loyalty Club, TLC, is all about our customers. At Toyota we never stop searching for ways to improve the experience of motorists. We have brought together outstanding offers and amazing discounts for you, right here, right now.

Toyota has already partnered with over 80 leading brands in Ireland and expects to grow this number significantly in the coming months. TLC members can now avail of exclusive discounts from Aer Lingus, The Body Shop, Bord na Móna, Easons, Elverys Sports, McCabe’s Pharmacies, Hugo Boss, Optilase, Samsonite, Shaws, Sketchers, Tubs & Tiles and many more.

The full list is available at www.toyotatlc.ie.

New deals will appear every month, exclusively for TLC members, where Toyota drivers and owners can enjoy a wide range of special offers and discounts courtesy of Toyota. Over 23,000 Toyota customers have enjoyed the benefits of TLC... just another way that it pays to be a Toyota driver!

"At Toyota we never stop searching for ways to improve the experience of motorists. We have brought together outstanding offers and amazing discounts for you, right here, right now."

28 Health Matters

alcohol abuse

Clear links between heavy drinking and rates of self-harm Alcohol’s role as a serious risk factor in mental health difficulties was put under the spotlight at a national conference held by Alcohol Action Ireland, the national charity for alcohol-related issues, in November.

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acing ‘The Fear’: Alcohol and Mental Health in Ireland took place at the Royal College of Physicians on Kildare Street in Dublin, where a packed conference room heard – through both expert speakers and personal testimony – about the impact that harmful drinking is having on a range of mental health issues including depression, anxiety, self-harm and suicide.

“It is impossible to be serious about addressing mental health in Ireland without also taking decisive action to tackle our harmful relationship with alcohol,” said Suzanne Costello, CEO of Alcohol Action Ireland welcoming attendees to the conference, which was part-funded by the National Office of Suicide Prevention.

“Despite growing awareness of and openness around the subject of mental health in Ireland, as a society we have been very slow to acknowledge the very damaging consequences that alcohol can have for our mental health, particularly given that over half of Irish people drink in a harmful manner,” she said. The conference was opened by Minister of State with Responsibility for Primary Care Alex White TD, who recently brought forward a range of measures to deal with alcohol misuse and its related harms, which will be included in the Public Health (Alcohol) Bill.

“We know about the adverse effects of alcohol consumption on children, families and communities and the impact it can have on mental health. The time has come to act. We should proceed by consensus as far as we can. But to be effective we will have to be radical,” said Minister White. “The nature of the challenge we are addressing requires a significant public health response. This is what the government has agreed and I hope and believe that with the help of conferences such as this, it will gain the support of the broader community and society.”

Expert speakers at the event included

+ Dr Bobby Smyth, Consultant Child and Adolescent Psychiatrist, speaking at the conference.

Dr Bobby Smyth, Consultant Child and Adolescent Psychiatrist; Professor Ella Arensman, Director of Research with the National Suicide Research Foundation; Dr Conor Farren, Consultant Psychiatrist; and Dr Philip McGarry, Consultant Psychiatrist.

Professor Arensman presented new insights from extensive data (covering more than 100,000 presentations for self-harm) and showed clear links between heavy drinking and rates of self-harm. Her many striking findings included that women are now presenting with self-harm after heavy alcohol consumption in the same numbers as men, which is a new trend over the past five years. “We have discovered a significant association between heavy drinking and self-harm. Most significantly, we find that if we could end heavy drinking among adolescents and young people, we could reduce self-harm by 17 per cent in

two to three years,” said Prof Arensman.

Dr Smyth said that young people are particularly at risk and he outlined exactly why in an engaging presentation.

“Teenagers are now drinking at an earlier age compared to previous generations in Ireland. This is exposing them to increased risk of subsequent alcohol dependence and is probably causing changes to their developing brains.

“Upon entry into adulthood, most young people in Ireland are drinking in a harmful manner, according to accepted international standards. The more young people drink, the more likely they are to have depressive and anxiety symptoms.

If alcohol is used by young people as a method of coping with stress and life’s difficulties, it may hamper their ability to learn more effective and proactive coping strategies,” said Dr Smyth.

Health Matters 29

primary care

Weaning as a Primary Care Initiative Primary care provides an ideal opportunity to provide families with information on the importance of good nutrition, writes Patricia Whyte, Public Health Nurse and Sonja Lynch, Dietician, Shankill Health Centre, Dublin. n infantâ&#x20AC;&#x2122;s nutrition will determine their health, physical development, cognitive abilities and wellbeing for the rest of their life. Good nutrition should ideally start with exclusive breastfeeding for the first six months and appropriate weaning practices during the first year of life. This time provides a unique opportunity to shape an infant's future health and help reduce the risk of certain diseases.

Public health nurses (PHNs) are key professionals in supporting parents on infant nutrition. Routine developmental checks carried out by PHNs in health centres provide opportunities to discuss issues related to weaning and feeding.

Difficulties identified at these clinics include issues with breast and formula feeding, starting solids, texture progression, food quantities and fussy eating. Arising from this identified need, we established a community-based infant weaning programme in 2010 to support parents living in Shankill.

This programme is delivered jointly in the local community by a PHN and dietitian.

Participants are recruited via the threemonth PHN developmental clinics, and two-month GP immunisations. It is also widely advertised in local parent support groups, pharmacies, supermarkets and community centres. The once-off, hour and a half-long session includes the delivery of information on nutrition in the first year of life. To date, 22 programmes have been delivered to 159 participants.

Infants attending had an average age of 21 weeks; 58 per cent had not yet been weaned.

The session highlights the current WHO guidelines on the timing and introduction of solid foods at six months of age.

A demonstration of how to prepare

ŠiStockphoto/Thinkstock

A

Weaning Session outline What is weaning?

Finger foods and snack ideas Why wait till six months?

Foods to be avoided Why not to delay beyond 6 months? Practicalities/equipment required Signs an infant is ready Food safety preparation and storage Stages of weaning & skill learned Vitamin D, iron and gluten introduction Suitable drinks Recipes

suitable foods to the correct consistencies is also carried out. Parents are encouraged to bring their babies to the session. The relaxed atmosphere provides an ideal opportunity for plenty of discussion and questions.

Parents leave the session feeling confident and empowered to make the right choices for their baby. A support booklet containing all the information delivered has now been completed and is

provided to participants. Working together as a team of professionals has allowed us the opportunity to provide accurate and appropriate information on best weaning practices which provide the essential building blocks for optimum health.

For further information contact Patricia Whyte, Public Health Nurse, Sonja Lynch, Dietitian, Shankill Health Centre, HSE, Dublin South (01) 282 0344.

30 Health Matters

patient communication

Open Disclosure Launch A new national policy on open disclosure will encourage better patient care through improved communication.

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he HSE and the State Claims Agency (SCA) recently launched a national policy, national guidelines and supporting resources in relation to open disclosure. Open disclosure is defined as “an open, consistent approach to communicating with patients when things go wrong in healthcare. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event.”

Minister for Health James Reilly TD attended the event and formally launched the policy, guidelines and other resource documents as follows: • Open Disclosure: National Policy.

• Open Disclosure: National Guidelines – Communicating with Service Users and their Families Following Adverse Events in Healthcare.

• Open Disclosure: Communicating When Things Go Wrong (a patient information leaflet).

• Supporting Staff Following an Adverse Event – The ‘Assist Me’ Model – (a staff support booklet).

• Open Disclosure: A Brief Guide for Health and Social Care Staff (a staff briefing document).

“These resource documents will help us develop and support a culture of open disclosure to service users when they have experienced harm as a result of their healthcare. They will also assist us in our drive to provide safe and quality health care to all people accessing and using our services,” said Dr Philip Crowley, National Director of Quality and Patient Safety in the HSE. The open disclosure project is a joint initiative by the HSE and the SCA. The open disclosure documents were developed following, and including the learning from, a two-year open disclosure pilot programme in the Mater Hospital, Dublin and Cork University Hospital.

Speaking at the launch, Ciaran Breen, Director of the State Claims Agency, said that: “at the heart of open disclosure lies the concept of open, honest and timely communication. Patients and relatives must receive a meaningful explanation.”

Ms Margaret Murphy, External Lead Advisor for the WHO Patients for Patient Safety Programme, speaking on behalf of service users, says that “open disclosure is not about blame, either apportioning blame or accepting blame. It is about integrity and being truly professional.

It is essential to really connect with the injured and resolve to examine the what, where, when, why and by whom with the purpose of preventing recurrence.”

Work is already under way in many of our acute hospitals in relation to implementing the principles of open disclosure. The open disclosure policy and guidelines will be implemented across all of our health and social care services.

Further information is available on: www.hse.ie/opendisclosure.

“It is essential to really connect with the injured and resolve to examine the what, where, when, why and by whom with the purpose of preventing recurrence.”

Health Matters 31

crisis pregnancy

Johnny's Got You Covered It may not happen every time... but when it does, “Johnny’s got you covered” – a message from Think Contraception.

+ Members of the outreach team spreading the word about the Think Contraception campaign on the streets of Dublin in December.

T

hink Contraception is an initiative of the HSE Crisis Pregnancy Programme. The Think Contraception campaign entered a new phase in November 2013, with the launch of a new TV, cinema and online campaign aimed at 18 to 24 year-olds.

The theme of this year’s advert focuses on telling a few wry stories about well-laid plans to have sex that don’t quite work out. Our audience enjoys sharing their own experiences of awkward moments around sex, and this advert brings a few examples to life on the big screen. The message is that it may not happen for you every time, but when it does – Johnny’s got you covered.

The campaign began on TV from Thursday 21st November. It will be live in cinemas through December and into

January, and online ads will be ongoing on Facebook, YouTube, RTÉ and TV3 players, and Google throughout the period.

Dr Stephanie O’Keeffe, Director of the Health and Wellbeing Directorate in the HSE said: “The new phase of the Think Contraception campaign aims to encourage young men and women to be prepared when it comes to sex, with the message that “It may not happen for you every time, but when it does – Johnny’s got you covered”. The new Think Contraception campaign promotes consistent use of contraception, particularly condoms, to address the issue of unplanned pregnancy and to combat the high numbers of sexually transmitted infections (STIs) among the 20 to 29 age group. We are confident

that this new campaign delivers the key message to the target audience in a fun and entertaining way.”

Think Contraception will be running competitions to win Think Contraception protection packs, One4all vouchers and much more over the December period.

To be in with a chance of winning these goodies follow ‘Johnny’ on Twitter (@thinkjohnny) or ‘like’ his Facebook page.

For more information: • Connect with Johnny on Twitter @thinkjohnny • Connect with Johnny on Facebook. com/thinkjohnny • Visit www.thinkcontraception.ie

32 Health Matters

Mental Health

New Mental Health E-Learning Module

n o w ava i l a b l e A new e-learning module has been developed in collaboration with service users to assist staff to meet the needs of people with an intellectual disability and a mental health challenge.

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he new e-learning module, developed by the HSE’s Mental Health Act Training Group, is available on the Mental Health Learning Hub which is located on the HSE Learning and Development website, www. hseland.ie. You must first register on www. hseland.ie to access the Mental Health Learning Hub and its resources.

Highly skilled services and individuals in the intellectual disability and mental health sectors have for many years worked with the real life and evidence-based overlap between these two speciality areas and this experience and expertise is being captured and made available to a wider audience in the e-learning module. This programme meets the requirements of the code of practice, ‘Guidance for Persons working in Mental Health Services with People with Intellectual Disabilities’ (MHC 2009) and the need for mental health professional staff to have training in this area.

The focus of the module is on communication skills. In our busy and pressurised service delivery systems the need to ensure that individual plans of care are timely and effective depends on communication systems that have the patient at the centre. Factors such as time limitations, language barriers and medical jargon can interfere with this process and slow down the patients’ journey to recovery.

Online Learner The new module uses video clips by the participating clients with an intellectual disability who speak about their

experience of service delivery. With the assistance of evidence-based material, resources and information, the module guides the online learner so that they can learn the most effective ways of working with this group.

Staff are encouraged to develop and modify their existing skill set so that they can more effectively meet the needs of their clients. The video clips are integrated with legislative content for the new module.

The module was recently launched by Kathleen Lynch, Minister of State at the Department of Health and the Department of Justice, Equality and Defence with Responsibility for Disability, Older People, Equality and Mental Health.

The learning contained in this module has the potential to benefit both service users and service providers. Service users should benefit from a better quality service, while service providers will benefit from an increased confidence in addressing the particular needs of this client group.

All disciplines and grades will be challenged to think about their practice and service delivery, not just when working with those who have an intellectual disability but with anyone who needs support around communication and understanding on their journey to recovery. Even if you do not work specifically in mental health services, you could benefit from accessing the module.

A Vision for Change ADVANCING MENTAL HEALTH IN IRELAND

Training Group The Mental Health Act Training Group (MHATG) was established in 2009 and reports to the National Strategic Management Group for Mental Health. The group seeks to provide workable and practical solutions in addressing key themes and issues associated with the implementation of the Mental Health Act 2001.

To date, the group has worked on the following: • Development and ongoing delivery of the authorised officer training programme.

• Development and ongoing delivery of the assisted admission training programme to HSE staff and An Garda Síochána.

• Development of the HETAC accredited programme ‘Certificate in the Application of Mental Health Legislation to Practice’ in collaboration with colleagues from the Regional Centre for Nursing and Midwifery Education, Tullamore, Co Offaly.

• Design and development of the Mental Health Service eLearning Hub on www.hseland.ie. Resources include five eLearning modules on aspects of the implementation of the Mental Health Act 2001. There are policies, procedures and guidelines, links to rules, regulations and codes of practice, and related materials.

+ Malachy Feely (HSE), Anna Maria Luddy (HSE), Suzanne Hyland, Anthony Fitzpatrick (HSE), Christy Fagin, Amelia Cox, Mary McGuirk, Suzanne Higgins and Liam Christie.

Health Matters 33

sexually transmitted infections

Good Sexual Health Practice Good sexual health is an important indicator of the health of the population, writes Dr Fionnuala Cooney of the Public Health Department, HSE East.

S

Advice on good sexual health practice An individual’s sexual behaviour and sexual health cannot be separated from their social and cultural context. As a result, specific advice on good sexual health practice is best tailored to the particular circumstances.

Importance of safer sex One of the core components of good sexual health practice is safer sex. Safer sex means having sex with less risk of transmission (catching or passing on) of a sexually transmitted infection (STI).

STIs include HIV, syphilis, chlamydia, gonorrhoea, trichomoniasis, herpes simplex, hepatitis B, lymphogranuloma venereum and ano-genital warts.

Promotion of the safer sex message is very important for the health of the population in Ireland, particularly as we continue to have increasing trends in notifications of certain STIs. Recent increases in gonorrhoea notifications are currently being addressed by a gonorrhoea control group. There are concerns also about transmission of HIV and chlamydia as well as other STIs. Promotion of behaviours to reduce risk of transmission of STIs is clearly very important as these infections can significantly affect the general health, wellbeing and reproductive capacity of those infected.

©iStockphoto.com/KingMatz1980

ex and sexuality are core dimensions of the human experience and are important determinants of wellbeing.

For sexually active people, good sexual health practice is important for health and wellbeing. It is important that all individuals, and especially younger people, be aware that participation in sexual risk behaviours can result in serious problems including sexually transmitted infections (STIs) and crisis pregnancy.

In practising safer sex, recommendations for individuals include: • Before having sex with a new partner, each should get screened for STIs and share the test results with each other.

• Don’t have sexual contact with anyone but one’s partner.

• Use a condom for all penetrative sex (vaginal and anal).

• The condom should be in place from the beginning to the end of the sexual activity.

• Use a condom every time one is having sex.

• Be aware that STIs can be spread by contact with surrounding skin areas. A condom reduces the risk.

• Use a condom or other barrier such as dental dams for oral sex.

• Be aware that alcohol and drugs can impair judgement. When not sober, individuals may not choose their partner carefully, may forget to use condoms, or use condoms incorrectly.

Safer sex is important for the health of the population and promotion of safer sexual behaviours is an important public health message. More information on STIs and sexual health services is available at www.yoursexualhealth.ie and www.hpsc.ie/ hpsc/A-Z/HIVSTIs/

The World Health Organisation’s definition of sexual health: Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

The World Health Organisation’s key conceptual elements of sexual health: • Sexual health is about well-being, not merely the absence of disease.

• Sexual health involves respect, safety and freedom from discrimination and violence.

• Sexual health depends on the fulfilment of certain human rights.

• Sexual health is relevant throughout the individual’s lifespan, not only to those in the reproductive years, but also to both the young and the elderly.

• Sexual health is expressed through diverse sexualities and forms of sexual expression.

• Sexual health is critically influenced by gender norms, roles, expectations and power dynamics.

34 Health Matters

Commercial Feature

Better Glucose Control for people with diabetes Using sensor augmented pump therapy (SAP) can help people with type 1 diabetes to achieve better glucose control while reducing the risk of hypogylcaemia.

I

t is well established that improved glycaemic control can reduce the microvascular and macrovascular complications associated with type 1 diabetes. In practice it can be difficult to achieve good glucose control and one of the main barriers attributed to this is hypoglycaemia.

Insulin pump therapy has been clinically proven to provide tighter glucose control than multiple daily injection therapy (MDI).

In the last five years improvements have been made to insulin pump systems with the introduction of sensor augmented pumps (SAP). Medtronic’s SAP pump – the MiniMed Paradigm® Veo™ – requires the use of a small transmitter called the MiniLink and a glucose sensor called Enlite®, which are worn by the patient on the abdomen, thigh or buttocks.

The Enlite glucose sensor measures glucose levels in real time throughout the day and night, accurately tracking and recording interstitial glucose readings every five minutes to produce 288 readings per 24-hour period. These glucose readings are wirelessly sent and displayed on the pump, which enables the patient to make precise diabetes management decisions based upon a continuous trace rather than a single glucose measurement provided by a finger stick.

SAP therapy has been clinically proven in randomised controlled trials to provide a greater HbA1c reduction vs. MDI therapy (0.8 per cent vs 0.2 per cent). An RCT cross-over multicentre study has also assessed the impact of adding glucose sensing to existing insulin pump users who were inadequately controlled (7.5 per cent < HbA1c <9.5 per cent). The sensor on arm showed a HbA1c reduction of 0.51 per cent, with these patients spending significantly less time within the hypoglycaemic range (<3.8 mmol/L). This

+ The MiniMed Paradigm VEO.

+ The Minilink transmitter.

clinically demonstrates the benefit of SAP to achieve greater glucose control for patients with type 1 diabetes.

Low Glucose Suspend How can SAP help your patients have less hypoglycaemia and give them confidence to gain tighter glucose control? Medtronic’s MiniMed Veo insulin pump is the first and only insulin pump with a built-in low glucose suspend feature which causes insulin delivery to be automatically ceased when a patient’s blood glucose level drops below a pre-defined threshold.

Health care professionals and patients now have a greater opportunity to achieve tighter glucose control, while limiting the risk of hypoglycaemia.

A newly published study in the New

England Journal of Medicine called the ASPIRE in-home study assessed the benefit of the low glucose suspend feature versus SAP without this feature switched on over a three-month period. Medtronic’s MiniMed Veo insuilin pump with its low glucose suspend feature switched on reduced the number of nocturnal hypoglycaemic events by 31.8 per cent and the severity and duration of the nocturnal hypoglycaemic events by 37.5 per cent whilst maintaining the patient HbA1c.

A second study, this time of six months duration, has also been published which assesses the impact of the Medtronic MiniMed Veo low glucose suspend feature.

This study demonstrated that no major hypoglycaemic episode occurred with the use of this system.

Medtronic’s MiniMed Veo insulin pump with low glucose suspend is the only insulin pump that has clinically been proven to reduce HbA1c and hypoglycaemia to help your patients achieve greater control of their diabetes.

The Enlite glucose sensor is now fully reimbursed on the GMS Scheme (ref code 83204) so your patient can now benefit from using the low glucose suspend feature on the MiniMed Paradigm Veo insulin pump.

For further information please contact Medtronic on +447920023093.

36 Health Matters

DISABILITY

Training for people with disabilities Holly’s Horse Haven stables in Co Louth has recently provided a five-week stable management course for six clients attending Louth Disability Services.

Positive feedback Gerard Finnegan from Dundalk, who took part in the training course, said: “I love Holly’s Horse Haven and the course was great because now I can help to look after the horses every week and I can’t wait to do Level Two.” Leanne Dunne from

+ Catherine McAlevery (left) from Dundalk, who participated in the basic stable management course in Holly’s Horse Haven in Omeath (right) along with Rita Seery, course tutor.

+ Katie Croft from Dunleer, who participated in the basic stable management course in Holly’s Horse Haven in Omeath.

© 2013, Giggles and Smiles Photography.

T

he course was provided as part of an innovative day opportunities scheme for people with disabilities. The charity rescues unwanted or abandoned horses and donkeys. Participants on the project were aged between 18 and 64 years of age and included those with learning, physical and/or sensory disabilities.

Michele Finnegan, Community Link Worker with HSE’s Louth Disability Services, who engaged with Holly’s Horse Haven to facilitate the opportunity for the six people with disabilities, said: “Holly’s Horse Haven responded so positively when we approached them about providing training to people with disabilities. They have experience of providing therapeutic training and provided a fantastic experience for our clients, who have a range of disabilities.

Through directly working with and caring for rescue horses, our clients have expanded their knowledge and developed new skills. We are very grateful to Holly’s Horse Haven for the support they have provided.”

Drogheda, who also took part in the course, said: “Holly’s is a nice place and the horses are well looked after. I really enjoyed the course and it was so good that I think everyone should do it!”

High standard of care According to Joe and Elaine Duffy from Holly's Horse Haven, “we all enjoyed immensely the experience of working alongside the course participants and are delighted that the training programme provided the skills and knowledge needed to make sure that our rescue horses receive the high standard of care they deserve.”

Funding for the scheme was secured from the EU’s INTERREG IVA programme by the Co-operation and Working Together (CAWT) cross-border health partnership. This EU funding enabled the establishment of day opportunities for people with disabilities so

+ Gerard Finnegan (right) from Dundalk, who participated in the basic stable management course in Holly’s Horse Haven in Omeath along with Michele Finnegan, Community Link Worker, HSE.

that they can live ordinary lives and be part of their local community. The scheme, which is supported by the HSE, has enabled community link workers to help clients with disabilities to identify and access daytime activities and opportunities.

Health Matters 37

MEDICINES

Use Antibiotics Wisely We all have a role to play in making sure that antibiotic misuse doesn’t threaten all our futures, writes Dr Fidelma Fitzpatrick.

M

isuse of antibiotics threatens to return medicine to the days when people could die from scratches and cuts and may place the future use of everyday practices like chemotherapy and orthopaedic surgery at risk. A casual attitude to antibiotics is damaging their effectiveness and we are seeing an alarming global rise in so called superbugs, such as drug-resistant bacteria that cause pneumonia and meningitis, MRSA and E. coli.

Taking antibiotics when they aren’t needed means that they might not work when you really need them for a serious infection, because bugs can develop immunity to drugs. This can render antibiotics useless and could see a return to the pre-antibiotic era when common injuries such as cuts and scratches that became infected could result in death or serious illness because there was no treatment available.

Thankfully, this doesn’t happen any more as we have antibiotics available to treat these infections – but we all have a role to play in ensuring that antibiotics will still be useful for future generations. For example,

“Taking antibiotics when they aren’t needed means that they might not work when you really need them for a serious infection, because bugs can develop immunity to drugs.”

you should not need to ask your doctor to prescribe an antibiotic. Your doctor will know when your illness can be treated by antibiotics. Antibiotics should only be used as prescribed and when needed.

We also need to remember that antibiotics don’t work for colds or flu. If you have a cold or flu you need to take good care of yourself and get better naturally with rest, fluids and TLC. Antibiotics should be taken exactly as prescribed – at the right time for the right duration. If you are prescribed antibiotics for your illness, it is important to finish the antibiotic course – even if you feel a lot better. This is to ensure that all the bacteria are killed completely and that no survivors are left that could multiply and develop resistance.

The importance of preserving antibiotics for future generations is the reason why leading clinicians from the HSE, general practice, hospital care, surgery, dentistry and pharmacy are uniting to tackle the global health threat of antibiotic resistance.

Keep an eye out for the HSE leaflets and posters on antibiotics in GP surgeries and pharmacies or visit www.hse.ie/antibiotics

to download these materials and to read more information.

Dr Fidelma Fitzpatrick is a consultant microbiologist and HSE clinical lead on healthcare-acquired infection.

+ Diana Hogan-Murphy, Antimicrobial Pharmacist, Dr Paulo Pinheiro, Consultant Physician and Dr Milada Tavodova, Consultant Microbiologist from Cavan General Hospital. They hosted an antibiotic awareness day in Cavan General Hospital in November to promote the European Antibiotic Awareness Day campaign.

38 Health Matters

mental health

Driving Change in Mental Health Services New National Director of Mental Health Stephen Mulvany and his team are mapping out the future of mental health services. After undertaking a valuable listening exercise across the sector he has identified a range of operational barriers that the new mental health divison will work to address in order to free up more staff time and energy for service improvements. The three years of his term will see a focus on reducing inappropriate variation, more involvement of service users in service design and delivery and greater earned autonomy for local services as we implement the wider health reform programme.

Ruraidh Conlon O'Reilly reports.

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his year has seen a significant reform of how the HSE is structured, with appointments to the new HSE Directorate becoming a landmark moment in the health service's evolution. Among the new directors is Stephen Mulvany, National Director of Mental Health. From his office in Dr Steevens' Hospital in Dublin, he and his team are mapping out the future of mental health services in Ireland.

"The vision for mental health – what it should look like – is fairly well set out in A Vision for Change, the policy document," he explains. "We want a recovery-focused service that involves service users, family members and carers in every aspect of how the service is designed and delivered – not in a tokenistic way. This includes appropriately involving service users in the detailed and challenging aspects of their care including planning for crisis and how it should be responded to.

"In terms of how to get there, some people think that you have a choice between a service focused on people recovering, or a service that's clinically excellent, with good quality doctors, staff and equipment: one or the other. But we're saying that a high-quality mental health service has to be recovery focused with full service user, carer and family involvement, but must also be clinically excellent. It's not an either/or scenario."

To accomplish this, he is building a sixmember mental health national management team. Mulvany, along with Head of Quality, Safety, Standards and Compliance Martin Rogan and Head of Planning, Performance

and Programme Management Yvonne O'Neill are already in post. Head of Operations and Improvement Anne O'Connor is due to start in December. Mulvany will also fill a Head of Service User Engagement post, in line with A Vision for Change, for someone with service user experience to be a key member of the national team; as well as a national clinical adviser who will also be the clinical programme group lead for mental health clinical programmes.

Operational Barriers One of his first actions upon appointment was to embark upon a lengthy listening exercise: around 180 people in 70 meetings across 10 weeks. "That's been very useful, and made it relatively straightforward to write the 2014 mental health divison operational plan," he says. "We're trying to listen to staff and understand what I call operational barriers, which include approval for essential replacements, recruitment process, IT, the amount of local control, etc. There's a variety of practical everyday things that soak up a huge amount of people's time. We're trying to free up time, energy and motivation by beginning to address those within the resources available to us. That's one of the three key priorities in the mental health plan for next year."

Another key priority arose from various pieces of stakeholder feedback that didn't fit neatly into individual projects. Mulvany was told by the people he met that there can be variation in services and there can be a lack of clarity about how you access

“We're going to focus on community teams and what sits in front of them: the gardai and other emergency services, primary care teams and GPs, emergency departments, children and family social workers.” some services, especially out of hours. With the help of A Vision for Change, the aim is to create a clinical programme around an overarching model of care and answer the question: what should the service look like?

"We're going to focus on community teams and what sits in front of them: the gardai and other emergency services, primary care teams and GPs, emergency departments, children and family social workers," he says. "That's where new service users most often come to us from.

We want to wrap it up into an overall change programme, consult and then seek to implement it over the next few years.

At the end, it should be much clearer for members of the general public to understand: “that's what the mental health service is supposed to do”. It shouldn't

Health Matters 39

mental health be so different everywhere. That kind of reasonable standardisation will bring reassuring clarity and certainty to those who need to access the service or have family or friends they are concerned about."

A final key priority is to improve how suicide prevention and mental health promotion are approached. Next year, the Reach Out strategy concludes and while as a strategy it fits well with all the international evidence, it could be improved in three ways. There could be better co-operation between arms of the state, as parts of Reach Out can never be delivered by a health service acting alone. It could also be improved by making actions and targets much more measurable, and thirdly it can be improved with real local implementation at a county level and below.

Finance and Regional Focus Mulvany's appointment is for three years.

He plans to spend six to nine months creating the model of care, and spend the next two years following it, with a similar timeline in place for suicide prevention. "By the end of my three years we would hope to be well down that road," he says. He brings significant and varied experience to the role but is clear that he must learn from past roles and be willing to change in order to support staff and others in mental health to make the necessary changes to improve the service. A chartered accountant with IT, industrial relations and service managerial experience, he was previously regional director of operations (Dublin North East 2009 to 2013) and most recently interim National Director of Finance before taking up his current role in mental health in July.

With his financial background, he's well attuned to the need for finances to add up.

"One of the big things for next year is that we have to put measurements and targets around safety, quality and responsiveness of service on a par with measurements around costs and budgets. That's the essence of value for money," he says.

He and his team have to operationally run the system, continue to improve it, and prepare it for health reform including enhanced commissioning, purchaser/ provider split (via ISA review), money follows the patient (initially in acute general hospitals) and ultimately universal health insurance. The work done already in bringing together a national database of

all mental health costs and budgets and the various work under way in terms of the operational barriers and the model of care are all essential building blocks within mental health as part of the delivery of the wider health reform programme.

Another noticable change in approach will be decentralisation: even though Mulvany's office runs the service nationally, he wants to be careful to leave local managers to make their own decisions within a framework of national guidance â&#x20AC;&#x201C; in fact, he strongly encourages them to do so. "Our approach is that we don't want to make a decision nationally unless it needs to be made nationally: all that does is disempower local services. We want local mental health services to eventually become part of community trusts and to be ready and able to manage their own affairs largely autonomously. If the national system steps in every time something looks like it's going wrong they'll never be ready."

Local services The emphasis on building up the capacity of local services to largely self-manage came into focus in the course of his engagment with local services. Mulvany heard feedback that local services don't believe they get enough input into the annual service and operational planning process. He took this onboard by giving local services written guidance and a fiveweek period from the end of September to create the bones of their own mental health area operational plans for 2014. + Stephen Mulvany.

They were also encouraged to share this guidance and the process with each of their own local teams, who should be supported to produce their own mental health local operational plans for 2014 (by the end of February 2014). His team also organised a two-day mental health team event on November 21st and 22nd, which was built around the planning process for 2014 with a series of speakers and workshops focused on shaping and delivering next year's mental health national opertional plan. This informed the mental health chapter in the National Service Plan 2014 which was submitted for ministerial approval on November 26th. It has also informed the preparation of the mental health national operational plan 2014, which is expected to be considered by the Directorate of the HSE in mid-December.

Mulvany is clear that mental health was the division which he most wanted to lead. "It appealed to me as a field.

Personally, like many people, I have a number of close family members who have been users of the mental health services. Organisationally, I had a sense that mental health had significant potential and it's somewhat discrete: it's relatively easy, at least from the inside, to say what the mental health service is. There was a strong sense that you could make some worthwhile changes there, and it was ripe for that change. That change involves changing the culture and I hope by our actions since the end of July that change has already begun."

40 Health Matters

National Quality Improvement Programme

Diploma in Leadership and Quality in Healthcare The diploma in leadership and quality in healthcare is part of the National Quality Improvement Programme, which is a joint initiative by the HSE’s Quality and Patient Safety Directorate and the Royal College of Physicians of Ireland.

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he diploma in leadership and quality in healthcare programme was introduced in 2011 for managers and medical professionals to build leadership skills and expertise in quality improvement, thereby helping them to achieve their common goal of improving Irish healthcare. As part of the diploma, participants engage in workshops, site visits and coaching, following which the next step is the development of quality improvement projects in their own workplaces. Below are just some examples of improvements that recent graduates introduced into their workplace as a result of their quality improvement projects:

Project One: Tallaght Hospital Implementation of a ventilator-associated pneumonia (VAP) prevention bundle in the ICU In January 2013, Dr Jérôme Fennell, Consultant Microbiologist; Mairead Holland, Clinical Nurse Specialist in the Infection Prevention and Control Team; and Mr Eddie McCullagh, Chief Scientist, Dept of Clinical Microbiology, all from Tallaght Hospital, applied in order to learn and implement change in their system. The focus of the project was implementing a ventilatorassociated pneumonia (VAP) prevention bundle in the ICU, with an aim of 100 per cent compliance within six months.

Ventilator Associated Pneumonia VAP is the most common ICU-acquired infection and is generally defined as a hospital-acquired pneumonia which commences 48 hours or more after the commencement of mechanical ventilation.

VAP is associated with increased duration of ventilation, mortality, length of stay, antibiotic use and costs. The attributable mortality for VAP has been estimated to be

between 1.5 and 13 per cent. VAP has been estimated to be responsible for a quarter of all ICU-acquired infections. A 2004 study estimated that VAP was the most expensive healthcare-acquired infection and that each VAP episode costs $25,072. Another study that year calculated that an episode of VAP costs their institution $57,000. In 2007, it was estimated that VAP cost the US healthcare system between $1.03 and $1.5 billion. It has been estimated that 55 per cent of VAP episodes are preventable, which shows the potential for financial savings by implementing a VAP prevention bundle. Of course, the patient benefits also provide even greater justification for this process.

Plan-Do-Study-Act Cycles Using an approach based on the model for improvement as developed by Langley, Nolan and Nolan and advocated by the Institute for Healthcare Improvement (IHI), the team focused on plan-do-study-act cycles and small tests of change. They mapped change through run charts and trend analyses. They also referred to guidance on how to prevent VAP by implementing selected aspects of the IHI bundle (IHI, 2012). Engaging with key stakeholders was crucial to the success of the project.

Results The results to date have been extremely positive. Marked and sustained improvements in correct patient and ventilator tube positioning was observed.

Measures related to weaning of ventilation and sedation proved more complex and it was difficult to sustain improvement. Each of the cycles was accomplished through smaller interventions and tests of change.

The median duration of ventilation fell from 16 days in 2012 to 13 days in 2013 and

the median length of ICU stay fell from 16 days to 14.6 days in the same time period.

Although these results suggest that the VAP bundle may have had a benefit in terms of reducing ICU stay and duration of ventilation, the study is too brief to be certain that the bundle is responsible for the improvements.

Costs At an average cost of c2,500 per day for each patient ventilated, it is estimated that this equals c3,500 for patients ventilated for more than eight hours. Based on figures from 2011, 104 patients were ventilated for more than 96 hours – so a reduction of 1.4 days for each of these patients would have saved 145 bed days and c362,500. In reality, the ICU beds will always be filled but this would increase efficiency and allow the limited hospital resources to be used for the benefit of more patients.

The work of the ICU staff and in particular Dr Maria Donnelly, the Head of ICU, was crucial to the implementation and success of this project and cannot be underestimated.

Project 2: National Rehabilitation Hospital Improving the patient pathway at a urology nurse-led surveillance clinic In January 2013, Bernie Lee began her quality improvement journey on the diploma in leadership and quality in healthcare. As part of this diploma, Bernie – with a team of colleagues in the National Rehabilitation Hospital – implemented a project in their workplace to improve the patient pathway in a urology clinic. Their project has since been accepted as a poster presentation to the Multidisciplinary Association of Spinal Cord Injured Professionals Conference.

The project specifically aimed for: •M ore than 90 per cent of patients

Health Matters 41

National Quality Improvement Programme

+ Recent graduates of the diploma in leadership and quality in healthcare include (second row, third from the left) Bernie Lee and (fourth row from left) Eddie McCullagh and Mairead Holland, both from Tallaght Hospital.

attending the surveillance clinic to go through a registration process on arrival at the clinic.

• Improve efficiencies between consultation and post clinic outcome letter to the patient's GP by reducing the turnaround time by seven days.

• 100 per cent of patients to have their nursing assessment completed using ISBAR Communication Tool.

• 75 per cent of patients attending the surveillance clinic to receive information on the clinic outcome visit and this to be completed by the end of July.

• Development and implementation of policies around the management of the urology service.

Quality improvement tools/technique Using quality improvement tools and techniques, the team leveraged existing resources and expertise to provide a framework for implementing QI in the NRH. Initially, process flow data was collected to establish the baseline. Data was then collected following various plan-do-study-act (PDSA) cycles and presented in run charts to easily identify the improvements.

Outcomes The ICU multidisciplinary team, especially nursing staff, changed their work practices to carry out the interventions which had an extremely positive effect on the project.

The following benefits to patients and the healthcare service were observed:

• Some 78 per cent of patients now go through patient registration on arrival at the clinic compared with pre-QI of 33 per cent • Six-day reduction in turnaround time between consultant consultation and posting outcome letter to the patient's GP with a reduction from 16 days to 10 days • All patients have their nursing assessment completed using ISBAR Framework. No formal framework being used prior to QI process • Urology service policy approved by consultant urologist. Standard of practice for nurse-led clinic under development.

There was no formal policy of procedure in place • A third of patients now receive written information on clinic outcome, compared with a pre-QI rate of 0.05 per cent.

The focus of this project was to build quality into every step of the service for the patient and the team feels the six Institute of Medical dimensions of quality have been improved with the projects. Bernie and her team are now looking to maintain the changes and implement the improvements on a broader scale.

Project 3: Letterkenny Hospital Redesigning peri-operative care for patients undergoing joint replacement surgery As part of a quality improvement project of the diploma in leadership and quality in healthcare, Dr Paul O’Connor, a Consultant Anaesthetist in Letterkenny General

Hospital, decided to attempt to introduce day-of-surgery admission as the standard of care (target > 90 per cent) in the Joint Replacement Programme and to reduce length of stay (LOS) in hospital from a mean of 8.8 days in 2010 to 6.8 days in 2012.

At this time, international practice had moved towards rapid recovery from orthopaedic surgeries. Dr O’Connor and a number of colleagues attended a conference on this in the UK and agreed they needed to implement it in Letterkenny.

Initially, a core leadership team was established consisting of Dr O’Connor, a consultant surgeon, senior nursing and a physiotherapist. Looking back, Dr O’Connor feels that the development of this multidisciplinary team was crucial to the success of the project.

The team created a multidisciplinary assessment process whereby all patients met with the team in advance of the surgery in preparation for the process. This enabled patients to be educated on what would happen on the day of their surgery. The team also initiated some process changes within the orthopaedic clinical services that enhanced the process during surgery.

Another key factor in the project was the introduction by the HSE of tariffs whereby hospitals would benefit from the amount of surgeries completed. This change meant that senior hospital management increased their support of the project, as it affected their revenue.

Following all of this, and a huge amount of hard work, by September 2012 76 per cent of patients were admitted on the morning of the procedure. The team also recorded high patient satisfaction scores and there was no evidence of unplanned hospital readmissions.

Since then, the success from the project has been sustained. Between August 2012 and July 2013, 83 per cent of patients were admitted on the morning of the procedure.

National QI Programme wins award The diploma in leadership and quality in healthcare won an Excellence in Healthcare Management Award in recognition of the difference it is making to patient safety in Irish hospitals at the Irish Healthcare Awards held in November 2013.

42 Health Matters

OBESITY

Tackling Obesity

©moodboard/Thinkstock

One in four Irish children are either overweight or obese.

Dr Nazih Eldin, HSE Lead on Obesity outlines the supports that have been put in place to help address the situation.

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e only have to look around us to know that Irish people, and particularly children, are becoming heavier.

They wear clothes for older children, spend more time watching TV and playing computer games than playing outside, and eat food high in fat, sugar and salt. We as parents indulge this sedentary behaviour by giving them TVs in their bedrooms, allowing them mobiles and tablets so they can text their friends, and drive them to and from school. With six out of every 10 adults overweight or obese, we are not proving good role models for our children to lead a healthier lifestyle.

Critical period While childhood is a critical period for developing obesity it is also a key time to prevent it or treat it before it becomes established, as childhood is a time when eating and physical activity habits are formed. Habits form behaviour and behaviour can be changed. To really halt this tendency towards unhealthy weight gain in children we need to start helping women to enter pregnancy at a healthy

weight, because children conceived by an obese mother have a four-fold greater risk of childhood obesity by the age of four years. If we look at it from a purely financial standpoint, we know that treating the childhood co-morbidities of obesity costs the health service e5,000 per child.

Intervention To ensure value for money and to increase the likelihood of success, we need to intervene as early in a child’s life as possible. Evidence tells us that intervening with children under 13 yields the greatest chance of success as children’s eating and physical activity habits are still under parental control and the strategy of employing weight maintenance in the growing child is both practical and possible.

After the age of 13, obese boys have a one-in-two chance of becoming obese adults – with the risk greater in girls, who have a two in three chance.

Strategy I believe a three-pronged approach is needed to:

• Prevent children becoming overweight and obese through health promotion and other initiatives.

• Promote healthy weight management for overweight and mildly obese children through family, community-based, multidisciplinary lifestyle interventions like W82Go, the Triple P Programme, UP4IT and so on.

• Treat the children who are severely obese and in need of clinical intervention (10 per cent of Irish children: 60,000 to 100,000). Some 1 per cent of these, or approximately 1,000 children per year, require hospital treatment support.

Supports A population shift towards a healthy lifestyle for all will be needed to prevent children becoming overweight and obese.

We will also need to target those children who are already overweight or obese with interventions that will prevent them becoming overweight or obese adults.

The HSE-ICGP weight management treatment algorithm for children www.hse.ie/weightmanagement provides a clear clinical pathway for health professionals in addressing overweight and obesity.

The HSE-ICGP healthy weight management guidelines before, during and after pregnancy, www.hse.ie/ weightmanagement, will greatly assist, at the population level, in preventing women entering pregnancy either overweight or obese. The three year national childhood obesity media campaign, www.safefood.eu, has already raised parental awareness about the health implications of childhood obesity.

It also supports them through practical doable health-promoting habits that they as a family can adopt as well as making available support resources from self-help websites and leaflets, signposting to local initiatives and referral to clinical interventions according to a hierarchy of need.

The children’s algorithm will assist in identifying overweight and obese children in junior infants who require support to halt their tendency towards weight gain through family, community-based multidisciplinary

Health Matters 43

OBESITY Parents will also be directed to self-help resources, e.g. the HSE Eat Smart Move More booklet (www.healthpromotion.ie), the media campaign parents’ booklet Your Child’s Weight and www.getirelandactive. ie, our one-stop shop for all information on becoming more physically active. Our Health Promotion physical activity coordinators with Clare Sports Partnership are developing a national active play resource for parents and carers of children aged two to six years, which will be available early in 2014.

Assistance We will assist overweight and obese children and their families by adopting the following approach. Obese children will be referred for treatment to the newly trained MDTs. Temple Street Children’s Hospital will provide the clinical backup and will liaise with the physician on the MDT. Once the initial clinical assessment is carried out and a care plan is initiated, the obese child and their family can begin the W82GO programme in the community.

All-Island Tackling childhood obesity is a public health priority and of key concern for the Minister for Health’s Special Action Group on Obesity (SAGO). In taking on this issue Safefood, the HSE, Department of Health and Department of Children and Youth Affairs have come together to deliver an all-island three-year childhood obesity campaign. Its objectives are: • To communicate practical solutions that parents can adopt in order to tackle the everyday habits that are associated with excess weight in childhood.

• To maintain awareness among parents of the health challenges posed by excess weight in childhood, the negative impact this can have on quality of life, and the importance of tackling this for the longterm.

Self-Help resources Overweight children can be referred to selfhelp resources and prevention programmes in the community, e.g. the CAWT Up 4 IT programme which is available in border areas, the W82GO Limerick Kids, the Triple P parenting programme in the midlands, Darndale and Tallaght, Don’t Weight Parents (Galway), and Be Active After School Programme (in 23 local sports partnerships).

“While childhood is a critical period for developing obesity it is also a key time to prevent it or treat it before it becomes established, as childhood is a time when eating and physical activity habits are formed.”

Resources There are two resources that can assist health professionals in dealing with parents and children regarding body weight: • Your Child’s Weight: a Guide to Preventing Childhood Obesity, available to download or order from healthpromotion.ie. Order code: HPM00851.

•A Guide for Health Professionals: Assisting Parents and Guardians in Communicating with their Children about Body Weight. www.hse.ie/ weightmanagement.

Campaign messages Our campaign emphasises the importance of taking on practical changes for the whole family that are sustainable for the long term.

Messaging will focus on six core actions for parents on a phased, three-year basis: • Portion sizes for children.

• How to manage treat foods.

• Being more physically active.

• How to improve parenting.

• Saying no.

• Replacing sugary drinks.

• Encouraging more sleep/less screen-time.

Readers will have seen that the first phase of the campaign is focusing on reducing portion sizes for children, replacing sugary drinks with water and being realistic about treat foods. Making simple changes like these can make a big difference to the health and wellbeing of children and help combat the population’s tendency towards unhealthy weight. ©iStockphoto.com/GeorgeNight777

lifestyle interventions. Planning is underway to introduce child growth monitoring as part of the school health check in four pilot sites (Laois-Offaly, Dublin North City, Mayo and parts of North and South Lee) during the current school year. This will be carried out at the same time as the sight test and hearing checks, with results communicated to parents. We will also provide training for the establishment of four multidisciplinary teams (MDTs) to support these pilots in providing the W82GO Lifestyle Intervention Programme in the community.

Supports for Parents Your Child’s Weight: a Guide to Preventing Childhood Obesity available to order on www.healthpromotion.ie.

Order code: HPM00851.

The campaign website www.safefood.eu for support material and a number of podcasts from health experts on topics such as parenting tips on how to say no, dealing with fussy eaters, etc.

Guide to Talking to your Child About Weight: www.safefood.eu Supports for Health Professionals and Parents – a listing of resources and web links for additional support: www.hse.ie/weightmanagement Prevention and Intervention Programmes by setting for Overweight and Obese Children and Families. A directory of programmes grouped under community, school and clinical settings: www.hse.ie/weightmanagement www.getirelandactive.ie: a one-stop shop for promoting local, regional and national physical activity for individual and family participation and competition to achieve and surpass the recommendations of the Physical Activity Guidelines for Ireland.

44 Health Matters

Green HealthCAre

Preventing Waste and Saving Money The Environmental Protection Agency-sponsored Green Healthcare Programme (GHCP) aims to promote resource efficiency in healthcare facilities with a view to identifying financial savings. The programme was fully launched nationally in 2010. he focus of the Green Healthcare Programme is in identifying waste prevention and diversion measures for food waste, general waste and healthcare risk waste (HCRW). Examples of savings achieved by some of the participating facilities are provided below. These examples show that preventing waste and improving resource efficiency, often by implementing simple steps requiring limited resources, can result in significant savings for your facility.

The GHCP has developed a number of guidance documents and case studies that are available on the programme’s website, www.greenhealthcare.ie.

These include: • Best practice guides – for waste prevention and management of different waste streams.

• ‘How to’ instructional guides – how to undertake surveys and other work that will help to identify potential waste reduction measures and associated savings.

• Case studies – good practices observed in facilities.

• Factsheets – outline the results of work undertaken in the GHCP. The website also outlines how to join a private information-sharing network for healthcare workers set up by the programme. This network allows staff to ask questions or seek guidance from other staff working in similar areas in other hospitals. Through the sharing of knowledge and experiences, hospitals can save time and resources by avoiding problems already encountered by others.

Visit the website today to get some ideas on how to make savings in your facility.

Examples of savings achieved by GHCP participating hospitals

1

Midland Regional Hospital, Tullamore reviewed the provision and positioning of recycling bins in their theatres and reduced the quantity of HCRW and general waste it produced.

• SAVINGS: f26,000 (compared to the average GHCP facility)

2

Temple Street Children’s University Hospital implemented a number of measures including: • Reducing the quantity of food placed in the containers brought to the wards. This was achieved without affecting patient food portions.

• Revising the timing of food preparation in the canteen to prevent food being prepared near the end of service – food that is not purchased and would be thrown out as food waste.

• Re-use of suitable excess unserved food in refrigerated vending machines, to provide a meal for staff and visitors out of hours.

• Increasing recycling throughout the hospital.

Before joining the programme the hospital had implemented significant measures in relation to the segregation of non-healthcare

risk waste from certain isolation rooms, resulting in savings of s21,000 per annum.

After the GHCP survey highlighted further potential savings in this area, the hospital increased staff awareness of the segregation procedures, improved segregation further and made additional savings.

• SAVINGS: f45,000 per annum

3

University Hospital Galway has implemented a number of measures including reducing the quantity of food sent to the wards (without affecting the food provided to patients), removal of high wastage foods and replacement with a higher nutritional content option, tighter control on the provision of perishable ward stock and condiments, and revision of the menu system.

Additionally, the hospital has reviewed the segregation of non-healthcare risk waste from certain isolation rooms and introduced reusable biosharps containers, reducing the quantity of HCRW it generates by around 27 tonnes per annum.

• SAVINGS: These measures have resulted in notable cost savings for the hospital

©iStockphoto.com/HelpingHandPhotos

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Health Matters 45

LIBRARY Resources

E-Books From HSE Libraries Online If you take the train, Luas or bus to work, you’ll have seen people reading books on electronic devices of varying kinds.

They accounted for 22 per cent of all book spending in the second quarter of 2012, according to figures from Bowker Market Research.

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ublic libraries in Ireland already offer extensive collections of e-books, with more than 1,000 titles borrowed each month. Academic libraries in Ireland offer ebooks to students and some have developed what is called ‘patron-driven acquisition’ which enables the borrower to recommend an e-book to their library for purchase. HSE libraries have adapted to this trend by introducing a range of e-books. Since the mid-2000s, e-books have been available to all registered HSE users via MDConsult. As with access to all HSE electronic library resources, an Athens account is required, which enables you to login from any internet location. To register, just sign up for an Athens account

from the www.hselibrary.ie website.

These MDConsult e-books are not freely available anywhere else on the internet. Whether you are a surgeon, nurse practitioner, occupational therapist or manager, there will be a book to suit your interests and professional development path. All e-books are accessible from home, work or on any internet-enabled mobile device.

In addition to MDConsult, other local collections of e-books are available depending on your location. Users can access these via the library catalogue or by following the e-books links from hselibrary.ie.

The books’ fonts can easily be resized

123Library.org Top 10 EBooks borrowed in HSE (Dublin, Wicklow, Kildare) Position

Title

Author

1

Core Psychiatry

Padraig Wright, Julian Stern, Michael Phelan

2

1,000 Questions and Answers from Kumar & Clark’s Clinical Medicine

Parveen Kumar, Michael L Clark

3

Improving Child and Family Assessments

Julie Selwyn, Elaine Farmer, Danielle Turney, Dendy Platt

4

Practical Evidence-Based Physiotherapy

Robert Herbert, Gro Jamtvedt, Kåre Birger Hagen, Judy Mead

5

Occupational Therapy and Mental Health

Jennifer Creek, Lesley Lougher

6

Games and Activities for Exploring Feelings with Children

Vanessa Rogers

7

Child and Adolescent Mental Health 2nd Edition

Margaret Thompson, Christine Hooper

8

Best Practices in Leadership Development and Organization Change

Louis Carter, David Ulrich, Marshall Goldsmith

9

Project Management For Dummies

Stanley E. Portney

10

Acute Medicine

David C. Sprigings, John B. Chambers

for optimal viewing on mobile devices. This format also enables easy navigation to chapters of the book. The e-book’s table of contents has links to individual sections for easy access. You don’t even need to have an e-reader to read the books, just an internet connection.

E-books are currently available in the following subject areas: clinical medicine, public health, psychiatry, nursing, mental health, occupational therapy, physiotherapy, communications, childcare, management and many more.

For more information please contact your local HSE library.

Online development for Irish health repository LENUS, the Irish health repository, has been included as a participating repository in RIAN. RIAN is a webbased portal that harvests and displays the content of the research repositories of the seven Irish universities and the Dublin and Dundalk Institutes of Technology.

Since its establishment by the HSE’s Regional Library and Information Service at Dr Steevens’ Hospital in 2009, LENUS has championed and promoted the dissemination of health service research and its availability in RIAN is a major development in Irish open access publishing, as well as a significant boost to researchers working in the Irish health services.

Commenting on the inclusion of LENUS in this portal, Bennery Rickard, Regional Librarian with the HSE’s Regional Library and Information Service said that Ireland was now at the forefront of the Open Access movement. “RIAN is among the first wave of national open access portals in the world and the inclusion of LENUS will greatly increase the international profile of research carried out within the HSE.”

46 Health Matters

volunteering

Linking in with Londiani A chance encounter in 2004 between hill-walkers on Mweelrea mountain in Mayo led to an invitation to Mayo staff to visit a mountain clinic in Kenya by Friends of Londiani, writes Méabh Ni Bhuinneáin.

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he Friends of Londiani (FOL) charity was founded in 2002 by a group of Irish volunteers who worked on community development projects in partnership with the people of Londiani in Kenya.

Londiani is 220km north-west of Nairobi, in Kenya’s Rift Valley province. This is a rural area. Some 70 per cent of the population rely on subsistence farming, 65 per cent have no electricity and 50 per cent have no running water. The charity’s main programme areas are health, education, water-sanitation-hygiene and economic empowerment. The NGO hosts international service volunteers, who gain from development education and cosharing of technical skills.

Last month, a team from Mayo General Hospital returned to the Rift Valley for an annual trip that has now been made seven times. We travelled 250km north-west of Nairobi to Londiani, high up in on the Mau

escarpment, known as a place where it is particularly cold. The challenging daily dawn run/walk at 2,500m altitude explains why these Kalenjin people are such successful long-distance Olympians.

The natural beauty that attracts the trekker belies the reality of life as a subsistence farmer in these remote rural villages where cholera, polio and measles outbreaks still occur, where one per cent of mothers die in childbirth and some 20 per cent of children do not reach their fifth birthday. Malaria, TB, typhoid and HIV infections are endemic.

As a result of a community health needs assessment, Friends of Londiani partnered with the local Ministry of Health. As part of its wider health program, it facilitated a hospital link between Londiani SubCounty Hospital and Mayo General Hospital that was formally established through a memorandum of understanding in 2009.

+ L-R: Maria Kidney, Pauline Corcoran, Anne Freeley, Mary McGrath, Mary Kilcoyne, Tony Canavan, Mary Dunford, Justin Kerr, Michael O’Neill and Meabh Ni Bhuinneain at the entrance to Londiani District Hospital.

“The natural beauty that attracts the trekker belies the reality of life as a subsistence farmer in these remote rural villages where cholera, polio and measles outbreaks still occur.”

Operating Theatre The management teams from Londiani and Mayo hospitals met in Nairobi in 2009 and jointly explored the hospital structures and healthcare delivery models in Kenya’s urban and rural settings. The visit culminated in the breaking of ground to build an operating theatre at Londiani District Hospital.

Londiani Sub-County Hospital is a small government hospital with three young Kenyan doctors and seven clinical officers led by Dr Kigen, 20 nurses led by Matron Soi, and support staff led by administrator Langat. The hospital provides emergency and secondary care services for a population of over 200,000 people.

The provision of a fully commissioned operating theatre at Londiani Sub-County Hospital in 2012, funded by FOL, Irish Aid and Mayo General Hospital Medical Staff Committee, has made comprehensive emergency obstetric care (life-saving obstetric surgery including caesarean section and blood transfusion) available in this district.

We are given the opportunity to shadow our Kenyan colleagues in a bid to truly understand the challenges they face on a

Health Matters 47

volunteering daily basis to deliver complex healthcare with limited resources. The breadth of practice from paediatrics to gynaecology, tropical medicine, mental health, general surgery and trauma demonstrates the wide and varied skillset that is demanded.

Continuing medical education is shared by both the Mayo and Londiani teams, and skills trainings are run.

Reciprocal visit While Mayo General has already hosted visits from Londiani community groups, the next significant step in our link will be the reciprocal visit for the staff of Londiani Hospital, which is planned for 2014.

During this visit it is hoped that we will apply for ESTHER Alliance recognition – a global health European initiative that sets the highest quality standard for health institution linking.

Mary Kilcoyne, Advanced Nurse Practitioner in Emergency Medicine at Mayo General, noted many improvements on her return visit this year. “The improvements from 2009 are impressive; seeing the improvements structurally with the theatre building completed and fully operational is really enhancing patient care,” she said.

“The staff are delivering healthcare in very difficult circumstances with dignity and empathy and are striving to improve through multidisciplinary teaching every Thursday morning, which we had the pleasure of attending… our colleagues in Londiani district are amazing in the way they manage with so little resources.”

See our website www.friendsoflondiani. com to read more about the following programmes: healthy villages, healthy homesteads, healthy schools, alternative rite of passage, girls4girls, sustainable development; or email us at info@ friendsoflondiani.com for information on volunteering.

Méabh Ni Bhuinneáin is an obstetrician/ gynaecologist at Mayo General Hospital since 2001. She joined Friends of Londiani in 2004 and has been volunteering in Kenya with various service teams since then. Her interests include global maternal, child health and health service provision in the resource-poor setting. She teaches emergency obstetric skills to healthcare students and providers in MGH, NUIG Mayo Academy and Kenya.

+ Members of the mobile EONC team earlier this year: Mary Stafford, Tony Murage, Una Fahy, Tanya Sheehy, Carole Barry, Miriam McCarthy and Kate Riley.

Carole Barry (Obstetrics and Gynaecology, Rotunda), who also works with ‘Friends of Londiani’, writes: High maternal and child mortality is a devastating issue in many low-income countries worldwide, and especially in Sub-Saharan Africa.

The maternal survival programme driven by Friends of Londiani and the Ministry of Health in Londiani addresses this issue at three levels: through community sensitisation with peer education, through active engagement with the traditional birth attendants as community referral agents, and through health-system strengthening. The provision of comprehensive emergency obstetric and newborn care is a key element in this strategy.

Teaching life-saving skills in obstetric and newborn care (EONC) is a key intervention supported by WHO and the Royal College of Obstetricians and Gynaecologists.

Volunteers from Mayo General Hospital (MGH), Mercy Hospital Cork, Waterford and Clonmel with Friends of Londiani have provided instruction in EONC in Londiani since 2007.

In November, Gladys Langat and Imma Chebet of Ndubusat Clinic delivered mobile EONC study days in remote rural health centres where there are no doctors. They did so with visiting obstetricians, GPs, midwives and nurses from Ireland and the UK: Una Fahy (University Maternity Hospital Limerick), Carole Barry (Rotunda Hospital/RCSI), Miriam McCarthy (GP, Killarney), Kate Riley (GP, Bristol), Eilis Carmody (nurse, Milford Hospice), Tanya Sheehy (Mercy University Hospital Cork), Mary Stafford (retired midwife, Wexford) and Josline Chepkoech (administrator).

Some 27 community nurse-midwives and health workers received skills training and demonstrated competence in most of the seven key signal functions of EONC. The team also provided in-service revision training for the staff of Londiani Sub-County Hospital. The perinatal mortality is high in the district. Local midwife Catherine said: “We are upset when we lose these babies.” Una Fahy explained: “The African newborn resuscitation doll-trainer caused great amusement amongst children and adults alike.

Little did we realise that Resuci-Baby had done a great day's work – Kate and I had retreated to the familiar surroundings of the Londiani maternity ward for ward-based training. The magic moment occurred the next morning when matron announced that our teaching effort had met real-life success overnight.”

48 Health Matters

HAND HYGIENE

Clean Hands Save Lives Hand hygiene is one of the most important things we can do to prevent infection. It protects our patients and ourselves, writes Dr Fidelma Fitzpatrick, Consultant Microbiologist.

A

Know the five moments for hand hygiene • Before patient contact – e.g. shaking hands, clinical examination. Clean your hands before touching a patient, when approaching him/her.

• Before a clean or aseptic task – e.g. mouth care (clean procedure), catheter insertion (aseptic procedure). Hands must be cleaned immediately before the procedure.

• After body fluid exposure risk – e.g. after drawing and manipulating blood, clearing up urine, faeces, handling waste.

Immediately after an exposure risk to body fluids, remove gloves and clean your hands.

• After patient contact – e.g. shaking hands, clinical examination. Clean your hands after touching a patient when leaving the patient’s side.

• After contact with patient surroundings – the patient’s immediate environment will be contaminated with germs, for example staphylococci on skin scales.

Clean your hands after touching any object or furniture in the patient’s immediate surroundings when leaving – even if the patient has not been touched.

How long does it take?

To be effective, alcohol-based hand-rubbing takes only 20 to 30 seconds. Adequate hand-washing with water and soap requires 40 to 60 seconds.

©iStockphoto.com/gangliu10

s HSE staff, it is important that we take personal responsibility and ensure that we perform hand hygiene. We should also ensure that those working with us do the same and show our patients, residents and clients how they can help too.

There are five moments or opportunities during which we must make sure that hand hygiene is performed. These are based on the occasions when you are most likely to contaminate your hands and/or transmit infection to your patient.

Alcohol hand rub is not always enough There are two occasions when you can’t use alcohol hand rub for hand hygiene. You need to wash your hands: • When hands are visibly dirty or visibly soiled.

•W hen caring for a patient/resident with C. difficile infection. Spores are not inactivated by alcohol based hand rub; this is why you need to wash your hands.

Gloves and hand hygiene The use of gloves does not replace the need for hand hygiene. You should wear gloves only when indicated and remove when the procedure is complete. Perform hand hygiene before putting on and immediately after you remove gloves.

Further information and resources Think you know your five moments? Check out this game and try not to get timed out! www.npsa.nhs.uk/cleanyourhands/ resource-area/wi-five-game/ For more information go to www.hse.ie/go/handhygiene.

HSE staff should help patients understand that hand washing is the best way to prevent germs spreading. If your patient can’t get to a sink to wash their hands, provide them with a means to clean their hands (e.g. a basin of water and soap, wipes or alcohol hand rub) so that they can keep their hands clean.

Patients should wash their hands: • After coughing/sneezing.

• After going to the toilet.

• After touching anything wet (e.g. ooze from their wounds, urine from their catheter, blood-stained dressings).

• Before mealtimes.

Let your patients know that they should: • Avoid touching any wounds or the area around drips, drains or catheters.

• Remind their visitors/carers to wash their hands before and after visiting/ caring for them.

• As a patient it is OK to speak up. Let them know that you welcome them reminding you to wash your hands.

HAND HYGIENE

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Ecolab’s hand hygiene customers are fully supported by our comprehensive training and education package.

Delivered through our unique Hand Hygiene Compliance Education Program, we work with our customers to develop a bespoke support offering that follows WHO methodology and includes compliance assessment tools, interactive training resources and awareness signage.

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The newest addition to our hand hygiene range, we’re proud to launch Seraman Soft, which is formulated with ingredients to reduce moisture loss, to provide extra care for our customers’ hands.

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50 Health Matters

PRIMARY CARE

Developments at Mallow Primary Healthcare Centre Mallow Primary Healthcare Centre opened in 2010 and is one of the largest primary healthcare centres in the country. Health Matters asked Centre Manager Conor Healy to update us on developments since its opening.

I

t has been a really busy time for everyone working at Mallow Primary Healthcare Centre (MPHC) since we opened our doors to the public in April 2010. We now have more than 1,000 people a day visiting the centre and almost 250 people are working here.

There are 140 HSE staff working closely with the 20 GPs based in three group practices – the Medical Centre, the Cork Road Clinic and the Red House Family Practice. Some 24 new jobs have been created in the centre since it opened. Three HSE primary care teams, in conjunction with GP practices, deliver key services to patients living throughout the North Cork region and this collaboration, we feel, has substantial benefits for patients.

The centre is located in a 70,000 sq ft building spread over four levels. HSE services occupy most of the second floor and they include a community mental health team. The general practices are located on the first floor and SouthDoc, the GP co-op out-of-hours service, has its own entrance.

Awards MPHC has been recognised for the quality of its work by winning a number of awards: • North Cork HSE Psychology Department was awarded the 2012 WAIMH (World Association for Infant Mental Health) Award at the 13th World Congress of WAIMH in South Africa in April 2012.

This award was presented in recognition of their contribution to the worldwide infant mental health community through the setting up of an affiliate Infant Mental Health Group in Ireland and the promotion of the development of infant mental health services in this country.

• Impressive reductions in emergency hospital admissions of high-risk patients aged over 70 years, through innovative thinking and efficient practice in primary care, won MPHC the Best Public Health Initiative accolade at the 2012 Irish Healthcare Awards. This project, ‘Emergency Hospital Admissions for the Over-70s: Risk Assessment, Interventions and Practical Solutions’, used a simple questionnaire and targeted interventions

to reduce emergency hospital admission in this patient group. The project is funded by the HSE and works in collaboration with UCC, HSE and GPs in MPHC. • MPHC was named Ireland’s Best Healthcare Building at the Local Authority Members’ Association Awards in Dublin in February 2012. Mallow Town Council nominated the centre for the award.

• WONCA, the world organisation of family doctors, hold their international conference every three years and this year MPHC entered eight posters at the world conference in Prague in July.

MPHC was awarded Best Poster for two of the entries, which is significant because just six prizes were awarded.

The first poster was entitled Reasons for Encounter and illustrated an extensive study of 26,452 reasons for encounter, or visits, during 19,766 GP consultations over a two-year period at one of the GP practices based at MPHC. The study found that respiratory disease is the main reason for visits and is greatest in the 0-15 years age group. The second

Health Matters 51

PRIMARY CARE + Minister for Primary Care Alex White TD having a warfarin test in MPHC with practice nurse Stephanie Cronin.

poster, entitled Group Based Psycho Education for Family of People with Dementia, was a collaborative study between the HSE, occupational therapy and psychology departments, the Alzheimer Society and the GPs in MPHC. It found that group-based education increases carers’ knowledge of dementia.

It also reduces their levels of burden and increases their confidence when caring for a family member with dementia.

Dementia Care There have been several new initiatives in MPHC in relation to dementia care. Many of these initiatives have involved joint working between HSE, GPs, UCC, the Alzheimer Society of Ireland and family carers. Two new support services for dementia are now available in MPHC. • In May, the HSE launched the Memory Resource Room in the centre. This initiative has been established by the North Cork Occupational Therapy Department, where a dedicated occupational therapist for dementia has been assigned. The room is an informal space and has a drop-in facility one day a week (Tuesday) where family, carers or people concerned about their memory can speak to a healthcare professional. Appointments on other days can also be accommodated by phoning the Occupational Therapy Department in advance. The Memory Resource Room provides advice, support and information at a time when it is most needed. This

service is open to all and no referral is necessary. While the project is based in Mallow, the Memory Resource Room is open to anyone living in North Cork. The room will have a number of resources available for family members and staff. The service is available to anyone concerned about their memory or anyone with a diagnosis of dementia.

• The Crystal Project: ‘Creating clarity and connections for people with dementia’ supports people with dementia and their families. A key objective of the project is also to support staff working with people with dementia and assist them in raising awareness of the condition, promoting early diagnosis and reducing stigma. This project is co-ordinated and managed by the HSE Occupational Therapy Department.

We estimate that there are almost 1,000 people living with dementia in the North Cork area and just over 300 in the Mallow area. By 2042, it is estimated that there will be almost 1,100 people with dementia living in the Mallow area.

“There are a number of new initiatives planned in dementia services and awareness, including making Mallow a dementiafriendly town.”

Health Promotion A number of stress control courses were run in MPHC throughout 2013 organised by the HSE Psychology Department. The courses focused on identifying and managing stress.

In addition, a stop smoking support group is being run in MPHC to provide support to those wanting to quit smoking but who feel they may need some extra help.

Some 54 primary schools are now registered as health promoting schools in North Cork and 42 of these attended a support training session for health promoting school co-ordinators in MPHC. A

mental and emotional health and wellbeing programme for children from five to seven years of age, called Zippy’s Friends, has also been rolled out in North Cork schools.

The 4th Practice The 4th Practice is a suite of 25 privatelyrun specialist services now being provided at MPHC. These include physiotherapy, clinical psychology, an ultrasound diagnostic clinic, speech and language, a warfarin clinic, a psoriasis clinic, counselling and psychotherapy services, a diabetic clinic, travel medicine clinic and cardiac clinic with exercise stress test and echocardiogram under the guidance of a consultant cardiologist. Many of these services were not available in Mallow previously.

Prior to moving to MPHC, the general practices offered a number of extra services but had limited space. The 4th Practice consists of a reception and waiting area and several consultation rooms with a fulltime receptionist and practice nurse.

One of the busiest clinics in the 4th Practice is the warfarin clinic, which has over 300 patients attending. The 4th Practice has a laboratory quality testing machine and uses British Haematological Guidelines. The process involves four steps and takes three minutes per patient.

Patients are given appointments every 10 minutes and leave with their daily warfarin doses and appointment for their next visit all on one card. Patient satisfaction is high. There is also a significant saving to the hospital laboratory system in that the practices no longer have to send blood samples from MPHC for laboratory testing.

Future We are optimistic about the future at MPHC and look forward to the imminent arrival of a dental practice and the addition of more new services in the 4th Practice next year. There are a number of new initiatives planned in dementia services and awareness, including making Mallow a dementia-friendly town.

Both GPs and HSE staff have been involved in many research projects and have been the recipients of several awards.

A great deal of work has taken place in the building, along with numerous community outreach projects. All this has contributed to MPHC becoming an important part of the Mallow community.

Go-2-Tender Tender Workshops and Mentoring

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Health Matters 53

Procurement

SMEs Encouraged To Supply Health Sector HSE Procurement recently supported IntertradeIreland ‘Meet the Buyer’ events in Dublin and Belfast.

I

ntertradeIreland has been given responsibility by both governments to boost North/South economic co-operation to the mutual benefit of Northern Ireland and Ireland.

More than 1,400 small and mediumsized enterprises (SMEs), North and South, attended these Meet the Buyer engagements, which have been taking place since 2011. These events are designed to develop North/South trade and business development opportunities for the mutual benefit of both economies.

HSE Procurement supports these events to ensure that in the current economic climate, SMEs are aware of the opportunities open to them in doing business with HSE. Speaking about the HSE IntertradeIreland seminars, John Swords said: “With over 1,400 businesses attending the 2013 engagements, it signifies the importance of public sector activity. HSE Procurement is delighted to be part of the Intertrade Ireland engagements to provide SMEs with a unique opportunity to engage in faceto-face meetings. I wish to acknowledge we have an expert team of procurement specialists attending each event who are extremely enthusiastic to offer guidance on how to do business with HSE Procurement. HSE Procurement continues to encourage competition and optimise the achievement of value for money across all areas of spend. As a result, by working closer with the supply base, we aim to maximise the benefits to frontline patient care and services.

“Within HSE Procurement, engagement with the supply base forms a regular feature of procurement activity on an ongoing basis. As part of our strategy, our goal is to work in partnership with our suppliers to ensure that all supply chain activities are managed in line with HSE business principles, values and requirements.”

+ Margaret Hearty, Director of Programme and Business Services, InterTrade Ireland; Brian Hayes, Minister of State at the Department of Public Expenditure and Reform and John Swords, Head of Procurement, HSE Procurement Shared Services.

Mr Brian Hayes, Minister of State at the Department of Public Expenditure and Reform officially opened the event in Dublin. “The SME sector is the backbone of our economy, employing over 70 per cent of our workforce and making up 99 per cent of active enterprises,” he said. “The scale of this event demonstrates the importance of SMEs to build on recent positive news on the jobs and growth front. That this is the largest procurement event to take place on the island of Ireland reflects positive action to stimulate more and better engagement between small and medium enterprises and public sector buyers.”

The Minister said he was confident that the event would drive home the message that effective and professional public procurement provides greater opportunities and incentives for small and medium enterprises.

“As part of our strategy, our goal is to work in partnership with our suppliers to ensure that all supply chain activities are managed in line with HSE business principles, values and requirements.”

54 Health Matters

News // Dublin north east Meath Traveller Health Project Celebrates 10 Years The Meath Primary Health Care Project for Travellers celebrated its 10th anniversary in September. The project, which is funded by the HSE, was established as + L-R, back row: Eileen Gilsenan, Public Health Nurse and Co-Ordinator a recommendation of Traveller Health in Co Meath; Community Health Workers Mary Joyce, Sharon Nevin, Mary Joyce, Lisa McDonagh, Brigid Collins. Front row: from Traveller Health Louise Levins, Community Development Worker; Community Health – A National Strategy Workers Julie Power, Nathanya McDonagh and Julieann Joyce.

2002-2005, and is led

by Eileen Gilsenan, Public Health Nurse and Co-Ordinator of Traveller Health.

The aim of the project is to empower, train and support members of the Travelling community in Co Meath. As part of the initiative, 12 Traveller women have been trained to work as community health workers. The women link directly with local Traveller families in providing health information and support.

The project also works closely with departments such as health promotion, maternity services, men’s health, mental health, social work and foster care and has been involved in the development of a number of initiatives, some of which have been shared at national level including the ToothWise oral health programme, Mother and Child DVD, and nutrition programmes such as A Guide to Spoonfeeding and Healthy Eating for Pregnancy. The project also offers Traveller cultural awareness training to HSE staff.

At present they are working to progress delivery of the recommendations of the All Ireland Traveller Health Study through emphasising the priority areas identified – cardiovascular health, mental health, suicide, men’s health, diabetes, addition and alcohol, and domestic violence.

Cavan General Hospital Claims Radiography Award The Radiography Department of Cavan General Hospital has won Radiography Department of the Year at the recent Medray/IIRRT X-Ray awards.The IIRRT is the professional body representing radiographers and radiation therapists in Ireland. The Medray/ IIRRT Department of the Year awards recognise departments and staff that demonstrate the highest standards and deliver exceptional service to patients.

The Radiography Department opened in June 1989, when Cavan General Hospital was commissioned. At that time approximately 16,000 examinations per year were performed and this has increased to approximately 72,000 following significant investment and expansion.

The Friends of Cavan General Hospital have greatly contributed to the expansion of the department by funding the purchase of the first CT scanner in 1995 and the DEXA unit in 2004. Half of the s2 million cost of the MRI scanner was donated by Brendan Murray on behalf of the Blume family in 2008. Phyl Smith, Radiology Services Manager said: “We’re delighted to have won this award as it recognises the commitment and dedication of all the staff within the department in continuing to provide a quality service.”

Bridget Clarke, General + L-R: Dr Shane Manager, Cavan and Foley, IIRRT Monaghan Hospital added: President; “We are very proud of the Phyl Smith, high quality service provided Radiography Services Manager, by the radiology staff in Cavan General Cavan General Hospital.”

Hospital and Aidan O’Reilly, Managing Director, Medray.

Mighty Mouth Programme Senior infant children in primary schools across the north east are full of smiles following their participation in the Mighty Mouth oral health promotion programme. The programme, which is delivered by HSE Health Education Officers (Oral Health), consists of lesson plans on nutrition, tooth brushing and visiting the dentist. Children learn through fun and roleplay on how to look after their teeth.

Teachers receive training, support and resources; parents/guardians receive an information booklet and are offered an information session as part of the programme. On completion, an award ceremony is held in the schools whereby each child is presented with a Mighty Mouth award certificate. The children also receive a toothbrush, fluoride toothpaste, tooth brushing chart and a tooth fairy envelope. Teachers have the option of inviting parents/guardians to the ceremony where children perform a rap song containing the key oral health messages.

The Mighty Mouth programme was developed and produced by the Dental Health Foundation in collaboration with the HSE and is supported by the Expert Body on Fluorides and Health.

+ Children from Marymount School, Drogheda proudly showing off their Mighty Mouth certificates.

Health Matters 55

Dublin north east // News World Sepsis Day at Our Lady of Lourdes As part of the Global Sepsis Alliance, Our Lady of Lourdes Hospital highlighted World Sepsis Day on September 13th, with a full schedule of events aimed at increasing staff awareness of the condition.

Sepsis is a global emergency that kills more than 10,000 people worldwide every single day. The day itself is the culmination of a global effort to educate and engage staff, the general public and political powers in the steps required to lower the incidence of death caused by sepsis.

The theme of this year’s world event was ‘stop sepsis, save lives’. Staff and management in Our Lady of Lourdes emphasised this important message with a number of information events for staff, + L-R: Miriam Kelly, Midwifery Practice Development Co-ordinator; which included a series of master classes, Catriona Crowley, Director of Transformation; Sinead Lardner, CNM3 Emergency Department and MAU; and Anne James, Midwifery CPC. presentations and a quiz. Information posters and leaflets were also displayed in the hospital foyer and corridors. Staff also disseminated sepsis awareness creatively, through poetry, performance and song.

Martha Reilly, Respiratory Clinical Nurse Specialist, composed a poem entitled ‘Sepsis?’ which highlighted the signs of sepsis and the six steps that should be followed if it’s diagnosed. The Nursing Practice Development Team, led by creative director Catriona McCahey, wrote ‘Disease Lightening’, a song ably sung by CPC nurse Darren Behan, 2012 Voice of Ireland contestant Katie-Anna Mohan and a chorus of backing singers. The song was performed for staff and members of the public in the hospital’s foyer throughout the day.

Earlier this year, Our Lady of Lourdes staff Miriam Kelly, Midwifery Practice Development Co-ordinator; Mary Rowland, Midwifery Clinical Skills Facilitator and Karn Cliffe, Midwifery Clinical Placement Co-ordinator won a major award in the prestigious Changing Tomorrow Awards sponsored by Astella’s Pharma Europe Ltd for their ‘Sepsis Awareness’ project.

Maternity Hospitals re-designated as 'Baby Friendly' Our Lady of Lourdes Hospital and Cavan General Hospital were recently presented with awards to acknowledge their achievement in being re-designated as Baby Friendly Hospitals.

The Baby Friendly Hospital (BFHI) is a global project of the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF). It promotes best practice in maternity services as crucial to the success of programmes promoting breastfeeding.

To gain the internationally recognised Baby Friendly status, the hospital maternity service must implement the ten steps to successful + Pictured at the award ceremony in Cavan General Hospital (L-R): Aileen Doyle, Clinical Midwife Specialist in Lactation; Margaret Mulvany, Assistant Director, Women and Children’s Services, Cavan Monaghan breastfeeding. This means that the service has Hospitals; Dr Genevieve Becker, National Co-ordinator for the Baby Friendly Health Initiative in Ireland; Dr developed a breastfeeding policy, provides Alan Finan, Consultant Paediatrician and Clinical Director, Women and Children’s Services and Siobhan training for staff, promotes informed parental Hourigan, HSE National Breastfeeding Co-ordinator. choice through the provision of appropriate, accurate and unbiased discussions, as well as implementing practices supportive of good mother and baby care.

Our Lady of Lourdes Hospital was first designated as a Baby Friendly hospital in 2007 and Cavan General Hospital in 2008. Following regular audit and external assessment, the hospitals were deemed to have met the criteria to be re-designated as Baby Friendly hospitals.

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News // Dublin north east Cavan/Monaghan Facilities Become Tobacco-Free Zones

+ L-R: Dr Nazih Eldin, Head of Health Promotion, HSE DNE; Dr Patrick Doorley, Chair of the National Tobacco Free Implementation Group; Dr James Hayes, Clinical Director, Cavan Monaghan Hospital and Bridget Clarke, General Manager, Cavan Monaghan Hospitals.

On November 1st, Cavan General Hospital, Monaghan Hospital and all HSE health care facilities in Cavan and Monaghan became tobacco-free campuses.

Launching the policy, Dr Patrick Doorley, Chair of the National Tobacco Free Implementation Group said: “A key element in reducing the number of people who smoke is to de-normalise smoking in our society. Initiatives such as the Tobacco Free Campus Initiative launched today play an important role in achieving this. In particular it assists in discouraging our children and young people from starting to smoke.”

Dr James Hayes, Clinical Director, Cavan Monaghan Hospital and Chair of the Tobacco Free Campus Committee said: “Smoking is the single biggest cause of ill-health and death in our society. By introducing this new policy we are sending out a clear message that we are committed to protecting and promoting the health of our patients, staff and all who visit our hospitals and health care facilities.”

The HSE has a target of introducing a Tobacco Free Campus policy at all health campuses by 2015. The policy is already in place at many hospitals around the country including Our Lady of Lourdes Hospital in Drogheda, Connolly Hospital in Blanchardstown, the Mater Hospital and Cork University Hospital.

Blanchardstown Primary Care Centre Opened The new Blanchardstown Primary Care Centre opened its doors to the public in November. Located in Grove Court Complex beside Fingal County Council’s offices and in close proximity to the Blanchardstown Shopping Centre, the centre will deliver health and social care services to the local population in Dublin 15 and surrounding areas.

The centre accommodates a full range of social care services, including public health nursing, physiotherapy, occupational therapy, speech and language therapy, psychology, social work, clinical nutrition and dietetics and a community mental health team. Two local GP practices will also be moving into the new centre in the near future. It is the area's first purpose-designed structure for primary care, and is an example of the high standards that are envisaged in future developments including those due to be built in Corduff, Finglas, Grangegorman and Ashtown/Navan Road.

Nursing Procedures Manual Available Online The Royal Marsden Hospital Manual of Clinical Nursing Procedures is now available online for nurses working in the north-east.

Clinical nurse experts from one of the UK’s leading centres of expertise have brought together all the latest clinical evidence nurses need in order to confidently meet the requirements of their demanding profession. The manual includes over 350 evidencebased clinical procedures related to every aspect of care, from hand washing to cardiopulmonary resuscitation.

The Nursing and Midwifery Planning and Development Unit in the north east combined resources with the North East Regional Library and Information Service to provide the resource. One of the most advantageous aspects of having a manual such as this online is that all staff have access both in the hospitals and in the community care areas.

Staff can access the manual from their workplace by logging on to the library website, www.hse.library.ie/ northeast, and clicking the link to the Royal Marsden Manual of Clinical Nursing. The manual is also available from home if you have an internet connection. To access from home you will need an Athens username and password, which can be easily obtained directly from the library website. For further information contact the HSE NE Regional Library Service at library.olol@hse.ie or phone (041) 984 3696.

This resource is also available online in other HSE areas including the south east, west, north west and east.

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Dublin north east // gallery

+ Some of the staff members from Louth County Hospital in Dundalk who took part in GOAL Jersey Day. The day is a flagship fundraising event for GOAL, which helps to raise money to help some of the most vulnerable people in the developing world. Employees wear their favourite jersey to work and donate what they can to GOAL. There was a fabulous array of colour, a great buzz and a bit of friendly team/county rivalry around the campus. The event, which was organised by the Finance Department, raised s710.

+ Louise McCormack, a nurse in Cavan General Hospital, with the award she won for Nurse of the Year at the Maternity & Infant Awards 2013. The awards celebrate inspiring individuals who have touched the lives of those around them, while also recognising the leading maternity products and services tested by real mums and dads.

+ Chantal Watts, a midwife at Our Lady of Lourdes Hospital in Drogheda, Co Louth, with the award she won for Midwife of the Year at the Maternity & Infant Awards 2013.

+ The ‘Failte Isteach’ project in Tyrrelstown, north Dublin recently won first runner up prize in Fingal County Council Community Development Category. The project is supported by the HSE and Fingal County Council, and is delivered in conjunction with volunteer tutors from the local community. It runs free conversational English classes for migrants living in the area. Pictured at the award presentation (L-R): Violete Kajic from Serbia, Rupa Chakraborty from India, Breda Heron, Tyrellstown Residents' Committee; Mayor of Fingal Kieran Dennison, Colette Manning, HSE Community Development Worker; Lina Gadliauskiene from Lithuania, John Peelo, HSE Community Development/Family Support Manager, and Joytsna Sambhe from India.

+ Mercia Power and her team from Our Lady’s Hospital Navan pictured at the recent Island of Ireland Productive Ward Conference in Dublin. As part of the productive ward programme the staff in the Male Medical Ward have made many changes in the unit, all aimed at improving the quality of care provided, including the introduction of information boards across the ward, the ‘Patient Status at a Glance’ board, which provides easy access for patient information and reduces interruptions on patient care, and the relocation of the ward treatment room to the centre of the ward.

+ Nuala Rafferty, CNM2 and staff from the Acute Stroke/Medical Unit in Our Lady of Lourdes Hospital pictured with their winning ‘Legend of the Fall’ poster at the recent Island of Ireland Productive Ward Conference in Dublin. The poster shows the methods that they have successfully implemented to reduce falls on their ward, including a falls risk assessment on all patients admitted to the ward and an advice leaflet for patients’ carers and relatives on reducing the risk of falls. Staff have seen a dramatic reduction in fall rates, almost 50 per cent, since this initiative was introduced.

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News // Dublin mid-leinster Project helps staff to capture “special moments” in palliative care Educating staff to recognise the “special moments” or times when patients with dementia were spontaneously expressing their end-of-life wishes has ensured better recording of patient preferences.

A report, Planning for the Future project: Initiating ‘End of Life’ Discussion for people with Dementia was recently released and is a joint project which began in 2009. The project involved Le Cheile, the 10-bedded dedicated dementia unit within Vincent’s Hospital, Athy and St Brigid’s Hospice in the Curragh, Co Kildare.

The Irish Hospice Foundation (IHF) development grants provided funding as part of the IHF Palliative Care for All programme, which seeks to extend palliative care to people with life limiting non-cancer illnesses.

About 41,000 people are living with dementia in Ireland today. This number is projected to increase to over 140,580 by 2041. An estimated 40 per cent of Irish people with dementia currently live in residential care. 18 per cent of acute medical beds are occupied by people with dementia.

Research has found that people with dementia and sometimes their families are often excluded from end-of-life discussions, leading to poorer symptom management, especially pain relief. Research also found that Irish nurses and healthcare assistants working in residential settings require more education around palliative care issues.

However, the Le Cheile project found that most staff reported no difficulty initiating conversations on end-of-life care. Nurses

+ L-R: Siobhan Kelly, CNM2 Le Cheile; Helen Dreelan, Director of Nursing, St Vincent’s Hospital Athy and St Brigid’s Hospice The Curragh; Tony O’Brien, Director General, HSE; Marie Kehoe O’Sullivan, Director, Safety and Quality, HIQA; Carmel Collins, Irish Hospice Foundation; Dr Miriam Colleran, Consultant in Palliative Medicine, St Brigid’s Hospice.

were more comfortable having end-of-life talks with families rather than residents, while healthcare assistants were uncomfortable asking too many questions. Most staff reported difficulties giving sad/bad news.

However, a resident care plan audit undertaken as part of the project found that despite nurses reporting being comfortable initiating end-of-life discussions with families, the Dying Domain in care plans were left blank in 80 per cent of cases. When endof-life discussions or documentation took place, all were initiated by senior nurses at clinical nurse specialist or clinical nurse manager 2 level. All of these discussions took place as a result of an acute event impacting the resident/patient. Where preferences were recorded, residents were less likely to be transferred to an acute facility or have unnecessary invasive procedures.

Dr Miriam Colleran, Consultant in Palliative Medicine at St Brigid’s Hospice, explained:

“Providing effective caring, person-focused and individualised palliative care for people with dementia presents unique challenges including symptom control and pain management.

“The aim of the development of the symptom management guidelines for residents with advanced dementia in St Vincent’s Hospital, Athy who are receiving end of life care is to optimise quality of life for residents so that they are living in comfort and with dignity.”

A number of actions were then taken, including the adaptation of care plans, and an education programme was developed.

Following these actions, a re-audit of residents’ care plans in Le Cheile found 100 per cent entry on the End-of-Life Domain, with individualised preferences and wishes documented. It found that end-of-life discussions were now part of each resident’s regular three-monthly review.

Good governance saves lives A recent meeting hosted by the Adelaide Health Policy Initiative, Trinity College Dublin discussed the recommendations of the Higgins Report on how hospitals in Ireland will be governed under the new hospitals groups system.

These changes will underpin the transition of our hospitals from single operating units to groups, which are expected to operate in administrative managerial and clinical synchronicity. Over time these groups will become independent not-for-profit trusts.

Dr Ambrose McLoughlin, Secretary

General of the Department of Health said: “Development of these hospital groups is expected to advance the universal health insurance agenda further,” that lessons have been learnt from the HIQA report on hospital governance, and that “boards will be competency based.”

Dr Rhona Mahony, Master of the National Maternity Hospital, indicated her concerns that there will be “little to no clinical representation at board level”.

Dr Catherine Darker, Adelaide Assistant Professor in Trinity College added: “It was

the firm opinion of the meeting that ministerial appointments of the chair of hospital groups and in turn the board members is not compatible with good governance. We recommend that a more independent system of selecting board members be developed, taking cognisance of the skills mix required and the need for patient and community involvement.”

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Dublin mid-leinster // News ‘Shelf Help’ Reading Scheme to help overcome challenges

+ Recommending reading for personal wellbeing at the Riverbank Arts Centre, Newbridge, on World Mental Health Day. L-R: Kildare County Arts Officer Lucina Russell; Rosario Power, Psychologist with the HSE, Athy; John Burke from Castledermot, attached to the HSE Athy; Michael Cummins of Mental Health Ireland; Brenda Hughes of the National Educational Psychological Services (NEPS), Naas.

It is widely acknowledged that there is a high need for people in every community to have easier access to ways of developing their skills and strategies for coping with daily challenges.

The ultimate aim is to feel better and become more in charge of their own lives. However, there can be many blocks to people accessing such supports. In an effort to deal with these issues ‘Shelf Help’, a set of 10 collections of books and resources aimed at supporting people who are trying to manage challenges within their lives, was launched on World Mental Health Day on October 10th.

Topics dealt with include parenting children, psychological wellbeing, excessive substance use and difficult emotions such as sadness, anger and stress.

The Shelf Help bibliotherapy scheme for Kildare and west Wicklow has been developed over the last few years in partnership between the HSE Primary Care Psychology Service, the Regional Drugs Task Force and the Kildare library service, with support from the west Wicklow library service and the Mental Health Association.

The collections are now available in seven libraries in Kildare and three in west Wicklow.

Each capsule collection of more than 60 books is available to the public both on-site and through online digital download services.

Stress Control Classes The popularity of stress control classes since their introduction to Kildare has shown that people are prepared to acknowledge that experiencing stress is a normal part of life.

Managing stress is something that everyone could improve upon. Men and women of all ages attended and travelled from Kildare, Wicklow and neighbouring counties to avail of free classes that teach how to deal with stress.

Dr Rosario Power, Senior Clinical Psychologist in Kildare explains: “It seems that initially some people had ideas that maybe the classes were aimed at people with financial pressures, or at people who were struggling with anxiety or depression only, but

as time has gone on, people are discovering that these classes really have something for everyone.”

In Kildare, the classes ran in Athy, Naas and Newbridge with six sessions, one held per week. Stress control is not a therapy group; it is a class where we can learn ways to cope with stress. In effect, those who attend learn to be their own therapist. Topics covered centred around information about stress and controlling your body.

Meanwhile, in Longford classes were geared towards anyone interested in learning cognitive behavioural skills or making lifestyle changes that are proven to be effective in addressing stress, anxiety and low mood.

Hearing screening for babies extended to Mount Carmel A hearing screening test for newborn babies in Mount Carmel Hospital is now available to parents prior to being discharged from hospital. The test is available free-of-charge for all babies and is part of the Universal Newborn Hearing Screening Programme that is being rolled out to all babies born in the State.

Dr Saulius Satas, Lead Consultant Paediatrician at the hospital said: “The earlier a hearing loss can be picked up in a baby, the better the outcome they will have. The extension of the HSE screening programme will allow any babies identified with a possible difficulty to access further services as early as possible.”

In Ireland, one to two babies in every 1,000 are born with a hearing loss in one or both ears. Most of the babies are born into families with no history of hearing loss.

The programme is aiming to identify hearing impairment as soon as possible after birth.

Babies who do not have clear response in one or both ears from the initial screening will be referred to the HSE Audiology Service for further hearing tests.

This marks the final phase of implementation of the Universal Newborn Hearing Screening Programme in Dublin Mid Leinster, with the service now available to all of the maternity hospitals/units within the region. Further information at: www.NewbornScreening.ie

Smoking Cessation in Baltinglass We all know smokers who want to quit.

We also know that quitting is not easy. For those in the Baltinglass area there was good news recently when a free six-week stop smoking course was held in the local library.

An information session about the course was held first, followed by six Wednesday morning sessions at Baltinglass Hospital.

The course was delivered by the HSE Health Promotions Department with the support of the Baltinglass Library.

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News // Dublin mid-leinster Communication Friendly in Tallaght Rua Red Café in Tallaght recently received a “Communication Friendly” logo in recognition of its staff’s participation in supportive communication training.

The training aims to increase awareness of communication difficulties including aphasia post stroke, literacy difficulties, intellectual disability or where English is not the first language. It provides staff with practical skills that can improve access for people with communication difficulties when availing of everyday services in their community such as shops, cafés and restaurants.

This training was originally piloted in Cup Café, Dublin by the Aphasia Advocacy for Access Project which was set up by the Department of Clinical Speech and Language Studies, Trinity College Dublin. It incorporates principles from the Making Communication

Accessible training offered by Connect, a registered UK charity, which focuses on implementing practical strategies to improve communication.

The training was provided by people with communication difficulties to staff in the café and was facilitated by community

speech and language therapists and students from Trinity College Dublin.

It is hoped that this will become a recognisable logo indicating that staff have awareness of communication difficulties and strategies for dealing with people with these types of difficulties.

+ Left: Joe Power and Dominic Gelston (communication group participants).

Right: AnnMarie Duffy and Siofra Mulkerrin (speech and language therapy students, TCD).

Tallaght Health Fair Connects With Community In September, HSE primary care social workers in Tallaght held their third annual community health fair, at Fettercairn Community Centre. This initiative was developed following consultations with the Tallaght community in 2010, whereby residents identified a need for more information to be made available on health difficulties and the services available to them.

As a follow on to these consultations, the health fair aimed to raise awareness of various health issues that can occur across the life span, both physical and mental; and to promote ways by which such illnesses can be prevented, alleviated and/or managed.

Information was also provided regarding services available locally and nationally to address these issues, both statutory and non-statutory. The health fair was also aimed at empowering the community in understanding the social determinants of health and recognising how their own individual lifestyle choices can impact on them and on their family’s personal health.

The full-day event, which was free to the public, included a vast array of more than 75 varying information stands covering a range of health and social issues. Such services included the Marie Keating Foundation, Headway, Foroige and Aspire.

Ruth Lennon, spokesperson for support group Headway, which had an information stand there on the day, said: “The event was very much worth my time regarding enquiries.”

A range of free health screening opportunities was also available, including screening for HIV and other STIs by the GUIDE clinic, blood pressure checks by the Irish Heart Foundation and Hickeys Pharmacy, lung functioning tests by the HSE Smoking Cessation Service, and asthma and sugar level testing by Tallaght Hospital.

In adopting a holistic approach to health, complimentary therapies were provided with information on how to relieve stress and manage

+ Community members attending the Tallaght Health Fair.

anxiety. A healthy food demonstration was also held in the afternoon while Fettercain Community Garden was open to all with fresh produce available for tasting.

Due to the success of the fair, plans are now afoot to foster links between the various organisations which took part and with those working within the HSE. Patrice Reilly, HSE Primary Care Social Worker, West Tallaght Network explained: “Overall we were delighted with the success of the event. It really does demonstrate the value of the HSE and community services working together in partnership to bring such a high level of information and screening opportunities to the local community residents in Tallaght.”

The event was funded by the HSE Health Promotion Unit in Dublin South West, South Dublin County Council – RAPID, the Adelaide Hospital Society and South Dublin County Partnership Ltd. The event was launched by the Mayor of South Dublin, Dermot Looney.

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Dublin mid-leinster // Gallery

+ Clients and staff of the Portlaoise Mental Health Services participated in Daffodil Day earlier in the year. A coffee morning was held in the Triogue Centre – a community mental health centre supported by clients, staff, retired staff and local businesses as well as members of the public. A total of s1,115 was raised for the Irish Cancer Society.

+ Shelf Help Launch special guest speaker Dr Gary Collins, Clinical Psychologist of the Primary Care Psychology Service with the HSE; Eimear McGinn, Senior Executive Librarian, Kildare Library and Arts Service; Mayor of Kildare Mark Wall; and Kildare County Manager Michael Malone at the Kildare County Council Library Services launch of ‘SHELF help: recommended reading for personal well-being’ at the Riverbank Arts Centre, Newbridge on World Mental Health Day, October 10th.

+ Members of the public attending Tallaght Health Fair.

+ Members of the public attending Tallaght Health Fair.

+ John Burke from Castledermot, attached to the HSE Athy, pictured at the Kildare County Council Library Services launch of ‘SHELF help: recommended reading for personal well-being’ at the Riverbank Arts Centre, Newbridge on World Mental Health Day, October 10th.

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NEWS // SOUTH World Sepsis Day at STGH

+ Present at the Surviving Sepsis Day in South Tipperary General Hospital, Clonmel were Eileen Lynch, SNM; Dr Majeed, Clinical Director; Michelle Doyle, Infection Control Nurse; Oonagh Keating, Assistant Director of Nursing; Mairead Vaughan, CNM Emergency; Marie Laste, Practice Development; Regina Bennett, ICU; Viva Phelan, Dietician; Dr Marcella Lanzinger; Teresa Deery; Siobhan Flanagan, Infection Control and Richard Dooley, Hospital Manager, HSE South.

South Tipperary General Hospital (STGH) in Clonmel recently hosted a series of events for World Sepsis Day. Sepsis is an illness in which the body can have a severe response to bacteria or other germs.

Beginning in 2011, STGH implemented a hospital-wide ‘Sepsis Survival Chain’ and became a member of the international Surviving Sepsis Campaign. This quality improvement initiative supports staff in providing treatment according to the best current international standard of care for adult septic patients throughout the hospital.

Through targeted initiatives, the global Surviving Sepsis Campaign follows a multi-point strategy from start to finish of building awareness, improving diagnosis, increasing the use of appropriate treatment, educating healthcare professionals and improving care for sepsis survivors.

STGH is continuously training nursing staff, midwives, allied health professionals and doctors in the best management of sepsis. The sepsis chain is designed to include all wards, the emergency department and maternity. Initial management is supported with evidence-based medical expertise in critical care so that best standards are maintained throughout all teams and levels of experience. Complete and timely adherence to the sepsis guidelines over five years make a 25 per cent reduction in sepsis-related mortality achievable.

The highlight of the day was the introduction of the newly updated international sepsis guidelines and updated local pathways in a dedicated lecture for healthcare professionals.

See www.survivingsepsis.org.

TB Screening for Vulnerable Groups A one-day tuberculosis (TB) screening programme for over 300 of Cork city’s most vulnerable and marginalised people resulted in 100 per cent of residents in the local Simon hostel being screened.

A concerted effort by health professionals, charitable organisations and others secured screening for people experiencing homelessness, drug and alcohol addiction, and for prisoners.

The screening involved a chest X-ray using a mobile unit supplied by the UKbased charity Find and Treat, which was commissioned by Safetynet (a network of healthcare professionals providing healthcare to the homeless). According to a Find and Treat spokesperson, this was the first 100 per cent turnout from a hostel for people who are homeless.

Results from 10 chest X-rays required further follow-up. One showed positive for TB and the patient, who had no symptoms, is doing well.

According to one of the organisers, Dr Don Coffey, who works with the adult homeless team in Cork, “the HSE recorded 368 new cases of TB in 2012 and noted a much higher incidence among socially excluded groups such as homeless people and drug users.

“We also screened 25 people for hepatitis C, with four new cases found, and screened 25 people for HIV and all were negative.”

Cooking Class For Renal Patients A renal cookery demonstration class for 20 patients attending the dietetic chronic kidney disease out-patient clinics at Cork University Hospital was held in Brennan’s Cookery School, Cork in September. A demonstration of simple and tasty homecooked meals as a practical alternative to processed foods was presented.

Processed foods are often high in salt and other minerals such as potassium and phosphorus. If patients with kidney disease prepare their own meals, they gain more control over their diet content, thereby actively participating in the therapeutic

management of their condition.

Salt can raise blood pressure. Tight blood pressure control is pivotal in attempting to delay the progression of chronic kidney disease and reducing dietary salt intake plays an important part in this treatment.

Phosphorus is important for bone health, but when the kidney function is decreased, it is not removed as effectively from the body.

Senior renal dietitian Irene Lynch liaised with chef Johann Doorley to present an array of pleasing recipes, which will be available to all renal patients attending CUH. For further information contact Irene.lynch@hse.ie.

+ Pictured are those who organised the TB screening (L-R): George Curley, Al Story and Jane Knight, NHS; Dr Don Coffey, Adult Homeless Medical Team; Siobhan Murphy and Dr Laura Cullen, Cork Simon volunteers; Sr Maria Cuffe, Bon Secours Hospital; Dermot Kavanagh, Cork Simon and Diana Taubman, NHS. Photo: Clare Keogh.

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SOUTH // NEWS Waterford African Taxi Drivers Donate Wheelchairs

+ Pictured at the handing over ceremony in Waterford Regional Hospital for five new wheelchairs purchased by the Waterford African Taxi Drivers’ Association were (L-R): Steven Mbu (Vice President, WATDA), Mark Ogunleye (WATDA), Olaniyi Oladiti (WATDA), Frank Oduh (WATDA), Alice Medjaou (Deputy General Manager, WRH), Claire Phelan (Household Services Manager, WRH), Catherine Neary (Hospital Manager, WRH), Mayor of Waterford Councillor John Cummins, George Ehiagwina (WATDA), George Ogun, (President, WATDA), Oladele Oke (WATDA), Akinola Dauda (WATDA), Abdul Owaleye (WATDA), Martina Reck (Patient Services Manager, WRH) and Charles Orjiakor (WATDA). Photo: John Power Photography.

Patients at Waterford Regional Hospital (WRH) are to benefit from a donation of five new wheelchairs purchased by the Waterford African Taxi Drivers’ Association.

At a recent handover ceremony in WRH, which featured Mayor of Waterford Councillor John Cummins as special guest, WRH Hospital Manager Catherine Neary said: “Management and staff at WRH are very appreciative of the support from the Waterford African Taxi Drivers’ Association.

“WRH’s existing stock of wheelchairs is continually in use for a range of purposes, including in-ward use, transfer to X-ray, discharge or even for patients being brought down to the foyer by relatives and/or visitors. Particularly with this latter utilisation in mind, we’re delighted that our stock has been supplemented with these five new wheelchairs. During these challenging times, in terms of hospital budgeting, it’s heartening that groups like the Waterford African Taxi Drivers’ Association support us by identifying practical things that can be purchased as ancillaries to the care and services being delivered by our dedicated staff here.”

George Ogun, President of the Waterford African Taxi Drivers’ Association, said that his organisation “was delighted to make such a practical gesture to the benefit of the community they and WRH serve day in, day out”.

Mental Health and Media at Wexford Conference The HSE recently supported a conference held in Wexford entitled Mental Health and the Media: Friend or Foe? organised by Mental Health Nurse Managers Ireland (MHNMI).

A panel of speakers, joined by Minister of State for Mental Health and Disabilities Kathleen Lynch TD, discussed perceptions and representations of mental health in the media. Problematic areas surfaced in several contributions and discussions, such as the eagerness of media to make or complete a story without consideration to what may often be very vulnerable circumstances for individuals and their families. In many cases, there was emphasis on the lack of humanity afforded to subjects of media interest who may have mental issues. There was also focus, however, on how some media have taken responsibilities seriously as regards lessening stigma in the area of mental health.

Guest speakers John Lonergan, Mary McEvoy, Aonghus McAnally, Carl O’Brien, Professor Harry Kennedy, Stephen Mulvanney and Paul Connors were wellplaced to illustrate the discussion with experiences garnered in their roles in life.

Kevin Plunkett, the HSE’s Director of Nursing for the Waterford and Wexford Mental Health Services Area and Chair of MHNMI, said the media had an important role in how issues around mental health are put into and discussed in the pubic domain.

Speech and Language Training for Pre-school Teachers Some 40 staff based in community pre-schools in Ballincollig and west Cork participated in a speech and language support training course organised by Cork South’s Community Work and Speech and Language Therapy Departments.

The course was delivered by speech and language therapists trained in the Elklan method – a well recognised training organisation that writes and delivers bespoke training courses on developing communication in children and young people.

The training was organised in response to concerns expressed by staff on an increasing number of pre-school children presenting with speech and language difficulties.

The course covered the following areas: -Processes involved in the development of children’s communication skills; -Strategies for supporting children’s development of attention skills, play skills, vocabulary, language comprehension, expressive language and social skills; -Dos and don’ts of managing the needs

of children who are presenting with difficulties in speech pronunciation and dysfluency (stammering); and -Accessing services for children with communication needs.

The feedback from the course was very positive, with participants testifying to the practical nature of the course.

This initiative proved a very good model of HSE interdepartmental co-operation.

For further information, contact Julie Murphy, Community Worker at julie. murphy@hse.ie.

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NEWS // SOUTH Antenatal Health and Breastfeeding Promoted in Kerry The public health Nursing service in Kerry recently launched a new initiative to promote antenatal health and increase the number of women breastfeeding.

The initiative aims to have every newborn baby in Kerry experiencing skin-to-skin contact by being placed on their mother’s chest and receiving colostrum. Colostrum is a form of milk containing antibodies to protect the newborn against disease, as well as being lower in fat and higher in protein than ordinary milk.

Skin-to-skin contact calms and relaxes both mother and baby, regulates heart rate and breathing in the baby, stimulates digestion and feeding behaviour, regulates temperature, protects against infection, stimulates the release of hormones to support breastfeeding and mothering, and has numerous other benefits for preterm babies.

The public health nurses ring every expectant mother to introduce the service, informing them that they can organise a home visit at 24 to 32 weeks into the

HSE and Department of Education Launch Autism Resource

+ Mary Ann Leen with baby Ronan Fitzgerald from Killarney and Collette Hayes with baby Daisy from Kilgarvan at a breastfeeding support group.

pregnancy. During the home visit, the public health nurse discusses all aspects of pregnancy, birth and parenting and addresses any concerns the woman may have.

The service provides antenatal classes in Killarney, Kenmare and Dingle and is setting up bi-monthly two-hour breastfeeding workshops for pregnant women and their families throughout the county.

National Wound Management Conference ‘Wound care – the journey through life’ was the theme of this year’s national conference of the Wound Management Association of Ireland, emphasising the relevance of wound care to all age groups and all clinical settings, from neonate to end-of-life.

National and international guest speakers shared their expertise, ranging from the + Standing/back row: Paula Gardiner, Eileen O’Riordan, difficulties of complex acute wounds in Siobhan Murphy, Eileen Walsh, Eileen Kelly, Pat McCluskey, both paediatric and adult patients to the Mary Conroy. Sitting/front row: Emer Shanley, Breeda prevention and treatment of chronic wounds O’Donoghue, Mary Madden, Bernie Buckley and Sheila such as pressure ulcers and diabetic foot Gilmartin. Photograph courtesy of Donagh Glavin. wounds. The value of surgical site infection (SSI) surveillance was highlighted and recent research presented from Cork University Maternity Hospital, where SSIs are being monitored, leading to changes in practice and improved quality of care. Ethical challenges in wound care were considered in a presentation which encouraged delegates towards a more introspective approach to the wounded patient.

Workshops provided delegates the opportunity to revise or update their skills and knowledge, including one on seating and positioning which highlighted the importance of particular materials and appropriate patient positioning in the prevention of physical deformities and pressure ulcers. The classification of dressings workshop provided guidance on the use of anti-microbial dressings, in accordance with recent publications by the European Wound Management Association.

A ‘Transition Pack’ for children with Autism Spectrum Disorders (ASD) in between primary and secondary school ages in the Waterford area has been jointly developed by the HSE’s Disability Services and the Department of Education’s National Educational Psychological Service (NEPS).

The pack was recently launched at a presentation to parents and teachers at the HSE’s Disability Services centre at Johnstown, Waterford and was addressed

by Katherine Deegan (Liaison Worker/ Autism Services, Waterford Disability Services), Lisa Power (Senior Occupational Therapist, HSE) and Shirley Murphy (NEPS Psychologist).

Katherine Deegan said: “Through the HSE’s work with parents of and children with an ASD and what we call social communications difficulties, and in our cooperation with NEPS, we identified a need for this pack. It’s primarily aimed at those children attending mainstream schools who would be transitioning to secondary, although it will also be available for children currently attending an ASD unit at primary level.

“We wanted to create a pathway that would help to reassure both parents and school staff that with the appropriate level of planning and preparation, the transition process could be made as smooth as possible for all those involved – especially the child.”

+ Pictured at the launch in Waterford of the HSE Disability Services and NEPS/Department of Education’s Transition Pack for children with ASD were (L-R): Katherine Deegan (Liaison Worker/ Autism Services, Waterford Disability Services) and Lisa Power (Senior Occupational Therapist, HSE).

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SOUTH // Gallery

+ Dr Jason van der Velde, one of HSE South’s emergency medical response team doctors, was featured in the recent RTÉ Search and Rescue TV series with his colleagues and paramedics. The series covered doctors and paramedics treating a critically ill baby with sepsis, a man injured while felling a tree, a mother and child following an RTA and a man gored by a bull. The first series drew over one million viewers.

+ Friends of Dunmanway Community Hospital and staff organised a Downton Abbey-themed Victorian tea party in November to raise funds for the hospital. Many of those attending the two tea parties dressed up in the style of the era. Pictured (L-R): “Jeeves” (Denis Deasy), Rose Kelly, Michael Hayes, Pauline Lynes, “Rosie” (Moira Deasy) and Maureen Hurley.

+ Waterford Minor hurlers visit STGH’s Paediatric Unit. L-R: Olivia Butler (CNM2, Paediatric Unit, STGH), Willie Hassey (Waterford minor hurling team), Helen Harvey (Paediatric Unit, STGH), Conor Gleeson (Waterford minor hurling team), Jean Maher (Paediatric Unit, STGH), Sean Clancy (Waterford minor hurling team), Sinead Kennedy (Paediatric Unit, STGH), Niamh Gough (Paediatric Unit, STGH), Dermot Ryan (Waterford minor hurling team) and Emma Ferris (Paediatric Unit, STGH).

+ Grove House, a residential service for clients with intellectual disabilities based in St Mary’s Health Campus, Cork city has established a garden space that encompasses therapeutic activities to re-establish the client’s connection with the natural world. The Our Garden project is an accessible, sensory garden used to eliminate physical and attitudinal barriers and create an area where people of all ages and abilities can enjoy its benefits. Pictured is Patrick Curtin with one of the hens at the Our Garden project.

+ Pictured at the Irish Healthcare Awards are the winners of the Outpatient Initiative of the Year, with commendations for Best Public Health Initiative and Best Patient Education Project – Non Pharmaceutical. L-R: Deirdre Scully, Area Manager; Mary Hickey, Clinical Nurse Manager; Gabrielle O’Keeffe, General Manager; Mary J Foley, Advanced Nurse Practitioner; Dr Norma Harnedy, Consultant Geriatrician and Suzanne O’Sullivan, SEO.

+ Pictured at the recent patient empowerment day on hand hygiene awareness at Waterford Regional Hospital were (L-R): Marie Shalloe (A/ADON HIQA Quality Improvement Plans for Healthcare Associated Infections); Sean Swift (Service User and Chair, WRH Patient Partnership Forum); Geraldine Caulfield (service user); Frances Darcy (service user), Alice Medjaou (Deputy Hospital Manager, WRH) and Martina Reck (Patient Services Manager, WRH).

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News // west New Community Mental Health Centre for Donegal Town The HSE in Donegal, along with Boyle Construction of Trentagh, Letterkenny, have signed contracts for the construction of a new community mental health centre in Donegal town. The s2 million development will deliver a modern centre for community mental health services in the south Donegal area.

The construction of a new purpose-built Mental Health and Child & Family Services building on the Donegal Community Hospital campus will replace and enhance those services currently provided from a number of different locations within Donegal town. The 680 square metre two-storey building has been designed as a modern, well equipped, accessible premises which is user friendly and will accommodate the needs of those availing of mental health services.

The new Mental Health and Child & Family Services building will provide: • Consultant-led medical services for adult mental health.

• Consultant-led medical services for child and family mental health.

• Clinical nurse specialists in adult mental health.

• Multidisciplinary professionals such as psychology, social + Pictured at the contract signing are (back, L-R): Trevor James, Liam Donnelly, work and OT. Tony Kitterick, Trevor McBrearty, Eugene McElroy and Seamus McLaughlin. Front, • Visiting psychiatry of L-R: Ian Pudney, Donal Boyle, Mike Bermingham and John Hayes. old age services. and their families. Mr Hayes acknowledged • Visiting clinical nurse specialist and staff from the Adult Mental Health Services advanced nurse practitioner services. and the Child and Adolescent Mental Health The building will act as a hub for southServices (CAMHS) who were involved west Donegal for outpatient clinics, nurse in the design stage of planning. He also lead cinics and home-based services. acknowledged the work of the HSE Estates John Hayes, Area Manager, HSE Donegal Department and the design team in bringing said that the commencement of this building the project to fruition. project will result in the delivery of services Dr Don Mc Dwyer, Consultant Psychiatrist, in the south Donegal area in a modern CAHMS also welcomed the development. environment, thus benefiting service users

New Rehabilitation Facility at St Ita's The HSE, in conjunction with the Friends of St Ita’s Hospital, Newcastle West, Co Limerick, signed contracts on November 5th with O’Brien Builders and Civil Engineering Contractors Ltd for the construction of a new rehabilitation facility on the grounds of St Ita’s Hospital. Designed by a multidisciplinary team led by O’Connell Mahon Architects, the project promises to improve patient services and provide a modern environment for both staff and residents.

The project comprises of the construction of a rehabilitation facility providing fully HIQAcompliant single and twin ensuite room accommodation and a number of ancillary rooms, a new plant room and associated site works. Construction works will commence immediately on site and are to be completed over a 12 month period.

Launch of Croílíne Chois Fharraige in Co Galway Croílíne Chois Fharraige was officially launched in Spiddal, Co Galway on October 26th. Croílíne Chois Fharriage was established earlier this year to provide the local community with the resources to respond quickly and effectively to cardiac arrest. Croílíne has now trained 150 people in CPR, 35 as Cardiac first responders and has installed seven defibrillators with 24/7 access throughout the local area.

The group is officially registered with the National Ambulance Service West and will be activated through the Ambulance Control Centre in Castlebar to respond to appropriate calls in the area. + Members of the Croílíne cardiac first responders team.

+ Pictured at the contract signing, L-R: Noel Nagle, HSE; Irene O’Connor, HSE; Victor Lowe, O’Connell Mahon Architects; Margaret Culhane, Friends of St Ita’s; Maria Bridgeman, HSE; Breda O’Keefe, St Ita’s Hospital; Fergus Scanlon, Chairman, Friends of St. Ita’s Hospital; Terence O’Brien, O’Brien Builders; Richard Naughton, Friends of St. Ita’s and Joe Hoare, HSE.

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west // News Galway University Hospitals Leads way in Coronary Care Procedure Since October last year, Galway University Hospitals (GUH) has been leading the way in providing an emergency 24-hour heart attack treatment programme, formally known as primary percutaneous coronary intervention or PPCI. This non-surgical procedure is the gold standard treatment for a full-blown heart attack and is used to treat the narrowed or blocked coronary arteries found in heart disease. Recent international evidence has shown PPCI to be the most effective treatment of a major heart attack.

PPCI has been rolled out nationally since January this year as part of the HSE’s National Acute Coronary Syndrome Programme. The national clinical lead for the programme is Professor Kieran Daly, Consultant Cardiologist at Galway University Hospitals, which led the way as the first hospital to go live in October 2012 providing a seven-day, 24-hour service. The cardiology intervention team at Galway comprises of a number of consultant cardiologists, medical staff, cardiac technicians, cardiology nurses and radiographers, and is supported by other

+ Irish Air Corps personnel with staff from GUH (L-R): Captain Jake MacCarthy; Kevin Malone, Staff Nurse, Cardiac Catheterisation Lab; Dr Roisin Colleran, Specialist Registrar in Cardiology; Sgt Mark Dunne; Sgt Val Murray; Dr Stephen Tuohy, Specialist Registrar in Cardiology; Rosemary Walsh, Clinical Nurse Manager, Coronary Care Unit; Advanced Paramedic Pat Moran; and Captain Niall Buckley. Photo taken with the Air Corps Medevac 112 helicopter at the helipad at University Hospital Galway.

healthcare professionals. For every case 24 hours a day, there is a consultant cardiologist, cardiology registrar, cardiology nurse, cardiac technician and radiographer made available.

Galway University Hospitals was one of six hospitals designated as a primary PCI centre based on having a catheter laboratory available along with the required number of cardiologists who are trained in PPCI. GUH is now receiving patients from all over the

west of Ireland, with many being transported by the Air Corps Medevac 112 helicopter as part of the Emergency Aeromedical Service.

Over the past year, Galway University Hospitals has treated patients not only from Mayo, Galway and Roscommon but also from Sligo, Leitrim, Donegal, Limerick, Tipperary, Offaly, Longford and Westmeath, as well as people on holidays from the USA, Canada and France.

Mayo Heart Attack Awareness Campaign Will Save Lives ‘Learn what a heart attack feels like – I could save your life!’ was the message from the Mayo Heart Attack Awareness Campaign organised by Croí, in collaboration with Mayo PCCC, HSE West and Mayo General Hospital. This inaugural campaign saw the month of October dedicated to informing the public about the main signs and symptoms of heart attack.

The campaign stems from the ongoing partnership between Croí and Mayo HSE on the Mayo Action on Heart Disease and Stroke programme, which aims to reduce the impact of heart disease and stroke in + At the launch of the Heart Attack Awareness Campaign by Mayo were (L-R): David McHugh, Operations the county.

Resource Manager, National Ambulance Service; Ailish Houlihan, Croí Prevention Nurse Lead; Charlie Meehan, General Manager, Mayo General Hospital; Neil Johnson, CEO, Croí, the West of Ireland Cardiac Foundation; Ann Speaking about the initiative, Croí Boland, Director, Public Health Nursing, Mayo PCCC; Ann Marie Brown, Co-ordinator, Cardiac Rehabilitation, nurse and Co-ordinator of the Partnership Mayo General Hospital; and Brian Moran, Paramedic Supervisor, National Ambulance Service.

Programme Ailish Houlihan said: “This campaign will inevitably save lives and we are delighted it was piloted in Mayo. The main aim of this month-long campaign was to raise awareness about heart attack.”

Co-ordinator of Cardiac Rehabilitation in Mayo General Hospital Ann Marie Brown agreed: “This campaign was designed to increase public awareness about the warning signs of heart attack and to encourage individuals to act quickly to get the medical treatment they need in order to save lives.

“So many individuals who come through the cardiac rehabilitation service following a heart attack express concern that they did not recognise that they were having a heart attack at the time of their event. It is important that the public realise that there are many signs of heart attack, and by becoming aware of these, we hope people will seek help sooner.”

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News // west Áras Mhuire Celebrates Heritage Week Áras Mhuire Community Nursing Unit in Tuam, Co Galway celebrated Heritage Week in September, providing its residents and day care clients with a very enjoyable and interesting few days of heritage activities. The unit was decorated with artefacts and memorabilia from the past, which enhanced the spirit and atmosphere of Heritage Week.

The week commenced with a lively discussion on our heritage, providing an opportunity for residents and daycare clients to reminisce on traditions relevant to their era. After a discussion on genealogy, + Padraic Joyce pictured with residents and staff residents completed a family tree record at Áras Mhuire Community Nursing Unit during with assistance from relatives. During the Heritage week. Back, L-R: Caroline Coen, May week, Padraic Joyce, winner of two All Ireland Miskell, and Padraic Joyce. Front, L-R: Paddy senior football titles with Galway, chatted and Reaney and Pat Gormally. had photographs taken with the residents and daycare clients. Residents from Killererin and the surrounding area were very excited and honoured to have Padraic in their midst and friends and family wore Killererin and Galway jerseys for the special occasion!

There were also viewings of old videos throughout the week, depicting the Ireland of long ago. Heritage Week promotes communication, participation and interest in our Irish heritage and folklore and enriched everyone with a trip back to the past.

World Mental Health Day Celebrates Life Through Art To celebrate World Mental Health Day in October, the HSE Create-a-Link art centre in Donegal sent 30 postcards to art galleries and art centres around the world to promote positive mental health through the medium of art. Each postcard was an original work of art that was produced especially for World Mental Health Day by artists past and present who use the Create-a-Link art centre in Letterkenny. + Posting the postcards to promote positive mental Teresa Haughey, HSE Mental Health Services health for World Mental Health Day (L-R): Thomas Putt, Dearbhla McBride and Caroline Kruta.

Donegal said: “It is estimated that in Ireland today there are more than 80,000 people who suffer from mental health issues, and many thousands more suffer from addictions and substance misuse disorders. As part of World Mental Health Day we wanted to share our art around the world in order to encourage galleries and art centres to exhibit more work by disabled artists, to embrace and promote social and emotional wellbeing in the community and have a better understanding and acceptance of mental ill health.”

Create-a-Link was formed by the HSE West Mental Health Services in 2002 to promote positive mental heath and wellbeing through art. People with a wide range of mental health issues, including depression, schizophrenia, obsessive compulsive disorder and addiction to alcohol and drugs, go through the doors of Create-a-Link to complete an 18-month rehabilitative art course.

GP Exercise Programme begins in Sligo and Leitrim The GP Exercise Referral Programme is up and running in Sligo and Leitrim and is proving to be a great success. General practitioners have been recruited by the HSE’s Health Promotion Service and clients are being directly referred from their GPs to local co-ordinators as part of the Exercise Referral Programme.

There are five GP Exercise Referral Programme co-ordinators in Sligo and one in Leitrim. According to co-ordinator Michelle Fanning, “the benefits are proven in terms of people becoming more active.

This scheme reduces the risk of getting heart disease and diabetes. For those with diabetes it can mean that it is controlled a little bit better. This is a different approach to looking after people with lifestyle-related health problems. The GP Exercise Referral Programme can only do good and will be a support to people becoming more active.”

Liz Martin, Health Promotion Officer, HSE West is one of the organisers of the programme in the North West. Liz explains: “Each client is referred to a qualified local co-ordinator who guides them through a 12-week physical activity programme. The local co-ordinator offers specialist advice about physical activity and health promotion, as well as motivational support.”

Liz notes that up to 41 per cent of Irish people are sedentary and this programme specifically targets these people. The Health Promotion team is responsible for ongoing support to the local GPs and co-ordinators, as well as the provision of promotional packs and GP referral resources. + Michelle Fanning, a local co-ordinator for the GP Exercise Referral Programme, and Marie Prior, participant.

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west // Gallery

+ HSE staff and service users of the Ballytivnan Training Service in Sligo at the launch of the Artability exhibition, showcasing the work of artists with a disability, held in Sligo in October.

+ At the launch of the Children’s Remembrance Day Committee Christmas cards and lights at University Hospital Galway, L-R: Fr Peter Joyce, Hospital Chaplain; Maurice Moran, Portering Staff; Margaret Duignan, Chairperson, Children’s Remembrance Day Committee; Una Carr, Assistant Director of Nursing and Midwifery; Seán Bán Breathnach, radio and TV sports presenter; Fidelma Kenny, Secretary, Children’s Remembrance Day Committee; Marie Cox, Group Assistant Director of Nursing and Midwifery and Bernie O’Malley, Business Manager, Women’s and Children’s Directorate.

+ At the five-year anniversary celebrations of the Meet and Greet Volunteer Programme at Galway University Hospitals (GUH), L-R: Ann Cosgrove, General Manager, GUH; Phil Whyte, Volunteer Co-ordinator, GUH; volunteers Patricia Dooley, Mary Heneghan, Deborah Reilly, Ronald Sayers, Phil Grealish, Mary Griffin, Muriel Silke and Alice Parsons; Colette Cowan, Group Director of Nursing and Midwifery, West/North West Hospitals Group; Mary Hynes, HR Manager, GUH; John Shaughnessy, Director of Human Resources, West/North West Hospitals Group. + Galway University Hospitals reached a milestone on November 1st as the 500th patient underwent minimally invasive prostate cancer radiation treatment (prostate brachytherapy). Members of the prostate brachytherapy team, L-R: Professor Frank Sullivan, Consultant Radiation Oncologist and Lead Clinician, Department of Radiation Oncology; Martina Sweeney, Staff Nurse; Jackie Barrett, Anaesthetic Nurse; Ger O’Boyle, Clinical Nurse Manager 2; Marie Cox, Group Assistant Director of Nursing; Mr Jam Khalid, Consultant Radiation Oncologist; and Mary Hodkinson, Staff Nurse.

+ The HSE Roscrea Primary Care Team held a free information evening for the relatives and carers of people with dementia in Roscrea in November. Pictured is the organising group. Back row, L-R: Catherine Timmons, Dean Maxwell Community Nursing Unit; Michael Wright, Home Instead; Mairead Ramsbottom, Tesco Ireland. Front row, L-R: Noreen Rooney, Roscrea Primary Care Team; Mary Dwan, Alzheimer’s Association; Teresa Mason, Roscrea Primary Care Team. + Paula Quinn, HSE Consumer Services Manager; Martina Blake and Davina Coulter, Stanford University Master Trainers, with participants who successfully completed the HSE Self Management Trainers programme in Co Donegal.

EMERGENCY RESPONSE OFFERS SOLUTIONS TO HELP RESTORE INDEPENDENCE TO YOU AND YOUR LOVED ONES. With our technology you can remove the fear of living alone enabling you to live independently secure in the knowledge that help is always available 24 hours a day, 365 days a year.

Help can be summoned by simply pressing your personal trigger which can be worn around the neck or around the wrist. Our centre operators will take the appropriate action, whether it be contacting a family member, neighbour, doctor or the emergency services.

LISTED ARE SOME OF THE ADDITIONAL PRODUCTS ALSO AVAILABLE: Our range of sensors can be tailored to suit your needs.

• Bogus Caller Button • Temperature Extremes Detector • Epilepsy Sensor • Bed Occupancy Sensor

• Medication Dispenser • Care Assistant Pager • Fall Detector • Vega GPS Bracelet

Each sensor is programmed into your unit and if activated alerts our monitoring centre or family member.

HELP AT THE TOUCH OF A BUTTON Contact our Telecare Support Team on 1850 247 999

www.emergencyresponse.ie

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Home Instead senior care special report

7 Ways to Investigate Your Loved One’s Needs During a Christmas Visit As you pile the gifts into the back of the car and check off any last-minute errands from your list before heading home for the Christmas holidays, you might also want to prepare to handle any changes you notice in your ageing loved ones. Keep your eyes open for these seven common issues that can threaten a senior’s independence.

1.Pain Does your mother now pull up a stool by the sink to peel the potatoes? Does she wince when she bends down? Does she complain about a bad back? If you notice any red flags, try gently asking her: “How long has your back been hurting you?” Even if she tries to pretend she’s managing fine, consider helping her schedule a doctor’s appointment to be sure.

3.Depression If you see any hints of irritability, sadness or sleep difficulties, these could be signs of depression. Depression is common among seniors, and any related concerns should be checked out by a doctor or mental health care professional.

4.Social Engagement Ask your mother to tell you about her friends. Social seniors generally have a healthier and more optimistic outlook on life. If she doesn’t have a strong social network, look into community activities that she may enjoy, or companionship services from Home Instead Senior Care.

5.Safety If your mother has more difficulty walking, make sure she has a cane, walker or the proper support; remove rugs or other potential tripping hazards and look into installing grab bars and no-slip strips where needed. If you’re worried about falls or other safety issues, look into getting a medical alert system or hiring a Professional CAREGiver from Home Instead Senior Care who can check up on her frequently.

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2.Memory Does she have trouble recalling events from that morning? Has she told you the same story over and over? You may want to keep a list of concerns to bring up with her GP or public health nurse.

6.Housekeeping As seniors experience declining health, they may have more trouble keeping up with the housework. If you notice the house looks more unkempt than usual, consider senior care services that include light housekeeping.

7.Medication Try to notice if your senior loved one is taking the appropriate pills at mealtimes or before bed and if she is keeping the pillbox organised. If she is not reliable with a medication schedule, you may want to look into home care services that provide medication reminders.

How to Address the Issues You Uncover Even if you meet with some resistance when gently confronting a loved one about potential issues you may observe during your visit, it is in both your and your loved one’s best interest to find a solution

that can help keep him or her safe and independent at home.

If you’re unsure about the best way to diplomatically discuss issues with your loved one, download Home Instead Senior Care’s 40-70 conversation starter guide at www.homeinstead.ie.

For any physical or mental health concerns you may have, consulting your ageing loved one’s GP might be the best thing to do. It’s better to address a concern early than wait until it becomes a health emergency.

If you get the sense that your loved one needs more assistance with activities of daily living, Home Instead Senior Care offers free care consultations that allow you and your family to sit down and discuss care options with a home care professional, without you having to pay for the consultation or committing to services.

For more information call 1890 930 013 or log on to www.homeinstead.ie.

72 Health Matters

Home Instead senior care news & Views National CAREGiver of the year Honoured for Commitment and Service to Older People Limerick CAREGiver Michelle Curran has been crowned National CAREGiver of the Year 2013 by Home Instead Senior Care at its annual gala awards ceremony in Killashee House Hotel, Co Kildare.

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his year at Home Instead Senior Care's gala awards ceremony, CAREGiver Michelle Curran was recognised for her commitment and service to older people in the Limerick area. “Professional CAREGivers like Michelle are the core of our business,” said local owner Liam Toland.

“Without dedicated CAREGivers, we couldn’t provide the superior quality of service to seniors that sets our organisation apart from others. Professional CAREGivers are the foundation of Home Instead Senior Care and provide the support that helps older adults remain in their homes longer than they otherwise could.”

Michelle was nominated by local clients, their families and other CAREGivers and staff.

A daughter of one of Michelle’s clients said: “Michelle cared for my Dad for over three years. She was very committed to ensuring his wellbeing. She often reassured the family that she lived nearby and could call in on him if we were ever worried. That was a kindness that went beyond the call of duty.”

Another son of a client said: “I would like to express my ongoing appreciation for Michelle. She has been caring for my mother since last November. It is clearly evident to me that the care and attention she is providing has had a significant impact on the improved quality of life of my mother.”

According to Mary Golden, Manager of Home Instead Senior Care in Limerick, “Michelle has every quality it takes to make a special caregiver. She is extremely kind

What Does a Professional CAREGiver Do? Professional Home Instead CAREGivers provide a variety of non-medical services that allow seniors to remain in their homes.

These services may include: • Providing companionship and conversation • Planning and preparing meals • Light housekeeping • Medication reminders • Running errands • Encouraging social and mentallystimulating activities • Facilitating opportunities to exercise • Transportation • Personal Care • Post-hospital care • Disability Care • Specialised Alzheimer's care • Palliative care • Respite care The majority of Home Instead CAREGivers have experience carrying out many of these tasks for their own family or older friends.

This year, Professional CAREGiving from Home Instead Senior Care has delivered over 1.2 million hours' worth of care to more than 3,000 older people in local communities throughout Ireland, enabling them to live rich, independent lives.

+ Michelle Curran, CAREGiver of the Year 2013

and considerate to her clients. They all absolutely love her. To me it’s her quiet and unassuming manner and her unbelievable patience that makes her stand out. She is very pleasant, good-humoured and passionate about learning and attends all additional Home Instead training. I congratulate her on winning this award.

Home Instead Senior Care is blessed to have such a wonderful lady as Michelle on our team.”

ADVANCED HOME INSTEAD TRAINING Professional Home Instead CAREGivers are rigorously recruited, Garda-vetted, insured and trained to Fetac level 5. Many Home Instead CAREGivers begin by providing basic companionship and home helper services. They then have the opportunity to advance their senior care skills through special training programmes offered by Home Instead Senior Care. Advanced CAREGiving opportunities include: • Personal care training: CAREGivers receive personal care training and become qualified to help clients with bathing, incontinence, hygiene, and other hands-on tasks of daily living that they can no longer manage themselves.

• Specialised Alzheimer’s and other dementias CARE training: It takes an exceptionally dedicated, specially trained CAREGiver to provide care for someone who has Alzheimer’s disease or other dementias. Home Instead’s Alzheimer’s or Other Dementias CARE: Changing Ageing Through Research and Education training programme equips Professional CAREGivers with proven techniques that enable them to provide the highest quality of customised care and support to clients and their families.

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Home Instead senior care news & Views Why Professional CAREGivers?

Every single day, families are struggling.

Balancing the demands of life such as child-rearing and careers while taking care of older loved ones can take its toll on a family.

Professional Home Instead CAREGivers such as Michelle Curran can serve as a respite to families and help seniors remain independent for as long as possible.

Women especially are balancing the care of their parents with piano lessons and transporting children to numerous clubs, a

full-time job, house-keeping, community, and volunteer activities. These family caregivers eventually run out of hours in the day; the stress becomes too great and the balance is broken. That's where Professional CAREGivers come in. Professional CAREGivers from Home Instead Senior Care can help these families restore balance, order and peace to their lives and help their senior loved ones remain at home.

Being a Professional CAREGiver is a unique job with responsibilities and

challenges, both physical and emotional.

But it also offers many joys and rewards that simply aren’t found in other careers.

Professional CAREGivers have the opportunity to meet wonderful people, build fulfilling relationships and make a difference in the lives of their clients and their families.

To find out more about Professional CAREGiving services contact Home Instead Senior Care on 1890 930 013 or log on to www.homeinstead.ie.

Home Instead ‘care partner’ of the ‘Sandwich Generation’ H

ome Instead Senior Care understands the pressures and stress faced by 'the sandwich generation'. The sandwich generation are women aged between 50 and 69 with a living parent and children (accounting for a third of this age group, or 141,400 women in Ireland), according to the Trinity College Dublin study on intergenerational transfers.

Most of these women give a range of financial or non-financial help to both their elderly parents and their children. Over half of these women (58 per cent) give help to their parents and 83 per cent give help to their dependent and non-dependent children, according to the research that is part of the Irish Longitudinal Study on Ageing (TILDA).

In addition, one third of the sandwich generation women look after their grandchildren – this proportion increased with age and decreased with education level.

Half of the women also work and a quarter had third-level education, the study found.

Home Instead Senior Care agrees with a key finding of the report that “providing such support can have a negative impact on the health of these women and lead to increased depression”. The sandwich generation is

becoming more relevant with changing population structure as people live longer, fertility is delayed and more women remain in the workforce, the report said.

The recession also impacts on the ability of elderly parents and younger adult children to offer support as availing of home care support is often thought of as an expensive option, which isn’t necessarily the case.

“Many of our older clients have adult children who work and have their own children and grandchildren to care for,” explains Ed Murphy, CEO of Home Instead Senior Care. “These pressures of ‘modern family life’ do not lend themselves to providing the necessary support to elderly loved ones.

“This is where home care is a highly effective service. We essentially become their 'Care Partner'. Our Professional CAREGivers support older adults to remain at home when perhaps family members have other commitments they need to see to. Home care is proven to help older people remain happier and healthier for

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Home Instead Senior Care has highlighted its concerns surrounding the new report on the growing ‘sandwich generation’ of older women supporting three generations – their elderly parents, their children and their grandchildren.

longer than otherwise possible because they are living in familiar surroundings. This reduces the pressure on the sandwich generation, giving them peace of mind when they feel worried and stressed about the care of their ageing loved one. Up to 41 per cent tax relief is available on the cost of home care so it is certainly more affordable for families than financing expensive nursing homes and hospital beds.”

To find out more about how Home Instead Senior Care can support you, call us on 1890 930 013 or log on to www.homeinstead.ie.

74 Health Matters

Home Instead senior care news & Views

UNIQUE ALZHEIMER'S CARE SERVICES FROM HOME INSTEAD ACHIEVE STRONG RESULTS Remaining in familiar surroundings helps to manage the challenges of memory loss – and Home Instead Senior Care's approach can help seniors and their families to cope.

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rom the comfort of a favourite armchair by the fireplace to the familiarity of each floorboard that creaks in the hall, there’s no place like home. For a person with Alzheimer’s disease, research has shown that remaining in familiar surroundings helps to manage the challenges of memory loss.

Home Instead Senior Care’s personcentered approach to Alzheimer’s care, backed by advanced research and professional CAREGiver education, can help seniors cope with the challenges of Alzheimer’s while enabling them to continue doing what they can on their own in the comfort of home. Home Instead’s unique Alzheimer’s and dementia training programme was developed as part of its CARE: Changing Ageing through Research and Education programme. This expert-

endorsed programme equips Professional Home Instead CAREGivers to provide the highest quality of customised care that: • Allows the senior to remain safe and calm at home • Encourages engagement • Provides nutritious meals • Creates social interaction • Provides mind-stimulating activities • Manages changing behaviours • Honours who the senior was earlier in life • Supports the family Most importantly, Professional CAREGivers can provide assistance with enhancing and restoring the simple pleasures of life, such as a walk in the park, a spin in the car to get ice cream or spending time in the

garden. Proven to maximise abilities and independence, such senior care activities remain one of the best non-medical treatments for Alzheimer’s disease.

Following on from the success of Home Instead’s recent ‘Until there is a Cure’ campaign, which offered free dementia education workshops to family and community members caring for a loved one with Alzheimer’s or other dementia, Home Instead is now scheduling workshops across the country on a regular basis.

If you need professional help caring for your loved one or would like to attend a dementia education workshop, contact your local Home Instead Senior Care office on 1890 930 013 or log on to www.homeinstead.ie.

Health Matters 75

Home Instead senior care news & Views

Age Loudly with Senior Citizen: The Essential Guidebook 2014 Home Instead Senior Care is encouraging older people to ‘age loudly’ in 2014 with the launch of their new edition of Senior Citizen: The Essential Guidebook. Endorsed by Age Action, the free annual guidebook is relied upon by tens of thousands of seniors and their families every day. It offers practical information on topics from care options, entitlements, finance, health, law and nutrition to unique insights and useful tips on successful ageing.

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ome Instead Senior Care’s mission is to enhance the lives of seniors, enabling them to live happy, healthy and independent lives in their homes for longer than otherwise possible. They are passionate about ageing well and preventing loss of independence.

Interestingly, health literacy is regarded as a stronger predictor of health status than age, income, employment status, education level, race or ethnic group (Weiss, American Medical Association, 2007). Hence the value Home Instead places on educating Irish senior citizens with accessible and practical information in the shape of its 2014 edition of Senior Citizen: The Essential Guidebook.

The Care Journey This quality reference guide will take readers on what Home Instead Senior Care calls ‘the care journey’. The care journey aims to optimise the opportunities for successful ageing including living at home, health, lifelong learning, participation and security in order to enhance quality of life.

Ed Murphy, CEO of Home Instead Senior Care says: “The Central Statistics Office in Ireland predicts that over the next 30 years, the number of people over the age of 65 will double and the number over 80 will quadruple. Our ageing population is certainly one of humanity’s greatest triumphs. But it is also one of our greatest challenges with increased economic and social demands on our country, in terms of our funding for quality health and welfare services, increased cost of living, changes to family and community settings with increased emigration, social isolation and so on.

“We want Senior Citizen: The Essential Guidebook to support the development of a ‘culture of care planning’ as we believe this is the foundation needed to age successfully. This holistic approach to ageing involves highlighting key areas such as diet, exercise, understanding your

entitlements – your medical condition if you have one, appointing a power of attorney, considering your preferred care options for later life. We want care planning to be seen as the necessary and smart option for seniors. Ultimately this concept is for everyone, as one thing we can be sure of: no-one can escape the ageing process.”

As a professional organisation dedicated to providing quality home care services, Home Instead Senior Care is resilient in its belief that older people should be encouraged to live at home for as long as possible, and if they require extra support to do so, this should be promoted. Research has shown time and time again that home is where older people are happiest, healthiest and most importantly where they want to be.

“Home Instead understands that older people living at home is very different to having a quality of life at home”, says Ed Murphy.

“Our Professional CAREGivers are fully trained not only in delivering specialised home care services, but they also encourage and support older clients to fulfil their potential, whatever that may look like for that individual.

“It is crucial that senior citizens make it their mission to plan for quality of life at home. This is a fantastic message that is held within the Senior Citizen guidebook and one I would urge older people, family, friends and carers to really think about. The time to plan is now.”

Senior Citizen: The Essential Guidebook 2014 will be launched in January with 45,000 copies available free from local Home Instead Senior Care offices or digitally at www.homeinstead.ie.

Pre-book your FREE copy TODAY on 1890 989 755

76 Health Matters

Home Instead senior care news & Views Home Instead Wins Ireland's Top Franchise Award Home Instead Senior Care has been crowned Franchise of the Year (Service) at the Ulster Bank Irish Franchise Association Awards 2013.

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he Ulster Bank Irish Franchise Association Awards recognise excellence in franchising and reward the outstanding achievements of businesses and individuals in the franchise industry.

David Killeen, Chairman of the Irish Franchise Association, said: “I would like to congratulate Home Instead Senior Care on winning the top accolade. Through the collective effort of all involved, they continue to drive improvements in standards and have a genuine and passionate understanding of best practice and ethical franchising in Ireland.”

Ed Murphy, CEO of Home Instead Senior Care said: “It is so rewarding to see that Home Instead Senior Care and the home care service we provide to Ireland’s seniors has been so strongly recognised by the Irish Franchise Association. We are very passionate about not only providing the highest quality of home care service across the country but we are proud to see the very real difference the care we provide is

making to the lives of seniors.

It is a terrific accolade for such efforts to be acknowledged.”

Orna Stokes, Senior Manager, SME Propositions, Ulster Bank said: Congratulations to Home Instead Senior Care – this company is a wonderful example of what can be achieved using enterprise, innovation and hard work."

+ Ed Murphy, Danette Connolly and Peter Taylor from Home Instead Senior Care are presented with the Franchise of the Year (Service) award by Derek Manning of Ulster Bank, with John Perry TD, Minister for Small Business (right).

WHY HOME INSTEAD WON • Has delivered over 1.2 million hours' worth of care to more than 3,000 older people.

• Employs 2,500 Professional CAREGivers: experienced, Garda-vetted, insured, trained • Comprehensive training programmes.

• Achieved ISO 9001:2008, Healthmark, Q Mark Awards for Quality Management System.

• Responsive staff available 24/7.

• Launched e300k Trinity College Dublin research.

• Trained over 1,000 family caregivers at dementia education workshops.

• Offers unique resources for free to family caregivers and the wider community.

• Active online community.

• Best Healthcare Provider of the Year Award.

Meet Charlotte Reilly Charlotte Reilly is the owner of the recently opened Home Instead Senior Care office in Trim, Co Meath.

Charlotte and her team will provide professional home care services to older people in Meath and Louth.

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proud Meath woman, Charlotte grew up in Trim and was educated locally by the Mercy Sisters before going on to continue her education at the regional technical college in Athlone. Charlotte’s early career saw her working in a variety of different customer service and sales roles in America, England, Dublin and Australia before returning to Ireland permanently in 1992. At that time Charlotte became the first field sales representative for Snap Printing. Her success in this role led her to opening her own Snap Printing franchise in Dublin with her husband in 1996.

After 10 years owning and developing this business, Charlotte was involved in the setting up and growth of a series of dry cleaning shops throughout Dublin and Kildare. In 2012 Charlotte had her initial insight into the world of homecare when

she took a key role in the rolling out of a new IT system for HSE-funded home help organisations in north Dublin. This experience led her to appreciate at first hand the need for suitable homecare solutions in Ireland.

Charlotte says: “I am absolutely delighted and so proud that my latest business venture is a Home Instead Senior Care company less than a stone’s throw from where I grew up and now live with my own family.

I understand the stress and worry families experience as their loved ones age and that's why I am passionate about caring for older people in my community. Through the provision of high quality services, my team at Home Instead Senior Care is determined to support more older people in Meath and Louth to live, with quality of life, in their own homes for as long as possible.”

+ Charlotte Reilly.

For more information please contact Charlotte on (046) 948 3338 or charlotte.reilly@hisc.ie.

Health Matters 77

Commercial Feature

Solutions for Independent living Irish company Tunstall Emergency Response provides expert telecare solutions to over 36,000 customers and their families across the country.

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ith technological advances greatly increasing the safety of people living at home independently, Tunstall Emergency Response’s telehealthcare services remotely monitor clients’ health and wellbeing, including instant response to emergencies.

Tunstall Emergency Response units and environmental sensors provide the freedom for clients to remain independent and supported in their own homes. In an emergency, the company’s trained response operators will speak directly to the client over the unit to identify how they can best assist and notify the appropriate contact or service.

The company provides Ireland’s largest 24hour dedicated monitoring centre, with help easily accessible at the touch of a button.

Services include detectors for falls, smoke, floods and carbon monoxide as well as sensors for bed/chair occupancy, epilepsy, property exit and temperature extremes.

“While our services provide instant response in emergencies, they also include the monitoring of a person’s health and wellbeing. We are here to support older people, people with dementia and physical disabilities and other long-term needs to live independently. Our availability round the clock, for emergencies and reassurance, gives real peace of mind to our clients,” says James Doyle, Director, Tunstall Emergency Response.

Dementia Tunstall Emergency Response has developed a new monitoring service for improved communications and enhanced levels of safety and care for Ireland’s 44,000 people living with dementia and their families. This technology allows for the discreet remote monitoring of users by the company’s expert monitoring centre and communicates to the monitoring centre in the event of an incident occurring (such as a bath flooding).

“This technology has already greatly improved the lives of those living with dementia and their families. It provides real-time alerts on the movements of service users and can be accessed remotely on a 24-hour basis ensuring that the correct levels of home care can be implemented. This service also prolongs independent living,” says Doyle.

Response from keyholder or emergency services

Personal trigger or telecare sensor raises alert

Operator decides Lifeline Vi Independent Living appropriate course of action home unit Tunstall Emergency Response has just launched its new GSM Dual product which allows users all the Alert received at monitoring centre same benefits of its services without the need for a landline. This system works over the mobile phone network, is connected to the company’s dedicated 24-hour monitoring centre, and includes sensors to detect activity/ inactivity and smoke. The GSM Dual also comes with a personal alarm pendant. In addition, clients can also add on the Bogus Caller alert. This is used when answering the door: users can press the discreet button that sends a silent call to the monitoring centre, allowing staff to listen in on the conversation, giving added reassurance and security.

The company also now offers its new groups. Its services provide families with V1 Fall Detector – a discreet, easy-togreat peace of mind and gives healthcare wear pendant which detects falls and professionals, including discharge officers, automatically notifies the monitoring centre. occupational therapists and public health nurses, specially tailored options to facilitate Tunstall Emergency Response patients to live independently.

Tunstall Emergency Response provides over 100 telehealthcare solutions for a range of needs from private home care to services for See www.emergencyresponse.ie or phone hospitals, healthcare clinics and community 1850 247 999.

“Tunstall Emergency Response’s services provide the 24-hour monitoring of people’s health and wellbeing, supporting independent living.”

78 Health Matters

MENTAL HEALTH

Kerry teenager's message of hope and inspiration Before his death from cancer Donal Walsh, a 16 year-old from Kerry, made a video entitled LiveLife with the National Office for Suicide Prevention.

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n online video message encouraging young people who are experiencing tough times to seek help is being widely viewed and shared across a range of platforms and media. The message features the late Kerry teenager Donal Walsh and was launched by his parents, Fionnbar and Elma, on RTÉ television’s Saturday Night Show in September.

The LiveLife video came about when in April 2013 Donal, a 16 year-old from Kerry who had cancer, wrote an open letter in the media about young people and suicide.

Donal was subsequently invited to appear on the Saturday Night Show, where he spoke about how he was coping with his illness and about the problems facing young people, encouraging them to seek help.

Donal’s message to young people struck a chord with the public. Minister of State at the Department of Health Kathleen Lynch TD asked the HSE’s National Office for Suicide Prevention (NOSP) to look at how Donal’s message encouraging young people to talk to someone they trusted about the problems they were experiencing could be used to support NOSP’s preventative work with young people.

With the support of the Walsh family, NOSP developed a short online video aimed at 15-19 year-olds using footage from Donal’s interview on the show as well as an interview filmed later in Donal’s home in Tralee. Donal’s message in the video very much focuses on encouraging young people who are feeling low or going through tough times to talk to someone they trust and to seek help.

Mental health professionals, suicide resource officers and youth groups had input into the video to ensure the message was appropriate for its target audience of young people. A number of young people were also involved in providing feedback on the video and assisted with its development. The video was also

developed in line with the media reporting on suicide guidelines.

The National Office for Suicide Prevention would like to thank Inspire Ireland, Jigsaw and Spunout.ie; Bressie for doing the voiceover, and in particular Donal’s family and friends for their support of the project. Gerry Rayleigh, Director of the National Office of Suicide Prevention said: “Donal’s story has touched people of all generations. His clear and strong

message encourages those going through tough times to talk about their difficulties and to seek help. It is a message shaped from his own experiences as he courageously met the challenge of cancer with the help and support of his family and friends. It is a message of hope and inspiration.”

Donal sadly passed away on May 12th 2013. His message about valuing life and seeking help is part of his legacy.

View Online The LiveLife video has received widespread media coverage and has been viewed and shared thousands of times on a range of media and other websites. Donal’s message can be viewed on: • Health Service Executive: www.hse.ie • National Office for Suicide Prevention: www.nosp.ie • ReachOut.com: www.reachout.com • Spun Out: www.spunout.ie The Department of Education and Skills has also made the video available

on the Social Personal and Health Education Website www.sphe.ie and trained school personnel are invited to use it as a resource in supporting postprimary schools in the delivery of the SPHE curriculum and in implementing the WellBeing in Post Primary Schools Guidelines for Mental Health Promotion and Suicide Prevention.

Help and advice for people going through tough times, or for those who are concerned about someone, is available on the websites above.

Health Matters 79

meet the team

Meet the St Mary’s Team St Mary’s Hospital in Dublin’s Phoenix Park is now home to a new Community Falls Service.

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new Community Falls Service recently opened at St Mary’s Hospital, Phoenix Park, Dublin. This initiative provides a onestop shop for assessing and treating older people who have fallen or who are at risk of falling.

The Community Falls Service team is led by consultant geriatricians. The team can cater for patients from the point of initial clinical assessment right through to post-assessment education and support.

Led by consultant geriatricians Dr Mimi Fan and Dr Frances McCarthy, staff from a range of disciplines – nursing, medicine, physiotherapy, occupational therapy, social work, education and support – work together to provide this comprehensive service.

St Mary’s Day Hospital provides outpatient services to the older adult population in Dublin North City. For many older adults in the Dublin North City area it is often the point of first entry to care services outside GP care. As the care of older adults can be varied and sometimes complex, the multidisciplinary team in St Mary’s has the skills, expertise and a clear focus on meeting the needs of the people of Dublin North City, which includes the development of new services.

The new Community Falls Service was launched in October 24 by Irene O’Byrne Maguire, Joint Co-ordinator of the AFFINITY National Falls and Bone Health Implementation Project.

Speaking about what the service will

mean for older people, Dr Fan said: “The addition of a falls clinic will further enhance the long tradition of providing healthcare for older people at St Mary’s Hospital.’’

Director of Nursing Mary Flanagan acknowledged the commitment of staff in getting the falls service up and running as they identified a significant need for this service and have worked together to establish it at St Mary’s.

Working together Echoing this point, Dr Frances McCarthy praised the contribution of all the staff and departments who work collaboratively to provide this service. “This initiative is a great example of how a multi-disciplinary team can work together in an efficient and

+ Front row, L-R: Caroline Walsh, CNMI; Dorothy McGarry, Assistant Director of Nursing; Frances McCarthy, Consultant Geriatrician; Clare Aspell, CNMII Day Hospital Nurse Manager; Mimi Fan, Consultant Geriatrician; Elizabeth Griffin, Senior Physiotherapist; Wemi Chukwureh, Physiotherapist.

Back row, L-R: Subha Balasubramanian, Staff Nurse; Marie Fox, Health Care Assistant; Doris Church, household staff; Anne O Connor, Area Manager, Dublin City North; Frances Pidgeon, Senior Area Medical Officer; Renata Katz, Registrar; Daragh Rodger, Advanced Nurse Practitioner.

80 Health Matters

meet the team

+ L-R: Dorothy McGarry, Assistant Director of Nursing; Frances McCarthy, Consultant Geriatrician; Irene O Byrne, Clinical Risk Adviser and Joint Co-ordinator AFFINITY National Falls Prevention and Bone Health Implementation Project; Mimi Fan, Consultant Geriatrician; Mary Flanagan, Director of Nursing; Anne Marie Ryan, HSE Office of the Assistant National Director for Older Persons and Joint Co-ordinator of the AFFINITY National Falls Prevention and Bone Health Implementation Project; Daragh Rodger, Advanced Nurse Practitioner and Clare Aspell, CNMII Day Hospital Nurse Manager.

effective manner to provide a quality service to our older patients. Our patients are often challenged by the sometimes fragmented nature of our health service, but this ‘onestop shop’ is a welcome initiative for our local frail older adult population.”

Hospital Manager Deirdre Murphy said: “The community falls service is a welcome addition to the St Mary’s Hospital campus, augmenting the comprehensive range of services already provided for the older person across the Dublin North City area.”

Referrals to the Community Falls Service are accepted from GPs in the Dublin North City area and may also be triggered by healthcare professionals who come in contact with the older person experiencing falls. A referral pathway also exists for older people presenting at the emergency department of Mater Misericordiae University Hospital as an admission avoidance initiative.

Falls in older people are common, affecting 30 per cent of people over 65 years annually. They result in significant morbidity and an increased mortality due to injury. Falls cost the state at least s500 million annually. Clinical trials report that a multifaceted intervention approach can reduce falls by up to 40 per cent.

In the Community Falls Service, the factors causing patients to fall can be fully investigated in a purpose-built day hospital.

A comprehensive nursing and medical clinical assessment is undertaken and as required, access to the following is available

on site: 24-hour blood pressure monitoring to assess blood pressure status, DXA scanning to assess bone health and reduce the risk of future fractures, and Finometer and tilt table to assess patients presenting with blackouts or unexplained falls.

Physiotherapy staff provide a range of assessments and interventions individually tailored to patient requirements, including one-to-one, home and group exercise programmes.

The occupational therapist (OT) supports the falls clinic by way of conducting patients’ cognitive, functional and home

“The community falls service is a welcome addition to the St Mary’s Hospital campus, augmenting the comprehensive range of services already provided for the older person across the Dublin North City area.”

environment assessments. OT staff also provide information and assistance to patients in relation to aids and equipment.

The social worker provides support to those presenting with falls and assists with accessing relevant community supports and services

Care of Older Adult St Mary’s Campus comprises of the Phoenix Park Community Nursing Unit, St Mary’s Hospital, St Mary’s Day Hospital, the Healthy Ageing Clinic and Osteoporosis Clinic. It is the largest care of the older adult facility in the country.

To support the falls service at St Mary’s Hospital, a dedicated website has been established: www.bonehealth.co.

Developed by Daragh Rodger, Advanced Nurse Practitioner, Care of the Older Adult Community; and Anne Spencer, Clinical Educational Technologist, this website is central to the implementation of an online education programme, Bone Health in the Park, developed for staff, patients, residents and their respective families.

The first phase – ‘I am not falling for you!’ – was implemented in May 2011 and is a comprehensive bone health education programme for people of all ages, with a focus on bone health, falls awareness and osteoporosis. The second phase – ‘Forever Autumn’, implemented in 2012 – is a falls prevention and falls reduction programme developed and implemented in St Mary’s campus for all staff, clinical and non-clinical.

Health Matters 81

humour

Happy Christmas, Eve Thinking about Christmas starts me reminiscing about my own childhood. I was born in a bed in Mullingar Hospital because I wanted to be near my mother. I grew up in a poor family with three brothers and three sisters during the 1960s and 1970s. If you want to know what Mullingar was like during the 60s and 70s, go there now. I now live in east Westmeath.

I lost my mother when I was seven. It was our first time in Dublin, she lets go my hand and we get separated. When I finally found her with the help of the gardaí, she looked disappointed.

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hristmas is a stressful time of the year.

I’m one of those people who don’t put up their tree until about a week beforehand. The lights work perfectly. It looks beautiful. Then on Christmas Eve, two hours before the shops close, every little light goes bang. And for the next two hours I’m scampering like a demented preson around Navan searching madly for one little green Christmas tree light that was made in Asia years ago.

And music – all of the Christmas music is so noisy. It’s the church bells are ringing; church bells at eventide; jingle bells, sleigh bells; hear the angel trumpet sound; hark the herald angels sing; dong-dong merrily on high. Can you see the Virgin in the stable – all the din from heaven – the choirs and the trumpets and the heavenly bells stopped and she’s just got the newborn baby asleep – who comes marching up the road? The Little Drummer Boy. What do people actually mean when they say they slept like a baby? Do they mean they woke up every hour, on the hour, screaming for food?

“I hated Christmas because I never got what I wanted. One year I ask for a bicycle and I get a dictionary.

My mother says, “Well ‘bicycle’ is in the dictionary.” I flick through the pages and go “Oh look, so is pennypinching.”

My earliest memory is my first day at school. I went to the Presentation Sisters in the town. I recall my mother bringing me on a carrier seat on the back of her bicycle. She brought me to the classroom to meet my teacher and said, “Hello Sister Joseph, this is my son Finian.” Sister Joseph replied: “You’re welcome Finian. I hope you’re going to behave yourself?” I looked behind her and saw a life size crucifix – a fella nailed to a cross on the wall. I went “you bet I am Sister, you bet I am”.

I hated Christmas because I never got what I wanted. One year I ask for a bicycle and I get a dictionary. My mother says, “Well ‘bicycle’ is in the dictionary.” I flick through the pages and go “Oh look, so is penny-pinching”.

Another year all I wanted for Christmas was an Action Man but what I got was a plastic doll with a cord on the back. When you pulled him: “twenty-five, twenty-five, thirty, thirty-five, thirty-five, forty…” I looked at the packet: Auction Man. I was always perturbed at how Santa Claus seemed to perpetuate the class divide by giving expensive presents to rich kids and cheap ones to poor kids. I thought this about Santa for a number of years but then one day in primary school my teacher called me aside and said: “Listen, there is no such thing as… poor kids”.

The most peaceful Christmas I remember was the year my mother mistakenly covered the cake with Temazepam.

Have you ever thought of what we ask children to believe in at Christmas? We actually ask our children to believe in an enormously fat, red-faced 1,600 year old man who – to make himself less conspicuous – dresses in a bright red suit with white fur edges, black shiny boots and a big hat with a bell. And for 364 days of the year he lives in the North Pole with lots of elves. Whose total vocabulary seems to consist of “ho-ho-ho! My name is Santa Claus! Would you like to sit on my knee?” And for the rest of the year we’re telling them not to talk to strangers.

The final word goes to Adam, who on December 24th, said to his wife: “Happy Christmas, Eve.”

Finian Murray is men’s health development officer with HSE Dublin North East.

His hobbies include performing stand-up comedy.

TRINITY COLLEGE

The University of Dublin Faculty of Health Sciences

M.Sc./P.Grad.Dip Programmes – Interdisciplinary • M.Sc. / P.Grad.Dip.in Dementia • M.Sc. / P.Grad.Dip.in Mental Health (in association with the National Forensic Mental Health Service) • M.Sc. / P.Grad.Dip.in Mental Health – Child, Adolescent and Family Strand • M.Sc. / P.Grad.Dip.in Palliative Care (in association with St Francis Hospice, Raheny) • M.Sc. / P.Grad.Dip in Clinical Health Sciences Education Application Information: INITIAL CLOSING DATE for receipt of completed applications for all postgraduate programmes: 31 MAY 2013.

Application information please see: www.nursing-midwifery.tcd.ie/ Further information on all programmes please contact: School of Nursing & Midwifery, 24 D’Olier Street, Dublin 2.

T: (01) 896 2692; E: nursing.midwifery@tcd.ie Visit our website: www.nursing-midwifery.tcd.ie Find us on Facebook: www.facebook.com/TCD.Nursing.Midwifery

Health Matters 83

Dementia

Musical boost for patients with dementia

www.istockphoto.com

Two new choirs for older people are being set up in south Dublin and are specifically welcoming to people affected by dementia, writes Sarah Murphy.

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wo new choirs for older people are being formed as part of the Dún Laoghaire/Rathdown HSE Arts and Health Partnership, together with the 'Living Well with Dementia' Stillorgan-Blackrock project. The project is jointly funded by Atlantic Philanthropies and the HSE, and is supported by Genio Trust.

The purpose of the choirs is to give people an opportunity to come together in a relaxed environment and reconnect through music. Music and singing helps lift mood, provides cognitive stimulation and supports social interaction.

The Arts and Health Partnership aims to make creativity intrinsic to life. The groups are being led by a choral director and supported by a team of volunteers. There is no element of competition or performance.

The choirs may participate in a local musical performance, but this will be optional.

The choirs are being held on two different days: one on Thursdays in Deansgrange Library and the other at St Raphael’s in Stillorgan on Saturdays.

Raising awareness Living Well with Dementia is a three-year

community-based project which aims to raise awareness about dementia, reduce stigma, promote early diagnosis and provide support for people living with dementia in the Stillorgan and Blackrock areas of Dublin.

“Musical Memories is a very important project where people from our community who may ordinarily be isolated are joined together in an inclusive environment through the joy of singing.”

Maire Davey, Assistant Arts Officer with Dún Laoghaire/Rathdown County Council explained: “We were interested in initiating

this project with the Living Well with Dementia Project as there is ample research that indicates that participation in choral and singing activity has a positive effect on people with dementia.

“The Dún Laoghaire/Rathdown HSE Arts in Health Partnership believes that everyone should have access to the arts and Musical Memories is one of the ways that this ethos is brought into being. In the United States, for example, The Unforgettables choir was set up by Dr Mary Mittleman from the NYU Langone School of Medicine to see if memory and cognition could improve with music. Research has shown that familiar music from the past can calm people with dementia and increase socialisation. ‘‘Musical Memories is a very important project where people from our community who may ordinarily be isolated are joined together in an inclusive environment through the joy of singing.”

Training is being provided for the volunteers and staff who assist with the choirs.

The ‘Communication and Dementia’ training programme aims to equip participants with a basic knowledge and competence to help people with dementia to partake in the activity and maximise their enjoyment. The programme is designed specifically for people supporting the Musical Memories choir, but the content is relevant to volunteers for other activities as well.

Bridget Doyle of the Living Well with Dementia Project added: “Living Well with Dementia is all about supporting people with dementia to continue doing the things they love in their own community in a safe and welcoming environment. As singing is a natural part of many people’s lives, either through choirs or simply enjoying songs from childhood or younger life, Musical Memories was established to meet the need for a community choir which is welcoming to people with dementia.”

The project is supported by the Alzheimer Society of Ireland and Sonas.

84 Health Matters

Commercial Feature

Centre for AdvanceD Medical Imaging A snapshot of the work at one of Ireland’s dedicated research Magnetic Resonance Imaging (MRI) scanners.

+ The CAMI team at St James' Hospital (left to right): Dr Danielle Byrne, Research Registrar, Dr Andrew Fagan, Medical Physicist; Mr Keith McGrath, Radiographer, Prof James Meany, CAMI Director, Dr Jason McMorrow, CAMI Programme Manager.

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pilepsy, prostate cancer and breast cancer patients are just some of the groups benefiting from the work of the Centre of Advanced Medical Imaging or CAMI, according to Professor James Meaney, the Director of CAMI. “The centre was established in 2007 with a grant from the Health Research Board. That grant allowed us to purchase a state-of-theart MRI scanner and to create a network of dedicated research and ancillary personnel who can support groups interested in using the MRI scanner for research projects. CAMI is currently the only 3 Tesla (3T) whole-body MRI scanner dedicated for research in Ireland at a hospital site.

“Our facilities are adjacent to the new Wellcome Trust – HRB clnical research facility at St James’s Hospital. We very much want to be an integral part of the clinical research activity on campus and provide a national state-of-the-art medical research imaging capability. This autumn

we carried out a number of upgrades to the scanner which completely modernised it, bringing it up to the standard of a new scanner. We have also just received a major imaging award from Science Foundation Ireland and the Wellcome Trust to purchase a dedicated ultrasound system. We will shortly be able to offer researchers the ability to do combined MRI and ultrasound studies at a single location.”

Dr Anne Cody, Head of Clinical and Applied Biomedical Research at the HRB agrees. “CAMI is a fundamental component of Ireland’s national clinical research infrastructure,” she says. “It complements the HRB investments in clinical research facilities and it provides the specialist equipment and expert personnel to support clinical imaging research to the highest international standards.”

“Some of the imaging challenges have been quite unusual,” says Dr Jason McMorrow, the Programme Manager at

CAMI. “We’ve had to be quite inventive on a number of projects over the years.

One particular study was on new-borns at risk of seizures. However, because it was a research project, it wasn’t ethical to administer sedatives to keep the baby still, as you might do if you were scanning them for a clinical reason. We had to use a specially designed foam mattress that pretty much envelops the baby and swaddles them tight, and therefore limits their movement.

The babies have a big feed and nappy change ahead of the scan, before being swaddled in this mattress. We do carry out more conventional procedures, but we like to think that we’re ready for anything.”

Biopsy Research Dr Andrew Fagan, a medical physicist based at CAMI and Trinity College Dublin, has been carrying out a number of studies on prostate cancer. “One particular project that we’ve been working on could eliminate

Health Matters 85

Commercial Feature the need for patients to undergo a biopsy when doctors are trying to determine whether a tumour is benign or malignant.

“The biopsy is a painful enough procedure in its own right and as with any biopsy, there is a finite risk that clinicians might miss their intended target. As a result, the patient gets an ‘all clear’ because the biopsy may have missed the malignant cells and hit normal ones. We have been working to develop an MRI technique that can accurately distinguish between healthy cells and malignant ones and which will give us a quantitative measurement of the size and extent of malignant cells.

“This information would be invaluable in determining the subsequent treatment direction for that individual patient. We think that we’re close to validating this technique, and we hope to publish our results fairly soon.

This is just one of a number of studies that we’ve been able to carry out which would have been impossible without a research scanner, and it has the potential to make a global impact on prostate cancer care’.

Epilepsy Research Dr Gianpiero Calaveri is a researcher based in the Royal College of Surgeons and has specialised in the area of epilepsy. “Epilepsy is the most common serious neurological disorder of young people. Recent data estimates that between 33,000 and 37,000 Irish people have the disorder. Brain imaging has emerged as a key diagnostic test in the evaluation of seizures. MRI scanning can detect lesions that cause epilepsy, in addition to structural brain abnormalities that

+ Anonymised MRI scan from CAMI research.

are linked to the condition.

“In our studies we have been trying to get a better understanding of the fundamental biology of epilepsy. We are trying to find features in, or changes to, brain structures and correlate them to genetic signatures in the population. If we can identify genes that are linked with epilepsy, then we can find out the proteins that they make. This opens the door to identify biomarkers for the condition and give us direction for the design of novel treatments. This type of research would be impossible without the HRB investment in a facility like CAMI,” he says.

“In addition to providing research opportunities, CAMI is making a very real and positive contribution to actual clinical care,” Dr Jason McMorrow adds. “The centre contributes one day per week to service provision, which has the benefit of integrating research radiography staff with the wider radiography team at the hospital.

It keeps the research team’s clinical skills up to date, and facilitates a culture of knowledge exchange from the research sphere out into the clinical domain. We also have an agreement with the National Epilepsy Care Programme where we carry out clinical scans on patients and as a result have contributed to eliminating patient backlogs and reducing waiting times for MRI scans.

“We plan to increase our radiography staff so that the centre can, in effect, double the number of research scanning slots it can provide. We have built very successful collaborations with research groups in all the major institutions and hospitals across

“The HRB has pursued a very deliberate and strategic approach to developing Ireland’s clinical research infrastructure that will support a strong clinical research ecosystem into the future” Dublin, including Beaumont Hospital, St Vincent’s, St Luke’s, UCD, DCU and RSCI. We are currently working on a study with NUI Galway and are looking to establish formal collaborations with investigators in Galway and Cork through working with the HRB-CRF Galway and HRB-CRF Cork.

“We feel that we making great strides towards becoming a key national infrastructure for medical imaging research and we would encourage anyone interested in conducting imaging research to get in touch, and we would be delighted to see how we could contribute to your project.”

See www.3tcentre.com.

According to the HRB's outgoing Chief Executive, Enda Connolly, “a vibrant clinical research system is necessary for a high-performing health service, and best international practice clearly demonstrates that embedding research at the core of services leads to better patient outcomes”.

“The HRB has pursued a very deliberate and strategic approach to developing Ireland’s clinical research infrastructure that will support a strong clinical research ecosystem into the future. Central to this is the ready availability of key research infrastructures and technologies, which are essential to underpin the delivery of new and enhanced treatments and therapies as well as creating capacity for Irish hospitals to absorb innovative approaches to care.”

All HRB grant calls are advertised on the HRB website at www.hrb.ie/grants and you can sign up to receive an e-mail alert every time a grant call goes live at www.hrb.ie/ about/rss-e-mail-alerts/

86 Health Matters

Mental Health

Dance Therapy Popular in North Cork Mental health professionals in north Cork are introducing dance movement therapy to their clients, writes Norma Deasy, Communications, who recently attended a 5 Rhythms dance workshop.

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arrived with a sense of trepidation at knowing no-one and being expected to dance with them for the day. I gradually gained a sense of ease as the music gently started and I quickly realised that there are no tricky dance steps to follow in the 5 Rhythms movement. Rather than trying to mimic the teacher, the dancers move entirely according to their own flow, choice of movement and self-expression.

The first stage of the 5 Rhythms is called Flowing. This gently awakened our senses and helped us to lose inhibitions as we simply walked in all directions around the room and said hello to those around us – without speaking. From there we continued for the day, taking in the other rhythms: Staccato – moving with more discipline in straight lines and having conversations, again without talking; Chaos, which one participant aptly described as “like being in New York with everyone walking in every direction”; Lyrical, where we took dance partners, danced as a group and connected with the other dancers; and ending the day on Stillness, a more meditative movement.

In January and October 2013, Eileen Murray, a mental health nurse at St Stephen's Hospital in Glanmire who has 10 years' dance therapy experience, organised Cathy Ryan, an internationally renowned 5 Rhythms dance therapy teacher, to run two workshops in October for clients and colleagues. As the workshop drew to a close and we talked as a group, the feedback was positive. One client said: “I wasn’t in great form in the morning coming here. I feel much better now after the day.” Another said she found it “very expressive, creative, an outside the box way of expressing one’s feeling rather than oneto-one therapy.”

Eileen herself has been holding weekly dance movement therapy sessions for the past 18 months with her clients throughout North Cork Mental Health Services (both in the inpatient and outpatient setting).

Wellbeing According to Eileen: “The benefits are self-evident, with clients reporting how it improves their sense of wellbeing, creates a sense of calmness and empowerment

+ North Cork-based mental health nurses (L-R) Geraldine Buckley, Frances Hodnett, Eileen Murray, Monica Cleary, Margaret Keohane and Nancy Mooring getting into the flow at the Mental Health Services dance therapy workshop.

and makes them feel more fully alive.

Clients go from being static to more fluid and less rigid. They become more connected with their physical body and this in turn takes the attention away from the thinking mind, which gives them a sense of both mental and emotional release.

“Dance therapy promotes autonomy, increases social activity and reduces illness burden in keeping with recovery-orientated principles within modern mental health service delivery.”

Nancy Mooring, Community Mental Health Nurse, reported that at the beginning of weekly dance movement sessions, clients would have used words such as tense, anxious, nervous, and afterwards relaxed, calm and content.

Mallow-based Margaret Keohane, Community Mental Health Nurse, said that she was “heartened to see some of her clients who normally don’t engage in group activities participating today”.

Consultant Psychiatrist Dr Ann Payne, who also participated in the workshop, said: “I certainly see the benefits in dance movement therapy. I think it would be a very useful adjunct for individuals who suffer from mental health issues from mild illness to severe and enduring mental health disorders.”

According to Operations Manager Gretta Crowley, “The therapeutic benefits to patients from dance therapy are recognised by both professional and managerial colleagues. I wish to acknowledge the pioneering and caring work of Eileen Murray and her colleagues for introducing this new patient-centered initiative in north Cork.”

For further information regarding dance movement therapy within the mental health services, contact eileen.murray@hse.ie.

Classes for the general public are run in Cork by qualified teacher Helen Bohan: hbohan@gmail.com.

88 Health Matters

Gardening

Mindfulness Gardening Gardens have always been thought of as a relaxing place to work. A ‘mindfulness’ garden can spark a sense of spirituality and life, writes John Sweeney, manager at Plantmarket.

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veryday life teaches us to focus on what we are doing in work, what needs doing at home, in the garden or just in life generally. As such, we end up accepting the popular belief that stress is caused by events, circumstances and mostly other people outside of our control.

This can encourage us to look outside of ourselves for the solutions, when in fact often what we need to do is look at our own inner resources to support our own wellbeing. Cultivating our mind just like our garden is one such way that we can alter our life by altering our attitude.

Creating your ‘mindfulness’ garden Zen is a specific arena of Buddhism which emphasises contemplation and meditation as ways of achieving self-knowledge.

A Zen garden can help you to live mindfully. To develop such a garden, start by identifying a favourite area within your garden that you identify with in some way.

It could be a sunny corner, your favourite plant, a nice view or your vegetable garden.

This can become the beginning of your ‘mindfulness’ garden.

As plants can hold a specific purpose in a Zen garden, you can select plants that have a special association or meaning to you. But aside from the natural elements of

www.thinkstockphotos.com/istock

What is mindfulness?

Mindfulness's origins are derived from the Buddhist practice of ‘living in the moment’. It is the practice of purposefully paying attention in the moment, in a nonjudgemental way.

The practice includes learning how to make time for oneself and learning how to slow down and nurture calmness and self-acceptance: purposefully allowing the body and mind to come to rest in the moment, no matter what is "on" your mind or how your body feels. Gardening brings to all of us the opportunity to pay attention, on purpose, in the present moment and without making judgments.

plants, some architectural elements can be added, such as pathways, bridges, lanterns, water (pond or stream): all of these are frequently found in a ‘Zen’ garden.

Irrespective of the size or type of gardening space you create, the focus for you is to create an area you can relate to.

The way we interpret external influences determines whether we are happy or sad, calm or distressed. Our interpretation is what we bring to the moment; it becomes our ‘presence’. The exercise of creating your ’mindfulness’ garden can create for you a space that allows you to slow down

and nurture calmness and self-acceptance.

Gardens have always been thought of as a relaxing place to work or observe.

Zen or mindfulness gardens go beyond the emotion of simple enjoyment. They allow us to create a sense of personal space, calmness and an opportunity to experience the ‘moment’. A mindfulness garden can spark a sense of spirituality and life.

Mindfulness: a lot like gardening Mindfulness is experiential, so the effort comes in the development of the practice.

Health Matters 89

Gardening

1. Mindful breathing The exercise is simply to identify the in-breath as in-breath and the out-breath as out-breath. When you breathe in, you know that this is your in-breath. When you breathe out, you are mindful that this is your out-breath breathing. The object of your mindfulness is your breath. This can be practiced while carrying out any garden function from grass cutting, planting or weeding to just sitting in your garden.

2. Concentration Follow your breath from the beginning to the end. From the beginning of my out-breath to the end of my out-breath, my mind is always with it. Mindfulness becomes uninterrupted, and the quality of your concentration is improved.

3. Awareness of Your Body The third exercise is to become aware of your body as you are breathing. In the first exercise, you became aware of your in-breath and your out-breath. Because you have now generated the energy of mindfulness through mindful breathing, you can use that energy to recognise your body. “Breathing in, I am aware of my body. Breathing out, I am aware of my body.” I know my body, this brings the mind wholly back to the body. Mind and body become one reality. When your mind is with your body, you are well-established in the here and the now and you are fully alive.

www.thinkstockphotos.com/istock

First, you have to clear the weeds and prepare the ground. Meditation has many meanings but the root, the actual literal meaning in Sanskrit, is ‘to cultivate’, to become familiar with something, to become familiar with a new way of being, with new qualities, with a perception of the world which is more attuned with reality.

It is something that needs to be trained and practised; otherwise the mind will continue to run all over the place. First you have to see and clear the various barriers that are in the way. Pull them out by the root so they don’t come back, and then you prepare the ground by giving the mind training and discipline. Then you sow the seed and harvest crops of calm, clarity, self-awareness and compassion.

There are five steps to mindfulness according to renowned Vietnamese Zen Buddhist monk Thich Nhat Hanh.

4. Releasing Tension The next exercise is to release the tension in the body. When you are truly aware of your body, you may notice there is some tension and pain in your body; some stress.

In a sitting, lying, or standing position, it’s always possible to release the tension. So next time you’re weeding in the garden you might like to sit back and practise the fourth exercise: “Breathing in, I’m aware of my body. Breathing out, I release the tension in my body.” Peace is possible at that moment, and it can be practised many times a day, while you are cutting the grass, digging, planting or just being mindful in your garden.

5. Walking Meditation When you practice mindful breathing, you simply allow your in-breath to take place. You become aware of it and enjoy its effortlessness. The same thing is true with mindful walking. You don’t have to make any effort during walking meditation, because it is enjoyable. You are there, body and mind together. You are fully alive, fully present in the here and the now. With every step, you touch the wonders of life that are in you and around you, especially in the garden.

Challenges of life Often, when we are busy or under pressure, we give up the things that replenish us, the

fun stuff, meditation, exercise, rest and relaxation. We put our heads down and try to get more done until we are increasingly depleted and unable to deal with the challenges of life. Perhaps we should make a list of our daily activities – ask ourselves: what increases our sense of being alive and present rather than just existing? This way we can be more mindful of what we actually do with our time from one moment to the next. By being present in more of our moments and making mindful decisions about what we really need in each of those moments, mindfulness becomes a lived reality.

The garden with its many wonders affords us the opportunity to practise and experience mindfulness, by living in the moment and being non-judgemental.

Plantmarket Plantmarket is one of 22 services provided by the HSE’s EVE network, which offers a range of community based training and work services for people with mental health difficulties in Dublin, Wicklow and Kildare. Plantmarket Garden and Training Centre is located at Blake’s Cross near Lusk in north Dublin and is open to the public on weekdays from 9am to 4.30pm (Monday-Thursday) and from 9am-3.30pm (Friday).

90 Health Matters

COMMUNITY GAMES

Bonner on side with health GOALS The HSE and Community Games with the help of former international footballer Packie Bonner have announced the 2013 Healthy Events Award winners.

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he winners represent the counties of Longford, Kerry and Kilkenny and include Ardagh/Moydow/Glen in Co Longford, who were awarded first place; Duagh/Lyre in Co Kerry, who came in second place; and Lisdowney/Ballyragget in Co Kilkenny, were placed third.

Speaking at the event in October, Packie Bonner said: “I am delighted to be here to personally congratulate the HSE Community Games Areas who are finalists in the inaugural Healthy Events Award. These Areas have achieved their goals and made a real and significant effort in encouraging healthy lifestyles within their communities. It is great to see the HSE and the Community Games working together with a common ethos of health and wellbeing for all. We can all make small changes to our lifestyle which will benefit our health and this is why the Healthy Events Award is having such a positive influence.”

Over 50 Areas entered the inaugural HSE Awards, which are designed to encourage Community Games organisers, volunteers, parents and participants to think about the way events are run in their communities and to try to make them more health promoting in the Areas of sun safety, physical activity, nutrition, substance misuse and mental health. The winning Areas were able to successfully demonstrate the effectiveness of their efforts in terms of the sustainability of the initiative and the potential long-term impacts of promoting health in their communities.

Creative and fun The winners adopted creative and fun ways to promote health awareness and encourage parents and children to make small changes for long-term health benefits. HSE Health Promotion staff and community dieticians provided support and information to help Areas organise more health promoting events.

The events organised included regular talks

+ In with Irish goalkeeping legend Packie Bonner were (L-R): Aoibhinn Harte, Duagh-Lyre, Co Kerry; Niamh Holohan, Lisdowney, Co Kilkenny and Brendan Finnan, Ardagh/Moydow/Glen, Co Longford.

on topics including healthy eating and positive mental health, poster competitions focusing on health messaging, table quizzes, and sporting activities where healthy food options were provided and sweets and fizzy drinks banned.

The Areas worked with local schools and developed relationships with the local media to highlight the work being carried out at their events. This has helped to promote the benefits of being more health aware to the wider community.

Leslie Finan, representing Ardagh/ Moydow/Glen in Longford, the overall winner of the Healthy Events Award, said: “The Healthy Events Award have made us think about the health and the lifestyle choices we make. We conducted a lunchbox survey and found that only 60 of the 102 students surveyed had a piece of fruit. This was a real eye-opener. We no longer provide fizzy drinks, crisps and sweets at any of our events and while that has been a difficult transition, now the children are enjoying fruit and open to tasting different, nutritious snacks. If anything the Healthy Events Award has introduced a whole new way of thinking, planning and enjoying our work as volunteers. This can only benefit the children.”

According to Dr Stephanie O’Keeffe, HSE National Director, Health and Wellbeing, “The Community Games participants and volunteers throughout the country are proving to be the ideal advocates for healthy living.

We are already seeing the positive effect this initiative is having on the Areas involved in terms of their awareness of the benefits of health and wellbeing and the adoption of simple measures such as restricting sweets and fizzy drinks at local events.

"But, with one in four of our children either overweight or obese we must ensure that our children get the best start in life. If we can help parents to make the better choices now, this can really make a difference in the long term,” she added.

Gerry Davenport, President of the Community Games said: “Congratulations to all the Areas who took part in this award, especially to the three finalists representing Longford, Kilkenny and Kerry. The Healthy Events Award is about acknowledging the hard work of all Areas over the last 12 months. In the first year of this initiative we have seen how influential we can be to promote health in our communities.”

For more information see www.communitygames.ie

Health Matters 91

GP REFERRAL

HSE introduces electronic GP referral system The HSE has introduced an electronic referral system for GPs referring public patients for outpatient hospital appointments, with the Mercy University Hospital being the first to introduce it in Ireland. The general referral form that the GPs will use is suitable for referring patients to all public outpatient clinics.

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n January, a number of Cork-based GPs began to refer public patients electronically into the cardiology, respiratory and vascular specialties at the Mercy University Hospital.

By the end of July, over 250 electronic referrals had been received and the process was opened up to all specialties in the hospital and all GPs in the catchment area.

The project then extended to Mallow General Hospital and to paediatric specialties in Tallaght Hospital. By November 2013, the three hospitals combined had received over 800 electronic referrals and Cork University Hospital started to accept electronic referrals. It is expected that the remaining three pilot hospitals (South Infirmary Victoria University Hospital, Bantry General Hospital and Kerry General Hospital) will have electronic referral available by mid-2014.

The purpose of the pilot project is to establish an electronic referral pathway for public outpatient hospital appointments between GPs and the seven pilot hospitals.

Healthlink, an electronics communications project which facilitates the transfer of information between primary and secondary care in Ireland, provides a webbased messaging service that securely transmits the electronic referral from a GP to the hospital. The GP receives an acknowledgement of receipt of the referral.

Considerable work has been done at pilot site hospitals to centralise and standardise the management of all outpatient referrals.

This ensures that each electronic referral received at the hospital generates an electronic response to the GP within seven days detailing if the patient has been listed for an urgent or a routine appointment and the appointment date, if it is available.

Dr Tom Molloy, a Charleville-based GP, started using the electronic system the minute it became available. “I just began using it and have found it very straightforward and self explanatory,” he

+ Members of the GP Electronic Referral Project Team. Front, L-R: Professor Richard Greene, Professor of Obstetrics and Gynaecology, Cork University Maternity Hospital; Joyce Healy, Project Manager; Mary Twohig and Tracey Martin, Mercy University Hospital, Cork. Back, L-R: Norma Deasy, HSE South Communications; Graham Murphy and Breda O’Riordan, South Infirmary Victoria University Hospital, Cork.

says. “It is an excellent system that I am totally satisfied with – a vast improvement on the old paper referrals system.

“There are numerous benefits to be reaped from using the system, including ease of use, the referral is rapid and made during the patient’s consultation, the GPs get an acknowledgment that the referral has been received and is being handled and there is a permanent record made of the referral.

“I would encourage all GPs to start using the system and am sure that once they start they won’t look back; it’s a great benefit to our practice and certainly improves patient care.”

The system is designed in such a way that it can be rolled out nationally to all GPs and acute hospitals. When fully operational, all outpatient referrals will be managed using a standardised approach, which will improve the overall patient experience by improving access to outpatient appointments, reducing duplication and delays and providing a much more efficient system. The system also provides a faster and easier access to a consultant opinion as electronic referrals are

+ The Out Patients Department (OPD) team at the Mercy University Hospital, Cork.

Sitting: Helen Meaney.

Standing, L-R: Rasif Kamal, Sheila O’Brien, Ann O’Regan (Clerical OPD Supervisor) and Geraldine McCarthy.

transmitted to the hospital immediately.

The introduction of this pilot project is based on HIQA’s general referral form for certain cancers and has been informed by the NCCP, Healthlink, the National General Practice IT Group, ICGP and the HSE’s ICT Department.

Throughout the project there has been extensive engagement with multiple stakeholders including GPs, consultants, unions, referral administrative staff and patients to ensure that the system is accessible, transparent, measurable and sustainable.

92 Health Matters

Your Stories

Me and My Job Billy Burke has been the gardener at Dr Steevens’ Hospital in Dublin 8 since 2000. He talks to Health Matters about his two passions in life: gardening and golfing. carpark means that it’s highly visible to motorists, pedestrians and staff,” he says. Liscannor stone was used to build the circular structure and was filled with approximately 20 tonnes of topsoil and compost. The initial planting theme used summer and winter bedding plants. All in all, it took three months to be designed, built and planted.

+ Billy Burke, gardener at Dr Steevens' Hospital.

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illy Burke has been working since he was ten years of age, when he used to caddy at Newlands Golf Club. “When I was 15 I was asked to work on the golf course during my summer holidays. I liked it so much there I agreed and over the next nine and a half years I worked my way up to assistant greenkeeper,” explains Billy. It was during this time that Billy developed his love for golf and played off a handicap of eight, and also honed his gardening skills.

Billy joined the gardening section of St Brendan’s Hospital, Rathdown Road in the early 1980s. Following a request for some gardening work at Dr Steevens’ Hospital

by Philip Doyle, the estate manager, Billy was asked to stay on and fill the

position as gardener. One of Billy’s jobs has been to develop a feature to display the HSE logo. For design inspiration, Billy met with the resort superintendent at the K Club in Co Kildare, Gerry Byrne, who is responsible for maintaining two championship golf courses where the Ryder Cup has been held.

In consultation with bricklayers Jimmy and Mark from St Brendan’s, Billy designed a pattern which included an elevated yet slanted structure to ensure maximum visibility. “I chose to position the structure near the security hut for safety reasons.

I felt if it was in the middle of the lawn, kids could potentially climb up on it. Also, its prominent position near the road and

The HSE Logo Subsequently, the landscaping design was updated using the HSE logo. Billy had help from two colleagues, Garry and Paddy from Cherry Orchard Hospital, who used stakes and twine to create a frame in the shape of the HSE logo. Billy explains: “All in all, to change over the design to the HSE logo, it took three years of regular feeding and pruning for the box hedging plants to fill out to create the shape of the HSE logo.” To finish off the design, a sheet of heavy plastic was used to suppress weeds and a layer of brown and white pebbles was added as a contrast to the green box hedging. “It was very strenuous and took great patience but it paid off.”

The inner courtyard at Dr Steevens’ Hospital is laid out in a formal lawn and according to Billy it is the focal part of the building. “I’ve great interest in the courtyard; when visitors arrive I want them to see the lawn looking its best so that it will catch people’s eye,” says Billy. Accordingly, Billy approached Ceara Cowap and Tony Nolan from HSE Estates with a programme of work in spring 2013 to improve the lawn, which included using weedkiller, fertiliser and regular mowing.

“I’m starting to see the results of my programme now and staff and visitors have commended me, which is music to my ears.” Billy has high praise for his colleague Willie Daly, who provides backup if he ever needs a hand. As for future plans, Billy says he takes great pride in his work and wants to continue on what he is doing: “If something needs to be improved, I’ll improve it,” he says.

Health Matters 93

BREASTFEEDING

Every Breastfeed Makes a Difference Five out of every 10 babies born in Ireland are being breastfed upon leaving hospital. This compares with eight out of every 10 in the UK.

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cross Europe, on average nine out of every 10 babies born are breastfed, with almost all babies born in Norway, Denmark and Sweden being breastfed. By three months, four in 10 babies in Ireland are breastfed.

In a bid to help increase the number of mothers who begin breastfeeding, the HSE recently launched a number of new breastfeeding support materials including new posters and an updated information leaflet: Breastfeeding – A Good Start In Life.

Digital HSE breastfeeding support ads targeting new mums have also been running. New mothers will receive the new booklet from their public health nurse. The new posters are available to order from www.healthpromotion.ie.

All of the new materials carry the message ‘Every Breastfeed Makes a Difference’. The new key messages on the breastfeeding support materials are designed to be supportive, positive, empowering and non-judgemental. They also aim to drive more breastfeeding mothers to the supportive information on the website www.breastfeeding.ie and to the local support groups listed there.

Health Protecting Breastfeeding protects the health of babies and their mothers and it is important for healthy growth and development. It gives babies all the nutrients they need for the first six months of life and protects them against infection and disease.

Children who are not breastfed are more likely to develop: • ear, nose and throat infections • gastroenteritis, kidney and chest infections • asthma • obesity and diabetes Impact of breastfeeding Breastfeeding is important for the health of

+ Pictured at a breastfeeding support group meeting in Lusk, north county Dublin were (L-R): Emma Lericque with son Colin, Suzanne Webb with daughter Lucy Niland, Karolina McKittrick and son Jack, Anna Clarke with Jeremiah, Michelle Cannon with Leah-Joy and Aine Conneff with Oisin at Lusk Community Centre.

children and mothers, with every breastfeed making a difference. The first few days of breastfeeding provide antibodies that give natural immunity and protect the baby from infection. Colostrum contains nutrients and large amounts of antibodies to protect against infections. It is extremely easy to digest and protects baby’s digestive system.

Breastfeeding, for the first two weeks, helps mums and baby to bond and establish feeding. Breast milk changes to meet the baby’s needs and to provide all its nutrients. It protects the baby’s digestive system and contains unique components which aid the immune system and protect from infection.

There is a direct correlation between the duration of breastfeeding and protection against many illnesses and infections, with greater protection provided the longer a mother breastfeeds.

Breastfeeding for the first month, for example, reduces the risk of respiratory tract infections by 27 per cent, with every

extra month of breastfeeding further reducing risk of illness from infections.

Any breastfeeding helps to reduce the risk of ear infection by 23 per cent, with a risk reduction of 50 per cent if breastfeeding continues for three months. Breastfeeding is associated with a 36 per cent reduction in risk of SIDS, compared to not breastfeeding.

Breastfeeding Goals Speaking to a group of breastfeeding mothers at a breastfeeding support group in Lusk, Co Dublin just before National Breastfeeding Week in October, the HSE’s National Breastfeeding Co-ordinator Siobhan Hourigan emphasised the importance of support groups for breastfeeding mums.

“We know that breastfeeding is important for the health of children and mothers, with every breastfeed making a difference,” she said. “But every breastfeed also brings a mum closer to her personal breastfeeding goals.

94 Health Matters

BREASTFEEDING “Many Irish mothers do not reach their breastfeeding goals and stop breastfeeding sooner than planned. We know support can help mums to breastfeed for longer. There are nearly 200 support groups throughout the country and contact details are available on www.breastfeeding.ie. ‘‘I would encourage mums to try to breastfeed as long as you can. It helps to link with supports, to find out what to expect and to get help if you need it.’’

Helpful tips from mums Speaking at a weekly breastfeeding support group in Lusk Community Centre in north County Dublin, first-time mum Aine Conneff, who attends the weekly group with baby Oisin (five months) said: “When I started out I said I’d do it for the first couple of months; now I don’t want to stop.

“Breastfeeding is convenient: no matter where you are you can feed. I found the first week tough. I got a lot of support at home, from my mum and my husband. I didn’t have to do any of the changing or cooking.

All I had to do was spend time with Oisin and feed him. The midwives and my public health nurse were really encouraging. After five or six days everything started to click.

Every breastfeed is good for his health and helps him develop. I’ve been coming here every week since he was a week and a half old and now I can share what I learned.’’

Support groups are led by public health nurses, lactation consultants, Cuidiu breastfeeding counsellors and La Leche League leaders. Women can attend for support and the opportunity to meet other mothers. Mothers have the expertise of a health professional, counsellor or leader at hand to help them if they are experiencing any breastfeeding challenges.

Mums Nicola Browne, Sandra O’Connor and Aine Conneff from the Lusk area who also attend the weekly breastfeeding support group in Lusk share some of their helpful breastfeeding tips in video clips on the HSE website www.breastfeeding.ie.

Mum of three Nicola Browne attended the support group with baby Andrew (22 weeks) and Ben (2). When her four-year-old Lauren was a baby she said she felt pressure from others to stop breastfeeding.

She explained: “I’ll feed as long as Andrew wants to feed. I would say to other mums not to feel under pressure to give up and change to a bottle. Feed as long as you can. Every feed is a good feed. Going to the group helped and I made great friends.

Just talking about things like night feeds, you find other mums are going through the same thing and you get lots of tips on things like weaning onto solids.’’

The Department of Health and HSE recommend exclusive breastfeeding of infants for the first six months, after which mothers are recommended to continue to breastfeed as solid foods are introduced for up to two years or beyond.

Baby Friendly Hospital Awards Award ceremonies took place in September at Our Lady of Lourdes Hospital Drogheda and Cavan Monaghan Hospital, where the hospitals were designated as baby friendly hospitals. All maternity hospitals and

units in Ireland participate in the WHO/ UNICEF Baby Friendly Hospital Initiative (BFHI) and are working towards achieving the award, which has been received by eight hospitals to date.

Peter Power, Executive Director, UNICEF Ireland congratulated Our Lady of Lourdes and Cavan Monaghan Hospitals on being designated baby friendly hospitals and said: “BFHI’s quality initiatives genuinely serve to make a lasting difference in the life of a child.”

Presenting the awards, Dr Genevieve Becker, National Co-ordinator for the BFHI said: “A baby, in Ireland, is more likely to start breastfeeding and to leave hospital breastfeeding when born in one of the eight hospitals which are meeting the international standards and designated as a baby friendly hospital. Supporting mothers is about helping all mothers to feed their baby the way they want to, and so mothers don’t stop breastfeeding when they want to continue.’’

Support groups For mums at home with newborns, a public health nurse will visit soon after they come home from the maternity hospital. Mums can also ring the public health nurse or the maternity hospital if they have concerns.

Voluntary breastfeeding organisations, La Leche League and Cuidiu also offer telephone support.

Breastfeeding support groups are provided by HSE Public Health Nurses, La Leche League and Cuidiu – the Irish Childbirth Trust around the country. Women can attend for support and the opportunity to meet other mothers. Other health professionals including midwives, GPs, practice nurses and dieticians also provide one-to-one information and support. For details of support in your county log on to www.breastfeeding.ie or call the HSE Infoline: 1850 24 1850.

Breastfeeding support is also provided by voluntary organisations such as La Leche League (www.lalecheleagueireland.com), Cuidiú – Irish Childbirth Trust (www.cuidiu.ie) and Friends of Breastfeeding (www.friendsofbreastfeeding.ie).

car & home insurance now even easier with AXA EasiPay EasiPay allows many health care employees to pay their motor and home insurance premium directly from their salary over 10 months at no extra cost.

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You can also get up to 10% discount on your motor insurance and free 24 hour breakdown assistance (€317 minimum premium applies).

AXA customers can also save money on DIY, car accessories and lots more. Go to axaplus.ie for more information.

For more information and to find out if your employer is part of the EasiPay scheme drop into your local AXA Insurance branch or call us on 1890 600 600

redefining

standards

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96 Health Matters

Mental Health

Making a case: the arts in mental health Mary Dineen, Community Mental Health nurse and chair of Arts + Minds, argues for the integration of arts programmes into mental health services.

I

n an era of austerity, a participatory arts programme as an integral part of the mental health services would appear to be an unaffordable luxury. I am a community mental health nurse and chair of Arts + Minds, a Cork-based programme that aims to enhance the health and wellbeing of mental health service users through engagement with the arts. I would argue that arts programming can be justified within the context of current government policy on mental health and that persuasive arguments can be made that the arts in mental healthcare are an effective tool in the recovery process.

I work in an area of Cork city that includes areas of high social deprivation. Many service users in my care live alone in poor circumstances. They have limited social networks and have little or no contact with the community in which they live. They experience a high degree of social isolation and have little stimulation in their lives apart from television.

I have a strong personal interest in the arts and a firm belief in their invaluable contribution to our lives. As the late American poet Jayne Cortez said: “The arts are just a part of the weapons…of life.” An encounter with arts consultant Ann O’Connor at an information day during the 2005 Cork City of Culture, showcasing innovative music workshops in two mental health facilities, piqued my interest in introducing service users to high-quality arts experiences. I hoped that this would have the two-fold effect of improving the quality of life of service users and facilitating their social inclusion.

As a result of this meeting a steering group was formed. This group became Arts + Minds and what began as a series of music workshops has expanded to include sessions on dance, creative writing, animation, storytelling, visual art and choral singing.

Healthcare staff are hands-on. We liaise with participants, book artists and venues, research ideas for new programmes, manage

+ Mary Dineen

funding and are active participants in the workshops. This makes the service user/staff relationship more equal.

Irish mental health policy is guided by the 2006 Department of Health report on the mental health services, A Vision for Change. The report recommends that a recovery approach to mental health be adopted as a cornerstone of the policy: “While recovery does not necessarily imply a cure, it does suggest that the individual can live a productive and meaningful life

despite vulnerabilities that may persist.” The report raises concerns about the effects of social exclusion as experienced by mental health service users and recommends that community and personal development initiatives which impact positively on mental health status should be supported.

The inclusion of an arts programme as part of mental health care sits comfortably within the context of Irish mental health policy. It is a cost-effective measure with proven capacity to enhance the lives of service users. Staff say it has changed their relationships with service users for the better and has improved the healthcare working environment. As Arts + Mind’s Beyond Diagnosis report concludes on the integration of the arts into mental health care, “[it requires] a cultural shift in the way we understand, respond to and engage with human distress. This is a shift towards embracing creativity of expression, nurturing strengths and facilitating service user care choices, both inside and outside mental health structures.”

This article was first commissioned by artsandhealth.ie. To read the full article and more arts and health perspectives see www. artsandhealth.ie/perspectives.

Health Matters 97

in brief // News

Physiotherapists' Society Celebrates 30 Years The Irish Society of Chartered Physiotherapists (ISCP), the professional body representing chartered physiotherapists in Ireland, is celebrating 30 years this year.

The society’s foundation in 1983 coincided with the establishment of the first physiotherapy degree course in Trinity College Dublin (TCD) and University College Dublin (UCD). Since then, the ISCP has seen its membership grow from under 500 to 3,200 members.

The number of Irish physiotherapy schools has doubled from two to four, offering degrees at both primary and master's levels. The schools are located in TCD, UCD, the Royal College of Surgeons and the University of Limerick.

One quarter of the ISCP’s current members are male and private practitioners now make up one third of the society’s membership, compared to 1983 when the vast majority of physiotherapists were female and worked in hospitals.

As part of the 30th anniversary celebrations at TCD, nine ISCP members were awarded with the society’s most prestigious specialist members' award (SMISCP) in the areas of women’s health and continence, gerontology, musculoskeletal, occupational health

+ As part of the recent 30th anniversary celebrations, nine prizes were awarded to students of the four Irish physiotherapy schools. Pictured (L-R) are three of the winners: Catherine Sadlier (RCSI), Jill Long (President, ISCP), Eadaoin O'Hanlon (UL) and Catherine Quinn (TCD).

and ergonomics and sports medicine.

In addition, nine further prizes were awarded to students of the four Irish physiotherapy schools, five for research (student research prize) and a further four for clinical assessment in their final year (Anne O’Brien prize).

KILKENNY WOMAN WINS DIETITIAN OF THE YEAR AWARD Margaret O’Neill, a native of Callan, Co Kilkenny, has just won the Irish Nutrition and Dietetic Institute (INDI) Dietitian of the Year 2013 Award. Margaret joined the Health Promotion Department of the HSE, where she established the community dietetic services in Dublin. She also has developed and delivers a nutrition health promotion service in the community in the Dublin south central and Dublin south west/Kildare/west Wicklow areas.

“Being presented with the award of INDI Dietitian of the Year was a real honour for me,” she said. “It also has made me stop and reflect on what we, as an organisation and individual dietitians working with the HSE in community have achieved over the past few years in improving people's nutritional health… the award will take pride of place at home. It's great for my four children to see that what you do is really valued and it's fantastic to have that acknowledged by the INDI.”

98 Health Matters

YOUR STORIES

SPORTING pASSIONS HSE staff officer Gerard Gilroy took part in the World Dwarf Games in Michigan, USA, in the summer of 2013.

He shares his experiences with Health Matters.

I

work with the HSE in the Physical and Sensory Disability Service, Sligo/Leitrim/ West Cavan and have the disability acceptably known as dwarfism, or achondroplasia in my own case. I have always loved participating in and attending sporting events. As part of Team Ireland, I attended my second World Dwarf Games in the summer of 2013 in Michigan State University (MSU) in the USA. I also had the honour of being Team Ireland’s co-flag bearer with 11 year-old Nicole Turner from Portlaoise at the opening ceremony. Some 395 athletes from 17 countries took part, 13 from Ireland, making this event the largest ever of its kind.

It’s a four-hour train journey from Chicago to East Lansing, Michigan, where MSU is located. It has over 45,000 students and a faculty of 3,700. The level of facilities on the campus at our disposal was impressive compared to what we have in Europe, not to mind Ireland. The Spartans (as the college teams are known) have a stadium for American football with a capacity of 95,000, while the ice hockey and basketball

+ HSE staff officer Gerard Gilroy.

arenas can facilitate over 5,000 indoor spectators.

My events were discus, shot putt, javelin, badminton, table tennis and archery. Along with other athletes from Europe and Ireland, I was part of Team Europe in soccer and volleyball. Team Europe also had teams in basketball and floor hockey. I managed to

“My abiding memory was the intensity of competition involved and forgetting that we are all dwarf athletes. Typical of this was watching the determined efforts of my friend Niall win his world title in badminton.”

win silver in discus, silver in shot putt, silver in badminton singles, silver in badminton men’s doubles and a bronze in archery.

Team Ireland won 16 gold, 11 silver and 10 bronze medals; some 37 medals in total in sports from boccia to power lifting. We finished in fifth position in the medal count behind the US, Great Britain, Australia and Canada.

New-found Friendships Personal memories from the games include all the new-found friendships. This includes people I would have being competing against. We exchanged wrist bands, badges and so on as mementoes. Being part of Team Europe was extra special and life-long friendships are assured.

As with all get-togethers associated with dwarfism or disability, the World Dwarf Games was an opportunity to share and empathise in everyday issues associated with being a dwarf. My abiding memory was the intensity of competition involved and forgetting that we are all dwarf athletes.

Typical of this was watching the determined efforts of my friend Niall win his world title in badminton; the irony of him still managing to inspire me and he being years younger than me.

I’d like to think my taking part has done something to encourage younger dwarves in Ireland to take up sport as a means of integrating and making new friends. I’ve realised too that the term ‘dwarf’ is accepted as a definition of our disability the world over.

Finally, like I said at the beginning, I’ve always had an interest in sport, and grew up basically fantasising about representing Ireland one day in any sport. My greatest pride was wearing the green of Ireland, seeing it been worn by my team mates, decking out our apartments in the tri-colour, cheering on or being cheered on, seeing the logo of DSAI (Dwarf Sports Association of Ireland) around the campus, and knowing I was part of Team Ireland in the World Dwarf Games 2013.

Health Matters 99

in brief // News

Mental Health Nursing Conference Outlines Progress The Office of the Nursing Service in the HSE hosted a national mental health conference in Dublin Castle on November 5th. The conference, which was launched

by Minister Kathleen Lynch TD, outlined progress achieved in the implementation of the HSE’s national nursing strategy for mental health nursing: A Vision for Psychiatric/Mental Health Nursing – A Shared Journey for Mental Health Care in Ireland.

The strategy, which was published in 2012, is the first mental health nursing strategy for Ireland and is applicable to all age groups. It was developed following extensive engagement, collaboration and consultation with key stakeholders, service users, carers and agencies nationally and clearly identifies the goals and the conditions required in order to achieve a contemporary recovery-orientated mental health service fit for purpose.

Irish and international speakers highlighted the essential requirement of

+ Professor Agnes Higgins, Head of School of Nursing and Midwifery, Trinity College Dublin; Dr. Michael Shannon, Nursing and Midwifery Services Director (HSE); Minister Kathleen Lynch TD, Minister with Responsibility for Mental Health; Martin Rogan, Assistant National Director (Mental Health); Eithne Cusack, ONMSD National Lead for Mental Health Nursing; and Patricia Gilheaney; Chief Executive, Mental Health Commission.

engagement and partnership working with service users and family members from a value base of collaboration, equality and respect of diversity, autonomy and rights.

Conference programmes and copies of

Review of Rialto Community Health Projects Alex White TD, Minister of State for Primary Care, has launched the Review of Rialto Community Health Projects 2011-2012. The health projects aim to tackle the high levels of ill health within the Rialto area. Health workers communicate with local residents to identify health issues and develop programmes in response to local residents needs. Partnership is a key element of the Rialto Community Health Projects with partnership working between the local community, local primary care teams, GPs, Dublin City Council, neighbouring community initiatives and the HSE Health Promotion DML team.

The Rialto Community Health Projects address health issues in a variety of ways including parenting programmes, physical activity, cooking and nutrition, a men’s health social group, counselling services and stress, well-being programmes. The review was carried out by the discipline of + L-R: pictured at the Review of Rialto Community Health occupational therapy, Trinity Projects 2011-2012: Marion Regan, Senior Health Promotion College Dublin, to give an Officer, Health Promotion Tallaght, DML; Gillian Farrelly, Primary insight into the work taking Care Manager, Dublin South Central, Liberties Primary Care Unit; place in the Rialto Community Alex White TD, Minister of State for Primary Care and Fergal Fox Interim Lead for Health Promotion, DML. Health Projects.

the conference presentations are available from the Nursing and Midwifery Planning and Development Unit, Balheary Road, Swords, Co Dublin, lorna.byrne@hse.ie or (01) 813 1810.

Stroke conference: date for your diary A conference on stroke rehabilitation and recovery will take place on February 28th in Maryborough House Hotel, Cork. The conference will be of interest to medical, nursing and allied health professionals with an interest in stroke rehabilitation and recovery. The topics covered include: communications disorder/ aphasia, visual deficits, dystonia and spasticity, post-stroke depression and neuropsychology. Professor Joe Harbison and Dr Valerie Twomey are two of the proposed speakers for the conference.

The conference is organised by HSE South in partnership with the Cork Stroke Support Group.

For further information and to book your place please contact Irene Walsh on 021 492 3270 or email irene. walsh@hse.ie

100 Health Matters

Children

Paediatric Massage: Essential Touch for Children Massage can be of particular benefit to children, writes Tina Allen.

M

assage is beneficial to almost anyone, but children in particular have an essential need for touch. Touch stimulates our brains in many ways, most noticeably in our limbic cortex, which is the area of the brain that allows us to generate emotions and to make connection with others. In children, touch not only furthers growth and development: it is biologically necessary for their survival, and can be a vital source of healing and healthy development.

The Benefits of Starting Young Sleeping through the night may not seem like a very big feat for most, but for children this full night's rest can aid in the healing process, as well as create the optimal time for the largest percentage of their healthy growth to take place. Paediatric massage has been found to have many benefits,

including aiding children in falling asleep quicker, deeper and for longer.

Research has suggested that massage therapy can ease both physical symptoms and those associated with paediatric medical conditions. Studies have shown that pain, anxiety and depression can be minimised.

This gentle touch therapy also provides relief from chronic conditions such as asthma, nausea, constipation and muscle aches.

Immediately after receiving massage, children with juvenile rheumatoid arthritis notice decreased anxiety and stress hormone levels. For children with autism spectrum disorders, those who have difficulties with verbal language acquisition, eye-contact and tactile aversions, evidence suggests that the application of touch therapy may be very effective. After massage, children appear to relax more quickly and focus with greater success.

+ Tina Allen demonstrates paediatric massage therapy with her son Otis.

An Increased Need Providing touch therapy is within the scope of practice of many health care providers including physicians, nurses, physical therapists and occupational therapists.

However, massage is not frequently practiced by these practitioners because of time constraints or lack of comfort.

Unfortunately, not all healthcare facilities have the services of those trained in paediatric massage. There is an increasing need for more practitioners with specialised experience in paediatric massage therapy.

Inside the Healthcare Setting Massage therapy can enhance a childâ&#x20AC;&#x2122;s hospital experience and allow for healing. It can provide comfort for families, as no other procedures will occur during a massage.

The number of children receiving a variety of CAM (complementary alternative medicine) therapies is growing internationally, as more healthcare practitioners become educated in the area and parents read the research findings advocating for these services. For the healthcare professional or parent inspired to practise paediatric massage, there are many considerations to prepare for when providing age-specific and developmentally appropriate therapy. Further training is required to feel fully confident providing paediatric massage.

At Home Not only may healthcare providers use massage therapy, so can parents who learn techniques that make huge impacts on their childâ&#x20AC;&#x2122;s health. Many caregivers use nurturing touch in their day-to-day lives, but having an understanding of specific techniques and their uses can provide a valuable resource when your child has growing pains, exam anxiety or falling asleep at night.

Children who benefit from receiving healthy touch are often more giving of gentle touch to their family members and peers. In the current healthcare climate, it is more important than ever to add nurturing and compassion back into the care of our children.

Tina Allen is the founder and director of the Liddle Kidz Foundation. She is an international author, lecturer and authority on infant and paediatric massage therapy.

She will present paediatric massage and touch therapy for autism spectrum disorders courses at Golden Egg Holistic Centre in Glenfield, Portlaoise, Co Laois in June 2014.

Contact her at info@liddlekidz.com or see www.LiddleKidz.com.

Health Matters 101

National Ambulance Service

Ambulance Service Reform A significant reform programme has been under way in recent years in pre-hospital care services across the country, writes Martin Dunne, Director, National Ambulance Service (NAS).

I

have been in the ambulance service for 26 years, having begun my career in the former North Eastern Health Board. In 1998 I moved to the Eastern Region Ambulance Service and in January 2011 I became Area Operations Manager for the newly formed North Leinster area.

While I have seen considerable change and development in the service during that time, additional change is required in order to address our ongoing challenges such as response times, elimination of on-call working arrangements and the progression of the National Ambulance Service Control Centre Reconfiguration Project.

The NAS plays a significant part in the acute coronary syndrome element of the HSE National Clinical Care Programme.

NAS advanced paramedics are now transporting heart attack or patients with s-t elevation myocardial infarctions (STEMI) directly to cardiac catheterisation centres

for definitive treatment.

The National Ambulance Service is moving towards the development of a clinically driven, nationally co-ordinated system, supported by improved technology.

Traditionally, the Ambulance Service has been responsible for providing ambulance and transport services to acute hospitals and other medical and care facilities. Many countries worldwide have separated the delivery of emergency care and patient transport services in order to ensure that emergency ambulances are best placed to respond to emergency situations as they arise.

The introduction of the Intermediate Care Service (ICS) in order to provide transport for patients between hospitals and other medical facilities reduces the reliance on emergency ambulances and ensures emergency ambulances are available to respond to emergency situations. The NAS

Joe thanks ambulance staff for saving his life Joe Swords, a taxi driver from Edenderry, Co Offaly attended his GP with severe chest pain in March. His doctor immediately called for an ambulance to bring Joe to hospital, and one ambulance arrived within four minutes of the call. Vital signs were taken that indicated that Joe was a sick person.

A 12 lead ECG was performed and the result showed that Joe was having a myocardial infarct (heart attack) and the inferior and main muscle of the heart was being severely impaired. Joe was in agony and a very unstable patient. The results of a 12 lead ECG are vital to paramedics as they can indicate the best course of action.

It can determine what drugs are needed to reduce the damage to the heart muscle and what hospital the patient needs to go to. In Joeâ&#x20AC;&#x2122;s case, the crew quickly realised that Joe would need to go directly to a PCI center for cardiac stenting. A stent is a small mesh tube that's used to treat narrow or weak arteries.

The crew contacted the cardiac catheterisation laboratory in St James's and it was confirmed as Joe's destination.

This saves time, as the patient by-passes the ED. The air ambulance was mobilised to ensure Joe arrived as quickly as possible. It took 15 minutes to transport him to Dublin.

When Joeâ&#x20AC;&#x2122;s family arrived at St James's Joe had had his surgery to remove a near-100 per cent blockage from his main artery, and was in the recovery room.

Joe made an amazing recovery.

With his family he went to meet the staff of the National Ambulance and Aeromedical Service to thank them for saving his life.

102 Health Matters

National Ambulance Service and the Retrieval and Transport Medicine Programme will also utilise the ICS as part of the HSE Critical Care Programme, through the establishment and extension of critical care retrieval services

Emergency Aeromedical Service The Emergency Aeromedical Service (EAS) was a joint 12-month pilot project between the NAS and the Air Corps, providing dedicated aeromedical service to the NAS in the west, specifically where land ambulance transit times would not be clinically appropriate. This service has completed over 300 missions to date and has proved to be an excellent addition to the delivery of pre-hospital care. The pilot emergency aeromedical service, based in Athlone, has been reviewed by the EAS Audit and Evaluation Group. The evaluation included an assessment of a range of data including tasking frequency, mission duration and patient transport times. The evaluation report was submitted to the Minister for Health, Dr James Reilly TD, in July.

The National Ambulance Service Control Centre Reconfiguration Project and associated ICT enabling projects, aim to reduce the number of ambulance control centres from eight to one centre operating over two sites. At the same time significant

“D

on’t hang up. “Please don’t hang up, Mr Lowry” were the last words that Eamon Lowry heard before he lost consciousness.

He was at home in Birr, Co Offaly on May 29th when he got a crushing pain across his chest. Eamon knew he was in

investment will be made in new voice, data and mapping technologies.

The new national operations centres will be located in Tallaght and Ballyshannon so as to ensure that a disaster affecting one site will not affect the other.

The total value of this project, which commenced in 2010, is €23m. This project is one of the most critical and complex pieces of the State’s emergency service infrastructure ever undertaken.

Our intention to reconfigure existing ambulance control centres is consistent with international best practice and endorsed by the Health Information and Quality Authority as the most appropriate approach to improve the quality of services to patients.

This project is also a key element of Future Health: A Strategic Framework for Health Reform in Ireland 2012 – 2015.

We have developed a control centre migration plan that sets out when and how we will relocate centres and in what order.

To date, due to operational imperatives, Cork, Tralee and Navan Control Centres have migrated to Townsend Street in Dublin.

Following the migration of the three control centres to Townsend Street, the NAS has successfully introduced digital radio technology to these areas, which has

greatly improved voice communication, vehicle location and data management.

trouble. He had a history of heart problems. He asked his brotherin-law, who was visiting, to get his wife while he phoned the ambulance service.

Eamon’s wife arrived home shortly after, followed by a National Ambulance Service rapid response vehicle, emergency ambulance and local fire service. The paramedics started advanced life support techniques. Midlands Ambulance Control Centre contacted the National Aeromedical Co-ordination Centre, which dispatched the Emergency Aeromedical Service (EAS) Medevac 112 to Eamon’s home.

After approximately 25 minutes, Eamon was found to have a strong pulse. He was prepared for transport and driven

the short distance from his house to the awaiting helicopter. He was flown directly to University College Hospital, Galway where his care was transferred to staff at the emergency department.

Eamon underwent treatment and was transferred to the intensive care unit. After almost three weeks in Galway, Eamon was transferred to the Midland Regional Hospital, Tullamore for the remainder of his recovery.

Eamon and his family recently met with the staff of University College Hospital, Galway; the National Ambulance Service and the Emergency Aeromedical Service to convey their thanks. An emotional Eamon and his family told staff how they were touched by the dedication of health service staff. He added that he will be forever grateful for all that was done for him.

Meeting response time targets Meeting response time targets continues to challenge the NAS. While considerable improvement has occurred, geographical location and poor road infrastructure are impeding responses within the requisite timeframe.

The NAS continues to engage and liaise with community first responder groups across the country. The utilisation of offduty practitioner, fire service and work place responder schemes continues to provide an invaluable emergency response to patients suffering cardiac or respiratory arrest.

As quality of service and patient safety are core principles of the National Ambulance Service, key priorities for 2014 will include improved response times, implementing additional quality and patient safety indicators, as well as the establishment of the single National Ambulance Control Centre.

Martin Dunne took up his new role as Director of the National Ambulance Service (NAS) in July 2013. He was previously Area Operations Manager for NAS North Leinster.

TRINITY COLLEGE

Ireland’s leading School of Nursing and Midwifery offers a comprehensive suite of nursing and midwifery courses in addition to a number of interdisciplinary programmes suited to a range of health care professionals.

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Application Information:

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Cardiovascular Emergency Nursing Haematology Care Intensive Care Orthopaedics Perioperative Care (options available) Renal Cancer Care

INITIAL CLOSING DATE for receipt of completed applications for all postgraduate / post-registration programmes: 31 May 2014

Please see www.nursing-midwifery.tcd.ie/ for application information Further information on all programmes please contact: School of Nursing & Midwifery, 24 D’Olier Street, Dublin 2.

T: (01) 896 2692; E: nursing.midwifery@tcd.ie Visit our website: www.nursing-midwifery.tcd.ie Find us on Facebook: www.facebook.com/TCD.Nursing.Midwifery

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104 Health Matters

Palliative Care

End-of-Life While most of us would prefer to die at home, seven out of every 10 of us will die in some form of care institution – and four of those seven will die in an acute hospital, writes Michael O’Reilly. call to fly home to be with a loved one near death can have the space and the privacy for final words and where families can be with someone who has just passed away, in dignified and respectful surroundings.”

How can we stand over circumstances where people at the end of life have to contend with the clatter and crowding of hospital wards?

I

ncreasing longevity and the expanding range of treatment options will probably keep those statistics roughly where they are for the foreseeable future.

We need to think more about the physical environment in which people spend their final hours. A lot comes down to basic design – design for effective care-giving at end-oflife, and design to create an environment that reflects the significance of the final moments of a person’s life when, as Seamus Heaney put it, the space we stood around is “emptied” and “a pure change” happens.

Good design Professor Roger Ulrich, a healthcare design specialist, has spoken on both sides of the Atlantic about the effects of good design.

Good design leads to good practice and to better care.

Speaking at a public lecture in Dublin in 2008, Ulrich pointed out that a nurse walks 10 to 15 kilometres per day in a traditional floor, but two to five kilometres in a welldesigned floor; that the time for caring duties soared from 16 to 24 minutes per patient per shift in a traditional floor to 35 to 45 minutes in a well-designed layout; and 85 to 90 per cent of the time, room-mates were a source of stress rather than social support.

The Irish Hospice Foundation (IHF) is

working with the HSE to develop and cofund a project called Design & Dignity. The project is very practical; it offers money and design expertise for hospital projects to improve interior and exterior spaces so that the end of a person’s life is treated with the respect that we all wish for ourselves and our families.

Lessens pain Colour, lighting, art-work, acoustics, fabrics, furnishings, structural materials and planting are all part of the mosaic of good, lifeenhancing design – design that reduces stress, lessens pain and loneliness and makes the unbearable bearable.

The aim of Design & Dignity is to fund exemplar public hospital projects that can effect transformation and set the standard across the hospital sector. Sometimes it’s a new build and there is an opportunity to get it right first time. But creative retrofitting can also produce very positive results.

Speaking at the New York launch of the IHF’s Design & Dignity Fund, actor Gabriel Byrne – patron of the fund – confirmed that the project was already changing things for the better. “In co-operation with hospital staff they are providing design expertise to create spaces where bad news can be broken, where those who have got the dreaded

Quiet spaces Design & Dignity has already succeeded in creating spaces such as family rooms that are quiet, private and calming in those moments of huge distress. In 2008, the IHF launched its Design and Dignity Guidelines for Physical Environments of Hospitals Supporting End-of-Life Care. To date, 11 hospital projects have implemented these and are being funded through the Design & Dignity project to the tune of €1.5 million.

Three projects – a renovated mortuary, a family room in an acute medical ward and a family and viewing room in an emergency department – have been completed.

Work continues on another eight projects all over Ireland, including a bereavement room on a maternity ward. All of these projects create spaces to help soothe the soul at its most vulnerable.

Michael O’Reilly is Chair of the Irish Hospice Foundation’s Design & Dignity project. To learn more or to make a contribution, see www.hospicefoundation.ie

design and dignity project The Design & Dignity Project, led by Mary Lovegrove of the Irish Hospice Foundation with support from architect advisor Ronan Rose Roberts, has been running 'design workshops ' with staff across hospitals. If you are interested in learning more or need advice on redesigning spaces/renovating rooms in your healthcare setting you can contact mary.lovegrove@hospicefoundation.ie..

Health Matters 105

The Gathering

Reflections on Ireland Irish-born Michael Kearney lives in Santa Barbara, California and works as a palliative care and hospice physician. In this excerpt from The Gathering – Reflections on Ireland, entitled ‘Dual Citizenship’, he describes how living in the US has made him feel more Irish

Photo: Stephanie Baker.

T

he word ‘indigenous’ means being ‘native to’ or ‘born within’ a particular place.

The opposite of indigenous is ‘foreign’ or ‘alien’. I am an Irishman who + Dr Michael Kearney. has been living in the US for over 10 years. I have come into a deep relationship with this land, especially through contact with Native American teachers, which has, somewhat unexpectedly, led me into a deeper sense of what it means to be Irish and a new kind of relationship with Ireland.

There is no nostalgia and I do not pine to return to live in Ireland. And yet, I feel more Irish now than I ever did when I lived there. I have discovered what it means to be Irish by becoming familiar with the place that Native Americans call ‘Turtle Island’, this American land.

P

roducer and co-founder of Riverdance Moya Doherty, Micheál Ó Muircheartaigh and journalist Miriam Donohoe pictured (right) at the launch of the Irish Hospice Foundation’s publication The Gathering – Reflections on Ireland. The book features stories from Gathering events and an inspiring collection of reflections on Ireland from influential individuals such as the late Seamus Heaney, Colum McCann, Bono, Moya Doherty, Brian O’Driscoll, Marian Finucane and Niall O Dowd.

Edited by journalist Miriam Donohoe, the 256 page full colour hardback book celebrates a year in the life of a nation and her people – at home and abroad.

It also examines what it means to be

In February 2013 I took US citizenship, and sat with 2,500 other people in the Los Angeles Convention Center at the swearing-in ceremony, with an 80-year-old Colombian woman to my left and an 80-year old Iranian man to my right. Shortly afterwards I travelled to Ireland with my new American passport in one pocket and my Irish passport in the other.

As I have become more and more connected to this place, to this American land, my own sense of Irishness has awakened. How could this be? I believe that it is because my introduction to this place was through those who are indigenous here, those who intimately know and are known by this land. Their Native American ceremonies have enabled me to come into deep connection with ‘all my relations’. But why did this process not result in my becoming more American in some generic, melted-down sort of way? Why, instead, am I feeling more Irish?

Insights from schools of thought as diverse as Buddhist philosophy and general systems theory reveal that the flow of energy and information between different parts of an open system does not lead to sameness or

uniformity of those parts, but to their becoming ever more differentiated and particular.

Think of two lovers who, in their togetherness, become more distinctively themselves. Think of parts of the brain, which, through the constant exchange of energy and information, evolve into more and more sophisticated differentiation. Or, think of an owl and a mouse in a forest. Their interactions over time do not make the owl more mouse-like and the mouse more owl-like. On the contrary; owl becomes more owl, evolving soft inner rims to her feathers for silent flight and swooping on mouse, and mouse becomes more mouse, literally, having up to 12 young in each of her six litters a year to outnumber owl’s manoeuvres.

With the help of those who are indigenous to this place I have come into a deep relationship with this American land. And, as I have come home to the dynamic web of information and energy that is the American experience, I have changed from being a ‘permanent resident alien’ to being a citizen, and more the Irishman I am than I ever was.

Dual citizenship seems the way to go.

Irish through a series of thoughtful and thought-provoking reflections. The funds raised from the sale of the book will be used to support the IHF’s work, particularly its activities in hospitals. Funds will be invested in the pioneering Design and Dignity project.

The Gathering – Reflections on Ireland retails at s20 (RRP) and is available in all good bookshops countrywide as well as

from the IHF website at www.hospicefoundation.ie.

106 Health Matters

Medical History

Thoughts From Abroad

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Some 32 years ago I moved to New York as a trainee surgeon, writes Dr Paddy Boland.

L

ike most of the Irish diaspora I still refer to Ireland as ‘home’ and take solace in the anticipation of Bás in Éirinn. It is perhaps this anticipation, and the fact that it is the year of The Gathering, that has prompted me to reflect on the influence Irish medicine has had on the world – and the influence the world has had on Irish medicine.

Ireland has made a significant contribution to learning, philosophy and theology. But we should not forget also the huge input of Ireland in the field of medicine.

The 1850s were the golden years of Irish medicine, when scholars from around the world came to Ireland to benefit from the teachings of medical giants of that century.

Notable amongst them were

Colles (Kilkenny), Hallaran (Cork) and Graves, Stokes, Adams and Corrigan from Dublin. Their names are eponyms, still used today for common diseases which they described.

The mid-19th century was also a time of starvation, with disease and the failure of the potato crop resulting in emigration.

Successive epidemics of cholera, typhus and typhoid had devastating consequences. Practitioners such as Robert Graves revolutionised treatment of these conditions, but most patients still suffered miserable deaths.

One hundred years later, Irish medicine was still having a far-reaching influence, with four medical graduates shining out.

Dr Denis Burkitt, a native of Co Fermanagh and graduate of TCD, discovered a lethal form of childhood cancer while working as a missionary surgeon in equatorial Africa. As a result of his epidemiologic and subsequent oncologic research this disease, which also occurs in the western world, is largely curable.

In the 1950s, Dr Jack Kyle, a graduate of Queen's University Belfast and one of the all-time greats of rugby, left Ireland to serve as a humanitarian surgeon in poorly served areas including Sumatra, Indonesia, and later Zambia. The GAA had its own medical sportsman and hero in Dr Padraig Carney, a UCD graduate from Swinford who played a pivotal role in Mayo’s last two AllIreland football victories in the early 1950s.

Having been passed over for a dispensary appointment in rural Mayo, he emigrated to the US where he became a renowned obstetrician and gynaecologist and a powerful advocate for patients in California.

Meanwhile, a fourth physician was making his lasting impression on medicine in Ireland, using his knowledge as a doctor to effect social policy as Minister for Health in the coalition government of 1948. Dr Noel Browne TD introduced and executed sweeping changes in public health policies at a time that coincided with the introduction of the antibiotic streptomycin,

Health Matters 107

medical history which resulted in the near eradication of tuberculosis in Ireland.

High-profile Irish Doctors The end of the 20th century saw a marked increase in the number of Irish medical graduates who emigrated to the United States as a result of intense lobbying of US universities by Irish medical schools.

This has had far-reaching benefits for world medicine in general.

In Ireland, over 95 per cent of professors in the major medical specialties received a substantial part of their post-doctoral medical training abroad, including those in the medical school at University College Galway, which is one of the world’s leading centres for research in stem cell, regenerative medicine and breast cancer.

Dublin has regained its international reputation as a centre of medical and surgical excellence thanks to those who received training in the US and UK. Currently, two Irish university presidents are physicians, and both received post-doctoral training in the US – Hugh Brady, President of UCD and Michael Murphy, President of UCC.

Over here in the US, it is great to see that so many Irish medical graduates have risen to positions of international importance.

On the east coast there are Martin Carey, Trevor McGill and Garret Fitzgerald, all senior professors in prestigious universities.

Another is Eileen O’Reilly, a TCD graduate and pioneer in the management of cancer of the liver and pancreas, whom I have the honour of working with.

On the west coast, Professor Ralph de Vere White is an internationally renowned urologist. The renowned Mayo Clinic has several Irish-trained doctors. They include J. Aidan Carney, Emeritus Professor of Pathology, who gave his name to the complex neoplastic syndrome, and recently arrived UCD graduate Andrew Keaveny, Chief of Hepatobiliary Medicine.

Recently a huge honour has been bestowed in the UK on Dublin-born Stephen O’Rahilly from Finglas, a UCD graduate, Professor of Clinical Biochemistry and Medicine at Cambridge University and a fellow of the Royal Society. He received

a knighthood in the 2013 Queen’s birthday honours for services to medical research.

Another Irishman, Dermot Kelleher – a former Professor of Medicine at TCD – has recently accepted the position of principal of the faculty of medicine at the worldrenowned Imperial College in London.

So the Irish influence on medical research is pretty clear. It is an influence that will remain strong in the future, as journeys are made backwards and forwards across the Atlantic.

And keeping with the spirit of The Gathering, it is fitting that some of the world’s leading cancer specialists met in Dublin in October for the Gathering around Cancer meeting, to discuss developments in treatments for the disease and to map a way forward for new breakthroughs. Ireland should hold its head proud.

Paddy Boland is an Irish oncologist and a senior member of the Orthopedic Oncology Service at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical School in New York.

“In Ireland, over 95 per cent of professors in the major medical specialties received a substantial part of their postdoctoral medical training abroad, including those in the medical school at University College Galway, which is one of the world’s leading centres for research in stem cell, regenerative medicine and breast cancer.” + Paddy Boland.

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Health Matters 109

Personal Finance

A guide to travel insurance Marc Evans of Cornmarket explains all the insurance options for your trip abroad.

What are your options?

In most forms of travel insurance that are available, the most popular place to purchase cover is online. The travel insurance marketplace is very competitive and there are many different providers.

When you come to purchase travel insurance you will typically be offered either a single trip or annual multi trip policy.

Single trip: suitable for one-off trips or short breaks.

Annual multi-trip: suitable if you plan to take more than one trip in a 12-month period. Insurers may impose a limit on the number of trips you can take in a year and a maximum duration limit for any single trip. These limitations may vary depending on the insurer, so it is always best to check at the time of purchase.

Other factors that determine the price for travel insurance include your age, whether you require cover for a spouse and dependent children, the country you are travelling to and certain activities (such as golf and skiing) that can make your quotation more expensive.

Cancellation cover Cancellation cover provides cover for your flights and accommodation in the event that you are unable to travel for certain insured reasons. One such reason could be unforeseen emergencies such

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There are many considerations when you come to book a winter sun holiday, a long weekend European city break or the annual ski trip. Flights and accommodation must be organised, you may need foreign currency and you may have to book annual leave with your employer.

These are just a few considerations.

Travel insurance can easily be overlooked.

This could be a costly mistake! For example, if you or a member of your family is taken ill before you travel, your flights may be non-refundable and your hotel may require advance notice of cancellation. If you havenâ&#x20AC;&#x2122;t purchased travel insurance you may be liable for these costs.

as illness, injury or death to you, your travelling companion or a relative.

Common misconceptions are that travel insurance provides cover if you cancel your holiday due to work obligations, deciding not to travel or if your airline goes out of business.

Emergency medical expenses cover This is one of the most important forms of cover to consider when purchasing travel insurance. If you become ill or you are involved in an accident abroad, costs can rapidly begin to build up. Ambulance costs, hospital treatment and the expense of returning home if medically necessary are just some of the benefits of having emergency medical expenses cover in place.

Your travel insurance provider will supply you with contact details for their medical emergency assistance service at the time of purchase. They will also request

that you contact this service as soon as possible in order that they can liaise with your hospital or assist with organising repatriation to Ireland if necessary.

Many of us have private health insurance or avail of the European Health Insurance Card, which covers the cost of necessary medical care while travelling in any EU or EEA State. However, ambulance costs and medical repatriation may not be covered by your private health insurance plan or the EHIC.

Personal effects and baggage cover Another important consideration when travelling abroad is your baggage. Insurers provide cover for loss, damage and theft of your baggage and personal effects. In the event of a claim for theft or loss of your baggage or personal effects abroad, you will be required to report this to the police in that country and produce a police report to your insurer upon your return.

110 Health Matters

Health LITERACY

Does everyone get your health message?

A health service that is literacy aware ensures that everyone can access and understand basic health information to make decisions that promote wellness and better health, writes Helen Ryan.

T

he new Healthy Ireland framework highlights the importance of health literacy. It is important for health workers to be aware that many people have literacy difficulties. The 2013 OECD Adult Skills Survey showed that almost 18 per cent, or about one in six, Irish adults are at or below level one on a five-level literacy scale. Ireland ranks 15th out of 24 participating countries. At this level a person may be unable to understand basic written information. From a health literacy viewpoint this means that people may have difficulty: • Making sound health decisions at home and in the community.

• Giving informed consent to treatment and following dosage instructions.

• Understanding how to live with chronic health conditions.

• Having the skills and confidence to ask questions.

• Navigating healthcare systems.

This survey also showed that adults who report an excellent state of health have considerably higher literacy than those who report a fair or poor state of health. Across the levels of the literacy scale we see more people at or below level one with poor (40.3 per cent) or fair (31 per cent) health compared with excellent (11.7 per cent) or very good (14.6 per cent) health. This mirrors the international trend whereby in all countries surveyed, individuals with lower levels of literacy skills are more likely than those with higher levels of skills to report poor health (OECD, 2013a).

How do we compare?

Ireland is not alone in having a health literacy problem. A 2012 EU Health Literacy Survey showed that nearly every second person (46 per cent) across the participating eight European countries had low or problematic health literacy.

The report showed that: • 9.3 per cent have inadequate health literacy.

• 29.5 per cent have problematic health literacy.

• 39 per cent have sufficient health literacy.

• 22.3 per cent have excellent health literacy.

What does this mean for healthcare workers?

1. Use plain English: As a healthcare worker you can help by avoiding medical jargon and using plain English instead. Plain English is a style of presenting information that helps someone understand it the first time they read or hear it. It is a more efficient way of writing. To write in plain English you first need to put yourself in your reader’s shoes.

When you use plain English you: • write in clear language

What is literacy?

Literacy involves listening and speaking, reading, writing, numeracy (using numbers) and using everyday technology. Literacy skills are changing all the time and are influenced by the skills we use in work and day-to-day living. We don’t learn these skills once and for all during primary education – we must develop and maintain them throughout our lives. Over half the adult population in Ireland has a difficulty with the literacy tasks that are part of everyday life: filling in forms, understanding contracts, following instructions and so on.

• give relevant information in the right order • help people to find this information quickly.

2. Use images or visual aids if appropriate.

3. Use the ‘teach back method’ – this means asking the person to repeat what you have told them in their own words to make sure they understand and remember the important message.

For more tips on plain English check out the Simply Put website.

NALA’s Writing and Design Tips booklet is very useful and you’ll find it at simplyput.ie See www. healthliteracy.ie for more information. Helen Ryan is a Policy Officer with the National Adult Literacy Agency (NALA).

A quarter of adults find it difficult to carry out straightforward tasks such as reading and understanding the dosage instructions on a medicine label or food packaging.

But we all may have literacy needs at different times in our lives depending on where we are and what we have to do. For example, I attend a course on a topic I am not familiar with and there are terms that I don’t understand; or I need to hear and read new health information and there are terms that I don’t understand.

Health Matters 111

getting to know you/nursing

Getting to know you Siobhan Bruton is a Public Health Nurse at Skerries Health Centre in Co Dublin.

How long have you worked with the HSE? I have been working as a public health nurse since 2005. Before then I was a midwife in the Coombe Women’s Hospital from 1993 until 2005.

Describe your job in five words.

People-centred, diverse, challenging, lots of on the job learning and enjoyable.

What’s your average working day like?

My job involves dealing with people of all ages – from the cradle to the grave. A lot of the time I’m visiting mothers with new babies to carry out blood spot tests on the baby and to support the mother if they are breastfeeding their baby. There is a high initiation rate of breastfeeding in Skerries.

My role is to provide support and information to parents.

Often I am reassuring mothers that it is normal that their newborn baby is feeding every one to two hours day and night in

the early days! I also encourage them to engage with the local support group.

There is a very successful coffee morning in Skerries Mills each Thursday and it is a great way for new mothers to get support from other mums.

What do you like about your job?

I like the diversity of it. I’m always meeting new people from patients to GPs, social workers, etc. I’m always learning on the job; there is always something to be learnt from each experience.

How do you help mothers who want to breastfeeding get off to good start?

Firstly, I try and visit them as early as possible. I advise them on what to expect in the early days such as the frequent feeding, how to look for signs the baby is feeding well, and also how to know if the baby is getting enough milk by keeping on eye on the number of wet and dirty nappies!

I weigh the baby so we have a baseline weight. Most babies lose some weight in the first day or two as they get rid of extra fluid, and after this they gain weight steadily and are back to their birth weight around day 14. I would also encourage mothers to exclusively breastfeed in order to build up a good supply. I tell them about the support available to them. I would often encourage them to come to the next meeting of the breastfeeding support group and if they don’t come along I might follow up with a phone call to see how they are getting on.

What’s your favourite book/film/ show etc and what did you like about it?

Les Miserables – I love musicals.

What is the top thing on your dream list if you won the Lotto?

I’d bring two empty suitcases to New York and do a little bit of shopping while staying some place nice!

ICHN Launches Irish Intervention Wheel The Institute of Community Health Nursing (ICHN) launched the first edition of the Irish Intervention Wheel in August at the third International Conference of Public Health Nursing in Galway.

T

he publication Public Health Nursing in Ireland: Demonstrating Interventions from Practice (PHIG 2013) describes how members of the institute’s Population Health Interest Group validated public health interventions from the American Intervention Wheel (MDH 2001). It supplies a visual description of the interventions grouped into five colour-coded wedges within a wheel diagram highlighting individual, community and systems levels of practice.

Following definition, the 17 interventions are then presented in stories from contemporary Irish public health nursing practice outlining actions that nurses

undertake to promote and protect the health of the whole population. A common theme throughout the stories is the depth of relationships built, over time and on a foundation of trust, between nurses and their patients within families and communities.

This first collection of Irish stores will promote visibility of, and provide insight into, the role of the Irish PHN for the nursing profession, the multidisciplinary team in primary and integrated care, public health educational programmes and for policy makers. Future editions will embrace stories from a wider group of nurses, ensuring that public health nursing

in Ireland and elsewhere remains visible and valid.

Copies of the publication are available from the ICHN at a cost of eur10. Phone: (01) 220 0200 or email: admin@ichn.ie.

112 Health Matters

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