IHCA Yearbook and Diary 2020 by Ashville Media Group

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For superior skin clearance vs secukinumab and adalimumab TREMFYA® achieved PASI 90 in: • 84.5% of patients at week 48, compared with 70% on secukinumab (P<0.001)1 • 73.3% of patients at week 16, compared with 49.7% on adalimumab (P<0.001) sustained out to week 482

For long-lasting skin clearance that stands the test of time TREMFYA® maintained PASI 90 out to 3 years in 82.8% of patients3

For skin clearance with a generally well-tolerated safety profile* TREMFYA® has no specific class effect warnings for candidiasis, Crohn’s disease, demyelinating diseases or congestive heart failure†4

Stand for lasting skin clearance with TREMFYA®3 PASI = Psoriasis Area and Severity Index * The most common adverse drug reaction was upper respiratory infection † Special warning and precautions for TREMFYA®: infections, tuberculosis, serious hypersensitivity reaction and immunisations (please refer to Summary of Product Characteristics for further details).

Tremfya▼ 100 mg solution for injection in pre-filled syringe and pre-filled pen PRESCRIBING INFORMATION. ACTIVE INGREDIENT(S): guselkumab. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATION(S): Treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy. DOSAGE & ADMINISTRATION: For use under guidance/supervision of physician experienced in diagnosis and treatment of plaque psoriasis. Subcutaneous injection. Avoid areas showing psoriasis. Adults: 100 mg at weeks 0 and 4, followed by maintenance dose every 8 weeks. Consider discontinuation if no response after 16 weeks of treatment. Children: No data available in children/adolescents <18 years. Elderly: No dose adjustment required, limited information in subjects aged ≥ 65 years. Renal & Hepatic impairment: Not studied. CONTRAINDICATIONS: Serious hypersensitivity to active substance or excipients; clinically important, active infection. SPECIAL WARNINGS & PRECAUTIONS: Infections: Potential to increase risk. If signs/symptoms of clinically important chronic/acute infection occur, monitor closely and discontinue Tremfya until resolved. Tuberculosis: Evaluate patients for TB pre-treatment; monitor for signs/symptoms of active TB during and after treatment. Consider anti-TB therapy

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prior to Tremfya if past history of latent/active TB and adequate treatment course not confirmed. Serious hypersensitivity reaction: some cases occurred several days after treatment and included urticaria and dyspnoea. If occurs, discontinue Tremfya immediately and initiate appropriate therapy. Immunisations: Consider completing all appropriate immunisations prior to Tremfya. Do not use live vaccines concurrently with Tremfya; no data available; before live vaccination, withhold Tremfya for at least 12 weeks and resume at least 2 weeks after vaccination. SIDE EFFECTS: Very common: Upper respiratory infection. Common: Gastroenteritis, herpes simplex infections, tinea infections, headache, diarrhoea, urticaria, arthralgia, injection site erythema. Other side effects: hypersensitivity, rash. Refer to SmPC for other side effects. PREGNANCY: Avoid use of Tremfya; no data. Women of childbearing potential should use effective contraception during and for at least 12 weeks after treatment. LACTATION: Discontinue breast-feeding during treatment and up to 12 weeks after the last dose or discontinue Tremfya. INTERACTIONS: No dose adjustment when co-administering with CYP450 substrates. Concomitant immunosuppressive therapy or phototherapy not evaluated. Refer to SmPC for full details of interactions. LEGAL CATEGORY: POM. PRESENTATIONS, PACK SIZES,

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MARKETING AUTHORISATION NUMBER(S): Pre-filled syringe, x1, EU/1/17/1234/001. Pre-filled pen, x1, EU/1/17/1234/002 MARKETING AUTHORISATION HOLDER: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. FURTHER INFORMATION IS AVAILABLE FROM: Janssen Sciences Ireland UC, Barnahely, Ringaskiddy, IRL - Co. Cork, P43 FA46. Prescribing information last revised: February 2019.

. d . e r : , , n r e h r ,

References: 1. Langley R et al. Poster presented at: International Society of Dermatologic Surgery (ISDS) Congress; December 12–15, 2018; Vienna, Austria. 2. Blauvelt A et al. J Am Acad Dermatol 2017; 76(3); 405–417. 3. Griffiths CEM, et al. 2018 VOYAGE 1 3yr data. 4. TREMFYA® Summary of Product Characteristics. Available at www.medicines.ie. CP-79722 | Date of Preparation: February 2019 | Janssen Sciences Ireland UC 2019

Adverse events should be reported. ▼ This medicinal product is subject to additional monitoring and it is therefore important to report any suspected adverse events related to this medicinal product. Healthcare professionals are asked to report any suspected adverse events via: HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2, Tel: +353 1 6764971, Fax: +353 1 6762517, Website: www.hpra.ie, E-mail: medsafety@hpra.ie. Adverse events should also be reported to Janssen-Cilag Limited on +44 1494 567447 or at dsafety@its.jnj.com. © Janssen-Cilag Limited 2019

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Advanced Medicine Exceptional Care

Organisation accredited by Joint Commission International

www.bonsecours.ie

Cork | Dublin | Galway | Limerick | Tralee Advert template.indd 1 247677_1C_Bon Secours_JM_IHCA 20.indd 1

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EXPERIENCING CHEST PAIN, PALPITATIONS OR BREATHLESSNESS? ALWAYS LISTEN TO YOUR HEART.

The Mater Private Dublin is the only private hospital in Ireland offering 24/7 Urgent Cardiac Care, from expert cardiologists. Thatâ&#x20AC;&#x2122;s expert heart care 24/7, delivered in the most respected cardiac hospital in the country.

Urgent Cardiac Care 1800 24 79 99

24 hour walk-in service. No GP referral needed.

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IRISH HOSPITAL CONSULTANTS ASSOCIATION

2020 Yearbook & Diary

Heritage House, Dundrum Office Park, Main Street, Dundrum, D14 C2R2 Telephone: +353 1 298 9123 Fax: +353 1 298 9395 Email: info@ihca.ie Web: www.ihca.ie

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CUTTING-EDGE RADIOTHERAPY TREATMENT St. Vincent’s Private Hospital is part of the St. Vincent’s Healthcare Group which also includes St. Vincent’s University Hospital, Elm Park and St. Michael’s Hospital, Dun Laoghaire. St. Vincent’s Private Hospital Elm Park, Dublin 4 Ireland. T E

+353 1 263 8000 info@svph.ie

www.svph.ie

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Tattoo-less radiotherapy now available to breast cancer patients for the first time in Ireland. The new, high precision, innovative technology called Surface Guided Radiotherapy (SGRT) offers an alternative to tattoos by using a 3D optical scan of the body surface to set up and verify the patient’s position against their CT planning reference scan.

It has led the way, since the mid 1970s, embracing new advances in pharmacology, medicine and nursing.

Using over twenty thousand reference points on the patient’s skin surface the technology can track and detect motion with sub-millimetre accuracy.

Olivia Scollard, Radiotherapy Services Manager

The Oncology and Haematology multidisciplinary service and team at St. Vincent’s Private Hospital is one of the most progressive in Irish private medicine.

This technology will be rolled out to all oncology patients in 2020. Contact

E o.scollard@svph.ie T +353 1 260 9310

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PERSONAL DETAILS Name: Hospital: Address:

Tel: Fax: Email: Medical Council Reg. No.: MPS/Challenge/MDU Reg. No.: Vhi Dr No.: Laya Healthcare Dr No.: Irish Life Health Dr No.:

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Contents 9

End of Year Checklist

President’s Address

Members’ Handbook Contents

Consultants’ Common Contract 2008 – Enabling Circular

Consultants’ Common Contract 2008

Professional Directory

Medical Indemnity Organisations Health Insurers & Medical Council

76 IHCA National Council 2019-2020 77

IHCA Officer Board 2019-2020

78 Voluntary & Support Organisations

Charts & Tables

Errors and Omissions Disclaimer: While every effort has been made to ensure that all information contained in this yearbook is accurate and correct at time of publication, errors, omissions, or discrepancies may have occurred in preparation of the manuscript. Ashville Media Group and the Irish Hospital Consultants Association cannot accept any liability for loss, distress or damage resulting from errors or omissions. © 2019/2020

Published on behalf of The Irish Hospital Consultants Association by Ashville Media Group • Tel: (01) 432 2200 • www.ashville.com

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Options Menarinin Vit man 8:Layout 1 22/04/2016 13:39 Page 1

A. MENARINI

PHARMACEUTICALS IRELAND LTD

Healthcare for Life

- A.Menarini Committed to medical education Date of item: April 2016 Item code: IR-MEN-02-2016

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End of Year Checklist

Item Check Medical Council Requirements

Ensure you adhere to all Medical Council Registration requirements.

Medical Indemnity & Ensure that any payment made by Direct Debit is actually processed by your bank. This is particularly important Direct Debit Payments in the case of medical indemnity and Medical Council registration fees. Basic Salary Check that your annualised salary corresponds with the latest Salary Scale for your contract type. B Factor Check that you are receiving the appropriate B Factor for your on-call rota and rate of call out. Note for those on 1:1 and 1:2 rotas, additional allowances are payable for higher numbers of call outs. Structured Weekend Inputs and C Factor

Check that all structured weekend inputs and C Factor claims have been submitted and paid. Where claims have not been paid send a reminder to your employer.

Rest Days Check that you have claimed and have been paid for your rest day entitlements where not taken. Annual Leave Notify your employer of any untaken annual leave for current year. Payment should be sought for any untaken leave not rolled over. Travel & Subsistence Ensure all outstanding claims for travel and subsistence have been submitted and paid. Note: travel expense is claimable for C Factor calls in the hospital. CME Allowance

Members are advised to claim their CME Allowance before the end of the year as management are setting limitations. Your College and CPD fees are eligible costs. Those who have accrued unutilised CME funding should write to their employer to carry it over to 2020.

Phone

Ensure that rental on mobile or landline is claimed and paid by employer when due.

Flat-Rate Expense Allowance

Check that you are benefiting from the â&#x201A;Ź695 flat-rate expense allowance in your tax credits each year. You can claim a tax rebate for the previous four years, therefore claims for 2015 need to be made by 31 December 2019.

Statement of Interest under the Ethics Act

Interests that could materially influence you in the performance of your contract must be declared under Ethics in Public Office Legislation.

Tax Clearance Cert

All Consultants must within nine months of their date of appointment provide a Tax Clearance Certificate and Statutory Declaration to the Standards in Public Office Commission.

Health Insurer and Reconcile all outstanding payments with private health insurers, paying particular attention to pended claims. Medico Legal Fees Review medico-legal fees and notify requesting solicitors accordingly â&#x20AC;&#x201C; see Pro Forma letter on page 23.

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President’s Address Dear Colleagues, It gives me great pleasure to introduce the 23rd edition of the IHCA Yearbook and Diary. Our Association was founded with the twin aims of advocating for quality care for our patients and providing representation for Consultants. The crisis in Consultant staffing and the resulting impact this has on patient care and service delivery has become even more acute in the last year. The facts are stark: one in five permanent posts cannot be filled, over a third of advertised consultant posts failed to fill in recent years, and there is an overreliance on temporary and agency staff. The Association’s survey in March 2019 confirmed that the lack of suitably qualified Consultants is resulting in a decline in the standard of patient care, and the failure to fill permanent Consultant posts is directly attributable to the ongoing pay inequality imposed by the Government on new Hospital Consultants. The survey also confirmed excessive Consultant workload in our acute services is having a negative impact on the provision of care. The Government has acknowledged there is a serious problem in recruiting and retaining consultants but there has not been any meaningful engagement to address the consultant shortage. The result is an entirely predictable reduction in the safety and quality of patient care that we can provide in our acute hospital and mental health services. There are now over 550,000 people awaiting an outpatient appointment with a Consultant and 70,000 awaiting appointments for surgery and other procedures. The Association launched its #CareCantWait campaign to highlight patients’ continuing lack of access to acute hospital care and increasing waiting times for consultant appointments and treatment. I would ask all our members to explore the #CareCantWait campaign and support it in advocating for patients who are on ever lengthening waiting lists. The campaign encourages patients, the public and those working in healthcare to support the Association’s call for Government to restore parity for new Consultants to ensure that vacant Consultant posts are filed and timely care can be provided to patients and the population. There are two main capacity deficits in our acute services which are restricting the timely delivery of patient care; the large number of permanent Consultant posts that cannot be filled and infrastructure capacity deficits. The Association continues to highlight the Government’s complacency in addressing these overwhelming deficits. No realistic plan has been developed by the Government to commission the additional 2,600 acute beds by 2027. This restoration of critically needed bed capacity was recommended in last year’s Capacity Review and funded in the National Development Plan (NDP). The NDP funding for the promised additional beds needs to be frontloaded over the next five years to stop the current deterioration of our acute hospital and mental health services. Demand for care is growing with the increase in population and the increase in the numbers of those over 65 years of age. Last year a record number of acutely-ill patients were admitted to hospitals but had to be treated on a trolley not a hospital bed. On behalf of my National Council colleagues and the executive staff of the Association, I would like to take this opportunity to thank you for your continued support. We look forward to successfully addressing the concerns of our members in the year ahead. Finally, I wish you and your families a successful 2020. Dr Donal O’Hanlon, President

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Advertorial Feature Doctors in the witness box By Dr Rob Hendry, Medical Director at Medical Protection.

As a doctor, you may be asked to give evidence in many different types of hearings, such as the criminal, civil or coroner’s court as well as employment or mental health tribunals. The role of a witness is to provide impartial evidence to help the court reach its decision. You will either be a witness who provides information as the treating or attending doctor in a case, or as an ‘expert witness’ to provide an independent opinion on the facts of a case that you have not been personally involved in.

1) How should I prepare? Know your brief very well and remember the evidence which you have provided in the past so that it is consistent with your oral evidence. Put yourself in the shoes of another party and think of what other issues could arise and how you will address them in your oral evidence. Audio and visual aids, anatomical models may help you in giving evidence and impress the court. You may wish to attend a course to gain courtroom skills. Alternatively, you can attend a court hearing to observe or watch such clips on YouTube, noting down what the witness does well or poorly.

2) How to give good evidence in court? Here are five quick tips to demonstrate your credentials to the court: • Maintain eye contact with people Ensure you maintain eye contact when giving evidence to the judge/coroner/chairman, as this will instil confidence in those you are providing evidence to. • Projection

Project your voice, or you may appear as though you have something to hide. This is easier to do if you are standing up. • Pace

Speak at appropriate pace, using short sentences. Lawyers write down everything and they hang on to every word you say. When you have given your answer, stop speaking. It is not your job to fill any silence that follows. • Positioning/posture Behavioural experts say that if you put your hands at the back, you are trying to hide something; if on the front with two hands close together, you appear submissive. We suggest that you put your hands at the edge of the witness box. • Perception Wear something sombre to meet the occasion. A sports jacket is probably not a good idea.

3) Any other tips? The barrister/counsel may repeat your answer in their own words, subtly changing the meaning. Highlight this change before cross-examination continues, so you are able to clarify what it is you wanted to convey. When nervous, there is a tendency to agree with the barrister - but you can interject if what they said was inaccurate. The barrister may also ask you a closed question based on a false premise. Tell the judge that it is a complex question which requires a longer response, so you need more time to give a full answer, in the interest of justice. For more tips, visit https://www.medicalprotection.org/ireland/resources/factsheets/factsheets/roi-giving-evidence. Contact us at 0113 241 0200 or email us at querydoc@mps.org.uk for further advice.

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Members’ Handbook Contents

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INTRODUCTION IHCA - Brief History - Basic Rules

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- Retired Consultants - Services Offered - Public Appointments - Consultants’ Common Contract - Probation - Joint Appointments - Pension Arrangements - Existing Superannuation Scheme Members - Single Public Service Pension Scheme Members - Standard Fund & Personal Fund Thresholds - Early Retirement - Travelling & Subsistence Expenses - Continuing Medical Education (CME) - Out of Hours Service - Rest Days

PRIVATE PRACTICE

MEDICAL INDEMNITY

MEDICO-LEGAL MATTERS

RESOURCE LIMITATIONS

DATA PROTECTION & PATIENT CONFIDENTIALITY

POST-MORTEMS & INQUESTS REPRESENTATIONAL ASSISTANCE

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GOVERNMENT HEALTH POLICY

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Members’ Handbook INTRODUCTION

The Members’ Handbook is provided to all members of the Irish Hospital Consultants Association. It is a useful resource which will assist members to quickly identify key features and entitlements arising from their appointments, whether public or private.

(ab) be Top-Grade Bio-Chemists of Consultant status as defined in correspondence from the Department of Health of January 17 1972 (reference A155-42) and who hold posts structured by the Health Service Executive. or

It also provides an outline of the services that the Association offers to its members. Members are encouraged to avail of these services by contacting the Secretariat as and when necessary.

IRISH HOSPITAL CONSULTANTS ASSOCIATION Brief History Initial steps to establish the Irish Hospital Consultants Association were taken in 1988. Hospital consultants at that time felt that their needs were not being adequately represented by existing representative bodies and so formed their own Association. Since then the organisation has thrived, representing members’ interests in contractual and broader medico-political matters. It is also steadfast in its advocacy of patients’ interests. The Association currently represents in excess of 90% of hospital consultants in the Irish health service. It is the only representative body in Ireland that speaks solely for hospital consultants.

Basic Rules There are different classes of membership with varying rights and entitlements. Membership of the Association is open to the following: (a) The members of the Association shall either: Hold a current enrolment on the Irish Medical Register or Irish Dental Register and be: (i) Hospital Consultants who have subscribed to and paid in full the annual membership fee to the Association at the date of adoption of these Rules; or (ii) Consultants who are holders of the Common Contract; or (iii) Medically qualified Consultants in hospital practice who though not holding the Common Contract, are eligible to hold a Health Service Executive structured public appointment; or (iv) Academic Dental Consultants referred to in Paragraph 8.8 of Report Number 36 of the Review Body on Higher Remuneration in the Public Sector; or (v) Consultant Orthodontists and Consultant Oral Surgeons in public hospital practice;

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(ac) be life members appointed by the National Council pursuant to Rule 3(d). (b) In addition to the above, no person shall be eligible for membership of the Association unless they are either registered on, or eligible to be registered on, the Specialist Division of the Register of Medical Practitioners as maintained by the Irish Medical Council, save for the following groups of persons who are exempt from this requirement: (i) Top-Grade Bio-Chemists of Consultant status as defined in correspondence from the Department of Health of January 17 1972 (reference A155-42) and who hold posts structured by the Health Services Executive; (ii) Academic Dental Consultants referred to in Paragraph 8.8 of Report Number 36 of the Review Body on Higher Remuneration in the Public Sector; (iii) Consultant Orthodontists and Consultant Oral Surgeons in public hospital practice; and (iv) Existing fully paid up members of the Association who were accepted as members by the Association prior to Oct 4 2008. (v) Life members of the Association who have withdrawn from the Register of Medical Practitioners subsequent to they becoming life members.

(c) Associate Members (ca) Doctors who have not yet been appointed to a Consultant post and who meet the requirements outlined in this subsection will be eligible to apply for Associate Membership of the Association in which case none of the requirements outlined above in Sections (a) or (b) will apply. An Associate member is required to: Hold or have previously held enrolment on the Irish Medical Register or Irish Dental Register; and (ii) Have commenced in or completed the final year of his or her specialist training; or (iii) Have received a Certificate of Satisfactory Completion of Specialist Training from an Irish Postgraduate Training Body. (cb) An Associate Member will be eligible to receive such advice, representation and other services from the Association as may be determined by the National Council at its absolute and sole

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Membersâ&#x20AC;&#x2122; Handbook discretion from time to time. The National Council will determine the annual membership fee, if any, to be charged for Associate Membership and the nature of voting rights, if any, attached to such membership. (cc) A person shall ipso factor cease to be an Associate Member of the Association with immediate effect upon the happening of any of the following: upon resignation in writing; or upon death; or upon failure to pay the annual membership fee, if any, for the time being in force to the Association in the manner prescribed by the National Council; or upon expulsion pursuant to Rule 5 hereof; or upon a decision by the National Council to cease his or her Associate Membership for such reason or reasons as it may at its absolute and sole discretion consider appropriate. (cd) The procedure for the expulsion of an Associate Member will operate in accordance with Rule 5 save that an Associate Member will not have any voting rights. (ce) For the avoidance of doubt, with the exception of Rule 5 as referenced in subparagraph (cd) above and Rule 12(a), all other references in these Rules to a member will be read and construed as a reference to a member who satisfies the requirements outlined in Section (a) and (b). (d) No person shall, for the purposes of these Rules, be deemed to be a member of the Association or be entitled to exercise or receive any of the benefits or privileges of membership (including the right to be present and vote at any general meeting of the Association) unless and until he has paid in full the annual membership fee as determined from time to time by the National Council in such manner as is determined by the National Council. (e) The amount of annual membership fee and the manner of payment thereof for Hospital Consultants who have reached retirement age under the Common Contract or who had they held such Contract would be deemed to have reached retirement age thereunder or academic Dental Consultants referred to in Rule 3(a) (aa)(iv) who have either reached or deemed to have reached retirement age shall be determined from time to time by the National Council. The National Council shall have power to grant such members who have reached retirement age as outlined in this Rule and who have been members of the Association for each of the five years immediately prior to reaching such retirement age life membership upon payment of a lump sum

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and upon satisfying such conditions as the National Council may in its discretion impose and such life members shall not be liable for annual membership fee of whatever nature thereafter.

RETIRED CONSULTANTS Members who reach retirement age under the Common Contract or who, had they held such a Contract, would be deemed to have reached retirement age thereunder, may become life members of the Association on payment of a once-off fee, provided they were fully paid up members during the preceding five years. Life members are entitled to the same rights and privileges of membership as full members, including the right to vote at General meetings and in elections to National Council. The National Council is obliged to co-opt a life member to membership of the National Council with effect from June 2000. Termination of Membership A person shall ipso facto cease to be a member of the Association with immediate effect upon the happening of any of the following events: (a) upon resignation in writing; or (b) upon death; or (c) upon failure to pay the annual membership fee for the time being in force to the Association in the manner prescribed by the National Council; or (d) upon removal for whatever reason from the Irish Medical Register (other than pursuant to an order granted under the Medical Practitioners Act, 1978, or the Medical Practitioners Act, 2007); or the Irish Dental Register (other than pursuant to an application pursuant to Section 44 of the Dentistâ&#x20AC;&#x2122;s Act, 1985) where the decision of the Medical Council or the Dental Board (as appropriate) to remove the member from such register is not the subject of an appeal by such member to the High Court, prosecuted with due diligence; or (e) upon expulsion pursuant to Rule 5 hereof; or (f) upon ceasing to qualify for membership of the Association pursuant to Rule 3(a) or life membership referred to in Rule 3(d) of these Rules.

National Council The National Council manages the affairs of the Association. The Council consists of 30 members; 25 members are directly elected

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Members’ Handbook and the remaining five are co-opted. Members of Council hold office for a period of four years. They may be re-elected for a further period of four years after which they must resign. The members of Council are representative of eight regions whose functional areas coincide with the corresponding former Health Board functional areas. The co-opted members are appointed so that there is representation on Council from the following specialties: • Anaesthesiology • Surgery • Obstetrics/Gynaecology • Paediatrics • Psychiatry • Medicine • Radiology • Pathology One of the co-opted members must be a life member of the Association. In addition to the Council, a full-time Secretariat is employed. The Secretary General, Assistant Secretary General, Senior Executive Officer and Senior Policy & Research Executive are supported by an administrator and secretaries.

PUBLIC APPOINTMENTS Health Service Executive The number and range of consultant appointments in the public sector in Ireland are regulated by the Health Service Executive. As of April 2019 there were 3,095 WTE approved Consultant posts in the public health system under public contract. There are an estimated 250 consultants in full-time private practice in Ireland. The granting of admitting rights and/or practice privileges to consultants in private hospitals is a matter for each individual hospital.

Consultants’ Common Contract Each consultant with a public appointment works under the consultants’ common contract. The terms of the 2008 Consultant contract were agreed between the Health Service Executive, on behalf of all employers, and the Irish Hospital Consultants Association on behalf of Consultants. The terms and conditions of this contract apply to all new appointees with effect from 1st June 2008. Each consultant and his/her employer sign a copy of the contract. Sections 2(a), 5 and 8(a) along with the HSE letter of approval (Appendix I) are unique to each individual consultant. These should be carefully checked prior to signing to ensure accuracy. The Association will assist in this process. Section 2 identifies the employer’s name and address, the Consultant’s name and address, the title of the post and the agreed start date.

Services Offered The Association provides a broad range of services to members, including: • Contract negotiations with employers and other bodies; • The provision of legal advice to members; • A range of financial services through leading banks, investment houses and pension advisers; • Seminars on topics such as revenue audits and medical indemnity matters; • Negotiations on behalf of individual members who encounter difficulties in their employment. The Association represents the views of consultants through the formulation of policy documents and position papers on a wide range of issues affecting acute hospital services, mental health services, and patient care.

Section 5 identifies the type of contract being offered. Section 8(a) identifies the employer and the location(s) in which the consultant will work. The location(s) should be a physical location and not the name of a service.

Probation Public sector appointments are permanent and pensionable. Appointees are, however, subject to a 12-month probationary period. This may be extended at the employer’s discretion. At the end of your probationary period the employer shall certify that your service has been satisfactory and confirm your appointment or give stated reasons why it has not and you will cease to hold the appointment. In the event of a consultant moving from one public appointment to another, he or she will not be required to serve more than 12 months’ probation in the aggregate.

Joint Appointments A number of posts in Ireland are structured as joint appointments. Consultants holding such posts have two employers with the commitment to be devolved to each employer being decided by the HSE. This will be indicated by way of sessional split in the letter structuring the post.

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PUBLIC APPOINTMENTS Health Service Executive The number and range of Consultant appointments in the public sector in Ireland are regulated by the Health Service Executive. As of April 2019 there were 3,095 WTE approved Consultant posts in the public health system under public contract. There are an estimated 250 Consultants in full-time private practice in Ireland. The granting of admitting rights and/or practice privileges to Consultants in private hospitals is a matter for each individual hospital.

Consultants’ Common Contract Each Consultant with a public appointment works under the Consultants’ Common Contract. The terms of the 2008 Consultant Contract were agreed between the Health Service Executive, on behalf of all employers, and the Irish Hospital Consultants Association on behalf of Consultants. The terms and conditions of this contract apply to all new appointees with effect from 1 June 2008. Each Consultant and his/her employer sign a copy of the contract. Sections 2(a), 5 and 8(a) along with the HSE letter of approval (Appendix I) are unique to each individual Consultant. These should be carefully checked prior to signing to ensure accuracy. The Association will assist in this process. Section 2 identifies the employer’s name and address, the Consultant’s name and address, the title of the post and the agreed start date.

Services Offered The Association provides a broad range of services to members, including: • Contract negotiations with employers and other bodies; • The provision of legal advice to members; • A range of financial services through leading banks, investment houses and pension advisers; • Seminars on topics such as revenue audits and medical indemnity matters; • Negotiations on behalf of individual members who encounter difficulties in their employment. The Association represents the views of Consultants through the formulation of policy documents and position papers on a wide range of issues affecting acute hospital services, mental health services, and patient care.

Section 5 identifies the type of contract being offered. Section 8(a) identifies the employer and the location(s) in which the Consultant will work. The location(s) should be a physical location and not the name of a service.

Probation Public sector appointments are permanent and pensionable. Appointees are, however, subject to a 12-month probationary period. This may be extended at the employer’s discretion. At the end of your probationary period the employer shall certify that your service has been satisfactory and confirm your appointment or give stated reasons why it has not and you will cease to hold the appointment. In the event of a Consultant moving from one public appointment to another, he or she will not be required to serve more than 12 months’ probation in the aggregate.

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Members’ Handbook If you hold a joint appointment, e.g. with a University and a hospital, your holding of one part of the post is contingent on you holding the other part also.

if they do not avail of the career break scheme to pursue their training. It is possible to “buy back” this service at a later stage. The Department of Finance issues tables under which credits for these years and appropriate contributions are calculated.

Pension Arrangements All consultant posts in the Public Health Sector are pensionable.

Existing Superannuation Scheme Members Consultants who are not new entrants, e.g. Consultants who took up their public appointments before 1st January 2013, are deemed to be superannuated under their pre-existing schemes. There are three main schemes in place, namely: • The Voluntary Hospitals Superannuation Scheme; • The HSE/Local Government Superannuation Scheme; and • The Nominated Health Agency Superannuation Scheme. There is interchangeability between each scheme. The scheme under which a member is superannuated is contingent on the employer’s status. Consultants who were recruited before 1 April 2004 who previously had a mandatory retirement age of 65 can now remain in employment up to age 70 if they wish. The pension payable on retirement is based on years of reckonable service. 1/80th of the final pensionable remuneration is payable for every completed year of reckonable service up to a maximum of 40/80th. A pro rata adjustment is made for parts of years. The schemes make allowance for the late entry age of consultants into public sector employment by the discretionary award of ‘Professional Added Years’, which can result in an award of additional service calculated as 1/3 of actual service up to a maximum of 10 years at no cost to the member. For new entrants recruited on or after 1st April 2005 an award of up to five years may be granted. Members must purchase all reckonable service e.g. temporary service, for which refunds/gratuity was authorised before granting an award for professional added years. Following the death of a retired consultant, a pension of 50% of the member’s pension is payable to the spouse. One third of the member’s pension is payable to each dependent child up to a maximum of three children. All service in a pensionable position, including that served during training, counts in arriving at the length of service. NCHDs who leave with less than 5 years’ service after completion of training may be given a refund of their superannuation contributions

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A lump sum is payable on retirement. It is calculated at the rate of 3/80th of the final pensionable remuneration for each year of reckonable service up to a maximum of 120/80th. This may be subject to abatement in respect of any period during which the Consultant was not contributing to the Spouse and Child element of the scheme. The first e200,000 of pension lump sum payable on retirement is tax-free. This is a total lifetime limit even if lump sums are taken at different times and from different pension arrangements. Lump sums between e200,001 and e500,000 are taxed at 20%, with any balance over this amount taxed at the marginal rate and subject to the Universal Social Charge.

Single Public Service Pension Scheme Members Consultants deemed to be new entrants taking up public appointments after 1st January 2013 are superannuated under the Single Public Service Pension Scheme. Those who are not deemed new entrants continue to be superannuated under their pre-existing scheme (see above). Main features of the Single Public Service Pension Scheme: • career average earnings are used to calculate benefits (a pension and lump sum amount accrue each year and are up-rated each year by reference to CPI) • minimum pension age for most members is linked to the State Pension age (66 years initially, rising to 67 in 2021 and 68 in 2028) • compulsory retirement age of 70 applies for most members • post retirement pension increases are linked to CPI. • there is no provision for the award of professional added years. Pension and lump sum are separately accrued each year using the following formulae: Pension: Accruing rate of 0.58% pensionable remuneration up to a ceiling of 3.74 x State Pension Contributory (SPC) (currently e48,450) plus (where applicable) 1.25% of pensionable remuneration above that level. Lump Sum: 3.75% of pensionable remuneration. Contributions to the scheme are deducted at 3.5% of net pensionable remuneration i.e. pensionable

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Members’ Handbook remuneration less twice the rate of the State Pension, plus 3% of pensionable remuneration. During the scheme membership, the amounts accrued each year will be increased to reflect the CPI increase between that year and retirement. The annual pension and lump sum payable at retirement will equal the total of these CPI adjusted amounts. The minimum retirement age under this scheme is 66 years (rising to 67 in 2021 and 68 in 2028) and retirement becomes compulsory at 70. Members required to retire on medical grounds with less than two years' service will receive a gratuity of 8.5% of pensionable remuneration per year of service. Those with more than 2 years' service will receive an immediate payment of retirement benefits accrued to the point of retirement (with no actuarial reduction). Where a member superannuated under the Scheme dies in service, a lump sum becomes payable to the estate of the deceased member equal to twice the annual pensionable remuneration at time of death. In those circumstances the spouse/civil partner will receive a pension equal to 50% of the member's pension. Also, children's benefits become payable on the basis that total payments will not exceed 100% of the member's pension. Following retirement, pension increases will be based on increases in the CPI.

Standard Fund Thresholds & Personal Fund Thresholds In 2014, budgetary measures were introduced to reduce the Standard Fund Threshold (SFT) for the capital value of pension funds from e2.3m to e2.0m with effect from 1 January 2014. The reduction in the SFT means that an increased number of hospital consultants could potentially incur a tax liability in respect of the capital value of their superannuation and other pension entitlements at point of retirement. Up until July 2015, a mechanism existed whereby members affected by the SFT reduction could apply for a Personal Fund Threshold (PFT) to protect superannuation entitlements in excess of the SFT, up to a maximum of e2.3m as at 1 January 2014. While the deadline to apply for a PFT has now passed, members may still be eligible to apply for a PFT at point of retirement on a ‘look back’ basis. The ‘look back’ arrangements are relevant for Consultants who receive Professional Added Years as part of their reckonable service at point of retirement. Consultants who have already been issued with a PFT as at either 7 December 2010 or 1 January 2014 may be eligible on foot of the High Court Settlement Agreement (HC-SA) to apply on a ‘look back’ basis for a revised PFT. Those who were not previously eligible to apply for a PFT in either 2010 or 2014 may now be eligible on foot of the HC-SA to apply on a ‘look back’ basis. Members are advised to contact the Secretariat for further information in this regard.

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Early Retirement A consultant, who commenced employment in the public health service prior to April 2004, may take retirement from age 60 onwards when in normal health. Retirement benefits are based on the salary at retirement and the length of completed service plus added years. There are provisions in all superannuation schemes, including the Single Public Service Scheme, for Consultants to retire on an actuarially reduced pension from age 50 or 55 depending on date of entry. Where a consultant retires on grounds of ill health and has more than five years’ service, his pension and gratuity is based on completed reckonable service. Further years may be added to reckonable service as follows: • A consultant with between 5 and 10 years of service may add the equivalent amount of service actually served to a limit of his potential service at age 65. • A consultant with between 10 and 20 years of reckonable service may add the more favourable of: (a) The difference between actual service and 20 years subject to a limit of potential service at age 65; or (b) 6.67 years subject to a limit of potential service at age 60. • A consultant with more than 20 years’ service may add 6.67 years to a limit of his potential service at age 65. A Consultant with less than five years’ service retiring on ill health grounds will receive a gratuity of 1/12th of salary for each year of service. In addition, if he/she completed service of more than two years, a further 3/80th of salary for every year of service is paid. No pension is payable in these circumstances. Note: There are slightly different arrangements applying in respect of consultant psychiatrists working in certain registered mental hospitals. Reckonable service in excess of 20 years may be counted as double and they may retire from age 55 onwards.

Travelling & Subsistence Expenses Travelling and subsistence expenses necessarily incurred in the course of a consultant’s work are paid according to the public sector rates for senior staff. Travel expenses are payable in respect of each emergency call-out and in respect of travel between locations when a consultant is scheduled to work away from his or her base.

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Members’ Handbook Details of the most recent rates applying domestically are available in HR Circular 027/2018 which is available on request from the Assocciation, on the IHCA website or from your Human Resources department. Subsistence Allowance (Domestic) Members should note that claims may be made for periods in excess of five hours when a consultant is absent from his/ her base as part of his/her contractual obligation or when representing his/her employing authority hospital (day allowance). HR Circular 027/2018 outlines revised arrangements for overnight allowances in Dublin. Full details can be found on the IHCA website or from your Human Resources department.

and Dispute procedure provided for in Consultant Contracts. The Association subsequently wrote to the HSE highlighting that the contract CME entitlements must be honoured. This includes the provision for the carryover of unused CME for up to five years, indexation of the e3,000 annual CME allowance, recognition of a wider range of CME activities, the extension of coverage of course types and the funding of a more extensive range of software and hardware. The Association’s advice to its members is that the CME entitlements contained in their contracts cannot be diminished or restricted by unilateral communications from the HSE HR office. Members are advised to claim their CME Allowance before the end of the year.

Out of Hours Service Subsistence Allowance (Overseas) Members should be aware of the specific rates of subsistence which are payable for international travel. Details applicable since April 2017 are available in the members section of the website - www.ihca.ie.

Employers are responsible for arranging clinical cover for emergencies that arise within the hospital or for patients brought to the hospital for emergency treatment. The employers are responsible for arranging suitable rosters to provide this cover.

Continuing Medical Education

An allowance is payable in respect of this availability for duty. This Allowance (B Factor) is part of the pensionable remuneration.

In April 2014, the HSE issued a revised CME Guidance document with the following proposals: • Continuation of the existing e3,000 CME annual allowance, with provision for the relevant Clinical Director to apply for funding in excess of that amount on an exceptional basis. • Eligible costs would include registration fees for courses/conferences, associated travel, e-learning courses, certain medical journals and text books, computer software that has a CME/CPD component, annual registration fees for enrolment on a recognised Professional Competence Scheme in Ireland or outside Ireland where it is not possible for the Consultant to register on a professional competence scheme in Ireland for their specialty or subspecialty and the annual registration fee for professional memberships. • In relation to computer hardware such as laptops, tablets and iPads, the Guidance provides that “HSE MET reserves the right to directly fund site purchase of computer hardware for CME/CPD purposes. Such funding will be in line with national medical education and training policy and final decision on allocation rests with MET.” • “In very exceptional circumstances” a Clinical Director may apply prospectively for funding in excess of the e3,000 per annum figure or may apply for approval for an individual consultant’s fund to roll over for a maximum period of three years. • Refusals to provide funding may be appealed initially to hospital management and subsequently under the Grievance

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The rotas used for this are those that have been formally ratified by the hospital management. Consultants who wish to operate a sub roster within a general specialty, e.g. vascular surgery within general surgery, need to have management approval in order to attract the additional allowance. Consultants are paid additional monies (C Factor) in respect of instances where they are called to the hospital for emergencies. To qualify for these additional payments, a consultant must be: • Rostered for on-call duty and contacted by another hospital doctor, by a senior nurse or other member of the hospital staff specifically designated for the purpose and attends at the hospital; or • Rostered for on-call duty and in the exercise of his professional judgement (EPJ) attends at the hospital and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures. Details of the relevant B Factor, C Factor and other allowances are outlined in the Consolidated Salary Scales, which are available on request from the Association. B Factor allowance should be paid together with salary payments.

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Members’ Handbook Details of the most recent rates applying domestically are available in HR Circular 027/2018 which is available on request from the Assocciation, on the IHCA website or from your Human Resources department. Subsistence Allowance (Domestic) Members should note that claims may be made for periods in excess of five hours when a Consultant is absent from his/ her base as part of his/her contractual obligation or when representing his/her employing authority hospital (day allowance). HR Circular 027/2018 outlines revised arrangements for overnight allowances in Dublin. Full details can be found on the IHCA website or from your Human Resources department.

Continuing Medical Education

An allowance is payable in respect of this availability for duty. This Allowance (B Factor) is part of the pensionable remuneration.

In April 2014, the HSE issued a revised CME Guidance document with the following proposals: • Continuation of the existing e3,000 CME annual allowance, with provision for the relevant Clinical Director to apply for funding in excess of that amount on an exceptional basis. • Eligible costs would include registration fees for courses/conferences, associated travel, e-learning courses, certain medical journals and text books, computer software that has a CME/CPD component, annual registration fees for enrolment on a recognised Professional Competence Scheme in Ireland or outside Ireland where it is not possible for the Consultant to register on a professional competence scheme in Ireland for their specialty or subspecialty and the annual registration fee for professional memberships. • In relation to computer hardware such as laptops, tablets and iPads, the Guidance provides that “HSE MET reserves the right to directly fund site purchase of computer hardware for CME/CPD purposes. Such funding will be in line with national medical education and training policy and final decision on allocation rests with MET.” • “In very exceptional circumstances” a Clinical Director may apply prospectively for funding in excess of the e3,000 per annum figure or may apply for approval for an individual Consultant’s fund to roll over for a maximum period of three years. • Refusals to provide funding may be appealed initially to hospital management and subsequently under the Grievance

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The rotas used for this are those that have been formally ratified by the hospital management. Consultants who wish to operate a sub roster within a general specialty, e.g. vascular surgery within general surgery, need to have management approval in order to attract the additional allowance. Consultants are paid additional monies (C Factor) in respect of instances where they are called to the hospital for emergencies. To qualify for these additional payments, a Consultant must be: • Rostered for on-call duty and contacted by another hospital doctor, by a senior nurse or other member of the hospital staff specifically designated for the purpose and attends at the hospital; or • Rostered for on-call duty and in the exercise of his professional judgement (EPJ) attends at the hospital and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures. Details of the relevant B Factor, C Factor and other allowances are outlined in the Consolidated Salary Scales, which are available on request from the Association. B Factor allowance should be paid together with salary payments.

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Members’ Handbook Members are reminded of the HSE circular to hospitals requiring that claims for emergency call outs (C Factor claims) must be made no later than three months from the earliest date of the on-call liability to which they relate in default of which they will be forfeited. While this is not a contract requirement, members are advised to submit their claims for emergency call outs (C Factor claims) without delay to ensure that claims are not deemed ineligible. If necessary, please contact the Secretariat for advice on the issue. In addition, travelling expenses to and from the hospital are payable. Income tax should not be levied on Emergency Call-out (C Factor) travel when claimed in respect of a named patient (See Revenue Statement of Practice - SP - IT/2/07 - Tax treatment of the reimbursement of Expenses of Travel and Subsistence to Office Holders and Employees (Revised July 2015)).

Rest Days In April 2014, the HSE unilaterally circulated proposals for Consultants on 1:3 and 1:4 on-call rotas which can be summarised as follows: • Under the proposed arrangements, regardless of the rest assigned for each category of on-call incident, there will be a minimum of 15 rest days for Consultants on a 1:3 on-call rota and a minimum of 10 days for those on a 1:4. • For attendance on site on weekdays, the amount of rest assigned with each on-call incident will be 2 hours where the callout occurs before midnight and 3 hours after midnight, or the actual time if exceeded. In addition, travel time will be allowed to and from the location. • For telephone consultations, the amount of rest assigned with each call will be 30 minutes before midnight and 60 minutes after midnight, or the actual time if exceeded. • The amounts of rest assigned above will be doubled in circumstances where the on-call incident occurs on a Saturday, Sunday or bank holiday. • Each Consultant will be responsible for recording each incidence of call-out and submitting the claim to the Clinical Director by a defined date. • Rest will be taken where possible by the end of the next following month or, at the latest, within 8 weeks. • When for operational reasons, a Consultant cannot take all or any of their compensatory rest within 8 weeks, the hours outstanding will be paid at the relevant hourly rate. • Clinical Directors will have authority to assign additional rest to Consultants, where time spent providing on-call services consistently exceeds 3 call-outs per month. In such circumstances, the Clinical

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Director will assign up to 150% additional rest. • Payment of B Factor and C Factor will continue as per existing contracts. The Association’s advice to its members is that the rest day entitlements provided in their contracts cannot be diminished or restricted by unilateral communications from the HSE HR office. Accordingly, members should continue to claim their rest day entitlements without any of the restrictions or reductions proposed by the HSE which have not been agreed.

Roster Rest Day Entitlement* 1:1 5 1:2 3 1:3 2 1:4 1 * Days in lieu per four-week period

PRIVATE PRACTICE It is estimated that there are around 250 consultants in full-time private practice. Consultants wishing to establish admitting rights to a private hospital should apply, in the first instance, to the hospital management. The medical board normally considers the application and a recommendation is put forward for consideration by the hospital directors. The terms and conditions under which consultants work in private hospitals vary from institution to institution. Consultants considering such a move should satisfy themselves in relation to these matters with the hospital directly. Consultants who propose treating patients privately should register with the health insurers at an early date. Insurers will recognise consultants who hold posts approved by the HSE. They will also recognise consultants in private practice who are eligible to hold permanent posts. Each health insurer publishes a schedule of benefits for professional fees in respect of procedures and treatments provided by Consultants.

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Members’ Handbook There are three main health insurers operating in the Irish market: VHI Healthcare, Laya Healthcare, and Irish Life Health. In August 2016, Irish Life Group completed its acquisition of Aviva and GloHealth.

indemnity provider. Under the caps on professional indemnity for Consultants in private practice, the CIS covers claims in excess of minimum levels provided that such Consultants purchase indemnity up to the relevant cap applying to his or her specialty.

Other private health insurance schemes operating in Ireland include: • St Paul’s Garda Medical Aid Society • ESB Staff Medical Provident Fund • ESB Marina Staff Medical Provident Fund • The Goulding Voluntary Medical Scheme • Prison Officers Medical Aid Society • New Ireland/Irish National Staff Benevolent Fund • Sun Alliance Ireland Staff Medical Expenses Scheme • Irish Life Assurance Plc Medical Aid Society • Irish Life Assurance Plc Outdoor Staff Benevolent Fund • CIE Clerical Staff Hospital Fund

It is the unequivocal advice of the Association that consultants maintain membership of a medical defence body, such as the Medical Protection Society or other provider, for those aspects of practice not covered by the CIS.

Membership of these schemes is limited to employees of the relevant organisations only and their families. In addition, serving Officers of the Permanent Defence Forces are covered for private health insurance by the military authorities. Those of the rank of Lieutenant and Captain, or equivalent, are entitled to semi-private cover whilst officers of higher ranks are entitled to private cover. Non-commissioned officers of the Permanent Defence Forces are not covered for private health care by the military authorities.

MEDICAL INDEMNITY All Consultants are obliged to indemnify themselves against claims arising from malpractice and negligence. The Clinical Indemnity Scheme (CIS) provides cover in respect of practice in public hospitals. The Medical Practitioners (Amendment) Act 2017 has introduced a mandatory legal requirement for all medical practitioners currently registered or applying to register with the Irish Medical Council (IMC) to have the required level of professional medical indemnity. If evidence of adequate indemnity is not provided to the IMC on registration or renewal, via a Professional Indemnity Declaration Form, the doctor will not be placed on the medical register. The CIS covers all Consultants working in public hospitals and mental health services and is deemed to be sufficient for the purpose of the Act. For those working in private hospitals, evidence of the relevant minimum level of indemnity will have to be provided by way of a certificate from your insurer/broker or

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As a consultant undertakes full clinical responsibility for his or her patients, he or she could be held personally liable in the event of an adverse event occurring. Indemnity may provide cover against such an eventuality, details of which may not materialise until many years after the incident that gave rise to the injury.

MEDICO-LEGAL MATTERS Consultants are regularly called upon to provide opinions in medico-legal matters. This can vary from providing an examination and report in respect of an insurance policy application, to acting as an expert witness in a court action arising from an accident. The Medical Council, in agreement with the Law Society, states that a doctor has a moral and professional responsibility to supply a medico-legal report on request from a patient’s solicitor as failure to comply may lead to a patient being deprived of benefits to which he/she may be entitled. The Medical Council has also indicated that, under ordinary circumstances, medico-legal reports should be provided within two months after the examination or receipt of the request, whichever occurred last. Consultants are entitled to charge fees in respect of this work. The fee charged by a Consultant in this regard is a matter entirely at his or her own discretion. As a result of certain competition law provisions, the Association no longer publishes a scale of medico-legal fees. In 2012, the Revenue Commissioners issued guidance to the effect that medico-legal work may be liable for VAT. Members are advised to contact the Association and to consult with their financial advisors with regard to the appropriate treatment of such income and whether they are required to register with Revenue for VAT purposes. You are strongly advised to respond to requests for medico-legal opinions using the pro-forma letter on the following page. By so doing you will avoid any confusion or disagreement later in the matter of fees.

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Members’ Handbook PRO FORMA LETTER Re: Medico-Legal Fees: Terms & Conditions Dear Sir/Madam I write to you in response to your request to examine and prepare a medical report on behalf of your client, …………………….. I detail hereunder my fees for the following items for medico-legal work. • Examination and First Report e • Follow up Report e Note: Reports will be dispatched on receipt of the appropriate fee Attendance at Court • Half Day e • Full Day e • Travelling expenses at public service rate of e • Consultation with Solicitor or Counsel (other than at Court Hearing) e Consultation with other party’s medical advisor • By telephone e • By correspondence e • By attendance at examination e Cancellations - Courts • Standby for any reason, with less than 1 working day e • Standby for any reason, with less than 3 working days e • Attendance for any reason, with less than 1 working day e • Attendance for any reason, with less than 3 working days e I would be grateful if you would provide me with your written undertaking that your firm will be responsible for the above fees, irrespective of the outcome of the Court case or the decision of any third party. Yours faithfully,

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Members’ Handbook RESOURCE LIMITATIONS It is acknowledged that Consultants are currently working in underresourced hospitals and attending to increased demand for patient care. Recognising your professional, ethical and contractual obligation to advocate on behalf of the patient and the services you provide, see below and right a draft wording that may be used in these circumstances and addressed to Management. Please contact the Secretariat for further advice as it relates to the specific circumstances.

relationship between the patient and the Consultant in which the patient places trust in the Consultant personally involved in his/her care to make clinical decisions and to take continuing responsibility for their consequences.” 4 (c) “Services not provided as a consequence of a resource limit are the responsibility of the Employer and not the Consultant.” 4 (d) “The Employer recognises the Consultant’s obligations regarding the application of the Medical Council’s (or Dental Council, as appropriate) ethical and professional conduct guidance to the clinical and professional situations in which (s)he works.”

Private & Confidential PRO FORMA LETTER Re: Early Discharge/Bed Shortages/Resource Restrictions Dear, I wish to advise you that I had to discharge _______________ at ___________ to provide a bed for _______________ who required emergency/urgent admission on _________. I am not satisfied that ______________ was sufficiently well to be discharged and I would not have discharged him/her at this time except, as I have stated, the demand for beds from patients requiring emergency/urgent admission had to take precedence. I do not regard this practice as in the interest of patients and I am not satisfied that best standards are being observed as I am not allowed to exercise my clinical judgement in an independent manner and in the best interest of my patients. I am obliged to inform you that should anything untoward devolve on (name) due to lack of resources or should anything untoward devolve on any patient who is discharged prematurely due to a shortage of beds, responsibility for same will rest with (name of board/hospital). Note: You should quote the relevant extracts below from the Contract that you personally hold in the above letter.

2008 Consultant Contracts 10 (b) “The Consultant is clinically independent in relation to decisions on the diagnosis, treatment and care of individual patients. This clinical independence derives from the specific

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1997 ‘Buckley’ Consultant Contract 6.3.2 “Being a consultant involves taking responsibility in his own name for the diagnosis and treatment of his patients, or that aspect of care appropriate to him when consulted, without supervision of his clinical judgement. This is the essence of clinical independence.” 6.3.3 “Clinical independence derives from the concept of the specific relationship between the patient and the doctor in which the patient authorises and trusts the doctor(s) personally involved in his care to make clinical decisions in the patient’s best interest and to take continuing responsibility for their consequences.” 6.3.5 “The contract must, therefore, recognise and expressly protect the right of the patient to the independent judgement of his personal consultant except where appropriately transferred by that consultant.” 6.5.4 “Services not provided as a consequence of a resource limit are the responsibility of the Employing Authority and not the consultant”. Medical Council, Guide to Professional Conduct and Ethics, Section 24 Healthcare Resources 24.1 “Your duty is to act in the best interests of patients and you have a responsibility to engage and advocate with the relevant authorities to promote the provision of suitable healthcare resources and facilities. If you work in a facility that is not suitable for patients or for the treatment provided, you have a responsibility to advocate on behalf of your patients for better facilities.”

Yours sincerely,

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Members’ Handbook DATA PROTECTION AND PATIENT CONFIDENTIALITY Consultants and their colleagues are subject to Irish Data Protection legislation and the EU General Data Protection Regulation (GDPR) along with the obligations required of them in respect of patient data. The integrity of the health system relies upon defined and adhered rules regarding patient confidentiality. Depending on the circumstances, the following draft letter may be relied upon in corresponding with Management on issues of patient data and confidentiality. Please contact the Secretariat for further advice as it relates to the specific circumstances.

Private & Confidential PRO FORMA LETTER Copying of Charts/Medical Notes Dear, It has come to my attention that the charts/medical notes belonging to (patient’s name) have been photocopied without my prior knowledge and I having had an opportunity to express an opinion. You will be aware that all patients are entitled to the maximum possible confidentiality in all matters concerning their medical management. This requirement applies particularly to patients who attend the psychiatric services. Consultants are obliged by their contract, the Medical Council’s Ethical Guidelines and their binding contract with their patients to observe the strictest confidence regarding their treatment. (1) I am extremely concerned that patients’ charts/notes are not always securely deposited so as to eliminate the possibility of their being perused by unauthorised personnel. (2) I have equal concerns that patients’ charts/notes have been copied by personnel who may not be fully briefed on the need for adherence to strict confidentiality. (3) I also wish to place on record my concerns that copying of charts/notes of patients under my care has taken place without any reference to me. I acknowledge that these charts/notes are the property of the patient and I am aware that the final decision on the release of information under, for example the Freedom of Information Act, is a matter for the CEO and not the managing consultant. However, I wish to emphasise that it is prudent that the managing consultant should be advised that charts are to be copied and the consultant should be allowed the opportunity to study the chart/notes in order to advise on whether or not it is appropriate to provide copies of any or all documents in a chart, depending on the nature of the request. I wish to advise that I cannot be held responsible for any action that may be taken by a patient/next of kin in the event of sensitive patient information falling into the possession of any inappropriate or unauthorised persons. This responsibility must lie with (name of employer). Yours sincerely,

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Members’ Handbook

POST-MORTEMS & INQUESTS Consultants are, on occasion, asked to perform post-mortems or to appear as witnesses at inquests. The revised scale of fees (SI 155 of 2009) has been published by the Department of Justice. Consultants wishing to acquaint themselves with the current scale may contact the Association.

REPRESENTATIONAL ASSISTANCE FOR CONSULTANTS The Association is always available to provide representational assistance to consultants in their dealings with employers and other service providers. If you require such assistance please contact a member of the Secretariat in writing, by email or by telephone. Please provide as much information as possible about the issue concerned together with any relevant documentation.

taken by the consultant in his or her own right and he or she will assume responsibility for the associated legal costs. Finally, members may be assured that any request for assistance is treated in the utmost confidence.

HEALTHY IRELAND — A FRAMEWORK FOR IMPROVED HEALTH AND WELLBEING The Government published Health Ireland – A Framework for Improved Health and Wellbeing 2013-2025 in March 2013. It described four high level goals and 64 actions that were to work together to help achieve these goals. The four high level goals are: 1. Increase the proportion of people who are healthy at all stages of life 2. Reduce health inequalities 3. Protect the public from threats to health and wellbeing 4. Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.

The provision of legal advice may be facilitated for members on request. In general, if a consultant decides to pursue legal action following the provision of such advice, the action will be

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Members’ Handbook These goals were to be delivered through a series of 64 separate actions grouped into six themes. The themes cover the following broad areas. Theme 1 – Governance and Policy The Cabinet Subcommittee on Social Policy was to oversee the implementation of the plan and oversee, monitor and address common Government policy, agenda, targets and action plans to improve health and wellbeing. All public sector organisations were to be required to promote and protect the health and wellbeing of their workforce, their clients and the community they serve. Theme 2 – Partnerships and Cross Sectoral Work This set out a series of fourteen actions designed to ensure that health and wellbeing be devolved to local areas for implementation. Theme 3 – Empowering People and Communities Action points within this theme were directed at supporting, linking and improving existing partnerships so that various sectors of society could improve their health and wellbeing. Theme 4 – Health and Health Reform The most concrete action within this theme was one to establish multi-disciplinary national teams that will lead and take responsibility for policy areas. There was to be the development of a health and wellbeing human resource plan with a view to building capacity for health and wellbeing activities. Theme 5 – Research and Evidence The development of a Healthy Ireland research plan was at the core of this theme. It was also planned to work with the Health Research Board to implement a plan to build research capacity. Theme 6 – Monitoring Reporting and Evaluating A series of nine actions were set out to ensure that the capacity and systems were in place to report and evaluate the success of Healthy Ireland. In December 2018, the Department of Health published an Outcomes Framework to monitor and drive the achievement of Health Ireland’s targets.

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GOVERNMENT HEALTH POLICY Regional Health Areas The Government announced on 17 July 2019 plans to establish six new regional health areas. Area A takes in the northeast of the country, including Dublin North, Meath, Louth, Cavan and Monaghan. Area B takes in Longford, Westmeath, Offaly, Laois, Kildare and parts of Dublin and Wicklow. Area C focuses on the south and southeast, including Tipperary South, Waterford, Kilkenny, Carlow, Wexford, Wicklow and part of South Dublin. Counties Kerry and Cork account for Area D, while Area E is made up of Limerick, Clare and Tipperary North. Area F includes Donegal, Sligo, Leitrim, Roscommon, Mayo and Galway. The regional bodies will have clearly defined populations and will plan, resource and deliver health and social care services for the needs of its population. The restructuring is in line with the Sláintecare Report, which recommended that regional bodies should be responsible for the planning and delivery of integrated health and social care services. The HSE will continue to be the central executive with responsibility for planning and strategy. HSE Board The Health Service Executive (Governance) Act 2019 was signed into law on 5 June 2019. It provides for an independent Board for the HSE, as opposed to a directorate, aimed at strengthening the management, governance and accountability of the organisation. Under the new legislation the Board will be accountable to the Minister for the performance of its functions and it will be responsible for the appointment of a CEO. The CEO will be responsible to the Board and the Board will take responsibility for assessing the CEO’s performance. The Act provides for a 10 person non-executive board together with the Chairperson and the Deputy Chairperson. National Development Plan The Government’s National Development Plan (NDP) 2018-2027 published in February 2018 pledged e10.9 billion in capital funding for the health services, to include the planned addition of a minimum of 2,600 acute hospital beds and new dedicated elective-only hospitals in Dublin, Cork and Galway to tackle waiting lists and provide access to diagnostic services. An additional 4,500 long term and short term residential beds in Community Nursing Homes in the public system are also proposed in the NDP.

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Members’ Handbook Health Service Capacity Review 2018 The NDP followed the publication in January 2018 of the Health Service Capacity Review 2018 by the Department of Health, which outlines projections of demand and capacity requirements for a range of health services to 2031. If key reforms and productivity measures are implemented, the following additional capacity will be required by 2031: • nearly 2,600 extra acute hospital beds • 48% increase in primary care workforce • 13,000 extra residential care beds (older persons services) and; • 120% increase in homecare. Without reform, the Capacity Review estimates that more than 7,000 extra acute hospital beds will be required to meet projected demand.

1. The Approach to Reform - Four Pillars 1.1 Health and Wellbeing There was to be a new focus on the need to move away from simply treating ill people to a new concentration on keeping people healthy. Future Health committed to the development of a comprehensive Health and Wellbeing Policy Framework and the establishment of a Health and Wellbeing Agency.

Sláintecare Report The Oireachtas Committee on the Future of Healthcare published the Sláintecare Report in May 2017 – its proposals for a 10 year strategy for healthcare and health policy in Ireland. The proposed new model envisages a universal single-tier health and social care system, the shifting of care out of hospitals and into the primary and community setting, waiting time guarantees for hospital care, expanded hospital capacity and the phased elimination of private care in public hospitals. A separate independent group chaired by Donal de Búitléir was set up to examine the impact of removing private practice from public hospitals and was expected to report in Q3 of 2019. Sláintecare also recommends the alignment of Hospitals Groups and Community Health Organisations (CHOs). However, the cost of implementing the proposals in the Sláintecare Report has been understated and will actually cost the taxpayer e20bn, based on IHCA estimates, if implemented over 10 years, compared with e2.8bn stated in the Report. The removal of the private practice income from public hospitals will also have a devastating effect on hospital operating budgets, costing e6.5bn over a 10 year period or in the region of e8bn per decade when adjusted for inflation, thus crippling the ability of public hospitals to treat an ever increasing number of patients.

1.3 Structural Reform Future Health committed to the structural reform of the health service and indicated that this would be critical in the journey towards Universal Health Insurance. The key concerns of structural reform included good governance, avoiding duplication and ensuring a strong regional focus in managing performance and delivering value for money. This reform included the abolition of the HSE board, the establishment of a Directorate and a new management structure in the HSE. This included the establishment of Hospital Groups, with Group CEOs having budgetary responsibility for both the HSE and voluntary hospitals within their group.

Future Health Future Health: A Strategic Framework for Reform of the Health Service 2012-2015 set out the government’s intention to deliver major reshaping of the health system by restructuring service delivery and improving organisational, financial, governance and accountability systems across the primary, community and hospital sectors.

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1.2 Service Reform Future Health supported a move away from hospital centric care to a new model of integrated care. It was the intention of Future Health that people be treated at the lowest level of complexity that was safe, timely, efficient and as close to home as possible. This was to support the reduction of costs, improve access and move towards a model of preventative and planned care.

1.4 Financial Reform Future Health committed to introducing measures aimed at addressing the financial control issues within the HSE which included the return of the Vote to the Department of Health from the HSE; the introduction of programme based budgeting; implementation of the recommendations of the 2012 Review of Financial Management Systems in the Irish Health Service; and the development and roll-out of a comprehensive financial management system as a matter of priority. A new ‘Money Follows the Patient’ (MFTP) funding model was to be introduced in order to create incentives that encourage treatment at the lowest level of complexity. This was in order to reduce costs and achieve key quality and safety objectives. 2016 was the year in which hospitals began migrating from the historic block budget approach to a model of ‘Activity Based Funding’ (ABF) for public hospital care covering inpatients and day-cases. ABF involves a ‘revenue’ stream being given to each group/hospital for specified inpatient and day-case activity, together with a block grant for other work. The combined total can be referred to as the budget, but with a very different underlying construction — if the specified work is not delivered, the ABF revenue will not be paid.

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Consultants’ Common Contract 2008 Enabling Circular 25th July 2008

To: Hospital Network Managers, Assistant National Directors (PCCC), Health Agencies Please forward this circular and attached document to all HSE agencies, voluntary hospitals, relevant corporate bodies and other non-HSE agencies under your remit. Please ensure the required form is completed in respect of each Consultant in your employment (i.e. hospital/agency). 1) General a) The purpose of this circular is to convey approval to the introduction with effect from 1st June 2008, of a revised contract for Consultant medical staff providing services under the Health Acts and to notify arrangements for the implementation of the provisions of the revised contract. A copy of the new contract is enclosed. The contract is hereafter referred to as ‘Consultant Contract 2008’. b) The terms of Consultant Contract 2008 follow negotiations with the representative bodies of the medical profession. c) Agencies should ensure that the name of the employer is inserted in the locations indicated in the document and that

e) Consultants holding the Academic Consultant Contract 1998 on a Category 1 basis may opt for a Type A or Type B Contract. Section 15 of Consultant Contract 2008 will apply to such individuals. f) Consultants holding the Academic Consultant Contract 1998 on a Category 2 basis may opt for a Type A, Type B or Type B* Contract. Section 15 of Consultant Contract 2008 will apply to such individuals. g) Regional Consultant Orthodontists may opt for a Type A, Type B or Type B* Contract on a pro-rata basis. Should such Consultants opt for a Type B or Type B* their entitlement to retained private practice is as described at Section 21 of the Consultant Contract 2008. h) Consultants (including Regional Consultant Orthodontists) holding Temporary or Locum appointments may opt for a Type A, Type B or Type B* Contract on a Temporary or Locum basis commensurate with their current Temporary or Locum post. i) Consultants who are not encompassed by the above should apply to the HSE Consultant Appointments Unit via the relevant Hospital Network Manager/Assistant National Director PCCC to be offered Consultant Contract 2008.

the appropriate deletions are made where indicated. 2) Consultants to be offered the Contract The Contract consists of the documentation specified in the preamble to the Consultant Contract 2008 document. The terms and conditions of Consultant Contract 2008 shall be offered to the following: a) Consultants currently in your employment holding permanent posts. b) Consultants currently in your employment holding fixed term (temporary) posts. The expiry date of their existing fixed-term (temporary) contract and/or its specified purpose must be incorporated into their new contract. c) Consultants currently in your employment holding locum posts. The structure, time and attendance arrangements of

4) Atypical Work Arrangements a) Consultants who are currently engaged in atypical working (e.g. flexible working, job sharing, etc.) will be offered Consultant Contract 2008 on a pro-rata basis to their current working arrangements. Should such Consultants wish to restructure their commitments such restructuring shall be subject to approval from the HSE Consultant Appointments Unit in line with the provisions of the Consultant Contract. b) Consultants who opt for Consultant Contract 2008 and who wish to avail of atypical work arrangements (e.g. flexible working, job sharing, etc.) may do so with the prior agreement of the employer.

their contract must be incorporated into their new contract. 3) Options for Existing Consultants Subject to Section 2 above: a) Category I Consultants may opt for a Type A or Type B contract. b) Category I Consultants in Emergency Medicine may also opt for a Type B* contract. c) Category II Consultants may opt for a Type A, Type B or Type B* contract. d) Geographical wholetime without fees Consultants may opt for a Type A or Type B contract.

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5) Joint Appointments a) The following wording should be used where the Consultant has a joint appointment at Section 2 of Consultant Contract: i) “This Contract is a contract of employment between (name(s) and address(es) of employer(s) for __ hours per week) and (name and address of employee)” or ii) “This Contract is a contract of employment between (name and address of employer) for __ hours per week and for __ hours per week with (name and address of other agency/agencies) and (name and address of employee)”

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b) Employers who are the contract holders for joint appointments should ensure at all times, and in respect of all aspects of the appointment, that they keep each other fully informed of any matter likely to affect the appointment. Particular attention should be paid to matters affecting probation and the confirmation or termination of appointments. 6) Making the Offer a) Employers should take great care in drawing up and issuing the contract documents. All of the bracketed spaces in the contract documentation should be filled by the employer before a contract is offered. b) Signed acceptances of the offer of Consultant Contract 2008 must be received by the employer on or before 31st August 2008. Only Consultants who accept the offer before 1st September 2008 will benefit from retrospective salary arrangements. c) Should the Consultant accept the offer of the Contract, the employer and the Consultant must sign the contract simultaneously. Under no circumstances should an employer issue signed blank forms of contract to Consultants. Where it is not possible to have the

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contract signed simultaneously, the Consultant must sign the Contract prior to the employer. The returned signed contract should be checked carefully to ensure that it is identical to that issued for signature. Any corrections, alterations, etc., should be made by the employer and fresh documents issued for signature. 7) Working Hours Consultant Contract 2008 provides – inter alia – for the following: a) The Consultant is required to undertake such duties/ provide such services as are set out in the contract in the manner specified for 37 hours per week. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The Consultant will not be obliged to work more than eight hours in any one day. b) The Consultant may be required to participate in the on-call roster as determined by the Employer. c) The Consultant rostered on-call may be required to provide an additional structured commitment on-site of up to five hours on a Saturday and/or five hours on a Sunday and/or five hours on a public holiday.

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Consultants’ Common Contract 2008 Enabling Circular 25th July 2008

8) Private Practice The private practice arrangements (where applicable) for the different contract types are set out in Sections 20 and 21 of Consultant Contract 2008. A joint management/ union committee is currently devising a measurement system to support the new private practice arrangements. 9) Salary and Other Payments a) The remuneration provisions of Consultant Contract 2008 are outlined in Section 23 of the contract document. b) A schedule setting out the updated salaries and other payments (i.e. current) for the various contract types is attached to this circular. c) Serving Consultants who opt for Consultant Contract 2008 by 31st August 2008 shall be paid the applicable revised rate at the maximum point with effect from 1st June 2008 and 1st June 2009, as set out in the attached schedule. d) Serving Consultants who exercise their option to take the revised contract between 1st September 2008 and 31st December 2008 will be assimilated onto the applicable new salary scale, at the maximum point, from the date of their signing of Consultant Contract 2008. e) Applications for the offer of the Consultant Contract 2008 after 31st December 2008 should be made to the HSE Consultant Appointments Unit. 10) Superannuation a) The Consultant will be covered by the terms of the HSE/VHSS/NHSS (as appropriate) Superannuation Scheme and the contributory associated spouses and children superannuation schemes. Appropriate deductions will be made from his/her salary in respect of his/her contributions to the scheme. In general, 65 is the minimum age at which pension is payable; however, for appointees who are deemed not to be ‘new entrants’ as defined in the Public Service Superannuation Miscellaneous Provisions Act 2004 an earlier minimum pension age may apply. b) Should: i) the Consultant be deemed to be a new entrant (as defined in the Public Service Superannuation [Miscellaneous Provisions] Act 2004), there is no specified retirement age in respect of his/her appointment to this position.

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or ii) the Consultant be deemed not to be a new entrant (as defined in the Public Service Superannuation [Miscellaneous Provisions] Act 2004), retirement is compulsory on reaching 65 years of age. 11) Clinical Directors Consultant Contract 2008 provides at Appendix IV for the appointment and selection of Clinical Directors. Information on how these appointments and selections will be made will issue separately. 12) Rest Days a) Consultants with an on-call liability shall have an entitlement to avail of rest days on the following basis: i) 1 : 1 on-call roster entitles the Consultant to five days in lieu per four week period; ii) 1 : 2 on-call roster entitles the Consultant to three days in lieu per four week period; iii) 1 : 3 on-call roster entitles the Consultant to two days in lieu per four week period; iv) 1 : 4 on-call roster entitles the Consultant to one day in lieu per four week period. b) Rest days should be taken as soon as possible following the on-call liability to which they relate. Where service demands do not permit them to be taken immediately, rest days may be accumulated: i) for a maximum of six months from the earliest date of the on-call liability to which they relate and at that point they must be availed of or forfeited. or ii) for a maximum of three months from the earliest date of the on-call liability to which they relate. If it is not possible to avail of them at the end of the three month period the Consultant may seek to be compensated for them at a rate equivalent to the daily rate for the type of post which (s)he occupies. c) A Consultant who established an entitlement to historic rest days which was recognised under the 1997 Consultant Contract retains such entitlement. 13) Record of Transition to Consultant Contract 2008 The HSE Consultant Appointments Unit will forward letters to the Employer for issue to each Consultant who opts for the Consultant Contract 2008 noting his/ her move to this contract and relevant terms.

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Consultants’ Common Contract 2008 Page No. Preamble

Section A – Terms and Conditions 1) Core Principles 2) Appointment and Tenure 3) Probation 4) Mutual Obligations 5) Contract Designation 6) Reporting Relationship 7) Hours of Work 8) Location and Residence 9) Scope of Post 10) Role of Consultant 11) Professional Competence 12) Standard Duties and Responsibilities 13) Intellectual Property 14) Medical Education, Training and Research 15) Provisions Specific to Academic Consultants 16) Advocacy 17) Consultative Structures 18) Leave, Holidays and Rest Days 19) Locum Cover 20) Regulation of Private Practice 21) Contract Type 22) Change in Contract Type 23) Salary and Other Payments 24) Superannuation 25) Confidentiality 26) Records/Property 27) Clinical Indemnity 28) Grievance and Disputes Procedure 29) Role of Review Body on Higher Remuneration 30) Conflict of Interest/Ethics in Public Office 31) Review by Employers and Medical Organisations 32) Acceptance of Contract

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Section B – Appendices Appendix I – HSE Letter of Approval Appendix II – Disciplinary Procedure Appendix III – Clinical Directorate Service Plan Appendix IV – Clinical Director Appointment and Profile Appendix V – Extracts from Consultants Contract 1997 Appendix VI – Granting of Sick Leave Appendix VII – Correspondence Between the Parties Appendix VIII – Special Leave Provisions for Consultants in Non-HSE Employment Appendix IX – Committees to Advise HSE on Consultant Applications

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Consultants’ Common Contract 2008 PREAMBLE

SECTION A - TERMS AND CONDITIONS

This document is comprised of the following:

1) Core Principles The core principles of this Contract are: a) That both the Consultant and the Employer recognise that the relationship must be founded upon mutual trust and respect for each other and that any differences under the agreement should be processed expeditiously through the grievance and disputes procedure or such other procedures provided for herein; b) Recognition of the importance of the role of Clinical Director, which places Consultants within the leadership structure in the management of the health service; c) Recognition of clinical independence and the unique nature of the relationship between each Consultant and his/her patients; d) Recognition by the Consultant that (s)he must operate within a system in which policy and procedures are determined through the corporate entity in which staff at all levels must be accountable; e) Recognition of the Consultant’s role as an advocate and the concomitant responsibility, in the first instance, to express any concerns within the employment context;

a) Terms and Conditions; b) Appendices; c) Correspondence exchanged between the parties as set out at Appendix VII; d) Terms expressly incorporated. The foregoing, constituting the contract documents, shall be read together and embody the entire understanding of the parties in respect of the matters contained therein. Note 1: Throughout this document the use of the masculine pronoun is intended to also denote the feminine gender, save where the context does not admit of such meaning. Note 2: Job descriptions for new appointees will form part of the Consultants’ Contract.

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Consultants’ Common Contract 2008 f) Recognition of the Consultant’s role in the delivery of education and training and research. 2) Appointment and Tenure a) This Contract is a contract of employment between (name and address of Employer) and (name and address of employee). (name of appointee)* is appointed to a post of ___________ and accepts the appointment from (insert date). The Contract is: i) permanent, subject to the completion of probation (as set out in Section 2); or ii) for a fixed term/purpose; or iii) a locum appointment. In the case of Consultants appointed on a fixed term / locum basis in accordance with Sections 2 a) ii) or 2 a) iii) above, Section 3 of this Contract (entitled ‘Probation’), other than paragraph 3 (f) thereof, does not apply. *Hereafter referred to as ‘The Consultant’

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b) A candidate for and any person holding the office must be in a state of health such as would indicate a reasonable prospect of ability to render regular and efficient service. c) The qualifications required for this post are set out in the Health Service Executive’s Letter of Approval as attached at Appendix I. d) Should the Consultant be required by the terms of the offer of appointment to comply with specified requirements or conditions (including a requirement or condition that (s)he shall acquire a specified qualification) before the expiration of a specified period the employment shall be terminated unless within that period the Consultant has complied with such requirements or conditions. e) With regard to resignation or retirement, the holder of a joint appointment* must act similarly in relation to each of his/her component commitments, e.g. (s)he cannot retire or resign from one participating Employer and not from the other(s). *A joint appointment is one which involves a commitment by the Consultant to two or more employing authorities. Consultants appointed on such a basis are entitled to a single contract or interdependent contracts (with reciprocal clauses).

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Switc

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Switch to ENTRESTO sooner ®

in your symptomatic chronic Heart Failure patients (HFrEF)* and keep them on the right path.1,4

Help patients stay out of hospital, live longer and feel better.1-4 ENTRESTO®. THE SOONER, THE BETTER.4 *Entresto® is indicated in adult patients for treatment of symptomatic chronic heart failure with reduced ejection fraction ABBREVIATED PRESCRIBING INFORMATION - ▼ENTRESTO film-coated tablets. This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 of the SmPC for how to report adverse reactions. Please refer to Summary of Product Characteristics (SmPC) before prescribing. Presentation: Film-coated tablets of 24 mg/26 mg, 49 mg/51 mg and 97 mg/103 mg of sacubitril and valsartan respectively (as sacubitril valsartan sodium salt complex). Indications: In adult patients for treatment of symptomatic chronic heart failure with reduced ejection fraction. Dosage and administration: The recommended starting dose of Entresto is one tablet of 49 mg/51 mg twice daily, doubled at 2-4 weeks to the target dose of one tablet of 97 mg/103 mg twice daily, as tolerated by the patient. In patients not currently taking an ACE inhibitor or an ARB, or taking low doses of these medicinal products, a starting dose of 24 mg/26 mg twice daily and slow dose titration (doubling every 3 - 4 weeks) are recommended. A starting dose of 24 mg/26 mg twice daily should be considered for patients with SBP ≥100 to 110 mmHg, moderate or severe renal impairment (use with caution in severe renal impairment) and moderate hepatic impairment. Do not co-administer with an ACE inhibitor or an ARB. Do not start treatment for at least 36 hours after discontinuing ACE inhibitor therapy. ENTRESTO may be administered with or without food. The tablets must be swallowed with a glass of water. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Concomitant use with ACE inhibitors. Do not administer until 36 hours after discontinuing ACE inhibitor therapy. Known history of angioedema related to previous ACE inhibitor or ARB therapy. Hereditary or idiopathic angioedema. Concomitant use with aliskiren-containing medicinal products in patients with diabetes mellitus or in patients with renal impairment (eGFR <60 ml/min/1.73 m2). Severe hepatic impairment, biliary cirrhosis and cholestasis. Second and third trimester of pregnancy. Warnings/Precautions: Dual blockade of the renin angiotensin-aldosterone system (RAAS): Combination with an ACE inhibitor is contraindicated due to the increased risk of angioedema. ENTRESTO must not be initiated until 36 hours after taking the last dose of ACE inhibitor therapy. If treatment with ENTRESTO is stopped, ACE inhibitor therapy must not be initiated until 36 hours after the last dose of ENTRESTO. Combination of ENTRESTO with direct renin inhibitors such as aliskiren is not recommended. ENTRESTO should not be co administered with another ARB containing product. Hypotension: Treatment should not be initiated unless SBP is ≥100 mmHg. Patients with SBP <100 mmHg were not studied. Cases of symptomatic hypotension have been reported in patients treated with ENTRESTO during clinical studies, especially in patients ≥65 years old, patients with renal disease and patients with low SBP (<112 mmHg). Blood pressure should be monitored routinely when initiating or during dose titration with ENTRESTO. If hypotension occurs, temporary down-titration or discontinuation of ENTRESTO is recommended. Impaired or worsening renal function: Limited clinical experience in patients with severe renal impairment (estimated GFR <30 ml/min/1.73 m2). There is no experience in patients with end-stage renal disease and use of ENTRESTO is not recommended. Use of ENTRESTO may be associated with decreased renal function, and down-titration should be considered in these patients. Hyperkalaemia: ENTRESTO should not be initiated if the serum potassium level is >5.4 mmol/l. Monitoring of serum potassium is recommended, especially in patients who have risk factors such as renal impairment, diabetes mellitus or hypoaldosteronism or who are on a high potassium diet or on mineralocorticoid antagonists. If clinically significant hyperkalaemia occurs, consider adjustment of concomitant medicinal products or temporary down-titration or discontinuation of ENTRESTO. If serum potassium level is >5.4 mmol/l discontinuation should be considered. Angioedema: Angioedema has been reported with ENTRESTO. If angioedema occurs, discontinue ENTRESTO immediately and provide appropriate therapy and monitoring until complete and sustained resolution of signs and symptoms has occurred. ENTRESTO must not be re administered. Patients with a prior history of angioedema were not studied. As they may be at higher risk for angioedema, caution is recommended if ENTRESTO is used in these patients. Black patients have an increased susceptibility to develop angioedema. Patients with renal artery stenosis: Caution is required and monitoring of renal function is recommended. Patients with NYHA functional classification IV: Caution should be exercised due to limited clinical experience in this population. Patients with hepatic impairment: There is limited clinical experience in patients with moderate hepatic impairment (Child Pugh B classification) or with AST/ALT values more than twice the upper limit of the normal range. Caution is therefore recommended in these patients. B-type natriuretic peptide (BNP): BNP is not a suitable biomarker of heart failure in patients treated with ENTRESTO because it is a neprilysin substrate. Interactions: Contraindicated with ACE inhibitors, 36 hours washout is required. Use with aliskiren contraindicated in patients with diabetes mellitus or in patients with renal impairment (eGFR <60 ml/ min/1.73 m2). Should not be co-administered with another ARB. Use with caution when co-administering ENTRESTO with statins or PDE5 inhibitors. No clinically relevant drug-drug interaction was observed when simvastatin and ENTRESTO were co-administered. Monitoring serum potassium is recommended if ENTRESTO is co-administered with potassium-sparing diuretics or substances containing potassium (such as heparin). Monitoring renal function is recommended when initiating or modifying treatment in patients on ENTRESTO who are taking NSAIDs concomitantly. Interactions between ENTRESTO and lithium have not been investigated. Therefore, this combination is not recommended. If the combination proves necessary, careful monitoring of serum lithium levels is recommended. Co-administration of ENTRESTO and furosemide reduced Cmax and AUC of furosemide by 50% and 28%, respectively, with reduced urinary excretion of sodium. Co-administration of nitroglycerin and ENTRESTO was associated with a treatment difference of 5 bpm in heart rate compared to the administration of nitroglycerine alone, no dose adjustment is required. Co administration of ENTRESTO with inhibitors of OATP1B1, OATP1B3, OAT3 (e.g. rifampicin, ciclosporin), OAT1 (e.g. tenofovir, cidofovir) or MRP2 (e.g. ritonavir) may increase the systemic exposure of LBQ657 or valsartan. Appropriate care should be exercised. Co-administration of ENTRESTO with metformin reduced both Cmax and AUC of metformin by 23%. When initiating therapy with ENTRESTO in patients receiving metformin, the clinical status of the patient should be evaluated. Fertility, pregnancy and lactation: The use of ENTRESTO is not recommended during the first trimester of pregnancy and is contraindicated during the second and third trimesters of pregnancy. It is not known whether ENTRESTO is excreted in human milk, but components were excreted in the milk of rats. ENTRESTO is not recommended during breastfeeding. A decision should be made whether to abstain from breast feeding or to discontinue ENTRESTO while breast feeding, taking into account the importance of ENTRESTO to the mother. Adverse reactions: Very common: Hyperkalaemia, hypotension, renal impairment. Common: Anaemia, hypokalaemia, hypoglycaemia, dizziness, headache, syncope, vertigo, orthostatic hypotension, cough, diarrhoea, nausea, gastritis, renal failure, acute renal failure, fatigue, asthenia. Uncommon: Hypersensitivity, postural dizziness, pruritis, rash, angioedema. Please refer to SmPC for a full list of adverse events for ENTRESTO. Legal Category: POM. Pack sizes: ENTRESTO 24 mg/26 mg - 28 tablet pack; ENTRESTO 49 mg/51 mg - 28 and 56 tablet pack; ENTRESTO 97 mg/103 - 56 tablet pack. Marketing Authorisation Holder: Novartis Europharm Limited, Vista Building, Elm Park, Merrion Road Dublin 4, Ireland. Marketing Authorisation Numbers: ENTRESTO 24 mg/26 mg film coated tablets EU/1/15/1058/001; ENTRESTO 49 mg/51 mg film coated tablets EU/1/15/1058/002-003; ENTRESTO 97 mg/103 mg film coated tablets EU/1/15/1058/006. Full prescribing information is available on request from Novartis Ireland Ltd, Vista Building, Elm Park Business Park, Merrion Road, Dublin 4. Tel: 01 2601255 or at www.medicines.ie Date of Creation of API Text: May 2018.

Adverse events should be reported. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517; Website: www.hpra.ie; E-mail:medsafety@hpra.ie. Adverse events should also be reported to Novartis Ireland by calling 01-2080 612 or by email to drugsafety.dublin@novartis.com. References: 1. ENTRESTO Summary of Product Characteristics (SmPC) available at www.medicines.ie. 2. Claggett B, et al. N Engl J Med. 2015;373(23):2289-2290. 3. Lewis EF, et al. Circ Heart Fail. 2017;10(8):e003430. 4. McMurray JJ, et al. N Engl J Med. 2014;371(11):993-1004. © 2019 Novartis Pharma AG

Date of preparation: January 2019

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Consultants’ Common Contract 2008 The Consultant’s total commitments should not exceed that which is expected from Consultants in the same specialty who have a full-time commitment to one employer. f) If the Consultant wishes to terminate this employment (s)he shall provide the Employer(s) with three months notice of his/her proposed termination date. g) Except in cases of serious misconduct, the Employer will provide the Consultant with three months notice of the intention to terminate his or her employment. 3) Probation a) Appointment to a Consultant post (under Section 2 a) i) above) is dependent upon the satisfactory completion of a probationary period of 12 months. The probationary period may be extended at the discretion of the Employer for a period of not more than 6 months. In such event the specific reasons for the extension shall be furnished in writing to the probationary Consultant. b) At the end of the probationary period, the Employer shall either: i) certify that the Consultant’s service has been satisfactory and confirm the appointment on a permanent basis; or ii) certify, with stated specified reasons, that the Consultant’s service has not been satisfactory, in which case the Consultant will cease to hold his/her appointment. c) If the Employer should fail to certify in accordance with (b) above, the Consultant shall be deemed to have been appointed on a permanent basis. d) The Employer undertakes to advise the probationary Consultant on a timely basis of issues likely to result in the termination or extension of the probationary period. e) A Consultant who currently holds a permanent Consultant appointment in the Irish public health service will not be required to complete a probationary period should (s)he have done so already. f) A Consultant will not be required to complete the probationary period where (s)he has for a period of not less than 12 months acted in the post pending its filling on a permanent basis. g) During the probationary period, the probationary Consultant will be subject to ongoing review and a formal review will take place not more than six months after the date of first appointment on a probationary basis. h) In cases where an allegation of serious misconduct is made against a probationary Consultant, the matter will be dealt with in accordance with Stage 4 of the Disciplinary Procedure (attached at Appendix II). This does not affect

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the Consultant’s statutory rights under the Industrial Relations Acts, 1946-2004 or any other statute. i) In the case of joint appointments, the holding of any one part of the post is contingent on continuing to hold the other part or parts of the post. j) Employment may be terminated by either party during the probationary period. Should employment be terminated by the Employer, the Employer shall set out in writing the specific reasons for such termination. 4) Mutual Obligations a) Both the Consultant and the Employer recognise the need for mutual trust, confidence and respect in giving effect to the terms of this contract. b) Both the Consultant and the Employer shall co-operate in giving effect to such arrangements as are put into place to verify the delivery of the Consultant’s contractual commitments. c) The determination of the range, volume and type of services to be provided and responsibility for the provision of same within available resources rests with the Employer. Services not provided as a consequence of a resource limit are the responsibility of the Employer and not the Consultant. d) The Employer recognises the Consultant’s obligations regarding the application of the Medical Council's (or Dental Council, as appropriate) ethical and professional conduct guidance to the clinical and professional situations in which (s)he works. 5) Contract Designation This contract is designated as a Type ___ (insert in line with HSE Letter of Approval) Contract as set out in the HSE Letter of Approval for this post attached at Appendix I. Details regarding Type of Contract and change of Type of Contract are set out at Sections 21 and 22. 6) Reporting Relationship The Consultant’s reporting relationship and accountability for the discharge of his/her contract is: i) t o the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) through his/her Clinical Director* (where such is in place). The Hospital Network Manager or Assistant National Director HSE PCCC Directorate may require the Consultant to report to him/her from time to time. or ii) in the case of Consultant Psychiatrists, to the Clinical Director and the Local Health Office Manager PCCC Directorate

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Consultants’ Common Contract 2008 (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE). *Details of the Appointment and Profile of the Clinical Director are contained in Appendix IV 7) Hours of Work a) The Consultant is contracted to undertake such duties/ provide such services as are set out in this Contract in the manner specified for 37 hours per week. This 37 hour commitment will normally be delivered across a span of 12 hours between the hours of 8am and 8pm Monday to Friday. The Consultant will not be obliged to work more than eight hours in any one day. This will be structured as a single continuous episode. Scheduling arrangements may be changed from time to time within the 8am to 8pm period in line with clinical and/or service need as determined by the Clinical Director/Employer in consultation with the Consultant. b) The aggregation of the Consultant’s commitments in a given time period shall be on a cumulative basis of 37 hours per week. This does not imply that the Consultant’s work is organised in equal periods of time. If the time worked consistently and significantly varies from the scheduled commitment, there will be a review of the commitment to ensure that the Consultant is not working regularly in excess of or less than the 37 hour weekly commitment. Where the commitment is being unavoidably exceeded for reasons of a temporary nature, local arrangements will be made to compensate the Consultant concerned. c) In addition to the contracted commitment per week specified at Section 7 (a) above: i) the Consultant may be required to participate in the on-call roster as determined by the Clinical Director/Employer. Payment arrangements for on-call liability are set out at Section 23 (i) and for the provision of call-out services when on-call outside scheduled commitments at Section 23 (j). ii) the Consultant rostered on-call may be required to provide a structured commitment on-site of up to five hours on a Saturday and/or five hours overtime on a Sunday and/or five hours on a public holiday. Consultants on onerous on-call rosters* shall not be expected to deliver the upper end of this requirement as determined by the Clinical Director. The Consultant’s liability for on-call outside such structured or other scheduled overtime hours will continue to apply. *Only on-call rosters of 1:4, 1:3, 1:2 or 1:1 are regarded as onerous

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d) As a senior professional employee, the Consultant may be required, from time to time, to work beyond his/her rostered period in line with the exigencies of the service. The Employer will endeavour to ensure that this will be an exceptional rather than a standard requirement. e) Where there is local agreement to implement different work patterns, (including any arrangements providing for up to 24/7 hour working) the involvement of any individual consultant in any such arrangement(s) shall be subject to his/her agreement. 8) Location and Residence a) The Consultant’s appointment shall be to ___________________ (name HSE area/HSE-funded Hospital/Agency as set out in the HSE Letter of Approval). The Consultant’s employment location(s) is ____________ (as per HSE Letter of Approval for the post if relevant). b) The Consultant’s employment location may be changed within the functional area and service range applicable to his/her Employer. In the first instance, this will be within the Hospital Network area/remit of the HSE-funded Hospital/ Agency. The Consultant shall be consulted should (s)he be required to change to an employment location outside the (Hospital Network Area/ HSE-funded Hospital/ Agency). In circumstances where a change of location is required, (e.g. hospital closures or major changes taking place in the character of the work being carried out there) the Consultant will be offered an appropriate alternative appointment without competition and consideration will be given to any request from the Consultant to change Contract Type or title of post. Subject to the provisions of the removal expenses scheme for the Health Service Executive, removal expenses shall be payable, if claimed. c) The Consultant shall be available to respond readily to clinical or service needs at the location(s) specified above. This will require the Consultant to reside convenient to the hospital/agency in which (s)he holds his/her appointment. 9) Scope of Post a) The scope of this post is as set out in the HSE letter of approval for this position at Appendix I and the Job Description as issued by the Employer. These describe the Consultant’s service commitments, accountabilities and specific duties. b) The Consultant’s annual Clinical Directorate Service Plan

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d) As a senior professional employee, the Consultant may be required, from time to time, to work beyond his/her rostered period in line with the exigencies of the service. The Employer will endeavour to ensure that this will be an exceptional rather than a standard requirement. e) Where there is local agreement to implement different work patterns, (including any arrangements providing for up to 24/7 hour working) the involvement of any individual Consultant in any such arrangement(s) shall be subject to his/her agreement. 8) Location and Residence a) The Consultant’s appointment shall be to ___________________ (name HSE area/HSE-funded Hospital/Agency as set out in the HSE Letter of Approval). The Consultant’s employment location(s) is ____________ (as per HSE Letter of Approval for the post if relevant). b) The Consultant’s employment location may be changed within the functional area and service range applicable to his/her Employer. In the first instance, this will be within the Hospital Network area/remit of the HSE-funded Hospital/ Agency. The Consultant shall be consulted should (s)he be required to change to an employment location outside the (Hospital Network Area/ HSE-funded Hospital/ Agency). In circumstances where a change of location is required, (e.g. hospital closures or major changes taking place in the character of the work being carried out there) the Consultant will be offered an appropriate alternative appointment without competition and consideration will be given to any request from the Consultant to change Contract Type or title of post. Subject to the provisions of the removal expenses scheme for the Health Service Executive, removal expenses shall be payable, if claimed. c) The Consultant shall be available to respond readily to clinical or service needs at the location(s) specified above. This will require the Consultant to reside convenient to the hospital/agency in which (s)he holds his/her appointment. 9) Scope of Post a) The scope of this post is as set out in the HSE letter of approval for this position at Appendix I and the Job Description as issued by the Employer. These describe the Consultant’s service commitments, accountabilities and specific duties. b) The Consultant’s annual Clinical Directorate Service Plan

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Consultants’ Common Contract 2008 will detail how these are to be implemented and will be validated by a series of performance monitoring arrangements. c) C ertain decision-making functions and commensurate responsibilities may be delegated to the Consultant by the Employer. These will be documented in the Clinical Directorate Service Plan. d) The Consultant may apply through the Employer to the Health Service Executive to change the structure of this post as set out in the HSE Letter of Approval. Any change in the structure of the post is subject to the determination of the HSE. e) The Consultant may apply for atypical working arrangements under the relevant health service scheme. 10) Role of Consultant a) For the purposes of this contract, a Consultant is defined as a registered medical or dental practitioner who by reason of his/her training, skill and expertise in a designated specialty, is consulted by other registered medical practitioners and who has a continuing clinical and professional responsibility for patients under his/her care, or that aspect of care on which (s)he has been consulted. b) The Consultant is clinically independent in relation to decisions on the diagnosis, treatment and care of individual patients. This clinical independence derives from the specific relationship between the patient and the Consultant in which the patient places trust in the Consultant personally involved in his/her care to make clinical decisions in the patient’s best interests and to take continuing responsibility for their consequences. c) The Consultant acknowledges that (s)he is subject to statutory and regulatory requirements and corporate policies and procedures. d) The Consultant has a substantial and direct involvement in the medical diagnosis, treatment and delivery of care to patients. Each patient will have a named Consultant who has continuing responsibility for his/her diagnosis, treatment and care. e) The Consultant may discharge his/her responsibilities through: i) a direct personal relationship with the patient; ii) shared responsibility with other Consultants who contribute significantly to patient management; iii) delegation of aspects of the patient’s care to another appropriate staff member. Delegation of responsibility to other doctors or staff by a Consultant is subject to: (1) t he Consultant being satisfied that the relevant staff member has the necessary professional capability and (2) t he continued provision of a commensurate level of

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diagnosis, treatment and care to the patient. The Consultant shall retain a continuing overall responsibility for the care of the patient. f) The Consultant will generally work as part of a Consultant team. The primary purpose of Consultant teams is to ensure Consultant provided services to patients on a frequent and continuing basis. In effect this requires that the Consultant provides diagnosis, treatment and care to patients under the care of other Consultants on his/her Consultant team and vice versa. This may include discharge and further treatment arrangements, as appropriate. g) The membership of the Consultant team will be determined in the context of the local working environment. The team may be defined at specialty/ sub-speciality level or under a more broadly based categorisation, e.g. general medicine, general surgery. 11) Professional Competence The Consultant shall maintain his/her professional competence on an ongoing basis pursuant to any Medical Council/Dental Council professional competence scheme applicable to the Consultant as a medical/dental practitioner. The Employer shall facilitate the maintenance of the Consultant’s professional competence pursuant to any Medical Council/Dental Council professional competence scheme applicable to the Consultant as a registered medical practitioner. Commitments in this regard will be reflected in the Clinical Directorate Service Plan. 12) Standard Duties and Responsibilities a) To participate in development of and undertake all duties and functions pertinent to the Consultant’s area of competence, as set out within the Clinical Directorate Service Plan*and in line with policies as specified by the Employer. *A sample Clinical Directorate Service Plan is attached at Appendix III. Appendix VII also refers. b) To ensure that duties and functions are undertaken in a manner that minimises delays for patients and possible disruption of services. c) To work within the framework of the hospital/agency’s service plan and/or levels of service (volume, types etc.) as determined by the Employer. Service planning for individual clinical services will be progressed through the Clinical Directorate structure or other arrangements as apply. d) To co-operate with the expeditious implementation of the Disciplinary Procedure (attached at Appendix II).

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Consultants’ Common Contract 2008 e) T o formally review the execution of the Clinical Directorate Service Plan with the Clinical Director/ Employer periodically. The Clinical Directorate Service Plan shall be reviewed periodically at the request of the Consultant or Clinical Director/Employer. The Consultant may initially seek internal review of the determinations of the Clinical Director regarding the Service Plan. f) To participate in the development and operation of the Clinical Directorate structure and in such management or representative structures as are in place or being developed. The Consultant shall receive training and support to enable him/her to participate fully in such structures. g) To provide, as appropriate, consultation in the Consultant’s area of designated expertise in respect of patients of other Consultants at their request. h) To ensure in consultation with the Clinical Director that appropriate medical cover is available at all times having due regard to the implementation of the European Working Time Directive as it relates to doctors in training. i) To supervise and be responsible for diagnosis, treatment and care provided by non-Consultant Hospital Doctors (NCHDs) treating patients under the Consultant’s care. j) To participate as a right and obligation in selection processes for non-Consultant Hospital Doctors and other staff as appropriate. The Employer will provide training as required. The Employer shall ensure that a Consultant representative of the relevant specialty/sub-specialty is involved in the selection process. k) T o participate in clinical audit and proactive risk management and facilitate production of all data/ information required for same in accordance with regulatory, statutory and corporate policies and procedures. l) To participate in and facilitate production of all data/information required to validate delivery of duties and functions and inform planning and management of service delivery. 13) Intellectual Property Intellectual property generated by the Consultant in the course of his/her employment shall be in the ownership of the relevant health sector/academic Employer(s). Due regard shall be given to national policy and national codes of practice*. *e.g. the National Code of Practice for Managing Intellectual Property from Publicly Funded Research (ICSTI, April 2004) and National Code of Practice for Managing and Commercialising Intellectual Property from Public-Private Collaborative Research (ASC, November 2005).

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14) Medical Education, Training and Research a) The Consultant shall, as part of his/her standard contractual commitment, contribute to the education, training and supervision of students, non-Consultant Hospital Doctors and trainee professionals including members of the multi-disciplinary team. b) The Consultant shall, as part of his/her standard contractual commitment, contribute to the advancement of knowledge by facilitating and supporting research. c) Where the Consultant is employed by an Academic Teaching Hospital/Agency, the Employer(s) shall, through the Clinical Director, ensure that the Clinical Directorate Service Plan takes account of the academic schedule and related delivery of academic commitments. d) The Employer shall liaise with: i) The relevant University/Universities regarding local arrangements for the provision of undergraduate medical education and training, and research; and ii) The relevant University/Universities and the relevant recognised Postgraduate Training Body(ies) regarding local arrangements for the provision of postgraduate medical education and training e) The Consultant may, with the agreement of the Employer, within the 37 hour commitment, make an explicit further structured and scheduled commitment to educational activities commensurate with his/her role in conjunction with (i) the relevant affiliated Medical/Dental School(s) and (ii) training bodies for postgraduate medical education and training. Such structured and scheduled commitment, responsibility and accountability for same will be agreed with the relevant Medical/Dental School or training body and will be consistent with the agreed training principles for postgraduate medical education and training*. These structured commitments shall be set out in the Clinical Directorate Service Plan. *‘Training Principles to be incorporated into new working arrangements for doctors in training’, published by the Medical Education and Training Group, July 2004. f) The Consultant may, in line with Section 9, have the opportunity to restructure his/her commitments to facilitate structured research or educational programme development for a defined period, subject to the agreement of the relevant Employer; funding being identified to support such activity for that period and such research being subject to appropriate research governance and ethics.

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Consultants’ Common Contract 2008 15) Provisions Specific to Academic Consultants a) All terms of this contract are applicable to the holders of Academic Consultant posts which have been approved through the established HSE/HEA process in response to agreed submissions from the relevant University(ies) and clinical Employer(s). The provisions set out in this section are confined to holders of Academic Consultant posts approved by the HSE/HEA* and are additional and particular to Academic Consultants. *And previously Comhairle na nOspidéal. b) Academic Consultant posts are joint appointments between Universities* and the HSE or its funded agencies. They are structured to ensure a minimum 50 per cent commitment to the academic institution. *For the purposes of this document the term ‘University’ shall include the Royal College of Surgeons in Ireland. c) The HSE (or HEA, as appropriate), may, following consultation and agreement with the Employer(s), structure Academic Consultant posts at Senior Lecturer and Associate Professor level to reflect a lower commitment*, where: i) the nature of the clinical sub-specialty associated with the Academic Consultant post is such that a commitment to clinical duties in excess of 50 per cent is required for the appointee to maintain the required skills and competencies and/or ii) the academic department does not require an individual structured commitment of 50 per cent to deliver its teaching and research programmes. *Structured Academic Consultant posts will have a minimum 30 per cent commitment to the Academic Institution. d) Academic Consultants are graded as follows: i) Professor/Consultant; ii) Associate Professor/Consultant; iii) Senior Lecturer/Consultant. The Professor/Consultant, where appointed pursuant to the relevant statutes and regulations of the University, will act as head of the Academic Department or other relevant academic unit, with responsibility for the academic curriculum and administration of the Academic Department or unit*. *The academic governance and management structures in universities are subject to ongoing reform and change and the Academic Departments may no longer be the fundamental organisational unit within these structures. e) The Academic Consultant is accountable for the

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delivery of the clinical component of the post as provided for in the body of this Contract. f) The Academic Consultant is accountable via the management and governance structures in place in the University in relation to the delivery of their academic commitment. g) The Academic Consultant’s role in teaching and training on the University campus extends to the relevant clinical site(s) for both undergraduates and postgraduates and shall, where required, include responsibility for relevant University students, teaching, training, assessment, modules and courses. h) Management and governance structures in respect of academic activities will be described in a framework developed by the Employer(s) which shall, inter alia, set out the relationship between academic and clinical activities; roles and responsibilities within these structures, including the respective roles of the Clinical Director and the Academic Head of Department(s) and/or other relevant academic unit; have regard to national policy on medical education and training, and standards of medical education and training for basic and specialist medical qualifications set and published by the Medical Council. i) The Academic Consultant will fully commit to and play a key role in the development and reform of medical education and training and research in alignment with Government policy. This may include a requirement to participate in and collaborate across University and clinical sites and with postgraduate bodies and the Medical Council on international, national and regional initiatives in academic and related activities. j) The rights and obligations implied in the exercise of academic independence are recognised. 16) Advocacy a) The Consultant may advocate on behalf of patients/ service users or persons awaiting access to service. b) In the first instance such advocacy should take place within the employment context through the relevant Clinical Director or other line manager. c) Information given to the public should be expressed in clear and factual terms. It must never cause unnecessary public concern or personal distress nor should it raise unrealistic expectations. 17) Consultative Structures It is recognised that Consultants organise themselves in groupings within hospitals/health agencies in order to deal with collegiate or non-executive matters. This representative system provides a

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Consultants’ Common Contract 2008 mechanism to complement and inform the work of corporate management structures including Clinical Directorates. Where these representative structures do not exist, Employers will encourage and support their establishment, provide appropriate administrative support and encourage the fullest participation by all Consultants in the arrangements. The appropriate representative head (Chairperson or Secretary) of such a structure, e.g. Medical Board, Medical Advisory Board, Medical Committee will be accorded a consultative status regarding issues which have a significant effect on the delivery of clinical services within the hospital/health agency commensurate with their important representative function. 18) Leave, Holidays and Rest Days a) All leave or planned absences, other than those described under (e) and (f), must have prior approval from the Clinical Director/Employer. b) Leave and absences from work will normally be planned and scheduled in advance in conjunction with the Clinical Director/Employer. Leave will be approved by the Clinical Director/line manager in line with agreed rota and service requirements and notice is required in accordance with the Employer’s policy. c) Annual Leave: The Consultant’s annual leave entitlement is 31 working days per annum and as determined by the Organisation of Working Time Act 1997. d) Public Holidays Entitlement: Public holidays shall be granted in accordance with the Organisation of Working Time Act 1997 as follows: (i) In respect of each public holiday, an employee’s entitlement is as follows: (1) a paid day off on the public holiday; or (2) a paid day off within the month; or (3) an extra day’s annual leave; or (4) an extra day’s pay as the Employer may decide. e) Sick Leave: The Consultant may be paid under the Sick Pay Scheme for absences due to illness or injury. Granting of sick pay is subject to a requirement to comply with the Employer’s sick leave policy. Details of the scheme are set out at Appendix VI. f) Other Leave: Details regarding Maternity, Adoptive, Paternity, Parental, Force Majeure, Compassionate and other leave in accordance with procedures can be obtained from the Employer. g) Sabbatical Leave/Career Breaks:

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The Consultant may apply for Sabbatical Leave or Career breaks in accordance with the terms of the relevant circulars. The Employer has the right to approve or refuse such leave. h) Leave to provide services abroad: The Consultant may apply for special leave to provide services in countries where health services are underdeveloped in accordance with the relevant circular. The Employer may grant or refuse such leave. i) Special Leave: (i) Leave for special circumstances shall be available to the Consultant in accordance with the relevant circulars and subject to the agreement of the Employer. (ii) In addition and unless otherwise addressed by circular, for Consultants employed by the HSE, the provisions below and those set out in the HSE Employee Handbook apply. For Consultants employed by non-HSE agencies, the provisions below and those set out at Appendix VIII apply. The Employer may grant leave with pay for: (1) continuing education or attendance at clinical meetings of societies appropriate to the Consultant’s specialty of not more than seven days in any one year excluding travel time. (2) attendance at courses, conferences, etc. approved by the Minister for Health and Children and which the Employer is satisfied are relevant to the work on which the Consultant is engaged. (3) World Health Organisation or Council of Europe Fellowships. j) Rest Days: Consultants with an on-call liability shall have an entitlement to avail of rest days on the following basis: (1) 1 : 1 on-call roster entitles the Consultant to five days in lieu per four week period; (2) 1 : 2 on-call roster entitles the Consultant to three days in lieu per four week period; (3) 1 : 3 on-call roster entitles the Consultant to two days in lieu per four week period; (4) 1 : 4 on-call roster entitles the Consultant to one day in lieu per four week period. Rest days should be taken as soon as possible following the on-call liability to which they relate. Where service demands do not permit them to be taken immediately, rest days may be accumulated: • For a maximum of six months from the earliest date of the on-call liability to which they relate and at that point they must be availed of or forfeited; or

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Consultants’ Common Contract 2008 • For a maximum of three months from the earliest date of the on-call liability to which they relate. If it is not possible to avail of them at the end of the three-month period the Consultant may seek to be compensated for them at a rate equivalent to the daily rate for the type of post which (s)he occupies. k) Historic Rest Days: A Consultant who established an entitlement to historic rest days under the Consultant Contract 1997 (i.e. by 30th June 1998) retains such entitlement. l) Other HR Policies: All other generally applicable human resource policies, e.g. Flexible Working, Trust in Care, Dignity at Work, etc. shall apply to the Consultant. m) Travel and Subsistence: Travelling and subsistence expenses necessarily incurred in the course of a Consultant’s duties shall be met on the basis applicable to persons of appropriate senior status in the public sector. Consultants holding joint appointments or appointments involving a commitment at more than one location will be reimbursed expenses in respect of travel between locations specified in the Clinical Directorate Service Plan and agreed with the Employer(s). 19) Locum Cover a) In the event of the Consultant being absent on a scheduled or unscheduled basis, the Clinical Director/ Employer will determine the requirement for locum cover and make necessary arrangements. b) The Clinical Director/Employer will work with the Consultant in the development and execution of such arrangements as required. c) In exceptional circumstances where either sufficient cover cannot be provided or appropriate locum cover obtained, the Clinical Director/Employer may request the existing Consultants to undertake the routine work of an absent colleague in addition to their scheduled commitment. In such circumstances, appropriate compensation will be agreed with the Clinical Director. 20) Regulation of Private Practice a) S ubject to the provisions of this section, the Consultant may engage in privately remunerated professional medical/dental practice as determined by his or her Contract Type as described at Section 21 below. b) The volume of private practice may not exceed 20 per cent

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of the Consultant’s workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. c) The volume of practice shall refer to patient throughput adjusted for complexity through the medium of the Casemix system. d) The 80:20 ratio of public to private practice will be implemented through the Clinical Directorate structure. The Employer has full authority to take all necessary steps to ensure that for each element of a Consultant’s practice, s(he) shall not exceed the agreed ratio. e) The Consultant will be advised on a timely basis if his or her practice is in excess of the 80:20 ratio of public to private practice in any of his or her clinical activities. An initial period of six months will be allowed to bring practice back into line but, if within a further period of three months the appropriate ratio is not established, (s)he will be required to remit private practice fees in excess of this ratio to the research and study fund under the control of the Clinical Director. f) The Clinical Director may exercise some discretion in dealing with the implementation of the ratio either for an individual or a group of Consultants once the overall ratio in relation to the particular clinical activity is satisfied. g) The implementation of the 80:20 ratio of public to private practice shall be the subject of an audit, including an audit by the Department of Health and Children. 21) Contract Type Consultant Contract Type A a) A Consultant holding Contract Type A may engage in professional medical/dental practice exclusively for the public Employer(s) or as provided for at (c) below. b) A Consultant holding Contract Type A shall not engage in privately remunerated professional medical/dental practice. (S)he can only be remunerated for professional medical practice by way of salary as an employee under this contract or as provided for in (c) below. c) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies*, medical/dental education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical/dental opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice. The HSE may specify additional bodies* dealing with public patients or aspects of the public health system to which this

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer. *An indicative list of such bodies is available from the HSE Employers Agency, 63-64 Adelaide Road, Dublin 2, Tel: 01 6626966, Web: www.hseea.ie. Consultant Contract Type B a) A Consultant holding Contract Type B may engage in privately remunerated professional medical/dental practice only in hospitals or facilities operated by the Employer, as part of such activities that arise as part of the employment contract (e.g. home visits), colocated private hospitals on public hospital campuses and as described at (b) below. b) A Consultant holding Contract Type B who previously held a Category I or Category II Contract under the Consultants Contract 1997 may continue to hold the right to engage in privately remunerated professional medical/dental practice in locations outside the public hospital campus, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer and such private practice being commensurate with the entitlement to off-site private practice held by a Category I Consultant under the Consultants Contract 1997*; *Sections 2.9.4 to 2.9.7 inclusive of the Memorandum of Agreement attached to the Consultants Contract 1997 refer. These are attached at Appendix V. c) Where a Consultant holding Contract Type B cannot be provided with facilities on the hospital campus for outpatient private practice the Employer shall make provision for such facilities off-campus, on an interim basis, pending provision of on-campus facilities. d) The volume of private practice as described at (a) and (c) may not exceed 20 per cent of the Consultantâ&#x20AC;&#x2122;s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. e) With respect to Emergency and Outpatient Departments specifically, the Consultant shall not charge private fees in respect of: i) patients attending Emergency Departments in public hospitals; or ii) patients attending Public Outpatient Services in public hospitals. f) A common waiting list operated by the public hospital will apply

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to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director. The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an outpatient basis subject to: i) the common waiting list provisions described above; ii) all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. g) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. h) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice. The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer. Consultant Contract Type B* a) Contract Type B* is immediately available to: i) A Consultant who held a Category II Contract under the Consultants Contract 1997; subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. ii) A Consultant who held a Category I or II Contract

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 as a Consultant in Emergency Medicine under the Consultants Contract 1997, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. b) A Consultant who held a Category I Contract under the Consultants Contract 1997 may apply to change Contract Type to Contract Type B* two years after taking up Contract Type A or B. c) A Consultant holding Contract Type B* may engage in privately remunerated professional medical/dental practice in: i) hospitals or facilities operated by the Employer; ii) as part of such activities that arise as part of the employment contract (e.g. home visits), and/or in colocated private hospitals on public hospital campuses; iii) in locations outside the public hospital campus, subject to such private practice being: (1) commensurate with the entitlement to off-site private practice of a Category II Consultant under the Consultants Contract 1997; and (2) confined to periods outside the aggregate 37 hour weekly commitment and other scheduled commitments to the public service. d) The volume of private practice as described at (c) (i) and (ii) may not exceed 20 per cent of the Consultantâ&#x20AC;&#x2122;s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. e) With respect to Emergency and Out-patient Departments specifically, the Consultant shall not charge private fees in respect of: i) patients attending Emergency Departments in public hospitals, or ii) patients attending Public Out-patient Services in public hospitals. f) A common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director. The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an out-patient basis subject to: i) the common waiting list provisions described above;

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ii) all billing being processed by the Consultant in a manner that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. g) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. h) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation of reports for the Courts and Court attendance shall not be regarded as private practice. The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer. Consultant Contract Type C a) A Consultant holding Contract Type C may engage in privately remunerated professional medical/dental practice in: (i) hospitals or facilities operated by the Employer; (ii) as part of such activities that arise as part of the employment contract (e.g. home visits), in colocated private hospitals on public hospital campuses; (iii) in locations outside the public hospital campus, subject to the Consultant fully discharging his/her aggregate 37-hour weekly standard commitment as required by the Employer. b) The volume of private practice as described at (a) (i) and (ii) may not exceed 20 per cent of the Consultantâ&#x20AC;&#x2122;s clinical workload in any of his or her clinical activities, including in-patient, day-patient and out-patient. c) With respect to Emergency and Outpatient Departments specifically, the Consultant shall not charge private fees in respect of:

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(i) patients attending Emergency Departments in public hospitals; or (ii) patients attending Public Outpatient Services in public hospitals. d) A common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list will be determined by clinical need only. The list will be subject to clinical validation by the relevant Clinical Director. The Consultant may charge private fees in relation to private patients undergoing diagnostic investigations, tests and procedures on an outpatient basis subject to: i) the common waiting list provisions described above; ii) all billing being processed by the Consultant in a manner

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that is satisfactory to the hospital and in the event that insufficient information is available for verification purposes recourse may be had to the measures provided for at Section 20 (d) and (e); iii) the volume of such private practice not exceeding 20 per cent. e) The Consultant may charge private fees in relation to diagnostic investigations, tests and procedures (including radiology and laboratory procedures) referred to the public hospital by private hospitals, private clinics or other sources outside of the public health system but only where all arrangements for such referrals are effected through the Employer. f) Professional medical/dental practice carried out for or on behalf of the Mental Health Commission, the Coroner, other Irish statutory bodies or medical education and training bodies shall not be regarded as private practice. In addition, the provision of expert medical opinion relating to insurance claims, preparation

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Consultants’ Common Contract 2008 of reports for the Courts and Court attendance shall not be regarded as private practice. The HSE may specify additional bodies dealing with public patients or aspects of the public health system to which this provision will also apply. The use of public facilities for all such activities is subject to the prior agreement of the Employer. 22) Change in Contract Type a) Consultants may apply to change Contract Type to Type A, B or C at five-yearly intervals. An appeals process is set out at Section 22 (d) below. b) Those Consultants who previously held a Category I or Category II Contract under the Consultants Contract 1997 may, 2 years after accepting the Consultant Contract 2008 and thereafter at 5 yearly intervals, make application to the Health Service Executive Consultant Applications Advisory Committee* to transfer to Contract Type B*. A decision on such application will be made by the HSE following the advice of the Committee. Applicants must demonstrate that the change in Contract Type is consistent with the public interest and that there is a demonstrable benefit to the public health system. *Please refer to Appendix IX. c) Where significant changes occur in a particular area in the delivery of acute hospital care (e.g. hospital closures or major changes taking place in the character of the work being carried out there*) or where the volume of private practice is significantly below 20 per cent of total clinical workload, the Consultant shall be entitled to have his/her Contract Type reviewed by the Health Service Executive Consultant Applications Advisory Committee/ Type C Committee within the five year period. *Please refer to Section 8. d) Applications for change of Contract Type A, B or B* will be considered by the Health Service Executive Consultant Applications Advisory Committee together with the Employer’s views on the application. A decision on such application will be made by the HSE following the advice of the Committee. Applications for change of Contract Type to Contract Type B* will be considered subject to the condition that the total number of Consultants holding B*, Type C and Category 2 Contracts will be subject to an upper limit of such posts within the system. In the event that the HSE does not accede to the request, the Consultant may refer the matter to the Independent Appeals Panel for a recommendation.

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The Independent Appeals Panel shall be composed of: i) an Independent Chairperson, ii) a representative of the Consultant (e.g. from the relevant medical organisation), and iii) an Employer representative. e) Appointments for reclassification to a Type C post will be considered by the Health Service Executive Type C Committee*. A decision on such application will be made by the HSE following the advice of the Committee. Applications for change of Contract Type to Type C will be considered with reference to the total number of Consultants holding Type B*, Type C and Category II Contracts not exceeding the specified limit. In the event that the Type C Committee does not accede to the request, the matter will be referred to Chief Executive Officer of the Health Service Executive for a final decision. *Please refer to Appendix IX. 23) Salary and Other Payments a) The Consultant’s annual salary shall be as follows (in June 2007 terms) and shall be implemented on a phased basis as set out at d) below: i) for Type a Contracts a salary scale in four points as follows will apply: e222,000, e228,000, e234,000, e240,000; ii) for Type B Contracts a salary scale in four points as follows will apply: e205,000, e210,000, e215,000, e220,000; iii) for Type B* Contracts a salary rate of e190,000 will apply. iv) for Type C Contracts a salary scale in four points as follows will apply: e160,000, e165,000, e170,000, e175,000. b) The annual salary for Consultant Academics shall be as follows: i) For a Professor (Type A Contract) a salary scale in four points as follows will apply: e272,860, e280,240, e287,620, e295,000. ii) For a Professor (Type B Contract) a salary scale in four points as follows will apply: e265,650, e272,100, e278,550, e285,000 iii) For a Professor (Type B* Contract) a salary of e255,000 will apply. iv) For a Professor (Type C Contract) a salary scale in four points as follows will apply: e219,450, e226,300, e233,150, e240,000 c) All serving Consultants who take up the offer of the Consultant Contract 2008 by 31st August 2008 will be assimilated to the maximum point of the applicable new salary scale. d) The salary scales at a) and b) above will be phased on the following basis:

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Consultants’ Common Contract 2008 i) a five per cent increase on the Consultant’s existing (June 2007) rate from 14th September 2007; ii) half the balance* from 1st June 2008; iii) the remaining balance from 1st June 2009. *The term ‘half the balance’ refers to the difference between the 14th September 2007 rate and the fully implemented salary scale. These rates will attract a 2.5 per cent Towards 2016 general round increase from the 1st March 2008 and a further 2.5 per cent Towards 2016 general round increase from 1st September 2008. e) An allowance of e50,000 per annum will be paid to those Consultants appointed as Clinical Directors. f) Saturday, Sunday and Public Holidays: Structured on-site attendance at weekends and on public holidays will be subject to the following premium payments: i) Time + ½ on Saturdays. ii) Double time on Sundays and Public Holidays. g) Continuing Medical Education: The CME allowance will be increased to e3,000 with effect from the 1st June 2008. Payment will continue to be on a vouched basis, to be adjusted in line with the Consumer Price Index (CPI). This allowance may be carried over annually for a maximum of five years. h) Telecommunications: The Consultant shall be reimbursed either the cost of home or mobile phone rental. i) B Factor (On-Call) Payments: An increase in the flat annual payment to e6,000 will take effect from 1st June 2008. The payments for more onerous rosters will increase by five per cent from the same date. j) C Factor (Call-Out) Payments: The Consultant will be eligible for payment on a per call-out basis for the provision of on-site services when: i) rostered for on-call duty and is contacted by another medical practitioner in the hospital, by a senior nurse or other member of staff specifically designated for that purpose and attends on-site to provide emergency services; ii) rostered for on-call duty and who, in the exercise of his/her professional judgment, attends on-site and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures; iii) requested by another Consultant to provide on-site services in public hospital/agency to which the Consultant does not have a scheduled commitment and where such services cannot be provided within the Consultant’s scheduled commitment

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as adjusted by the Clinical Director/Employer. This payment shall be on the basis of the equivalent payment per call-out. 24) Superannuation a) The Consultant will be covered by the terms of the HSE/VHSS/ NHSS Superannuation Scheme and the contributory associated spouses and children superannuation schemes. Appropriate deductions will be made from his/her salary in respect of his/ her contributions to the scheme. In general, 65 is the minimum age at which pension is payable. However, for appointees who are deemed not to be ‘new entrants,’ as defined in the Public Service Superannuation Miscellaneous Provisions Act 2004, an earlier minimum pension age may apply. b) Should: i) the Consultant be deemed to be a new entrant (as defined in the Public Service Superannuation (Miscellaneous Provisions) Act 2004), there is no specified retirement age in respect of his/her appointment to this position. or ii) the Consultant be deemed not to be a new entrant (as defined in the Public Service Superannuation (Miscellaneous Provisions) Act 2004), retirement is compulsory on reaching 65 years of age. 25) Confidentiality a) In the course of the Consultant’s employment (s)he may have access to, or hear information concerning the medical or personal affairs of patients and/or staff. Such records and information are strictly confidential and in whatever format and wherever kept, must be safeguarded. 26) Records/Property a) The Consultant should take all reasonable measures to ensure that records are stored in such a manner that ensures confidentiality, security and ready accessibility for clinical staff when required for patient management. b) The Consultant shall not remove from the employment location any records in any format, electronic or otherwise, belonging to the Employer/Health Service Executive at any time without having authorisation. Such authorisation will be issued in advance of the first instance and apply thereafter. c) The Consultant will return to the Employer/Health Service Executive upon request, and, in any event, upon the termination of his/her employment, all records and property and equipment belonging to the Employer/Health Service Executive which are in his/her possession or control.

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Consultants’ Common Contract 2008 27) Clinical Indemnity a) The Consultant will be provided with an indemnity against the cost of meeting claims for personal injury arising out of bona fide actions taken in the course of his/her employment. b) This indemnity is in addition to the Employer’s(s’) Public Liability/Professional Indemnity/Employer’s(s’) Liability in respect of the Consultant’s nonclinical duties arising under this contract. c) Notwithstanding (a) above, the Consultant is strongly advised and encouraged to take out supplementary membership with a defence organisation or insurer of his/her choice, so that (s)he has adequate cover for matters not covered by this indemnity such as representation at disciplinary and fitness to practise hearings or Good Samaritan acts outside of the jurisdiction of the Republic of Ireland. d) Under the terms of this indemnity the Consultant is required to report to an officer designated by the Employer in such form which may be prescribed, all adverse incidents which might give rise to a claim and to otherwise participate in the Employer’s risk management programme as may be required from time to time. In the event that an adverse incident is first reported by a third party, the Consultant/ Head of Department should be notified as soon as practicable. 28) Grievance and Disputes Procedure a) In the case of a dispute arising regarding these terms and conditions, the Employer and Consultant will have recourse to and, as necessary, complete the Grievance and Disputes Procedure below. b) The purpose of this procedure is to deal with problems arising under the Contract. To the greatest extent possible, such problems should be addressed and resolved within the normal structures of the employing authority and at the earliest possible point. The parties recognize the finite nature of resources and agree that issues involving the resourcing of services, roles of hospitals and other general service issues are not amenable to the Grievance and Disputes Procedure. However, the parties further agree that disputes may arise, which although touching on or concerning such issues, are essentially concerned with the operation of the individual contract and are therefore amenable to the procedure. c) Stage 1: Local level discussions must be undertaken and completed within three months from the date on which each party to a dispute indicates in writing that it wishes to avail of this

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procedure. Where individual issues of an urgent nature arise, such as difficulties in obtaining locum cover, the Consultant shall have the right to process the matter up to the level of the Chief Executive or his nominated representative/deputy. d) Stage 2 – Mediation/Adjudication: In exceptional cases where resolution at local level does not prove possible, the matter may be referred by way of written submission to the Mediator/Adjudicator by either party. The said submission shall be transmitted in the first instance to the Secretariat who shall immediately forward the complaint to the Mediator/Adjudicator. It is prerequisite to the invocation of this procedure that local discussions have taken place prior to referral to the Mediator/Adjudicator. The Mediator/Adjudicator shall decide whether all avenues at local level have been adequately explored and exhausted and further whether the matter is appropriate for his/ her consideration. The respondent will have a period of six weeks within which to prepare and lodge a counter statement with the Secretariat and shall forward a copy of same immediately to the complainant. Mediation/ Adjudication shall commence within two weeks of the expiry of the aforesaid time limit. Should the dispute not be resolved by mediation the Mediator/Adjudicator shall proceed to issue a recommendation within four weeks of the completion of the adjudication hearing or such further time as might be agreed between parties. i) disputes about the admissibility of particular cases shall be decided by the mediator/adjudicator; ii) hearings before the Mediators/ Adjudicators shall be held in private; iii) both parties shall be entitled to representation at their own expense; iv) decisions of the Mediator/Adjudicator shall be non-binding but the parties agree that such decisions shall be afforded the status of a Labour Court Recommendation; v) the costs of the mediator/adjudicator process shall be borne by the employing authority; vi) the HSE Employers Agency shall provide the Secretariat; e) List of Mediators/Adjudicators: A list of Mediators/Adjudicators have been agreed between the parties as suitable nominees for appointment in any individual case*. It shall be for the Secretariat, in conjunction with the parties, to determine the precise Mediator/ Adjudicator to be employed in any given case. The Secretariat

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Consultants’ Common Contract 2008 will have due regard in the appointment of Mediators/Adjudicators from the panel to any possible conflict that might arise. * These are available from the HSE Employers Agency at 63-64, Adelaide Road, Dublin 2, Tel: (01) 662 696, Web: www.hseea.ie. f) Review: The parties agree that the Grievance and Disputes procedure shall be reviewed within two years of date of implementation i.e. not later than 2010. However, in the event that difficulties arise concerning individual issues of an urgent nature, then an earlier review may take place in respect of such matters at the election of any of the parties hereto not earlier than the end of June 2009.

have actual knowledge that you, or a connected person, has a material interest in a matter to which the function relates, provide at the time a statement of the facts of that interest. You should provide such statement to the Chief Executive Officer. The function in question cannot be performed unless there are compelling reasons to do so and, if this is the case, those compelling reasons must be stated in writing and must be provided to the Chief Executive Officer. e) Under the Standards in Public Office Act 2001, you must within nine months of the date of your appointment provide the following documents to the Standards in Public Office Commission at 18 Lower Lesson Street, Dublin 2: i) A Statutory Declaration, which has been made by you not more than one month before or after the date of your appointment, attesting to compliance with the tax obligations set out in section 25(1) of the Standards in Public Office Act and declaring that nothing in section 25(2) prevents the issue to you of a tax clearance certificate and either: i) a Tax Clearance Certificate issued by the CollectorGeneral not more than nine months before

29) Role of Review Body on Higher Remuneration The parties to this agreement accept that Consultants' remuneration and terms and conditions of employment should be reviewed on a regular basis. Accordingly, the Review Body on Higher Remuneration in the Public Sector should undertake such reviews as part of the general reviews undertaken by the Review Body from time to time. 30) Conflict of Interest/Ethics in Public Office a) Each Consultant should refrain from knowingly engaging in any outside matter that might give rise to a conflict of interest. b) If in doubt (s)he should consult the relevant Clinical Director/ Employer and, subject to a right of appeal, any direction given must be followed. The term ‘you’ is used in the remainder of this section to refer to the Consultant. c) Should you occupy a designated position of employment* under the Ethics in Public Office Acts 1995 and 2001, you are required, in accordance with Section 18 of the Ethics in Public Office Act 1995, to prepare and furnish an annual statement of any interests which could materially influence you in the performance of your official functions: • by Consultants employed by the Health Service Executive to the Chief Executive Officer Health Service Executive; • by Consultants employed by HSE funded agencies to the Chief Executive of the agency; not later than 31st January in the following year. * Applicable to those employees in public service whose remuneration is not less than the lowest remuneration for a Deputy Secretary in the Civil Service, i.e. e168,992 as at 14th September 2007. d) In addition to the annual statement, you must whenever you are performing a function as an employee and you

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or after the date of your appointment; or ii) an Application Statement issued by the CollectorGeneral not more than nine months before or after the date of your appointment. f) You are required under the Ethics in Public Office Acts 1995 and 2001 to act in accordance with any guidelines or advice published or given by the Standards in Public Office Commission. Guidelines for public servants on compliance with the provisions of the Ethics in Public Office Acts 1995 and 2001 are available on the Standards Commission’s website www.sipo.gov.ie. 31) Review by Employers and Medical Organisations The terms and conditions of employment as set out in this contract will be reviewed in 2013 by the representatives of the Employers and the medical organisations. 32 A cceptance of Contract a) This Contract, the associated Terms and Conditions and Appendices and terms expressly incorporated by reference or by statute contain the terms of the Consultant’s employment with _____ (insert name of Employer). b) The Consultant confirms his/her agreement to the following declaration by signing below:

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Consultants’ Common Contract 2008 Name (Block Capitals): i) I declare that I am not the subject of any investigation by a medical registration or licensing body or authority in any jurisdiction with regard to my medical practice or conduct as a practitioner. I have not been suspended from registration nor had my registration or licence cancelled or revoked by any medical registration or licensing body or authority in any jurisdiction in the last ten years nor am I the subject of any current suspension or any restrictions on practise. Also, I confirm that I am not aware that I am the subject of any criminal investigation by the police in any jurisdiction. ii) I am aware of the qualifications and particulars of this position and I hereby declare that all the particulars furnished by me are true. I hereby declare that to the best of my knowledge there is nothing that would adversely affect the position of trust in which I would be placed by virtue of this appointment. iii) I understand that any false or misleading information submitted by me will render me liable to automatic disqualification or termination of employment if already employed. I understand that this appointment is subject to the receipt of appropriate registration with the Medical Council/ Dental Council, satisfactory references, Garda/Police Clearance and Occupational Health clearance. Name (Block Capitals): Signature of Consultant: Date: iv) I have read and understood the Medical Council's 'Guide to Ethical Conduct and Behaviour'/Dental Council guidance on ethical conduct and behaviour and any other relevant guidance provided by the relevant Council in relation to ethical or professional conduct. I undertake to apply the relevant Council's ethical and professional conduct guidance to the clinical and professional situations in which I may work. v) I have read this document and I hereby accept the post of in accordance with the terms and conditions specified and I undertake to commence duty on:

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Signature of Consultant: Date: Employer (Block Capitals): Signature on behalf of Employer: Date:

SECTION B – APPENDICES APPENDIX I – HSE LETTER OF APPROVAL The HSE Letter of Approval is individual to each post and will be inserted at this section of each contract.

APPENDIX II – DISCIPLINARY PROCEDURE Guidance Notes Guidance notes on the practical operation of this disciplinary procedure are set out below. These guidelines form part of the Disciplinary Procedure: i) Where it is proposed to bypass Stages 1 or 2 of the Procedure in any case not involving an allegation of serious misconduct, the Consultant shall be advised why it is so proposed. ii) With respect to the right to confront one’s accuser and to introduce witnesses, dealt with more particularly under Stage 4 and the Appendix to the Procedure, there should be consideration in each case of the most effective manner in which disputed facts might be determined, respecting principles of natural and constitutional justice, the right of a Consultant to his/ her good name and the relevant provisions of any Code of Practice issued by the Labour Relations Commission. iii) Review of a decision to continue a Consultant on administrative leave, dealt with more particularly under the heading Protective Measures, should refer specifically to the reason(s) why continuation of the administrative leave is proposed. iv) In any investigation conducted under Stage 4 of the Procedure there should be close scrutiny of all of the evidence in arriving at any decision, having regard to the potentially serious consequences for the Consultant of a finding of misconduct. v) Disciplinary Proceedings should be confidential save where disclosure is required by law. All parties to such proceedings shall be advised that breach of such duty could itself give rise to disciplinary proceedings.

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Cosentyx® reduces the symptoms of PsA and AS and helps improve patients Quality of Life1-4 Rapid and sustained improvements in pain and fatigue for your PsA and AS patients through 2 years5-7 Sustained efficacy and favourable safety profile established across all indications through 5 years1,8,9

PsA = Psoriatic Arthritis AS = Ankylosing Spondylitis

ABBREVIATED PRESCRIBING INFORMATION ▼ COSENTYX 150 mg solution for injection in pre-filled pen. This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. See section 4.8 of the SmPC for how to report adverse reactions. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: COSENTYX 150 mg solution for injection in pre-filled pen. Therapeutic Indications: The treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy; the treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy; the treatment, alone or in combination with methotrexate (MTX), of active psoriatic arthritis in adult patients when the response to previous disease modifying anti rheumatic drug (DMARD) therapy has been inadequate. Dosage & Method of Administration: Plaque Psoriasis: Recommended dose in adults is 300 mg given as two subcutaneous injections of 150 mg. Dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Ankylosing Spondylitis: The recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Psoriatic Arthritis: For patients with concomitant moderate to severe plaque psoriasis or who are anti TNFα inadequate responders, the recommended dose is 300 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2 3 and 4, followed by monthly maintenance dosing. Each 300 mg dose is given as two subcutaneous injections of 150 mg. For all other patients, the recommended dose is 150 mg by subcutaneous injection with initial dosing at Weeks 0, 1, 2, 3 and 4, followed by monthly maintenance dosing. Based on clinical response, the dose can be increased to 300 mg. For all of the above indications, available data suggest that a clinical response is usually achieved within 16 weeks of treatment. Consideration should be given to discontinuing treatment in patients who have shown no response up to 16 weeks of treatment. Some patients with initially partial response may subsequently improve with continued treatment beyond 16 weeks. The safety and efficacy in children below the age of 18 years have not yet been established. Contraindications: Severe hypersensitivity reactions to the active substance or to any of the excipients. Clinically important, active infection (e.g. active tuberculosis). Warnings/Precautions: Infections: Cosentyx has the potential to increase the risk of infections. Serious infections have been observed in patients receiving Cosentyx in the post-marketing setting. Infections observed in clinical studies are mainly mild or moderate upper respiratory tract infections such as nasopharyngitis not requiring treatment discontinuation. Non serious mucocutaneous candida infections more frequently reported for secukinumab than placebo in psoriasis clinical studies. Caution in patients with a chronic infection or a history of recurrent infection. Instruct patients to seek medical advice if signs or symptoms suggestive of an infection occur. If a patient develops a serious infection, close monitoring and discontinue treatment until the infection resolves. Should not be given to patients with active tuberculosis. Anti tuberculosis therapy should be considered prior to initiation in patients with latent tuberculosis. Inflammatory bowel disease: Cases of new or exacerbations of Crohn’s disease and ulcerative colitis have been reported. Caution should be exercised when prescribing to patients with inflammatory bowel disease including Crohn’s disease and

ulcerative colitis. Patients should be closely monitored. Hypersensitivity reactions: In clinical studies, rare cases of anaphylactic reactions have been observed in patients receiving Cosentyx. If an anaphylactic or other serious allergic reactions occur, administration should be discontinued immediately and appropriate therapy initiated. Latex-sensitive individuals: The removable cap of the Cosentyx pre filled pen contains a derivative of natural rubber latex. Vaccinations: Live vaccines should not be given concurrently with Cosentyx. Patients may receive concurrent inactivated or non live vaccinations. Concomitant immunosuppressive therapy: Use in combination with immunosuppressants, including biologics, or phototherapy have not been evaluated. Interactions: Live vaccines should not be given concurrently with Cosentyx. In a study in subjects with plaque psoriasis, no interaction was observed between secukinumab and midazolam (CYP 3A4 substrate. No interaction seen when administered concomitantly with methotrexate (MTX) and/or corticosteroids. Fertility, Pregnancy and Lactation: Women of childbearing potential should use an effective method of contraception during treatment and for at least 20 weeks after treatment. It is preferable to avoid the use of Cosentyx in pregnancy as there are no adequate data from the use of secukinumab in pregnant women. It is not known whether secukinumab is excreted in human milk. A decision on whether to discontinue breast feeding during treatment and up to 20 weeks after treatment or to discontinue therapy with Cosentyx must be made taking into account the benefit of breast feeding to the child and the benefit of Cosentyx therapy to the woman. The effect of secukinumab on human fertility has not been evaluated. Undesirable Effects: Very common (≥1/10); Upper respiratory tract infections. Common (≥1/100 to <1/10); Oral herpes, rhinorrhoea, diarrhoea, urticaria Uncommon (≥1/1,000 to <1/100); Oral candidiasis, tinea pedis, otitis externa, neutropenia, conjunctivitis. Rare (≥1/10,000 to <1/1,000) Anaphylactic reactions. Please see Summary of Product Characteristics for further information on undesirable effects. Legal Category: POM. Marketing Authorisation Holder: Novartis Europharm Ltd, Vista Building, Elm Park, Merrion Road, Dublin 4, Ireland. Marketing Authorisation Numbers: EU/1/14/980/004-005. Date of Revision of Abbreviated Prescribing Information: October 2018. Full prescribing information is available upon request from: Novartis Ireland Limited, Vista Building, Elm Park Business Park, Elm Park, Dublin 4. Tel: 01-2204100 or at www.medicines.ie. Detailed information on this product is also available on the website of the European Medicines Agency http://www.ema.europa.eu ▼ This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Adverse events should be reported. Healthcare professionals are asked to report any suspected adverse reactions via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517; Website: www.hpra.ie E-mail: medsafety@hpra.ie. Adverse events should also be reported to Novartis Ireland by calling 01-2080 612 or by email to: drugsafety.dublin@novartis.com

References: 1. PJ Mease et al. Poster 2568. Presented at American College of Rheumatology Annual Meeting (ACR), 20-24 October 2018, Chicago, USA. 2. Strand et al. Poster 2553. Presented at American College of Rheumatology Annual Meeting (ACR), 20-24 October 2018, Chicago, USA. 3. H Marzo-Ortega et al. Poster 2556. Presented at American College of Rheumatology (ACR) Annual Meeting, October 19-24, 2018, Chicago, USA. 4. A Deodhar et al. Poster 2583. Presented at American College of Rheumatology (ACR) Annual Meeting, October 19-24, 2018, Chicago, USA. 5. McInnes et al. Arthritis Research & Therapy (2018) 20:113. 6. Gossec et al. Poster SAT0463 presented at Annual European Congress of Rheumatology, 14-17 June 2017, Madrid, Spain. 7. A Deodhar et al; Clinical and Experimental Rheumatology 2018. 8. Baraliakos X et al. Abstract L13 presented at American College of Rheumatology (ACR) Annual Meeting, October 19-24, 2018, Chicago, USA. 9. Bissonnette et al. Secukinumab demonstrates high sustained efficacy and a favourable safety profile in patients with moderate-to severe psoriasis through 5 years of treatment (SCULPTURE Extension Study); JEADV 2018. Date of Preparation: January 2019 IE02/COS19-CNF002

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 1. Purpose The delivery of a high quality health service is dependent on all staff meeting the highest standards of performance and conduct. Where possible, and as appropriate, the Clinical Director/Line Manager or such person(s) as is/are determined by the Employer will deal with individual shortcomings through discussion, counselling and appropriate assistance. The key objective is to assist the Consultant to meet the required standards. If, however, the Consultant continues to fail to meet the required standards then the disciplinary procedure will be invoked. The principles of natural and constitutional justice apply and the Consultant will be afforded the right of representation at all stages of the disciplinary process. Where the issue(s) of concern are of a clinical nature, appropriate clinical input will be obtained by the Employer in advance of any steps of the Procedure being undertaken. Where it is alleged that a Consultantâ&#x20AC;&#x2122;s capability, competence or conduct does not meet the required standards, the matter will be dealt with under the following procedure. 2. Scope This procedure covers all Consultants. 3. Procedure in Operation While the disciplinary procedure will normally be operated on a progressive basis, in cases of apparent serious misconducts Stages 1, 2 and 3 of the procedure may be bypassed and in other cases Stage 1 and/or Stage 2 may be bypassed if appropriate. In each instance where it is intended to invoke the Disciplinary Procedure, the Consultant shall be advised in writing of the specific grounds of the complaint(s) made against him/her and afforded an adequate opportunity to respond before any disciplinary action is imposed. Stage 1: Oral Warning The Consultant will normally be issued with a formal oral warning by the Clinical Director/Line Manager. This shall follow prior notification of the purpose of the meeting at which the Oral Warning may be delivered. The Oral Warning will give details of the precise nature of the matter, the improvements required and the timescale for improvement. S/he will be advised that the Oral Warning constitutes the first stage of the disciplinary procedure and failure to improve within the agreed timescale may result in further disciplinary action under Stage 2 of the disciplinary procedure. A record of the warning will be kept on the Consultantâ&#x20AC;&#x2122;s personnel file and will be removed after six months,

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subject to satisfactory improvement during this period. The Consultant will have a right to appeal the Oral Warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 working days of the Consultant being notified of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate. Stage 2: Written Warning If the Consultant fails to make the necessary improvements, s/he will normally be issued with a formal written warning by the Clinical Director/Line Manager. The written warning will give details of the matter, the improvements required and the timescale for improvement. The Consultant will also be advised that failure to improve within the agreed timescale may result in the issuing of a final written warning under Stage 3 of the disciplinary procedure. The warning will be removed after 9 months, subject to satisfactory improvement during the specified period. The Consultant will have a right to appeal the written warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 days of the Consultant being informed of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate. Stage 3: Final Written Warning If the Consultant fails to make the necessary improvements, s/ he will normally be issued with a final written warning by the Clinical Director/appropriate Line Manager. The warning will give details of the matter, the improvements required and the timescale for improvement. The Consultant will be advised that failure to improve within the agreed timescale may lead to dismissal or some other sanction short of dismissal under Stage 4 of the disciplinary procedure. The warning will be removed after a specified period, usually 12 months, subject to satisfactory improvement during this period. Where the warning relates to clinical practice there will be a peer review. The Consultant will have a right to appeal the written warning to a more senior level of management*. Appeals must be made in writing setting out the grounds for appeal within 14 days of the Consultant being notified of the decision. *Appeals will be to the Assistant National Director, NHO/National Director PCCC/CEO of the HSE-funded Agency, as appropriate.

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Consultants’ Common Contract 2008 Stage 4: Dismissal or Action Short of Dismissal Failure to meet the required standards of performance/conduct following the issuing of a final written warning will lead to a disciplinary hearing under Stage 4. The decision-maker will be the relevant National Director, HSE or CEO/General Manager in other health agencies. The outcome of the disciplinary hearing may be dismissal or action short of dismissal. The delegation of such a decision should take place only in the most exceptional circumstances. i) Serious Misconduct: The following are some examples of serious misconduct which will be dealt with from the outset under Stage 4: • Serious negligence/serious dereliction of duties; • Incapacity to perform duties due to being under the influence of alcohol, prescribed drugs or unprescribed medication; • Serious breach of the Employer’s policy(ies) on electronic equipment; • Serious bullying, sexual harassment or harassment (This would only arise where a complaint has been upheld following an investigation under the Dignity at Work policy); • Abuse of patients or clients (intellectual disability service users, relatives, etc.)*. Note: The above list is not exhaustive. *This would only arise where a complaint has been upheld following an investigation under the Trust in Care policy. ii) Capability and Competence: Where possible, as made clear at ‘Purpose’ above and subject to the relevant provisions of the Medical Practitioners Act 2007, issues of capability and competence (including clinical competence and health) will be resolved through ongoing review and support and, where necessary, through the progressive stages of the Disciplinary Procedure. However, it is acknowledged that there may be exceptional cases where there has been an apparent serious failure on the part of a Consultant to deliver the required standard of care due to some lack of capability on his/her part. In such cases of apparent serious failure, the matter will be investigated and dealt with under this stage. The investigation will include appropriate clinical input. iii) Mechanism for dealing with complaints under (i) and (ii) above: Complaints under (i) and (ii) above will be dealt with as follows: a) Notifying the Consultant of the allegation: Upon being made aware of any instance of apparent serious misconduct, senior management/the Clinical Director/Line Manager will arrange for the gathering of preliminary facts relating to the issue in order for the precise allegation to be formulated. The Consultant

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against whom the allegation is made will be advised in writing of the precise details of the allegation and invited to make an initial response. When dealing with the allegation, management will ensure, insofar as possible, that confidentiality is maintained and the Consultant against whom the allegation is made is fully protected throughout the process. b) Protective Measures: Where it appears to the Hospital General Manager/Chief Executive, HSE Network Manager, Assistant National Director PCCC that by reason of the conduct of a Consultant there may be an immediate and serious risk to the safety, health or welfare of patients or staff the Consultant may apply for or may be required to and shall, if so required, take immediate administrative leave with pay for such time as may reasonably be necessary for the completion of any investigation into the conduct of the Consultant in accordance with this procedure. This investigation should take place with all practicable speed. Placing the Consultant on paid administrative leave pending the outcome of the investigation will be reserved for only the most exceptional of circumstances. The Chair of the Medical Board or his/her deputy shall be consulted and his or her opinion considered before a decision is taken to place the Consultant on administrative leave. A review of the decision to place the Consultant on administrative leave shall be taken within two weeks of the decision and fortnightly thereafter until the matter is concluded. Where a review is sought by or on behalf of the Consultant, and the grounds for the review are stated, the review should take place immediately (the above two week limit is therefore an outer limit). The Consultant will be advised that the decision to place him/her on administrative leave is a precautionary measure designed to ensure his or her personal safety and well-being/the safety and well-being of patients and staff and not as a disciplinary sanction nor an indication of guilt. Alternative protective measures may include: • Providing an appropriate level of additional supervision. • Amendment or restriction of certain clinical duties. • Other appropriate action. The views of the Consultant and his or her response will be taken into consideration when determining the appropriate protective measures to take in the circumstances but the final decision rests with the Hospital General Manager/Chief Executive, HSE Network Manager, Assistant National Director PCCC or another equivalent person. This would also include the Masters of Maternity Hospitals, Chief Executives/General Managers of Intellectual Disability Agencies and Chief Executives of specific agencies.

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Consultants’ Common Contract 2008 c) Investigation: An investigation will be conducted by person(s) who is/are acceptable to both parties. The principles governing the conduct of the investigation and the steps in conducting the investigation are set out in Appendix 1. If the findings of the investigation uphold the allegation of serious misconduct, a disciplinary hearing will be held as at Stage 4. Both the Consultant and the employing authority shall co-operate with the investigation team to ensure that any investigation is conducted as expeditiously as possible. Investigations should normally be completed within one month of the commencement date. Both parties agree to full co-operation with the investigation process in order to ensure that it can be conducted expeditiously. The timescale may be extended in exceptional circumstances and the Consultant will be advised of the reasons for the proposed extension and given the opportunity to comment. Where an allegation is not upheld the Consultant is considered to be exonerated. d) Disciplinary Hearing: The decision maker will be the relevant National Director, HSE or the Hospital Chief Executive/General Manager as appropriate. The Consultant will be provided with a copy of the investigation report and all relevant documentation and will be informed of the following in writing in advance of the disciplinary hearing: • The status of the hearing, i.e. that it is a formal disciplinary hearing under Stage 4 (Dismissal or Action Short of Dismissal) of the Disciplinary Procedure; • The purpose of the hearing, i.e. to consider representations on the Consultant’s behalf and to decide if disciplinary action is appropriate and the nature of the sanction if any; • The possible outcome of the hearing, i.e. it may result in a decision to terminate his or her employment; and • The right to be accompanied by a representative or work colleague. The disciplinary hearing will be conducted as follows: • The Consultant will be informed of the purpose of the disciplinary hearing, the nature of the allegation and the findings of the investigation. • The Consultant and his/her representative will have the opportunity to present his/her case in response to the findings of the investigation. • The disciplinary hearing will allow the Consultant to raise any concerns regarding the investigation process if s/he feels that these concerns were not given due consideration by the investigation team. • The hearing will be adjourned to allow the decision maker to carefully

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consider the representations made on the Consultant's behalf. • The hearing will be reconvened and the Consultant will be advised of the outcome. The outcome of the disciplinary hearing will be confirmed to the Consultant in writing and copied to his/her representative. The decision may be that the allegation was not upheld, to take no further action, to dismiss the Consultant or to take disciplinary action short of dismissal which may include final written warning, suspension without pay or such other lesser sanction as is deemed appropriate. The Consultant will be advised of his/ her right to appeal the decision. iv) Appeals under Stage 4: a) Appeals against Disciplinary Sanctions Short of Dismissal: Appeals against Stage 4 disciplinary sanctions short of dismissal will be heard by an independent adjudicator who is acceptable to the Consultant. The Consultant will be required to submit the grounds for the appeal in writing within 14 days of being notified of the original decision. b) Appeal against Dismissal Decisions: If the outcome of the disciplinary hearing is a decision to dismiss, the Consultant may appeal the decision to a committee of three persons. The Consultant will be required to submit the grounds for the appeal in writing within 14 days of being notified of the original dismissal decision. An appeal against dismissal decisions will be heard by a committee comprising persons selected from a nominated panel which has been agreed between the HSE and the Consultant’s representative body. Membership of the panel will consist of: • An Independent Chairperson; • An Employee representative; and • An Employer representative. Membership of the panel will be reviewed every three years. The Chair will be selected from an agreed panel of appropriately qualified legal practitioners or other appropriate persons that may be agreed between the parties. The Committee will adopt its own procedures and may conduct such enquiries as it deems appropriate. The Committee will decide whether to confirm or vary the original dismissal decision. If the original decision is confirmed, the Consultant will be removed from the payroll.

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Consultants’ Common Contract 2008 c) Ad Misericordium Appeal: In the event of an appeal against the decision to dismiss being unsuccessful, the Consultant may make a final “mercy appeal” to the Hospital Chief Executive Officer, HSE, or other appropriate persons in the case of non-HSE agencies. The grounds for this appeal must be submitted in writing within 21 days of the employee being notified of the Committee’s decision. Nothing in this Procedure affects the Consultant’s legal rights. Appendix to Disciplinary Procedure – Investigation The investigation into allegations of serious misconduct will be carried out in accordance with the following principles: • The investigation will be conducted as expeditiously as possible and without inordinate delay; • The investigation will be carried out in strict accordance with the terms of reference and with due respect for the right of the Consultant who is the subject of the allegation to be treated in accordance with the principles of natural justice, including a presumption of innocence; • Allegations of serious misconduct or allegations that there has been a breach of discipline sufficient to invoke Stage 4 of the Disciplinary Procedure should be made in writing so that there is clarity as to the allegation(s) faced by the Consultant; • Where an allegation of serious misconduct is denied the facts supporting an allegation must be proved and an opportunity afforded to the Consultant to confront any accuser(s); • The investigation team will have the necessary expertise to conduct an investigation impartially and expeditiously; • Confidentiality will be maintained throughout the investigation to the greatest extent possible, consistent with the requirements of a fair investigation. It is not possible, however, to guarantee the anonymity of the complainant or any person who participates in the investigation; • A written record will be kept of all meetings and treated in the strictest confidence; • The investigation team may interview any person who they feel can assist with the investigation. All employees are obliged to co-operate fully with the investigation process; • Employees who participate in the investigation process will be required to respect the privacy of the parties involved by refraining from inappropriately discussing the matter with other work colleagues or persons outside the organisation; and • It will be considered a disciplinary offence to intimidate or exert pressure, directly or indirectly, on any person who may be required to attend as a witness or to attempt to obstruct the investigation process in any way.

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Steps in conducting the Investigation: • The investigation will be conducted by person(s) nominated by senior management and acceptable to both parties. • The investigation will be governed by predetermined terms of reference based on the alleged misconduct (which will be set out in writing) and any other matters relevant to the allegation. The terms of reference shall specify the following:  The timescale within which the investigation will be completed; and  The scope of the investigation.  The Consultant against whom the allegation is made will be advised of the right to representation and given copies of all documentation prior to and during the investigation process, e.g:  Details of alleged misconduct.  Witness statements (if any).  Minutes of any interviews held with witnesses.  Any other evidence of relevance. • The investigation team will interview any witnesses and other relevant persons. Confidentiality will be maintained as far as practicable. • Persons may be required to attend further meetings to respond to new evidence or provide clarification on any of the issues raised. • The investigation team will form preliminary conclusions based on the evidence gathered in the course of the investigation and invite the Consultant concerned to provide additional information or challenge any aspect of the evidence. • On completion of the investigation, the investigation team will form its final conclusions and submit a written report of its findings to the Hospital General Manager/Chief Executive/HSE Network Manager/Director PCCC/ Assistant Director PCCC, as appropriate. • The Consultant against whom the allegation is made will be given a copy of the investigation report. • On completion of the investigation, the investigation team will submit a written report in accordance with its terms of reference. However, no decision regarding disciplinary sanction should be decided upon until the decision maker has held a disciplinary hearing with the Consultant.

APPENDIX III – CLINICAL DIRECTORATE SERVICE PLAN Clinical Directorate Service Plans – Consultant Assignment/Work Schedules 1. Introduction • Provisions for organisation and delivery of services at the front-line at operational level are set out primarily in Directorate Service Plans. • The Plan is concerned, inter alia, with specifying resources/

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funding available (including workforce, facilities, etc.) and how these are deployed in delivering services. The plan specifies quantity of services to be delivered and quality/outcomes parameters to apply thereto. • The Consultant is simultaneously the key directorate resource with respect to service delivery and the core decision-maker regarding utilisation of resources of the Directorate and the organisation generally. • It is accordingly centrally important that the Consultant’s contribution at individual level is scheduled into the Directorate Service Plan over designated parameters (i.e. assignments, services, etc.) • This paper sets out high level provisions to apply in this regard.

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These provisions are likely to develop considerably over time. Further development of these issues will also be required at local level. 2. Directorate Service Plan • The Directorate Service Plan is developed and executed at two levels as follows:  Corporate level: As part of the overall Service Plan of the organisation. Set at high level. Progressed and reported on quarterly.  Directorate level: As part of the operations provisions of the Directorate. Set at directorate level. Developed, progressed and reported on monthly. • Individual Consultant assignment/work schedules are

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Consultants’ Common Contract 2008 incorporated as part of the latter. • Responsibility for development and execution of the Directorate Service Plan lies with the Clinical Director. This is effected with the full participation of Directorate personnel. • In developing the Directorate Service Plan the Clinical Director, inter alia,  Quantifies the total resources available to the Directorate for the forthcoming year/month;  Specifies services to be delivered through these resources in quantity and qualitative terms by the Directorate on an annual/ monthly basis;  Explores and determines with key Directorate personnel (including Consultants) how to deploy resources in a manner which optimises service delivery, quantity and quality in the context of requirements set out in the Corporate Service Plan;  Determines the monthly assignment/work schedule for Consultants and how each Consultant’s commitment will be discharged in achievement of the planned level of service determined for the Directorate. 3. Consultant Assignment/Work Schedules The Directorate Service Plan incorporates, inter alia, Consultant assignment and work schedules set at both Directorate and personal levels monthly. Sample assignment/work schedule documentation is found on the following pages. 4. Reporting on Directorate/Consultant Performance against Service Plans Reports on Directorate/Consultant performance against targets set in the Service Plan are produced on a monthly basis. Typically, these are provided at the following levels: • Directorate; • Specialty; and • Consultant. A sample outline of a performance report can be found on page 58. 5. General This document addresses Directorate Service Plans at a high framework level. Detailed provisions in this respect will be developed at local level within the parameters set out herein.

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APPENDIX IV – CLINICAL DIRECTOR APPOINTMENT AND PROFILE Appointment of Clinical Directors 1) The post of Clinical Director is an Executive position, appointed by the Employer. 2) It is recognised that for an appointee to function effectively as a Clinical Director (s)he would require the general confidence and support of Consultant colleagues and management. 3) The normal appointment process for a Clinical Director is a follows: a) Applications are invited in a formal manner from all Consultants in the eligible Consultant grouping b) All applicants are interviewed c) Interview panel to comprise: i) Chair ii) Two management/board representatives iii) Two Consultant representatives of whom one will be a member of the directorate grouping and the other, a non-directorate grouping member. In the case of academic appointments the interview board will include a Consultant Academic attached to the relevant Academic School. 4) In recognition of the importance of securing confidence of all parties in these new provisions, appointment in the first instance will be for two years, made on the following basis: a) Applications are invited in a formal manner from all Consultants in the eligible Consultant grouping. b) The body of Consultants within the Directorate may nominate a candidate agreed by all members of the group for the post to the Employer. In the event of an agreed nomination being secured and submitted in writing, signed by all members of the grouping, the nominee, if acceptable to the Employer, will be appointed to the post. c) In the event that no such agreed candidate emerges, the normal process will apply. Clinical Director Profile 1) A Clinical Director may cover one speciality area or a range of specialities. Each Directorate is headed by a Clinical Director, generally supported by a Nurse Manager and a Business Manager. 2) A Clinical Director will be a Medical/Dental Consultant Contract holder of the relevant Clinical Directorate, appointed by the employing authority.

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 Clinical Directorate Plan Consultant Assignment Schedule: Month:

Clinical Directorate Work Schedule - Location and Activity Service Commitment

Absence/ leave

OPD

Ward Rounds / Inpatient care

Theatre / Day Theatre

On-call

Quality & Risk (incl. Audit)

Medical Education Training and Research

Statutory Commitment

CME / CPD (protected time)

Day of month 1st

Am Pm

2nd

Am Pm

3rd

Am Pm

4th

Am Pm

5th

Am Pm

6th

Am Pm

7th

Am Pm

8th

Am Pm

9th

Am Pm

10th

Am Pm

11th

Am Pm

Etc

Am Pm

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008

Consultant Work Schedule - Month Service Commitment

Absence/ leave

OPD

Ward Rounds / Inpatient care

Theatre / Day Theatre

On-call

Quality & Risk (incl. Audit)

Medical Education Training and Research

Statutory Commitment

CME / CPD (protected time)

Day of month 1st

Am Pm

2nd

Am Pm

3rd

Am Pm

4th

Am Pm

5th

Am Pm

6th

Am Pm

7th

Am Pm

8th

Am Pm

9th

Am Pm

10th

Am Pm

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Am Pm

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 Performance Report - at Directorate, speciality / sub-speciality and Consultant level Planned vs. Actual (month) Planned

Actual

Areas of Focus Public

Private

Total

Public

Private

Total

In-patient Measures ............... ............... Day Patient Measures ............... ............... Out Patient Measures ............... ............... Ed Measures ............... ............... Other Measures ............... ............... Quality Performance Indicators ............... ............... Corporate ............... ............... Management ............... ............... Operational ............... ............... Clinical (including outcomes) ............... ...............

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 3) The primary role of a Clinical Director is to deploy and manage Consultants and other resources, plan how services are delivered, contribute to the process of strategic planning and influence and respond to organisational priorities. This will involve responsibility for agreeing an annual Directorate Service Plan, identifying service development priorities and aligning Directorate Service Plans with Hospital or Network Plans. 4) Executive power, authority and accountability for planning and developing services for and managing available resources (direct or indirect) by the Clinical Directorate are delegated from the Employer. 5) Clinical Directors report to a voluntary hospital or agency: the Chief Executive; under the Health Service Executive: Hospital Manager, the Hospital Network Manager, the Local Health Manager or the Assistant National Director, HSE PCCC Directorate, as appropriate. 6) The Clinical Director is accountable for resources used, directly and indirectly, by the Directorate and the transformation of these resource inputs into pre-planned and commensurate levels of service output in line with clinical need and as defined in patient service or other relevant terms and agreed with the Employer. 7) Each member of staff in the Directorate has a reporting relationship, through their line manager, to the Clinical Director. Each Consultant reports to the Clinical Director. 8) The role of the Clinical Director is exercised within the framework of prevailing corporate policy in areas including clinical assurance and effectiveness, quality assurance, Personnel, Finance, ICT, Estates and subject to budgetary and allocation constraints. 9) The principal duties and responsibilities of the Clinical Director include: a) Provision of strategic input and clinical advice; b) Leading the development and execution of a Service Plan for the Directorate. c) Monitoring and controlling actual performance of the Directorate against planned clinical, business and budgetary performance indicators. d) Identifying service development priorities and annual budget bids. e) Implementing the clinical audit function within the Directorate. f) Developing Practice Plans with individual Consultants and monitoring implementation. g) Fostering and implementing teamworking within the Directorate. h) Implementing the measures required to meet accreditation requirements i) Implementing and compliance with risk management policy and provisions. j) Participating in the grievance and disciplinary procedures in line with corporate policy.

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k) Ensuring a consistency of approach across the Directorate in relation to application of corporate and ethical standards/ clinical protocols in accordance with best practice. l) Contributing to effective communications within the Directorate, across the hospital/ service and with external stakeholders. m) Supporting clinical training and continuing professional development throughout the Directorate. n) Fostering a culture of teaching and research within the Directorate. o) Participating in the recruitment of permanent, temporary and locum staff as required. p) Engaging with Service Users and Representatives and actively including the Service User perspective in Service Management. q) Clinical Directors in Psychiatry have specific duties pursuant to the Mental Health Act, 2001.

Appendix V â&#x20AC;&#x201C; Extracts from Consultants Contract 1997 Sections 2.9.4 to 2.9.7 of the Memorandum of Agreement attached to the Consultants Contract 1997: â&#x20AC;&#x153;2.9.4 Each consultant will be entitled to engage in private practice within the hospital or hospitals in which he is employed. The extent to which a consultant is entitled to engage in private practice outside the hospital or hospitals in which he is employed is determined by the category of post which he holds (see Section 3 of the Memorandum of Agreement) and subject to him satisfying the employing authority that he is fulfilling his contractual commitment to the public hospital(s). 2.9.5 Where a consultant is engaged in private practice within institution(s) financed from public funds, and with which he has a contract, then that private practice will be considered as on-site. 2.9.6 Conversely, where a consultant is engaged in private practice within institution(s) where the managing authority is separate from the public hospital and/or the hospital is financed from private funds, then that private practice will be considered as off-site. 2.9.7 Notwithstanding the provisions of paragraphs 2.9.4 and 2.9.5 above, a Category 1 Consultant who, by definition, devotes substantially the whole of his professional time to a public hospital cannot treat patients in a private hospital or clinic. He may, however, see private patients in consulting rooms which are not on the site of the public hospital. The nature and extent of the

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Appendix V â&#x20AC;&#x201C; Extracts from Consultants Contract 1997 Sections 2.9.4 to 2.9.7 of the Memorandum of Agreement attached to the Consultants Contract 1997: â&#x20AC;&#x153;2.9.4 Each Consultant will be entitled to engage in private practice within the hospital or hospitals in which he is employed. The extent to which a Consultant is entitled to engage in private practice outside the hospital or hospitals in which he is employed is determined by the category of post which he holds (see Section 3 of the Memorandum of Agreement) and subject to him satisfying the employing authority that he is fulfilling his contractual commitment to the public hospital(s). 2.9.5 Where a Consultant is engaged in private practice within institution(s) financed from public funds, and with which he has a contract, then that private practice will be considered as on-site. 2.9.6 Conversely, where a Consultant is engaged in private practice within institution(s) where the managing authority is separate from the public hospital and/or the hospital is financed from private funds, then that private practice will be considered as off-site. 2.9.7 Notwithstanding the provisions of paragraphs 2.9.4 and 2.9.5 above, a Category 1 Consultant who, by definition, devotes substantially the whole of his professional time to a public hospital cannot treat patients in a private hospital or clinic. He may, however, see private patients in consulting rooms which are not on the site of the public hospital. The nature and extent of the

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Consultants’ Common Contract 2008 activities pursued in consulting rooms should not extend beyond consultation, examination of patients and the performance of minor treatments, i.e. activities normally carried out in out-patient clinics. It does not encompass day-ward procedures involving anaesthesia. The principal criterion to be employed in assessing whether any particular activity falls within the permitted limits is the effect which it has on a consultant's ready availability to the public hospital. The long-term objective is to provide consulting rooms in the public hospital(s) which may be availed of by Category 1 Consultants to see fee paying patients. Occasional consultations at the request of another consultant are not precluded by the above provisions.”

APPENDIX VI – GRANTING OF SICK LEAVE a) Sick leave may be granted to the Consultant if (s)he is incapable of performing their duties owing to illness or physical injury by the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE) only if he/she is satisfied that there is a reasonable expectation that the Consultant will be able to resume the performance of his/her duties and in the case of a fixed-term Consultant will be able to resume during his/her period of office. b) The Consultant may be required to submit him/ herself to independent medical examination before (s) he is granted sick leave and at any time during the continuance of sick leave granted to him/her. c) The Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE) may pay salary during sick leave to permanent officers in accordance with the following provisions. i) Except in the case mentioned at (c) (iv) below no salary shall be paid to a Consultant when the sick leave granted to such a Consultant during any continuous period of four years exceeds in the aggregate 365 days. ii) Subject to limitation mentioned in at (c) (i) above, salary may be paid to a Consultant at the full rate in

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respect of any days sick leave unless, by reason of such payment the period of sick leave during which such Consultant has been paid full salary would exceed 183 days during the twelve months ending on such day. iii) Subject to the limitation mentioned at (c) (i) above, salary may be paid at half the full rate after salary has ceased by reason of the provision at (c) (ii) above to be paid at the full rate. iv) If before the payment of salary ceases by reason of the provision at (c) (i) and the Chief Executive of the HSE (where the Consultant is employed by the HSE)/Chief Executive Officer/Master of the hospital or other employing institution (where the Consultant is not employed by the HSE) so consents; salary may be paid to a pensionable officer with not less than 10 years service notwithstanding (c) (i) at either half the full rate or at a rate estimated to be the rate of pension to which such officer would be entitled on retirement, whichever of such rates shall be the lesser. d) For the purposes of these provisions every day occurring within a continuous period of sick leave shall be reckoned as part of such period. From the salary paid during sick leave to a Consultant who is an insured person within the meaning of the Social Welfare Acts, 1952 to 1968, there shall be deducted the amount of any payments to which such officer has become entitled under those Acts during the period of such sick leave. e) The Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE)/Chief Executive Officer (where the Consultant is not employed by the HSE) may make appropriate salary payments during sick leave to a fixed term/locum Consultant if (s)he considers that having regard to all the circumstances of the case, such payment is reasonable. f) Where a Consultant is suffering from tuberculosis and is undergoing treatment, the Chief Executive Officer/General Manager/Master of the hospital (or other employing institution) or in the case of Consultant Psychiatrists, the Local Health Office Manager PCCC Directorate (where the Consultant is employed by the HSE) or Chief Executive Officer (where the Consultant is not employed by the HSE) may extend the foregoing provisions to allow the payment of salary at three quarters the full rate to the Consultant for the second six months of his/her illness and at half the full rate during the third six months of his/her illness.

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Consultants’ Common Contract 2008 activities pursued in consulting rooms should not extend beyond consultation, examination of patients and the performance of minor treatments, i.e. activities normally carried out in out-patient clinics. It does not encompass day-ward procedures involving anaesthesia. The principal criterion to be employed in assessing whether any particular activity falls within the permitted limits is the effect which it has on a Consultant's ready availability to the public hospital. The long-term objective is to provide consulting rooms in the public hospital(s) which may be availed of by Category 1 Consultants to see fee paying patients. Occasional consultations at the request of another Consultant are not precluded by the above provisions.”

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Consultants’ Common Contract 2008 APPENDIX VII – CORRESPONDENCE BETWEEN THE PARTIES The following correspondence is incorporated into this contract as noted in the preamble: Irish Hospital Consultants Association & Irish Medical Organisation 25th July 2008 I write to you in response to your request for written confirmation of our position on the following issues which have arisen during the negotiations on the proposed terms and conditions for a contract for consultants employed in the public health service. This letter now supersedes my earlier letter of 16th May 2008 in this regard. Co-location In accordance with Mark Connaughton’s letter of 1st February 2008, discussions will take place on the practical issues arising from co-location, when appropriate. Working Hours The normal span of the working day will be between the hours of 8am to 8pm, Monday through Friday (Section 7A of the contract refers). However some scheduled variations outside these hours will be permitted where this is demonstrably in the best interest of patient care. With respect to local agreements provided for under section 7 (e), any issues which arise around the implementation of this provision will be referred to the Contract Implementation Group. With respect to the more onerous requirements of the on-call arrangements provided for under the contract, and particularly late night working, it is agreed that consideration will be given to the position of older consultants, having regard to the provisions of equality legislation. Flexible Working Consultants are eligible to apply for flexible working under the “Health Service Flexible Working Scheme” which is designed to facilitate the retention and recruitment of staff and the maintenance of the workforce at the levels required to deliver and develop services into the future, while seeking to accommodate their work life balance. Membership of Specialist Register New appointees to consultant posts must be either eligible for entry in the Register of Medical Specialists maintained by the Medical Council pursuant to the Medical Practitioners Act 1978, or be already entered in that Register. Once the relevant sections of the Medical Practitioners Act 2007 are commenced, new

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appointees to consultant posts must be either eligible for registration, or be already registered in the Specialist Division of the register of medical practitioners to be established and maintained by the Medical Council under that Act. Letter of Appointment Letters of appointment will stipulate that contracts to be offered to each individual consultant will be consistent with the nationally agreed contract. 1997 Contract Holders – Pension Adjustments Retired consultants will, in addition to the standard national pay round increases, have special increases applied to their pensions on the same basis as their serving counterparts who opt to remain on the 1997 contract. Public Private Ratio – Serving Consultants Serving consultants whose public to private ratio in 2006 was greater than 20 per cent will be permitted to retain this higher ratio, subject to an overriding maximum ratio of 70:30, and this will endure for the lifetime of the agreement. Separation vs. Aggregation of Clinical Activity While the HSE’s position is that the 80:20 ratio should apply to in-patient, day case and out-patient activity (i.e. the same ratio will apply in all cases but will be calculated separately for each type of activity), the Public Private Mix Measurement Group shall consider whether such activities can be aggregated to form a single 80:20 public:private ratio. However, this is subject to the implementation of Clause 20(b) with effect from 1st September 2008, in the absence of any agreed alternative measurement arrangement by that date. Contract Implementation Committee A Contract Implementation Committee, comprising representatives of the HSE and the medical organisations, will be established. The Committee will be chaired by Mr Mark Connaughton, SC. Deadline Date for Contract Acceptance Consultants who sign for the new contract by 31st August 2008 will benefit from the enhanced pay rates with effect from 1st June 2008. However, consultants who sign up for the new contract between 1st September 2008 and 31st December 2008 will only benefit from the improved pay rates from the date of sign up.

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Consultants’ Common Contract 2008 APPENDIX VII – CORRESPONDENCE BETWEEN THE PARTIES The following correspondence is incorporated into this contract as noted in the preamble: Irish Hospital Consultants Association & Irish Medical Organisation 25 July 2008 I write to you in response to your request for written confirmation of our position on the following issues which have arisen during the negotiations on the proposed terms and conditions for a contract for Consultants employed in the public health service. This letter now supersedes my earlier letter of 16 May 2008 in this regard. Co-location In accordance with Mark Connaughton’s letter of 1 February 2008, discussions will take place on the practical issues arising from co-location, when appropriate. Working Hours The normal span of the working day will be between the hours of 8am to 8pm, Monday through Friday (Section 7A of the contract refers). However some scheduled variations outside these hours will be permitted where this is demonstrably in the best interest of patient care. With respect to local agreements provided for under section 7 (e), any issues which arise around the implementation of this provision will be referred to the Contract Implementation Group. With respect to the more onerous requirements of the on-call arrangements provided for under the contract, and particularly late night working, it is agreed that consideration will be given to the position of older Consultants, having regard to the provisions of equality legislation. Flexible Working Consultants are eligible to apply for flexible working under the “Health Service Flexible Working Scheme” which is designed to facilitate the retention and recruitment of staff and the maintenance of the workforce at the levels required to deliver and develop services into the future, while seeking to accommodate their work life balance. Membership of Specialist Register New appointees to Consultant posts must be either eligible for entry in the Register of Medical Specialists maintained by the Medical Council pursuant to the Medical Practitioners Act 1978, or be already entered in that Register. Once the relevant sections of the Medical Practitioners Act 2007 are commenced, new

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appointees to Consultant posts must be either eligible for registration, or be already registered in the Specialist Division of the register of medical practitioners to be established and maintained by the Medical Council under that Act. Letter of Appointment Letters of appointment will stipulate that contracts to be offered to each individual Consultant will be consistent with the nationally agreed contract. 1997 Contract Holders – Pension Adjustments Retired Consultants will, in addition to the standard national pay round increases, have special increases applied to their pensions on the same basis as their serving counterparts who opt to remain on the 1997 contract. Public Private Ratio – Serving Consultants Serving Consultants whose public to private ratio in 2006 was greater than 20 per cent will be permitted to retain this higher ratio, subject to an overriding maximum ratio of 70:30, and this will endure for the lifetime of the agreement. Separation vs. Aggregation of Clinical Activity While the HSE’s position is that the 80:20 ratio should apply to in-patient, day case and out-patient activity (i.e. the same ratio will apply in all cases but will be calculated separately for each type of activity), the Public Private Mix Measurement Group shall consider whether such activities can be aggregated to form a single 80:20 public:private ratio. However, this is subject to the implementation of Clause 20(b) with effect from 1 September 2008, in the absence of any agreed alternative measurement arrangement by that date. Contract Implementation Committee A Contract Implementation Committee, comprising representatives of the HSE and the medical organisations, will be established. The Committee will be chaired by Mr Mark Connaughton, SC. Deadline Date for Contract Acceptance Consultants who sign for the new contract by 31 August 2008 will benefit from the enhanced pay rates with effect from 1 June 2008. However, consultants who sign up for the new contract between 1 September 2008 and 31 December 2008 will only benefit from the improved pay rates from the date of sign up.

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Consultants’ Common Contract 2008 The number of Category 2/Type B*/Type C appointments With reference to the number of Category 2/Type B*/ Type C appointments, the approach to be adopted will be in line with Mark Connaughton’s document of 2nd May 2008 in which he expected “an upper limit in the order of approximately 700 appointments of Category 2/ Type B*/Type C appointments within the system”. Practice Plans/Service Plans Consistent with Mark Connaughton’s letter dated 2nd May 2008, it is agreed that further discussions shall take place on this subject at the Contract Implementation Committee, informed by the general principles already agreed between the parties. Yours sincerely, Gerard Barry Chief Executive

APPENDIX VIII – SPECIAL LEAVE PROVISIONS FOR CONSULTANTS IN NON-HSE EMPLOYMENT These provisions are in addition to those set out in Section 18 (i).

Eligibility Regulations I refer to Section 11.6 (Private Practice) of Mark Connaughton’s report of 4th October 2007 and again confirm our acceptance of the totality of Mr Connaughton’s Report.

Clinical Indemnity/Scope of Practice Document I can confirm that the revised Scope of Practice document, which is currently being finalised by the State Claims Agency will, when completed, be appended to the consultant contract. Psychiatry/Clinical Directors The practice whereby Clinical Directors were appointed for up to 7 years and the method associated with such appointment may continue under the new contract. However, it’s important to understand that this arrangement is quite separate from the transitional arrangement under the new consultants contract (i.e. 2 year appointments).

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The Employer may grant leave with pay: g) To a Consultant appointed by a Minister of State to be a member of any Commission, Committee of Statutory Board or a Director of a Company to enable him/ her to attend meetings of the body in question. h) To a Consultant invited by the Public Appointments Service, a Government Department, the HSE, or a local or other public authority, to act on a selection board to enable him/her to serve on the Board. i) For annual training with the Defence Forces/Reserves for one week. Subsequent leave is without pay. j) For up to three days on the serious illness or death of a near relative. k) When the Consultant is a candidate for a post, advertised by the Public Appointments Service, a Government Department, the HSE, or a local or other public authority for a maximum of six days with pay in any one year, to enable him/her to appear before such selection board. l) To the Consultant for the purpose of attending clinical meetings of societies appropriate to his/ her specialty of not more than seven days with pay, in any one year (exclusive of travel time).

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Consultants’ Common Contract 2008 The number of Category 2/Type B*/Type C appointments With reference to the number of Category 2/Type B*/ Type C appointments, the approach to be adopted will be in line with Mark Connaughton’s document of 2 May 2008 in which he expected “an upper limit in the order of approximately 700 appointments of Category 2/ Type B*/Type C appointments within the system”. Practice Plans/Service Plans Consistent with Mark Connaughton’s letter dated 2 May 2008, it is agreed that further discussions shall take place on this subject at the Contract Implementation Committee, informed by the general principles already agreed between the parties. Yours sincerely, Gerard Barry Chief Executive

APPENDIX VIII – SPECIAL LEAVE PROVISIONS FOR CONSULTANTS IN NON-HSE EMPLOYMENT These provisions are in addition to those set out in Section 18 (i).

Eligibility Regulations I refer to Section 11.6 (Private Practice) of Mark Connaughton’s report of 4 October 2007 and again confirm our acceptance of the totality of Mr Connaughton’s Report.

Clinical Indemnity/Scope of Practice Document I can confirm that the revised Scope of Practice document, which is currently being finalised by the State Claims Agency will, when completed, be appended to the Consultant contract. Psychiatry/Clinical Directors The practice whereby Clinical Directors were appointed for up to seven years and the method associated with such appointment may continue under the new contract. However, it’s important to understand that this arrangement is quite separate from the transitional arrangement under the new Consultants contract (i.e. two year appointments).

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Consultantsâ&#x20AC;&#x2122; Common Contract 2008 APPENDIX IX â&#x20AC;&#x201C; COMMITTEES TO ADVISE HSE ON CONSULTANT APPLICATIONS Health Service Executive Terms of Reference Establishment The Consultant Applications Advisory Committee (CAAC) will be established by the CEO of the HSE. Purpose

The purpose of the CAAC is to provide independent and objective advice to the HSE on applications for medical Consultants and qualifications for Consultant posts. The CAAC provides a significant opportunity for Consultants to contribute their expertise and professional knowledge to the decision-making process for the development of Consultant services throughout the country.

Membership

Membership will comprise: (i) An independent Chair; (ii) Senior HSE planning officials from relevant Directorates (i.e. NHO, PCCC, Population Health, HR and Finance). The METR Unit band the Nursing Services Director will also be represented; (iii) Consultant representatives covering the nine relevant medical specialties (anaesthesia, emergency medicine, medicine, pathology, paediatrics, psychiatry, obstetrics & gynaecology, radiology, surgery). These members will be selected by the CEO from a pool comprising the Chairs of the Expert Advisory Groups and proposed nominees of the training bodies such as the Chairpersons and Honorary Secretaries; (iv) Patient advocacy groups; (v) Voluntary hospital CEO; (vi) Two representatives of each of the Irish Hospital Consultants Association and Irish Medical Organisation Members will be appointed by the CEO. Factors such as gender mix and geographic spread will be taken into account in the selection of members.

Modus Operandi

It is envisaged that the CAAC will meet every two months, or more often as required. The members of the CAAC will consider applications (new and replacement) submitted to it which have been processed by the Consultant Appointments Unit. All posts presented to the CAAC will have received financial clearance from the relevant service Directorate (NHO/PCCC).The officials of the Consultant Appointments Unit (CAU) will prepare background information on and initial analysis of each application and will present this to the CAAC. The CAAC will consider each application in the context of information received from the officials of the CAU, published policy, workload statistics, precedent, literature review, professional advice and knowledge, developments in medical education and training, relevant local information, demography, workload statistics and any other relevant advice (e.g from Expert Advisory Groups). The CAAC will provide advice in relation to each individual application. Advice could include: (i) Recommendation to approve the post. (ii) Recommendation to seek clarification of aspects of the post or aspects of policy not already clarified by the CAU. (iii) Recommendation to amend the structure, sessional commitment, etc. (iv) Recommendation to refuse approval to the post. The CAAC will also provide advice to the HSE on the appropriate qualifications for Consultant posts. Other functions may be assigned by the National Director, Human Resources, following discussion with the Committee. Advice provided by the CAAC will be forwarded by the Head of the CAU to the National Director, Human Resources, to whom responsibility for the regulation of Consultant posts has been delegated by the CEO of the HSE. The National Director will in turn regulate each post taking into account the advice provided. The recruitment and appointment of Consultants and related staff is approved by the National Employment Monitoring Unit (NEMU) in accordance with the Employment Control Framework approved by the Board of the HSE.The National Director, Human Resources, provides regular updates to the Board of the HSE on the Consultant posts recommended for approval.

Executive Support

The CAAC will be supported by the officials of the Consultant Appointments Unit (CAU).

Term

The CAAC will be appointed for an initial period of one year.

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Consultants’ Common Contract 2008 Consultant Applications Advisory Committee Type C Consultant Posts

• Recommendations from the Type C Consultant Committee will be forwarded to the CEO of the HSE for approval/final decision.

Establishment process

3. Type C Consultant Committee • The Committee will be established by the CEO of the HSE. • Appointments to the Committee will be made by the CEO of the HSE. • Representation on the Committee will include:  Chairperson;  HSE Corporate;  DoHC;  Public voluntary agencies;  Members of the public;  One representative of the Irish Hospital Consultants Association;  One representative of the Irish Medical Organisation.

1. Introduction • The proposal with respect to Type C Consultant posts is set out in the report of the Independent Chairman of the Consultant Contract negotiations – Mark Connaughton SC – dated 4th October 2007. The report was fully adopted by the HSE and DoHC. • The requirement to be more specific with respect to how such posts might be established and be somewhat less rigid in its application than envisaged in the Chairman’s report and associated discussion was also recognised. • This paper sets out, at a high level, the process to be pursued in establishing such posts. 2. Establishment process 2.1 Application process • Applications for Consultant posts are generated through the pertinent hospital/network/PCCC agency/area in the prescribed format. • The applicant organisation is required to specify its proposed post type (A, B or C) in its related submission. • Where a Type C post is recommended, the applicant organisation will be required to satisfy a number of criteria pertinent thereto, which would include, but not be limited to, the following:  A clear indication as to why the post requirements cannot be met through a Type A or B arrangement;  A clear demonstration as to the added patient, service and public system benefits and values to be achieved through establishment of the post as a Type C rather than a Type A or B position. 2.2 Decision process • The application will be submitted to the HSE Consultant Appointments Unit (CAU) for initial review. This review will be undertaken with input from NHO/PCCC Corporate. Where, following internal review, the CAU considers that the case for a Type C designation is not adequately made, by reference to the specified criteria, the proposal will be returned to the applicant source for further development and resubmission. Where the CAU considers that the proposal meets the specified criteria, the submission will be furnished to a Type C Consultant Committee for consideration and recommendation.

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Advertorial Feature Vaccinate Against Deadly Flu Vaccination is the best protection against influenza, a disease that is responsible for hundreds of deaths in Ireland each year. Influenza is an acute viral respiratory illness, which affects all age groups and occurs every winter. Symptoms include the acute onset of fever, with headache, myalgia, cough and sore throat. The disease is highly transmissible from 1-2 days while asymptomatic and for a further 5 days after symptoms develop. Influenza is responsible for between 200 and 500 deaths each year in Ireland. In a severe season it can cause up to 1,000 deaths. Those most vulnerable to flu are people aged 65 years and older, pregnant women and adults and children with long term medical conditions. Influenza leads to an increased incidence of acute myocardial infarction and strokes, as well as presenting serious complications in previously healthy people. In 2017/2018, 4,713 people with influenza were hospitalised and 191 people needed admission to critical care units. Along with morbidity and mortality, this leads to a significant disruption of services. VACCINATION Influenza is preventable by vaccination. Each year the World Health Organisation (WHO) recommends the vaccine composition based on the four virus strains most likely to be circulating in the coming season. For the 2019/2020 seasonal influenza campaign, an inactivated quadrivalent influenza vaccine will be used instead of the trivalent vaccine used in previous seasons. UPTAKE IN AT-RISK GROUP In Ireland, although significant improvements in uptake have been made in recent years, vaccine uptake for those in the at-risk groups has never reached the WHO target of 75%. Older persons and those in the at risk groups are dependent on their health providers, nurses, doctors and pharmacists, for information on influenza vaccination, and there is a strong

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correlation between a recommendation for vaccination from health care professionals and vaccine acceptance and receipt. HEALTH CARE WORKERS Health Care Workers (HCWs) have a higher than average chance of contracting flu, with up to 20% developing it each season. Because flu is transmissible before symptoms develop, many HCWs transmit the disease to their high-risk patients. At-risk patients rely on healthcare workers to be vaccinated for their own protection, since they often cannot generate an adequate immune response from vaccination themselves. Flu vaccination of HCWs results in an up to 40% reduction in influenza related patient deaths. While rates of vaccine uptake among HCWs in Ireland have been low, they have risen in recent years; 53.2% of HCWs in public hospitals received the flu vaccine in the 2018/2019 season. This improvement is welcome but uptake remains below the target of 60%. Leadership by senior medical and nursing staff has shown to be a key factor in better uptake rates.

PREGNANCY Influenza in pregnancy carries a significantly increased risk of severe respiratory illness and hospitalisation. Vaccination reduces maternal illness in pregnancy, improves foetal outcomes and prevents influenza in the infant up to 6 months of age. Results of many studies have shown the vaccine is safe in pregnancy.

SUMMARY Influenza remains a major public health issue and vaccination is the best intervention available. Senior medical staff must continue to promote vaccination for their at-risk patients and take a leadership role to ensure health care staff get vaccinated each season.

Influenza vaccine remains the best protection against influenza and is recommended by all major expert bodies including the World Health Organisation, Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control and the National Immunisation Advisory Committee of the Royal College of Physicians of Ireland.

The National Immunisation Advisory Committee recommends annual influenza vaccination for the following groups: ■ Persons aged 65 and older ■ Pregnant women (vaccine can be given at any stage of pregnancy) ■ Those aged 6 months and older with a long-term health condition such as: • chronic medical illness requiring regular follow up including chronic cardiovascular, respiratory, hepatic, and neurological disease, diabetes mellitus and haemoglobinopathies • cancer • immunosuppression due to illness or treatment • Down syndrome • morbid obesity i.e. body mass index over 40 • children with moderate to severe neurodevelopmental disorders • children on long term aspirin therapy (risk of Reye’s syndrome) ■ Residents of nursing homes and other long stay institutions ■ Carers ■ Health Care workers ■ People in regular contact with pigs, poultry or water fowl

References available on request.

31/07/2019 12:48

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Professional Directory Medical Indemnity Organisations

Medical Protection Society Victoria House, 2 Victoria Place, Leeds LS11 5AE, UK. Tel: 1800 509 441 * Fax: (0044) (113) 241 0500 Email: info@medicalprotection.org *Freephone number from Republic of Ireland Challenge Challenge House, Baldoyle, Dublin 13. Tel: (01) 839 5942 Fax: (01) 832 4254 Email: insurance@challenge.ie Medical Defence Union (MDU) One Canada Square, London E14 5GS, UK. Tel: (0044) (207) 202 1500 Tel Ireland: 1800 535 935 Fax: (0044) (207) 202 1666 Email: advisory@themdu.com

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Professional Directory Health Insurers

Irish Life Health Irish Life Centre, Abbey Street Lower, Dublin 1. Tel: 1890 714 444 or PO Box 764, Togher, Co Cork. (021) 480 2040 Email: partnersupport@irishlifehealth.ie Head of Provider Affairs: Mr Brian Scollard ESB Staff Medical Provident Fund PO Box 384, Rosbrien, Limerick. Tel: (061) 430561 or Ext 55361 Fax: (061) 430500 Email: mpf@esb.ie Manager: Mr James O’Loughlin

Laya Healthcare Eastgate Business Park, Little Island, Cork. Tel: (021) 202 2000 Email: info@layahealthcare.ie Medical Practice Manager: Ms Noreen Quinlan Prison Officers’ Medical Aid Society 397e North Circular Road, Dublin 7. Tel: (01) 830 8963/6212 Fax: (01) 830 9420 Email: info@pomas.ie Secretary: Mr PJ Dunne

Vhi Healthcare Vhi House, 20 Lower Abbey Street, Dublin 1. Tel (Dublin): (01) 872 4499 Tel (Kilkenny): (056) 444 4444 Fax: (01) 799 4091 Email: info@vhi.ie Medical Director: Dr Bernadette Carr Medical Relations Manager: Mr James Norton

Professional Directory Medical Council

MEDICAL COUNCIL The Medical Council was established under the Medical Practitioners Act, 1978 as amended by the Medical Practitioners Act of 2007. It is the guardian of the public’s interest in relation to the Medical profession and protects the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among doctors. The principal functions of the Council are: • To prepare and establish a register of medical practitioners that is known as the Register of Medical Practitioners; • To satisfy itself as to the suitability of medical education and training, the standards of theoretical and practical knowledge for primary qualifications, the clinical training and experience required for the granting of a certificate of experience, and the adequacy and suitability of postgraduate education and training; • To enquire into the conduct of registered medical practitioners for alleged professional misconduct or fitness to engage in the practice of medicine by reason of physical or mental disability • To promote good medical practice and oversee doctors’ continuing professional development.

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The Council has 25 members including elected and appointed members. Under the provisions of the Medical Practitioners Act, 2007, the new Council is comprised of 13 non-medical members and 12 medical members representing a range of medical specialties, teaching bodies and members of the public and stakeholders, all of whose appointments have been approved by the Minister for Health. The current Council’s period of office is 2018 to 2023. Consultants are advised to be registered in the Specialist Division of the Medical Register. Details of this are to be found overleaf. The Medical Council published a revised Guide to Professional Conduct and Ethics in 2016. This is the eighth edition of the Guide. Consultants are strongly advised to acquaint themselves with the contents of the Guide. It lays out information on the operation of the Registers, on ethical conduct and behaviour, and on the operation of the fitness to practise process. The Medical Council Kingram House, Kingram Place, Dublin 2 Tel: (01) 498 3100 Fax: (01) 498 3102 www.medicalcouncil.ie

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Professional Directory Medical Council

MEMBERSHIP Dr Rita Doyle (President) Dr Anthony Breslin (Vice President) Dr John Barragry Ms Vicky Blomfield Ms Teresa Bulfin Dr Thomas Crotty Dr Suzanne Crowe Dr Marcus De Brun Ms Mary Duff Prof Fidelma Dunne Mr John Gleeson Mr Paul Harkin Prof John Hyland

Medical Member Medical Member Medical Member Non-Medical Member Non-Medical Member Medical Member Medical Member Medical Member Non-Medical Member Medical Member Non-Medical Member Non-Medical Member Medical Member

REGISTER OF MEDICAL PRACTIONERS The Medical Council maintains this Register in which every practising doctor must be registered. It is an offence to practise medicine, except in some strictly defined exceptions, if you are not registered. Every doctor is responsible for ensuring that their registration is current within one of the following categories: (a) General Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 46 and such other identifying particulars of those practitioners as the Council considers appropriate. Doctors with general registration may practise independently without supervision but may not represent themselves as being specialists; (b) Specialist Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 47 and such other identifying particulars of those practitioners as the Council considers appropriate. Doctors with specialist registration may practise independently, without supervision, and may represent themselves as specialists; (c) Trainee Specialist Division, which shall include the names of those medical practitioners registered in that division pursuant to Section 48 or 49 and such other identifying particulars of those practitioners as the Council considers appropriate. Doctors with trainee specialist registration are on recognised training programmes and practise solely within the confines of posts allocated by the HSE, in conjunction with the national postgraduate training bodies; and (d) Visiting EEA Practitioners Division, which shall include the names of those medical practitioners registered in that division

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Prof Mary Leader Ms Alison Lindsay Prof Marina Lynch Dr Erica Maguire Ms Catherine McKenna Dr Maeve Moran Dr Aoife Mullally Mr John Murray Mr Joe O’Donovan Mr Tom O’Higgins Mr Jim O’Sullivan Prof Mary O’Sullivan

Medical Member Non-Medical Member Non-Medical Member Medical Member Non-Medical Member Medical Member Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Non-Medical Member

pursuant to Section 50 and such other identifying particulars of those practitioners as the Council considers appropriate. (e) Internship Registration allows a doctor to carry out internship training in a hospital recognised by the Medical Council. Internship registration is open to both graduates of Irish and EU/EEA member State Medical Schools. (f) Supervised Division For doctors to be considered for registration within the Supervised Division they must have been offered a post with the HSE that has been approved as an individually numbered, identifiable post. SPECIALIST DIVISION The following specialties are recognised in the Specialist Division of the Register: Anaesthesia • Anaesthesia • Intensive Care Medicine • Pain Medicine Emergency Medicine • Emergency Medicine General Practice • General Practice • Military Medicine

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Professional Directory Medical Council

Medicine • Cardiology • Clinical Genetics • Clinical Neurophysiology • Clinical Pharmacology & Therapeutics • Dermatology • Endocrinology & Diabetes Mellitus • Gastroenterology • General (Internal) Medicine • Genito-Urinary Medicine • Geriatric Medicine • Infectious Diseases • Medical Oncology • Nephrology • Neurology • Palliative Medicine • Pharmaceutical Medicine • Rehabilitation Medicine • Respiratory Medicine • Rheumatology • Tropical Medicine Obstetrics & Gynaecology • Obstetrics & Gynaecology Occupational Medicine • Occupational Medicine Ophthalmology • Ophthalmology Paediatrics • Paediatrics • Paediatric Cardiology • Neonatology

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Pathology • Chemical Pathology • Haematology (Clinical & Laboratory) • Histopathology • Immunology (Clinical & Laboratory) • Microbiology • Neuropathology Psychiatry • Child & Adolescent Psychiatry • Psychiatry • Psychiatry of Learning Disability • Psychiatry of Old Age Public Health Medicine • Public Health Medicine Radiology • Diagnostic Radiology • Radiation Oncology Sports & Exercise Medicine • Sports & Exercise Medicine Surgery • Cardiothoracic Surgery • General Surgery • Neurosurgery • Ophthalmic Surgery • Oral & Maxillo-Facial Surgery • Otolaryngology • Paediatric Surgery • Plastic, Reconstructive & Aesthetic Surgery • Trauma and Orthopaedic Surgery • Urology • Vascular Surgery

www.ihca.ie

22/07/2019 11:51

45 MAGAZINE TITLES ▲ 10 EVENTS ▲ 3.6 MILLION REACH

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Professional Directory IHCA National Council 2019 – 2020

NAME HOSPITAL/REGION SPECIALITY Eastern Region Dr Donal O’Hanlon Naas General Hospital Psychiatry Dr Roy Browne Phoenix Care Centre Psychiatry Dr Ioannis Polyzois Dublin Dental Hospital Periodontology Dr Tom Ryan St James’s Hospital Anaesthesia Prof Alan Irvine Crumlin Children’s Hospital Dermatology Mr Maurice Neligan Beacon Hospital Surgery Dr Laura Durcan Beaumont Hospital Rheumatology South Eastern Region Dr Paul Kelly Dr Conor O’Riordan Vacant

Wexford General Hospital St Luke’s General Hospital, Kilkenny

Emergency Med Radiology

Midland Region Dr Charles d’Adhemar Prof Clare Fallon

Midland Regional Hospital, Tullamore Midland Regional Hospital, Mullingar

Pathology Geriatrics

North Eastern Region Dr Mike Staunton Dr Tripuraneni Prasad

Our Lady of Lourdes, Drogheda Our Lady’s Hospital, Navan

Anaesthesia Radiology

North Western Region Dr John Scully Dr Áine Burke

Letterkenny University Hospital Sligo University Hospital

Anaesthesia Pathology

Western Region Mr Garrett Durkan Mr Colm Fahy Dr Connall Dennedy

Galway University Hospitals Galway Clinic Galway University Hospitals

Surgery Surgery Endocrinology

Mid Western Region Ms Shona Tormey Dr Patrick Dillon

University Hospital Limerick University Hospital Limerick

Surgery Anaesthesia

Southern Region Dr Mary McCaffrey University Hospital Kerry Mr Peter Ryan Bon Secours Cork Dr Sinead Harney Cork University Hospital Dr Oisin O’Connell Bon Secours Cork Co-Options Dr P J Breen Dr Orla Franklin Mr Joe Dowdall Dr Gabrielle Colleran Dr Kieran Moore

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Retired Crumlin Children’s Hospital St Vincent’s University Hospital Children’s University Hospital Temple Street Crumlin Children’s Hospital (formerly Wexford Mental Health)

Obs/Gynae Surgery - Urology Rheumatology Respiratory

Anaesthesia Paediatric Cardiology Vascular Surgery Radiology Psychiatry

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Professional Directory IHCA Officer Board 2019 – 2020

President Dr Donal O’Hanlon Consultant Psychiatrist, Naas General Hospital, Naas, Co Kildare. Vice President Dr Orla Franklin Consultant Paediatric Cardiologist, Our Lady’s Children’s Hospital, Crumlin, Dublin 12. Vice President Dr Laura Durcan Consultant Rheumatologist, Beaumont Hospital, Dublin 9.

Membership Secretary Dr Conor O’Riordan Consultant Radiologist, St Luke’s Hospital, Kilkenny. Treasurer Prof Alan Irvine Consultant Dermatologist, Our Lady’s Children’s Hospital, Crumlin, Dublin 12. Immediate Past President Dr Tom Ryan Consultant in Intensive Care and Anaesthesia, St James’s Hospital, Dublin 8.

IHCA Secretariat SECRETARY GENERAL: Martin Varley Tel: 087 2274099 Email: m.varley@ihca.ie

ASSISTANT SECRETARY GENERAL: Alice McGarvey Tel: 086 803 2707 Email: a.mcgarvey@ihca.ie

SENIOR EXECUTIVE OFFICER: Aidan O’Reilly Tel: 086 1590733 Email: a.oreilly@ihca.ie

SENIOR POLICY AND RESEARCH EXECUTIVE: Dara Gantly Tel: 087 803 3336 Email: d.gantly@ihca.ie

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Professional Directory Voluntary & Support Organisations

Alcoholics Anonymous Ireland General Service Office, Unit 2, Block C, Santry Business, Park, Swords Road, Dublin 9. Tel: (01) 842 0700, Fax: (01) 842 0703 Email: gso@alcoholicsanonymous.ie Web: www.alcoholicsanonymous.ie

ASH – Action on Smoking & Health 17-19 Rathmines Road Lower, Dublin 6. Tel: (01) 634 6948 Email: info@ash.ie Web: www.ash.ie

Bodywhys – Eating Disorders Association of Ireland PO Box 105, Blackrock, Co. Dublin. Tel: (01) 283 4963 Helpline: 1890 200 444 Email: info@bodywhys.ie Web: www.bodywhys.ie

Alzheimer Society of Ireland Temple Road, Blackrock, Co. Dublin. Tel: (01) 207 3800 Fax: (01) 210 3772 Helpline: 1800 341 341 Email: info@alzheimer.ie Web: www.alzheimer.ie

Asthma Society of Ireland 42-43 Amiens Street, Dublin 1. Tel: (01) 817 8886 Helpline: 1850 445 464 Email: reception@asthmasociety.ie Web: www.asthma.ie

Epilepsy Ireland 249 Crumlin Road, Crumlin, Dublin 12, D12 RW92. Tel: (01) 455 7500 Fax: (01) 455 7013 Email: info@epilepsy.ie Web: www.epilepsy.ie

Arthritis Ireland 1 Clanwilliam Square, Grand Canal Quay, Dublin 2. Tel: 1890 252 846 Fax: (01) 661 8261 Helpline: 1890 252 846 Email: helpline@arthritisireland.ie Web: www.arthritisireland.ie

Aware 9 Upper Leeson Street, Dublin 4. Tel: (01) 661 7211 Fax: (01) 661 7217 Helpline: 1800 804 848 Email: info@aware.ie Web: www.aware.ie

Cheshire Ireland Central Office, Block 4, Bracken Business Park, Bracken Road, Sandyford Industrial Estate, Dublin 18. Tel: (01) 297 4100 Fax: (01) 205 2060 Email: info@cheshire.ie Web: www.cheshire.ie

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Professional Directory Voluntary & Support Organisations

CLAPAI - Cleft Lip and Palate Association of Ireland c/o 36 Woodlands Avenue, Glenageary, Co. Dublin. Tel: 087 131 9803 Email: info@cleft.ie Web: www.cleft.ie Coeliac Society of Ireland Carmichael Centre for Voluntary Groups, 4 North Brunswick Street, Dublin 7, D07 RHA8. Tel: (01) 872 1471 Email: info@coeliac.ie Web: www.coeliac.ie Coolmine Therapeutic Community Coolmine House, 19 Lord Edward Street, Dublin 2. Tel: (01) 679 4822 Email: info@coolminetc.ie Web: www.coolmine.ie COPE Foundation Bonnington, Montenotte, Cork, T23 PT93. Tel: (021) 464 3100 Fax: (021) 450 7580 Email: headoffice@cope-foundation.ie Web: www.cope-foundation.ie

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Cuidiú – Irish Childbirth Trust Carmichael Centre, 4 North Brunswick Street, Dublin 7. Tel: (01) 872 4501 Email: info@cuidiu.ie Web: www.cuidiu.ie Cystic Fibrosis Ireland CF House, 24 Lower Rathmines Road, Dublin 6. Tel: (01) 496 2433 Tel: 1890 311211 Fax: (01) 496 2201 Email: info@cfireland.ie Web: www.cfireland.ie Chime - National Charity for Deafness and Hearing Loss 35 North Frederick Street, Dublin 1. Tel: (01) 817 5700 Text: (087) 922 1046 Fax: (01) 878 3629 Email: info@chime.ie Skype: Chime NFS Web: www.chime.ie

Diabetes Ireland 19 Northwood House, Northwood Business Campus, Santry, Dublin 9, D09 DH30. Tel: (01) 842 8118 Email: info@diabetes.ie Web: www.diabetes.ie Down Syndrome Ireland Unit 3, Park Way House, Western Parkway Business Park, Ballymount Drive, Dublin 12, D12 HP70. Tel: (01) 426 6500 LoCall: 1890 374 374 Email: info@downsyndrome.ie Web: www.downsyndrome.ie Enable Ireland 32F Rosemount Park Drive, Rosemount Business Park, Ballycoolin Road, Dublin 11. Tel: (01) 872 7155 Fax: (01) 866 5222 Email: communications@enableireland.ie Web: www.enableireland.ie

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Professional Directory Voluntary & Support Organisations

GROW – World Community Mental Health Movement in Ireland National Support Office, Apartment 6, Forrest Mews, Forrest Road, Swords, Co. Dublin. Tel: (01) 840 8236 Infoline: 1890 474 474 Email: info@grow.ie Web: www.grow.ie Health Protection Surveillance Centre 25-27 Middle Gardiner Street, Dublin 1. Tel: (01) 876 5300, Fax: (01) 856 1299 Email: hpsc@hse.ie Web: www.hpsc.ie My Options - HSE Sexual Health & Crisis Pregnancy Programme Freephone: 1800 828 010 Web: www.myoptions.ie Huntington’s Disease Association of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7. Tel: (01) 872 1303 FreeFone: 1800 393939 Email: info@huntingtons.ie Web: www.huntingtons.ie Irish Cancer Society 43/45 Northumberland Road, Ballsbridge, Dublin 4. Tel: (01) 231 0500 Freephone: 1800 200 700 Email: reception@irishcancer.ie Web: www.cancer.ie

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Irish Deaf Society Deaf Village Ireland, Ratoath Road, Cabra, Dublin 7. Tel: (01) 860 1878 Text: (086) 380 7033 Skype: irishdeafsociety Email: info@irishdeafsociety.ie Web: www.irishdeafsociety.ie Irish Family Planning Association Solomons House, 42a Pearse Street, Dublin 2. Tel: (01) 607 4456 Fax: (01) 607 4486 National Pregnancy Helpline: 1850 495051 Email: reception@ifpa.ie Web: www.ifpa.ie Irish Haemophilia Society First Floor, Cathedral Court, New Street, Dublin 8, D08 VH64. Tel: (01) 657 9900 Fax: (01) 657 9901 Email: info@haemophilia.ie Web: www.haemophilia.ie Irish Heart Foundation 17-19 Rathmines Road Lower, Dublin D06 C780. Tel: (01) 668 5001 Fax: (01) 668 5896 Email: info@irishheart.ie Web: www.irishheart.ie Irish Hospice Foundation 4th Floor, Morrison Chambers, 32 Nassau Street, Dublin 2, D02 YE0. Tel: (01) 679 3188 Fax: (01) 673 0040 Email: info@hospicefoundation.ie Web: www.hospicefoundation.ie

Irish Kidney Association Head Office, Donor House, Block 43A, Park West, Dublin 12, D12 P5V6. Tel: (01) 620 5306 Email: info@ika.ie Web: www.ika.ie Irish Motor Neurone Disease Association Coleraine House, Coleraine Street, Dublin 7. Tel: (01) 873 0422 Helpline: 1800 403 403 Email: info@imnda.ie Web: www.imnda.ie Irish Multiple Births Association Carmichael House, 4 North Brunswick Street, Dublin 7. Tel: (01) 874 9056 Email: info@imba.ie Web: www.imba.ie Irish Society for Autism Unity Building, 16/17 Lower O’Connell Street, Dublin 1. Tel: (01) 874 4684 Fax: (01) 874 4224 Email: admin@autism.ie Web: www.autism.ie A Little Lifetime Foundation - for bereaved parents and their families 18 Orion Business Campus, Rosemount Business Park, Ballycoolin, Blanchardstown, D 15. Tel: (01) 882 9030 Email: info@alittlelifetime.ie Web: www.alittlelifetime.ie

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Professional Directory Voluntary & Support Organisations

Irish Wheelchair Association Áras Chúchulainn, Blackheath Drive, Clontarf, Dublin 3. Tel: (01) 818 6400 Email: info@iwa.ie Web: www.iwa.ie Meningitis Research Foundation 83 Amiens Street Dublin 1. Tel: (01) 819 6931, Fax: (01) 819 6903 Email: Dublin@meningitis.org Web: www.meningitis.org Mental Health Ireland 1-4 Adelaide Road, Glasthule, Co. Dublin. Tel: (01) 284 1166 Email: info@mentalhealthireland.ie Web: www.mentalhealthireland.ie Miscarriage Association of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7. Tel: (01) 873 5702 Email: info@miscarriage.ie Web: www.miscarriage.ie MS Ireland National Office, 80 Northumberland Road, Dublin 4. Tel: (01) 678 1600 Helpline: 1850 233 233 Email: info@ms-society.ie Web: www.ms-society.ie

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Muscular Dystrophy Ireland 75 Lucan Road, Chapelizod, Dublin D20 DR77. Tel: (01) 623 6414 Fax: (01) 620 8663 Email: info@mdi.ie Web: www.mdi.ie

Rehab Care Roslyn Park, Beach Road, Sandymount, Dublin 4. Tel: (01) 205 7200 Fax: (01) 205 7211 Email: info@rehabcare.ie Web: www.rehabcare.ie

National Council for the Blind Head Office, Whitworth Road, Drumcondra, Dublin 9. Tel: (01) 830 7033 Fax: (01) 830 7787

Samaritans Ireland 4-5 Usher’s Court, Usher’s Quay, Dublin 8. Tel: (01) 671 0071 Text: (087) 260 9090 Helpline: 116 123 Email: jo@samaritans.ie Web: www.samaritans.org

Email: info@ncbi.ie Web: www.ncbi.ie Pact – Adoption Agency Arabella House, 18D Nutgrove Office Park, Rathfarnham, Dublin 14, D14 FC03. Tel: (01) 296 2200 Email: info@pact.ie Web: www.pact.ie Rape Crisis Network Ireland Carmichael Centre, North Brunswick Street, Dublin 7, D07 RHA8. Tel: (01) 865 6954 Email: admin@rcni.ie Web: www.rcni.ie

St Michael’s House Ballymun Road, Ballymun, Dublin 9. Tel: (01) 884 0200 Fax: (01) 884 0211 Email: info@smh.ie Web: www.smh.ie

Scoliosis Ireland Email: scoliosisirl@gmail.com Web: www.scoliosis-Ireland.ie Shine – Supporting People Affected by Mental Ill Health Block B, Maynooth Business Campus, Straffan Road, Maynooth, Co Kildare W23 W5X7. Tel: (01) 541 3715 Email: info@shine.ie Web: www.shine.ie Spina Bifida Hydrocephalus Ireland National Resource Centre, Old Nangor Road, Clondalkin, Dublin 22, D22 W5C1. Tel: (01) 457 2329 Email: info@sbhi.ie Web: www.sbhi.ie

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Charts & Tables (as of March 2019)

ACUTE HOSPITALS Acute Hospital OVERVIEW OF KEYServices ACUTE HOSPITAL ACTIVITY Overview of Key Acute Hospital Activity Expected Activity YTD

Activity Area

Result YTD Mar 2019

Result YTD Mar 2018

% Var YTD

SPLY % Var

Current (-2)

Current (-1)

Current

Emergency Presentations

349,432

372,139

+6.5%

348,209

+6.9%

127,931

115,446

128,762

New ED Attendances

292,646

312,918

+6.9%

292,259

+7.1%

107,638

97,532

107,748

OPD Attendances

813,345

814,270

+0.1%

812,306

+0.2%

291,157

246,627

276,486

Expected Activity YTD

Activity Area (HIPE data month in arrears)

Result YTD Feb 2019

Result YTD Feb 2018

% Var YTD

SPLY % Var

Current (-2)

Current (-1)

Current

Inpatient [IP] Discharges

103,295

104,171

+0.8%

103,273

+0.9%

53,124

54,851

49,320

Inpatient Weighted Units

104,153

99,583

-4.4%

104,756

-4.9%

53,751

52,489

47,094

176,298

175,175

-0.6%

176,427

-0.7%

77,877

92,788

82,387

173,415

168,938

-2.6%

173,701

-2.7%

74,865

90,592

78,346

-0.1%

279,700

-0.1%

131,001

147,639

131,707

Day Case [DC] Discharges (includes dialysis) Day Case Weighted Units (includes dialysis) IP & DC Discharges

279,593

279,346

% IP

36.9%

37.3%

36.9%

+1%

40.6%

37.2%

37.4%

% DC

63.1%

62.7%

63.1%

-0.6%

59.4%

62.8%

62.6%

Emergency IP Discharges

72,600

74,209

+2.2%

71,848

+3.3%

37,219

38,993

35,216

Elective IP Discharges

13,092

13,009

-0.6%

13,762

-5.5%

6,832

6,655

6,354

Maternity IP Discharges

17,603

16,953

-3.7%

17,663

-4%

9,073

9,203

7,750

INPATIENT, DAYCASE AND OUTPATIENT WAITING LISTS Inpatient, Daycase and Outpatient Waiting Lists

Target/ Current Performance Freq Health Servicesarea Performance ProfileExpected January to March 2019 Quarterly PeriodReport YTD Activity Inpatient adult waiting list 85% M 83.8% within 15 months Day case adult waiting list 95% M 92.1% within 15 months Inpatient children waiting list 85% M 89% within 15 months Day case children waiting list 90% M 83.4% within 15 months Outpatient waiting list within 52 weeks

80%

69.6%

Inpatient & Day Case Waiting List 10,000 5,000 0

8,781

80,000

100,000 50,000 0

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 15m+ 18m+

Current

84.2%

-0.4%

84.2%

83.9%

83.8%

91.2%

+0.9%

92.5%

92.2%

92.1%

88.6%

+0.4%

89.2%

88.8%

89%

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

520,000 480,000

Health Services Performance Profile January to March 2019 Quarterly Report

082_96_IHCA Client Section 2020_Charts _ Tables_V5.indd 82

18 out of 20 hospitals reached target

-1.3%

84.1%

83%

83.4%

71.2%

-1.6%

69.7%

69.6%

18 out of 43 hospitals reached target

Mayo (66.7%), GUH (69.2%) CHI (79.3%), GUH (80%), UHW (87.1%) Croom (50.7%), RVEEH (53.7%), Tullamore, UHW (58.1%)

Waiting List Numbers 130,995

106,080

101,724

77,547

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 15m+ 18m+

546,630

Adult IP Adult DC Adult IPDC Child IP Child DC Child IPDC OPD

504,111

Total

Total SPLY

SPLY Change

>12 Mths

>15 Mths

18,487

19,942

-1,455

3,945

2,990

45,629

52,946

-7,317

5,519

3,618

64,116

72,888

-8,772

9,464

6,608

2,365

3,021

-656

390

259

3,738

4,149

-411

857

621

6,103

7,170

-1,067

1,247

880

546,630

504,111

42,519

166,399

130,995

500,000

Total

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Outliers

RUH (27.3%), SUH (73.5%), GUH (75%) Tallaght â&#x20AC;&#x201C; Adults (82.2%), SJH (84.2%), CUH (86.1%)

26 out of 41 hospitals reached target

84.7%

540,000 70,219

Best performance 30 out of 40 hospitals reached target

23 out of 28 hospitals reached target

560,000

70,000

P A G E

Current (-1)

Outpatient Waiting List Total

80,058

75,000 65,000

Current (-2)

150,000

5,311

Inpatient & Day Case Waiting List Total 85,000

SPLY Change

Outpatient Waiting List 7,488

5,497

SPLY YTD

Mar Apr May Jun Jul AugSep Oct NovDec Jan Feb Mar Total

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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Charts & Tables (as of March 2019)

ED PERFORMANCE ED Performance Performance area % 6 hours EDwithin Performance

Target/ Expected Activity

Freq

75%

Current Period YTD

SPLY YTD

62.1%

SPLY Change

Current (-2)

Current (-1)

Current

62.1%

62.3%

62%

95.2% SPLY YTD

SPLY +0.9% Change

Current 96% (-2)

Current 95.9% (-1)

96.3% Current

87.6% 62.1%

+1.9% 0%

89.4% 62.3%

89.2% 62%

89.9% 62%

% patients admitted or discharged within 6 hours 96.1% % in ED < 24 hours 99% M 80% 75% % 75 years within 24 89.5% 99% M hours 70%

ED over 24 hours 95.2% +0.9% 6,000 4,774

96%

95.9%

96.3%

89.4%

89.2%

% patients admitted or discharged within 6 hours 60% 62% 80% 50% 70% Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Month 18/19 60% 62%

ED over 24 hours 1,449 2,000

% in ED < 24 hours Performance area % 75 years within 24 % within 6 hours hours

Target/ 99% Expected Activity 99% 75%

M Freq M M

Current 96.1% Period YTD 89.5% 62.1%

Colonoscopy 50%

87.6% 4,000

62% 75%

1,436

0 4,774 4,387 4,000 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Patients 75+ >24 hrs All patients > 24 hrs 1,436 2,000 1,449

Mar 62%

0 0 Current Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar SPLY SPLY Current Current Period Patients hrs All(-2) patients > 24 hrs YTD75+ >24 Change (-1) YTD 45 Current Period102 YTD 50.7% 45

50.7%

40 Urgent Colonoscopy - number of people waiting (new) 20 0 0 61 60 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 40 Month 18/19

110% 80%

SPLY 319 YTD

SPLY -217 Change

Current 35 (-2)

Current 52 (-1)

15 Current

54.3% 69

-3.6% -24

53.6% 6

51.6% 39

50.7% 0

54.3%

Current -3.6% (-2)

Current 53.6% (-1)

Current 51.6%

Number scheduled over 20 working days

Number deemed suitable for colonoscopy 20 Number scheduled over Health Services Performance Profile January to March 2019 Quarterly Report 0 20 working days 0 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

176

35 Current (-2)

52 Current (-1)

15 Current

200

229

176

89.9%

99% 100% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 18/19 89.1% 90% 89.9% 80% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Current Best performanceMonth 18/19 Outliers

-24

Number deemed 200 229 BowelScreen – Urgent Colonoscopies suitable for colonoscopy

Month 18/19

89.1% % 75 90%years old or older admitted or discharged

BowelScreen – Urgent Colonoscopies 102 319 -217

Outliers Tallaght - Adults (36.7%), Beaumont (39.4%), Naas (42.9%) Naas (89.8%), UHL (91%), UHK Outliers (91.3%) GUH & UHL (74%), Naas (75.9%), Tallaght - Adults (36.7%), UHK (79.2%) Beaumont (39.4%), Naas (42.9%)

11 out of 28 hospitals Naas (89.8%),orUHL (91%), UHK % 75 years old or older admitted discharged achieved target (91.3%) 110% 9 out of 27 hospitals GUH & UHL (74%), Naas (75.9%), 99% 89.9% 4,387 achieved target UHK (79.2%) 100%

6,0000

Target/ Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Performance area Freq Month 18/19 Expected Activity COLONOSCOPY Urgent Colonoscopy – number of 0 M Colonoscopy people waiting > 4 weeks (new) Target/ Bowelscreen – number colonoscopies M Performance area Expected Freq scheduled > 20 working days Activity RoutineColonoscopy Colonoscopy–and OGDof<13 Urgent number 70% M 0 M weeks people waiting > 4 weeks (new) Bowelscreen – number -colonoscopies Urgent Colonoscopy number of people waiting (new) scheduled > 20 working days 61 Routine Colonoscopy and OGD <13 70% 60 weeks

+1.9%

Best performance SLK (93.6%), St Michael‟s (93.3%), CHI (84.1%) 11 out of 28 hospitals Best performance achieved target 9 out of 27 hospitals SLK (93.6%), St Michael‟s achieved target (93.3%), CHI (84.1%)

37 out of 37 hospitals achieved target 10Best hospitals have 0 performance 14 out of 37 37 hospitals 37 out of hospitals achieved target target achieved

GUH (9), Wexford (3), Outliers Mater & SUH (2) Nenagh (24.6%), UHL (26%), Naas (26.2%)

GUH (9), Wexford (3), Number on waiting list for GI Scopes 15 10 hospitals have 0 Mater & SUH (2) 11,259 10,152 of 37 hospitals Nenagh (24.6%), UHL 11,000 14 out 50.7% achieved target (26%), Naas (26.2%)10,933 9,000 Number on8,540 waiting list for GI Scopes 7,000 11,259 10,152 5,000 11,000 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 10,933 9,000 <13 weeks > 13 week breaches 8,540 7,000 5,000

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar <13 weeks > 13 week breaches

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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Charts & Tables (as of March 2019)

HCAI PERFORMANCE HCAI Performance Performance area Rate of new cases of Staph. Aureus infection Rate of new cases of C Difficile infection % of hospitals implementing the requirements for screening with HCAI Performance CPE Guidelines

Target/ Expected Activity

Freq

Current Period YTD

SPLY YTD

SPLY Change

Current (-2)

Current (-1)

0.4

0.7

-0.3

0.7

1.0

0.4

2.9

2.3

+0.6

2.3

2.4

2.9

100%

59.6%

27.7%

+31.9%

48.9%

55.3%

59.6%

Current

Best performance 40 out of 47 hospitals achieved target 28 out of 47 hospitals achieved target

Outliers Naas (1.6), Portiuncula (2.3), Portlaoise (2.7) Beaumont (8.3), Naas (9.3), Louth (3333.3)

28 out of 47 hospitals achieved target

Target/ Current SPLY SPLY Current Current Performance Expected Best performance Outliers Rate of Staph.area Aureus bloodstream infections Freq Rate of new cases of C Difficile associated diarrhoea Current Requirements for screening with CPE Guidelines Period YTD YTD Change (-2) (-1) Activity 100% 100% 1.5 2.6 Rate of 1.3 new cases of Staph. 40 out of 47 hospitals Naas (1.6), Portiuncula 0.4 <1 M 0.7 -0.3 0.7 1.0 0.4 1.3 2.4 Aureus infection achieved target (2.3), Portlaoise (2.7) 2.3 <1 1.1 of new cases of C Difficile 2.2 Rate 28 out of 47 hospitals Beaumont (8.3), Naas (9.3), 59.6% 2.9 <2 M 2.3 +0.6 2.3 2.4 2.9 50% 0.9 2.0 <2 infection achieved target Louth (3333.3) 0.7 0.7 1.8 1.8 % of hospitals implementing the 27.7% 0.5 28 out of 47 hospitals 1.6 59.6% requirements for screening with 100% Q 0.4 27.7% +31.9% 48.9% 55.3% 59.6% 0.3 0% achieved target Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar CPE Guidelines Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 Q1 Quarter 18/19 Month 17/18 Month 18/19diarrhoea Month bloodstream 17/18 Month 18/19 Rate of Staph. Aureus infections Rate of new cases of C Difficile associated Requirements for screening with CPE Guidelines 100% 100% 1.5 2.6 Delayed 1.3 Discharges 1.3 Target/ Current 2.4 2.3 SPLY SPLY Current Current 1.1 2.2 Performance area Expected Freq <1 Period Current Best performance Outliers 50% YTD Change (-2) (-1) 59.6% 0.9 Activity YTD 2.0 <2 0.7 0.7 1.8 1.8 Number of beds subject to Mullingar, Mallow (0), PUH, SJH (78), MMUH (49), 27.7% 0.5 626 ≤550 M 572 +54 562 637 626 0.4 Delayed Discharges RUH Ennis & St John‟s (1) Beaumont (46) 1.6 0.3 0% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 Q1 Quarter 18/19 Monthby 17/18 Month 18/19 Month 17/18 Month 18/19 Delayed Discharges Delayed Discharges Destination Over Under Total 65 65 Home 117 28 145 572 Target/ Current SPLY SPLY Current Current Long Term 550 318 37 355 Performance area Expected Freq Period 550 Nursing YTDCare Change (-2) (-1) Activity YTD Other 79 47 126 Number of beds subject to 450 112 626 626Total 572 ≤550 M 562 637 +54514 Delayed Discharges Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18 Month 18/19 Delayed Discharges Delayed Discharges by Destination Health Services Performance Profile January to March 2019 Quarterly Report Over Under 626 650 Total 65 65 599 Home 117 28 145 572 Long Term 550 318 37 355 550 Nursing Care Other 79 47 126 450 Total 514 112 626 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18 Month 18/19

DELAYED DISCHARGES 650 599 Delayed Discharges

626

Health Services Performance Profile January to March 2019 Quarterly Report

Total % 23.2%

56.7% Current

Best performance

20.1% 100%626

Total % 23.2%

Mullingar, Mallow (0), PUH, RUH Ennis & St John‟s (1)

Outliers SJH (78), MMUH (49), Beaumont (46) 45

56.7% 20.1% 100%

Source: Health Service Performance Profile January to March 2019 Quarterly Report P A G E

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Charts & Tables (as of March 2019)

SURGERY AND MEDICAL PERFORMANCE Surgery and Medical Performance Target/ Expected Activity

Performance area Emergency re-admissions within 30 days of discharge Procedure conducted on day of admission (DOSA) Laparoscopic Cholecystectomy day case rate Surgical re-admissions within 30 days of discharge

Freq

Current Period YTD

10%

Best performance

+0.1%

10.7%

11.3%

11.2%

19 out of 34 hospitals achieved target

82%

M-1M

74.8%

75.8%

-1%

70%

74.3%

76%

11 out of 35 hospitals achieved target

60%

M-1M

53.3%

60.5%

-7.2%

47.8%

51.2%

55%

≤3%

M-1M

2.2%

2.1%

+0.1%

1.9%

2.1%

85%

11.2%

82%

Performance area

80% 75%

65%

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Month 17/18 Month 18/19

Response Times – ECHO

75.4%

76%

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan– Feb Response Times DELTA Month 17/18 Month 18/19

Pre-Hospital Emergency Care Services 60% Target/ Expected Activity

76.2%

Surgical re-admissions withinAmbulance 30 days Turnaround

Laparoscopic Cholecystectomy day case rate

55% Freq 52.6%

80%

Current Period YTD 1.9%

SPLY YTD

78.9%

16 out of 34 hospitals achieved target 27 out of 38 hospitals achieved target

Outliers SUH (16.9%), Tullamore (15%), LUH (14.4%) PUH (61.1%), Tallaght- Adults (63%), Beaumont (61.1%) 10 Hospitals that had cases are at 0% SLK (7.5%), OLOL (4.8%) LUH (4.3%)

Pre-Hospital Emergency Care Services

Procedure conducted on day of admissions

70%

40% 45%Times – ECHO Response

Current

11.5%

10.6%

50%

Current (-1)

11.6%

10.3%

Performance area

Current (-2)

M-1M

≤11.1%

60%

SPLY Change

≤11.1%

Emergency re-admissions within 30 days 12%

SPLY YTD

Freq

Current Period YTD

80%

78.9%

80%

95%

Current

SPLY YTD

SPLY Change

Current (-2)

78.6%

+0.3%

75.3%

55%

54.9%

+0.1%

55.2%

59.2%

52%

+7.2%

58.8%

97.4%

+1.1%

Best performance

98.5% 95% M North Leinster (88%), 78.1% Dublin Fire Brigade (80%), (69%) 46% 40%South Q-1Q

Outliers 98.3%

Western Area (68.9%), 42% +4% 56.5% 30% 1% Dublin Fire Brigade (45.4%), Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb 17/18 Month 80% 18/19 Month 17/18+0.1% Month55.2% 18/19 55% Response Times Month – DELTA M 54.9% 54.7% 54.9% North Leinster (60.1%) Southern Area (54.4%), Ambulance Turnaround - within 30 minutes Response Times – ECHO Western Area (58%) 90% Ambulance Turnaround 84.1% 95% 85% 59.2% % delays escalated within 95% M 52% +7.2% 61.3% 57.5% 85% 58.8% Health Services Performance Profile January to March 2019 Quarterly Report 46 30 minutes 80% 57.5% Ambulance Turnaround 65% 51.9% 75% 98.5% % delays escalated within 95% M 97.4% +1.1% 98.3% 98.3% 98.8% 51.7% 60 minutes 70% 45% Return of spontaneous Mar Apr May Jun Jul Aug Sep Oct Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 46% 40% Q-1Q 42% +4% 56.5% 48.1% 43.4% PRE-HOSPITAL circulation (ROSC) EMERGENCY CARE SERVICES Month18 Month 18/19 Month17/18 Mon Ambulance Turnaround - within 30 minutes 95%

85%

57.5%

65% 45%

51.9% 51.7% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month18 Month 18/19

Ambulance Turnaround - within 60 minutes 100%

98.5%

98.8%

98% 95.6%

96% 94%

95% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month17/18

78.6%

% delays escalated within 30 minutes SPLY Current ≤3% Current Ambulance Change (-2)Turnaround (-1) 2.1% % delays escalated within 60 minutes +0.3% 75.3% 83.3% 1.6% Return of spontaneous circulation (ROSC)

Target/ Expected Activity

Turnaround - within 60 minutes ROSC Response Times – DELTA Response Times –Ambulance ECHO 90% 80% 100% 98.5% 98.8% 84.1% 85% 55% 70% 80% 78.1% 98% 62.6% 80% 95.6% 42.3% 45% 60% 96% 43.4% 75% 76.6% 40% 95% 40% 70% 94% 50% 35% Mar Apr May Jun Jul Aug Oct Jun Nov Jul DecAug JanSep FebOct MarNov Dec Jan Feb MarQ4 Mar Sep Apr May Mar Sep Oct N Q1 Q2Apr May Jun Q3 Jul AugQ4 Month17/18 Month 18/19 Quarter 16/17 Quarter 17/18 Month17/18 Month 18/19 Month17/18 Mon Response Times – DELTA Health Services Performance Profile January to March 2019 Quarterly Report Call Volumes (arrived at scene) 80% 80% Target/ Current % Var Expected Period 70% YTD 62.6% Activity YTD 54.9% ECHO 1,233 1,221 -1% 60% 51.9% DELTA 32,250 32,415 +0.5% 50% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Month 18/19

Month17/18

SPLY YTD

SPLY change

1,286

-65

32,659

-244

Month 18/19

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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Charts & Tables (as of March 2019)

MENTAL HEALTH SERVICES Mental Health Services COMMUNITY MENTAL HEALTH TEAMS CHILD AND ADOLESCENT Child and Adolescent Community Mental Health Teams Target/ Expected Activity

Performance area

Current Period YTD

Freq

SPLY YTD

SPLY Change

Current (-2)

Current (-1)

Current

Best performance

Admission of Children to CAMHs

75%

80.2%

70%

+10.2%

74.2%

85.3%

80.6%

CAMHs Bed Days Used

95%

94%

96.3%

-2.3%

93.7%

95.1%

93.4%

CAMHs â&#x20AC;&#x201C; first appointment within 12 months

95%

97.3%

96.5%

+0.8%

96.9%

98%

97%

2,498

2,738

2,710

+28

2,576

2,623

2,738

CHO2 (17), CHO7 (176), CHO3 (214)

336

386

-50

311

303

336

CHO1, CHO2, CHO7 (0)

5,579

5,233

+346

1,828

1,866

1,885

2,969 Current Period YTD 70.1% 11,041

1,056

977

936

Current (-2) 79.6% 3,914

Current (-1) 67% 3,557

CAMHs waiting list CAMHs waiting list > 12 months No of referrals received

General Adult Number of new seen Mental Performance area to Child % of urgent referrals and Adolescent Mental Health Teams responded to Number of referrals received within three working days

4,536 YTD 18,128 FYT 2,718 YTD Health 10,833 FYT Target/

Fre q M M

Expected Activity 100% 10,955 YTD 43,819 FYT 7,191 YTD M Number of referrals seen 28,716 FYT % offered an appointment and seen within 12 weeks 85% % seen within 12 weeks 75%

75%

73.2%

Psychiatry 65%

M 73.7% 72%

2,736 SPLY YTD 11,255

100% 71.5% 73.8% 97% 96%

+2.3%

75.1%

Number of referrals seen

2,230 YTD 8,896 FYT

2,384

95% % seen within 12 weeks GENERAL ADULT & PSYCHIATRY OFM LATER93.3% LIFE Adult Mental Health - % offered an appointment and seen within 12 weeks 75.5%

73%

73.4% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18

CHO6 (100%), CHO2 (100%), CHO7 (99.7%) CHO2 (99.7%), CHO6 (98.9%), CHO5 (98.8%)

CHO1 (65.5%), CHO8 (91.5%), CHO4 (93.3%) CHO4 (92.7%), CHO1 (92.9%) CHO8 (393), CHO6 (491), CHO4 (698) CHO4 (209), CHO3 (61), CHO5 (52)

Best performance

Outliers

64.5% 3,570 2,174

72.7%

73.5% 97% 95.1% 95%

SPLY SPLY Current Current Current YTD Change (-2) (-1) Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 18/19 3,160 Month 17/18 -34 1,152 1,007 967 2,176

+208

876

754

95.7%

-2.4%

92.7%

92.6%

94.7%

Waiting list > 12 months CHO2 (88.7%), 386 400 (84.9%), CHO5 CHO1 (78.8%) 282 300

CHO9 (60.1%), CHO8 (65.6%), CHO7 (67.8%)

386 336

200 100 Best performance Outliers 0 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18

CHO2 (99.7%), CHO3 (98.7%), CHO1 (97.4%)

Month 18/19

CHO8 (84.2%), CHO7 (85.2%), CHO4 (88.1%)

Psychiatry of Later Life - % offered an appointment and seen within 12 weeks 100% 98%

75% 73.5%

Current

2,241

of Later life

Health Services Performance Profile January to March 2019 Quarterly Report

69%

-214

6,832 6,784 +48 2,417 First appointment within 12 months

69.7% 92% Target/ Current Performance area Expected Freq Period 88% 55% Activity YTD Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 3,115 YTD M 3,126 Number of referrals received Month 17/18 Month 18/19 12,455 FYT

77%

+233 SPLY Change

Outliers

97.1%

96% 94%

95% 95%

94.7%

92% 90%

Month 18/19

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18

Month 18/19

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report P A G E

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Charts & Tables (as of March 2019)

HEALTH SECTOR WORKFORCE: MARCH 2019 KEY MESSAGES Health Sector Workforce: March 2019 Key Messages

At the end of March 2019 Health Services employment levels At the end of March 2019 Health Services employment levels stand at 118,984 stand atWhen 118,984 WTEs. compared with the(118,096 FebruaryWTEs), 2019 the WTEs. compared withWhen the February 2019 figure change is an increase of +888the WTEs (+0.8%). figure (118,096 WTEs), change is an increase of +888 WTEs (+0.8%). Pay and Numbers Strategy

As advised last month, the approach to the 2019 Pay and Staffing Strategy is Pay and Numbers Strategy underpinned by the setting of WTE limits. The Total Health Service limit currently As advised last on month, the basis approach to theWTEs 2019(i.e. Paylimit and StaffingWTE reported against a monthly is 117,858 excluding associated 2019 development funding and limits. Pre-registration Strategy is with underpinned by the setting of WTE The TotalStudent Nurse/Midwife Interns). The WTE limit table below shows the total health service HealthforService limit currently reported against on a monthly basis WTE this month, the monthly WTE excluding Pre-Registration Student Nurse/Midwife Interns, withlimit variance to this latter Overall, with this month is 117,858 WTEs (i.e. excluding WTEWTE. associated 2019shows a variance of +486 WTEs above the total health service limit. At divisional level development funding and Pre-registration Student Nurse/Midwife both Acute (+332 WTEs) and Community Services (+450 WTEs) are reporting Interns).beyond The WTE showsand theNational total health service variance the limit limit. table H&WB,below Corporate Services reported WTE this month, month are WTEs WTE variance to limit. Pre-Registration WTElevels for this the-297 monthly excluding

Student Nurse/Midwife Interns, with variance to this latter WTE. Overall, this month shows a variance of +486 WTEs above the total health service limit. At divisional level both Acute (+332 WTEs) and Community Services (+450 WTEs) are reporting variance beyond the limit. H&WB, Corporate and National Services reported WTE levels this month are -297 WTEs variance to limit.

March 2019 WTE vs WTE Limit

Division Total Health Service National Ambulance Services Acute Hospital Services

WTE Limit

WTE March 2019

WTE March 19 excl preWTE reg Nurse/Midwife Change Feb 2019 intern

Variance March 2019 (under/Over+)

117,858

118,984

118,344

+888

+486

2,003

1,889

+10

-114

58,447

59,335

58,893

+484

+446

60,450

61,224

60,782

+494

+332

Mental Health

9,808

10,078

9,951

+69

+143

Primary Care

10,982

10,955

+146

-27

Disabilities

18,057

18,339

18,268

+87

+211

Older People

13,188

13,310

+63

+122

Social Care

31,245

31,649

31,579

+150

+334

Community Services

52,035

52,683

52,485

+365

+450

609

580

-2

-29

Corporate

3,212

2,875

+15

-337

Health Business Service H &W, Corporate and National Services

1,552

1,622

+15

+70

5,373

5,076

+29

-297

Acute Services

Health & Wellbeing

KEY FINDINGS THIS MONTH Overall this month, there is growth of +888 WTEs. This is by far the highest reported growth for March, whereby the 5 year average is +317 WTEs. The greatest increase this month is seen in the Nursing & Midwifery staff category (+533 WTEs), with 60% of this month‟s growth attributable to this staff category. Similarly to last month, this month‟s growth patterns are impacted by the fluctuations in this staff category, likely attributable to the recent industrial action. Last month, this staff category reported atypical large decreases, conversely mirrored again this month, with atypical large increases. This is likely to be attributable to the normalisation of this WTE subsequent to industrial action impact. Notably the growth of +888 WTEs this month is reflected in just +381 growth in total headcount, further showing the potential distortion in WTE due to these fluctuations. Of note, the growth this month in Nursing & Midwifery is +533 WTEs, which compares atypically with a 5 year average of +86 WTEs. Pre-registration nurse & midwife interns this month are of less impact to the overall position, at just +5 WTEs. Notably last month, excluding this staff group, Nursing and Midwifery fell by -435 WTEs compared with an increase of +528 WTEs, which is a variance of +93 WTEs. This figure is more comparable to the 5

Health Services Performance Profile January to March 2019 Quarterly Report

year average trend of +86 WTEs. Given the fluctuations in Nursing & Midwifery, excluding this staff category altogether, shows growth of +355 WTEs. Applying the same analysis over the last 5 years, the trend in this month is +231 WTEs, therefore, in similarity again to last month‟s analysis is showing growth higher than the average trend for this month.  All staff categories grew this month, with Patient & Client Care showing the second highest growth of +110 WTEs (secondary to +94 WTE growth in Health Care Assistant group), which is atypical for this group based on a 5 year average March trend of +19 WTE growth. Of note however, this staff category can be subject to large fluctuations as previously shown in monthly trends.  As noted in last month‟s report, the expected normalisation in the NCHD figures (Registrars, SHO/Interns), largely attributable to NCHD rotation, has occurred this month, and is showing a total increase this month of +56 WTEs. This is typical for this month, with the 5 year average for this month +40 WTEs. The total increase for Medical & Dental is +67 WTEs.  Management Admin and Health & Social Care Professionals are also showing increases at +89 and +55 WTEs respectively.  The Year-to-Date figure is +1,127 WTEs (+1.0%) which is

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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Charts & Tables (as of March 2019)

Dublin Mid Leinster showsWTEs, the largest growth in Medical comparable to the 5(DML). year SSWHG average also of 1,087 while the year on & Dental, again in NCHD (+21 WTEs), with DML showing the largest increase year increase is +3,619 WTEs (+3.1%). The year on year increase is in Management Admin, along with IEHG and RCSI showing the largest significantly than for the same period last year which saw an increases in lower General Support. increase of +4,011 WTEs. Nonetheless, the quarterly comparison  The change within Community Services (as shown in the tables further shows asisthe growth lastthan 5 March below)Q1 this2019 month an second increase highest of +365 Q1 WTEs, whichinisthe lower 2018 growth of +490 WTEs and marginally above the average 5 year pattern years. of +317 WTEs for this month. For reasons as outlined above, this too is likely All sectors recorded increases from last month; HSE at +753 influenced by the normalisation seen in Nursing & Midwifery of +197 WTEs, WTEs (+1.0%), Hospitals atjust +66+10 WTEs (+0.3%) and compared to a 5Voluntary year March average of WTEs, hence showing an atypical pattern this (Non-Acute) month also. Last month this staff category fell by -168 Voluntary Agencies at +68 WTEs (+0.4%). WTEs (excl. pre-registration nurse & midwife interns), compared with an Overall ofthis month, (+494 WTEs),ofCommunity increase +197 WTEs Acute this month, a difference +29 WTEs. (+365 WTEs), Taking Corporate the approach outlined above (i.e. excluding Nursing & Midwifery (+15 WTEs) and Health Business Services (+15 altogether) the change shows growth of +168 WTEs this month, compared to WTEs) are all showing increases. an average 5 year March trend of +26 WTEs.  After Nursing & Midwifery, the largest increase this month in Community Services is seen Patient &this Client Care at +88 WTEs (+80 WTEs in Health Operations key infindings month: Care Assistant Group) followed by Health & Social Care Professionals (+39 The change within Acute Services (as shown in the tables further WTEs) and Management Admin (+35 WTEs) with Medical & Dental +14 below) this month is an increase of +494 WTEs. This compares to WTEs of which 15 WTEs are Consultants in Psychiatry. March Seven2018 out of growth nine CHOs are showing thisaverage month, with bothpattern CHO 2 and of +315 WTEsgrowth and an 5 year CHO 6 showing decreases. Seven out of nine CHOs are showing increases in ofNursing +271 WTEs for this month. For reasons as outlined above, & Midwifery, with the largest in CHOs 4 & 5 (+45, +59 WTEs). Similarly seven out of nine CHOs are showing increases in Patient&& Client this is likely influenced by the normalisation seen in Nursing Care, with CHOs 1 & 8 showing the largest increase, and CHO 2 showing the Midwifery of +331 WTEs, compared to a 5 year March average of largest decrease (-52WTEs).

+76 WTEs, hence showing an atypical pattern this month also. Last month this staff category fell by -260 WTEs (excl. pre-registration nurse & midwife interns), compared with an increase of +326 WTEs this month, a difference of +66 WTEs. Taking the approach outlined above (i.e. excluding Nursing & Midwifery altogether) the change shows growth of +163 WTEs Health Services Performance Profile January to March 2019 Quarterly Report this month, compared to an average 5 year March trend of +195 WTEs. After Nursing & Midwifery, the largest increase this month in Acute Services is in Medical & Dental, again attributable to the re-growth in NCHDs, likely attributable to NCHD rotation at +53 WTE. This is followed by General Support (+39 WTEs) and Management Admin (+34 WTEs) predominantly in Grade V-VII. All Hospital Groups and CHI are showing increases this month and all showing increases in Nursing & Midwifery, the largest in SSWHG, Saolta and Dublin Mid Leinster (DML). SSWHG also shows the largest growth in Medical & Dental, again in NCHD (+21 WTEs), with DML showing the largest increase in Management Admin, along with IEHG and RCSI showing the largest increases in General Support.  The change within Community Services (as shown in the tables further below) this month is an increase of +365 WTEs, which is lower than March 2018 growth of +490 WTEs and marginally above the average 5 year pattern of +317 WTEs for this month. For reasons as outlined above, this too is likely influenced by the normalisation seen in Nursing & Midwifery of +197 WTEs, compared to a 5 year March average of just +10 WTEs, hence

By Division: March 2019 change since Feb 2019

% change since Feb 2019

change since Dec 2018

118,984

+888

+0.8%

+1,127

+1.0%

+3,619 +3.1%

1,889

+10

+0.5%

+0.1%

+17 +0.9%

59,335

+484

+0.8%

+757

+1.3%

+2,104 +9.0%

Acute Services

61,224

+494

+0.8%

+759

+1.3%

+2,121 +2.0%

Primary Care

10,955

+146

+1.3%

+25

+0.2%

+403 +2.2%

Division Total Health Service Ambulance Services Acute Hospital Services

WTE March 2019

% % change change change since Since since Dec March March 2018 2018 2018

Mental Health

10,078

+70

+0.7%

+180

+1.8%

+174 +4.7%

Disabilities

18,339

+87

+0.5%

+79

+0.4%

+513 +4.1%

Older People

13,310

+63

+0.5%

+0.0%

+219 +3.6%

Social Care

31,649

+150

+0.5%

+85

+0.3%

+732 +2.4%

52,683

+365

+0.7%

+290

+0.6%

+1,309 +2.5%

580

-2

-0.3%

+0.6%

Community Services Health & Wellbeing

-11

-1.9%

Corporate

2,875

+15

+0.5%

+16

+0.6%

+90 +3.2%

Health Business Service

1,622

+15

+0.9%

+58

+3.7%

+109 +7.2%

H&WB

5,076

+29

+0.6%

+78

+1.6%

+188 +3.8%

*Following their move from Health and Wellbeing, Environmental Health Services, PCRS and National Screening are reported under Corporate Services

showing an atypical pattern this month also. Last month this staff category fell by -168 WTEs (excl. pre-registration nurse & midwife interns), compared with an increase of +197 WTEs this month, a 74 difference of +29 WTEs.  Taking the approach outlined above (i.e. excluding Nursing & Midwifery altogether) the change shows growth of +168 WTEs this month, compared to an average 5 year March trend of +26 WTEs.  After Nursing & Midwifery, the largest increase this month in Community Services is seen in Patient & Client Care at +88 WTEs (+80 WTEs in Health Care Assistant Group) followed by Health & Social Care Professionals (+39 WTEs) and Management Admin (+35 WTEs) with Medical & Dental +14 WTEs of which 15 WTEs are Consultants in Psychiatry.  Seven out of nine CHOs are showing growth this month, with both CHO 2 and CHO 6 showing decreases. Seven out of nine CHOs are showing increases in Nursing & Midwifery, with the largest in CHOs 4 & 5 (+45, +59 WTEs). Similarly seven out of nine CHOs are showing increases in Patient & Client Care, with CHOs 1 & 8 showing the largest increase, and CHO 2 showing the largest decrease (-52WTEs).

Source: Health Service Performance Profile January to March 2019 Quarterly Report P A G E

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Charts & Tables (as of March 2019)

ACUTE SERVICE BY STAFF GROUP: MARCH 2019 Acute Service by Staff Group: March 2019 % Acute Service by Staff Group: March 2019

Acute Services

Acute Services Total Acute Services Total Acute Medical & Services Dental Medical & Consultants Dental Consultants Registrars

% % change change change change change change % % % WTE since since since since since since change change change change change change March Feb Feb Dec Dec March March WTE since since since since since since 2019 2019 2018 2018 2018 2018 March 2019 Feb Feb Dec Dec March March 2019 2019 2019 2018 2018 2018 2018 61,224 +494 +0.8% +759 +1.3% +2,121 +3.6% 61,224 8,253

8,253 2,650 2,650 2,828

+494 +52

+52 +0

+0 +21

+0.8% +0.6% +0.6% +0.0% +0.0% +0.7%

+759 +27

+27 +4

+4 +43

+1.3% +0.3% +0.3% +0.2% +0.2% +1.5%

2,828 Registrars +21 +0.7% +43 +1.5% 2,715 SHO/ Interns +32 +1.2% -21 -0.8% Medical/ Dental, 2,715 SHO/ Interns +32 +1.2% -21 -0.8% 60 -1 -1.6% +1 +2.3% other Medical/ Dental, 60 -1 -1.6% +1 +2.3% Nursing & other 23,043 +331 +1.5% +453 +2.0% Midwifery Nursing & 23,043 +331 +1.5% +453 +2.0% Nurse/ Midwife Midwifery 4,536 +82 +1.8% +10 +0.2% Manager Nurse/ Midwife 4,536 +82 +1.8% +10 +0.2% Nurse/ Midwife Manager 1,230 Specialist & +40 +3.4% +39 +3.3% Nurse/ Midwife AN/MP 1,230 Specialist & +40 +3.4% +39 +3.3% Staff Nurse/ AN/MP 16,414 +237 +1.5% +100 +0.6% Staff Midwife Staff Nurse/ 16,414 +237 +1.5% +100 +0.6% Public Health Staff Midwife 1 +0 +2.2% +1 +56.8% Nurse Public Health 1 +0 +2.2% +1 +56.8% Pre-registration Nurse Nurse/ Midwife 442 +4 +1.0% +371 +521.7 Pre-registration Intern Nurse/ Midwife 442 +4 +1.0% +371 +521.7 Post-registration Intern Nurse/ Midwife 173 -1 -0.4% +0 +0.0% Post-registration Student Nurse/ Midwife 173 -1 -0.4% +0 +0.0% Nursing/ Student Midwifery Nursing/ 44 -38 -46.4% -69 -61.0% awaiting Midwifery 44 -38 -46.4% -69 -61.0% registration awaiting Nursing/ registration 659 Midwifery -35 -5.0% +302 +84.4% Nursing/ Student 659 Midwifery -35 -5.0% +302 +84.4% Nursing/ Student 203 +7 +3.5% +2 +0.9% Midwifery other Nursing/ 203 +7 +3.5% +2 +0.9% Health & Social Midwifery other 7,515 +16 +0.2% +38 +0.5% Care Health & Social 7,515 +16 +0.2% +38 +0.5% Care Health Services Performance Profile January to March 2019 Quarterly Report

+2,121 +264

+264 +111 +111 +100 +100 +47

+47 +5

+5 +809

+3.6% +3.3% +3.3% +4.4% +4.4% +3.7% +3.7% +1.8% +1.8% +9.8%

+9.8% +3.6%

+809 +239

+3.6% +5.6%

+119 +519

+10.7% +3.3%

+239 +5.6% +119 +10.7%

+519 +3.3% +0 +38.0% +0 -2 -2

-13

+38.0% -0.4%

-0.4%

-7.1%

-61

-58.0%

-76

-10.4%

-61

-76 +8

+8 +265 +265

-58.0%

-10.4% +4.1%

Acute Services

Acute Services Therapy Professions Therapy Health Science/ Professions Diagnostics Health Science/ Social Care Diagnostics SocialWorkers Care Social

Social Workers Psychologists Psychologists Pharmacy

Pharmacy H&SC, Other Management H&SC, Other& Administrative Management & Management Administrative (VIII & above) Management Administrative/ (VIII & above) Supervisory (V Administrative/ toSupervisory VII) (V Clerical to VII) (III & IV) General Clerical (III & IV) Support General Support Support Maintenance/ Support Technical Maintenance/ Patient & Client Technical Care Patient & Client Health Care Care Assistants Health Care Ambulance Assistants Staff Ambulance Care, other Staff

WTE March WTE 2019 March 2019 1,907

1,907 4,139 4,139 2

3282

% % % change change change change change change % % % since change since change since change since change since change since change Feb Feb Dec Dec March since since since since since March since 2019 2019 2018 2018 2018 2018 Feb Feb Dec Dec March March 2019 2019 2018 2018 2018 2018 -2 -0.1% +14 +0.8% +100 +5.6% -2 +15

-0.1% +0.4%

+14 +11

+0.8% +0.3%

+100 +106

+5.6% +2.6%

+0 -0

+0.0% -0.0%

-1-0

-1.6% -0.4%

+0 +5

+1.6% +1.5%

+15 +0

+0.4% +0.0%

+11 -0

+0.3% -1.6%

328 81

+1-0

-0.0% +1.6%

+2-1

-0.4% +2.9%

841 218

+4 -2

+0.5% -1.0%

+6 +6

+0.7% +3.0%

81 841

+1 +4

+1.6% +0.5%

+2 +6

+106 +0

+5 +6

+6 +48

+3.0% +1.1%

+384-0

-0.1% +4.3%

+8.4% +9.9%

+48 -0

+34-2

-1.0% +0.4%

+6 +99

495 2,195

+5 +26

+1.0% +1.2%

-4 +58

-0.7% +2.7%

+38 +198

6,617 6,076

+3 +39

+0.0% +0.7%

+45 +52

+0.7% +0.9%

+147 +113

5,575 501

+40 -1

2,195 6,617 6,076 5,575

+34 +5

+26 +3

+39 +40

+0.4% +1.0%

+1.2% +0.0% +0.7% +0.7%

+0.7% -0.2%

+99 -4

+58 +45 +52 +54

+54 -2

+1.1% -0.7%

+2.7% +0.7% +0.9% +1.0%

+1.0% -0.3%

+384 +38

+198 +147 +113 +112

+112 +1

501 7,030

-1 +23

-0.2% +0.3%

-2 +89

-0.3% +1.3%

+1 +286

5,073 1,787

+13 +8

+0.3% +0.5%

+66 +5

+1.3% +0.3%

+249 +14

7,030 5,073 1,787 170

Note therapy now Care, other professions170

+23 +13

+8 +1 +1

+0.3% +0.3% +0.5% +0.6% +0.6%

+89 +66

+5 +18 +18

+1.5% +8.3%

+2.9% +0.7%

218 9,307

9,307 495

+2.6% +1.6%

+1.3% +1.3% +0.3% +11.6% +11.6%

+286 +249

+8.3% +6.1% +6.1% -0.1%

+4.3% +8.4%

+9.9% +2.3%

+2.3% +1.9% +1.9% +2.0%

+2.0% +0.3%

+0.3% +4.2% +4.2% +5.2% +5.2% +0.8%

+14 +15.6% +0.8% +23 +23

+15.6%

include:Dietitians,OccuptionalTherapists,Orthoptists,Physiotherapists,Podistrists & Chiropodists, Note therapy professions now speech & language Therapists. Health Science. Diagnostics is made up of Medical laboratory, include:Dietitians,OccuptionalTherapists,Orthoptists,Physiotherapists,Podistrists & Chiropodists, Physicians, Biochemists, Radiographers and Radiation Therapists. speech & language Therapists. Health Science. Diagnostics is made up of Medical laboratory, Physicians, Biochemists, Radiographers and Radiation Therapists.

+4.1% +3.7% +3.7%

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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Charts & Tables (as of March 2019)

ABSENCE RATE

Rates

Benchmark/ Target

February 2018

Full year 2018

Jan 2019

Feb 2019

% Medically Certified (February 2019)

3.5%

5.0%

4.6%

5.0%

4.8%

86%

Latest monthly figures (February 2018) 

February 2019 absence rate stands at 4.8%, a decrease when compared with the equivalent month in 2018 (5.0%) and also a decrease on the

Latest monthly figures2019 (February previous month (January atFull 5.0%).2018)

%% Medically Medically

Full

Benchmark/ February year Jan Feb  • Over the past four years February rates were follows: 4.6%Certified (2015) and Benchmark/ February year Jan Feb Certified  February 2019 absence rate stands atas4.8%, a decrease when Target 2018 2019 2019 2019) Target 2018 2018 2019 2019 (February (February 2019) 4.9% (2016), 4.4% (2017), 5.0% 2018 (2018).

compared with the equivalent month in 2018 (5.0%) and also 3.5% 5.0% 4.6% 5.0% 4.8% 86% 3.5% 5.0% 4.6% 5.0% 4.8% 86% a decrease on the previous month (January 2019 at 5.0%). Annual Rate for 2018 and Trend Analysis from 2008 Absence rates have shown a(February general downward trendwere sinceas2008.Annual Latest figures (February 2018) • Latest  monthly Over the past four years February follows: rates monthly figures 2018) rates are follows 2019   as February rate stands a adecrease February 2019absence absence rate standsat4.4% at4.8%, 4.8%, decrease whencompared compared 4.6% (2015) and 4.9% (2016), (2017), 5.0%when (2018). Rates Rates

with withthetheequivalent equivalentmonth monthin in2018 2018(5.0%) (5.0%)and andalso alsoa adecrease decreaseononthethe

2008previous 2009 month 2010 (January 2011 2019 2012at 5.0%). 2013 2014 previous month (January 2019 at 5.0%). 5.8% 5.1% 4.7% 4.9% 4.8% 4.7% 4.3%

2015

2016

2017

2018

4.2% 4.5% 4.4% 4.6%   Over thethe past four years rates were asas follows: 4.6% (2015) and Over past four yearsFebruary February rates were follows: 4.6% (2015) and 4.9% (2016), 4.4% (2017), 5.0% (2018). 4.9% (2016), 4.4% (2017), 5.0% (2018). Annual Rate for 2018 and Trend Analysis from 2008  The 2018 full year rate is 4.6% higher than the 2017 figure at 4.4%. It puts the Absence Health Services generally in‐line with the rates reported by ISME for large • Annual rates have shown a Analysis general downward since Annual Rate forfor 2018 and Trend Analysis from 2008 Rate 2018 and Trend from 2008trend organisations in the private sector downward and available information for other large Absence rates have shown aare general trend since 2008.Annual rates Absence rates have shown a general downward trend since 2008.Annual rates 2008.Annual rates as follows public sector organisations both in Ireland and internationally. are asas follows are follows  Nonetheless, it is important to note that Health Sector absence is not directly comparable to2010 other sectors2012 as the nature2014 of the work, 2016 demographic of 2008 2011 2013 2015 2017 2008 2009 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2018 employees, diversity of 4.8% the organisation needs to4.2% be recognised. Health 5.8% 5.1% 4.7% 4.9% 4.7% 4.5% 4.6% 5.8% 5.1% and 4.7% 4.9% 4.8% 4.7% 4.3% 4.3% 4.2% 4.5% 4.4% 4.4% 4.6% sector work can be physically and psychologically demanding, increasing the risk of work related illness and injury. However, these trends are generally in  The 2018 fullfull year rate is is 4.6% higher than thethe 2017 figure at at 4.4%. The 2018 year rate 4.6% higher than 2017 figure 4.4%.It puts It puts line with international public healthcare organisations. thethe Health Services generally in‐line with thethe rates reported byby ISME forfor large Health Services generally in‐line with rates reported ISME large  The latest NHS England absence rate for April 2018 was 3.83%, whilelarge the organisations in in thethe private sector and available information forfor other organisations private sector and available information other large • 2017 The 2018 full year rate is 4.6% higher than the 2017 figure annual rate was 4.13%, from and 4.05% the previous year. NHS public sector organisations both inup Ireland internationally. public sector organisations both in Ireland and internationally. reported anthe absence rate of 5.5% December 2017, and a directly yearly at 4.4%. Itit puts Health Services generally in‐line with the   Scotland Nonetheless, is important to to note that Health Sector absence is is not Nonetheless, it is important note that Health Sector absence not directly average of 5.39%, up from 5.20% in thenature previous year. Whiledemographic in NHS Wales, comparable to toother sectors asas thethe comparable other sectors natureof ofthethework, work, demographicof of rates reported by ISME for large organisations in the private the June 2018 absence rate was 4.8%. As with our international employees, and diversity of of thethe organisation needs to to bebe recognised. Health employees, and diversity organisation needs recognised. Health sector and available information for other demanding, large publicincreasing sector sector work can bebe physically and psychologically thethe sector work can physically and psychologically demanding, increasing risk of of work related illness and injury. However, these trends are generally in-inorganisations both in Ireland and internationally. risk work related illness and However, these trends are generally Health Services Performance Profile January toinjury. March 2019 Quarterly Report line with international public healthcare organisations. with international public healthcare organisations. • line Nonetheless, it is important to note that Health Sector absence   The latest NHS England absence rate forfor April 2018 was 3.83%, while thethe The latest NHS England absence rate April 2018 was 3.83%, while is not directly comparable to other sectors asthe the natureyear. ofyear.NHS 2017 annual rate was upup from 4.05% previous 2017 annual rate was4.13%, 4.13%, from 4.05%the previous NHS Scotland reported ananabsence 2017, and Scotland reported absence rateof of5.5% 5.5%December December 2017, anda ayearly yearly the work, demographic ofrate employees, and diversity of the average of of 5.39%, upup from 5.20% in in thethe previous year. While in in NHS Wales, average 5.39%, from previous While NHS organisation needs to be5.20% recognised. Healthyear. sector work can Wales, thethe June June2018 2018absence absencerate ratewas was4.8%. 4.8%.AsAswith withour ourinternational international

counterparts, sickness absence shows wide seasonal variation throughout

Note: National Service Plan 2019 sets absence rates as a key theThe yearHSE’s with the rate lower in summer and higher in winter. result area (KRA) with the objective of reducing the impact and cost of Note: The HSE’s National Service Plan 2019 sets absence rates as a key result area (KRA) with the objective of reducing the impact and cost of absence to a national absence and commits to a national target level of 3.5%andforcommits all hospitals andtarget level of 3.5% for all hospitals and agencies. The HSE continues to review its current sick leave policiesThe and HSE procedures as welltoasreview having its a range of current supports and interventions to agencies. continues current sick leave policies and address challenges being encountered in the whole area of attendance management and procedures as well as having a range of current supports and interventions absence rates through ill health. The objective of all these actions is to enhance the health sector’s capacity to address and manage more effectively absence rates, support people to address challenges being encountered inalso the whole area ofvariation attendance managers in better managing the issue, while supporting staff regain fitness throughout tothroughout work and counterparts, sickness shows wide counterparts, sicknessabsence absence shows wideseasonal seasonal variation resume work in athe positive and supportive environment as well asobjective of course the keythese objective of management and absence rates through ill health. The of all thethe year with rate lower in summer and higher in winter. year with the rate lower in summer and higher in winter. reducing the impact and cost of absence. actions isThe to enhance the health sector’s capacity to address and manage Note: HSE’s National Service Plan 2019 sets absence rates as as a key result area (KRA) Note: The HSE’s National Service Plan 2019 sets absence rates a key result area (KRA) thethe objective of of reducing the impact and cost ofmanagers absence and tomanaging a national target European Working Time Directive (EWTD) with objective reducing the impact and cost of absence and commits to a national target morewith effectively absence rates, support people incommits better level of 3.5% for all hospitals and agencies. The HSE continues to review its current sick leave level of 3.5% for all hospitals and agencies. Thewith HSE continues to its current sick leave % Compliance % review Compliance with policies and procedures as well as having a range of current supports and interventions the issue, while also supporting staff regain fitness to work and resume work policies and procedures as well as a range of current48 supports and interventions 24having hour shift hour working week to to address challenges being encountered in in thethe whole area of of attendance management and address challenges being encountered whole area attendance management and Acute Hospitals 97.3% 81.2% in a absence positive and supportive environment as well as of course the key objective rates through ill health. objective of of all all these actions is is to to enhance thethe health absence rates through ill health.The The objective these actions enhance health sector’s capacity to address and manage more effectively absence rates, support people sector’s capacity to address and manage more effectively absence rates, support people of reducing impact and cost of absence. Mental Healththe Services 93% staff regain fitness to work 86.9% managers in better managing the issue, while also supporting and managers in better managing the issue, while also supporting staff regain fitness to work and resume work in a and supportive environment as as well as as of of course thethe keykey objective of of resume work in positive a positive and supportive environment well course objective

Otherreducing Agencies thethe impact and cost of absence. reducing impact and cost of absence.

100%

European Working Time Directive (EWTD) European Working Time Directive (EWTD)

%% Compliance with Compliance with 2424 hour shift hour shift

Acute Hospitals Acute Hospitals

97.3% 97.3%

Mental Health Services Mental Health Services Other Agencies Other Agencies

%% Compliance with Compliance with 4848 hour working week hour working week

81.2% 81.2%

93% 93%

86.9% 86.9%

100% 100%

be physically and psychologically demanding, increasing the risk ofPerformance work related illness injury. However, these trends Health Services Profile January toand March 2019 Quarterly Report Health Services Performance Profile January to March 2019 Quarterly Report are generally in-line with international public healthcare organisations. • The latest NHS England absence rate for April 2018 was 3.83%, while the 2017 annual rate was 4.13%, up from 4.05% the previous year. NHS Scotland reported an absence rate of 5.5% December 2017, and a yearly average of 5.39%, up from 5.20% in the previous year. While in NHS Wales, the June 2018 absence rate was 4.8%. As with our international • counterparts, sickness absence shows wide seasonal variation throughout the year with the rate lower in summer and higher in winter.

79 79

Source: Health Service Performance Profile January to March 2019 Quarterly Report P A G E

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Areas of Level 3 Escalation [NPOG oversight]

General: Cancer Rapid Access Clinics (Prostate, Lung, Breast and Radiotherapy)

I R I S H

Service Acute Operation s/NCCP

H O S P I T A L Escalation level 3

C O N S U L T A N T S

Date escalated 11May 2015

A S S O C I A T I O N

Reason for escalation Escalated due to the persistence and breadth of underperformance in Rapid Access Cancer services

Charts & Tables

Responsible ND AO ND CCP

Improvement Plan National Cancer Control Programme Rapid Access Clinics Performance Review and Improvement Plan inclusive of recommendations and improvement plan 2017 – 2019 fully implemented Performance Review is complete – implementation in 2 phases:Phase 1 - Wave 1 Improvement Initiatives – 87% completion nationally Phase 2 – Wave 2 Improvement Initiatives – Summary Report and Workforce Analysis complete to inform future service planning process. NCCP provided revenue funding in 2017 and 2018 to fund additional WTE’s. Capital funding allocated to four hospitals in 2018 to purchase replacement equipment. AREAS OF LEVEL [NPOG OVERSIGHT] Continue focus on 3 theESCALATION NCCP Rapid Access Clinic KPI improvement recommendations for breast, lung and prostate cancers and specifically site specific improvement plans and trajectories for performance improvement.

(as of March 2019)

Performance Data Breast Cancer within 2 weeks

Lung Cancer within 10 working days 95%

90%

81.4%

70% 73.7% 50%

53.1%

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month 17/18

91.7%

86.4%

89.1%

70% 50%

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Month 18/19

Month 17/18

Prostate Cancer within 20 working days 90% 73.9%

90% 11

95%

90%

75%

Month 18/19

Radiotherapy within 15 working days 90%

Lung Cancer May 2015. Prostate Cancer July 2015 and de-escalated from Black to Red in March 2016. Breast Cancer July 2016. Radiotherapy September 2016.

90% 80.4%

84.3%

71.1%

60% 70% and % of people waiting < 52 weeks for first access 75.4%to OPD services Waiting Lists: % of adults and children < 15 months for an elective inpatient or day case procedure 43.1%

Health 45%Services Performance Profile January to March 2019 Quarterly Report

Service Escalation level Date escalated Reason for50% escalation 30% Acute Operations 3 Dec Jan Feb Mar October 2015 Escalated due toMar theApr continued waiting lists and May Jun growth Jul AuginSep Oct Nov Dec Janwaiting Feb Martimes Mar Apr May Jun Jul Aug Sep Oct Nov Month 17/18 Month 18/19 Month 18/19 Improvement Plan Month 17/18 Implementation of agreed DoH waiting list action plans for inpatient and day case procedures and outpatient appointments. Ensure all long waiters are treated at the earliest practical date. Ongoing work in the centralised validation unit in NTPF with hospitals which will provide clean, accurate and up to date waiting lists. Performance Data NPOG REDI elements Date agreed Due18m+) date Inpatient and Day Case Waiting List (Adult & Child 15m+ and 18m+) Outpatient Waiting List (15m + and 1 10,000 2 5,000 3

Improve: RAC performance will be monitored by NPOG on a monthly 8,781 7,488 5,497

80,000

Diagnose: CCO and/or ND NCCP and ND Acute Operations will undertake 2 site visits to facilitate a0 round-

07.05.18

02.07.19

Improve: NCCP will issue guidance to the system including guidance on triage such that performance across all sites is improved.

07.05.18

Mar table Apr May Jun Jul Aug Sep Oct Nov Jan Feb Mar comprehensive review andDec assessment of performance 15m+ 18m+

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 15m+ 18m+

Outpatient Waiting List (Total) 546,630

540,000 70,219

70,000

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

520,000

504,111

500,000 480,000

Mar Apr May Jun Jul AugSep Oct NovDec Jan Feb Mar

Total

NPOG REDI elements

Health Services Performance Profile January to March 2019 Quarterly Report

02.07.19

560,000

80,058

Status

130,995

106,080

On-going 101,724

75,000 65,000

100,000

on-going

Improve: Improvement Plans for breast, prostate and lung cancer services have been agreed with a number of 02.10.18 5,311 77,547 hospital sites where performance is below target. These will be monitored on a monthly basis. 50,000

Inpatient and Day Case Waiting List (Adult & Child Total) 85,000

06.12.17

150,000

Responsible ND AO

Diagnosis: Escalation actions in relation to scheduled and un-scheduled care will be aligned with the work on the 3 Year Plan which has been commissioned by the DDG Operations

Total

Date agreed

Due date

Status

06.09.17

on-going

Under management at operational level

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report

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I R I S H

H O S P I T A L

C O N S U L T A N T S

A S S O C I A T I O N

Emergency Department - % of all attendees at ED who are in ED < 24 hours and % of all attendees aged 75 years and over at ED who are discharged or admitted within 24 hours of registration Service Acute Operations

Escalation level 3 (re-assigned Jan 2018)

Date escalated May 2015

Reason for escalation Due to the number of people continuing to wait in ED for > 24 hours

Responsible ND AO

Improvement Plan Implementation of the Winter Plan 2018/19 including improving access through integrated working with community services. Plan activity and ensure alignment with the Sláintecare Implementation strategy to anticipate and manage critical demand pressure including increased acute bed capacity of 75 beds (part year in 10 locations) in Winter 2018/2019. AREAS OF LEVEL 3 ESCALATION CONT. Integrated working with community services to[NPOG improve theOVERSIGHT], following;  Improved access to diagnostics  Develop admission avoidance pathways by providing care closer to home and improving services for frail elderly in acute hospitals  Improve clinical pathways for patients admitted to ensure that variances in average length of stay, in particular medical patients, are monitored and reduced where feasible. Performance Data ED over 24 hours 6,000

% of 75 year old or older admitted or discharged within 24 hours of registration

4,774

4,387

110%

4,000 Colonoscopy - % of people waiting < 13 weeks following a referral for routine colonoscopy or OGD and No. of people waiting > 4 weeks for access to an urgent colonoscopy 2,000

1,449

1,436

Service Acute0 Operations

Escalation level 0 3 (re-assigned Jan Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2018) Patients 75+ >24 hrs

Date escalated 12March 2015

All patients > 24 hrs

99%

100%

Reason for escalation 89.1% 90% of patients waiting greater than 13 weeks for a routine Due to the number 89.9% colonoscopy/OGD and on-going breaches in urgent colonoscopies 80%

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Improvement Plan Month 18/19 Hospital Groups to ensure that hospital MOUs with the National BowelScreen programme align with capacity in order to comply with BowelScreen targets. NPOG- REDI elements Date agreed Due date Hospitals to seek support from the National Treatment Purchase Fund to treat long waiters for routine procedures. 1 Diagnosis: Under the auspices of the National Patient Flow Improvement Programme the diagnostic, actions 07.06.17 on-going Performance Data and projectionspatients for service improvement for projects at Galway and UL hospitals will be completed Urgent Colonoscopy greater than 4 weeks Number on waiting list for GI Scopes

Financial including pay management 61 position 2 Diagnosis: Escalation actions in relation to scheduled and un-scheduled care will be aligned with the work on 60

the 3 Year Plan which has been commissioned Service Escalation level by the DDG DateOperations escalated 40 Acute Operations 3 (re-assigned Jan February 2016 20 0 2018)

11,000

10,152

on-going11,259

06.09.17

Reason for escalation 9,000to financial performance within acute hospitals 10,933 Due to the risks 7,000

YTD Actual €’000

YTD Budget €’000

YTD Variance €’000

YTD % Variance

1,314,890

1,285,390

29,500

2.30%

NPOG REDI elements 1

Status Under management at operational level Under management at operationalResponsible level ND AO

8,540

5,000 Improvement Plan Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Review monthly gross and 18/19 net expenditure at hospital level to determine reasons for financial surpluses/deficits. Month <13 weeks > 13 week breaches Monitor actual WTEs versus profile by hospital. Health- Services Performance Profile January to March 2019 Quarterly Report Monitor budget versus actual expenditure in month and year to date in relation to direct pay and agency and overtime costs. NPOG REDI elements Date agreed Due date Performance Data 1 Review: Monthly review of urgent breachto data on-going Financial position: projected net colonoscopy expenditure year end including pay management 07.06.17

Acute Hospitals Care

Responsible ND AO

Enquire: Finance performance meetings to be held with each Hospital Groups and with hospitals subject to formal escalation.

Date agreed 04.05.16

Status on-going

Due date

Status

on-going

Complete

Routine colonoscopies escalated Red to Black in September 2015

Health Services Performance Profile January to March 2019 Quarterly Report

Source: Health Service Performance Profile January to March 2019 Quarterly Report P A G E

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I R I S H

H O S P I T A L

C O N S U L T A N T S

A S S O C I A T I O N

Notes

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H O S P I T A L

C O N S U L T A N T S

A S S O C I A T I O N

Notes

P A G E

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H O S P I T A L

C O N S U L T A N T S

A S S O C I A T I O N

Notes

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H O S P I T A L

C O N S U L T A N T S

A S S O C I A T I O N

Notes

P A G E

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IHCA Diary Pages 2020_V2.indd 1

31/07/2019 13:05

INTERNATIONAL INFORMATION COUNTRY

CAPITAL

GMT

DIAL CODE

MONETARY UNIT

Argentina

Buenos Aires

-3

Argentine Peso/Centavo

Australia (Sydney)

Canberra

+10

Australian Dollar/Cent

Austria

Vienna

Euro/Cent

Belgium

Brussels

Euro/Cent

Brazil

Brasilia

-3

Real/Centavo

Canada (Toronto)

Ottawa

-5

Canadian Dollar/Cent

China

Beijing

Yuan/Jiao

Denmark

Copenhagen

Krone/Ore

Egypt

Cairo

Egyptian Pound/Piastre

Finland

Helsinki

358

Euro/Cent

France

Paris

Euro/Cent

Germany

Berlin

Euro/Cent

Ghana

Accra

GMT

233

Cedi/Pesewa

Greece

Athens

Euro/Cent

Hong Kong SAR

Victoria City

852

Hong Kong Dollar/Cent

India

New Delhi

+5.5

Rupee/Paise

Indonesia

Jakarta

Rupiah/Sen

Ireland

Dublin

GMT

353

Euro/Cent

Israel

Jerusalem

972

New Shekel/Agora

Italy

Rome

Euro/Cent

Japan

Tokyo

Yen

Luxembourg

352

Euro/Cent

Malaysia

Kuala Lumpur

Ringgit/Sen

Mexico

Mexico City

-6

Mexican Peso/Centavo

Netherlands

Amsterdam

Euro/Cent

New Zealand

Wellington

+12

New Zealand Dollar/Cent

Nigeria

Abuja

234

Naira/Kobo

Philippines

Manila

Philippine Peso/Sentimo

Portugal

Lisbon

GMT

351

Euro/Cent

Russia (Moscow)

Moscow

Rouble/Kopeck

Saudi Arabia

Riyadh

966

Riyal/Halala

Singapore

Singapore Dollar/Cent

South Africa

Pretoria

Rand/Cent

Spain

Madrid

Euro/Cent

Sweden

Stockholm

Krona/Ore

Switzerland

Berne

Franc/Centime

Taiwan

Taipei

886

New Taiwan Dollar/Cent

United Kingdom

London

GMT

British Pound/Pence

USA (New York)

Washington DC

-5

US Dollar/Cent

Zimbabwe

Harare

263

US Dollar/Cent

The information in this publication is checked carefully at the time of printing. No responsibility can be accepted if any errors occur.

IHCA Diary Pages 2020_V2.indd 2

31/07/2019 13:05

YEAR PLANNER 2020 1 RoI & UK

JANUARY

17 St.Patrick’s Day Observed. RoI (B.Hol. NI)

MARCH

FEBRUARY

❋ Holidays 13 RoI & UK

4 RoI & UK 25 UK

1 RoI

APRIL

MAY

JUNE

Sun. Week 1

Mon.

Week 5 2

Week 10

Week 14

Week 18 1 ❋

Tue.

Wed.

1❋

Thur.

Fri.

Sat.

Sun.

Mon.

Week 2 3

Week 6 9

Week 11 6

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 3 10

Week 16 11

Week 20 15

Tue.

17 ❋

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 4 17

Week 8 23

Week 13 20

Week 17 18

Week 21 22

Tues

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 5 24

Week 9 30

Week 14 27

Tue.

Wed.

Thur.

Fri.

Sat. Sun.

IHCA Diary Pages 2020_V2.indd 3

Week 7 16

Week 23

Week 12 13 ❋

Week 15 4 ❋

Week 18 25 ❋

Week 19 8

Week 22 29

Week 24

Week 25

Week 26

Week 27

31/07/2019 13:05

YEAR PLANNER 2020 ❋ Holidays 3 RoI & Scot. 31 UK

JULY

AUGUST

Week 27

Mon.

26 RoI

SEPTEMBER

Week 31

Tue.

OCTOBER

Week 36

25 RoI & UK 26 RoI & UK

30 Scot.

NOVEMBER

Week 40

DECEMBER

Week 44

Week 48

1 2

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 32 7

Week 37 5

Week 41 2

Week 45 7

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week29 10

Week 33 14

Week 38 12

Week 42 9

Week 46 14

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 30 17

Week 34 21

Week 39 19

Week 43 16

Week 47 21

Tue.

Wed.

Thur.

Fri.

25 ❋

Sat.

26 ❋

Sun.

Mon.

Week 31 24

Week 35 28

Week 44 23

Week 48 28

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

31 ❋

30 ❋

IHCA Diary Pages 2020_V2.indd 4

Week 28 3 ❋

Week 40 26 ❋

Week 50

Week 51

Week 52

Week 53

31/07/2019 13:05

THREE YEAR CALENDAR JANUARY Wk M

1 2 3 4 5

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

Wk M

5 6 7 8 9

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28

2 9 16 23

3 10 17 24

1 3 4 5 6 7 8 10 11 12 13 14 15 17 18 19 20 21 22 24 25 26 27 28 29

2 9 16 23 30

MAY Wk M

18 19 20 21 22

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

Wk M

22 23 24 25 26

SEPTEMBER 35 36 2 37 9 38 16 39 23/30

MARCH

Wk M

9 10 11 12 13

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

3 10 17 24 31

1 3 4 5 6 7 8 10 11 12 13 14 15 17 18 19 20 21 22 24 25 26 27 28 29

40 41 42 43 44

Wk M

1 8 15 22 29

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

Wk M

14 15 16 17 18

JULY

Wk M

27 28 29 30 31

AUGUST

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

3 10 17 24

1 8 15 22 29

OCTOBER Wk M

APRIL F

JUNE

Wk M

2019

FEBUARY

31 32 33 34 35

1 5 6 7 8 12 13 14 15 19 20 21 22 26 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

NOVEMBER

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

Wk M

44 45 46 47 48

DECEMBER Wk M

48 49 2 3 50 9 10 51 16 17 52 23/30 24/31

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2020 JANUARY Wk M

1 2 3 4 5

FEBUARY

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

3 10 17 24 31

Wk M

5 6 7 8 9

18 19 20 21 22

1 3 4 5 6 7 8 10 11 12 13 14 15 17 18 19 20 21 22 24 25 26 27 28 29

2 9 16 23

35 36 37 38 39

Wk M

9 10 2 3 11 9 10 12 16 17 13 23/30 24/31

JUNE

Wk M

23 24 25 26 27

1 8 15 22 29

SEPTEMBER Wk M

MARCH S

MAY Wk M

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

39 40 41 42 43

APRIL F

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

Wk M

14 15 16 17 18

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

JULY

Wk M

27 28 29 30 31

Wk M

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

31 32 3 33 10 34 17 35 24/31

Wk M

NOVEMBER

Wk M

1 5 6 7 8 12 13 14 15 19 20 21 22 26 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

43 44 2 45 9 46 16 47 23/30

AUGUST

OCTOBER

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 21 25 26 27 28 29

2 9 16 23 30

DECEMBER

1 3 4 5 6 7 8 10 11 12 13 14 15 17 18 19 20 21 22 24 25 26 27 28 29

48 49 50 51 52

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

2021 JANUARY Wk M

1 2 3 4 5

FEBUARY F

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

3 10 17 24 31

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

Wk M

1 8 15 22

2 9 16 23

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

Wk M

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

2 9 16 23 30

3 10 17 24 31

6 7 8 9 10

MAY Wk M

18 19 3 20 10 21 17 22 24/31

36 37 38 39 40

23 24 25 26 27

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

Wk M

40 41 42 43 44

APRIL

1 8 15 22 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

Wk M

1 5 6 7 8 12 13 14 15 19 20 21 22 26 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

10 11 12 13 14

Wk M

14 15 16 17 18

1 5 6 7 8 12 13 14 15 19 20 21 22 26 27 28 29

2 9 16 23 30

3 10 17 24

4 11 18 25

JULY 27 28 29 30 31

OCTOBER

IHCA Diary Pages 2020_V2.indd 5

Wk M

JUNE F

SEPTEMBER Wk M

MARCH

45 46 47 48 49

1 8 15 22 29

AUGUST Wk M

31 32 2 3 33 9 10 34 16 17 35 23/30 24/31

NOVEMBER Wk M

1 4 5 6 7 8 11 12 13 14 15 18 19 20 21 22 25 26 27 28 29

DECEMBER

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

Wk M

49 50 51 52 53

1 6 7 8 13 14 15 20 21 22 27 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

31/07/2019 13:05

WORLD HOLIDAYS FOR 2020 IRELAND New Year’s Day: St Patrick’s Day Observed: Easter Mon: May Bank Hol: June Bank Hol: Aug Bank Hol: Oct Bank Hol: Christmas Day: St Stephen’s Day:

1 Jan 17 Mar 13 Apr 4 May 1 Jun 3 Aug 26 Oct 25 Dec 26 Dec

USA New Year’s Day: Martin Luther King Day: Presidents’ Day: Memorial Day: Independence Day: Labor Day: Columbus Day: Veterans Day: Thanksgiving Day: Christmas Day:

1 Jan 20 Jan 17 Feb 25 May 4 Jul 7 Sep 12 Oct 11 Nov 26 Nov 25 Dec

AUSTRALIA New Year’s Day: Australia Day Observed: Labour Day (WA): Public Hol (SA/ATC/VIC): Good Fri: Easter Mon: ANZAC Day: May Day (NT): Western Australia Day (WA): Queen’s B’Day (except WA): Labour Day (NSW/ACT/SA/QLD): Christmas Day: Boxing Day:

1 Jan 27 Jan 9 Mar 21 Mar 10 Apr 13 Apr 25 Apr 4 May 1 Jun 8 Jun 5 Oct 25 Dec 26 Dec

CHINA New Year’s Day: 1 Jan Spring Festival Golden Week/Chinese NY: 26-30 Jan Qing Ming Jie: 4 Apr Labour Day: 1 May Dragon Boat Festival: 25 Jun Mid-Autumn Festival: 1 Oct National Day: 1 Oct National Day Hol: 2 Oct - 7 Oct

IHCA Diary Pages 2020_V2.indd 6

UNITED KINGDOM New Year’s Day: St Patrick’s Day Observed (NI): Good Fri: Easter Mon (except SCO): Early May Bank Hol: Spring Bank Hol: The Twelfth/Orangemen’s Day (NI): Summer Bank Hol (SCO): Summer Bank Hol (UK, except SCO): St Andrew’s Day (SCO): Christmas Day: Boxing Day: CANADA New Year’s Day: Family Day (BC): Family Day (AB, ON, SK, MA, NB, NS): Good Fri: Easter Mon: Victoria Day (except NB/NS/PE): National Patriots’ Day (QC): National Aboriginal Day (NT): National Holiday of Quebec Canada Day: Public Hol (BC, SK, MB, ON, NB, NU, PE): Labour Day: Thanksgiving Day (BC, AB, SK, MB, ON, QC, YT, NT, NU): Remembrance Day (except ON/QC): Christmas Day: Boxing Day (except AB/BC/NU): JAPAN New Year’s Day: Coming-of-Age Day: National Foundation Day: Spring Equinox: Shõwa Day: Constitution Memorial Day: Greenery Day: Children’s Day: Marine Day: Mountain Day: Respect for the Aged Day: Autumn Equinox: Health & Sports Day: Culture Day: Labour Thanksgiving Day:

1 Jan 17 Mar 10 Apr 13 Apr 4 May 25 May 12 Jul 3 Aug 31 Aug 30 Nov 25 Dec 26 Dec

1 Jan 17 Feb 17 Feb 10 Apr 13 Apr 18 May 18 May 21 Jun 24 Jun 1 Jul 3 Aug 7 Sep 12 Oct 11 Nov 25 Dec 26 Dec

1 Jan 13 Jan 11 Feb 20 Mar 29 Apr 3 May 4 May 5 May 23 Jul 10 Aug 21 Sep 22 Sep 14 Oct 3 Nov 23 Nov

31/07/2019 13:05

CONVERSION FORMULAE

LITRES 4.55 6.82 9.09 11.36 13.64 15.91 18.18 20.46 22.73 27.28 31.82 36.37 40.91

1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 6.00 7.00 8.00 9.00

GALLONS 0.22 0.33 0.44 0.55 0.66 0.77 0.88 0.99 1.10 1.32 1.54 1.76 1.98

KILOGRAMS 0.11 0.23 0.45 0.68 0.91 2.27 2.27 3.18

0.25 0.50 1.00 1.50 2.00 5.00 6.00 7.00

POUNDS 0.55 1.10 2.20 3.31 4.41 11.02 13.23 15.43

METRES 0.91 1.83 2.74 3.66 4.57

1 2 3 4 5

YARDS 1.09 2.1 3.28 4.28 5.47

KILOMETRES 1.61 3.22 4.83 6.44 8.05 9.66 11.26 12.87 14.48

1 2 3 4 5 6 7 8 9

MILES 0.62 1.24 1.86 2.48 3.11 3.7 4.25 4.97 5.59

CENTIGRADE -18 -15 -12 -9 -7 -4 -1 2 4 7 10 13 16 18 21 24 27 32 38

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 90 100

FARENHEIT 32 41 50 59 68 77 86 95 104 113 122 131 140 149 158 167 176 194 212

58 203 121 169 146 323 171 188 195 89

61 105 31 163 108 82 452 87 129 351 140 158 61

21 278 111 264 219 402 95 153 266 140 51 116 76

117 174 222 185 90 135 486 97 105 404 55

68 142 105 288 43 227 275 407 119 60 306 129 53 158 146 93

251 85 212 71 280 272 303 130 301 175 282 254 130 166 151 183 151 51 225 285 286 114 113 175 69 100 190 227

224 156 156 32 251 245 343 84 254 251 211 151 151 164 126 119 80 158 264 249 198 150 31 129 64 109 171 163 103

330 153 285 201 348 351 295 267 391 208 398 391 204 240 245 312 274 98 275 364 391 211 241 280 198 203 259 333 135 241

206 214 150 117 200 227 428 121 185 336 135 66 201 169 206 68 138 245 343 240 113 233 106 126 135 188 177 111 188 85 327

346 177 307 137 375 367 185 225 230 103 346 320 227 261 79 278 145 76 132 380 367 40 180 270 166 192 285 322 95 169 124 254

425 298 380 222 473 446 109 306 480 119 430 398 346 380 138 364 206 214 32 459 452 101 266 351 251 296 367 407 216 251 291 335 11

333 163 298 164 357 354 216 224 394 126 383 357 211 246 166 280 220 48 193 367 381 129 204 269 164 195 267 322 100 208 79 293 82 212

303 257 253 150 303 325 377 188 288 293 238 169 254 267 151 171 84 256 277 338 216 180 146 225 179 224 275 214 220 114 352 103 220 282 309

309 135 264 183 330 330 277 256 372 187 378 372 190 225 227 295 253 80 254 344 372 190 224 261 180 183 240 314 116 222 19 307 143 272 61 333 219 51 145 177 145 266 233 113 137 251 288 275 98 134 209 129 270 124 335 209 217 277 161 153 121 89

IHCA Diary Pages 2020_V2.indd 7

89 185 124 198 116 261 169 257 142 233 90

Wicklow

137 48 106 101 183 158 394 68 204 275 201 182 27

Westport

92 158 114 140 117 278 211 217 150 43 106

Wexford

177 87 143 47 229 198 196 61 232 245 212 190 79

Tralee

51 240 60 222 220 360 121 113 249 90

Waterford

87 126 27 129 122 108 438 45 126 348 108 121 87

Sligo

183 127 126 43 220 204 354 53 224 262 183 146 119 132 154 85 111 156 275 217 187 164

Tipperary

323 193 278 121 372 344 188 204 377 105 328 296 243 278 37 262 105 113 111 357 351

Roscommon

48 198 161 322 101 251 333 455 146

Rosslare

150 237 122 230 122 171 533 156 82 449 32

Omagh

60 547 166 76 451 114 229 158 117 372 172 330 319 470

Portlaoise

34 204 93 261 34

Navan

436 304 389 232 481 457 77 315 488 87 441 407 352 386 145 364 193 198

Newry

285 114 264 116 309 306 243 175 346 148 335 309 167 201 150 232 172

Monaghan

306 212 237 93 336 327 293 177 323 209 272 204 227 245 68 183

Mullingar

61 132 103 245

Limerick

138 175 87 142 135 159 443 53 148 360 98

Longford

338 230 269 111 362 359 225 195 391 137 343 272 245 262

Larne

53 150 129 105 431 79 151 338 159 179 39

Letterkenny

Killkenny

92 132 167 143 396 90 192 304 196 192

PINTS 0.88 1.32 1.76 2.20 2.64 3.08 3.52 4.40 5.28 6.16 7.04 8.80

Killarney

122 50

Enniskillen

180 233 127 183 146 201 484 114 119 402 69

Galway

117 232 109 209 82 138 541 151 50 428

Dundalk

417 254 383 219 476 438 90 303 481

0.50 0.75 1.00 1.25 1.50 1.75 2.00 2.50 3.00 3.50 4.00 5.00

Distances in kilometres between principal towns

Ennis

Donegal

87 237 98 254 43 109 566 171

LITRES 0.28 0.43 0.57 0.71 0.85 0.99 1.14 1.42 1.70 1.99 2.27 2.84

IRELAND DISTANCE CHART Drogheda

Cork

84 167 153 393

The bold figures in the central columns can be read as either the Metric measure or the Imperial measure. For example: 1 metre=1.09 yards; or 1 yard=0.91 metres

Multiply by 2.54 0.3937 0.3048 3.281 0.9144 1.094 1.609 0.6214 6.452 0.155 10.76 0.0929 0.8361 1.196 2.59 0.3861 0.4047 2.471 16.39 0.06102 0.02832 35.31 0.7646 1.308 0.01639 61.03 4.546 0.22 0.0648 15.43 28.35 0.03527 453.6 0.002205 0.4536 2.205 1016.0 0.000984

Derry

132 114 72

Coleraine

513 346 468 311 560 534

Bantry

21 187 85 246 68

Cavan

45 195 82 253

Ballymena

227 127 158

Bangor

60 129

Armagh

166

To Centimetres Inches Metres Feet Metres Yards Kilometres Miles Sq Centimetres Sq Inches Sq Feet Sq Metres Sq Metres Sq Yards Sq Kilometres Sq Miles Hectares Acres Cubic Centimetres Cubic Inches Cubic Metres Cubic Feet Cubic Metres Cubic Yards Litres Cubic Inches Litres Gallons Grams Grains Grams Ounces Grams Pounds Kilograms Pounds Kilograms Tons

Athlone

Dublin

Distance in Kilometres From: Belfast Dublin Armagh Athlone Ballymena Bangor Bantry Cavan Coleraine Cork Derry Donegal Drogheda Dundalk Ennis Enniskillen Galway Kilkenny Killarney Larne Letterkenny Limerick Longford Monaghan Mullingar Navan Newry Omagh Portlaoise Roscommon Rosslare Sligo Tipperary Tralee Waterford Westport Wexford Wicklow

Belfast

From Inches Centimetres Feet Metres Yards Metres Miles Kilometres Sq Inches Sq Centimetres Sq Metres Sq Feet Sq Yards Sq Metres Sq Miles Sq Kilometres Acres Hectares Cubic Inches Cubic Centimetres Cubic Feet Cubic Metres Cubic Yards Cubic Metres Cubic Inches Litres Gallons Litres Grains Grams Ounces Grams Pounds Grams Pounds Kilograms Tons Kilograms

METRIC CONVERSION

31/07/2019 13:05

December 2019 WEEK 49

NOLLAIG

DECEMBER 2019 Wk

48 49 50 51

02 Monday | Luain

Mo Tu We Th

52 1

1 2 9

10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

03 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

04 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 8

31/07/2019 13:05

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

December 2019 NOLLAIG

WEEK 49

05 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

06 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

07 Saturday | Satharn

08 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 9

31/07/2019 13:05

December 2019 WEEK 50

NOLLAIG

DECEMBER 2019 Wk

48 49 50 51

09 Monday | Luain

Mo Tu We Th

52 1

1 2 9

10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

10 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

11 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 10

31/07/2019 13:05

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

December 2019 NOLLAIG

WEEK 50

12 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

13 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

14 Saturday | Satharn

15 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 11

31/07/2019 13:05

December 2019 WEEK 51

NOLLAIG

DECEMBER 2019 Wk

48 49 50 51

16 Monday | Luain

Mo Tu We Th

52 1

1 2 9

10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

17 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

18 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 12

31/07/2019 13:05

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

December 2019 NOLLAIG

WEEK 51

19 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

20 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

21 Saturday | Satharn

22 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 13

31/07/2019 13:05

December 2019 WEEK 52

NOLLAIG

DECEMBER 2019 Wk

48 49 50 51

23 Monday | Luain

Mo Tu We Th

52 1

1 2 9

10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

24 Tuesday | Máirt Christmas Eve 8 9 10 11 12 13 14 15 16 17 Notes

25 Wednesday | Céadaoin Christmas Day 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 14

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JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

December 2019 NOLLAIG

WEEK 52 St.Stephen’s Day 26

Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

27 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

28 Saturday | Satharn

29 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 15

31/07/2019 13:05

January 2020 WEEK 1

30 Monday | Luain

EANÁIR

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

31 Tuesday | Máirt New Year’s Eve 8 9 10 11 12 13 14 15 16 17 Notes

01 Wednesday | Céadaoin New Year’s Day 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 16

31/07/2019 13:05

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9

January 2020 EANÁIR

WEEK 1

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

02 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

03 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

04 Saturday | Satharn

05 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 17

31/07/2019 13:05

January 2020 WEEK 2

06 Monday | Luain

EANÁIR

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

07 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

08 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 18

31/07/2019 13:05

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9

January 2020 EANÁIR

WEEK 2

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

09 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

10 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

11 Saturday | Satharn

12 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 19

31/07/2019 13:05

January 2020 WEEK 3

13 Monday | Luain

EANÁIR

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

14 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

15 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 20

31/07/2019 13:05

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9

January 2020 EANÁIR

WEEK 3

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

16 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

17 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

18 Saturday | Satharn

19 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 21

31/07/2019 13:05

January 2020 WEEK 4

20 Monday | Luain

EANÁIR

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

21 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

22 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 22

31/07/2019 13:05

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9

January 2020 EANÁIR

WEEK 4

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

23 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

24 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

25 Saturday | Satharn

26 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 23

31/07/2019 13:05

January 2020 WEEK 5

27 Monday | Luain

EANÁIR

JANUARY 2020 Wk

Mo Tu We Th

1 2

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

28 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

29 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 24

31/07/2019 13:05

MARCH 2020 Wk

Mo Tu We Th

Su 1

February 2020 FEABHRA

WEEK 5

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

30 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

31 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

01 Saturday | Satharn

02 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 25

31/07/2019 13:05

February 2020 WEEK 6

03 Monday | Luain

FEABHRA

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

04 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

05 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 26

31/07/2019 13:05

MARCH 2020 Wk

Mo Tu We Th

Su 1

February 2020 FEABHRA

WEEK 6

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

06 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

07 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

08 Saturday | Satharn

09 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 27

31/07/2019 13:05

February 2020 WEEK 7

10 Monday | Luain

FEABHRA

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

11 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

12 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 28

31/07/2019 13:05

MARCH 2020 Wk

Mo Tu We Th

Su 1

February 2020 FEABHRA

WEEK 7

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

13 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

St.Valentine’s Day 14

Friday | Aoine

8 9 10 11 12 13 14 15 16 17 Notes

15 Saturday | Satharn

16 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 29

31/07/2019 13:05

February 2020 WEEK 8

17 Monday | Luain

FEABHRA

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

18 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

19 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 30

31/07/2019 13:05

MARCH 2020 Wk

Mo Tu We Th

Su 1

February 2020 FEABHRA

WEEK 8

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

20 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

21 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

22 Saturday | Satharn

23 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 31

31/07/2019 13:05

February 2020 WEEK 9

24 Monday | Luain

FEABHRA

FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

25 Tuesday | Máirt Shrove Tuesday 8 9 10 11 12 13 14 15 16 17 Notes

26 Wednesday | Céadaoin Ash Wednesday 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 32

31/07/2019 13:05

APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2020 MÁRTA

WEEK 9

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

27 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

28 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

29 Saturday | Satharn

01 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 33

31/07/2019 13:05

March 2020 WEEK 10

02 Monday | Luain

MÁRTA

MARCH 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

03 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

04 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 34

31/07/2019 13:05

APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2020 MÁRTA

WEEK 10

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

05 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

06 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

07 Saturday | Satharn

08 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 35

31/07/2019 13:05

March 2020 WEEK 11

09 Monday | Luain

MÁRTA

MARCH 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

10 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

11 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2020_V2.indd 36

31/07/2019 13:05

APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2020 MÁRTA

WEEK 11

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

12 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

13 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

14 Saturday | Satharn

15 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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March 2020 WEEK 12

16 Monday | Luain

MÁRTA

MARCH 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

17 Tuesday | Máirt St.Patrick’s Day 8 9 10 11 12 13 14 15 16 17 Notes

18 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2020 MÁRTA

WEEK 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

19 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

20 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

21 Saturday | Satharn

22 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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March 2020 WEEK 13

23 Monday | Luain

MÁRTA

MARCH 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

24 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

25 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2020 MÁRTA

WEEK 13

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

26 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

27 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

28 Saturday | Satharn

29 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2020 WEEK 14

AIBREÁN

APRIL 2020 Wk

14 1 2 3 4 5 15 16

30 Monday | Luain

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

31 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

01 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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MAY 2020 Wk

Mo Tu We Th

18 19

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April 2020 AIBREÁN

WEEK 14

02 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

03 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

04 Saturday | Satharn

05 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2020 WEEK 15

AIBREÁN

APRIL 2020 Wk

14 1 2 3 4 5 15 16

06 Monday | Luain

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

07 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

08 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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MAY 2020 Wk

Mo Tu We Th

18 19

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April 2020 AIBREÁN

WEEK 15

09 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

Good Friday 10

Friday | Aoine

8 9 10 11 12 13 14 15 16 17 Notes

11 Saturday | Satharn

Easter 12

Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2020 WEEK 16

AIBREÁN

APRIL 2020 Wk

14 1 2 3 4 5 15 16

13 Monday | Luain Easter Monday

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

14 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

15 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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MAY 2020 Wk

Mo Tu We Th

18 19

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April 2020 AIBREÁN

WEEK 16

16 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

17 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

18 Saturday | Satharn

19 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2020 WEEK 17

AIBREÁN

APRIL 2020 Wk

14 1 2 3 4 5 15 16

20 Monday | Luain

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

21 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

22 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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MAY 2020 Wk

Mo Tu We Th

18 19

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

April 2020 AIBREÁN

WEEK 17

23 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

24 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

25 Saturday | Satharn

26 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2020 WEEK 18

AIBREÁN

APRIL 2020 Wk

14 1 2 3 4 5 15 16

27 Monday | Luain

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12 13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

28 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

29 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JUNE 2020 Wk 23 24

Mo Tu We Th 1

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2020 BEALTAINE

WEEK 18

8 9 10 11 12 13 14 15 16 17 Notes

01 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

02 Saturday | Satharn

03 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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May 2020 WEEK 19

04 Monday | Luain May Day

BEALTAINE

MAY 2020 Wk

Mo Tu We Th

18 19

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

05 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

06 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JUNE 2020 Wk 23 24

Mo Tu We Th 1

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2020 BEALTAINE

WEEK 19

8 9 10 11 12 13 14 15 16 17 Notes

08 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

09 Saturday | Satharn

10 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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May 2020 WEEK 20

11 Monday | Luain

BEALTAINE

MAY 2020 Wk

Mo Tu We Th

18 19

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

12 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

13 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JUNE 2020 Wk 23 24

Mo Tu We Th 1

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2020 BEALTAINE

WEEK 20

8 9 10 11 12 13 14 15 16 17 Notes

15 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

16 Saturday | Satharn

17 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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May 2020 WEEK 21

18 Monday | Luain

BEALTAINE

MAY 2020 Wk

Mo Tu We Th

18 19

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

19 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

20 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JUNE 2020 Wk 23 24

Mo Tu We Th 1

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2020 BEALTAINE

WEEK 21

8 9 10 11 12 13 14 15 16 17 Notes

22 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

23 Saturday | Satharn

24 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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May 2020 WEEK 22

25 Monday | Luain

BEALTAINE

MAY 2020 Wk

Mo Tu We Th

18 19

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

26 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

27 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JUNE 2020 Wk 23 24

Mo Tu We Th 1

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

May 2020 BEALTAINE

WEEK 22

8 9 10 11 12 13 14 15 16 17 Notes

29 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

30 Saturday | Satharn

31 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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June 2020 WEEK 23

01 Monday | Luain June Bank Holiday

MEITHEAMH

JUNE 2020 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

02 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

03 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June 2020 MEITHEAMH

WEEK 23

8 9 10 11 12 13 14 15 16 17 Notes

05 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

06 Saturday | Satharn

07 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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June 2020 WEEK 24

08 Monday | Luain

MEITHEAMH

JUNE 2020 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

09 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

10 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June 2020 MEITHEAMH

WEEK 24

8 9 10 11 12 13 14 15 16 17 Notes

12 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

13 Saturday | Satharn

14 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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June 2020 WEEK 25

15 Monday | Luain

MEITHEAMH

JUNE 2020 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

16 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

17 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June 2020 MEITHEAMH

WEEK 25

8 9 10 11 12 13 14 15 16 17 Notes

19 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

20 Saturday | Satharn

21 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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June 2020 WEEK 26

22 Monday | Luain

MEITHEAMH

JUNE 2020 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

23 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

24 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

June 2020 MEITHEAMH

WEEK 26

8 9 10 11 12 13 14 15 16 17 Notes

26 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

27 Saturday | Satharn

28 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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July 2020 WEEK 27

29 Monday | Luain

IÚIL

JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

30 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

01 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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AUGUST 2020 Wk

Mo Tu We Th Fr Sa Su

31 1 2 32 33

3 4 5 6 7 8 9

July 2020 IÚIL

WEEK 27

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

02 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

03 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

04 Saturday | Satharn

05 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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July 2020 WEEK 28

06 Monday | Luain

IÚIL

JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

07 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

08 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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AUGUST 2020 Wk

Mo Tu We Th Fr Sa Su

31 1 2 32 33

3 4 5 6 7 8 9

July 2020 IÚIL

WEEK 28

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

09 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

10 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

11 Saturday | Satharn

12 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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July 2020 WEEK 29

13 Monday | Luain

IÚIL

JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

14 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

15 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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AUGUST 2020 Wk

Mo Tu We Th Fr Sa Su

31 1 2 32 33

3 4 5 6 7 8 9

July 2020 IÚIL

WEEK 29

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

16 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

17 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

18 Saturday | Satharn

19 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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July 2020 WEEK 30

20 Monday | Luain

IÚIL

JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

21 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

22 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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AUGUST 2020 Wk

Mo Tu We Th Fr Sa Su

31 1 2 32 33

3 4 5 6 7 8 9

July 2020 IÚIL

WEEK 30

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

23 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

24 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

25 Saturday | Satharn

26 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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July 2020 WEEK 31

27 Monday | Luain

IÚIL

JULY 2020 Wk

Mo Tu We Th

27 28

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

28 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

29 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

August 2020 LÚNASA

WEEK 31

30 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

31 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

01 Saturday | Satharn

02 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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August 2020 WEEK 32

LÚNASA

AUGUST 2020 Wk

31 1 2 32 33

03 Monday | Luain August Bank Holiday

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

8 9 10 11 12 13 14 15 16 17 Notes

04 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

05 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

August 2020 LÚNASA

WEEK 32

06 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

07 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

08 Saturday | Satharn

09 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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August 2020 WEEK 33

LÚNASA

AUGUST 2020 Wk

31 1 2 32 33

10 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

8 9 10 11 12 13 14 15 16 17 Notes

11 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

12 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

August 2020 LÚNASA

WEEK 33

13 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

14 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

15 Saturday | Satharn

16 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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August 2020 WEEK 34

LÚNASA

AUGUST 2020 Wk

31 1 2 32 33

17 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

8 9 10 11 12 13 14 15 16 17 Notes

18 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

19 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

August 2020 LÚNASA

WEEK 34

20 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

21 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

22 Saturday | Satharn

23 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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August 2020 WEEK 35

LÚNASA

AUGUST 2020 Wk

31 1 2 32 33

24 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

36 31

8 9 10 11 12 13 14 15 16 17 Notes

25 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

26 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

August 2020 LÚNASA

WEEK 35

27 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

28 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

29 Saturday | Satharn

30 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2020 WEEK 36

31 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

01 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

02 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September 2020 MEÁN FÓMHAIR

WEEK 36

03 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

04 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

05 Saturday | Satharn

06 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2020 WEEK 37

07 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

08 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

09 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September 2020 MEÁN FÓMHAIR

WEEK 37

10 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

11 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

12 Saturday | Satharn

13 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2020 WEEK 38

14 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

15 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

16 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September 2020 MEÁN FÓMHAIR

WEEK 38

17 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

18 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

19 Saturday | Satharn

20 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2020 WEEK 39

21 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

22 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

23 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

September 2020 MEÁN FÓMHAIR

WEEK 39

24 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

25 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

26 Saturday | Satharn

27 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2020 WEEK 40

28 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2020 Wk

Mo Tu We Th

36 37

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

29 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

30 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

October 2020 DEIREADH FÓMHAIR

WEEK 40

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

01 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

02 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

03 Saturday | Satharn

04 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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October 2020 WEEK 41

05 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

06 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

07 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

October 2020 DEIREADH FÓMHAIR

WEEK 42

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

08 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

09 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

10 Saturday | Satharn

11 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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October 2020 WEEK 42

12 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

13 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

14 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

October 2020 DEIREADH FÓMHAIR

WEEK 42

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

15 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

16 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

17 Saturday | Satharn

18 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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October 2020 WEEK 43

19 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

20 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

21 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

October 2020 DEIREADH FÓMHAIR

WEEK 43

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

22 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

23 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

24 Saturday | Satharn

25 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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October 2020 WEEK 44

DEIREADH FÓMHAIR

26 Monday | Luain October Bank Holiday

OCTOBER 2020 Wk

Mo Tu We Th

40 41

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

27 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

28 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

November 2020 SAMHAIN

WEEK 44

52 21 22 23 24 25 26 27 53

28 29 30 31

29 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

30 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

31 Saturday | Satharn Halloween

01 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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November 2020 WEEK 45

02 Monday | Luain

SAMHAIN

NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

03 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

04 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

November 2020 SAMHAIN

WEEK 45

52 21 22 23 24 25 26 27 53

28 29 30 31

05 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

06 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

07 Saturday | Satharn

08 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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November 2020 WEEK 46

09 Monday | Luain

SAMHAIN

NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

10 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

11 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

November 2020 SAMHAIN

WEEK 46

52 21 22 23 24 25 26 27 53

28 29 30 31

12 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

13 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

14 Saturday | Satharn

15 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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November 2020 WEEK 47

16 Monday | Luain

SAMHAIN

NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

17 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

18 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

November 2020 SAMHAIN

WEEK 47

52 21 22 23 24 25 26 27 53

28 29 30 31

19 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

20 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

21 Saturday | Satharn

22 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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November 2020 WEEK 48

23 Monday | Luain

SAMHAIN

NOVEMBER 2020 Wk

Mo Tu We Th

Su 1

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

8 9 10 11 12 13 14 15 16 17 Notes

24 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

25 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

November 2020 SAMHAIN

WEEK 48

52 21 22 23 24 25 26 27 53

28 29 30 31

26 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

27 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

28 Saturday | Satharn

29 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2020 WEEK 49

NOLLAIG

DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

52 21 22 23 24 25 26 27

30 Monday | Luain

28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

01 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

02 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JANUARY 2021 Wk

Mo Tu We Th Fr Sa Su

53 1 2 3

4 5 6 7 8 9 10

December 2020 NOLLAIG

WEEK 49

11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

03 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

04 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

05 Saturday | Satharn

06 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2020 WEEK 50

NOLLAIG

DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

52 21 22 23 24 25 26 27

07 Monday | Luain

28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

08 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

09 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JANUARY 2021 Wk

Mo Tu We Th Fr Sa Su

53 1 2 3

4 5 6 7 8 9 10

December 2020 NOLLAIG

WEEK 50

11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

10 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

11 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

12 Saturday | Satharn

13 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2020 WEEK 51

NOLLAIG

DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

52 21 22 23 24 25 26 27

14 Monday | Luain

28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

15 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

16 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JANUARY 2021 Wk

Mo Tu We Th Fr Sa Su

53 1 2 3

4 5 6 7 8 9 10

December 2020 NOLLAIG

WEEK 51

11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

17 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

18 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

19 Saturday | Satharn

20 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2020 WEEK 52

NOLLAIG

DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

52 21 22 23 24 25 26 27

21 Monday | Luain

28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

22 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

23 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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JANUARY 2021 Wk

Mo Tu We Th Fr Sa Su

53 1 2 3

December 2020

4 5 6 7 8 9 10

NOLLAIG

WEEK 52

11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

Christmas Eve 24

Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

Christmas Day 25

Friday | Aoine

8 9 10 11 12 13 14 15 16 17 Notes

26 Saturday | Satharn St. Stephen’s Day

27 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2020 WEEK 53

NOLLAIG

DECEMBER 2020 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 6 50

7 8 9 10 11 12 13

14 15 16 17 18 19 20

52 21 22 23 24 25 26 27

28 Monday | Luain

28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

29 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

30 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 53 New Years Eve 31

Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

New Years Day 01

Friday | Aoine

8 9 10 11 12 13 14 15 16 17 Notes

02 Saturday | Satharn

03 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2021 WEEK 01

EANÁIR

JANUARY 2021 Wk

53 1 2 3

04 Monday | Luain

Mo Tu We Th Fr Sa Su

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

05 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

06 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 01

07 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

08 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

09 Saturday | Satharn

10 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2021 WEEK 02

EANÁIR

JANUARY 2021 Wk

53 1 2 3

11 Monday | Luain

Mo Tu We Th Fr Sa Su

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

12 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

13 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 02

14 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

15 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

16 Saturday | Satharn

17 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2021 WEEK 03

EANÁIR

JANUARY 2021 Wk

53 1 2 3

18 Monday | Luain

Mo Tu We Th Fr Sa Su

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

19 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

20 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su 1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 03

21 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

22 Friday | Aoine 8 9 10 11 12 13 14 15 16 17 Notes

23 Saturday | Satharn

24 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2021 WEEK 04

EANÁIR

JANUARY 2021 Wk

53 1 2 3

25 Monday | Luain

Mo Tu We Th Fr Sa Su

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

4 25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

26 Tuesday | Máirt 8 9 10 11 12 13 14 15 16 17 Notes

27 Wednesday | Céadaoin 8 9 10 11 12 13 14 15 16 17 Notes

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