IHCA Yearbook 2019 by Ashville Media Group

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IRISH HOSPITAL CONSULTANTS ASSOCIATION

2019 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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STILL EXPLORING

34.7 median OS1

MO N T H S

94.9%

of patients treated with ZYTIGA® plus low-dose prednisolone did not experience grade 3 or 4 corticosteroidassociated adverse event2

reduction in the risk of

48% radiographic progression3 WITH

of median follow up

YEARS

ZYTIGA® maintains a favourable safety profile and is generally well-tolerated1

ZYTIGA® 500 mg Tablets PRESCRIBING INFORMATION. ACTIVE INGREDIENT(S): Abiraterone acetate. Please refer to Summary of Product Characteristics (SmPC) before prescribing. INDICATION(S): Taken with prednisone or prednisolone for the treatment of adult men with: newly diagnosed high risk metastatic hormone sensitive prostate cancer (mHSPC) in combination with androgen deprivation therapy; metastatic castration resistant prostate cancer (mCRPC) who are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy in whom chemotherapy is not yet clinically indicated; mCRPC whose disease has progressed on or after a docetaxel-based chemotherapy regimen. DOSAGE & ADMINISTRATION: Adults: 1000 mg (2 tablets) single daily dose. Not with food as this increases the systemic exposure (take dose at least two hours after eating; no food for at least one hour postdose). Swallow whole with water. Take with prednisone or prednisolone: for mHSPC, 5 mg daily; for mCRPC, 10 mg daily. Medical castration with LHRH analogue should be continued during treatment in patients not surgically castrated. Children: No relevant use. Hypokalaemia: In patients with pre-existing, or who develop hypokalaemia during treatment with Zytiga, consider maintaining potassium level at ≥4.0 mM. Patients who develop Grade ≥ 3 toxicities (hypertension, hypokalaemia, oedema and other non-mineralocorticoid toxicities) stop treatment and start appropriate medical management. Do not restart Zytiga until symptoms of the toxicity have resolved to Grade 1 or baseline. Renal impairment: No dose adjustment, however no experience in patients with prostate cancer and severe renal impairment; caution advised. Hepatotoxicity: If hepatotoxicity develops (ALT or AST >5x upper limit of normal - ULN), stop treatment immediately until liver function returns to baseline; restart Zytiga at 500 mg (1 tablet) once daily and monitor serum transaminases at least every 2 weeks for 3 months and monthly thereafter (see Special Warnings & Precautions). If hepatotoxicity recurs on reduced dose, stop treatment. If severe hepatotoxicity develops (ALT or AST 20xULN), discontinue Zytiga and do not restart. Hepatic impairment: Mild (Child-Pugh class A) - no dose adjustment required. Moderate (Child-Pugh class B) - approximately 4x increased systemic exposure after single oral doses of 1,000 mg. Moderate/Severe (Child-Pugh class B or C) – no clinical data for multiple doses. Use with caution in moderate impairment, benefit should clearly outweigh risk. CONTRAINDICATIONS: Pregnancy or potential to be pregnant. Hypersensitivity to active substance or any excipients. Severe hepatic impairment (Child-Pugh Class C). SPECIAL WARNINGS & PRECAUTIONS: Zytiga may cause hypertension, hypokalaemia and fluid retention due to increased mineralocorticoid levels. Cardiovascular: Caution in patients with history of cardiovascular disease. In patients with a significant risk for congestive heart failure (history of cardiac failure, uncontrolled hypertension, ischaemic heart disease) consider an assessment of cardiac function before treating (echocardiogram). Safety not established in patients with left ventricular ejection fraction < 50% or NYHA Class II to IV (pre-chemotherapy) and III or IV (post-chemotherapy) heart failure. Before treatment cardiac failure should be treated and cardiac function optimised. Correct and control hypertension, hypokalaemia and fluid retention pre-treatment. Caution in patients whose medical conditions might be compromised by hypertension, hypokalaemia or fluid retention e.g. heart failure, severe or unstable angina pectoris, recent myocardial infarction or ventricular arrhythmia, severe renal impairment. Monitor blood pressure, serum potassium and fluid retention and other signs and symptoms of congestive heart failure before treatment, then every two weeks for 3 months, and monthly thereafter. QT prolongation observed in patients experiencing hypokalaemia with Zytiga treatment. Consider discontinuation if there is a clinically significant decrease in cardiac function. Hepatotoxicity & hepatic impairment: Measure serum transaminases pre-treatment and every two weeks for first three months, then monthly. If symptoms/signs suggest hepatotoxicity, immediately measure serum transaminases. If ALT or AST > 5x ULN, stop treatment and monitor liver function. Restart treatment after liver function returns to baseline; use reduced dose (see dosage and administration). No clinical data in patients with active or symptomatic viral hepatitis. Rare reports of acute liver failure and hepatitis fulminant, some fatal. Corticosteroid withdrawal: Monitor for adrenocortical insufficiency if prednisone or prednisolone is withdrawn. Monitor for mineralocorticoid excess if Zytiga continued after corticosteroids withdrawn. Bone density: Decreased bone density may be accentuated by Zytiga plus glucocorticoid. Prior use of ketoconazole: Lower response rates may occur in patients previously treated with ketoconazole for prostate cancer. Hyperglycaemia: Use of glucocorticoids could increase hyperglycaemia, measure blood sugar frequently in patients with diabetes. Use with chemotherapy: Safety and efficacy of concomitant use of Zytiga with cytotoxic chemotherapy not established. Intolerance to excipients: Not to be taken by patients with galactose intolerance, Lapp lactase deficiency or

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glucose-galactose malabsorption. Take sodium content into account for those on controlled sodium diet. Potential risks: Anaemia and sexual dysfunction may occur in men with metastatic prostate cancer including those taking Zytiga. Skeletal muscle effects: Cases of myopathy reported. Some patients had rhabdomyolysis with renal failure. Caution is recommended in patients concomitantly treated with drugs known to be associated with myopathy/ rhabdomyolysis. SIDE EFFECTS: Very common: urinary tract infection, hypokalaemia, hypertension, diarrhoea, increased alanine aminotransferase, increased aspartate aminotransferase, peripheral oedema. Common: sepsis, hypertriglyceridaemia, cardiac failure (including congestive heart failure, left ventricular dysfunction and decreased ejection fraction), angina pectoris, atrial fibrillation, tachycardia, dyspepsia, rash, haematuria, fractures (includes all fractures with the exception of pathological fracture). Other side effects: adrenal insufficiency, myocardial infarction, QT prolongation, other arrhythmias, hepatitis fulminant, acute hepatic failure, myopathy, rhabdomyolysis. Refer to SmPC for other side effects. FERTILITY/PREGNANCY/LACTATION: Not for use in women. Not known whether abiraterone or its metabolites are present in semen. A condom is required if the patient is engaged in sexual activity with a pregnant woman. If the patient is engaged in sexual activity with a woman of childbearing potential, a condom is required along with another effective contraceptive method. Studies have shown that abiraterone affected fertility in male and female rats, but these effects were fully reversible. INTERACTIONS: Caution with drugs activated by or metabolised by CYP2D6 particularly when there is a narrow therapeutic index e.g. metoprolol, propranolol, desipramine, venlafaxine, haloperidol, risperidone, propafenone, flecainide, codeine, oxycodone and tramadol, dose reduction should be considered. Avoid strong inducers of CYP3A4 (e.g. phenytoin, carbamazepine, rifampicin, rifabutin, rifapentine, phenobarbital, St John’s wort). Zytiga is a CYP2C8 inhibitor. Monitor for signs of toxicity if combined with drugs with a narrow therapeutic index eliminated predominately by CYP2C8. May increase concentrations of drugs eliminated by OATP1B1. Food (see Dosage & Administration). Caution with medicines known to prolong QT interval or induce torsade de pointes e.g. quinidine, disopyramide, amiodarone, sotalol, dofetilide, ibutilide, antiarrhythmic medicinal products, methadone, moxifloxacin and antipsychotics. Use of Zytiga with spironolactone is not recommended. Refer to SmPC for full details of interactions. LEGAL CATEGORY: POM PRESENTATIONS, PACK SIZES, MARKETING AUTHORISATION NUMBER(S): Blister pack, 56 tablets, EU/1/11/714/002. MARKETING AUTHORISATION HOLDER: JANSSEN-CILAG INTERNATIONAL NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. FURTHER INFORMATION IS AVAILABLE FROM: Janssen-Cilag Limited, 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG UK. Prescribing information last revised: November 2017 Adverse events should be reported. 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 2017 References: 1. Ryan CJ, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapynaive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo controlled phase 3 study. Lancet Oncol 2015; 16: 152–60. 2. Fizazi, K., et al (2015). ASCO GU 2015 (abstract 169). 3. Rathkopf, DE et al. Updated Interim Efficacy Analysis and Long-term Safety of Abiraterone Acetate in Metastatic Castration-resistant Prostate Cancer Patients Without Prior Chemotherapy (COUAA-302). Eur Urol (2014), http://dx.doi.org/10.1016/j. eururo.2014.02.056. Date of Preparation: November 2017 | PHIR/ZYT/1014/0004(7)

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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

PERSONAL DETAILS Name: Hospital: Address:

Tel:

al g e. y/ a, s, d ll al s. n al a e s l, d e, of e n e, h M s, g s

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

yof al of U-

www.ihca.ie

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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

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 2018-2019 77

IHCA Officer Board 2018-2019

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. © 2018/2019

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

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4697 FC a 2457

INVENTING FOR LIFE At MSD we have and always will be... Inventing for Life. These three powerful words reflect our commitment to inventing new medicines and vaccines that save lives by preventing and fighting disease. MSD Ireland is one of the country’s leading healthcare companies, having first established here over 50 years ago. We currently employ over 1,700 employees across four sites in Ballydine, Co Tipperary, Brinny, Co Cork, Carlow and Dublin, with an additional site, MSD Biotech, Dublin planned for 2021. We have substantial Human Health and Animal Health businesses, have invested $2.5 billion in our Irish operations and are consistently ranked as one of Ireland’s top 20 companies. A member of Guaranteed Irish, we are proud to be one of Ireland’s leading exporters and our Irish sites manufacture approximately half of MSD’s top twenty products, saving and enhancing lives in over sixty countries around the world.

Learn more about the opportunities available in MSD Ireland at www.msdirelandjobs.com

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Breathe better, morning & night.

1-3

Twice daily dosing. Improvement of early morning, day and night-time COPD symptoms1, 2* *compared to placebo for Eklira® Genuair® and compared to placebo and monocomponents for Brimica®Genuair®

LAMA + LABA

LAMA Abbreviated Prescribing Information Eklira® Genuair® 322 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and a green dosage button. Each delivered dose contains 375 µg aclidinium bromide equivalent to 322 µg of aclidinium. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 322 micrograms aclidinium twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents. Contraindications: Hypersensitivity to aclidinium bromide or to any of the excipients. Warnings and Precautions: Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Use with caution in patients with symptomatic prostatic hyperplasia or bladder-neck obstruction or with narrow-angle glaucoma. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic-containing medicinal products. No other interactions expected. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Risk to newborns/infants cannot be excluded. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Side-effects: Common (1-10%): Sinusitis, nasopharyngitis, headache, cough, diarrhoea, nausea. Uncommon (0.1- 1%): Dizziness, blurred vision, tachycardia, palpitations, dysphonia, dry mouth, stomatitis, rash, pruritus, urinary retention. Rare (0.010.1%): hypersensitivity. Not known: angioedema, anaphylactic reaction. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/12/778/002 Marketing Authorisation holder: AstraZeneca AB, SE-151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: May 2018 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 to: 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 A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744. Date of item: June 2018. IR-BRI-19-2018 References: 1. Eklira® Genuair® Summary of Product Characteristics, last updated February 2018. 2. Bateman, E.D., et al. Respir Res, 2015. 16: p. 92. 3. Brimica® Genuair® Summary of Product Characteristics, last updated February 2018.

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Abbreviated Prescribing Information Brimica® Genuair® 340 micrograms/12 micrograms inhalation powder. Please consult the Summary of Product Characteristics (SPC) for the full prescribing information. Presentation: Inhalation powder in a white inhaler with an integral dose indicator and an orange dosage button. Each delivered dose contains 396 µg aclidinium bromide (equivalent to 340 µg of aclidinium) and 11.8 micrograms of formoterol fumarate dihydrate. Also, contains lactose. Use: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dosage: For inhalation use. Recommended dose is one inhalation of 340 µg/12 µg twice daily. Patients should be instructed on how to administer the product correctly as the Genuair inhaler may work differently from inhalers used previously. It is important to instruct the patients to read the Instructions for Use in the pack. No dose adjustments are required for elderly patients, or those with renal or hepatic impairment. No relevant use in children and adolescents. Contraindications: Hypersensitivity to the active substances or to any of the excipients. Warnings and Precautions: Do not use in asthma. Stop use if paradoxical bronchospasm occurs and consider other treatments. Do not use for the relief of acute episodes of bronchospasm. Use with caution in patients with myocardial infarction in the previous 6 months, unstable angina, newly diagnosed arrhythmia within the previous 3 months, or hospitalisation within the previous 12 months for heart failure functional classes III and IV. Discontinue if increases in pulse rate, blood pressure or changes in ECG occur. Use with caution in patients with a history of or known prolongation of the QTc interval or treated with products affecting the QTc interval. Use with caution in patients with severe cardiovascular disorders, convulsive disorders, thyrotoxicosis and phaeochromocytoma. Hypokalaemia may occur, is usually transient and supplementation not needed. In patients with severe COPD, hypokalaemia may be potentiated by hypoxia and concomitant treatment. Use with caution in patients with symptomatic prostatic hyperplasia, urinary retention or with narrowangle glaucoma. Dry mouth, observed with anticholinergic treatment, may be associated with dental caries in the long term. Do not use in patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Interactions: Do not administer with other anticholinergic and/or long-acting β2-adrenergic agonist containing medicinal products. Caution in use with methylxanthine derivatives, steroids, non-potassium-sparing diuretics, β-adrenergic blockers or medicinal products known to prolong the QTc interval. Please consult the SPC for more details. Fertility, pregnancy and lactation: No data on use in pregnancy. Consider risk-benefit before using during lactation. Unlikely to affect fertility at the recommended dose. Side-effects: Common (1-10%): Nasopharyngitis, urinary tract infection, sinusitis tooth abscess, insomnia, anxiety, headache, dizziness, tremor, cough, diarrhoea, nausea, dry mouth, myalgia, muscle spasms, peripheral oedema, increased blood creatine phosphokinase. Uncommon (0.1- 1%): Hypokalaemia, hyperglycaemia, agitation, dysgeusia, blurred vision, tachycardia, electrocardiogram QTc prolonged, palpitations, angina pectoris, dysphonia, throat irritation, stomatitis, rash, pruritus, urinary retention, increased blood pressure. Rare (0.01-0.1%): Hypersensitivity, bronchospasm, including paradoxical. Not known: anaphylactic reaction, angioedema. Pack sizes: Carton containing 1 inhaler with 60 unit doses. Legal category: POM Marketing Authorisation Number: EU/1/14/963/001 Marketing Authorisation holder: AstraZeneca AB, SE-151 85 Södertälje, Sweden. Marketed by: A. Menarini Pharmaceuticals Ireland Ltd., Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin A96 T924. Further information is available on request to A. Menarini Pharmaceuticals Ireland Ltd. or may be found in the SPC. Last updated: May 2018 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 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 A. Menarini Pharmaceuticals Ireland Ltd. Phone no: 01 284 6744.

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C O N S U L T A N T S

A S S O C I A T I O N

End of Year Checklist

Item Check Basic Salary Check that annualised salary is equal to that in latest Salary Scale for your contract, category and geographic region. 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 submitted all claims for out of hours work and that you have been or will be granted the appropriate time off in lieu or have been paid appropriately. The daily rate is calculated as 1/52.18 of the annual salary to derive the weekly rate and then 1/5 of the weekly rate. 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 who have accrued unutilised CME funding should write to their employer to carry it over to the next year. Phone

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

Health Insurer and Reconcile all outstanding payments with private health insurers, paying particular attention to pended claims. Medico Legal Fees Review medico-legal fees, taking account of inflationary factors since last review and notify requesting solicitors accordingly â&#x20AC;&#x201C; see Pro Forma letter on page 23. Direct Debit Payments Ensure that any payment made by Direct Debit is actually made by your bank. This is particularly important in the case of medical indemnity and Medical Council registration and fees.

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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

President’s Address

Dear Colleagues, It gives me great pleasure to introduce the 22nd edition of the IHCA yearbook and diary. The Association has in several submissions and meetings in the past year repeatedly highlighted the compelling evidence supporting the case for additional front-line resources that are needed to treat the ever increasing number of patients presenting for care in the acute hospital system. As a consultant body, we are treating more patients every year with one of the lowest number of acute beds in the OECD, the highest bed occupancy level and lowest number of consultants on a population basis. The fundamental causes of our hospital overcrowding crisis and delays in providing care to patients remain the capacity deficits in terms of acute infrastructure, hospital consultant numbers and other resources. The National Development Plan’s commitment to provide €10.9bn in capital funding for the health services in the next decade is an important first step, but its proposal for an additional 2,600 acute hospital beds must be assessed by reference to the fact that inpatient beds were cut by 1,400 over the past decade. While the deficit will not be remedied in full by this additional capacity, emphasis must now be placed on commissioning the beds earlier than the proposed ten-year period. The Association has highlighted that the cost of implementing the proposals in the Sláintecare Report has been understated and will actually cost €20bn if implemented over ten years; compared with €2.8bn stated in the Report. It is astonishing that the Sláintecare Report contains an underestimation of this magnitude. In its submission to the Independent Review Group in February 2018, the Association also outlined that the removal of private health insurance income from public hospitals will have a devastating effect on hospital operating budgets. The proposal to remove private patient income by itself will cost the public hospitals €6.5bn over a ten-year period, or €8bn when adjusted for inflation. The IHCA has no confidence that this loss in income will be replaced by the Exchequer, and the move would only serve to exacerbate the existing Consultant recruitment and retention crisis. The Association’s survey in July 2018 of recently appointed Consultant members confirmed that acute hospital and mental health services face an escalating and unprecedented recruitment and retention crisis because of the ongoing blatant discrimination by employers against new hospital Consultants. Almost all respondents (99%) agreed that the lower salary terms are having an adverse impact on the delivery of patient care due to the large number of permanent consultant posts that are unfilled or filled on a temporary basis. Over 70% of new Consultants confirmed that they will seriously consider resigning from their public hospital posts unless the discriminatory salary terms are corrected, with nearly three-quarters ranking equal pay for equal work as the most important aspect of their working terms and conditions. The results of the survey should set alarm bells ringing at Government level. 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 in these challenging times. We look forward to successfully addressing the concerns of our members over the next year. Finally, I wish you and your families a successful 2019. Dr Donal O’Hanlon, President

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2450

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10% Ointment: extract (as dry extract, refined) from Camellia sinensis (L) O.Kuntze, folimu (green tea leaf) (24-56:1), corresponding to: 55-72 mg of (-)-epigallocatechingallate

Three Pillars of Warts Management Effective Clearance

Low Recurrence

Tolerability

For further information please contact: (01) 8900406 PA: 1748/3/1 | EAN: 5391500440249 | Price: €50.11 / 15g tube | POM Abbreviated prescribing Information. Refer to full Summary of Product Characteristics before prescribing. Name: Catephen 10% Ointment Presentation: 15 g tube. 1 g of the ointment contains 100 mg of extract (as dry extract, refined) from Camellia sinensis (L.) O. Kuntze, folium (green tea leaf) (24-56:1), corresponding to: 55-72 mg of (-)-epigallocatechingallate. First extraction solvent: water. Indication: Catephen is indicated for the cutaneous treatment of external genital and perianal warts (condylomataacuminata) in immunocompetent patients from the age of 18 years. Dosage and administration: Adults (> 18 years) Up to 250 mg Catephen ointment as total single dose, corresponding to about 0.5 cm of ointment strand to be applied three times per day to all external genital and perianal warts (750 mg total daily dose). Duration of use Treatment with Catephen should be continued until complete clearance of all warts, however, no longer than 16 weeks in total (max. duration), even if new warts develop during the treatment period. Paediatric population: the safety and efficacy of Catephen in chil-dren and adolescents below the age of 18 years have not been investigated. No data are available. Older people: An insufficient number of older people were treated with Catephen ointment to determine whether they respond differently from younger subjects. Patients with hepatic impairment: Patients with severe liver dysfunction (e.g. clinically relevant elevation of liver enzymes, increase of bilirubin, increase of INR) should not use Catephen due to insufficient safety data. Method of administration: A small amount of Catephen should be applied to each wart using the fingers, dabbing it on to ensure complete coverage and leaving a thin layer of the ointment on the warts (max. 250 mg in total for all warts/per single dose). Only apply to affected areas; any application into the vagina, urethra or anus must be avoided. Do not apply to mucous membranes. For cutaneous use only. If a dose is missed, the patient should continue with the normal treatment regimen. It is recommended to wash the hands before and after application of Catephen. It is not necessary to wash off the ointment from the treated area prior to the next application. Catephen should be washed off the treated area before sex-

ual activity. Female patients using tampons should insert the tampon before applying Catephen. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Special warnings and precautions: Avoid contact with the eyes, nostrils, lips and mouth. Catephen should not be applied to open wounds, broken or inflamed skin. Therapy with Catephen is not recommended until the skin has completely healed from any previous surgical or drug treatment. Catephen has not been evaluated for the treatment of urethral, intra-vaginal, cervical, rectal or intra-anal warts and must not be used for the treatment of these conditions. Female patients with genital warts in the vulvar region should use the ointment with caution as treatment in this area is associated more often with severe local adverse reactions. Accidental application into the vagina must be avoided. In case of accidental application into the vagina immediately wash off the ointment with warm water and mild soap. Uncircumcised male patients treating warts under the foreskin should retract the foreskin and clean the area daily to prevent phimosis. When early signs of stricture occur (e.g. ulceration, induration or increasing difficulty in retracting the foreskin) the treatment should be stopped. New warts may develop during treatment. Condoms should be used until complete clearance of all warts as Catephen does not eliminate the HPV-virus and does not prevent transmission of the disease. Catephen may weaken condoms and vaginal diaphragms. Therefore, the ointment should be washed off the treated area before the use of condoms and sexual contact. Additional methods of contraception should be considered. If the sexual partner of the patient is infected, treatment of the partner is advisable to prevent re-infection of the patient. Do not expose the treated area to sunlight or UV irradiation, as Catephen has not been tested under these conditions. The use of an occlusive dressing should be avoided. Catephen stains clothing and bedding. Mild local skin reactions such as erythema, pruritus, irritation (mostly burning), pain and oedema at the site of application are very common and should not lead to discontinuation. They should decrease after the first weeks of treatment . An interruption of the treatment may be indicated in case of more intense local skin reaction causing unacceptable disFor Further Information please contact: UK: 0845 303 8631, IRE: +353 1 890 0406 Email: info@korahealthare.com Date of preparation July 2018 Material Code: PR_CATIE_071801

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comfort or increase in severity or associated with a lymph node reaction. The treatment with Catephen can be resumed after the skin reaction has diminished. In case a vesicular local reaction occurs, the patient should be advised to consult a doctor to exclude a genital herpes infection. The effectiveness and safety in patients taking immunomodulatory medicines have not been investigated. Those patients should not use Catephen ointment. The safety and effectiveness for treatment beyond 16 weeks or for multi-ple treatment courses have not been investigated. Patients with severe liver dysfunction (e.g. clinically relevant elevation of liver enzymes, increase of bilirubin, increase of INR) should not use Catephen due to insufficient safety data. Catephen contains propylene glycol monopalmitostearate which may cause skin irritations and isopropyl myristate which may cause irritation and sensitization of the skin. Sideeffects: Very common (≥1/10) Local reactions at the application site like erythema, pruritus, irritation/burning, pain, ulcer, oedema, induration and vesicles. Common (≥1/100 to <1/10) Local reactions at the application site like exfoliation, discharge, bleeding and swelling, Inguinal lymphadenitis/lymphadenopathy, Phimosis. Uncommon (≥1/1,000 to <1/100) Local reactions at the application site like discolouration, discomfort, dryness, erosion, fissure, hyperaesthesia, anaesthesia, scar, nodule, dermatitis, hypersensitivity, local necrosis, papules, and eczema, Application site infection, application site pustules, genital herpes infection, staphylococcal infection, urethritis, vaginal candidiasis, vulvovaginitis, Dysuria, micturition urgency, pollakisuria, Balanitis, dyspareunia, Rash and papular rash. The maximum mean severity of local reactions was observed in the first weeks of treatment. MA: PA 1748/3/1 (Ireland) MA Holder: Kora Corporation Ltd t/a Kora Healthcare, Swords Business Park, Swords Co. Dublin, Ireland Legal category: POM. Date of preparation: February, 2017 CATIE_021701. Adverse events should be reported. Reporting forms and information can be found at HPRA Pharmacovigilance, Earlsfort Terrace, Dublin 2, Ireland. Tel: +353 1 6764971 Fax: +353 1 6762517 Website: www.hpra.ie e-mail: medsafety@hpra.ie. Adverse events should also be reported to Kora Healthcare on 01-8900406 (Ire) or medinfo@korahealthcare.com

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Members’ Handbook Contents

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INTRODUCTION IHCA - Brief History - Basic Rules

- 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

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PRIVATE PRACTICE MEDICAL INDEMNITY

MEDICO-LEGAL MATTERS

RESOURCE LIMITATIONS

DATA PROTECTION & PATIENT CONFIDENTIALITY

POST-MORTEMS & INQUESTS REPRESENTATIONAL ASSISTANCE HEALTHY IRELAND FRAMEWORK

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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. 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 85% of hospital consultants in the Irish health service. It is the only representative body in Ireland that speaks solely for hospital consultants.

Basic Rules Membership of the Association is open to the following: (a) The members of the Association shall either: Hold a current enrolment on the Irish Register of Medical Practitioners 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; (ab) be Top-Grade Bio-Chemists of Consultant status

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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 (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) 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. (d) 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

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Members’ Handbook in this Rule 3(c) 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 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 Dentist’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;

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

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.

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® 0 followed by 45 mg at4,week then12every 12 weeks. >100 kg, at 90mg 0, followed by at 90mg STELARA STELARA 45 mg® and 45 mg 90and mg solution 90 mg solution for injection for injection and 130and mg130 concentrate mg concentrate for solution for solution for infusion for infusion PRESCRIBING PRESCRIBING INFORMATION INFORMATIONweek 0week followed by 45 mg at week then4,every weeks. PatientsPatients >100 kg, 90mg weekat0,week followed by 90mg weekat4,week then4, then 12 weeks. Psoriatic arthritis, & elderly: mg at0week 0 followed a 45 mgatdose then12every 12 weeks. every 12every weeks. Psoriatic arthritis, adults adults & elderly: 45 mg 45 at week followed by a 45bymg dose weekat4,week then4,every weeks. ACTIVEACTIVE INGREDIENT(S): INGREDIENT(S): Ustekinumab. Ustekinumab. Please Please refer torefer Summary to Summary of Product of Product Characteristics Characteristics (SmPC)(SmPC) before prescribing. before prescribing. INDICATION(S): INDICATION(S): Alternatively, in patients body weight >100 kg. Consider discontinuation if no response 28 weeks. Alternatively, 90 mg 90 maymgbemay usedbeinused patients with a with body aweight >100 kg. Consider discontinuation if no response after 28after weeks. PlaquePlaque psoriasis psoriasis adults:adults: Treatment Treatment of moderate of moderate to severe to severe plaque plaque psoriasis psoriasis in adults in adults who failed who to failed respond to respond to, or who to, orhave whoahave a Disease: Initial intravenous single intravenous dose on based body weight (260 mg or mg or 520diluted mg) diluted in sodium Crohn’sCrohn’s Disease: Initial single infusioninfusion dose based bodyonweight (260 mg or 390 mg390 or 520 mg) in sodium contraindication contraindication to, or are to, or intolerant are intolerant to othertosystemic other systemic therapies therapies including including ciclosporin, ciclosporin, methotrexate methotrexate or PUVA. or Plaque PUVA. Plaque psoriasis psoriasis andover givenatover least oneAthour. after intravenous dose, s.c.isdose is followed given; followed chloridechloride solutionsolution and given leastatone hour. weekAt8week after 8intravenous dose, 90 mg 90 s.c.mg dose given; by everyby12every 12 paediatrics: paediatrics: Moderate Moderate to severe to severe plaque plaque psoriasis psoriasis in adolescent in adolescent patientspatients from 12from years 12 ofyears age,ofwho age,arewho inadequately are inadequately controlled controlled weeks (or 8 based weeks on based on clinical judgement). Consider discontinuation if no response at 16 weeks. Immunomodulators weeks (or 8 weeks clinical judgement). Consider discontinuation if no response at 16 weeks. Immunomodulators and/or and/or by, or are by, intolerant or are intolerant to, otherto,systemic other systemic therapies therapies or phototherapies. or phototherapies. Psoriatic Psoriatic arthritis: arthritis: Alone orAlone in combination or in combination with methotrexate with methotrexatecorticosteroids corticosteroids may be continued but consider reducing/discontinuing corticosteroids if responding to STELARA. If therapy interrupted, may be continued but consider reducing/discontinuing corticosteroids if responding to STELARA. If therapy interrupted, for treatment for treatment of active of active psoriatic psoriatic arthritisarthritis in adultin patients adult patients when response when response to previous to previous non-biological non-biological disease-modifying disease-modifying anti- anti-resumeresume s.c.8every if safe/effective. Children: <12-years - Not recommended for psoriasis. <18-years - Not recommended s.c. every weeks8 ifweeks safe/effective. Children: <12 years Not recommended for psoriasis. <18 years Not recommended for for rheumatic rheumatic drug (DMARD) drug (DMARD) therapytherapy has been hasinadequate. been inadequate. Crohn’sCrohn’s Disease: Disease: Treatment Treatment of adultofpatients adult patients with moderately with moderately to severely to severelypsoriatic psoriatic and Crohn’s & Hepatic impairment: Not studied. CONTRAINDICATIONS: Hypersensitivity to product; arthritisarthritis and Crohn’s disease.disease. Renal &Renal Hepatic impairment: Not studied. CONTRAINDICATIONS: Hypersensitivity to product; active Crohn’s active Crohn’s diseasedisease who had who inadequate had inadequate response response with/lost with/lost response response to/wereto/were intolerant intolerant to eitherto conventional either conventional therapytherapy or TNFαor TNFαclinically clinically important, active infection. SPECIAL WARNINGS & PRECAUTIONS: Infections: Potential to increase of infections important, active infection. SPECIAL WARNINGS & PRECAUTIONS: Infections: Potential to increase risk of risk infections and and antagonist antagonist or haveorcontraindications have contraindications to suchtotherapies. such therapies. DOSAGEDOSAGE & ADMINISTRATION: & ADMINISTRATION: Adults:Adults: Under guidance Under guidance and supervision and supervision of a of reactivate a reactivate latent infections. in patients a chronic infection or history of recurrent infection, particularly TB. Patients latent infections. CautionCaution in patients with a with chronic infection or history of recurrent infection, particularly TB. Patients physician physician experienced experienced in diagnosis in diagnosis and treatment and treatment of psoriasis/psoriatic of psoriasis/psoriatic arthritis/Crohn’s arthritis/Crohn’s disease.disease. Psoriasis Psoriasis or psoriatic or psoriatic arthritis: arthritis:should should be evaluated for tuberculosis to initiation of STELARA. Consider anti-tuberculosis to initiation of STELARA be evaluated for tuberculosis prior toprior initiation of STELARA. Consider anti-tuberculosis therapytherapy prior toprior initiation of STELARA Subcutaneous Subcutaneous (s.c.) injection. (s.c.) injection. Avoid areas Avoidwith areas psoriasis. with psoriasis. Self-injecting Self-injecting patientspatients or caregivers or caregivers ensure ensure appropriate appropriate training. training. Physicians Physiciansin patients in patients withhistory past history or tuberculosis. active tuberculosis. seek medical or symptoms suggestive of with past of latentoforlatent active PatientsPatients should should seek medical advice advice if signsiforsigns symptoms suggestive of are required are required to follow-up to follow-up and monitor and monitor patients. patients. PlaquePlaque psoriasis, psoriasis, adults adults & elderly: & elderly: PatientsPatients < 100kg, < 100kg, 45 mg 45 at week mg at0week followed 0 followedan infection an infection If a serious infection develops, and STELARA not be administered until infection resolves. occur. Ifoccur. a serious infection develops, closely closely monitormonitor and STELARA should should not be administered until infection resolves. by a 45bymg a 45 dose mgatdose weekat4,week then4,every then12every weeks. 12 weeks. PatientsPatients >100 kg, >100 90 kg, mg 90 at week mg at0week followed 0 followed by a 90bymg a 90 dose mgatdose weekat4,week then4, thenMalignancies: Malignancies: Potential to increase risk of malignancy. No studies in patients with history of malignancy or in patients who develop Potential to increase risk of malignancy. No studies in patients with history of malignancy or in patients who develop every 12 every weeks 12 (45 weeks mg(45 wasmgless waseffective less effective in thesein patients). these patients). PlaquePlaque psoriasis psoriasis paediatrics paediatrics (12 years (12 and yearsolder): and older): PatientsPatients <60 <60malignancy malignancy while receiving STELARA. all patients, in particular thosethan older60, than 60, patients a medical of while receiving STELARA. MonitorMonitor all patients, in particular those older patients with a with medical history history of prolonged immunosuppressant thosea with a history PUVA treatment for non-melanoma skin cancer. Concomitant kg, 0.75kg,mg/kg 0.75 mg/kg at weekat0,week followed 0, followed by 0.75bymg/kg 0.75 mg/kg at weekat4week then 4every then12 every weeks 12 thereafter. weeks thereafter. PatientsPatients ≥60 - <100kg, ≥60 - <100kg, 45 mg 45 at mg atprolonged immunosuppressant therapytherapy or thoseor with history of PUVAof treatment for non-melanoma skin cancer. Concomitant

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�� Inhibition Inhibitionof ofjoint jointdamage damage �� Lasting Lastingimprovement improvementin inEnthesitis Enthesitisand andDactylitis Dactylitis �� Effective Effectivein inaxial axialinvolvement involvement �� Lasting Lastingrelief reliefof ofskin skinsymptoms symptoms �� Visible Visibleimprovements improvementsin innail nailsymptoms symptoms 6* 6* …with …withjust just4 maintenance 4 maintenancedoses dosesper peryear year

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of interactions. LEGAL LEGAL CATEGORY: Prescription Only Medicine. PRESENTATIONS, PACK SIZES, MARKETING AUTHORISATION immunosuppressive immunosuppressive therapy: therapy: Caution,Caution, including including when changing when changing immunosuppressive immunosuppressive biologicbiologic agents.agents. Hypersensitivity Hypersensitivity reactions: reactions:detailsdetails of interactions. CATEGORY: Prescription Only Medicine. PRESENTATIONS, PACK SIZES, MARKETING AUTHORISATION SeriousSerious hypersensitivity hypersensitivity reactions reactions (anaphylaxis (anaphylaxis and angioedema) and angioedema) reported, reported, in someincases someseveral cases several days after daystreatment. after treatment. If theseIfoccur these occurNUMBER(S): 45 mg,45 1 xmg, vial,1 EU/1/08/494/001; 45 mg,45 1 xmg, 0.51mlx 0.5 pre-filled syringe,syringe, EU/1/08/494/003; 90 mg,90 1 xmg, 1.01mlx 1.0 pre-filled NUMBER(S): x vial, EU/1/08/494/001; ml pre-filled EU/1/08/494/003; ml pre-filled appropriate appropriate therapytherapy should should be instituted be instituted and STELARA and STELARA discontinued. discontinued. Latex sensitivity: Latex sensitivity: Needle Needle cover contains cover contains naturalnatural rubber rubber (latex),(latex),syringe,syringe, EU/1/08/494/004; 130 mg,130 1 xmg, vial,1EU/1/08/494/005. MARKETING AUTHORISATION HOLDER: JANSSEN-CILAG INTERNATIONAL EU/1/08/494/004; x vial, EU/1/08/494/005. MARKETING AUTHORISATION HOLDER: JANSSEN-CILAG INTERNATIONAL may cause may allergic cause allergic reactions. reactions. Immunotherapy: Immunotherapy: Not known Not known whetherwhether STELARA STELARA affectsaffects allergy allergy immunotherapy. immunotherapy. SeriousSerious skin conditions: skin conditions:NV, Turnhoutseweg 30, B-2340 Beerse,Beerse, Belgium. FURTHER INFORMATION IS AVAILABLE FROM: FROM: Janssen-Cilag Limited,Limited, 50 – 100 NV, Turnhoutseweg 30, B-2340 Belgium. FURTHER INFORMATION IS AVAILABLE Janssen-Cilag 50 – 100 Exfoliative Exfoliative dermatitis dermatitis reportedreported following following treatment. treatment. Discontinue Discontinue STELARA STELARA if drug ifreaction drug reaction is suspected. is suspected. SIDE EFFECTS: SIDE EFFECTS: Common: Common: upper upperHolmersHolmers Farm Way, Buckinghamshire, HP12 4EG UK.4EG Prescribing information last revised: 09/201709/2017 FarmHigh Way,Wycombe, High Wycombe, Buckinghamshire, HP12 UK. Prescribing information last revised: respiratory respiratory tract infection, tract infection, nasopharyngitis, nasopharyngitis, dizziness, dizziness, headache, headache, oropharyngeal oropharyngeal pain, diarrhoea, pain, diarrhoea, nausea,nausea, vomiting, vomiting, pruritus, pruritus, back pain, back pain, myalgia, myalgia, arthralgia, arthralgia, fatigue,fatigue, injection injection site erythema, site erythema, injection injection site pain. siteOther pain.side Other effects: side effects: cellulitis, cellulitis, seriousserious hypersensitivity hypersensitivity reactions reactionsAdverse eventsevents shouldshould be reported. Healthcare professionals are asked to report any suspected adverse eventsevents via: HPRA Adverse be reported. Healthcare professionals are asked to report any suspected adverse via: HPRA (including (including anaphylaxis, anaphylaxis, angioedema), angioedema), skin exfoliation, skin exfoliation, exfoliative exfoliative dermatitis, dermatitis, lower respiratory lower respiratory tract infection. tract infection. StudiesStudies show adverse show adversePharmacovigilance, Earlsfort Terrace, IRL - Dublin 2, Tel: 2,+353 6764971, Fax: +353 6762517, Website: www.hpra.ie, Pharmacovigilance, Earlsfort Terrace, IRL - Dublin Tel: 1+353 1 6764971, Fax: 1+353 1 6762517, Website: www.hpra.ie, events events reportedreported in ≥12 in year ≥12 olds year with oldsplaque with plaque psoriasis psoriasis were similar were similar to thosetoseen thoseinseen previous in previous studiesstudies in adults in adults with plaque with plaque psoriasis. psoriasis.E-mail:E-mail: medsafety@hpra.ie. Adverse eventsevents shouldshould also bealso reported to Janssen-Cilag LimitedLimited on +44on1494 or at or at medsafety@hpra.ie. Adverse be reported to Janssen-Cilag +44 567447 1494 567447 Refer toRefer SmPC to for SmPC other forside other effects. side effects. FERTILITY: FERTILITY: The effect Theofeffect ustekinumab of ustekinumab has nothas been notevaluated. been evaluated. PREGNANCY: PREGNANCY: Should Should be avoided. be avoided.dsafety@its.jnj.com. dsafety@its.jnj.com. WomenWomen of childbearing of childbearing potential: potential: Use effective Use effective contraception contraception during during treatment treatment and forand at least for at15least weeks 15 post-treatment. weeks post-treatment. LACTATION: LACTATION: LimitedLimited data indata humans. in humans. INTERACTIONS: INTERACTIONS: In vitro,InSTELARA vitro, STELARA had no had effect noon effect CYP450 on CYP450 activities. activities. Vaccinations: Vaccinations: Live vaccines Live vaccines should should not not© Janssen-Cilag LimitedLimited 2017 2017 © Janssen-Cilag be givenbeconcurrently given concurrently with STELARA, with STELARA, and should and should be withheld be withheld for at least for at15least weeks 15 after weekslast after dose lastofdose STELARA. of STELARA. STELARA STELARA can resume can resume at at REFERENCES: 1. Kavanaugh A et al. AArthritis Care Res (Hoboken) 2015;doi: 10.1002/acr.22645. 2. Kimball AB et al.ABJ Eur REFERENCES: 1. Kavanaugh et al. Arthritis Care Res (Hoboken) 2015;doi: 10.1002/acr.22645. 2. Kimball et al.Acad J EurDermatol Acad Dermatol least 2 least weeks2 after weekssuch aftervaccinations. such vaccinations. No dataNoondata secondary on secondary transmission transmission of infection of infection by live vaccines by live vaccines in patients in patients receiving receiving STELARA. STELARA. Venereol. 2013;27:1535-1545. 3. Rich3.P Rich et al.PBretJ al. Dermatol. 2014; 170:398-407. 4. McInnes I et al. ILancet. 2013;382;9894:780-789. Venereol. 2013;27:1535-1545. Br J Dermatol. 2014; 170:398-407. 4. McInnes et al. Lancet. 2013;382;9894:780-789. Concomitant Concomitant immunosuppressive immunosuppressive therapy: therapy: Psoriasis: Psoriasis: Safety and Safety efficacy and efficacy of STELARA of STELARA in combination in combination with other withimmunosuppressants, other immunosuppressants, ® ® C et al.CAnn Rheum Dis. 2014;73:990-999. 6. Stelara 5. Ritchin et al. Ann Rheum Dis. 2014;73:990-999. 6. Stelara Summary Summary of Product of Product Characteristics, Characteristics, available available at www.medicines.ie at www.medicines.ie including including biologics, biologics, or phototherapy or phototherapy have not have been notevaluated. been evaluated. Psoriatic Psoriatic arthritis: arthritis: concomitant concomitant MTX didMTX notdid appear not appear to affectto STELARA. affect STELARA.5. Ritchin Crohn’sCrohn’s disease:disease: concomitant concomitant immunosupressive immunosupressive or corticosteroid or corticosteroid therapytherapy did notdid appear not appear to affect to STELARA. affect STELARA. Refer to Refer SmPC to for SmPC fullfor fullPHIR/STE/0518/0003 PHIR/STE/0518/0003 | Date |ofDate Preparation: of Preparation: May 2018 May 2018

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Members’ Handbook 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 2018 there were 2,986 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.

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. 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.

Consultants’ Common Contract

Pension Arrangements

Each consultant with a public appointment works under the consultants’ common contract. The terms of the 2008 Consultant contract had been 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.

All consultant posts in the Public Health Sector are pensionable.

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) and the Job Description (Appendix II) 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 gives the employer’s name and address, the Consultant’s name and address, the title of the post and the agreed start date. 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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Existing Superannuation Scheme Members Consultants who are not new entrants, i.e. 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. The pension payable on retirement is based on years of reckonable service. 1/80th of the final pensionable salary 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 i.e. 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.

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Members’ Handbook 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 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. A lump sum is payable on retirement. It is calculated at the rate of 3/80th of the final pensionable salary 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 e47,300) plus (where applicable) 1.25% of pensionable remuneration above that level.

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Lump Sum: 3.75% of pensionable remuneration. Contributions to the scheme are deducted at 3.5% of net pensionable remuneration i.e. pensionable 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. Members are advised to contact the Secretariat for further information in this regard.

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Members’ Handbook 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 base.

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Details of the most recent rates applying domestically are available in HR Circular 007/2017 which is available on request from the Assocciation, on the IHCA website or from the Human Resources Office. 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 007/2017 outlines revised arrangements for overnight allowances in Dublin. Full details can be found on the IHCA website or from the Human Resources Office. 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.

Continuing Medical Education 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 and Dispute procedure provided for in Consultant Contracts.

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Members’ Handbook 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.

Out of Hours Service 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.

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 An allowance is payable in respect of this availability for duty. This Allowance (B Factor) is part of the pensionable remuneration. 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 is 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. Members are reminded of the HSE circular to hospitals requiring

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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.

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Members’ Handbook • 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 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. Ireland is unique in that approximately 46% of the population is covered by private health insurance. 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.

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Each health insurer publishes a schedule of benefits for professional fees in respect of procedures and treatments provided by Consultants. 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. 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 Membership of these schemes is limited to employees and families of the relevant organisations only. 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 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 indemnity provider. Under the caps on professional indemnity

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Members’ Handbook 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. It is the unequivocal advice of the Association that consultants maintain membership of a medical defence body, such as the Medical Protection Society, for those aspects of practice not covered by the CIS. As a consultant undertakes full clinical responsibility for his patients, he 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 above. By so doing you will avoid any confusion or disagreement later in the matter of fees.

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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 ofthe 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 (employing authority) 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 or 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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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. 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

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be 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.

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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.

GOVERNMENT HEALTH POLICY HSE Board The Government published the General Scheme Health (Amendment) Bill – HSE Board Bill in May 2018 to establish an independent Board for the HSE aimed at strengthening the management, governance and accountability of the

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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 General Scheme provides for a nine person non-executive board including 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. 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. 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 2018. Sláintecare also recommends the alignment of Hospitals Groups and Community Health Organisations (CHOs). However, the cost of implementing the proposals in the Sláintecare

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Members’ Handbook 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. 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. 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.

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.

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. 1.3 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.

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Advertorial Feature Avoiding Burnout and Promoting Self-Compassion Burnout is increasingly common among doctors. Dr Suzy Jordache, Senior Medical Educator at Medical Protection shares more about the occupational hazard. 1) What is ‘burnout’? According to the Maslach Burnout Inventory (MBI)i, ‘burnout’ is characterised by three domains – Emotional exhaustion, depersonalisation (a cynical attitude with distancing behaviours) and a low sense of personal accomplishment.

2) What is the situation like for doctors in Irish hospitals? Which specialities are more affected than the rest? According to the National Study of Wellbeing of Hospital Doctors in Irelandii, 1 in 3 doctors experienced burnout, with 10% of doctors reported having severe or extremely severe levels of stress. The report found that doctors who work in emergency medicine are amongst those experiencing highest levels of burnout, followed by physicians and surgeons. Those in pathology were least likely to meet the criterion of being burnout.

3) How can ‘burnout’ be avoided? Avoiding or reversing burnout requires careful attention to developing good individual coping strategies in the workplace. Organisational policies and procedures must ensure these coping strategies are respected and enforced. For clinicians, this requires renewed focus on physical and emotional wellbeing and ensuring a sense of calling is not eroded. Being self-focused is an uncomfortable shift for many doctors. The concept of selfcompassion can be unsettling for a profession who pride themselves on caring for others and are driven by a moral obligation to serve.

4) How can hospital doctors adopt and promote ‘self-compassion’? Physical wellbeing: Developing rituals and routines that promote regular healthy eating, hydration and sleep underpins the more sophisticated strategies. Emotional wellbeing: Compassion fatigue or secondary traumatic stress disorder may affect doctors working with suffering patients. Moral distress is a further occupational hazard and working with limited resources can also add to a clinician’s stress. Mindfulness, reflective journaling, and attending Schwartz roundsiii promote self-awareness and resilience. Sense of calling: Remembering why you chose medicine and celebrating achievements that align with these values can be a powerful way to bounce back in an environment that constantly challenges and surprises. Organisations and teams can support this by collecting evidence and stories of good practice and rewarding, thanking and celebrating.

5) What support is available for doctors? Medical Protection members can attend the free ‘Building resilience and avoiding burnout’iv workshop available throughout the year at various locations. Non-members can attend the workshop at a fee. Our ‘Clinical Communication Programme’ addresses workload and other professional issues that may predispose members to burnout. One-to-one coaching sessions around avoiding burnout and building resilience can be arranged too. Contact Medical Protection at education@medicalprotection.org or visit https://www.medicalprotection.org/ireland/education-and-events to learn more. References i Baer et al, Pediatric Resident Burnout and Attitudes Toward Patients Pediatrics. Feb 23 (2017) //doi. org/10.1542/peds.2016-2163 ii The National Study of Wellbeing of Hospital Doctors in Ireland https://rcpi-live-cdn.s3.amazonaws.com/ wp-content/uploads/2017/05/Wellbeing-Report-web.pdf iii http://www.theschwartzcenter.org/supporting-caregivers/schwartz-center-rounds/ iv https://www.medicalprotection.org/ireland/education-and-events/workshops/sgp-building-resilience-andavoiding-burnout

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13/07/2018 13:25 10:41 17/07/2018

PLENVU PLENVU IRE IRE 210mm 210mm xx 297mm 297mm advert advert CMYK CMYK

1–3 The first 1 litre PEG bowel preparation1–3

Cut the volume keep the efficacy PLENVU® offers: Superior successful overall bowel preparation compared to MOVIPREP®® (PEG 3350 + sodium ascorbate + ascorbic acid + sodium sulfate + electrolytes) 1,4 using PM/AM dosing (p=0.014)*1,4 Safety profile comparable to ®1,5–7 MOVIPREP®1,5–7 Flexible dosing schedules55 and is designed to maximise patient adherence *In *In the the per per protocol protocol population. population. PM/AM: PM/AM: evening/morning. evening/morning.

Powder for Oral Solution PEG 3350, Sodium Ascorbate, Sodium Sulfate, Ascorbic Acid, Sodium Chloride, and Potassium Chloride

PRESCRIBING PRESCRIBING INFORMATION: INFORMATION: Plenvu Plenvu (Macrogol (Macrogol 3350 3350 ++ Sodium Sodium ascorbate ascorbate ++ Ascorbic Ascorbic acid acid ++ Sodium Sodium sulfate sulfate anhydrous anhydrous ++ Electrolytes) Electrolytes) Presentation: Presentation: Plenvu Plenvu isis administered administered inin two two doses. doses. Dose Dose one one isis made made up up of of 11 sachet sachet containing: containing:macrogol macrogol 3350 3350 100g, 100g,sodium sodium sulfate sulfate anhydrous anhydrous 9g, 9g,sodium sodium chloride chloride 2g, 2g, potassium potassium chloride chloride 1g. 1g. Dose Dose 22 isis made made up up of of 22 sachets sachets (A (A and and B). B). Sachet Sachet AA contains: contains: macrogol macrogol 3350 3350 40g, 40g, sodium sodium chloride chloride 3.2g, 3.2g, potassium potassium chloride chloride 1.2g. 1.2g.Sachet Sachet BB contains: contains:sodium sodium ascorbate ascorbate 48.11g, 48.11g,ascorbic ascorbic acid acid 7.54g. 7.54g. Indication: Indication: For For bowel bowel cleansing cleansing inin adults, adults, prior prior to to any any procedure procedure requiring requiring aa clean clean bowel. bowel. Dosage: Dosage: Adults Adults and and elderly: elderly: AA course course of of treatment treatment consists consists of of two two separate separate non-identical non-identical 500ml 500ml doses doses of of Plenvu. Plenvu. At At least least 500ml 500ml of of additional additional clear clear fluid fluid must must be be taken taken with with each each dose. dose. Treatment Treatment can can be be taken taken according according to to aa two-day two-day or or one-day one-day dosing dosing schedule. schedule. Two-day Two-day dosing dosing schedule: schedule: First First dose dose taken taken the the evening evening before before the the procedure. procedure. Second Second dose dose inin the the early early morning morning of of the the day day of of the the procedure. procedure. Morning Morning only only dosing dosing schedule: schedule: Both Both doses doses taken taken the the morning morning of of the the procedure. procedure.The The two two doses doses should should be be separated separated by by aa minimum minimum of of 11 hour. hour. Day Day before before dosing dosing schedule: schedule: Both Both doses doses taken taken the the evening evening before before the the procedure. procedure.The The two two doses doses should should be be separated separated by by aa minimum minimum of of 11 hour. hour. No No solid solid food food should should be be taken taken from from the the start start of of the the course course of of treatment treatment until until after after the the clinical clinical procedure. procedure. Consumption Consumption of of all all fluids fluids should should be be stopped stopped at at least least 22 hours hours prior prior to to aa procedure procedure under under general general anaesthesia anaesthesia or or 11 hour hour prior prior to to aa procedure procedure without without general general anaesthesia. anaesthesia. Children: Children: Not Not recommended recommended for for use use inin children children below below 18 18 years years of of age. age. No No special special dosage dosage adjustment adjustment isis deemed deemed necessary necessary inin patients patients with with mild mild to to moderate moderate renal renal or or hepatic hepatic impairment. impairment. Patients Patients should should be be advised advised to to allow allow adequate adequate time time after after bowel bowel movements movements have have subsided subsided to to travel travel to to the the clinical clinical unit. unit. Contraindications: Contraindications: Hypersensitivity Hypersensitivity to to the the active active substances substances or or to to any any of of the the excipients, excipients, gastrointestinal gastrointestinal obstruction obstruction or or perforation, perforation, ileus, ileus, disorders disorders of of gastric gastric emptying emptying (gastroparesis, (gastroparesis, gastric gastric retention), retention), phenylketonuria, phenylketonuria, glucose-6-phosphate glucose-6-phosphate dehydrogenase dehydrogenase deficiency, deficiency, toxic toxic megacolon. megacolon. Warnings Warnings and and precautions: precautions: The The fluid fluid content content of of reconstituted reconstituted Plenvu Plenvu does does not not replace replace regular regular fluid fluid intake. intake. Adequate Adequate fluid fluid intake intake must must be be maintained. maintained. As As with with other other macrogol macrogol containing containing products, products, allergic allergic reactions reactions including including rash, rash, urticaria, urticaria, pruritus, pruritus, angioedema angioedema and and anaphylaxis anaphylaxis are are aa possibility. possibility. Caution Caution should should be be used used with with administration administration to to frail frail or or debilitated debilitated patients, patients, inin patients patients with with impaired impaired gag gag

reflex, reflex, with with the the possibility possibility of of regurgitation regurgitation or or aspiration, aspiration, or or with with diminished diminished levels levels of of consciousness, consciousness, severe severe renal renal impairment, impairment, cardiac cardiac failure failure (grade (grade IIIIII or or IVIV of of NYHA), NYHA), those those at at risk risk of of arrhythmia, arrhythmia, dehydration dehydration or or severe severe acute acute inflammatory inflammatory bowel bowel disease. disease. InIn debilitated debilitated fragile fragile patients, patients, patients patients with with poor poor health, health, those those with with clinically clinically significant significant renal renal impairment, impairment, arrhythmia arrhythmia and and those those at at risk risk of of electrolyte electrolyte imbalance, imbalance, the the physician physician should should consider consider performing performing aa baseline baseline and and post-treatment post-treatment electrolyte, electrolyte, renal renal function function test test and and ECG ECG as as appropriate. appropriate. Any Any suspected suspected dehydration dehydration should should be be corrected corrected for for before before use use of of Plenvu. Plenvu.There There have have been been rare rare reports reports of of serious serious arrhythmias arrhythmias including including atrial atrial fibrillation fibrillation associated associated with with the the use use of of ionic ionic osmotic osmotic laxatives laxatives for for bowel bowel preparation, preparation, predominantly predominantly inin patients patients with with underlying underlying cardiac cardiac risk risk factors factors and and electrolyte electrolyte disturbance. disturbance. IfIf patients patients develop develop any any symptoms symptoms indicating indicating arrhythmia arrhythmia or or shifts shifts of of fluid/ fluid/ electrolytes electrolytes during during or or after after treatment, treatment, plasma plasma electrolytes electrolytes should should be be measured, measured, ECG ECG monitored monitored and and any any abnormality abnormality treated treated appropriately. appropriately. IfIf patients patients experience experience severe severe bloating, bloating, abdominal abdominal distension, distension, or or abdominal abdominal pain, pain, administration administration should should be be slowed slowed or or temporarily temporarily discontinued discontinued until until the the symptoms symptoms subside. subside. The The sodium sodium content, content, 458.5mmol 458.5mmol (10.5g), (10.5g), should should be be taken taken into into consideration consideration for for patients patients on on aa controlled controlled sodium sodium diet. diet. The The potassium potassium content, content, 29.4mmol 29.4mmol (1.1g), (1.1g), should should be be taken taken into into consideration consideration by by patients patients with with reduced reduced kidney kidney function function or or those those on on aa controlled controlled potassium potassium diet. diet. Interactions: Interactions: Medicinal Medicinal products products taken taken orally orally within within one one hour hour of of starting starting colonic colonic lavage lavage with with Plenvu Plenvu may may be be flushed flushed from from the the gastrointestinal gastrointestinal tract tract unabsorbed. unabsorbed. The The therapeutic therapeutic effect effect of of drugs drugs with with aa narrow narrow therapeutic therapeutic index index or or short short half-life half-life may may be be particularly particularly affected. affected. Fertility, Fertility, pregnancy pregnancy and and lactation: lactation:There There are are no no data data on on the the effects effects of of Plenvu Plenvu on on fertility fertility inin humans. humans.There There were were no no effects effects on on fertility fertility inin studies studies inin male male and and female female rats. rats. ItIt isis preferable preferable to to avoid avoid the the use use of of Plenvu Plenvu during during pregnancy. pregnancy. ItIt isis unknown unknown whether whether Plenvu Plenvu active active ingredients/metabolites ingredients/metabolites are are excreted excreted inin human human milk. milk. AA risk risk to to the the newborns/infants newborns/infants cannot cannot be be excluded. excluded. AA decision decision must must be be made made whether whether to to discontinue discontinue breast-feeding breast-feeding or or to to abstain abstain from from Plenvu Plenvu therapy. therapy. Undesirable Undesirable effects: effects: Diarrhoea Diarrhoea isis an an expected expected outcome. outcome. Common: Common: vomiting, vomiting, nausea, nausea, dehydration. dehydration. Uncommon: Uncommon: abdominal abdominal distension, distension, anorectal anorectal discomfort, discomfort, abdominal abdominal pain, pain, drug drug hypersensitivity, hypersensitivity, headache, headache, migraine, migraine, somnolence, somnolence, thirst, thirst, fatigue, fatigue, asthenia, asthenia, chills, chills, pains, pains, aches, aches, palpitation, palpitation, sinus sinus tachycardia, tachycardia, transient transient increase increase inin blood blood pressure, pressure, hot hot flush, flush, transient transient increase increase inin liver liver enzymes, enzymes, hypernatraemia, hypernatraemia,

hypercalcaemia, hypophosphataemia, hypophosphataemia, hypokalaemia, hypokalaemia, decreased decreased bicarbonate, bicarbonate, hypercalcaemia, anion gap gap increased/ increased/ decreased, decreased, hyperosmolar hyperosmolar state. state. Refer Refer to to the the Summary Summary of of anion Product Characteristics Characteristics (SmPC) (SmPC) for for aa full full list list and and frequency frequency of of adverse adverse events. events. Product Legal category: category: Prescription Prescription medicine medicine For For further further information information contact: contact: Legal Norgine Pharmaceuticals Pharmaceuticals Limited, Limited, Norgine Norgine House, House, Moorhall Moorhall Road, Road, Harefield, Harefield, Norgine Middlesex, United United Kingdom Kingdom UB9 UB9 6NS. 6NS. Telephone: Telephone: +44(0)1895 +44(0)1895 826606. 826606. Middlesex, E-mail: medinfo@norgine.com medinfo@norgine.com Product Product licence licence number: number: PA PA 1336/005/001 1336/005/001 E-mail: Date: March March 2018 2018 Company Company reference: reference: UK/PLV/0318/0061 UK/PLV/0318/0061 Date: Ireland Ireland

Ireland Ireland--Healthcare Healthcareprofessionals professionalsare areasked askedtotoreport reportany anysuspected suspected adverse adverse reactions reactions via via HPRA HPRA Pharmacovigilance, Pharmacovigilance, Earlsfort Earlsfort Terrace, Terrace, IRL IRL -- Dublin Dublin 2; 2; Tel: Tel: +353 +353 11 6764971; 6764971; Fax: Fax: +353 +353 11 6762517. 6762517. Website: Website:www.hpra.ie; www.hpra.ie; E-mail: E-mail:medsafety@hpra.ie. medsafety@hpra.ie. Norgine Norgine

Adverse events events should should also also be be reported reported to to Medical Medical Information Information Adverse at Norgine Norgine Pharmaceuticals Pharmaceuticals on on +44 +44 1895 1895 826606 826606 or or at E-mail: medinfo@norgine.com medinfo@norgine.com E-mail:

References: References: 1. 1. Bisschops Bisschops R, R, et et al. al. Presented Presented at at UEGW UEGW 2016, 2016, poster poster number number P0179. P0179. 2. 2. Schreiber Schreiber S, S, et et al. al. Presented Presented at at UEGW UEGW 2016, 2016, poster poster number number P1266. P1266. 3. 3. DeMicco DeMicco MP, MP, et et al. al. Gastrointest Gastrointest Endosc Endosc 2018;87(3):677-687.e3; 2018;87(3):677-687.e3; doi: doi: 10.1016/j. 10.1016/j. Summary of of Product Product Characteristics. Characteristics. October October 2017. 2017. 6. 6. MOVIPREP MOVIPREP®® IEIE Summary Summary of of Product Product Characteristics. Characteristics.August August 2017; 2017; 7. 7. MOVIPREP MOVIPREP®® Orange Orange IEIE gie.2017.07.047. gie.2017.07.047. 4. 4. Norgine Norgine Ltd. Ltd. DOF-PLENV-008 DOF-PLENV-008 version version 1.0. 1.0.August August 2017. 2017. 5. 5. PLENVU PLENVU®® IEIE Summary Summary Summary of of Product Product Characteristics. Characteristics.August August 2017. 2017.

001-077_IHCA Client Address_V2.indd 30 FC advert template.indd 1 2019_v11_No 245286_DPS_Norgine_JM_IHCA_V2.indd 1Minister 123842_PLENVU 123842_PLENVU IRE IRESection 210mm 210mm X X 297mm 297mm advert, advert, 69mm 69mm X X 297mm 297mm (PI)_Final.indd (PI)_Final.indd All All Pages Pages

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SPRING 2018

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THE CONSULTANT

must invest

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WINTER 2017

TRAUMA CARE NEEDED ■ MANAGING TREATMENT ONCOLOGISTS DIAGNOSIS AND LAW ■ MORE RESEARCH ■ LATEST DISCLOSURE IRISH PLUS OPEN FRONTIER ■ ■ NEW MEDICAL

ASSOCIATION

Government

CONSULTANTS THE IRISH HOSPITAL JOURNAL OF - OFFICIAL

4,000 beds

Needed Urgently:

AVOIDABLE DEATHS PLUS IHCA

ANNUAL CONFERENCE

■ IHCA PRESIDENT

URGES MASSIVE

CAPITAL INVESTMEN

26/04/2018

4,000 beds

Needed Urgently: Government digital editions

must invest

WINTER 2017

14/03/2018

Leading To

CAPITAL INVESTMENT URGES MASSIVE & TREATMENT ■ IHCA PRESIDENT IN DIAGNOSIS ANNUAL CONFERENCE CRISIS ■ LATEST PLUS IHCA MANPOWER SURGERY CONSULTANT

09:39

in acute hospitals

TRAUMA CARE NEEDED ■ MANAGING TREATMENT ONCOLOGISTS DIAGNOSIS AND LAW ■ MORE RESEARCH ■ LATEST DISCLOSURE IRISH PLUS OPEN FRONTIER ■ ■ NEW MEDICAL

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Treatment Delays

AVOIDABLE DEATHS

09:40

■ GENERAL

1 000_Consultant_Q4_2017_Cover.indd

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United United Kingdom Kingdom Adverse Adverse events events should should be be reported. reported. Reporting and information can be found at Reporting forms andevents information canbe bereported. found at United United Kingdom Adverse Adverse events should should bebe reported. United UnitedKingdom Kingdom Kingdomforms Adverse Adverse events events should should be reported. reported. www.mhra.gov.uk/yellowcard. Adverse events also be www.mhra.gov.uk/yellowcard. Adverse events should also be Reporting Reporting forms forms and information can cancan be bebe found found at at at Reporting forms and information found Reporting forms and and information information can beshould found at reported reported to to Medical Medical Information Information at at Norgine Norgine Pharmaceuticals Pharmaceuticals Ltd Ltd www.mhra.gov.uk/yellowcard. www.mhra.gov.uk/yellowcard. Adverse events should also bebe www.mhra.gov.uk/yellowcard. www.mhra.gov.uk/yellowcard.Adverse Adverse Adverseevents events eventsshould should shouldalso also alsobe be on on 01895 01895 826606. 826606. reported reported to to Medical Medical Information Information at at Norgine Norgine Pharmaceuticals Pharmaceuticals Ltd Ltd reported reportedIreland to to Medical Medical Information Information at at Norgine Norgine Pharmaceuticals Ltd Ltd Healthcare professionals are to Ireland Healthcare professionals areasked askedPharmaceuticals toreport reportany anysuspected suspected on onon 01895 01895 826606. 826606. on 01895 01895 826606. 826606. adverse reactions adverse reactions via via HPRA HPRA Pharmacovigilance, Pharmacovigilance, Earlsfort Earlsfort Terrace, Terrace, Ireland Ireland Healthcare Healthcare professionals professionals are are1are asked asked to toreport report any any suspected suspected Ireland Ireland Healthcare Healthcare professionals professionals asked asked to toFax: report report any any suspected IRL 2; 6764971; +353 11suspected 6762517. IRL -- Dublin Dublin 2; Tel: Tel: +353 +353 1are 6764971; Fax: +353 6762517. adverse adverse reactions reactions via via HPRA HPRA Pharmacovigilance, Pharmacovigilance, Earlsfort Earlsfort Terrace, Terrace, Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. adverse adverse reactions reactions via via HPRA HPRA Pharmacovigilance, Pharmacovigilance, Earlsfort Earlsfort Terrace, Terrace, Norgine Adverse should also be reported to Norgine Adverse events should Fax: also be+353 reported to Medical Medical IRL IRLIRL -- Dublin Dublin 2; 2; 2; Tel: Tel:Tel: +353 +353 11events 6764971; Fax: +353 +353 11 6762517. IRL -- Dublin Dublin 2; Tel: +353 +353 16764971; 1 6764971; 6764971; Fax: Fax: +353 16762517. 1 6762517. 6762517. Information at Norgine Pharmaceuticals on Information atE-mail: Norgine Pharmaceuticals on +44 +44 1895 1895 826606 826606 or or Website: Website: www.hpra.ie; www.hpra.ie; E-mail: medsafety@hpra.ie. medsafety@hpra.ie. Website: Website: www.hpra.ie; www.hpra.ie; E-mail: E-mail: medsafety@hpra.ie. medsafety@hpra.ie. E-mail: medinfo@norgine.com E-mail: medinfo@norgine.com Norgine Norgine Adverse Adverse events events should should also also be bebe reported reported to to to Medical Medical Norgine Norgine Adverse Adverse events events should should also also be reported reported to Medical Medical Information at at Norgine Pharmaceuticals onon +44 1895 826606 or or Information at Norgine Pharmaceuticals on +44 1895 826606 or Information Information at Norgine Norgine Pharmaceuticals Pharmaceuticals on +44 +44 1895 1895 826606 826606 or PLENVU, PLENVU, MOVIPREP, MOVIPREP, NORGINE NORGINE and and the the sail sail logo logo are are E-mail: medinfo@norgine.com E-mail: medinfo@norgine.com E-mail: E-mail: medinfo@norgine.com medinfo@norgine.com registered registered trademarks trademarks of of the the Norgine Norgine group group of of companies. companies.

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UK/PLV/0318/0067 UK/PLV/0318/0067 Date Date of of preparation: preparation: April 2018. PLENVU, PLENVU, MOVIPREP, MOVIPREP, NORGINE NORGINEApril and and2018. the the sail sail logo logo are are

PLENVU, PLENVU, MOVIPREP, MOVIPREP, NORGINE NORGINE and and the the sail sail logo logo are are registered registered trademarks trademarks of of the the Norgine Norgine group group of of companies. companies. registered registered trademarks trademarks of of the the Norgine Norgine group group of of companies. companies.

/ashvillemedia

UK/PLV/0318/0067 UK/PLV/0318/0067 UK/PLV/0318/0067 UK/PLV/0318/0067 Date Date of of preparation: preparation: April April 2018. 2018. Date Date of of preparation: preparation: April April 2018. 2018.

09/07/2018 15:35

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Moviprep Moviprep and and Moviprep Moviprep Orange Orange (Macrogol (Macrogol 3350, 3350, sodium sodium sulphate, sulphate, ascorbic ascorbic Moviprep Moviprep and and Moviprep Moviprep Orange Orange (Macrogol (Macrogol 3350, 3350, sodium sodium sulphate, sulphate, ascorbic ascorbic acid, acid, sodium sodium ascorbate ascorbate and and electrolytes) electrolytes) Prescribing Prescribing Information Information acid, acid, sodium sodium ascorbate ascorbate and and electrolytes) electrolytes) Prescribing Prescribing Information Information REFER REFER TOTO THETHE SUMMARY OFOF PRODUCT CHARACTERISTICS (SmPC) REFER SUMMARY PRODUCT CHARACTERISTICS (SmPC) REFERTO TOTHE THESUMMARY SUMMARYOF OFPRODUCT PRODUCTCHARACTERISTICS CHARACTERISTICS(SmPC) (SmPC) BEFORE PRESCRIBING BEFORE PRESCRIBING BEFORE PRESCRIBING BEFORE PRESCRIBING Presentation: AA box containing two transparent bags, each containing two Presentation: containing twotwo transparent bags, each containing twotwo Presentation: Abox containing transparent bags, each containing Presentation: A box box containing two transparent bags, each containing two separate sachets, AA and B. Sachet AA contains macrogol 3350 100g; sodium separate sachets, and B. B. Sachet contains macrogol 3350 100g; sodium separate sachets, AA and Sachet AA69mm contains macrogol 3350 100g; sodium separate sachets, and B. Sachet contains macrogol 3350 100g; sodium PLENVU PLENVU IRE IRE 69mm xx 297mm 297mm (PI) (PI) CMYK CMYK sulphate anhydrous 7.5g; sodium chloride 2.691g and potassium chloride sulphate anhydrous 7.5g; sodium chloride 2.691g andand potassium chloride sulphate anhydrous 7.5g; sodium chloride 2.691g potassium chloride sulphate anhydrous 7.5g; sodium chloride 2.691g and potassium chloride 1.015g as white to powder. Sachet BB contains ascorbic acid 4.7g and 1.015g as as white to yellow yellow powder. Sachet contains ascorbic acid 4.7g andand 1.015g white to powder. Sachet BB contains ascorbic acid 4.7g 1.015g as white to yellow yellow powder. Sachet contains ascorbic acid 4.7g and sodium ascorbate 5.9g as white to brown powder. Moviprep also contains sodium ascorbate 5.9g as as white to light light brown powder. Moviprep also contains sodium ascorbate 5.9g white to brown powder. Moviprep also contains sodium ascorbate 5.9g as white to light light brown powder. Moviprep also contains aspartame (E951), acesulfame potassium (E950) and aa lemon or orange aspartame (E951), acesulfame potassium (E950) andand or or orange aspartame (E951), acesulfame potassium (E950) alemon orange aspartame (E951), acesulfame potassium (E950) and a lemon lemon or orange Moviprep Moviprep and and Moviprep Moviprep Orange Orange (Macrogol 3350, 3350, sodium sodium sulphate, sulphate, ascorbic ascorbic flavour. Uses: Bowel cleansing prior to any clinical procedure requiring aa aa flavour. Uses: Bowel cleansing prior to (Macrogol anyany clinical procedure requiring flavour. Uses: Bowel cleansing prior to clinical procedure requiring flavour. Uses: Bowel cleansing prior to any clinical procedure requiring acid, acid, sodium sodium ascorbate ascorbate and and electrolytes) electrolytes) Prescribing Prescribing Information Information clean bowel. Dosage and administration: Adults and Older People: AA course clean bowel. Dosage and administration: Adults and Older People: course clean bowel. Dosage and administration: Adults and Older People: AA course clean bowel. Dosage and administration: Adults and Older People: course REFER TO SUMMARY OF (SmPC) REFER TOof THE SUMMARY OF PRODUCT PRODUCT CHARACTERISTICS (SmPC) of consists two litres of AA litre of Moviprep consists of of treatment treatment consists of THE two litres of Moviprep. Moviprep. litre ofCHARACTERISTICS Moviprep consists of of of consists of litres of AA litre of consists of treatment treatment consists of two two litres of Moviprep. Moviprep. litre of Moviprep Moviprep consists of BEFORE PRESCRIBING PRESCRIBING one Sachet ABEFORE one Sachet BB dissolved together inin in water to make one oneone Sachet A and oneone Sachet together water to to make oneone Sachet Aand Sachet Bdissolved together water make one Sachet A and and one Sachet B dissolved dissolved together in water to make one Presentation: Presentation: AA box box containing containing two two transparent transparent bags, bags, each each containing containing two two litre. This one litre reconstituted solution should be drunk over aa period of litre. This one litrelitre reconstituted solution should be be drunk over period of of litre. This one reconstituted drunk over a100g; litre. This one litre reconstituted solution should drunk over a period period of separate sachets, AA and Sachet contains macrogol 3350 100g; sodium separate sachets, and B. B.solution Sachet AAshould containsbe macrogol 3350 sodium one to two hours. This process should be repeated with aa second litre of oneone to to twotwo hours. This process should bechloride repeated with second litrelitre of of hours. This process should be repeated with aapotassium second one to two hours. This process should be repeated with second litre of sulphate anhydrous 7.5g; sodium 2.691g and chloride sulphate anhydrous 7.5g; sodium chloride 2.691g and potassium chloride Moviprep to complete course. AA further litre of fluid isis recommended Moviprep to 1.015g complete the course. further litre of Bclear clear fluid recommended Moviprep to the AA further litre clear fluid isis recommended Moviprep to complete complete the course. further litre ofcontains clear fluid recommended as white to yellow powder. Sachet ascorbic acid 1.015g as the white tocourse. yellow powder. Sachet Bof contains ascorbic acid 4.7g 4.7g and and during the course of treatment. course of treatment can be taken during thethe course of of treatment. This course of of treatment cancan be taken sodium ascorbate 5.9g white to brown powder. Moviprep also contains sodium ascorbate 5.9g as asThis white to light light brown powder. Moviprep also contains during course treatment. This course treatment be taken during the course of treatment. This course of treatment can be taken aspartame (E951), acesulfame potassium (E950) and or orange aspartame (E951), acesulfame potassium and aa lemon lemon or orange either as divided or as single doses and timing is(E950) dependent on whether either as as divided or or as single doses and timing is is dependent on on whether either divided as single doses and timing dependent whether either as divided or as single doses and timing is dependent on whether flavour. Uses: cleansing prior to any procedure requiring flavour. Uses: cleansing prior towithout any clinical clinical procedure requiring the clinical procedure isis Bowel conducted with or without general anaesthesia as thethe clinical procedure conducted with or or without general anaesthesia as as clinical procedure isBowel with general anaesthesia the clinical procedure is conducted conducted with or without general anaesthesia asaa clean bowel. Dosage and administration: Adults and Older People: AA course clean bowel. Dosage andconducted administration: Adults and Older People: course specified below: For procedures under general anaesthesia: specified below: For procedures conducted under general anaesthesia: specified below: For procedures conducted under general anaesthesia: specified below: For procedures conducted under general anaesthesia: of of treatment treatment consists consists of of two two litres litres of of Moviprep. Moviprep. AA litre litre of of Moviprep Moviprep consists consists of of 1. doses: one litre of inin the evening before and one litre of 1. Divided Divided doses: oneone litre of Moviprep Moviprep the evening before and oneone litre of of 1. doses: litre of Moviprep in the evening before and litre 1. Divided Divided doses: one litre of Moviprep in the evening before and one litre of one one Sachet Sachet AA and and one one Sachet Sachet BB dissolved dissolved together together inin water water to to make make one one Moviprep inin litre. the early morning of the day of the clinical Moviprep thethe early morning of of thethe daysolution of of theshould clinical procedure. Moviprep in early morning day the clinical procedure. Ensure Moviprep in the early morning of the day of the clinical procedure. Ensure This one litre reconstituted be drunk over period of litre. This one litre reconstituted solution should be procedure. drunk over aEnsure aEnsure period of consumption of Moviprep as well as any other clear fluids has at consumption of of Moviprep as as wellwell as as anyany other clear fluids hashas finished at at consumption Moviprep other clear fluids finished consumption of Moviprep as well as any other clear fluids has finished at one to two hours. This process should be repeated with aafinished second litre of one to two hours. This process should be repeated with second litre of least two hours before the start of the procedure. Single dose: least twotwo hours before thethe start of thethe procedure. 2. Single dose: least hours before start of clinical dose: least two hours before the start of the clinical procedure. 2. Single dose: Moviprep to the course. Aclinical further litre of fluid isisSingle recommended Moviprep to complete complete the course. Aclinical further litreprocedure. of clear clear 2. fluid2. recommended two litres of Moviprep inin inin the evening before the clinical procedure twotwo litres of Moviprep the evening before thethe clinical procedure or during the of treatment. This course of treatment can taken during the course course ofthe treatment. This course of treatment can be be or taken litres of Moviprep evening before clinical procedure or two litres of Moviprep the evening before the clinical procedure or either as divided or as doses and timing dependent on either asMoviprep divided in or in as single doses and timing isclinical dependent on whether whether two of the of the twotwo litres of of Moviprep in thesingle morning of of thethe procedure. litres the morning clinical procedure. twolitres litres ofMoviprep Moviprep in themorning morning of theisclinical clinicalprocedure. procedure. the isis conducted with general anaesthesia as the clinical clinical procedure procedure conducted with without general anaesthesia as Ensure of as any Ensure consumption of of Moviprep as as well asororas anyany other clear fluids Ensure consumption Moviprep well other clear fluids Ensureconsumption consumption ofMoviprep Moviprep aswell wellas aswithout anyother otherclear clearfluids fluids specified below: For conducted anaesthesia: specified below:two For procedures conducted under general anaesthesia: has at hours the start of clinical hashas finished at at least hours before thethe start of of thethe clinical finished least two hours before start clinical hasfinished finished atleast leasttwo twoprocedures hoursbefore before theunder startgeneral ofthe the clinical 1. 1. Divided Divided doses: doses: one one litre litre of of Moviprep Moviprep inin the the evening evening before before and and one one litre litre of of procedure. For conducted without general anaesthesia: procedure. For procedures conducted without general anaesthesia: procedure. For procedures conducted without anaesthesia: procedure. Forprocedures procedures conducted without general anaesthesia: Moviprep inin the of of clinical Ensure Moviprep the early early morning morning of the the day day of the the general clinical procedure. procedure. Ensure 1. doses: one litre of inin the evening and one litre of 1. Divided Divided doses: oneone litre of Moviprep Moviprep the evening before andand one litre of of 1. doses: of in before litre 1. Divided Divided doses: one litre of Moviprep Moviprep inas the evening before and one litre of consumption of Moviprep as any other clear fluids has finished at consumption oflitre Moviprep as well well asthe anyevening otherbefore clear fluids hasone finished at Moviprep inin least the early morning of the day the clinical procedure. Ensure Moviprep thethe early morning ofthe thestart dayday ofthe theclinical clinical procedure. Ensure Moviprep in morning of the of the clinical procedure. Ensure Moviprep in the early morning of the day of the clinical procedure. Ensure two hours before of procedure. 2. dose: least twoearly hours before the start ofof the clinical procedure. 2. Single Single dose: consumption of well as any other clear fluids has finished at consumption of Moviprep Moviprep as wellwell asininas any other clear fluids hashas finished at least least consumption of Moviprep as any other clear fluids finished at consumption of Moviprep as well as any other clear fluids has finished at least least two litres of Moviprep the evening before the clinical procedure or two litres of as Moviprep the evening before the clinical procedure or two litres of Moviprep in the morning of the clinical procedure. two litres of Moviprep in the morning of the clinical procedure. one hour before the start of the clinical procedure. 2. Single dose: two litres oneone hour before the start of the clinical procedure. 2. Single dose: two litres one hour hour before before the the start start of of the the clinical clinical procedure. procedure. 2. 2. Single Single dose: dose: two two litres litres consumption of Moviprep as well other fluids Ensure consumption of Moviprep as well or astwo any other clear fluids of inEnsure the evening before the clinical procedure litres of of Moviprep Moviprep in the evening before thethe clinical procedure oras two litres of Moviprep Moviprep of inin the evening before clinical procedure or two litres of Moviprep of Moviprep Moviprep the evening before the clinical procedure orany two litres ofclear Moviprep has finished at least two before the the clinical has of finished atclinical least two hours hours before the start start of the clinical inin in the morning the clinical procedure. Ensure consumption Moviprep thethe morning of thethe clinical procedure. Ensure consumption ofofofof Moviprep morning of procedure. Ensure consumption Moviprep in the morning of the clinical procedure. Ensure consumption of Moviprep procedure. For procedures conducted without general anaesthesia: procedure. For hours procedures conducted without generalprocedure. anaesthesia: has finished at least two before the start of the clinical hashas finished at at least two hours before thethe start of of thethe clinical procedure. finished least two hours before start clinical procedure. has finished at least two hours before the start of the clinical procedure. 1. 1. Divided Divided doses: doses: one one litre litre of of Moviprep Moviprep inin the the evening evening before before and and one one litre litre of of Ensure consumption clear fluids has finished least one hour before Ensure consumption of any clear fluids has finished atthe least oneone hour before Ensure consumption of clear fluids finished at least hour before Ensure consumption of any any clear fluids has finished atclinical least one hour before Moviprep in the early morning of the day of procedure. Ensure Moviprep of in any the early morning of has the day ofat the clinical procedure. Ensure the clinical procedure. Patients should advised allow for appropriate thethe clinical procedure. Patients should be advised to allow for appropriate clinical procedure. Patients should advised to allow for appropriate the clinical procedure. Patients should be advised to allow for appropriate consumption of Moviprep as well as any other clear fluids has finished at consumption of Moviprep as wellbe asbe any other to clear fluids has finished at least least time to to the colonoscopy unit. No solid food should taken from the time to travel travel to hour the colonoscopy unit. NoNo solid food should beSingle taken from thelitres time to to colonoscopy unit. solid food should be taken from the time to travel travel to the the colonoscopy unit. No solid food should be taken from the one before the of the clinical procedure. 2. dose: two one hour before the start start of the clinical procedure. 2.be Single dose: two litres start of the course of treatment after the clinical procedure. Children: start of of thethe course of inin treatment until after thethe clinical procedure. Children: of Moviprep the evening before the clinical procedure or of Moviprep of Moviprep the eveninguntil before the clinical procedure or two two litres litres of Moviprep start course of treatment until after clinical procedure. Children: start of the course of treatment until after the clinical procedure. Children: inin the of clinical consumption of the morning morning of the thebelow clinical procedure. Ensure consumption of Moviprep Moviprep Not recommended inin in children 18 years of age. Contra-indications, NotNot recommended children below 18procedure. years ofEnsure age. Contra-indications, recommended children below 18 years of age. Contra-indications, Not recommended in children below 18 years of age. Contra-indications, has finished at before the start the clinical has finished at least least two two hours hours before thesuspected start of ofhypersensitivity the clinical procedure. procedure. warnings etc: Contra-indications: Known or suspected to warnings etc: Contra-indications: Known or or suspected hypersensitivity to to warnings etc: Contra-indications: Known hypersensitivity warnings etc: Contra-indications: Known or suspected hypersensitivity to Ensure consumption of fluids has at hour before Ensure consumption of any any clear clearobstruction fluids has finished finished at least least one one hour before any of the ingredients, gastrointestinal or perforation, disorders anyany of of thethe ingredients, gastrointestinal obstruction or or perforation, disorders ingredients, gastrointestinal obstruction perforation, disorders any of the ingredients, gastrointestinal obstruction or perforation, disorders the the clinical clinical procedure. procedure. Patients Patients should should be be advised advised to to allow allow for for appropriate appropriate of emptying, ileus, phenylketonuria, glucose-6-phosphate dehydrogenase of gastric gastric emptying, ileus, phenylketonuria, glucose-6-phosphate dehydrogenase of emptying, ileus, phenylketonuria, glucose-6-phosphate dehydrogenase of gastric gastric emptying, ileus, phenylketonuria, glucose-6-phosphate dehydrogenase time time to to travel travel to to the the colonoscopy colonoscopy unit. unit. No No solid solid food food should should be be taken taken from from the the deficiency, toxic complicates severe inflammatory deficiency, toxic megacolon which complicates very severe inflammatory deficiency, toxic megacolon which complicates very severe inflammatory deficiency, toxic megacolon which complicates very severe inflammatory start of the course of until the clinical procedure. Children: start ofmegacolon the course which of treatment treatment until after aftervery the clinical procedure. Children: conditions of the intestinal tract. not use inin unconscious Warnings: conditions ofNot the intestinal tract. Do notnot use unconscious patients. Warnings: conditions of intestinal tract. Do use in patients. Warnings: conditions of the the intestinal tract. Do not use in unconscious patients. Warnings: recommended inin Do children below 18 years age. Contra-indications, Not recommended children below 18unconscious years of of patients. age. Contra-indications, Diarrhoea isis an expected effect. Administer with caution fragile patients inin poor Diarrhoea an expected effect. Administer with caution tosuspected fragile patients poor Diarrhoea isis an expected effect. Administer with caution to patients inin poor Diarrhoea an expected effect. Administer with caution to fragile fragile patients poor warnings etc: Contra-indications: Known or hypersensitivity to warnings etc: Contra-indications: Known orto suspected hypersensitivity to of the ingredients, gastrointestinal obstruction or perforation, disorders any ofwith the ingredients, gastrointestinal obstruction orimpaired perforation, disorders health or serious clinical impairment such as impaired gag reflex, health or patients patients with serious clinical impairment such as as impaired gaggag reflex, health or patients with serious clinical impairment such reflex, health or any patients with serious clinical impairment such as impaired gag reflex, of ileus, phenylketonuria, glucose-6-phosphate dehydrogenase of gastric gastric emptying, ileus, phenylketonuria, glucose-6-phosphate dehydrogenase or aa tendency to aspiration or impaired consciousness, severe or with with tendency to emptying, aspiration or regurgitation, regurgitation, impaired consciousness, severe or aa tendency to or regurgitation, impaired consciousness, severe or with with tendency to aspiration aspiration or regurgitation, impaired consciousness, severe deficiency, toxic megacolon which complicates severe deficiency, toxicimpairment megacolon which complicates very severe inflammatory renal insufficiency, cardiac (NYHA grade IIIIII or IV), those at risk of renal insufficiency, cardiac impairment (NYHA grade or IV),IV), those atinflammatory risk of of renal insufficiency, cardiac impairment (NYHA grade III or those at renal insufficiency, cardiac impairment (NYHA grade IIIvery or IV), those at risk risk of conditions intestinal tract. Do in patients. Warnings: conditions of of the the intestinal tract. Do not not use use bowel in unconscious unconscious patients. Warnings: arrhythmia, dehydration, severe acute inflammatory disease. Dehydration, arrhythmia, dehydration, severe acute inflammatory bowel disease. Dehydration, arrhythmia, dehydration, severe acute inflammatory bowel disease. Dehydration, arrhythmia, dehydration, severe acute inflammatory bowel disease. Dehydration, Diarrhoea Diarrhoea isis an an expected expected effect. effect.Administer Administer with with caution caution to to fragile fragile patients patients inin poor poor ifif present, should be corrected before using Moviprep. The reconstituted Moviprep present, should be corrected before using Moviprep. The reconstituted Moviprep ifif present, should be corrected before using Moviprep. The reconstituted Moviprep present, should be corrected before using Moviprep. The reconstituted Moviprep health health or or patients patients with with serious serious clinical clinical impairment impairment such such as as impaired impaired gag gag reflex, reflex, does not replace regular fluid intake and adequate fluid intake must be does notnot replace regular fluid intake andand adequate fluid intake must bemaintained. maintained. does replace fluid fluid intake must be does not replace fluid intake and adequate fluid intake must bemaintained. maintained. or aregular tendency to aspiration or regurgitation, impaired consciousness, severe or with with aregular tendency to intake aspiration oradequate regurgitation, impaired consciousness, severe Semi-conscious or patients prone to aspiration should closely Semi-conscious patients or or patients prone to(NYHA aspiration should be closely Semi-conscious patients patients prone to aspiration be Semi-conscious patients or patients prone to aspiration should be closely renal insufficiency, cardiac impairment grade or IV), those at risk renalpatients insufficiency, cardiac impairment (NYHA grade IIIIII orshould IV), be those atclosely risk of of monitored during administration, particularly ifif inflammatory this isis via aabowel naso-gastric IfIf IfIf monitored during administration, particularly this via naso-gastric route. arrhythmia, dehydration, severe acute disease. Dehydration, arrhythmia, dehydration, severe acute inflammatory bowel disease.route. Dehydration, monitored during administration, particularly ifif this isis via aa naso-gastric route. monitored during administration, particularly this via naso-gastric route. ififindicating present, should be before using Moviprep. The Moviprep present,arrhythmia should be corrected corrected before using Moviprep. The reconstituted reconstituted Moviprep symptoms indicating or of or electrolytes occur, plasma symptoms indicating arrhythmia or shifts shifts of fluid fluid or electrolytes occur, plasma symptoms arrhythmia or of or occur, plasma symptoms indicating arrhythmia or shifts shifts of fluid fluid or electrolytes electrolytes occur, plasma does not regular fluid and adequate fluid be maintained. does notreplace replace regular fluidintake intake and adequate fluid intake must be maintained. electrolytes should be measured, ECG performed and any abnormality electrolytes should be be measured, ECG performed andintake anymust abnormality electrolytes should measured, ECG performed and any abnormality electrolytes should be measured, ECG performed and any abnormality Semi-conscious patients or prone to should be closely Semi-conscious patients or patients patients prone to aspiration aspiration should bepoor closely treated InIn InIn debilitated fragile patients, patients with treated appropriately. debilitated fragile patients, patients with poor treated appropriately. debilitated fragile patients, patients with poor treatedappropriately. appropriately. debilitated fragile patients, patients with poor monitored monitored during during administration, administration, particularly particularly ifif this this isis via via aa naso-gastric naso-gastric route. route. IfIf health, those with clinically significant renal impairment, arrhythmia and health, those with clinically significant renal impairment, arrhythmia and health, those with clinically significant renal impairment, arrhythmia and health, those with clinically significant renal impairment, arrhythmia and symptoms symptoms indicating indicating arrhythmia arrhythmia or or shifts shifts of of fluid fluid or or electrolytes electrolytes occur, occur, plasma plasma those the those at at risk of of electrolyte imbalance, the physician should consider those risk electrolyte imbalance, the physician consider thoseat atrisk riskof ofelectrolyte electrolyte imbalance, thephysician physicianshould should consider electrolytes should measured, ECG performed and any abnormality electrolytes should be beimbalance, measured, ECG performed andshould anyconsider abnormality performing baseline and post-treatment electrolyte, renal function performing baseline and post-treatment electrolyte, renal function performing baseline and post-treatment electrolyte, renal function performing baseline and post-treatment electrolyte, renal function treated treated appropriately. appropriately. InIn debilitated debilitated fragile fragile patients, patients, patients patients with with poor poor test The possibility of testtest andand ECG asthose appropriate. TheThe possibility of impairment, serious arrhythmias, ECG as appropriate. possibility of serious arrhythmias, testand andECG ECGas asappropriate. appropriate. The possibility ofserious seriousarrhythmias, arrhythmias, health, with significant renal arrhythmia and health, those with clinically clinically significant renal impairment, arrhythmia and predominantly inin in those underlying cardiac risk factors and electrolyte those at risk of electrolyte imbalance, the physician should consider predominantly those with underlying cardiac risk factors andand electrolyte those at those riskwith of electrolyte imbalance, the physician should consider predominantly with underlying cardiac risk factors electrolyte predominantly in those with underlying cardiac risk factors and electrolyte performing baseline and post-treatment electrolyte, renal function performing baseline and post-treatment electrolyte, renal function disturbance cannot be ruled out. If patients experience symptoms which make disturbance cannot be ruled out. If patients experience symptoms which make disturbance cannot be ruled out. If patients experience symptoms which make disturbance cannot be ruled out. If patients experience symptoms which make and ECG as appropriate. The possibility of serious arrhythmias, test and the ECG as appropriate. The possibility of serious arrhythmias, itit difficult to continue preparation, they may slow down or stop difficult to test continue the preparation, they may slow down or temporarily temporarily stop itit difficult to the preparation, they may slow down or temporarily stop difficult to continue continue the preparation, they may slow down or temporarily stop predominantly inin those with underlying cardiac risk factors and predominantly those with underlying cardiac risk factors containing and electrolyte electrolyte consuming the solution and should consult their doctor. Moviprep consuming the solution and should consult their doctor. Moviprep containing consuming the solution and should consult their doctor. Moviprep containing consuming the solution and should consult their doctor. Moviprep containing disturbance disturbance cannot cannot be be ruled ruled out. out. IfIf patients patients experience experience symptoms symptoms which which make make orange flavour is not recommended for patients with glucose and galactose orange flavour is not recommended for patients with glucose and galactose orange isis not recommended for with galactose orange flavour flavour notcontinue recommended for patients patients with glucose and galactose itit difficult to the they slow down temporarily stop difficult to continue the preparation, preparation, they may may slowglucose down or orand temporarily stop malabsorption. Moviprep contains 56.2 mmol of per litre (caution malabsorption. Moviprep contains 56.2 mmol ofabsorbable absorbable sodium per litrelitre (caution malabsorption. Moviprep contains 56.2 mmol of sodium per (caution malabsorption. Moviprep contains 56.2 mmol ofabsorbable absorbable sodium per litre (caution consuming the solution and should consult their doctor. Moviprep containing consuming the solution and should consult theirsodium doctor. Moviprep containing inin patients on aon diet), 14.2 mmol potassium per litre (caution patients onorange a controlled controlled diet), 14.2 mmol potassium perper litrelitre (caution inin patients on aa controlled sodium diet), 14.2 potassium (caution patients controlled sodium diet), 14.2 mmol potassium per litre (caution flavour not recommended for patients with and galactose orange flavour issodium issodium not recommended formmol patients with glucose glucose and galactose ininpatients with reduced kidney function or on controlled potassium diet). patients with reduced kidney function orpatients patients onofofaon aon controlled potassium diet). ininpatients with reduced kidney function or aacontrolled potassium diet). malabsorption. Moviprep contains 56.2 mmol absorbable sodium per (caution patients with reduced kidney function orpatients patients controlled potassium diet). malabsorption. Moviprep contains 56.2 mmol absorbable sodium perlitre litre (caution inin patients on aa controlled sodium diet), mmol potassium per litre (caution patients onmedication controlled sodium diet), 14.2 mmol potassium per litre (caution Interactions: Oral medication should not be taken within one hour of Interactions: Oral medication should not be14.2 taken within one hour of of Interactions: Oral should not be taken within one hour Interactions: Oral medication should not be taken within one hour of ininas patients with kidney function patients on aacontrolled potassium diet). patients with reduced kidney function patients on controlled potassium diet). administration itas be flushed from the GI and not absorbed. Pregnancy administration as itasmay may bereduced flushed from the GI tract tract andand not absorbed. Pregnancy administration itit may be from the GI not absorbed. Pregnancy administration may be flushed flushed from the GIorortract tract and not absorbed. Pregnancy Interactions: Oral medication should not be taken within one hour of Interactions: Oral medication should not be taken within one hour of and lactation: There is no experience of use in pregnancy or lactation so it should and lactation: There is no experience of use in pregnancy or lactation so it should and and lactation: lactation:There There isis no no experience experience of of use use inin pregnancy pregnancy or or lactation lactation so so itit should should administration as be from tract and Pregnancy administration as itit may mayby be flushed flushed from the the GI GI tractEffects: and not not absorbed. absorbed. Pregnancy only be used ifif judged essential the physician. Side Very common only be be used judged essential by thethe physician. Side Effects: Very common only used iflactation: essential by physician. Side Effects: Very common only be used if judged judged essential by the physician. Side Effects: Very common and There and lactation: There isis no no experience experience of of use use inin pregnancy pregnancy or or lactation lactation so so itit should should or common: abdominal nausea, abdominal distension, anal discomfort, or or common: abdominal nausea, abdominal distension, anal discomfort, common: abdominal pain, nausea, abdominal distension, anal discomfort, or common: abdominal pain, nausea, abdominal distension, anal discomfort, only be judged essential by the Side Very common only be used used ifpain, ifpain, judged essential by the physician. physician. Side Effects: Effects: Very common malaise, pyrexia, vomiting, dyspepsia, thirst, sleep disorder, headache, malaise, pyrexia, vomiting, dyspepsia, hunger, thirst, sleep disorder, headache, malaise, pyrexia, vomiting, dyspepsia, hunger, thirst, sleep disorder, headache, malaise, pyrexia, vomiting, dyspepsia, hunger, thirst, sleep disorder, headache, or abdominal pain, nausea, abdominal distension, anal discomfort, or common: common: abdominal pain,hunger, nausea, abdominal distension, anal discomfort, dizziness, and rigors. Uncommon or Dysphagia, abnormal dizziness, and rigors. Uncommon or unknown: unknown: Dysphagia, discomfort, abnormal dizziness, and rigors. Uncommon or unknown: Dysphagia, discomfort, abnormal dizziness, and rigors. Uncommon or unknown: Dysphagia, discomfort, abnormal malaise, pyrexia, vomiting, dyspepsia, hunger, thirst, sleep disorder, headache, malaise, pyrexia, vomiting, dyspepsia, hunger, thirst,discomfort, sleep disorder, headache, liver function tests, allergic reactions including rash, urticaria, pruritus, erythema, liver function tests, allergic reactions including rash, urticaria, pruritus, erythema, dizziness, and rigors. Uncommon or Dysphagia, discomfort, abnormal dizziness, and rigors. Uncommon or unknown: unknown: Dysphagia, discomfort, abnormal liver function tests, allergic reactions including rash, urticaria, pruritus, erythema, liver function tests, allergic reactions including rash, urticaria, pruritus, erythema, liver function tests, reactions including rash, urticaria, erythema, liver function tests, allergic allergic reactions including rash, urticaria, pruritus, pruritus, erythema, angioedema and anaphylaxis, dyspnoea, electrolyte disturbances, dehydration, angioedema andand anaphylaxis, dyspnoea, electrolyte disturbances, dehydration, angioedema anaphylaxis, dyspnoea, electrolyte disturbances, dehydration, angioedema and anaphylaxis, dyspnoea, electrolyte disturbances, dehydration, angioedema and anaphylaxis, dyspnoea, disturbances, angioedema andwith anaphylaxis, dyspnoea, electrolyte electrolyte disturbances, dehydration, convulsions associated with severe hyponatraemia, transient increase inindehydration, blood convulsions associated with severe hyponatraemia, transient increase blood convulsions associated severe hyponatraemia, transient increase in convulsions associated with severe hyponatraemia, transient increase in blood blood convulsions associated with severe hyponatraemia, transient increase inin blood convulsions associated with severeand hyponatraemia, transient increase blood pressure, arrhythmia, palpitations, flatulence retching. Refer to Summary pressure, arrhythmia, palpitations, flatulence and retching. Refer to the the Summary pressure, arrhythmia, palpitations, flatulence and retching. Refer to the Summary pressure, arrhythmia, palpitations, flatulence and retching. Refer to the Summary pressure, pressure, arrhythmia, arrhythmia, palpitations, palpitations, flatulence flatulence and and retching. retching. Refer Refer to to the the Summary Summary of Characteristics (SmPC) for full list and frequency of events. of Product Product Characteristics (SmPC) for fullfull list and frequency of adverse adverse events. of (SmPC) for frequency of adverse of Product Product Characteristics (SmPC) for full list and frequency of of adverse events. of Product (SmPC) for full list frequency adverse events. ofCharacteristics Product Characteristics Characteristics (SmPC) forlist fulland list and and frequency of adverseevents. events. Overdose: InIn case of gross accidental overdosage, conservative measures Overdose: case ofInInof gross accidental overdosage, conservative measures Overdose: In case gross overdosage, conservative measures Overdose: In case of gross accidental overdosage, conservative measures Overdose: case of gross accidental overdosage, conservative measures Overdose: case of accidental gross accidental overdosage, conservative measures are usually sufficient. the rare event severe metabolic derangement, areare usually sufficient. In thethe rare event ofevent severe metabolic derangement, usually sufficient. In event of severe metabolic derangement, are usually sufficient. In the rare event of severe metabolic derangement, are usually sufficient. InInrare the rare of metabolic derangement, are usually In sufficient. the rareof event of severe severe metabolic derangement, intravenous rehydration may be used. Pharmaceutical Particulars: Sachets: intravenous rehydration may be be used. Pharmaceutical Particulars: Sachets: intravenous rehydration may used. Pharmaceutical Particulars: Sachets: intravenous rehydration may be used. Pharmaceutical Particulars: Sachets: intravenous rehydration may be used. Pharmaceutical Particulars: Sachets: intravenous rehydration may be used. Pharmaceutical Particulars: Sachets: inin the original package below 25°C. Reconstituted solution: Keep Store thepackage original package below 25°C. Reconstituted solution: Keep Store inin inin the original below 25°C. Reconstituted solution: Keep Store theStore original package below 25°C. Reconstituted solution: Keep Store the original package below 25°C. Reconstituted solution: Keep Store the original package below 25°C. Reconstituted solution: Keep covered. May be stored to 24 hours below 25°C in refrigerator. covered. May be for stored for up tohours 24below hours below 25°C in arefrigerator. refrigerator. covered. May be stored for up to 24 hours 25°C or in aor covered. May be be stored for up up tofor 24up hours below 25°C or in or ainrefrigerator. refrigerator. covered. May stored to 24 below 25°C or in aa arefrigerator. covered. May be stored for up to 24 hours below 25°C or Legal Category: UK – Pharmacy only, Ireland Prescription medicine. Packs: Legal Category: UK – Pharmacy only, Ireland Prescription medicine. Packs: Legal Category: UK –– Pharmacy only, Ireland -- Prescription medicine. Packs: Legal Category: UKUK Pharmacy only, Ireland Prescription medicine. Packs: Legal Category: –– Pharmacy only, Ireland -- Prescription medicine. Packs: Legal Category: UK Pharmacy only, Ireland Prescription medicine. Packs: One pack Moviprep or Orange contains treatment. OneMoviprep pack of of or Moviprep or Moviprep Moviprep Orange contains a single single treatment. One pack of Moviprep Orange contains aa single treatment. One pack of or Moviprep Orange contains treatment. One pack of Moviprep or Moviprep Orange contains asingle treatment. One pack ofMoviprep Moviprep or Moviprep Orange contains a asingle single treatment. Basic Basic NHS NHS Price: Price: UK UK £10.36, £10.36, Ireland Ireland €13.26 €13.26 Marketing Marketing Authorisation Authorisation Basic NHS Price: UK £10.36, Ireland €13.26 Marketing Authorisation Basic NHS Price: UK £10.36, Ireland €13.26 Marketing Authorisation Basic NHS Price: UK £10.36, Ireland €13.26 Marketing Authorisation Basic NHS Price: UK £10.36, Ireland €13.26 Marketing Authorisation Number: Number: UK: UK: PL PL 20142/0005 20142/0005 (Moviprep), (Moviprep), PL PL 20011/0006 20011/0006 (Moviprep (Moviprep Orange). Orange). Number: UK: PL 20142/0005 (Moviprep), 20011/0006 (Moviprep Number: UK:IE: PLPA 20142/0005 (Moviprep), PL 20011/0006 (Moviprep Orange). Number: UK: PL 20142/0005 (Moviprep), PL 20011/0006 (Moviprep Orange). Number: UK: PL 20142/0005 (Moviprep), PL 20011/0006 (Moviprep Orange). 1336/1/1(Moviprep), PA 1336/1/2 (Moviprep Orange). For further IE: PA 1336/1/1(Moviprep), PA PL 1336/1/2 (Moviprep Orange).Orange). For further IE: PA 1336/1/1(Moviprep), 1336/1/2 (Moviprep For further IE: IE: PAPA 1336/1/1(Moviprep), PA 1336/1/2 (Moviprep Orange). For further 1336/1/1(Moviprep), PA 1336/1/2 (Moviprep Orange). For further IE: PA 1336/1/1(Moviprep), PA 1336/1/2 (Moviprep Orange). For further information Norgine Pharmaceuticals Ltd, Moorhall Road, Harefield, information contact: contact:PA Norgine Pharmaceuticals Ltd,Orange). Moorhall Road, Harefield, information contact: Norgine Ltd, Moorhall Road, Harefield, information contact: Norgine Pharmaceuticals Ltd,Ltd, Moorhall Road, Harefield, Middlesex UB9 6NS Tel: +44 E-mail: medinfo@norgine.com Middlesex UB9 6NSPharmaceuticals Tel:Pharmaceuticals +44 (0) (0) 1895 1895 826606 826606 E-mail: medinfo@norgine.com information contact: Norgine Moorhall Road, Harefield, information contact: Norgine Pharmaceuticals Ltd, Moorhall Road, Harefield, Date of preparation/revision: March 2018. Ref UK/MPR/0318/0182 Date of6NS preparation/revision: March 2018.E-mail: RefE-mail: UK/MPR/0318/0182 Middlesex UB9 6NS Tel: +44 (0) 1895 826606 medinfo@norgine.com Middlesex UB9 6NS Tel:Tel: +44 (0)(0) 1895 826606 E-mail: medinfo@norgine.com Middlesex UB9 +44 1895 826606 medinfo@norgine.com Middlesex UB9 6NS Tel: +44 (0) 1895 826606 E-mail: medinfo@norgine.com Date of March 2018. Ref UK/MPR/0318/0182 Date of preparation/revision: preparation/revision: March 2018. RefRef UK/MPR/0318/0182 Date of March 2018. UK/MPR/0318/0182 Date of preparation/revision: preparation/revision: March 2018. Ref UK/MPR/0318/0182

THE CONSULTANT

PLENVU PLENVU IRE IREIRE 69mm 69mm xx 297mm 297mm (PI) (PI) CMYK CMYK PLENVU PLENVU IRE 69mm 69mm xx 297mm 297mm (PI) (PI) CMYK CMYK

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09/07/2018 15:46 09/07/2018 09/07/2018 15:43 17 07 201815:35 13 25 09/07/2018 15:35

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

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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A S S O C I A T I O N

Consultants’ Common Contract 2008 Enabling Circular 25th July 2008

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 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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36 36 37 39 39 39 40 40 40 41 41 41 42 42 43 43 43 44 45 45 45 49 49 50 50 50 51 51 52 52 52 52 53 53 58 60 64 65 66 67 68

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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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Hermitage Medical Clinic First Class Healthcare & Quality Patient Care

Hermitage Medical Clinic First Class Health Care

The Hermitage Medical Clinic provides a full range of medical and surgical care across a broad spectrum of specialities. We offer top quality healthcare with access to over 240 leading consultants Our hospital facilities include 112 in-patient beds, 35 day-beds and 8 operating theatres. As part of the expansion of the Neurosurgical programme at the Hermitage we have a dedicated, state of the art neurosurgical theatre. Our Orthopaedic Consultants provide services in all aspects of orthopaedic surgery, from minimally invasive joint, hip and knee replacement to ankle, shoulder procedures and foot surgery. The Hospital has particular expertise in Diagnostic and Interventional Cardiology Services.

in Ireland. For more information on CyberKnife you can visit our website www.hermitageclinic.ie

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www.hermitageclinic.ie or phone: 01 645 9000

18/07/2011

Hermitage Medical Clinic, Old Lucan Rd., Dublin 20, D20 W722.

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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

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

(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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Brintellix (vortioxetine) addresses the complexities of depression, so your patients can address the complexities of life1

Brintellix is indicated for the treatment of major depressive episodes in adults1 Brintellix®q (vortioxetine) film-coated tablets Prescribing information: Please refer to the full Summary of Product Characteristics (SPC) before prescribing, particularly in relation to side effects, precautions and contraindications. Presentation: Tablets containing 5, 10, 15 or 20mg of vortioxetine (as the hydrobromide). Indications: Treatment of major depressive episodes in adults. Dosage: 10mg once daily. Dose may be increased to a maximum of 20mg daily or reduced to 5mg if necessary. After depressive symptoms resolve, treatment for at least 6 months is recommended. Elderly (≥65 years): Initial dosage is 5mg once daily. Caution advised if using doses above 10mg daily as data are limited. Children and adolescents (<18 years): Not recommended as safety and efficacy not established. Cytochrome P450 inhibitors and inducers: Consider a dose reduction of vortioxetine if a strong CYP2D6 inhibitor is added. Consider a dose adjustment if a broad CYP450 inducer is added to treatment. Renal impairment: Exercise caution in severe impairment as data are limited in these patients. Hepatic impairment: Exercise caution in severe hepatic impairment as no data in these patients. Contraindications: Hypersensitivity to the active substance or any of the excipients. Concomitant use with non-selective, monoamine oxidase inhibitors (MAOIs) or selective MAO-A inhibitors (e.g. moclobemide). Fertility, pregnancy and lactation: Do not use in pregnancy unless clinically necessary. Limited data on the use of vortioxetine in pregnant women. Animal studies have shown reproductive toxicity. Use of SSRIs in pregnancy, particularly in late pregnancy, may increase the risk of persistent pulmonary hypertension in the newborn (PPHN). It is expected that vortioxetine will be excreted into human milk, and a risk to the suckling child cannot be excluded. Fertility: Animal data showed no effect on fertility, sperm quality or mating performance. Human case reports with some SSRIs have shown that an effect on sperm quality is reversible. Impact on human fertility has not been observed so far. Precautions: Use caution when driving a car or operating machinery. Closely supervise patients, especially those at high risk, for suicide-related behaviours during first few weeks of treatment and during dose changes. Use with caution in patients: at risk of hyponatraemia; with a history of mania/hypomania; undergoing ECT; with unstable epilepsy (discontinue if seizures begin for the first time or increase in frequency); with bleeding tendencies/disorders, taking anticoagulants or medicines affecting platelet function; in patients on lithium or tryptophan. Monitor patients for appearance of serotonin syndrome or neuroleptic malignant syndrome, and discontinue if occurs. Drug interactions: Alcoholic drinks not advisable. Vortioxetine is extensively metabolised in the liver, primarily through oxidation catalysed by CYP2D6 and to a minor extent CYP3A4/5 and CYP2C9. Potential for interactions with: MAOIs, MAO-A and MAO-B inhibitors; serotonergic medicines (e.g. triptans or tramadol); St John’s wort; products which may lower the seizure threshold, e.g. antidepressants (tricyclic, SSRIs, SNRIs), neuroleptics (phenothiazines, thioxanthenes and butyrophenones), mefloquine or bupropion. Depending on individual patient response, a lower dose of vortioxetine may be considered if strong CYP2D6 inhibitor (e.g. bupropion, quinidine, fluoxetine, paroxetine) is added to vortioxetine treatment. Additionally these effects may be greater in patients who are poor metabolisers of CYP2D6. A dose

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adjustment may be considered if a broad cytochrome P450 inducer (e.g. rifampicin, carbamazepine, phenytoin) is added to vortioxetine treatment. Adverse events: Adverse reactions were usually mild or moderate, transient and occurred within the first two weeks of treatment. The following adverse events were reported: Very common (>1/10 patients); nausea. Common (>1/100 <1/10); abnormal dreams, dizziness, diarrhoea, constipation, vomiting, pruritis, including generalised pruritis. Uncommon (>1,000 <1/100); flushing, night sweats. Unknown: Serotonin syndrome, hyponatraemia. Sexual dysfunction: The 20mg dose of vortioxetine was associated with an increase in treatment-emergent sexual dysfunction. Class effect: Studies in patients ≥50 years of age, show an increased risk of bone fractures in patients receiving SSRIs and TCAs. Not known if relevant to vortioxetine. Prescribers should consult the full SPC in relation to other side effects. Overdose: Limited experience. Management consisting of treating clinical symptoms and relevant monitoring. Legal category: POM. Brintellix Tablets, blisters of: 5mg (EU/1/13/891/002) 28 tablets. 10mg (EU/1/13/891/010) 28 tablets. 15mg (EU/1/13/891/019) 28 tablets. 20mg (EU/1/13/891/028) 28 tablets. Further information available from: Lundbeck Ireland Ltd, 4045 Kingswood Road, Citywest Business Park, Co. Dublin. Tel: 01 468 9800. ® Brintellix is a Registered Trade Mark. Date of last revision of PI: January 2017 Job number: UK/VOR/1602/0248c Date of preparation: July 2017 Reference 1. Brintellix Summary of Product Characteristics. Adverse events should be reported. Reporting forms and information can be found at www.hpra.ie. Adverse events should also be reported to Lundbeck on: 01 468 9800 Email: SafetyLuIreland@lundbeck.com

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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. 3) The primary role of a Clinical Director is to deploy and

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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

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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

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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

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Am Pm

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Actual

Areas of Focus Public

Private

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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 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. k) Ensuring a consistency of approach across the Directorate in

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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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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 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 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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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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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: (01) 480 2040 or 1890 714 444 or PO Box 764, Togher, Co Cork. (021) 237 3207 Email: partnersupport@irishlifehealth.ie Head of Provider Affairs: Mr Brian Scollard

Laya Healthcare Eastgate Business Park, Little Island, Cork. Tel: (021) 202 2000 Email: info@layahealthcare.ie Medical Insurance 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

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

Voluntary Health Insurance Board/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 Dr Anthony Breslin 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 Prof Mary Leader

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

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Ms Alison Lindsay Prof Marina Lynch Dr Erica Maguire Ms Catherine McKenna Dr Maeve Moran Dr Aoife Mullally Mr Joe O’Donovan Mr Tom O’Higgins Mr Jim O’Sullivan Prof Mary O’Sullivan Vacant (Nominated by Nursing and Midwifery Board Ireland in July)

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

(d) Visiting EEA Practitioners Division, which shall include the names of those medical practitioners registered in that division 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

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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 • Radiation Oncology • Radiology 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

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The only licensed treatment for the reduction in recurrence of overt hepatic encephalopathy (OHE)1

At home they are still at risk; ...TARGAXAN® rifaximin-a reduces the risk of recurrence of overt hepatic encephalopathy.1

Long-term secondary prophylaxis in hepatic encephalopathy (HE)2 TARGAXAN® 550 mg film-coated tablets (rifaximin-a). REFER TO FULL SUMMARY OF PRODUCT CHARACTERISTICS (SmPC) BEFORE PRESCRIBING Presentation: Film-coated tablet containing rifaximin 550 mg. Uses: Targaxan is indicated for the reduction in recurrence of episodes of overt hepatic encephalopathy in patients ≥ 18 years of age. Dosage and administration: Adults 18 years of age and over: 550 mg twice daily, with a glass of water, with or without food for up to 6 months. Treatment beyond 6 months should be based on risk benefit balance including those associated with the progression of the patients hepatic dysfunction. No dosage changes are necessary in the elderly or those with hepatic insufficiency. Use with caution in patients with renal impairment. Contraindications: Contraindicated in hypersensitivity to rifaximin, rifamycin-derivatives or to any of the excipients and in cases of intestinal obstruction. Warnings and precautions for use: The potential association of rifaximin treatment with Clostridium difficile associated diarrhoea and pseudomembranous colitis cannot be ruled out. The administration of rifaximin with other rifamycins is not recommended. Rifaximin may cause a reddish discolouration of the urine. Use with caution in patients with severe (ChildPugh C) hepatic impairment and in patients with MELD (Model for End-Stage Liver Disease) score > 25. In hepatic impaired patients, rifaximin may decrease the exposure of concomitantly administered CYP3A4 substrates (e.g. warfarin, antiepileptics, antiarrhythmics, oral contraceptives). Both decreases and increases in international normalized ratio (in some cases with bleeding events) have been reported in patients maintained on warfarin and prescribed rifaximin. If co-administration is necessary, the international normalized

FC advert template.indd 1 2019_v11_No 245285_1C_Targaxan_JM_IHCA.indd 1 Minister 122417_TARGAXAN 1 001-077_IHCA Client FP_210x297_Final.indd Section Address_V2.indd 75

ratio should be carefully monitored with the addition or withdrawal of treatment with rifaximin. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation. Ciclosporin may increase the rifaximin Cmax Pregnancy and lactation: Rifaximin is not recommended during pregnancy. The benefits of rifaximin treatment should be assessed against the need to continue breastfeeding. Side effects: Common effects reported in clinical trials are dizziness, headache, depression, dyspnoea, upper abdominal pain, abdominal distension, diarrhoea, nausea, vomiting, ascites, rashes, pruritus, muscle spasms, arthralgia and peripheral oedema. Other effects that have been reported include: Clostridial infections, urinary tract infections, candidiasis, pneumonia cellulitis, upper respiratory tract infection and rhinitis. Blood disorders (e.g. anaemia, thrombocytopenia). Anaphylactic reactions, angioedemas, hypersensitivity. Anorexia, hyperkalaemia and dehydration. Confusion, sleep disorders, balance disorders, convulsions, hypoesthesia, memory impairment and attention disorders. Hypotension, hypertension and fainting. Hot flushes. Breathing difficulty, pleural effusion, COPD. Gastrointestinal disorders and skin reactions. Liver function test abnormalities. Dysuria, pollakiuria and proteinuria. Oedema. Pyrexia. INR abnormalities. Legal category: UK - POM, IrelandPrescription only. Cost: UK - Basic NHS price £259.23 for 56 tablets. Ireland - €262.41 for 56 tablets Marketing Authorisation number: UK - PL 20011/0020. Ireland PA 102/29/1 For further information contact: Norgine Pharmaceuticals Limited, Norgine House, Moorhall Road, Harefield, Middlesex, United Kingdom UB9 6NS Telephone: +44(0)1895 826606 E-mail: medinfo@norgine.com Ref: UK/XIF5/0116/0173(2) Date of preparation: August 2017

United Kingdom - Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events should also be reported to Medical Information at Norgine Pharmaceuticals Ltd on 01895 826606. Ireland - 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 Medical Information at Norgine Pharmaceuticals on +44 1895 826606. Product under licence from Alfasigma S.p.A. TARGAXAN is a registered trademark of the Alfasigma group of companies, licensed to the Norgine group of companies. Norgine and the sail logo are registered trademarks of the Norgine group of companies. References: 1. National Institute for Health and Care Excellence. Rifaximin for preventing episodes of overt hepatic encephalopathy: appraisal guidance TA337 for rifaximin. Available from: http://www.nice.org.uk/guidance/ta337 2. Mullen KD, et al. Clin Gastroenterol Hepatol 2014;12(8): 1390-97. UK/XIF5/0917/0350 Date of preparation: September 2017.

13/07/2018 10:39 26/04/2018 09:25 12/10/2017 13:26 11:40 17/07/2018

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Professional Directory IHCA National Council 2018 – 2019

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 Kieran Moore Dr Conor O’Riordan

Wexford General Hospital Wexford Mental Health St Luke’s General Hospital, Kilkenny

Emergency Med Psychiatry Radiology

Midland Region Dr Charles d’Adhemar Dr 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 General Hospital Sligo University Hospital

Anaesthesia Pathology

Western Region Mr Garrett Durkan Dr Elizabeth Brosnan Mr Colm Fahy

Galway University Hospital Mayo General Hospital Galway Clinic

Surgery Endocrinology Surgery

Mid Western Region Ms Shona Tormey Dr Patrick Dillon

Mid Western Regional Hospital Mid Western Regional Hospital

Surgery Anaesthesia

Southern Region Dr Mary McCaffrey Mr Peter Ryan Dr Sinead Harney Dr Oisin O’Connell

Kerry General Bon Secours Cork Cork University Hospital Bon Secours Cork

Obs/Gynae Surgery Rheumatology Respiratory

Retired Crumlin Children’s Hospital St Vincent’s University Hospital Temple Street Children’s Hospital

Anaesthesia Cardiology Vascular Surgery Radiology

Co-Options Dr P J Breen Dr Orla Franklin Mr Joe Dowdall Dr Gabrielle Colleran To be co-opted

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Professional Directory IHCA Officer Board 2018 – 2019

President Dr Donal O’Hanlon Consultant Psychiatrist, Naas General Hospital, Naas, Co Kildare.

Treasurer Prof Alan Irvine Consultant Dermatologist, Our Lady’s Children’s Hospital, Crumlin, Dublin 12.

Vice President Dr Orla Franklin Consultant Paediatric Cardiologist, 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.

Vice President To be elected Membership Secretary To be elected

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

ASSISTANT SECRETARY GENERAL: Donal Duffy Tel: 086 8176901 Email: d.duffy@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: 0818 305055 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) 878 8866 Helpline: 1850 445 464 Email: reception@asthmasociety.ie Web: www.asthma.ie

Epilepsy Ireland 249 Crumlin Road, Crumlin, Dublin D12RW92. 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

Cleft Lip and Palate Association of Ireland c/o 36 Woodlands Avenue, Dún Laoghaire, 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 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. 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: 1890311211 Fax: (01) 496 2201 Email: info@cfireland.ie Web: www.cfireland.ie DeafHear 35 North Frederick Street, Dublin 1. Tel: (01) 872 3816 Text: (087) 922 1046 Fax: (01) 878 3629 Email: info@deafhear.ie Web: www.deafhear.ie

Diabetes Ireland 19 Northwood House, Northwood Business Campus, Santry, Dublin DO9 DH30. Tel: (01) 842 8118 Helpline: 1850 909 909 Email: info@diabetes.ie Web: www.diabetes.ie Down Syndrome Ireland Unit 3, Park Way House, Western Parkway Business Park, Ballymount Drive, Dublin D12HP70. 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 HSE Sexual Health & Crisis Pregnancy Programme 4th Floor, 89-94 Capel Street, Dublin 1. Tel: (076) 695 9130 Fax: (076) 6959147 Email: info@crisispregnancy.ie Web: www.crisispregnancy.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.deaf.ie Irish Family Planning Association Solomons House, 42a Pearse Street, Dublin 2. Tel: (01) 607 4456 Fax: (01) 607 4486 Email: reception@ifpa.ie Web: www.ifpa.ie Irish Haemophilia Society First Floor, Cathedral Court, New Street, Dublin DO8 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 Helpline: 1800 25 25 50 Email: info@irishheart.ie Web: www.irishheart.ie Irish Hospice Foundation 4th Floor, Morrison Chambers, 32 Nassau Street, Dublin DO2 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 P5V6. Tel: (01) 620 5306 Email: info@ika.ie Web: www.ika.ie Irish Motor Neurone Disease Association Coleraine House, Coleraine Street, Dublin 7. 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 18 Orion Business Campus, Rosemount Business Park, Ballycoolin, Blanchardstown, D 15. Tel: (01) 882 9030 Web: www.alittlelifetime.ie Irish Wheelchair Association Áras Chúchulainn, Blackheath Drive, Clontarf, Dublin 3. Tel: (01) 818 6400 Email: info@iwa.ie Web: www.iwa.ie

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Professional Directory Voluntary & Support Organisations

Meningitis Research Foundation Gardiner House, 64-66 Lower Gardiner 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 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

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

The Rehab Group Beach Road, Sandymount, Dublin 4. Tel: (01) 205 7200 Fax: (01) 205 7211 Email: info@rehab.ie Web: www.rehab.ie

Email: info@ncbi.ie Web: www.ncbi.ie

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

OANDA – Out and About Association 19 Ormond Quay Upper, INNS Quay, Dublin D07 EC84. Tel: 1800 252 524 Web: www.oandaireland.ie Pact – Caring Professional Services Arabella House, 18D Nutgrove Office Park, Rathfarnham, Dublin 14 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

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 W5C1. Tel: (01) 457 2329 Email: info@sbhi.ie Web: www.sbhi.ie

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

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Charts & Tables (as of December 2017)

Acute Hospitals Acute Hospitals

Overview of Key Acute Hospital Activity Overview of Key Acute Hospital Activity Activity Area Emergency Presentations New ED Attendances OPD Attendances Activity Area (HIPE data month in arrears) Inpatient [IP] Discharges Day Case [DC] Discharges IP & DC Discharges % IP % DC Emergency IP Discharges Elective IP Discharges Maternity IP Discharges

Result YTD Dec 2017

Expected Activity YTD

Result YTD Dec 2016

SPLY % Var

Result Oct

1,393,358

1,382,300

+2.5%

120,206

117,718

119,487

1,182,805 3,303,568

1,168,318 3,440,981

1,157,074 3,327,526

+2.2% -0.7%

101,156 276,587

98,831 301,595

101,623 219,572

Result YTD Expected Result YTD Nov 2017 Activity YTD Nov 2016 582,848 586,785 581,868

SPLY % Var +0.2%

Result Sept 52,880

Result Oct 52,652

Result Nov 54,050

993,713

980,386

976,214

+1.8%

89,409

89,506

96,095

1,576,561 37% 63% 395,526 85,831 101,491

1,567,171 37.4% 62.6% 393,067 87,260 106,458

1,558,082 37.3% 62.7% 391,073 84,972 105,822

+1.2% -0.3% +0.3% +1.1% +1% -4.1%

142,289 37.2% 62.8% 35,358 8,056 9,466

142,158 37% 63% 35,561 7,931 9,160

150,145 36% 64% 36,791 8,410 8,849

Target/ Expected Activity 90% 95%

Freq M M

Previous Period YTD 85.8% 93.2%

Current Period YTD 86.5% 92.6%

95%

88.9%

88.7%

-0.2%



94.1%

-5.4%



97%

87.5%

85.9%

-1.6%



92.7%

-6.8%



85%

72.9%

72.4%

-0. 5%



80.7%

-8.3%



Change +0.7%  -0.6% 

Inpatient and Day Case Waiting List

Outpatient Waiting List

15,000

150,000

10,000

7,710

7,656

100,000

5,000

2,937

4,495

50,000

Patient Experience Time % 75 years within 9 hours % 75 years within 24 hours (new KPI) % in ED < 24 hours % within 6 hours % who leave before completion of treatment

% patients admitted or discharged within 6 hours 90%

50%

75% 64.4%

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

63.1%

Freq M M M M

Previous Period YTD 62.5% 92.5% 96.9% 66.6%

Current Period YTD 62% 92.4% 96.9% 66.3%

5.5%

5.6%

5,000 4,000 3,000 2,000 1,000 0

8 2

Health Service Performance Profile – October to December 2017 Quarterly Report

082_96_IHCA Client Section 2019_(Charts _ Tables) - V10.indd 82

18m+

Change -0.5%  -0.1%   -0.3%  +0.1%



SPLY YTD 62.6%

SPLY Change -0.6% 

96.7% 67.3%

+0.2% -1%

 

5.3%

+0.3%



ED over 24 hours

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017

P A G E

99,474 69,904

18m+

< 5%

SPLY Change -4.5%  -0.6% 

35,945

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Target/ Expected Activity 100% 100% 100% 75%

SPLY YTD 91% 93.2%

58,766

15m+

70%

Result Dec

1,416,367

Waiting Lists Inpatient adult waiting list within 15 months Daycase adult waiting list within 15 months Inpatient children waiting list within 15 months Daycase children waiting list within 15 months Outpatient waiting list within 52 weeks

Result Nov

4,318

3,519

1,461

1,175

Source: Health Service Performance0 Profile October to December 2017 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Quarterly Nov Dec Report Patients 75+ >24 hrs

All patients > 24 hrs

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10,000

7,710

7,656

100,000

5,000

2,937

4,495

50,000

35,945

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

I R I S H

15m+

18m+

H O S P I T A L

99,474 69,904

58,766

15m+

C O N S U L T A N T S

Target/ Previous Expected Period Activity Freq YTD 100% M 62.5% 100% M 92.5% (as of December 2017) 100% M 96.9% 75% M 66.6%

Current Period YTD 62% 92.4% 96.9% 66.3%

Charts & Tables

Patient Experience Time % 75 years within 9 hours % 75 years within 24 hours (new KPI) % in ED < 24 hours % within 6 hours % who leave before completion of Acute Hospitals - Continued treatment of Key Acute Hospital Activity Overview

< 5%

% patients admitted or discharged within 6

5,000 4,000 3,000 2,000 1,000 0

75%

70%

64.4%

50%

A S S O C I A T I O N Change -0.5%  -0.1%   -0.3%  +0.1%

SPLY YTD 62.6%



SPLY Change -0.6% 

96.7% 67.3%

+0.2% -1%

 

5.3%

+0.3%



ED over 24 hours

hours 90%

5.6%

5.5%

18m+

63.1%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017

4,318

3,519

1,461

1,175

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Patients 75+ >24 hrs

All patients > 24 hrs

Health Service Performance Profile – October to December 2017 Quarterly Report

patients

over

years

admitted

% of patients who leave before completion of

discharged within 9 hours 105% 85% 65% 45% 25%

treatment

57.8%

6.4%

100%

4.9%

5% 57.2%

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

2016/2017

Colonoscopy Urgent colonoscopy – number of people waiting > 4 weeks (new KPI) Routine Colonoscopy within 13 weeks

2016/2017

Target/ Expected Activity

Freq

Previous Period YTD

Current Period YTD



70%

56.9%

57.8%

+0.9%



Change

SPLY YTD

SPLY Change

58%

-0.2%



Urgent Colonoscopy – number of people waiting > 4 weeks 50

Number on waiting list for GI Scopes 12,000

10,177

7,498

7,441

4,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2017

Cancer Services Urgent breast cancer within 2 weeks Routine breast cancer within 12 weeks Lung Cancer within 10 working days Prostate cancer within 20 working days Radiotherapy within 15 working days

Number deemed suitable for colonoscopy in December Target/ Expected Activity 95% 95% 95% 90% 90%

BreastHealth Cancer within 2 weeks Source: Service Performance Profile October to December 2017 Quarterly Report 99.5%

Freq M M M M M

Previous Period YTD 73.8% 70.9% 82% 60.3% 76.6%

220

Current Period YTD 75.3% 71.1% 82.3% 61.5% 76.3%

> 13 week breaches

Number scheduled over 20 working days in December 140

Change +1.5%  +0.2%  +0.3%  +1.2%  -0.3% 

SPLY YTD 87.9% 72.7% 81.5% 53.4% 83.1%

SPLY Change -12.6%  -1.6%  +1.1%  +8.1%  -6.8% 

Lung Cancer within 10 working days 95.2%

www.ihca.ie 87.7%

95% 78.1%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

082_96_IHCA Client Prostate Section 2019_(Charts _ Tables) - V10.indd 83 Cancer within 20 working

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

Bowel Screen Colonoscopy Activity

95% 85% 75% 65% 55%

9,943

8,000

days

100% 90% 80% 70%

88.54%

95% 88.9%

P A G E

82.1%

84.6%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

Radiotherapy within 15 working days

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waiting > 4 weeks (new KPI) Routine Colonoscopy within 13 weeks



70%

56.9%

57.8%

+0.9%



58%

-0.2%



Urgent Colonoscopy – number of people waiting > 4 weeks 50

12,000

I R I S H 0

Number on waiting list for GI Scopes

C O N S U 8,000 L T A N T S

H O S P I T A L

Charts & Tables 0

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

Urgent breast cancer within 2 weeks Routine breast cancer within 12 weeks Lung Cancer within 10 working days Prostate cancer within 20 working days Radiotherapy within 15 working days

Target/ Expected Activity 95% 95% 95% 90% 90%

Breast Cancer within 2 weeks 95% 85% 75% 65% 55%

95.2% 95%

87.7%

78.1% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

50% 0%

90%

64.2%

Previous Period YTD 73.8% 70.9% 82% 60.3% 76.6%

Current Period YTD 75.3% 71.1% 82.3% 61.5% 76.3%

Number scheduled over 20 working days in December 140

Change +1.5%  +0.2%  +0.3%  +1.2%  -0.3% 

SPLY YTD 87.9% 72.7% 81.5% 53.4% 83.1%

SPLY Change -12.6%  -1.6%  +1.1%  +8.1%  -6.8% 

100% 90% 80% 70%

65.1%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

95% 88.9%

88.54% 82.1%

84.6%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

Radiotherapy within 15 working days 100%

77%

45.5%

220

> 13 week breaches

Lung Cancer within 10 working days

99.5%

Prostate Cancer within 20 working days 100%

Freq M M M M M

7,441

<13 weeks

Number deemed suitable for colonoscopy in December

Bowel Screen Colonoscopy ActivityActivity Overview of Key Acute Hospital

A S S O C I A T I O N

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

(as of December 2017)

Acute Hospitals - Continued

Cancer Services

7,498

4,000

2017

10,177

9,943

80% 60%

Health Service Performance Profile – October to December 2017 Quarterly Report

90% 86.6%

76.3%

74.6%

73.7%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017 54

Source: Health Service Performance Profile October to December 2017 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

Charts & Tables (as of December 2017)

Acute Hospitals - Continued

Overview of Key Acute Hospital Activity Performance Area HCAI – Rate of new cases of Staph. Aureus infection (new KPI) HCAI – rate of new cases of C Difficile infection (new KPI) Maternity Safety Statements Medical Readmission Rates (new KPI) Surgical Readmission Rates Hip Fracture Surgery within 48 hours Medical Average Length of Stay

Target/ Expected Activity

Freq

Previous Period YTD

0.9

2.1

1.8

-0.3%

100% 11.1% < 3% 95% 6.3 days

M-2M M-1M M-1M M-1M M-1M

84.2% 11.1% 2% 85.4% 6.8

100% 11.1% 2% 85.5% 6.8

+15.8%

5 days

M-1M

5.3

5.4

+0.1

95%

92.7%

92.4%

-0.3%

> 60%

M-1M

45.6%

45.5%

-0.1%

<475

582

480

-102

Surgical Average Length of Stay Ambulance Clearance Times < 60 minutes Elective Laparoscopic Cholecystectomy Number of beds subject to Delayed Discharge Delayed Discharges 750

559 480 475 436

550 350

451

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016

35 6 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

4-5 hours

5 - 6 hours

> 3 hours

Rate of Staph. Aureus bloodstream infections in Acute Hospital per 10,000 bed days

0.6

+0.1%

        

94.7%

+5.3%



2.1% 85.4% 6.8

-0.1% +0.1%

  

5.4



93%

-0.6%

43.4%

-2.1%

436

+44



  

Total % 21.7% 57.9% 20.4% 100%

3-4 hours 4-5 hours 5 - 6 hours > 3 hours

Jun 17 11 1 0 12

Jul 17 6 1 0 7

Aug 17 4 1 1 6

Sept 17 7 0 1 8

Oct 17 11 3 0 14

Nov 17 11 1 0 12

Dec 17 35 6 0 41

Rate of new cases of Clostridium Difficile associated diarrhoea in Acute Hospitals per 10,000 bed days used 3.0

1.6 1.1



Delayed Discharges by destination Over Under Total 65 65 Home 70 34 104 Long Term 238 40 278 Nursing Care Other 49 49 98 Total 357 123 480

3-4 hours

SPLY Change

Ambulance Turnaround Times breakdown

SPLY YTD

Change

2016/2017

Ambulance Turnaround Times

Current Period YTD

2.5

2.0 1.8

1.0

0.9

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

0.0

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

2017

Source: Health Service Performance Profile October to December 2017 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

Charts & Tables (as of December 2017)

Mental Health Division

Target/ Expected Activity

Performance area

Freq

Previous Period YTD

Current Period YTD

Change

Admission of Children to CAMHs

95%

73.7%

CAMHs Bed Days Used

95%

97%

96.9%

-0.1%

2,599

2,223

2,300

334

314

Adult Mental Health – time to first seen

75%

74.1%

Psychiatry of Old Age – time to first seen

95%

95.3%

95.4%

CAMHs waiting list CAMHs waiting list > 12 months

SPLY YTD

SPLY Change

81.6%

-7.9%



97.3%

-0.3%



2,380

-157



-20

182

+152



73.5%

+0.6%



97%

-1.7%



0.1%





Admission of Children to CAMHs 100% 95% 88.9% 90% 87.5% 80% 73.3% 70% 60% 54.5% 50% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017 2015/2016

Bed days used in Child Adolescent Acute Inpatient Units as a total of bed days

CAMHs waiting list

CAMHs waiting list > 12 months

4,000

70% 65%

90% 85%

2300

300

1192 1108

200

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total to be Seen 0-3 months > 3 months

1,379 1,209

Adult Mental Health – % offered an appointment and seen within 12 weeks 80% 75%

95%

400 2,588

2,000

100%

77.2% 75% 74.5%

74.7% 69.1%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017

2015/2016

98.2% 96.6% 95%

95.7% 94.2%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017 2015/2016

314 218

100 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017 2015/2016

Psychiatry of Old Age – % offered an appointment and seen within 12 weeks 100% 99% 98% 97.7% 97% 95.9% 96.2% 96% 95% 95% 94% 94% 93% 92% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016/2017 2015/2016

Source: Health Service Performance Profile October to December 2017 Quarterly Report 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

Charts & Tables (as of December 2017)

Human Resources HSE 2017 Staff Category /Group

Total Health Service Medical/ Dental

+3,710

+3.5%

+399

+4.1%

-1

2,971

+109

+3.8%

+19

+2.3%

820 7,434

+155

+2.1%

+37

+547

+2.2%

+193

+95

+23.4%

-71

15,950

+586

+3.8%

+58

4,441

+207

+4.9%

+18

17,714

+948

+5.7%

+60

1,610

+165

+11.4%

9,454 20,779

+6 +830

+0.1% +4.2%

1,745

+105

+6.4%

25,315 500

other Acute Services

+783

16,105

+8.0%

+1.0%

+0.8%

-2

+3.4%

+39

+5.1%

+54

-6 +53 -6

19,034

+725 change since Dec 2016

+4.0% % change since Dec 2016

+59 change since Nov 2017

110,795

+3,710

+3.5%

+325

WTE Dec 2017

1,843 3,104 10,301 11,382 8,777 8,674 9,979 3,974 68

Acute Services CHO 1 CHO 2 CHO 3 CHO 4 CHO 5 CHO 6 CHO 7 CHO 8 CHO 9

58,102 4,875 4,943 3,997 6,850 4,453 3,762 6,363 5,705 6,412

Community Services Health & Wellbeing Corporate Health Business Services

48,180 1,450 1,567 1,497

Other Non-Acute PCRS

+380

11,509

Care

Ambulance Children's Dublin Midlands Ireland East RCSI Saolta Healthcare South/ South West University of Limerick

308

Ambulance

Total Health Service

+15

1,514

Management (VIII+)

Service Area

+127

1,706

Therapists (OT, Physio, SLT)

General Support Patient & Client Care

-2

+161

Nursing Student

Clerical & Supervisory (III to VII)

-1

+2.6%

Public Health Nurse

Management/ Admin

+4.5%

+942

Staff Nurse

Health Professionals (other)

+325

36,777

Nurse Specialist

Nursing (other)

+271

6,331

Nurse Manager

Health & Social Care

change since Nov 2017

10,121

NCHDs

Nursing

% change since Dec 2016

110,795

Consultants Medical (other) & Dental

change since Dec 2016

WTE Dec 2017

428 392

+109 +131 +229 +411 +330 +216 +394 +378

+6.3% +4.4% +2.3% +3.7% +3.9% +2.6% +4.1% +10.5%

+2,224 +77 +141 +90 +294 +81 -573 +834 +69 +152

+4.0% +1.6% +2.9% +2.3% +4.5% +1.8% -13.2% +15.1% +1.2% +2.4%

+87 +13 +12 -1 +31 +20 +18 +33 +42 +22

+1,212 +67 +76 +132

+2.6% +4.8% +5.1% +9.6%

+191 -4 +6 +45

+26

+21 +26

-7 +7 +22 -1 +1 -6 +32 +38

+62.6%

+5.2% +7.1%

+4 -3

Source: Health Service Performance Profile October to December 2017 Quarterly Report Health Service Performance Profile â&#x20AC;&#x201C; October to December 2017 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

Charts & Tables (as of December 2017)

Human Resources HSE 2017 - Continued Health Sector Workforce: December 2017 – Key Messages   

At the end of December 2017, health services‟ employment stood at 110,795 WTEs. When compared with the November 2017 figure (110,470 WTEs), the change is an increase of +325 WTEs and is 3,710 WTEs of an increase in the last 12 months. The increase this month compares with an increase of +276 WTEs in December 2016. In December growth was seen across all Service Areas, with biggest increases in by Social Care at +121 WTEs (+0.4%) followed Acute Services at +87 WTEs (+0.1%). Some of the more significant monthly increases in grade groups and individual grades were seen in; Staff Nurses +193 WTEs, Nurse Managers +37 WTEs, Main Therapy Grades +18 WTEs, Social Care/Social Workers +15 WTEs, Grades III to Grade VIIIs +54 WTEs and Healthcare Assistants +62 WTEs.

Pay and Staffing Strategy 



HSPC figure of 110,795 WTEs at end of December is 104 WTEs above direct WTE level as set out in the 2017 Health Sector funded workforce plan (December 2017 110,691 WTEs) that was submitted in August. However this figure is to be adjusted upwards to take account of increased budget allocations in the latter part of 2017 and thus direct employment levels will be within this revised figure. All service divisions, with the exception of the Acute Hospitals Services (+1,142 WTEs)) are within their projected direct employment profile at this time. It should be noted progress or otherwise in agency and overtime conversion impacts on the overall directly reported WTEs. Assessment of the overall position as at the end of 2017 is that despite increased agency expenditure and overtime expenditure running ahead of 2016 levels, with budget variances of the order of 31% and 16.5% respectively, the outturn of €7,625 billion is below overall pay budget by €23 million for 2017.

Absence Rates Service Acute Services Mental Health Primary Care Social Care Health & Wellbeing Corporate & HBS Overall Certified

Medical /Dental 0.9% 2.1% 2.5% 0.1% 4.6% 0.0% 1.2% 85.6%

Nursing 4.7% 4.8% 5.0% 5.4% 2.2% 2.7% 4.8% 86.7%

Health & Social Care 3.2% 4.0% 3.6% 4.0% 4.0% 0.0% 3.5% 88.4%

Health Service Performance Profile – October to December 2017 Quarterly Report

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Management Admin 4.2% 4.2% 4.7% 4.2% 4.6% 4.2% 4.34 % 90.1%

Patient & Overall Client Care 4.2% 5.6% 6.1% 4.5% 6.0% 4.7% 4.5% 4.9% 5.9% 5.1% 5.6% 5.4% 4.4% 8.4% 3.9% 4.1% 5.1% 7.6% 5.6% 5.6% 4.5% Source: Health Service Performance Profile 88.5% 91.2% 89.4%

General Support

October to December 2017 Quarterly Report

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Pay and Staffing Strategy HSPC figure of 110,795 WTEs at end of December is 104 WTEs above direct WTE level as set out in the 2017 Health Sector funded workforce plan (December 2017 110,691 WTEs) that was submitted in August. However 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 this figure is to be adjusted upwards to take account of increased budget allocations in the latter part of 2017 and thus direct employment levels will be within this revised figure.  All service divisions, with the exception of the Acute Hospitals Services (+1,142 WTEs)) are within their projected direct employment profile at this time. It should be noted progress or otherwise in agency and overtime conversion impacts on the overall directly reported WTEs. (as of December 2017)  Assessment of the overall position as at the end of 2017 is that despite increased agency expenditure and overtime expenditure running ahead of 2016 levels, with budget variances of the order of 31% and 16.5% Human Resources 2017 - Continued respectively, the outturnHSE of €7,625 billion is below overall pay budget by €23 million for 2017. 

Charts & Tables

Absence Rates Service Acute Services Mental Health Primary Care Social Care Health & Wellbeing Corporate & HBS Overall Certified

Medical /Dental 0.9% 2.1% 2.5% 0.1% 4.6% 0.0% 1.2% 85.6%

Nursing 4.7% 4.8% 5.0% 5.4% 2.2% 2.7% 4.8% 86.7%

Health & Social Care 3.2% 4.0% 3.6% 4.0% 4.0% 0.0% 3.5% 88.4%

Management Admin 4.2% 4.2% 4.7% 4.2% 4.6% 4.2% 4.34 % 90.1%

General Support 5.6% 6.0% 4.9% 5.6% 8.4% 5.1% 5.6% 91.2%

Patient & Client Care 6.1% 4.7% 5.9% 5.4% 3.9% 7.6% 5.6% 89.4%

Overall 4.2% 4.5% 4.5% 5.1% 4.4% 4.1% 4.5% 88.5%

Health Service Performance Profile – October to December 2017 Quarterly Report

 



Absence rates have been collected centrally since 2008 and in overall terms, there has been a general downward trend seen over that time, albeit some reversal in 2016, but still well below earlier years‟ overall rates. The 2017 Year-To-Date rate is 4.4%. Lower than the same period last year at 4.7%. It puts the Health Services generally in‐line with the rates reported by ISME for large organisations in the private sector and available information for other large public sector organisations both in Ireland and internationally. Latest NHS England absence rates for September 2016 recorded an overall rate of 4.0%, an increase from the previous one of 3.8%. Scotland‟s NHS absence rate for 2015/2016 was 5.2% while in Wales the rate recorded to November 2016 was 4.8%. Of course it needs to be recognised that health sectors' workforce, both here and across Britain, is extremely diverse in terms of occupation and skills when compared with many other public and private sector employers. For instance health sector work is often physically and psychologically demanding, which increases the risk of illness and injury and of course is one of few sectors that operate 24 hours services, for 365 days a year. Annual rates; 2008 – 5.8%, 2009 – 5.1%, 2010 – 4.7%, 2011 – 4.9%, 2012 – 4.8%, 2013 – 4.7%, 2014 – 4.3%, 2015 – 4.2% and 2016 - 4.5%.

European Working Time Directive (EWTD) % Compliance with 24 hour shift – National All NCHDs Acute Services Mental Health

99% 91%

% Compliance with 48 hour working week All NCHDs

Source: Health Service Performance Profile October December Report – approximately 100% of the total eligible for inclusion. Note that this is  Thetodata deals 2017 with Quarterly 5,769 NCHDs

83% 91%

calculated on the basis that the number of NCHDs is increasing on a month by month basis. The number of

www.ihca.ie NCHDs included in December 2015 was 5,314, in December 2016 it was 5,603;     

P A G E

Compliance with a maximum 48 hour week is at 84% as of end December – unchanged from November; Compliance with 30 minute breaks is at 98% - up 2% from November; Compliance with weekly / fortnightly rest is at 99% - up 2% since November; Compliance with a maximum 24 hour shift (not an EWTD target) is at 98% - unchanged from November; Compliance with a daily 11 hour rest period is at 98% - up 2% from November. This is closely linked to the 24

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Absence rates have been collected centrally since 2008 and in overall terms, there has been a general downward trend seen over that time, albeit some reversal in 2016, but still well below earlier years‟ overall rates.  The 2017 Year-To-Date rate is 4.4%. Lower than the same period last year at 4.7%. It puts the Health Services generally in‐line with the rates reported by ISME for large organisations in the private sector and available information for other large public sector organisations both in Ireland and internationally. NHS England the N I  R Latest I S H H O Sabsence P I Trates A Lfor September C O N 2016 S U recorded L T A anN overall T S rateAof S4.0%, S Oan Cincrease I A Tfrom I O previous one of 3.8%. Scotland‟s NHS absence rate for 2015/2016 was 5.2% while in Wales the rate recorded to November 2016 was 4.8%.  Of course it needs to be recognised that health sectors' workforce, both here and across Britain, is extremely diverse in terms of occupation and skills when compared with many other public and private sector employers. For instance (as of December 2017) which increases the risk of illness and injury health sector work is often physically and psychologically demanding, and of course is one of few sectors that operate 24 hours services, for 365 days a year.  Annual rates; 2008 – 5.8%, 2009 – 5.1%, 2010 – 4.7%, 2011 – 4.9%, 2012 – 4.8%, 2013 – 4.7%, 2014 – 4.3%, 2015 Performance Summary – 4.2% and 2016 - 4.5%. 2017 

Charts & Tables

European Working Time Directive (EWTD) % Compliance with 24 hour shift – National All NCHDs Acute Services Mental Health

99% 91%

% Compliance with 48 hour working week All NCHDs

83% 91%

The data deals with 5,769 NCHDs – approximately 100% of the total eligible for inclusion. Note that this is calculated on the basis that the number of NCHDs is increasing on a month by month basis. The number of NCHDs included in December 2015 was 5,314, in December 2016 it was 5,603;  Compliance with a maximum 48 hour week is at 84% as of end December – unchanged from November;  Compliance with 30 minute breaks is at 98% - up 2% from November;  Compliance with weekly / fortnightly rest is at 99% - up 2% since November;  Compliance with a maximum 24 hour shift (not an EWTD target) is at 98% - unchanged from November;  Compliance with a daily 11 hour rest period is at 98% - up 2% from November. This is closely linked to the 24 hour shift compliance above.  , with the exception of the Acute Hospitals Services (+437 WTEs) are within their projected direct employment profile at this time. It should be noted progress or otherwise in agency and overtime conversion will impact on the overall directly reported WTEs.  Recorded employment levels have increased by +12,484WTEs (+12.9%) since they bottomed out in October 2013.  Agency expenditure is showing an increase of 7.2% when compared with the same period in 2016. It is also well above profile against the updated funded workforce plan projection to the end of September, where the overall gap against budget stands at €39.3 million or +16.6%%. Level 4 [Black] escalation  Overtime/On-call is also ahead of same period in 2016 at +6.4%. The updated 2017 Pay and Staffing ED over 24 hours projected netexpenditure expenditure to Strategy/Funded Workforce Plan envisaged significant Financial reductions inposition: agency and that overtime in 2017 Acute Hospitals year end including pay management – Acute would be in line with 2016. 4,318 Hospitals 5,000 Overall pay expenditure to end of September is ahead of profile by €23.6 million, a variance of 0.41% 

Performance summary areas of escalation

3,519 4,000 3,000 1,461 2,000 Service Performance Profile – October to December1,175 Health 2017 Quarterly Report 1,000 Acute Hospitals Division 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Patients 75+ >24 hrs

Urgent Colonoscopy weeks Acute Hospitals 50

patients

greater

than

12,000

4,000 1

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

Breast Cancer within 2 weeks Acute Hospitals

4,733,224

4,593,523

139,701

3.04%

10,177

7,498

7,441

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

Lung Cancer within 10 working days Acute Hospitals

99.5%

95.2%

100%

95%

90%

78.1%

80%

87.7%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

70%

88.54%

082_96_IHCA Client Section 2019_(Charts _ Tables) - V10.indd 90

84.6% Source: Health Service Performance Profile Jan Feb Mar Apr October May Jun to JulDecember Aug Sep Oct NovQuarterly Dec 2017 Report 2015/2016 2016/2017

www.ihca.ie

Radiotherapy within 15 working days Acute Hospitals 90%

77%

95% 88.9%

82.1%

9 0

Prostate Cancer within 20 working days Acute Hospitals 64.2%

YTD % Variance74

9,943

<13 weeks

Level 3 [Red] escalation

100%

YTD Variance €’000

Number on waiting list for GI Scopes Acute Hospitals 8,000

P A G E

YTD Budget €’000

All patients > 24 hrs

2017

95% 85% 75% 65% 55%

YTD Actual €’000

100%

90%

17/07/2018 13:26

3,000 2,000 1,000 0

1,461

1,175

Patients 75+ >24 hrs

Urgent

Colonoscopy

I weeks R I S H

patients

greater

than

8,000

(as of

4,000

0 December

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

99.5%

95.2%

4,593,523

139,701

3.04%

A S S O C I A T I O N 10,177

7,498

7,441

2017)

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

64.2% 45.5%

100% 90%

78.1%

80%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

> 13 week breaches

Lung Cancer within 10 working days Acute Hospitals

95%

87.7%

Prostate Cancer within 20 working days Acute Hospitals

4,733,224

9,943

<13 weeks

Breast Cancer within 2 weeks Acute Hospitals

50%

% Variance

Charts & Tables 12,000

Performance Summary 2017 - Continued Level 3 [Red] escalation

100%

Variance €’000

Number on waiting list for GI Scopes

C O N SAcute U LHospitals T A N T S

H O S P I T A L

2017

95% 85% 75% 65% 55%

Budget €’000

All patients > 24 hrs

Acute Hospitals 50

Acute Hospitals Division

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

Actual €’000

70%

88.54% 82.1%

95% 88.9%

84.6%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

Radiotherapy within 15 working days Acute Hospitals 90%

77% 65.1%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

100% 80%

90% 86.6% 74.6%

60%

76.3% 73.7%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016 2016/2017

Health Service Performance Profile – October to December 2017 Quarterly Report

Source: Health Service Performance Profile October to December 2017 Quarterly Report

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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

Charts & Tables (as of December 2017)

Human Resources HSE 2017 - Continued Delayed Discharges Acute Hospitals and Social Care

Ambulance Turnaround Times Acute Hospitals and NAS 60

750

559 480 475 436

550 350

451

35 6 5 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016

3-4 hours

4-5 hours

Inpatient and Day Case Waiting List Acute Hospitals

Outpatient Waiting List Acute Hospitals

15,000

150,000

10,000

7,710

7,656

100,000

5,000

2,937

4,495

50,000

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

Total SREs Reported - Acute Hospitals Division

400

2015

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

442

2017

100%

60% 40%

100

20% 0% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

25.1% 23.0% Q4

25.1% 12.7% Q1

2016/2017 Occupational Therapy – Assessment waiting list ≤ 52 weeks 100%

80.4% 77%

70% 60%

2015/2016

Financial position: projected net expenditure to year end including pay management – Social Care (Disabilities)

92%

90% 84.3% 79.2% 80%

18m+

80%

200 0

35,945

Disability Act Compliance Social Care

500 300

> 3 hours

99,474 69,904

58,766

18m+

Total Number of SREs Reported Acute Hospitals

2016

5 - 6 hours

2016/2017

Social Care (Disabilities)

YTD Actual €’000

YTD Budget €’000

YTD Variance €’000

YTD % Variance

1,723,470

1,695,195

28,276

1.67%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015/2016

2016/2017

Source: Health Service Performance Profile October to December 2017 Quarterly Report Health Profile – October to December 2017 Quarterly Report P A Service G E Performance 9 2

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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

www.ihca.ie

082_96_IHCA Client Section 2019_(Charts _ Tables) - V10.indd 93

P A G E

9 3

17/07/2018 13:26

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

P A G E

9 4

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17/07/2018 13:26

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

www.ihca.ie

082_96_IHCA Client Section 2019_(Charts _ Tables) - V10.indd 95

P A G E

9 5

17/07/2018 13:26

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

P A G E

9 6

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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 2019_Draft.indd 2

13/03/2018 12:57

YEAR PLANNER 2019 1 RoI & UK

JANUARY

❋ Holidays

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

22 RoI & UK

6 RoI & UK

3 RoI

MARCH

APRIL

MAY

JUNE

FEBRUARY

Sun. Mon.

Week 1

Week 5

Week 9 1

Week 14

Week 18

Week 22

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 2 4

Week 6 4

Week 10 8

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 3 11

Week 7 11

Week 11 15

Week 16 13

Week 20 10

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 4 18

Week 17 20

Week 21 17

Tues

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 5 25

Week 9 25

Week 13 29

Week 18 27

Week 22 24

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

IHCA Diary Pages 2019_Draft.indd 3

Week 8 18❋

Week 12 22 ❋

Week 15 6 ❋

Week 19 3 ❋

Week 23

Week 24

Week 25

Week 26

13/03/2018 12:57

YEAR PLANNER 2019 ❋ Holidays

5 RoI & Scot. 26 UK

JULY

28 RoI

AUGUST

SEPTEMBER

25 RoI & UK 26 RoI & UK

30 Scot.

OCTOBER

NOVEMBER

DECEMBER

Sun. Mon.

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 32 2

Week 36 7

Week 41 4

Week 45 2

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week29 12

Week 33 9

Week 37 14

Week 42 11

Week 46 9

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 30 19

Week 34 16

Week 38 21

Week 43 18

Week 47 16

Tues

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 44 25

Week 48 23

Tue.

Wed.

25 ❋

Thur.

26 ❋

Fri.

Sat.

30 ❋

Week 27

Week 31

Week 28 5 ❋

Week 31 26 ❋

Week 35

Week 35 23

Week 40

Week 39 28 ❋

Week 44

Week 48

Sun.

Mon.

IHCA Diary Pages 2019_Draft.indd 4

Week 49

Week 50

Week 51

Week 52

13/03/2018 12:57

THREE YEAR CALENDAR JANUARY Wk M

1 2 3 4 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 30 31

Wk M

5 6 7 8 9

5 6 12 13 19 20 26 27

MAY Wk M

18 1 2 19 7 8 9 20 14 15 16 21 21 22 23 22 28 29 30

3 4 5 6 10 11 12 13 17 18 19 20 24 25 26 27 31

1 2 3 4 7 8 9 10 11 14 15 16 17 18 21 22 23 24 25 28

22 1 2 3 23 4 5 6 7 8 9 10 24 11 12 13 14 15 16 17 25 18 19 20 21 22 23 24 26 25 26 27 28 29 30

Wk M

JANUARY

FEBRUARY

1 2 3 4 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 30 31

Wk M

5 6 7 8 9

4 5 6 11 12 13 18 19 20 25 26 27

MAY Wk M

18 1 2 3 4 5 19 6 7 8 9 10 11 12 20 13 14 15 16 17 18 19 21 20 21 22 23 24 25 26 22 27 28 29 30 31

35 36 2 37 9 38 16 23 39 /30

3 4 5 6 7 10 11 12 14 14 17 18 19 20 21 24 25 26 27 28

1 8 15 22 29

1 2 3 4 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 30 31

Wk M

18 1 2 19 4 5 6 7 8 9 20 11 12 13 14 15 16 21 18 19 20 21 22 23 22 25 26 27 28 29 30

3 10 17 24 31

Wk M

5 6 7 8 9

35 1 36 7 8 37 14 15 38 21 22 39 28 29

2 9 16 23 30

Wk M

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

1 8 15 22 29

Wk M

9 1 2 10 4 5 6 7 8 9 11 11 12 13 14 15 16 12 18 19 20 21 22 23 13 25 26 27 28 29 30

3 10 17 24 31

1 2 8 9 15 16 22 23 29

9 10 11 12 13

Wk M

48 1 2 49 3 4 5 6 7 8 9 50 10 11 12 13 14 15 16 51 17 18 19 20 21 22 23 24 52 /31 25 26 27 28 29 30

14 1 2 3 4 5 6 7 15 8 9 10 11 12 13 14 16 15 16 17 18 19 20 21 17 22 23 24 25 26 27 28 18 29 30 Wk M

31 1 2 3 4 32 5 6 7 8 9 10 11 33 12 13 14 15 16 17 18 34 19 20 21 22 23 24 25 35 26 27 28 29 30 31

Wk M

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

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

2 3 4 5 6 7 9 10 11 12 13 14 16 17 18 19 20 21 23 /30 24/31 26 26 27 28

1 8 15 22 29

14 1 2 3 4 5 15 6 7 8 9 10 11 12 16 13 14 15 16 17 18 19 17 20 21 22 23 24 25 26 18 27 28 29 30

Wk M

27 1 2 3 4 5 28 6 7 8 9 10 11 12 29 13 14 15 16 17 18 19 30 20 21 22 23 24 25 26 31 27 28 29 30 31

Wk M

40 1 2 3 4 41 5 6 7 8 9 10 11 42 12 13 14 15 16 17 18 43 19 20 21 22 23 24 25 44 26 27 28 29 30 31

44 45 2 46 9 47 16 23 48 /30

3 10 17 24

AUGUST F

31 1 2 32 3 4 5 6 7 8 9 33 10 11 12 13 14 15 16 34 17 18 19 20 21 22 23 24 35 /31 25 26 27 28 29 30

NOVEMBER F

APRIL F

JULY F

31 1 2 3 4 5 32 6 7 8 9 10 11 12 33 13 14 15 16 17 18 19 34 20 21 22 23 24 25 26 35 27 28 29 30 31

MARCH M

DECEMBER S

44 1 2 3 45 4 5 6 7 8 9 10 46 11 12 13 14 15 16 17 47 18 19 20 21 22 23 24 48 25 26 27 28 29 30

AUGUST F

27 1 2 3 4 5 6 7 28 8 9 10 11 12 13 14 29 15 16 17 18 19 20 21 30 22 23 24 25 26 27 28 31 29 30 31

Wk M

APRIL S

Wk M

DECEMBER

2020 S

MARCH

Wk M

13 1 14 2 3 4 5 6 7 8 15 9 10 11 12 13 14 15 16 16 17 18 19 20 21 22 23 17 /30 24 25 26 27 28 29

NOVEMBER F

AUGUST

JULY F

22 1 2 3 4 5 6 7 23 8 9 10 11 12 13 14 24 15 16 17 18 19 20 21 25 22 23 24 25 26 27 28 26 29 30

Wk M

JUNE Wk M

APRIL F

44 1 2 3 4 45 5 6 7 8 9 10 11 46 12 13 14 15 16 17 18 47 19 20 21 22 23 24 25 48 26 27 28 29 30

OCTOBER S

3 4 5 6 10 11 12 13 17 18 19 20 24 25 26 27

IHCA Diary Pages 2019_Draft.indd 5

1 2 3 7 8 9 10 14 15 16 17 21 22 23 24 28

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

SEPTEMBER Wk

40 1 2 3 4 5 6 41 7 8 9 10 11 12 13 42 14 15 16 17 18 19 20 43 21 22 23 24 25 26 27 44 28 29 30 31

MAY Wk M

FEBRUARY F

26 27 2 3 28 9 10 29 16 17 23 24 30 /30 /31

OCTOBER S

2019

22 1 2 23 3 4 5 6 7 8 9 24 10 11 12 13 14 15 16 25 17 18 19 20 21 22 23 26 24 25 26 27 28 29 30

JANUARY Wk M

Wk M

JUNE Wk M

SEPTEMBER Wk

NOVEMBER F

40 1 2 3 4 5 6 7 41 8 9 10 11 12 13 14 42 15 16 17 18 19 20 21 43 22 23 24 25 26 27 28 44 29 30 31

9 1 2 3 4 10 5 6 7 8 9 10 11 11 12 13 14 15 16 17 18 12 19 20 21 22 23 24 25 13 26 27 28 29 30 31

OCTOBER S

JULY F

35 1 2 36 3 4 5 6 7 8 9 37 10 11 12 13 14 15 16 38 17 18 19 20 21 22 23 39 24 25 26 27 28 29 30

Wk M

MARCH

Wk M

JUNE Wk M

SEPTEMBER Wk M

2018

FEBRUARY

DECEMBER S

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

1 8 15 22 29

Wk M

48 1 2 49 7 8 9 50 14 15 16 51 21 22 23 31 28 29 30

3 4 5 6 10 11 12 13 17 18 19 20 24 25 26 27 31

13/03/2018 12:58

WORLD HOLIDAYS FOR 2019 IRELAND New Year’s Day: St Patrick’s Day: Easter Mon: May Bank Hol: June Bank Hol: Aug Bank Hol: Oct Bank Hol: Christmas Day: St Stephen’s Day:

1 Jan 18 Mar 22 Apr 6 May 3 Jun 5 Aug 28 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 21 Jan 18 Feb 27 May 4 Jul 2 Sep 14 Oct 12 Nov 28 Nov 25 Dec

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

CHINA New Year’s Day: Spring Festival Golden Week/Chinese NY: Qing Ming Jie: Labour Day: Dragon Boat Festival: National Day: Mid-Autumn Festival: National Day Hol:

IHCA Diary Pages 2019_Draft.indd 6

1 Jan 28 Jan 4 Mar 11 Mar 19 Apr 22 Apr 25 Apr 6 May 3 Jun 10 Jun 7 Oct 25 Dec 26 Dec

1 Jan 03-10 Feb 5 Apr 1 May 07 Jun 1 Oct 4 Oct 2-7 Oct

UNITED KINGDOM New Year’s Day: St Patrick’s Day: (NI): Good Fri: Easter Mon (except SCO): Early May Bank Hol: Spring Bank Hol: 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): 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: Respect for the Aged Day: Autumn Equinox: Health & Sports Day: Culture Day: Labour Thanksgiving Day: Emperor’s Birthday:

1 Jan 18 Mar 19 Apr 22 Apr 6 May 27 May 5 Aug 26 Aug 30 Nov 25 Dec 26 Dec

1 Jan 11 Feb 18 Feb 19 Apr 22 Apr 20 May 20 May 21 Jun 1 July 5 Aug 2 Sep 14 Oct 11 Nov 25 Dec 26 Dec

1 Jan 14 Jan 11 Feb 21 Mar 29 Apr 3 May 4 May 6 May 15 Jul 16 Sep 23 Sep 14 Oct 4 Nov 25 Nov 24 Dec

13/03/2018 12:58

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 2019_Draft.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

13/03/2018 12:58

December 2018 WEEK 49

03 Monday | Luain

NOLLAIG

DECEMBER 2018 Wk

Mo Tu We Th

48 49

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

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 2019_Draft.indd 8

13/03/2018 12:58

JANUARY 2019 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 2018 NOLLAIG

WEEK 49

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 2019_Draft.indd 9

13/03/2018 12:58

December 2018 WEEK 50

10 Monday | Luain

NOLLAIG

DECEMBER 2018 Wk

Mo Tu We Th

48 49

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

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 2019_Draft.indd 10

13/03/2018 12:58

JANUARY 2019 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 2018 NOLLAIG

WEEK 50

13 Thursday | DÃ©ardaoin

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

IHCA Diary Pages 2019_Draft.indd 11

13/03/2018 12:58

December 2018 WEEK 51

17 Monday | Luain

NOLLAIG

DECEMBER 2018 Wk

Mo Tu We Th

48 49

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

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 2019_Draft.indd 12

13/03/2018 12:58

JANUARY 2019 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 2018 NOLLAIG

WEEK 51

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 2019_Draft.indd 13

13/03/2018 12:58

December 2018 NOLLAIG

WEEK 52

24 Monday | Luain Christmas Eve

DECEMBER 2018 Wk

Mo Tu We Th

48 49

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

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

26 Wednesday | Céadaoin

St.Stephen’s Day

8 9 10 11 12 13 14 15 16 17 Notes

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JANUARY 2019 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 2018 NOLLAIG

WEEK 52

27 Thursday | DÃ©ardaoin

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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January 2019 WEEK 1

31 Monday | Luain New Year’s Eve

EANÁIR

JANUARY 2019 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

01 Tuesday | Máirt New Year’s Day 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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FEBRUARY 2019 Wk

Mo Tu We Th Fr Sa Su

5 1 2 3

4 5 6 7 8 9 10

January 2019 EANÁIR

WEEK 1

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

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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January 2019 WEEK 2

07 Monday | Luain

EANÁIR

JANUARY 2019 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

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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FEBRUARY 2019 Wk

Mo Tu We Th Fr Sa Su

5 1 2 3

4 5 6 7 8 9 10

January 2019 EANÁIR

WEEK 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

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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January 2019 WEEK 3

14 Monday | Luain

EANÁIR

JANUARY 2019 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

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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FEBRUARY 2019 Wk

Mo Tu We Th Fr Sa Su

5 1 2 3

4 5 6 7 8 9 10

January 2019 EANÁIR

WEEK 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

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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January 2019 WEEK 4

21 Monday | Luain

EANÁIR

JANUARY 2019 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

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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FEBRUARY 2019 Wk

Mo Tu We Th Fr Sa Su

5 1 2 3

4 5 6 7 8 9 10

January 2019 EANÁIR

WEEK 4

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

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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January 2019 WEEK 5

28 Monday | Luain

EANÁIR

JANUARY 2019 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

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 2019 Wk

Mo Tu We Th Fr Sa Su

5 1 2 3

4 5 6 7 8 9 10

February 2019 FEABHRA

WEEK 5

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28

31 Thursday | Déardaoin

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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February 2019 WEEK 6

04 Monday | Luain

FEABHRA

FEBRUARY 2019 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

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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MARCH 2019 Wk

Mo Tu We Th

9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

February 2019 FEABHRA

WEEK 6

07 Thursday | DÃ©ardaoin

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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February 2019 WEEK 7

11 Monday | Luain

FEABHRA

FEBRUARY 2019 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

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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MARCH 2019 Wk

Mo Tu We Th

9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

February 2019 FEABHRA

WEEK 7 St.Valentine’s Day 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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February 2019 WEEK 8

18 Monday | Luain

FEABHRA

FEBRUARY 2019 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

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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MARCH 2019 Wk

Mo Tu We Th

9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

February 2019 FEABHRA

WEEK 8

21 Thursday | DÃ©ardaoin

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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February 2019 WEEK 9

25 Monday | Luain

FEABHRA

FEBRUARY 2019 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

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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MARCH 2019 Wk

Mo Tu We Th

9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

March 2019 MÁRTA

WEEK 9

28 Thursday | Déardaoin

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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March 2019 WEEK 10

04 Monday | Luain

MÁRTA

MARCH 2019 Wk

Mo Tu We Th

9 10

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

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

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APRIL 2019 Wk 13

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

29 30

March 2019 MÁRTA

WEEK 10

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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March 2019 WEEK 11

11 Monday | Luain

MÁRTA

MARCH 2019 Wk

Mo Tu We Th

9 10

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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APRIL 2019 Wk 14

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

29 30

March 2019 MÁRTA

WEEK 11

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

St.Patrick’s Day17

Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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March 2019 WEEK 12

18 Monday | Luain St.Patrick’s Day Observed

MÁRTA

MARCH 2019 Wk

Mo Tu We Th

9 10

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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APRIL 2019 Wk 14

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

29 30

March 2019 MÁRTA

WEEK 12

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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March 2019 WEEK 13

25 Monday | Luain

MÁRTA

MARCH 2019 Wk

Mo Tu We Th

9 10

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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APRIL 2019 Wk 14

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

29 30

March 2019 MÁRTA

WEEK 13

28 Thursday | Déardaoin

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

Mother’s Day 31

Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2019 WEEK 14

01 Monday | Luain

AIBREÁN

APRIL 2019 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

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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MAY 2019 Wk

Mo Tu We Th

18 19

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

April 2019 AIBREÁN

WEEK 14

04 Thursday | Déardaoin

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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April 2019 WEEK 15

08 Monday | Luain

AIBREÁN

APRIL 2019 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

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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MAY 2019 Wk

Mo Tu We Th

18 19

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

April 2019 AIBREÁN

WEEK 15

11 Thursday | Déardaoin

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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April 2019 WEEK 16

15 Monday | Luain

AIBREÁN

APRIL 2019 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

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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MAY 2019 Wk

Mo Tu We Th

18 19

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

April 2019 AIBREÁN

WEEK 16

18 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

Good Firday19

Friday | Aoine

8 9 10 11 12 13 14 15 16 17 Notes

20 Saturday | Satharn

Easter Sunday

21 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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April 2019 WEEK 17

AIBREÁN

22 Monday | Luain Easter Monday, Bank Holiday (ENG/NI/ROI/WLS}

APRIL 2019 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

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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MAY 2019 Wk

Mo Tu We Th

18 19

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

April 2019 AIBREÁN

WEEK 17

25 Thursday | Déardaoin

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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May 2019 WEEK 18

29 Monday | Luain

BEALTAINE

MAY 2019 Wk

Mo Tu We Th

18 19

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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JUNE 2019 Wk

Mo Tu We Th

22 23

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

May 2019 BEALTAINE

WEEK 18

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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May 2019 WEEK 19

06 Monday | Luain May Bank Holiday

BEALTAINE

MAY 2019 Wk

Mo Tu We Th

18 19

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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JUNE 2019 Wk

Mo Tu We Th

22 23

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

May 2019 BEALTAINE

WEEK 19

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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May 2019 WEEK 20

13 Monday | Luain

BEALTAINE

MAY 2019 Wk

Mo Tu We Th

18 19

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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JUNE 2019 Wk

Mo Tu We Th

22 23

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

May 2019 BEALTAINE

WEEK 20

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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May 2019 WEEK 21

20 Monday | Luain

BEALTAINE

MAY 2019 Wk

Mo Tu We Th

18 19

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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JUNE 2019 Wk

Mo Tu We Th

22 23

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

May 2019 BEALTAINE

WEEK 21

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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May 2019 WEEK 22

27 Monday | Luain

BEALTAINE

MAY 2019 Wk

Mo Tu We Th

18 19

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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JUNE 2019 Wk

Mo Tu We Th

22 23

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

June 2019 MEITHEAMH

WEEK 22

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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June 2019 MEITHEAMH

WEEK 23

03 Monday | Luain

Bank Holiday (ROI)

JUNE 2019 Wk

Mo Tu We Th

22 23

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

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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JULY 2019 Wk 27 28

Mo Tu We Th 1

10 11 12 13

14 15 16 17 18 19 20

21 23 24 25 26 27 28

29 30 31

June 2019 MEITHEAMH

WEEK 23

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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June 2019 WEEK 24

10 Monday | Luain

MEITHEAMH

JUNE 2019 Wk

Mo Tu We Th

22 23

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

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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JULY 2019 Wk 27 28

Mo Tu We Th 1

10 11 12 13

14 15 16 17 18 19 20

21 23 24 25 26 27 28

29 30 31

June 2019 MEITHEAMH

WEEK 24

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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June 2019 WEEK 25

17 Monday | Luain

MEITHEAMH

JUNE 2019 Wk

Mo Tu We Th

22 23

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

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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JULY 2019 Wk 27 28

Mo Tu We Th 1

10 11 12 13

14 15 16 17 18 19 20

21 23 24 25 26 27 28

29 30 31

June 2019 MEITHEAMH

WEEK 25

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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June 2019 WEEK 26

24 Monday | Luain

MEITHEAMH

JUNE 2019 Wk

Mo Tu We Th

22 23

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

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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JULY 2019 Wk 27 28

Mo Tu We Th 1

10 11 12 13

14 15 16 17 18 19 20

21 23 24 25 26 27 28

29 30 31

June 2019 MEITHEAMH

WEEK 26

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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July 2019 WEEK 27

01 Monday | Luain

IÚIL

JULY 2019 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 31

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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AUGUST 2019 Wk

Mo Tu We Th Fr Sa Su

31 1 2 3 4 32 33

5 6 7 8 9 10 11

July 2019 IÚIL

WEEK 27

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

04 Thursday | Déardaoin

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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July 2019 WEEK 28

08 Monday | Luain

IÚIL

JULY 2019 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 31

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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AUGUST 2019 Wk

Mo Tu We Th Fr Sa Su

31 1 2 3 4 32 33

5 6 7 8 9 10 11

July 2019 IÚIL

WEEK 28

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

11 Thursday | Déardaoin

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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July 2019 WEEK 29

15 Monday | Luain

IÚIL

JULY 2019 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 31

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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AUGUST 2019 Wk

Mo Tu We Th Fr Sa Su

31 1 2 3 4 32 33

5 6 7 8 9 10 11

July 2019 IÚIL

WEEK 29

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

18 Thursday | Déardaoin

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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July 2019 WEEK 30

22 Monday | Luain

IÚIL

JULY 2019 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 31

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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AUGUST 2019 Wk

Mo Tu We Th Fr Sa Su

31 1 2 3 4 32 33

5 6 7 8 9 10 11

July 2019 IÚIL

WEEK 30

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

25 Thursday | Déardaoin

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 2019 WEEK 31

29 Monday | Luain

IÚIL

JULY 2019 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 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

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

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AUGUST 2019 Wk

Mo Tu We Th Fr Sa Su

31 1 2 3 4 32 33

5 6 7 8 9 10 11

August 2019 LÚNASA

WEEK 31

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

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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August 2019 WEEK 32

LÚNASA

AUGUST 2019 Wk

31 1 2 3 4 32 33

05 Monday | Luain Bank Holiday (ROI)

Mo Tu We Th Fr Sa Su 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 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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SEPTEMBER 2019 Wk

Mo Tu We Th

Su 1

August 2019 LÚNASA

WEEK 32

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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August 2019 WEEK 33

LÚNASA

AUGUST 2019 Wk

31 1 2 3 4 32 33

12 Monday | Luain

Mo Tu We Th Fr Sa Su 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 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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SEPTEMBER 2019 Wk

Mo Tu We Th

Su 1

August 2019 LÚNASA

WEEK 33

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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August 2019 WEEK 34

LÚNASA

AUGUST 2019 Wk

31 1 2 3 4 32 33

19 Monday | Luain

Mo Tu We Th Fr Sa Su 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 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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SEPTEMBER 2019 Wk

Mo Tu We Th

Su 1

August 2019 LÚNASA

WEEK 34

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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August 2019 WEEK 35

LÚNASA

AUGUST 2019 Wk

31 1 2 3 4 32 33

26 Monday | Luain

Mo Tu We Th Fr Sa Su 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 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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SEPTEMBER 2019 Wk

Mo Tu We Th

Su 1

September 2019 MEÁN FÓMHAIR

WEEK 35

10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

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

01 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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September 2019 WEEK 36

02 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2019 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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OCTOBER 2019 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 2019 MEÁN FÓMHAIR

WEEK 36

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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September 2019 WEEK 37

09 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2019 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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OCTOBER 2019 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 2019 MEÁN FÓMHAIR

WEEK 37

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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September 2019 WEEK 38

16 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2019 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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OCTOBER 2019 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 2019 MEÁN FÓMHAIR

WEEK 38

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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September 2019 WEEK 39

23 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2019 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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OCTOBER 2019 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 2019 MEÁN FÓMHAIR

WEEK 39

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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October 2019 WEEK 40

30 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2019 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

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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NOVEMBER 2019 Wk

Mo Tu We Th

44 45

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

October 2019 DEIREADH FÓMHAIR

WEEK 40

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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October 2019 WEEK 41

07 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2019 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

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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NOVEMBER 2019 Wk

Mo Tu We Th

44 45

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

October 2019 DEIREADH FÓMHAIR

WEEK 41

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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October 2019 WEEK 42

14 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2019 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

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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NOVEMBER 2019 Wk

Mo Tu We Th

44 45

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

October 2019 DEIREADH FÓMHAIR

WEEK 42

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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October 2019 WEEK 43

21 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2019 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

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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NOVEMBER 2019 Wk

Mo Tu We Th

44 45

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

October 2019 DEIREADH FÓMHAIR

WEEK 43

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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October 2019 WEEK 44

28 Monday | Luain Bank Holiday ROI

DEIREADH FÓMHAIR

OCTOBER 2019 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

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 2019 Wk

Mo Tu We Th

44 45

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

November 2019 SAMHAIN

WEEK 44 Hallowe’en 31

Thursday | Déardaoin

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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November 2019 WEEK 45

04 Monday | Luain

SAMHAIN

NOVEMBER 2019 Wk

Mo Tu We Th

44 45

Su 3

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

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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DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 23 24 25 26 27 28 29

30 31

November 2019 SAMHAIN

WEEK 45

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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November 2019 WEEK 46

11 Monday | Luain

SAMHAIN

NOVEMBER 2019 Wk

Mo Tu We Th

44 45

Su 3

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

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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DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 23 24 25 26 27 28 29

30 31

November 2019 SAMHAIN

WEEK 46

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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November 2019 WEEK 47

18 Monday | Luain

SAMHAIN

NOVEMBER 2019 Wk

Mo Tu We Th

44 45

Su 3

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

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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DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 23 24 25 26 27 28 29

30 31

November 2019 SAMHAIN

WEEK 47

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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November 2019 WEEK 48

25 Monday | Luain

SAMHAIN

NOVEMBER 2019 Wk

Mo Tu We Th

44 45

Su 3

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

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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DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 23 24 25 26 27 28 29

30 31

December 2019 NOLLAIG

WEEK 48

28 Thursday | Déardaoin

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

01 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2019 WEEK 49

02 Monday | Luain

NOLLAIG

DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 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

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JANUARY 2020 Wk

1 1 2 3 4 5

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12

December 2019 NOLLAIG

WEEK 49

13 14 15 16 17 18 19 20 21 22 23 24 25 26

5 27 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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December 2019 WEEK 50

09 Monday | Luain

NOLLAIG

DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 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

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JANUARY 2020 Wk

1 1 2 3 4 5

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12

December 2019 NOLLAIG

WEEK 50

13 14 15 16 17 18 19 20 21 22 23 24 25 26

5 27 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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December 2019 WEEK 51

16 Monday | Luain

NOLLAIG

DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 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

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JANUARY 2020 Wk

1 1 2 3 4 5

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12

December 2019 NOLLAIG

WEEK 51

13 14 15 16 17 18 19 20 21 22 23 24 25 26

5 27 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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December 2019 WEEK 52

23 Monday | Luain

NOLLAIG

DECEMBER 2019 Wk

Mo Tu We Th Fr Sa Su

48 1 49

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

52 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

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JANUARY 2020 Wk

1 1 2 3 4 5

Mo Tu We Th Fr Sa Su 6 7 8 9 10 11 12

December 2019 NOLLAIG

WEEK 52

13 14 15 16 17 18 19 20 21 22 23 24 25 26

5 27 28 29 30 31

St. Stephen’s Day, Bank Holiday (ENG/NIR/ROI/SCT/WLS)

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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January 2020 WEEK 1

EANÁIR

JANUARY 2020 Wk

1 1 2 3 4 5

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

5 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

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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

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January 2020 WEEK 2

EANÁIR

JANUARY 2020 Wk

1 1 2 3 4 5

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

5 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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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

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January 2020 WEEK 3

EANÁIR

JANUARY 2020 Wk

1 1 2 3 4 5

13 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

5 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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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

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January 2020 WEEK 4

EANÁIR

JANUARY 2020 Wk

1 1 2 3 4 5

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

5 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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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

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January 2020 WEEK 5

EANÁIR

JANUARY 2020 Wk

1 1 2 3 4 5

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

5 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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FEBRUARY 2020 Wk

Mo Tu We Th Fr Sa Su

5 1 2

3 4 5 6 7 8 9

January 2020 EANÁIR

WEEK 5

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

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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