IHCA Yearbook and Diary 2021 by Ashville Media Group

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Our Journey Continues With international headquarters in

Florence, Italy, A. Menarini established a presence in Ireland in 1999. Through a culture of excellence and innovation, we swiftly embarked on a path of sustained growth and advancement. Our goal was to become integral to the delivery of patient-focused healthcare solutions to meet medical needs and provide innovative quality medicines, which offer greater choice for clinicians in improving patient outcomes. Two decades on, and with a team of 46 skilled staff members trained in a variety of professional disciplines, we have grown our portfolio to over 27 products.

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• SUPPO R

S•

R R 2 0 YE

E• NC

IR-MEN-14-2020. Date of Item: March 2020

EXCEL NG LE TI

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CME

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RELIFE is looking forward to an exciting future and has a number of dermatology product launches scheduled, along with the launch of an aesthetic medicines portfolio.

CME

With the support and resources of our Italian parent company, we will continue to reinforce our presence as a leading provider of innovative medicines, centred on transforming patients’ lives.

• SUPPO R

Our first product range, Relizema, which includes products developed for eczema, dermatitis, baby care, dry and sensitive skin, is now available in pharmacies nationwide.

EXCEL NG LE TI

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Ireland is the first country outside of Italy to launch RELIFE.

We are also proud to be at the forefront of continuous medical education, supporting regular meetings and webinars tailored towards the needs of busy healthcare professionals.

E• NC

A. Menarini Pharmaceuticals Ireland Ltd., launched the RELIFE dermatology division in April 2019.

With patient welfare at the heart of everything we do, our medicines have been developed to the most stringent standards in the therapeutic areas of cardiology, respiratory care, rheumatology, neurology, analgesia, anti-allergics and anti-infectives.

R 2 0 YE

A. Menarini Pharmaceuticals Ireland Limited, Castlecourt, Monkstown Farm, Monkstown, Glenageary, Co. Dublin. For more information please visit www.menarini.ie

08/09/2020 03/09/2020 09:50 09:37

The journey to triple protection in T2D starts at the kidneys LICENCE EXTENSION INVOKANA now includes evidence for the treatment of diabetic kidney disease1

Choose INVOKANA – the only SGLT2i licensed to offer your T2D patients triple protection against renal events, CV events and elevated HbA1c1–4

INVOKANA® (canagliflozin) 100 mg & 300 mg film-coated tablets. PRESCRIBING INFORMATION. REPUBLIC OF IRELAND. Please refer to the Summary of Product Characteristics (SmPC) before prescribing. INDICATIONS: The treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise as monotherapy when metformin is considered inappropriate due to intolerance or contraindications, or in addition to other medicinal products for the treatment of diabetes. DOSAGE & ADMINISTRATION: Adults: recommended starting dose: 100 mg once daily. In patients tolerating this dose and with eGFR ≥ 60 mL/min/1.73 m2 needing tighter glycaemic control, dose can be increased to 300 mg once daily. For oral use, swallow whole. Caution increasing dose in patients ≥ 75 years old, with known cardiovascular disease or for whom initial canagliflozin-induced diuresis is a risk. Correct volume depletion prior to initiation. When add-on, consider lower dose of insulin or insulin secretagogue to reduce risk of hypoglycaemia. Children: no data available. Elderly: consider renal function and risk of volume depletion. Renal impairment: for the treatment of diabetic kidney disease (DKD) as add on to standard of care (SOC) (e.g. ACE inhibitors or ARBs), initiate with 100 mg dose. The glycaemic lowering efficacy of canagliflozin is reduced in patients with moderate renal impairment and likely absent in severe renal impairment. If eGFR falls below 60 mL/min/1.73 m2 during treatment, adjust or maintain dose at 100 mg once daily. eGFR(mL/min/1.73m2) or CrCl (mL/min)

Total daily dose of canagliflozin

≥60

Initiate with 100 mg If tolerating 100 mg and needing additional glycaemic control, increase dose to 300 mg

45 to < 60a

Initiate with 100 mg If already taking Invokana – continue 100 mg

30 to < 45a,b

Initiate with 100 mg If already taking Invokana – continue 100 mg

< 30

Do not initiate If already taking Invokana – continue 100 mgc

a,b

Consider addition of other anti-hyperglycaemic agents if further glycaemic control is needed With urinary albumin/creatinine ratio > 300 mg/g c Continue until dialysis or renal transplantation Hepatic impairment: mild or moderate; no dose adjustment. Severe; not studied, not recommended. Hepatic impairment: mild or moderate; no dose adjustment. Severe; not studied, not recommended. CONTRAINDICATIONS: Hypersensitivity to active substance or any excipient. SPECIAL WARNINGS & PRECAUTIONS: Not for use in type 1 diabetes.

Renal impairment: regardless of pretreatment, patients on canagliflozin had an initial fall in eGFR that attenuated over time. eGFR < 60 mL/min/1.73 m2: higher incidence of adverse reactions associated with volume depletion particularly with 300 mg dose; more events of elevated potassium; greater increases in serum creatinine and blood urea nitrogen (BUN); limit dose to 100 mg once daily. Not studied in severe renal impairment. Monitor renal function prior to initiation and at least annually. Volume depletion: caution in patients for whom a canagliflozin- induced drop in blood pressure is a risk (e.g. known cardiovascular disease, eGFR < 60 mL/min/1.73 m2, anti-hypertensive therapy with history of hypotension, on diuretics or elderly). Not recommended with loop diuretics or in volume depleted patients. Monitor volume status and serum electrolytes. Diabetic ketoacidosis (DKA): rare DKA cases reported, including life-threatening and fatal. Presentation may be atypical (blood glucose <14mmol/L). Risk appears higher in patients with moderate to severe decrease in renal function who require insulin. Consider DKA in event of non-specific symptoms. If DKA is suspected or diagnosed, discontinue Invokana treatment immediately. Interrupt treatment in patients who are undergoing major surgical procedures or have acute serious medical illnesses. Monitoring of (preferably blood) ketone levels is recommended in these patients. Consider risk factors for development of DKA before initiating Invokana treatment. Elevated haematocrit: careful monitoring if already elevated. Genital mycotic infections: risk in male and female patients, particularly in those with a history of GMI. Lower limb amputation: Consider risk factors before initiating. Monitor patients with a higher risk of amputation events, counsel on routine preventative foot care and adequate hydration. Consider discontinuing Invokana when events preceding amputation occur (e.g. lower-extremity skin ulcer, infection, osteomyelitis or gangrene). Necrotising fasciitis of the perineum (Fournier’s gangrene): post-marketing cases reported with SGLT2 inhibitors. Rare but serious, patients should seek medical attention if experiencing symptoms including pain, tenderness, erythema, genital/perineal swelling, fever, malaise. If Fournier’s gangrene suspected, Invokana should be discontinued, and prompt treatment instituted. Urine laboratory assessment: glucose in urine due to mechanism of action. Lactose intolerance: do not use in patients with galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Sodium: essentially “sodium-free”. INTERACTIONS: Diuretics: may increase risk of dehydration and hypotension. Insulin and insulin secretagogues: risk of hypoglycaemia; consider lower dose of insulin or insulin secretagogue. Effects of other medicines on Invokana: Enzyme inducers (e.g. St. John’s wort, rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease exposure of canagliflozin; monitor glycaemic control. Consider dose increase to 300 mg if administered with UGT enzyme inducer. Cholestyramine may reduce canagliflozin

exposure; take canagliflozin at least 1 hour before or 4-6 hours after a bile acid sequestrant. Effects of Invokana on other medicines: Monitor patients on digoxin, other cardiac glycosides, dabigatran. Inhibition of Breast Cancer Resistance Protein cannot be excluded; possible increased exposure of drugs transported by BCRP (e.g. rosuvastatin and some anti-cancer agents). PREGNANCY: No human data. Not recommended. LACTATION: Unknown if excreted in human milk. Should not be used during breast-feeding. SIDE EFFECTS: Very common (≥1/10): vulvovaginal candidiasis, hypoglycaemia in combination with insulin or sulphonylurea. Common (≥1/100 to <1/10): balanitis or balanoposthitis, urinary tract infection (including pyelonephritis and urosepsis), constipation, thirst, nausea, polyuria or pollakiuria, dyslipidemia, haematocrit increased. Uncommon (<1/100) but potentially serious: necrotising fasciitis of the perineum (Fournier’s gangrene) (frequency not known), anaphylactic reaction, diabetic ketoacidosis, syncope, hypotension, orthostatic hypotension, urticaria, angioedema, bone fracture, renal failure (mainly in the context of volume depletion), lower limb amputations (mainly of the toe and midfoot. Refer to SmPC for details and other side effects. LEGAL CATEGORY: POM. PACK SIZES & MARKETING AUTHORISATION NUMBER(S): Invokana 100 mg film-coated tablets: 30 tablets; EU/1/13/884/002. Invokana 300 mg filmcoated tablets: 30 tablets; EU/1/13/884/006. MARKETING AUTHORISATION HOLDER: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium. ® INVOKANA is a registered trade mark of Janssen-Cilag International NV and is used under licence. © 2020 Napp Pharmaceuticals Limited. Adverse events should be reported 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 Mundipharma Pharmaceuticals Limited on drugsafetyJNJ@mundipharma-rd.eu or by phone on 01 2063800 (1800 991830 outside office hours) FURTHER INFORMATION IS AVAILABLE FROM: Mundipharma Pharmaceuticals Limited, Millbank House, Arkle Road, Sandyford, Dublin 18. For medical information enquiries, please contact medicalinformation@mundipharma.ie UK/INV-18203(3) IRE/INVK-20206a Date of Preparation July 2020 References: 1. Invokana® Summary of Product Characteristics. Mundipharma 2020. 2. Dapagliflozin Summary of Product Characteristics. AstraZeneca 2019. 3. Empagliflozin Summary of Product Characteristics. Boehringer Ingelheim 2019. 4. Ertugliflozin Summary of Product Characteristics. MSD 2019.

CV: cardiovascular; HbA1c: haemoglobin A1c; SGLT2i: sodium-glucose cotransporter 2 inhibitor; T2D: type 2 diabetes. ® MUNDIPHARMA and the ‘mundipharma’ logo are registered trademarks of Mundipharma. Invokana® is a registered trademark of Johnson & Johnson. IRE/INVK - 20209

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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 approximately 2,500 employees across five sites. 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.msd.com

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08/09/2020 25/05/2020 09:59 09:44

2021 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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Advanced Medicine Exceptional Care

Organisation accredited by Joint Commission International

www.bonsecours.ie

Cork | Dublin | Galway | Limerick | Tralee Advert template.indd 1 249692_1C_Bon Secours_JM_IHCA 21.indd 1

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PERSONAL DETAILS Name: Hospital: Address:

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

www.ihca.ie

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Contents 9

End of Year Checklist

President’s Address

Minister for Health Foreword

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 2020-2021 77

IHCA Officer Board 2020-2021

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. © 2020/2021

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

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www.ihca.ie

02/10/2020 11:59

Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries

TREATING ACTIVE PEOPLE OF ALL AGES

SSC provides the following services: + Assessment, diagnosis and treatment of all + Sports related injuries conditions shoulder, + New, fully equipped Sports SSCorthopaedic in Santry, Dublin,including provides world-class medical facilities for:& Exercise hand, foot and ankle, spine, hip and knee Medicine Department including state-of Fully equipped Sports & Exercise department  diagnosis andjoint treatment of all + Assessment, Shoulder, hip and knee replacement the-art Physiotherapy and Medicine Performance orthopaedic conditions and sports injuries  State-of-the-art and Performance surgery RehabilitationPhysiotherapy Gym Rehabilitation departments  Shoulder, hip and knee joint replacement surgery + Hand, foot and ankle surgery + MRI / X-ray and fully equipped Diagnostic  Strength & Conditioning  Spinal assessment / spinal surgery Imaging Department + Spinal surgery  MRI / X-Ray  Hand, foot and ankle surgery SSC accepts direct settlement of claim payments from:

For more information call: 01 526 2300, fax: 01 526 2081 or e-mail: gp@sportssurgeryclinic.com

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02/10/2020 19/08/2020 10:37 19/02/2018 11:18 16:10

Enabling people with depression to feel, think and do better1

Brintellix is indicated for the treatment of major depressive episodes in adults1 Brintellix® (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. Can be taken with or without food. 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 or hepatic impairment: No dose adjustment is needed, however exercise caution given that these subpopulations are vulnerable and data on the use of Brintellix is limited. 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: Should only be administered to pregnant women if the expected benefits outweigh the potential risk to the foetus. 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 breastfeeding child cannot be excluded. 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: 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 adjustment may be considered if a broad cytochrome P450 inducer (e.g. rifampicin, carbamazepine, phenytoin) is added to vortioxetine treatment.

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Effects on ability to drive and operate machines: No or negligible influence however, as reactions such as dizziness have been reported, use caution at the start of treatment or when the dose is changed. Adverse events: The most common adverse reaction is nausea, which is usually mild or moderate, transient and occurs within the first two weeks of treatment. The following have been reported in clinical trials and during post-marketing use: Very common (≥1/10 patients); nausea. Common (≥1/100 to <1/10); abnormal dreams, dizziness, diarrhoea, constipation, vomiting, pruritus, including generalised pruritus. Uncommon (≥1/1,000 to <1/100); flushing, night sweats. Not known; Anaphylactic reaction, haemorrhage (including contusion, ecchymosis, epistaxis, gastrointestinal or vaginal bleeding), Serotonin syndrome, hyponatraemia, angioedema, urticaria, rash. Sexual dysfunction: The 20mg dose of vortioxetine was associated with an increase in 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: Management consisting of treating clinical symptoms and relevant monitoring. Legal category: POM, for non-renewable supply. 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. Date of last revision of PI: March 2020. Reference: IE-BRIN-0198. Brintellix® is a Registered Trade Mark. Job number: IE-BRIN-0196 Date of preparation: March 2020

Reference: 1. Brintellix Summary of Product Characteristics. Available at https://www.medicines.ie/medicines/brintellix-10-mg-film-coated-tablets-34817/smpc (Accessed: March 2020). 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

14/05/2020 18/09/2020 15:17 12:31

End of Year Checklist

Item Check Medical Council Requirements

Ensure you adhere to all Medical Council registration requirements.

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

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

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

Members are advised to claim their CME Allowance before the end of the year as management are imposing restrictions. Your College and CPD fees are eligible costs. Those who have accrued unutilised CME funding should write to their employer to carry it over to 2021.

Phone

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

Flat-Rate Expense Allowance

Check that you are benefiting from the â&#x201A;Ź695 flat-rate expense allowance in your tax credits each year. You can claim a tax rebate for the previous four years, therefore claims for 2016 need to be made by 31 December 2020.

Statement of Interest under the Ethics Act

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

Tax Clearance Cert

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

Health Insurers Reconcile all outstanding payments with private health insurers, paying particular attention to pended claims. Medico Legal Fees

www.ihca.ie

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Review medico-legal fees and notify requesting solicitors accordingly â&#x20AC;&#x201C; see Pro Forma letter on page 23.

02/10/2020 12:00

Presidentâ&#x20AC;&#x2122;s Address Dear Colleagues, It gives me great pleasure to introduce the 24th edition of the IHCA Yearbook and Diary. Our Association was founded with the twin aims of advocating for quality care for our patients and providing representation for Consultants. The importance of both objectives has been heightened in recent months due to the COVID-19 pandemic. Providing acute hospital care to patients while living alongside COVID-19 presents significant challenges because of the overwhelming public hospital capacity deficits that have existed over the past decade due to the lack of investment. These significant deficits have been exacerbated by the backlog of patients due to the pandemic. The COVID-19 outbreak has highlighted in the starkest terms the capacity deficits in our acute hospital and mental health services. Despite record numbers of people on NTPF waiting lists, it is expected that the number who need essential acute hospital care could be far greater, as the waiting lists at the time of writing in September did not yet include all those who have had their care disrupted or postponed seeking care and referrals to hospitals for appointments in the previous six months. The Government must urgently expand public hospital capacity by opening the recommended additional 2,600 acute public hospital beds, doubling the number of ICU beds to the 579 recommended a decade ago, and providing the additional 4,500 community step-down and rehab beds in the shortest possible timeframe. Given the new physical distancing rules, infection control requirements and need to reduce our bed occupancy rates, our inpatient units, outpatient facilities and Emergency Departments are all under increased pressure and required this additional capacity. The Government also urgently needs to fill the 500 permanent hospital consultant posts that are now vacant in view of the challenges our acute hospital services have endured and taking account of the greater challenges in the months and year ahead. The Consultant salary inequity imposed unilaterally by the Government in 2012 must be ended as it is the root cause of Irelandâ&#x20AC;&#x2122;s consultant recruitment and retention crisis and, by extension, the unacceptable numbers of people on record waiting lists. The Government must restore pay parity immediately to fill the 500 permanent Consultant posts that are vacant or filled on a temporary or agency basis. This year has been very stressful for Consultants who have experienced extreme work demands during the coronavirus crisis. More Consultants have been required for several years to alleviate the excessive workload being carried by understaffed medical teams. This is even more pressing now in view of the backlog of patients on waiting lists who require assessment and treatment. The IHCA has engaged with the new Minister for Health and the Government to prioritise urgently the funding, development and implementation of practical plans and workable solutions to expand our public hospital capacity and community step-down services to provide more-timely patient care. Now is the time to frontload the beds planned in the National Development Plan and to finally address the Consultant recruitment and retention crisis. Consultants and their medical teams have been front and centre providing care to patients in an extremely challenging environment throughout 2020. We know that we will always step up to the mark when the need arises; we now need to see this commitment and professionalism matched by Government through pay equality, increased capacity and more efficient running of our acute hospitals and mental health services. We all appreciate the gratitude which our patients and their families have expressed during what was an extremely challenging year. This appreciation needs to be built on with proper resourcing of our acute public hospital and mental health services. On behalf of my National Council colleagues and the staff of the Association, I would like to take this opportunity to thank you for your continued support. We look forward to successfully addressing the concerns of our members in the year ahead. Finally, I wish you and your families a happy and successful 2021. Alan Irvine, President

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HbA1c

When a DPP-4 inhibitor is needed

PROVEN EFFICACY for adults with T2D 1,2

Simplicity. Reinforced.

Demonstrated

CV AND KIDNEY SAFETY PROFILE 3,4

for a BROAD RANGE of adults with T2D

5mg once daily

UNIQUE CONVENIENCE

through always one dose, once daily 1

References: 1. TRAJENTA® (linagliptin) Summary of Product Characteristics. Available at: https://www.medicines.ie/medicines/trajenta-5-mg-film-coated-tablets-34014/ 2. McGill JB, et al. Diabetes Care. 2013;36:237–44 3. Rosenstock J, et al. JAMA. 2019;321:69–79 4. Rosenstock J, et al. Cardiovasc Diabetol. 2018;17:39

Prescribing Information (Ireland) TRAJENTA® (Linagliptin) Film-coated tablets containing 5 mg linagliptin. Indication: Trajenta is indicated in adults with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycaemic control as: monotherapy when metformin is inappropriate due to intolerance, or contraindicated due to renal impairment; combination therapy in combination with other medicinal products for the treatment of diabetes, including insulin, when these do not provide adequate glycaemic control. Dose and Administration: 5 mg once daily. If added to metformin, the dose of metformin should be maintained and linagliptin administered concomitantly. When used in combination with a sulphonylurea or with insulin, a lower dose of the sulphonylurea or insulin, may be considered to reduce the risk of hypoglycaemia. Renal impairment: no dose adjustment required. Hepatic impairment: pharmacokinetic studies suggest that no dose adjustment is required for patients with hepatic impairment but clinical experience in such patients is lacking. Elderly: no dose adjustment is necessary based on age. Paediatric population: the safety and efficacy of linagliptin in children and adolescents has not yet been established. No data are available. Take the tablets with or without a meal at any time of the day. If a dose is missed, it should be taken as soon as possible but a double dose should not be taken on the same day. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and Precautions: Linagliptin should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Caution is advised when linagliptin is used in combination with a sulphonylurea and/or insulin; a dose reduction of the sulphonylurea or insulin may be considered. Acute pancreatitis has been observed in patients taking

linagliptin. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Trajenta should be discontinued; if acute pancreatitis is confirmed, Trajenta should not be restarted. Caution should be exercised in patients with a history of pancreatitis. Bullous pemphigoid has been observed in patients taking Linagliptin. If bullous pemphigoid is suspected, Trajenta should be discontinued. Interactions: Linagliptin is a weak competitive and a weak to moderate mechanism-based inhibitor of CYP isozyme CYP3A4, but does not inhibit other CYP isozymes. It is not an inducer of CYP isozymes. Linagliptin is a P-glycoprotein substrate and inhibits P-glycoprotein mediated transport of digoxin with low potency. Based on these results and in vivo interaction studies, linagliptin is considered unlikely to cause interactions with other P-glycoprotein substrates. The risk for clinically meaningful interactions by other medicinal products on linagliptin is low and in clinical studies linagliptin had no clinically relevant effect on the pharmacokinetics of metformin, glibenclamide, simvastatin, warfarin, digoxin or oral contraceptives (please refer to Summary of Product Characteristics for information on clinical data). Fertility, pregnancy and lactation: Avoid use during pregnancy. A risk to the breast-fed child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from linagliptin therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. No studies on the effect on human fertility have been conducted for linagliptin. Undesirable effects: Adverse reactions reported in patients who received linagliptin 5 mg daily as monotherapy or as add-on therapies in clinical trials and from post-marketing

experience. Frequencies are defined as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000) or very rare (<1/10,000). Adverse reactions with linagliptin 5 mg daily as monotherapy: Common: lipase increased. Uncommon: nasopharyngitis; hypersensitivity; cough; rash; amylase increased. Rare: pancreatitis; angioedema; urticaria; bullous pemphigoid. Adverse reaction with linagliptin in combination with metformin plus sulphonylurea: Very common: hypoglycaemia. Adverse reaction with linagliptin in combination with insulin: Uncommon: constipation. Prescribers should consult the Summary of Product Characteristics for further information on side effects. Pack sizes: 28 tablets. Legal category: POM. MA number: EU/1/11/707/003. Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prescribers should consult the Summary of Product Characteristics for full prescribing information. Additional information is available on request from Boehringer Ingelheim Ireland Ltd, The Crescent Building, Northwood, Santry, Dublin 9. Prepared in December 2019.

Adverse events should be reported. Reporting forms and information can be found at https://www.hpra.ie/homepage/about-us/reportan-issue. Adverse events should also be reported to Boehringer-Ingelheim Drug Safety on 01 2913960, Fax: +44 1344 742661, or by e-mail: PV_local_UK_ Ireland@boehringer-ingelheim.com

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Minister for Health Foreword I’m delighted to have this opportunity to address the IHCA membership in this foreword following my appointment as Minister for Health. Last year when we met at the IHCA’s conference, we spoke of the urgent need to do better for patients in Ireland. We spoke of what is required to achieve this, including increasing community and acute capacity - from hiring more clinicians to deploying more beds to increasing access to diagnostics and much more besides. We spoke of the need to hire more consultants and of the barriers to that, including long standing contractual disputes. Little did we know what lay ahead of us. A global pandemic unlike anything in living memory. One that required an unprecedented response from our healthcare workers. As we all know, it was a challenge that our healthcare workers rose to across the country. The urgently needed surge capacity was created. Care pathways were redesigned. New technologies were deployed. Urgent services were kept going. In a matter of weeks our health service showed just how adaptable, responsive and innovative it can be. The work done in response to Covid-19 by our healthcare workers, including the members of the IHCA, has saved lives. Many frontline workers have told me their stories in recent months, sharing how hard they have worked and what they have given up in their own lives so that they could care for their patients. Many healthcare workers contracted Covid-19 and became very sick themselves. Tragically, some paid the ultimate price and lost their lives fighting to save others in the pandemic. Everyone in Ireland acknowledges their sacrifices, honours their dedication and mourns their deaths. The coming months are going to be difficult. As we discussed last year, before Covid-19 arrived, we didn’t have enough consultants. We didn’t have enough beds, from acute to rehab to community. We didn’t have enough diagnostics capability, either in hospitals or in the community. The result was some of the longest wait times for patients in Europe. Since then, our capacity has reduced considerably due to Covid-19 infection prevention and control requirements. In short, it now takes longer and costs more to do less. On top of that, waiting lists are now much longer due to the necessary pausing of many services from March onwards. The question for us all then is what we do next. How do we respond to what might well be the biggest challenge our healthcare system has faced in decades? We need to increase capacity. Our e600 million Winter Plan will help us in that aim. It includes funding for additional acute, rehab and community beds, for acute and community diagnostics, home help, community assessment hubs and more. We need to increase staffing. There are various activities underway including progressing to safe staffing levels for nurses and midwives. Specifically relating to IHCA members, a number of C contracts have been sanctioned since July. Work is progressing on the new Sláintecare contract. Other outstanding contractual issues are also being considered in the context of this year’s estimates process. The additional capacity is being added to the system in line with modern healthcare system design and Sláintecare. This includes resourcing and configuring community care to treat people as close to their home as possible. It includes redesign of certain care pathways, providing new access for GPs to diagnostics, community-based chronic disease management as well as community-based respiratory facilities. At the acute level, it includes additional resources for emergency departments, more beds, more diagnostics, elective-only facilities, and most importantly, more clinicians. As I said at the IHCA’s conference last year, we need action. Covid-19 has made some things more difficult to achieve, as capacity falls and available public funds are squeezed. However, this pandemic has also made it clear that we need to innovate as never before. We have seen the power of this already this year. Changes which previously would have taken years were achieved in weeks, sometimes days. This spirit of innovation is essential to our ongoing work and it is very often IHCA members who are at the forefront of making these changes happen. As Minister for Health, I look forward to working with the IHCA, and with consultants all over Ireland, as we build the much-needed capacity and make the much-needed changes to give the Irish people, and our healthcare workers, the healthcare system they all need and deserve. Stephen Donnelly, TD, Minister for Health

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Members’ Handbook Contents PAGE NO. 14

INTRODUCTION IHCA - Brief History - Basic Rules

15 16

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

PRIVATE PRACTICE

MEDICAL INDEMNITY

MEDICO-LEGAL MATTERS

RESOURCE LIMITATIONS

DATA PROTECTION & PATIENT CONFIDENTIALITY

POST-MORTEMS & INQUESTS

REPRESENTATIONAL ASSISTANCE

HEALTHY IRELAND FRAMEWORK

GOVERNMENT HEALTH POLICY

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FOR

CONSULTANTS

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Members’ Handbook

INTRODUCTION

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

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

IRISH HOSPITAL CONSULTANTS ASSOCIATION Brief History Initial steps to establish the Irish Hospital Consultants Association were taken in 1988. Hospital Consultants at that time felt that their needs were not being adequately represented by existing representative bodies and so formed their own Association. Since then the organisation has thrived, representing members’ interests in contractual and broader medico-political matters. It is also steadfast in its advocacy of patients’ interests. The Association currently represents 95% of Hospital Consultants in the Irish health service. It is the only representative body in Ireland that speaks solely for hospital consultants.

(ac) be life members appointed by the National Council pursuant to Rule 3(e). (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 or the Register of Medical Specialists 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 Comhairle na n-Ospidéal/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.

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

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

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Membersâ&#x20AC;&#x2122; Handbook

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

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

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Members’ Handbook

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.

PUBLIC APPOINTMENTS Health Service Executive

The co-opted members are appointed so that there is representation on Council from the following specialties: • Anaesthesiology • Surgery • Obstetrics/Gynaecology • Paediatrics • Psychiatry • Medicine • Radiology • Pathology One of the co-opted members must be a life member of the Association.

Consultants’ Common Contract

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 health service employers and other bodies; • High level representation and advice to members on contract, employment and industrial relations issues; • Local negotiations with health service employers in the context of resourcing issues, workplace disputes and grievances; • Representation of members’ views through the Association’s advocacy and communications function including publication of policy submissions, national circulars, press statements and member surveys; • Detailed guidance for members on a range of issues including private practice, health insurance, superannuation, taxation, incorporation, GDPR and medico-legal concerns; A range of financial risk products through the Association’s group scheme. 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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The number and range of Consultant appointments in the public sector in Ireland are regulated by the Health Service Executive. As of June 2020 there were 3,401 WTE approved Consultant posts in the public health system under public contract. There are an estimated 550 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.

Each Consultant with a public appointment works under the Consultants’ Common Contract. The terms of the 2008 Consultant Contract were agreed between the Health Service Executive, on behalf of all employers, and the Irish Hospital Consultants Association on behalf of Consultants. The terms and conditions of this contract apply to all new appointees with effect from 1 June 2008. Each Consultant and his/her employer sign a copy of the contract. Sections 2(a), 5 and 8(a) along with the HSE letter of approval (Appendix I) are unique to each individual Consultant. These should be carefully checked prior to signing to ensure accuracy. The Association will assist in this process. Section 2 identifies the employer’s name and address, the Consultant’s name and address, the title of the post and the agreed start date. Section 5 identifies the type of contract being offered. Section 8(a) identifies the employer and the location(s) in which the Consultant will work. The location(s) should be a physical location and not the name of a service.

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

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

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Members’ Handbook

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

Existing Superannuation Scheme Members Consultants who are not new entrants, e.g. Consultants who took up their public appointments before 1 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.

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

Single Public Service Pension Scheme Members There is interchangeability between each scheme. The scheme under which a member is superannuated is contingent on the employer’s status. Consultants who were recruited before 1 April 2004 who previously had a mandatory retirement age of 65 can now remain in employment up to age 70 if they wish. The pension payable on retirement is based on years of reckonable service. 1/80th of the final pensionable remuneration is payable for every completed year of reckonable service up to a maximum of 40/80th. A pro rata adjustment is made for parts of years. The schemes make allowance for the late entry age of consultants into public sector employment by the discretionary award of ‘Professional Added Years’, which can result in an award of additional service calculated as 1/3 of actual service up to a maximum of 10 years at no cost to the member. For new entrants recruited on or after 1 April 2005 an award of up to five years may be granted. Members must purchase all reckonable service e.g. temporary service, for which refunds/gratuity was authorised before granting an award for professional added years. Following the death of a retired Consultant, a pension of 50% of the member’s pension is payable to the spouse. One third of the member’s pension is payable to each dependent child up to a maximum of three children. All service in a pensionable position, including that served during training, counts in arriving at the length of service. NCHDs who leave with less than five 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.

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Consultants deemed to be new entrants taking up public appointments after 1 January 2013 are superannuated under the Single Public Service Pension Scheme. Those who are not deemed new entrants continue to be superannuated under their pre-existing scheme (see above). Main features of the Single Public Service Pension Scheme: • career average earnings are used to calculate benefits (a pension and lump sum amount accrue each year and are up-rated each year by reference to CPI) • minimum pension age for most members is linked to the State Pension age (66 years initially, rising to 67 in 2021 and 68 in 2028) • compulsory retirement age of 70 applies for most members • post retirement pension increases are linked to CPI • there is no provision for the award of professional added years. Pension and lump sum are separately accrued each year using the following formulae: Pension: Accruing rate of 0.58% pensionable remuneration up to a ceiling of 3.74 x State Pension Contributory (SPC) (currently e48,457) plus (where applicable) 1.25% of pensionable remuneration above that level. Lump Sum: 3.75% of pensionable remuneration. Contributions to the scheme are deducted at 3.5% of net pensionable remuneration i.e. pensionable 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

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Members’ Handbook

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 in the 12 months prior to the date of death. In those circumstances the spouse/civil partner will receive a pension equal to 50% of the member's pension that would have been awarded had the Single Scheme member retired on medical grounds on the date of death. Also, children's benefits is calculated at the rate of one sixth (1/6th) of the member’s pension per eligible surviving child up to three children; and where there are four or more eligible children, a child’s pension, calculated at the rate of one half (1/2) of the member’s pension divided by the number of eligible children, is payable per child. Following retirement, pension increases will be based on increases in the CPI.

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

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

Travelling & Subsistence Expenses Travelling and subsistence expenses necessarily incurred in the course of a Consultant’s work are paid according to the public sector rates for senior staff. Travel expenses are payable in respect of each emergency call-out and in respect of travel between locations when a Consultant is scheduled to work away from his or her base. Details of the most recent rates applying domestically are available in HSE HR Circular 016/2019 which is available on request from the Assocciation, on the IHCA website or from your Human Resources department.

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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 016/2019 outlines revised arrangements for overnight allowances in Dublin. Full details can be found on the IHCA website or from your Human Resources department.

wider range of CME activities, the extension of coverage of course types and the funding of a more extensive range of software and hardware. The Association’s advice to its members is that the CME entitlements contained in their contracts cannot be diminished or restricted by unilateral communications from the HSE HR office. Members are advised to claim their CME Allowance before the end of the year.

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

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

Continuing Medical Education

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

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

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The rotas used for this are those that have been formally ratified by the hospital management. Consultants who wish to operate a sub roster within a general specialty, e.g. vascular surgery within general surgery, need to have management approval in order to attract the additional allowance. Consultants are paid additional monies (C Factor) in respect of instances where they are called to the hospital for emergencies. To qualify for these additional payments, a Consultant must be: • Rostered for on-call duty and contacted by another hospital doctor, by a senior nurse or other member of the hospital staff specifically designated for the purpose and attends at the hospital; or • Rostered for on-call duty and in the exercise of his professional judgement (EPJ) attends at the hospital and performs clinical work of an urgent nature or carries out urgent diagnostic or therapeutic procedures. Details of the relevant B Factor, C Factor and other allowances are outlined in the Consolidated Salary Scales, which are available on request from the Association. B Factor allowance should be paid together with salary payments. Members are reminded of the HSE circular to hospitals requiring that claims for emergency call outs (C Factor claims) must be made no later than three months from the earliest date of the on-call liability to which they relate in default of which they will be forfeited. While this is not a contract requirement, members are advised

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to submit their claims for emergency call outs (C Factor claims) without delay to ensure that claims are not deemed ineligible. If necessary, please contact the Secretariat for advice on the issue. In addition, travelling expenses to and from the hospital are payable. Income tax should not be levied on emergency call-out (C Factor) travel when claimed in respect of a named patient (See Revenue Statement of Practice - SP - IT/2/07 - Tax treatment of the reimbursement of Expenses of Travel and Subsistence to Office Holders and Employees (Revised July 2015)).

Rest Days In April 2014, the HSE unilaterally circulated proposals for Consultants on 1:3 and 1:4 on-call rotas which can be summarised as follows: • Under the proposed arrangements, regardless of the rest assigned for each category of on-call incident, there will be a minimum of 15 rest days for Consultants on a 1:3 on-call rota and a minimum of 10 days for those on a 1:4. • For attendance on site on weekdays, the amount of rest assigned with each on-call incident will be two hours where the callout occurs before midnight and three 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 eight weeks. • When for operational reasons, a Consultant cannot take all or any of their compensatory rest within eight weeks, the hours outstanding will be paid at the relevant hourly rate. • Clinical Directors will have authority to assign additional rest to Consultants, where time spent providing on-call services consistently exceeds three 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.

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

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Other private health insurance schemes operating in Ireland include: • ESB Staff Medical Provident Fund • Irish Life Assurance Plc Outdoor Staff Benevolent Fund • Irish Life Medical Aid Society • New Ireland/Irish National Staff Benevolent Fund • Prison Officers Medical Aid Society • St Paul’s Garda Medical Aid Society • The Goulding Voluntary Medical Scheme Membership of these schemes is restricted to employees of the relevant organisations only and their families. In addition, serving Officers of the Permanent Defence Forces are covered for private health insurance by the military authorities. Those of the rank of Lieutenant and Captain, or equivalent, are entitled to semi-private cover whilst officers of higher ranks are entitled to private cover. Non-commissioned officers of the Permanent Defence Forces are not covered for private health care by the military authorities.

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

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It is the unequivocal advice of the Association that Consultants maintain membership of a medical defence body, such as the Medical Protection Society, Medisec/MedPro or other provider, for those aspects of practice not covered by the CIS. As a Consultant undertakes full clinical responsibility for his or her patients, he or she could be held personally liable in the event of an adverse event occurring. Indemnity may provide cover against such an eventuality, details of which may not materialise until many years after the incident that gave rise to the injury.

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

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

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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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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 Association has prepared a Guideline document, with expert input from Ward Solutions Ltd, to ensure that affected Consultants are aware of the actions they need to take to meet their obligations under the new GDPR data protection regime. The Guideline is available in the Members’ section of the Association’s website. It is strongly recommended that you read the Guideline and ensure that appropriate actions are taken, as may be required depending on your specific circumstances, to adhere to GDPR requirements. Consultants who satisfy the GDPR definition of a ‘Data Controller’ or ‘Data Processor’ should note that GDPR compliance is not discretionary. Enforcement actions for non-compliance include the imposition of significant fines. The Guideline document will help you to determine your status and whether you are affected. The Guideline is comprised of: • • • •

An overview of the legal basis for processing by Consultants A series of practical action points Frequently asked questions A suite of template policies and procedures (available in MS Word Format for adaptation).

The above suite of policy documents can be downloaded in MS Word Format from the Association’s website. The integrity of the health system relies upon defined and adhered rules regarding patient confidentiality. Depending on the circumstances, the following draft letter may be relied upon in corresponding with Management on issues of patient data and confidentiality. Please contact the Secretariat for further advice as it relates to the specific circumstances.

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

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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.

be taken by the Consultant in his or her own right and he or she will assume responsibility for the associated legal costs.

REPRESENTATIONAL ASSISTANCE FOR CONSULTANTS

HEALTHY IRELAND — A FRAMEWORK FOR IMPROVED HEALTH AND WELLBEING

The Association is always available to provide representational assistance to Consultants in their dealings with employers and other service providers.

The Government published Healthy 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.

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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Finally, members may be assured that any request for assistance is treated in the utmost confidence.

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These goals were to be delivered through a series of 64 separate actions grouped into six themes. The themes cover the following broad areas. Theme 1 – Governance and Policy The Cabinet Subcommittee on Social Policy was to oversee the implementation of the plan and oversee, monitor and address common Government policy, agenda, targets and action plans to improve health and wellbeing. All public sector organisations were to be required to promote and protect the health and wellbeing of their workforce, their clients and the community they serve. Theme 2 – Partnerships and Cross Sectoral Work This set out a series of fourteen actions designed to ensure that health and wellbeing be devolved to local areas for implementation. Theme 3 – Empowering People and Communities Action points within this theme were directed at supporting, linking and improving existing partnerships so that various sectors of society could improve their health and wellbeing. Theme 4 – Health and Health Reform The most concrete action within this theme was one to establish multi-disciplinary national teams that will lead and take responsibility for policy areas. There was to be the development of a health and wellbeing human resource plan with a view to building capacity for health and wellbeing activities. Theme 5 – Research and Evidence The development of a Healthy Ireland research plan was at the core of this theme. It was also planned to work with the Health Research Board to implement a plan to build research capacity. Theme 6 – Monitoring Reporting and Evaluating A series of nine actions were set out to ensure that the capacity and systems were in place to report and evaluate the success of Healthy Ireland. In December 2018, the Department of Health published an Outcomes Framework to monitor and drive the achievement of Healthy Ireland’s targets. In April 2019, Taoiseach Leo Varadkar and Minister for

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Health Simon Harris launched the 2019 Healthy Ireland campaign and announced funding of €1 million to boost community engagement on health and wellbeing. Analysis by the Healthy Ireland Unit in the Department of Health shows that 60% of Irish adults are overweight or obese, with only one in three adults meeting physical activity guidelines or eating enough fruit and vegetables. The 2019 campaign sought to address this by encouraging positive lifestyle choices and raising public awareness of gov.ie/HealthyIreland as the trusted source of information on improving one’s health and wellbeing. In 2020, Healthy Ireland launched the ‘In This Together’ campaign (www.gov.ie/together) in response to the Covid-19 outbreak, with advice on maintain one’s mental wellbeing, staying active and staying connected throughout the pandemic.

GOVERNMENT HEALTH POLICY Patient Safety Bill The Patient Safety (Notifiable Patient Safety Incidents) Bill 2019 is a draft piece of legislation which was approved by Government on 3 December 2019. When enacted, it will establish a framework for mandatory open disclosure. The legislation will require notification of serious patient safety incidents externally to the Health Information and Quality Authority (HIQA), the Chief Inspector of Social Services (CISS) and the Mental Health Commission (MHC) to contribute to national patient safety learning and improvement. Mandatory open disclosure and the notification system for these serious patient safety incidents will apply to both public and private health services. Regional Health Areas The Government announced on 17 July 2019 plans to establish six new regional health areas. Area A takes in the northeast of the country, including Dublin North, Meath, Louth, Cavan and Monaghan. Area B takes in Longford, Westmeath, Offaly, Laois, Kildare and parts of Dublin and Wicklow. Area C focuses on the south and southeast, including Tipperary South, Waterford, Kilkenny, Carlow, Wexford, Wicklow and part of South Dublin. Counties Kerry and Cork account for Area D, while Area E is made up of Limerick, Clare and Tipperary North. Area F includes Donegal, Sligo, Leitrim, Roscommon, Mayo and Galway.

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Members’ Handbook The regional bodies will have clearly defined populations and will plan, resource and deliver health and social care services for the needs of its population. The restructuring is in line with the Sláintecare Report, which recommended that regional bodies should be responsible for the planning and delivery of integrated health and social care services. The HSE will continue to be the central executive with responsibility for planning and strategy. HSE Board The Health Service Executive (Governance) Act 2019 was signed into law on 5 June 2019 and the newly established Board of the HSE, under the Chairmanship of Ciarán Devane, met for the first time on 28 June 2019. The legislation provides for an independent Board for the HSE, as opposed to a directorate, aimed at strengthening the management, governance and accountability of the organisation. The Board is accountable to the Minister for the performance of its functions and is responsible for the appointment of a CEO. The CEO is responsible to the Board and the Board takes responsibility for assessing the CEO’s performance. The Act provides for a 10 person non-executive board together with the Chairperson and the Deputy Chairperson. National Development Plan The Government’s National Development Plan (NDP) 2018-2027 published in February 2018 pledged e10.9 billion in capital funding for the health services, to include the planned addition of a minimum of 2,600 acute hospital beds and new dedicated elective-only hospitals in Dublin, Cork and Galway to tackle waiting lists and provide access to diagnostic services. An additional 4,500 long term and short term residential beds in Community Nursing Homes in the public system are also proposed in the NDP. However, the HSE’s Capital Plan 2019 published in September 2019 reduced the acute hospital bed target by 300 to just 480 beds between 2019 and 2021. This amounted to an almost 40% (38%) reduction in the already ‘modest’ NDP target of 780 extra acute beds over the three years. It is now accepted that the pace of implementing the National Development Plan has been far too slow and needs to be accelerated to open the recommended additional beds in the shortest possible timeframe. Practical plans need to be developed developed and implemented to expand urgently our public hospital capacity and community step down services to provide care to patients with COVID-19 and non-COVID-19 illnesses. Furthermore, there is an urgently need to double the ICU capacity to 579 beds as recommended in an HSE commissioned report a decade ago, because the existing

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public hospital capacity of 250 ICU beds is far too low and has over the years created significant problems in providing timely care. This must be addressed on a sustainable basis. 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 reported on 26 August 2019. The IHCA welcomed the fact that the Review Group acknowledged the current consultant recruitment and retention crisis and the need to end the existing pay inequity for consultants appointed after 2012. However, the proposal to remove private practice from public hospitals will have the effect of removing €6.5bn in private health insurance income over a 10-year period, from already severely underfunded acute public hospitals. Adjusted for inflation, the estimated loss will be closer to €8bn or €800m per year. The IHCA has no confidence that the loss in private health insurance income to public hospitals will be replaced by the Exchequer. The proposal to remove private practice from what is perceived as an inequitable system will perpetuate the delays in accessing care because public hospitals will be even more under-resourced. It will result in an extreme two-tier system with functioning and adequately resourced private hospitals operating separately in parallel with an under-resourced and overcrowded public hospital system. The further proposal put forward to offer public-only contracts to

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Consultants has been tried twice before, failing both times. The cost of implementing the proposals in the Sláintecare Report has been understated and will actually cost the taxpayer e30bn, based on Irish Fiscal Advisory Council 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, thus crippling the ability of public hospitals to treat an ever increasing number of patients. A total of €42m was committed to Sláintecare in Budget 2020, which was due to increase to €92m in 2021. 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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What does the future of sustainable healthcare look like in Ireland? Proudly supported by Date of preparation: February 2019.IE/COMM/0918/0025ap

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Consultants’ Common Contract 2008 Enabling Circular - 25th July 2008

To: Hospital Network Managers, Assistant National Directors (PCCC), Health Agencies Please forward this circular and attached document to all HSE agencies, voluntary hospitals, relevant corporate bodies and other non-HSE agencies under your remit. Please ensure the required form is completed in respect of each Consultant in your employment (i.e. hospital/agency). 1) General a) The purpose of this circular is to convey approval to the introduction with effect from 1 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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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 31 August 2008. Only Consultants who accept the offer before 1 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 31 August 2008 shall be paid the applicable revised rate at the maximum point with effect from 1st June 2008 and 1 June 2009, as set out in the attached schedule. d) Serving Consultants who exercise their option to take the revised contract between 1 September 2008 and 31 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 31 December 2008 should be made to the HSE Consultant Appointments Unit. 10) Superannuation a) The Consultant will be covered by the terms of the HSE/VHSS/NHSS (as appropriate) Superannuation Scheme and the contributory associated spouses and children superannuation schemes. Appropriate deductions will be made from his/her salary in respect of his/her contributions to the scheme. In general, 65 is the minimum age at which pension is payable; however, for appointees who are deemed not to be ‘new entrants’ as defined in the Public Service Superannuation Miscellaneous Provisions Act 2004 an earlier minimum pension age may apply. b) Should: i) the Consultant be deemed to be a new entrant (as defined in the Public Service Superannuation [Miscellaneous Provisions] Act 2004), there is no specified retirement age in respect of his/her appointment to this position.

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

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Consultants’ Common Contract 2008 Page No. Preamble

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

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

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02/10/2020 12:07

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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Advert template.indd Hosp_JM_IHCA.indd 1 249923_1C_Beacon 1

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Consultants’ Common Contract 2008

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

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

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Consultants’ Common Contract 2008

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

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

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Consultants’ Common Contract 2008

c) Certain 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 diagnosis, treatment and care to the patient. The Consultant shall retain a continuing overall responsibility for the care of the patient.

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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) T o 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.

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e) The Academic Consultant is accountable for the 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.

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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 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.

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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: 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.

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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 • 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.

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20) Regulation of Private Practice a) Subject 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 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

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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 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;

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or ii) patients attending Public Outpatient 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 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.

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ii) A Consultant who held a Category I or II Contract 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 i i) 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: (i) patients attending Emergency Departments in public hospitals;

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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 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.

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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) P rofessional 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.

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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, two years after accepting the Consultant Contract 2008 and thereafter at five 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. 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) a n 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

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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 31 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: i) a five per cent increase on the Consultant’s existing (June 2007) rate from 14 September 2007; ii) h alf the balance* from 1 June 2008; iii) t he remaining balance from 1 June 2009. *The term ‘half the balance’ refers to the difference between the 14 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 1 September 2008.

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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 1 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 1 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 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

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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. 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

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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 Employerâ&#x20AC;&#x2122;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 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 â&#x20AC;&#x201C; 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

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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 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

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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 or after the date of your appointment;

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. 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 31 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 14 September 2007. d) In addition to the annual statement, you must whenever you are performing a function as an employee and you 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.

001-077_IHCA Client Section 2021_v9.indd 52

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: 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

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Consultants’ Common Contract 2008

Name (Block Capitals): 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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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, subject to satisfactory improvement during this period.

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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 decisionmaker 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

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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 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.

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• The Plan is concerned, inter alia, with specifying resources/ 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.)

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• This paper sets out high level provisions to apply in this regard. 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.

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• Individual Consultant assignment/work schedules are 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 63. 5. General This document addresses Directorate Service Plans at a high framework level. Detailed provisions in this respect will be developed at local level within the parameters set out herein.

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

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

Clinical Directorate Work Schedule - Location and Activity Service Commitment

Absence/ leave

OPD

Ward Rounds / Inpatient care

Theatre / Day Theatre

On-call

Quality & Risk (incl. Audit)

Medical Education Training and Research

Statutory Commitment

CME / CPD (protected time)

Day of month 1st

Am Pm

2nd

Am Pm

3rd

Am Pm

4th

Am Pm

5th

Am Pm

6th

Am Pm

7th

Am Pm

8th

Am Pm

9th

Am Pm

10th

Am Pm

11th

Am Pm

Etc

Am Pm

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

Consultant Work Schedule - Month Service Commitment

Absence/ leave

OPD

Ward Rounds / Inpatient care

Theatre / Day Theatre

On-call

Quality & Risk (incl. Audit)

Medical Education Training and Research

Statutory Commitment

CME / CPD (protected time)

Day of month 1st

Am Pm

2nd

Am Pm

3rd

Am Pm

4th

Am Pm

5th

Am Pm

6th

Am Pm

7th

Am Pm

8th

Am Pm

9th

Am Pm

10th

Am Pm

11th

Am Pm

Etc

Am Pm

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

Performance Report - at Directorate, speciality / sub-speciality and Consultant level Planned vs. Actual (month) Planned

Actual

Areas of Focus Public

Private

Total

Public

Private

Total

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

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

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

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

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

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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 respect of any days sick leave unless, by reason of

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

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of the Medical Practitioners Act 2007 are commenced, new appointees to Consultant posts must be either eligible for registration, or be already registered in the Specialist Division of the register of medical practitioners to be established and maintained by the Medical Council under that Act. Letter of Appointment Letters of appointment will stipulate that contracts to be offered to each individual Consultant will be consistent with the nationally agreed contract. 1997 Contract Holders – Pension Adjustments Retired Consultants will, in addition to the standard national pay round increases, have special increases applied to their pensions on the same basis as their serving counterparts who opt to remain on the 1997 contract. Public Private Ratio – Serving Consultants Serving Consultants whose public to private ratio in 2006 was greater than 20 per cent will be permitted to retain this higher ratio, subject to an overriding maximum ratio of 70:30, and this will endure for the lifetime of the agreement. Separation vs. Aggregation of Clinical Activity While the HSE’s position is that the 80:20 ratio should apply to in-patient, day case and out-patient activity (i.e. the same ratio will apply in all cases but will be calculated separately for each type of activity), the Public Private Mix Measurement Group shall consider whether such activities can be aggregated to form a single 80:20 public:private ratio. However, this is subject to the implementation of Clause 20(b) with effect from 1 September 2008, in the absence of any agreed alternative measurement arrangement by that date. Contract Implementation Committee A Contract Implementation Committee, comprising representatives of the HSE and the medical organisations, will be established. The Committee will be chaired by Mr Mark Connaughton, SC. Deadline Date for Contract Acceptance Consultants who sign for the new contract by 31 August 2008 will benefit from the enhanced pay rates with effect from 1 June 2008. However, consultants who sign up for the new contract between 1 September 2008 and 31 December 2008 will only benefit from the improved pay rates from the date of sign up.

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

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

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).

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

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

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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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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 4 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 Medisec/MedPro 7 Hatch Street Lower, Dublin, D02 AW92. Freephone: 1800-460-400 Tel: (01) 611 0504 Email: info@medisec.ie 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) 20 7202 1662 Email: advisory@themdu.com

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Professional Directory Health Insurers Irish Life Health Irish Life Centre, Abbey Street Lower, Dublin 1. Tel: 1890 714 444 or PO Box 764, Togher, Co Cork. (021) 480 2040 Email: partnersupport@irishlifehealth.ie Head of Provider Affairs: Mr Brian Scollard ESB Staff Medical Provident Fund PO Box 384, Rosbrien, Limerick. Tel: (061) 430411 or (061) 430506 Fax: (061) 430500 Email: mpf@esb.ie Manager: Mr James O’Loughlin

Vhi Healthcare Vhi House, 20 Lower Abbey Street, Dublin 1, D01 DX77. Tel: 1890 444444 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 HSF Health Plan 5 Westgate Business Park, Kilrush Road, Ennis, Co. Clare, V95 TR66. Tel: 1890 473 473/ 065-686 2500 e-mail: enquiries@hsf.ie

Laya Healthcare Eastgate Road, Eastgate Business Park, Little Island, Co Cork , T45 E181. Tel: (021) 202 2000 Email: info@layahealthcare.ie Medical Practice Manager: Ms Noreen Quinlan Prison Officers’ Medical Aid Society 397e North Circular Road, Dublin 7, D07 TAC9. Tel: (01) 830 8963 Email: info@pomas.ie Secretary: Mr PJ Dunne

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.

The Council has 25 members including elected and appointed members. Under the provisions of the Medical Practitioners Act, 2007, the 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. Following on from the commencement of the Health (Regulation of Termination of Pregnancy) Act 2018, an updated and amended version of this Guide was issued by the Medical Council. 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, D02 XY88. Tel: (01) 498 3100 Fax: (01) 498 3102 Email: medicalcouncil@mcirl.ie www.medicalcouncil.ie

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Professional Directory Medical Council MEMBERSHIP Dr Rita Doyle (President) Dr Tom Crotty (Vice President) Dr John Barragry Ms Vicky Blomfield Dr Anthony Breslin Ms Teresa Bulfin Dr Suzanne Crowe 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 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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Prof Marina Lynch Dr Erica Maguire Ms Catherine McKenna Dr Maeve Moran Dr Aoife Mullally Mr John Murray Mr Joe O’Donovan Mr Tom O’Higgins Mr Jim O’Sullivan Prof Mary O’Sullivan Vacant Vacant

Non-Medical Member Medical Member Non-Medical Member Medical Member Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Non-Medical Member Non-Medical Member 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 by the HSE as an individually numbered, identifiable post. SPECIALIST DIVISION The following specialties are recognised in the Specialist Division of the Register: Anaesthesiology • Anaesthesiology • Intensive Care Medicine • Pain Medicine Emergency Medicine • Emergency Medicine General Practice • General Practice • Military Medicine

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Professional Directory Medical Council

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

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

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Prescribing Information (Ireland) SPIRIVA® RESPIMAT® (tiotropium)

Available in SMALL,

MEDIUM and

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Ashville Media’s online digital publications are now available to view our website

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Inhalation solution containing 2.5 microgram tiotropium (as bromide monohydrate) per puff. Indication: COPD: Tiotropium is indicated as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD). Asthma: Spiriva Respimat is indicated as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year. Dose and Administration: COPD Adults only age 18 years or over: 5 microgram tiotropium given as two puffs from the Respimat inhaler once daily, at the same time of the day. Asthma Adults and patients 6 to 17 years of age: 5 microgram tiotropium given as two puffs from the Respimat inhaler once daily, at the same time of the day. In adult patients with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (≥ 800 μg budesonide/day or equivalent) and at least one controller. In adolescents (12 - 17 years) with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (> 800 - 1600 μg budesonide/day or equivalent) and one controller or in addition to inhaled corticosteroids (400 - 800 μg budesonide/day or equivalent) with two controllers. For children (6 - 11 years) with severe asthma, tiotropium should be used in addition to inhaled corticosteroids (> 400 μg budesonide/day or equivalent) and one controller or in addition to inhaled corticosteroids (200 - 400 μg budesonide/day or equivalent) with two controllers. Contraindications: Hypersensitivity to tiotropium bromide, atropine or its derivatives, e.g. ipratropium or oxitropium or to any of the excipients; benzalkonium chloride, disodium edetate, purified water, hydrochloric acid 3.6 % (for pH adjustment). Warnings and Precautions: Benzalkonium chloride may cause wheezing and breathing difficulties; patients with asthma are at an increased risk for these adverse events. Not for the initial treatment of acute episodes of bronchospasm or for the relief of acute symptoms. Spiriva Respimat should not be used as monotherapy for asthma. Asthma patients must be advised to continue taking antiinflammatory therapy, i.e. inhaled corticosteroids, unchanged after the introduction of Spiriva Respimat, even when their symptoms improve. Immediate hypersensitivity reactions may occur after administration of tiotropium bromide inhalation solution. Caution in patients with narrowangle glaucoma, prostatic hyperplasia or bladder-neck obstruction. Inhaled medicines may cause inhalation-induced bronchospasm. Tiotropium should be used with caution in patients with recent myocardial infarction < 6 months; any unstable or life threatening cardiac arrhythmia or cardiac arrhythmia requiring intervention or a change in drug therapy in the past year; hospitalisation of heart failure (NYHA Class III or IV) within the past year. These patients were excluded from the clinical trials and these conditions may be affected by the anticholinergic mechanism of action. In patients with moderate to severe renal impairment (creatinine clearance ≤ 50 ml/min) tiotropium bromide should be used only if the expected benefit outweighs the potential risk. Patients should be cautioned to avoid getting the spray into their eyes. They should be advised that this may result in precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema. Should any combination of these eye symptoms develop, patients should stop using tiotropium bromide and consult a specialist immediately. Tiotropium bromide should not be used more frequently than once a day. Interactions: Although no formal drug interaction studies have been performed, tiotropium bromide has been used concomitantly with other drugs commonly used in the treatment of COPD and asthma, including sympathomimetic bronchodilators, methylxanthines, oral and inhaled steroids, antihistamines, mucolytics, leukotriene modifiers, cromones, anti-IgE treatment without clinical evidence of drug interactions. Use of LABA or ICS was not found to alter the exposure to tiotropium. The co-administration of tiotropium bromide with other anticholinergic-containing drugs has not been studied and is therefore not recommended. Fertility, Pregnancy and Lactation: Very limited amount of data in pregnant women. Avoid the use of Spiriva Respimat during pregnancy. It is unknown whether tiotropium bromide is excreted in human breast milk. Use of Spiriva Respimat during breast feeding is not recommended. A decision on whether to continue/discontinue breast feeding or therapy with Spiriva Respimat should be made taking into account the benefit of breast feeding to the child and the benefit of Spiriva Respimat therapy to the woman. Clinical data on fertility are not available for tiotropium. Effects on ability to drive and use machines: No studies have been performed. The occurrence of dizziness or blurred vision may influence the ability to drive and use machinery. Undesirable effects: COPD: Common (≥ 1/100 to < 1/10) Dry mouth. Uncommon (≥ 1/1,000 to < 1/100) Dizziness, headache, cough, pharyngitis, dysphonia, constipation, oropharyngeal candidiasis, rash, pruritus, urinary retention, dysuria. Rare (≥1/10,000 to <1/1,000): Insomnia, glaucoma, intraocular pressure increased, vision blurred, atrial fibrillation, palpitations, supraventricular tachycardia, tachycardia, epistaxis, bronchospasm, laryngitis, dysphagia, gastrooesophageal reflux disease, dental caries, gingivitis, glossitis, angioneurotic oedema, urticaria, skin infection/skin ulcer, dry skin, urinary tract infection. Not known (cannot be estimated from the available data): Dehydration, sinusitis, stomatitis, intestinal obstruction including ileus paralytic, nausea, hypersensitivity (including immediate reactions), anaphylactic reaction, joint swelling. Asthma: Uncommon (≥ 1/1,000 to < 1/100) Dizziness, headache, insomnia, palpitations, cough, pharyngitis, dysphonia, bronchospasm, dry mouth, oropharyngeal candidiasis, rash. Rare (≥1/10,000 to <1/1,000): Epistaxis, constipation, gingivitis, stomatitis, pruritus, angioneurotic oedema, urticaria, hypersensitivity (including immediate reactions), urinary tract infection. Not known (cannot be estimated from the available data): Dehydration, glaucoma, intraocular pressure increased, vision blurred, atrial fibrillation, supraventricular tachycardia, tachycardia, laryngitis, sinusitis, dysphagia, gastrooesophageal reflux disease, dental caries, glossitis, intestinal obstruction including ileus paralytic, nausea, skin infection/skin ulcer, dry skin, anaphylactic reaction, joint swelling, urinary retention, dysuria. Serious undesirable effects consistent with anticholinergic effects: glaucoma, constipation, intestinal obstruction including ileus paralytic and urinary retention. An increase in anticholinergic effects may occur with increasing age. Prescribers should consult the Summary of Product Characteristics for further information on undesirable effects. Pack sizes: Single pack: 1 Respimat re-usable inhaler and 1 cartridge providing 60 puffs (30 medicinal doses); Single refill pack: 1 cartridge providing 60 puffs (30 medicinal doses). Legal category: POM. MA number: PA 775/2/2. Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prescribers should consult the Summary of Product Characteristics for full prescribing information. Additional information is available on request from Boehringer Ingelheim Ireland Ltd, The Crescent Building, Northwood, Santry, Dublin 9. Prepared in October 2019. Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or by email to medsafety@hpra.ie. Adverse events should also be reported to Boehringer Ingelheim Drug Safety on 01 291 3960 or by email to PV_local_uk_ireland@boehringer-ingelheim.com

09/09/2020 26/08/2020 09:50 14:58

Prescribing Information (Ireland) SPIOLTO® RESPIMAT® (tiotropium and olodaterol) Inhalation solution containing 2.5 microgram tiotropium (as bromide monohydrate) and 2.5 microgram olodaterol (as hydrochloride) per puff. Action: Inhalation solution containing a long acting muscarinic receptor antagonist, tiotropium, and a long acting beta2-adrenergic agonist, olodaterol. Indication: Maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Dose and Administration: Adults only aged 18 years or over: 5 microgram tiotropium and 5 microgram of olodaterol given as two puffs from the Respimat inhaler once daily, at the same time of the day. Contraindications: Hypersensitivity to tiotropium or olodaterol or any of the excipients; benzalkonium chloride, disodium edetate, purified water, 1M hydrochloric acid (for pH adjustment); atropine or its derivatives e.g. ipratropium or oxitropium. Warnings and Precautions: Not for use in asthma or for the treatment of acute episodes of bronchospasm, i.e. as rescue therapy. Inhaled medicines may cause inhalation-induced paradoxical bronchospasm. Caution in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction. Patients should be cautioned to avoid getting the spray into their eyes. They should be advised that this may result in precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary blurring of vision, visual halos or coloured images in association with red eyes from conjunctival congestion and corneal oedema. Should any combination of these eye symptoms develop, patients should stop using Spiolto Respimat and consult a specialist immediately. In patients with moderate to severe renal impairment (creatinine clearance ≤ 50ml/min) use only if the expected benefit outweighs the potential risk. Caution in patients with a history of myocardial infarction during the previous year, unstable or life-threatening cardiac arrhythmia, hospitalised for heart failure during the previous year or with a diagnosis of paroxysmal tachycardia (> 100 beats per minute) as these patients were excluded from the clinical trials. In some patients, like other beta-adrenergic agonists, olodaterol may produce a clinically significant cardiovascular effect as measured by increases in pulse rate, blood pressure and/or symptoms. Caution in patients with: cardiovascular disorders, especially ischaemic heart disease, severe cardiac decompensation, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, hypertension, and aneurysm; convulsive disorders or thyrotoxicosis; known or suspected prolongation of the QT interval (e.g. QT>0.44 s); patients unusually responsive to sympathomimetic amines; in some patients beta2-agonists may produce significant hypokalaemia; increases in plasma glucose after inhalation of high doses. Caution in planned operations with halogenated hydrocarbon anaesthetics due to increased susceptibility of adverse cardiac effects. Should not be used in conjunction with any other long-acting beta2-adrenergic agonists. Immediate hypersensitivity reactions may occur after administration. Should not be used more frequently than once daily. Benzalkonium chloride may cause wheezing and breathing difficulties; patients with asthma are at an increased risk for these adverse events. Interactions: Although no formal in vivo drug interaction studies have been performed, inhaled Spiolto Respimat has been used concomitantly with other COPD medicinal products, including short acting sympathomimetic bronchodilators and inhaled corticosteroids without clinical evidence of drug interactions. The co-administration of the component tiotropium with other anticholinergic containing drugs has not been studied and therefore is not recommended. Concomitant administration of other adrenergic agents (alone or as part of combination therapy) may potentiate the undesirable effects of Spiolto Respimat. Concomitant treatment with xanthine derivatives, steroids, or non-potassium sparing diuretics may potentiate any hypokalaemic effect of adrenergic agonists. Beta-adrenergic blockers may weaken or antagonise the effect of olodaterol. Cardioselective beta-blockers could be considered, although they should be administered with caution. MAO inhibitors, tricyclic antidepressants or other drugs known to prolong the QTc interval may potentiate the action of Spiolto Respimat on the cardiovascular system. Fertility, pregnancy and lactation: There is a very limited amount of data from the use of tiotropium in pregnant women. For olodaterol no clinical data on exposed pregnancies are available. As a precautionary measure, avoid the use of Spiolto Respimat during pregnancy. Like other beta2-adrenergic agonists, olodaterol may inhibit labour due to a relaxant effect on uterine smooth muscle. It is not known whether tiotropium and/or olodaterol pass into human breast milk. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Spiolto Respimat should be made taking into account the benefit of breast-feeding to the child and the benefit of therapy for the woman. Clinical data on fertility are not available for tiotropium or olodaterol or the combination of both components. Effects on ability to drive and use machines: No studies have been performed. The occurrence of dizziness or blurred vision may influence the ability to drive and use machinery. Undesirable effects: Uncommon (≥ 1/1,000 to <1/100): Dizziness, headache, tachycardia, cough, dysphonia, dry mouth. Rare (≥ 1/10,000 to <1/1,000): Insomnia, vision blurred, atrial fibrillation, palpitations, supraventricular tachycardia, hypertension, laryngitis, pharyngitis, epistaxis, bronchospasm, constipation, oropharyngeal candidiasis, gingivitis, nausea, stomatitis, hypersensitivity, angioedema, urticaria, pruritus, rash, arthralgia, back pain, joint swelling, urinary retention, urinary tract infection, dysuria. Not known (cannot be estimated from the available data): Nasopharyngitis, dehydration, glaucoma, intraocular pressure increased, sinusitis, intestinal obstruction ileus paralytic, dysphagia, gastrooesophageal reflux disease, glossitis, dental caries, anaphylactic reaction, skin infection and skin ulcer, dry skin. Serious undesirable effects consistent with anticholinergic effects: glaucoma, constipation, intestinal obstruction including ileus paralytic and urinary retention. An increase in anticholinergic effects may occur with increasing age. The occurrence of undesirable effects related to beta-adrenergic agonist class should be taken into consideration such as, arrhythmia, myocardial ischaemia, angina pectoris, hypotension, tremor, nervousness, muscle spasms, fatigue, malaise, hypokalaemia, hyperglycaemia and metabolic acidosis. Prescribers should consult the Summary of Product Characteristics for further information on side effects. Pack sizes: Single pack: 1 Respimat re-usable inhaler and 1 cartridge providing 60 puffs (30 medicinal doses); Single refill pack: 1 cartridge providing 60 puffs (30 medicinal doses) Legal category: POM. MA numbers: PA 775/9/1. Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prescribers should consult the Summary of Product Characteristics for full prescribing information. Additional information is available on request from Boehringer Ingelheim Ireland Ltd, The Crescent Building, Northwood, Santry, Dublin 9. Prepared in May 2020 Adverse events should be reported to the Health Products Regulatory Authority at www.hpra.ie or by email to medsafety@hpra.ie. Adverse events should also be reported to Boehringer Ingelheim Drug Safety on 01 291 3960 or by email to PV_local_uk_ireland@boehringer-ingelheim.com

Help reduce your patient’s carbon footprint with SPIOLTO® Respimat® tiotropium & olodaterol

This unique soft-mist inhaler, designed for efficient lung delivery, is also:1–5 P Propellant free P Reusable with up to 6 cartridges

1st month

3rd

4th

5th

6th

Throwing away the Respimat® inhaler every month is a thing of the past Remember to prescribe refill cartridges

tiotropium tiotropium

tiotropium & olodaterol

Prescribing Information for SPIRIVA® Respimat® can be found on the adjacent page

References: 1. Hochrainer D et al. J Aerosol Med Pulm Drug Deliv 2005;18(3):273–82. 2. Dalby R et al. Int J Pharm 2004;283(1–2):1–9. 3. Pitcairn G et al. J Aerosol Med 2005;18(3):264–72. 4. Hansel M et al. Adv Ther 2019;36(9):2487–92. 5. SPIOLTO® Respimat® Summary of Product Characteristics. Date of preparation: July 2020

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09/09/2020 26/08/2020 14:41 09:50 15/07/2020 12:02

Professional Directory IHCA National Council 2020-2021

NAME HOSPITAL/REGION SPECIALITY Eastern Region Dr Gabrielle Colleran CHI at Temple Street/NMH Radiology Dr Laura Durcan Beaumont Hospital Rheumatology Prof Alan Irvine CHI at Crumlin Dermatology Dr David Kevans St James’s Hospital Gastroenterology Mr Rustom Manecksha Tallaght University Hospital Urological Surgery Dr Donal O’Hanlon Naas General Hospital Psychiatry Dr Ioannis Polyzois Dublin Dental Hospital Periodontology South Eastern Region Dr Carmel Ann Daly Dr Robert Landers Dr Conor O’Riordan

University Hospital Waterford University Hospital Waterford St Luke’s Hospital, Kilkenny

Radiology Histopathology Radiology

Midland Region Prof Clare Fallon Dr Conor Meehan

Midland Regional Hospital, Mullingar Midland Regional Hospital, Tullamore

Geriatric Medicine Radiology

North Eastern Region Dr Tripuraneni Prasad Dr Mike Staunton

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

Radiology Anaesthesiology

North Western Region Dr Áine Burke Dr John Scully

Sligo University Hospital Letterkenny University Hospital

Haematology Anaesthesiology

Western Region Dr Conall Dennedy Dr Brian Egan Mr Colm Fahy

Galway University Hospitals Mayo University Hospital Galway Clinic

Endocrinology Gastroenterology Otolaryngology

Mid Western Region Mr Colin Peirce Ms Shona Tormey

University Hospital Limerick University Hospital Limerick

General Surgery General Surgery

Southern Region Ms Eimear Conroy University Hospital Kerry Dr Sinead Harney Cork University Hospital Dr Noirin Russell Cork University Maternity Hospital Mr Peter Ryan Bon Secours Hospital, Cork Co-Options Dr P J Breen Retired Representative Vacant Vacant Vacant Vacant

001-077_IHCA Client Section 2021_v9.indd 76

Orthopaedic Surgery Rheumatology Obstetrics & Gynaecology Urological Surgery

Anaesthesiology

www.ihca.ie

02/10/2020 12:18

Professional Directory IHCA Officer Board 2020-2021

President Prof Alan Irvine Consultant Dermatologist, Children’s Health Ireland at Crumlin, Dublin 12.

Vice President Dr Gabrielle Colleran Consultant Paediatric Radiologist, National Maternity Hospital, Holles Street, Dublin 2 and CHI at Temple Street, Dublin 1. Vice President Vacant

Membership Secretary Dr Conor O’Riordan Consultant Radiologist, St Luke’s Hospital, Kilkenny. Treasurer Prof Clare Fallon Consultant in Geriatric Medicine, Midland Regional Hospital, Mullingar. Immediate Past President Dr Donal O’Hanlon Consultant Psychiatrist, Naas General Hospital, Co. Kildare.

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

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

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

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

www.ihca.ie

001-077_IHCA Client Section 2021_v9.indd 77

02/10/2020 12:18

Professional Directory

Voluntary & Support Organisations

A Little Lifetime Foundation - for bereaved parents and their families 18 Orion Business Campus, Rosemount Business Park, Ballycoolin, Blanchardstown, D 15. Tel: (01) 882 9030 Email: info@alittlelifetime.ie Web: www.alittlelifetime.ie Alcoholics Anonymous Ireland General Service Office, Unit 2, Block C, Santry Business Park, Swords Road, Dublin 9, D09 H584. Tel: (01) 842 0700, Mobile for the deaf and Hard of Hearing: (087) 146 0387 Email: gso@alcoholicsanonymous.ie Web: www.alcoholicsanonymous.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

078-081_IHCA Client Section 2021_v7.indd 78

Arthritis Ireland 1 Clanwilliam Square, Grand Canal Quay, Dublin 2, D02 DH77. Tel: 1890 252 846 / (01) 661 8188 Fax: (01) 661 8261 Helpline: 1890 252 846 Email: helpline@arthritisireland.ie Web: www.arthritisireland.ie

Bodywhys â&#x20AC;&#x201C; Eating Disorders Association of Ireland PO Box 105, Blackrock, Co. Dublin. Tel: (01) 283 4963 Helpline: (01) 210 7906 Email: info@bodywhys.ie Email Support Service: alex@bodywhys.ie Web: www.bodywhys.ie

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

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

Aware 9 Upper Leeson Street, Dublin 4, D04 KD80. Tel: (01) 661 7211 Helpline: 1800 804 848 Email: info@aware.ie Web: www.aware.ie

www.ihca.ie

02/10/2020 12:20

Professional Directory

Voluntary & Support Organisations

Chime - National Charity for Deafness and Hearing Loss 35 North Frederick Street, Dublin 1. Tel: (01) 817 5700 Text: (087) 922 1046 Email: info@chime.ie Skype: Chime NFS Web: www.chime.ie CLAPAI - Cleft Lip and Palate Association of Ireland c/o 36 Woodlands Avenue, Glenageary, Co. Dublin, A96 R2F4. Tel: 087 131 9803 Email: info@cleft.ie Web: www.cleft.ie

Coeliac Society of Ireland Carmichael Centre for Voluntary Groups, 4 North Brunswick Street, Dublin 7, D07 RHA8. Tel: (01) 872 1471 Email: info@coeliac.ie Web: www.coeliac.ie

www.ihca.ie

078-081_IHCA Client Section 2021_v7.indd 79

Coolmine Therapeutic Community Coolmine House, 19 Lord Edward Street, Dublin 2. Tel: (01) 679 4822 Email: info@coolminetc.ie Web: www.coolmine.ie COPE Foundation Bonnington, Montenotte, Cork, T23 PT93. Tel: (021) 464 3100 Fax: (021) 450 7580 Email: headoffice@cope-foundation.ie Web: www.cope-foundation.ie CuidiÃº Carmichael Centre, 4 North Brunswick Street, Dublin 7. Email: info@cuidiu.ie Web: www.cuidiu.ie Cystic Fibrosis Ireland CF House, 24 Lower Rathmines Road, Dublin 6. Tel: (01) 496 2433 Tel: 1890 311211 Fax: (01) 496 2201 Email: info@cfireland.ie Web: www.cfireland.ie

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

02/10/2020 12:20

Professional Directory

Voluntary & Support Organisations

Epilepsy Ireland 249 Crumlin Road, Crumlin, Dublin 12, D12 RW92. Tel: (01) 455 7500 Email: info@epilepsy.ie Web: www.epilepsy.ie GROW – Mental Health Recovery 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, D01 A4A3. Tel: (01) 876 5300, Fax: (01) 856 1299 Email: hpsc@hse.ie Web: www.hpsc.ie Huntington’s Disease Association of Ireland Carmichael House, 4 North Brunswick Street, Dublin 7. Tel: (01) 872 1303 Helpline: 1800 393939 Email: info@huntingtons.ie Web: www.huntingtons.ie Irish Cancer Society 43/45 Northumberland Road, Dublin 4, D04 VX65. Tel: (01) 231 0500 Fax: (01) 231 0555 Freephone: 1800 200 700 Email: info@irishcancer.ie Web: www.cancer.ie

078-081_IHCA Client Section 2021_v7.indd 80

Irish Deaf Society Deaf Village Ireland, Ratoath Road, Cabra, Dublin 7. Tel: (01) 860 1878 Text: (086) 380 7033 Skype: irishdeafsociety Email: info@irishdeafsociety.ie Web: www.irishdeafsociety.ie Irish Family Planning Association Solomons House, 42a Pearse Street, Dublin 2. Tel: (01) 607 4456 National Pregnancy Helpline: 1850 495051 Email: reception@ifpa.ie Web: www.ifpa.ie Irish Haemophilia Society First Floor, Cathedral Court, New Street, Dublin 8, D08 VH64. Tel: (01) 657 9900 Fax: (01) 657 9901 Email: info@haemophilia.ie Web: www.haemophilia.ie Irish Heart Foundation 17-19 Rathmines Road Lower, Dublin D06 C780. Tel: (01) 668 5001 Fax: (01) 668 5896 Email: info@irishheart.ie Web: www.irishheart.ie Irish Hospice Foundation 4th Floor, Morrison Chambers, 32 Nassau Street, Dublin 2, D02 YE06. Tel: (01) 679 3188 Bereavement Support Line: 1800 80 70 77 Email: info@hospicefoundation.ie Web: www.hospicefoundation.ie

Irish Kidney Association Head Office, Donor House, Block 43A, Park West, Dublin 12, D12 P5V6. Tel: (01) 620 5306 Email: info@ika.ie Web: www.ika.ie Irish Motor Neurone Disease Association Unit 3, Ground Floor, Marshalsea Court, 22/23 Merchant’s Quay, Dublin 8, D08 C6XP. Tel: (01) 873 0422 Helpline: 1800 403 403 Email: info@imnda.ie Web: www.imnda.ie Irish Multiple Births Association Carmichael Centre, 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 Email: admin@autism.ie Web: www.autism.ie Irish Wheelchair Association Áras Cúchulainn, Blackheath Drive, Clontarf, Dublin 3. Tel: (01) 818 6400 Email: info@iwa.ie Web: www.iwa.ie LGBT Ireland 7 Red Cow Lane, Smithfield, Dublin 7. Tel: (01) 6859280 Helpline: 1890 929 539 Email: info@lgbt.ie Web: www.lgbt.ie

www.ihca.ie

02/10/2020 12:20

Professional Directory

Voluntary & Support Organisations

Meningitis Research Foundation Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK. Helpline: 1800 41 33 44 Fax: (01) 819 6903 Email: helpline@meningitis.org Web: www.meningitis.org Mental Health Ireland 1-4 Adelaide Road, Glasthule, Co. Dublin, A96 D7W7. Tel: (01) 284 1166 Email: info@mentalhealth.ie Web: www.mentalhealthireland.ie Miscarriage Association of Ireland Carmichael Centre, 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 My Options - HSE Sexual Health & Crisis Pregnancy Programme Freephone: 1800 828 010 Web: www2.hse.ie/unplanned-pregnancy/

www.ihca.ie

078-081_IHCA Client Section 2021_v7.indd 81

National Council for the Blind Head Office, Whitworth Road, Drumcondra, Dublin 9. Tel: (01) 830 7033 Fax: (01) 830 7787 Helpline: 1850 33 43 53 Email: info@ncbi.ie Web: www.ncbi.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

Pact – Adoption Agency Arabella House, 18D Nutgrove Office Park, Rathfarnham, Dublin 14, D14 FC03. Tel: (01) 296 2200 Email: info@pact.ie Web: www.pact.ie

Spina Bifida Hydrocephalus Ireland National Resource Centre, Old Nangor Road, Clondalkin, Dublin 22, D22 W5C1. Tel: (01) 457 2329 Email: info@sbhi.ie Web: www.sbhi.ie

Rape Crisis Network Ireland Carmichael Centre, North Brunswick Street, Dublin 7, D07 RHA8. Tel: (01) 865 6954 Email: admin@rcni.ie Web: www.rcni.ie

St Michael’s House Ballymun Road, Ballymun, Dublin 9, D09 DX37. Tel: (01) 884 0200 Email: info@smh.ie Web: www.smh.ie

Rehab Group 10D Beckett Way, Park West Business Park, Park West, Dublin 12. Tel: (01) 205 7200 Fax: (01) 205 7211 Email: info@rehab.ie Web: www.rehab.ie Samaritans Ireland 4-5 Usher’s Court, Usher’s Quay, Dublin 8. Tel: (01) 671 0071 Helpline: 116 123 Email: jo@samaritans.ie Web: www.samaritans.org Scoliosis Ireland Email: scoliosisirl@gmail.com Web: www.scoliosis-Ireland.ie

02/10/2020 12:20

Charts & Tables (as of December 2019)

Acute Hospital Services Acute Hospital Services Overview of Key Acute Hospital Activity Overview of Key Acute Hospital Activity Expected Activity YTD

Activity Area

Result YTD Dec 2019

Result YTD Dec 2018

% Var YTD

SPLY % Var

Current (-2)

Current (-1)

Current

Emergency Presentations

1,475,136

1,506,343

+2.1%

1,467,646

+2.6%

126,687

124,572

128,971

New ED Attendances

1,228,415

1,251,405

+1.9%

1,224,495

+2.2%

104,780

103,413

107,925

OPD Attendances

3,339,859

3,354,168

+0.4%

3,337,048

+0.5%

304,370

290,594

234,027

Expected Activity YTD

Activity Area (HIPE data month in arrears) Inpatient discharges

584,475

Inpatient weight units

583,801

Day case (includes dialysis)

992,284

Day case weight units (includes dialysis) IP & DC Discharges

Result YTD Nov 2019

Result YTD Nov 2018

% Var YTD

582,946

-0.3%

588,844

579,005

-0.8%

1,022,994

+3.1%

SPLY % Var

Current (-2)

Current (-1)

Current

-1.0%

51,771

54,325

53,557

591,174

-2.1%

50,925

53,161

51,767

996,025

+2.7%

92,674

97,974

95,271

963,431

997,813

+3.6%

978,683

+2%

89,819

94,517

91,029

1,576,759

1,605,940

+1.9%

1,584,869

+1.3%

144,445

152,299

148,828

37.1%

36.3%

37.2%

-2.3%

35.8%

35.7%

36%

62.8%

+1.4%

64.2%

64.3%

64%

402,240

-0.3%

34,966

37,027

36,752

% IP % DC

62.9%

63.7%

406,841

400,848

-1.5%

Elective IP discharges

79,231

84,726

+6.9%

84,979

-0.3%

7,840

8,637

8,856

Maternity IP discharges

98,403

97,372

-1%

101,625

-4.2%

8,965

8,661

7,949

Emergency IP discharges

Health Services Performance Profile October 2019 Inpatient, Day case and- December Outpatient Waiting Lists

Inpatient, Day case and Outpatient Waiting Lists Target/ Expected Activity

Performance area Inpatient adult waiting list within 15 months Day case adult waiting list within 15 months Inpatient children waiting list within 15 months Day case children waiting list within 15 months Outpatient waiting list within 52 weeks

Current Period YTD

Freq

Outliers RUH (66.7%), GUH (69.1%), Tullamore (77.8%) MUH (84.6%), UHW (85.4%), SJH (85.7%)

+1.7%

84.8%

85.5%

86%

95%

93.3%

92.9%

+0.4%

92.3%

92.9%

93.3%

30 out of 41 hospitals reached target

85%

91.9%

89.8%

+2.1%

91.8%

91.5%

91.9%

19 out of 19 hospitals reached target

90%

85.4%

83.9%

+1.5%

83%

84.6%

85.4%

23 out of 26 hospitals reached target

CHI (81.4%), GUH (84.7%), UHW (86.7%)

80%

68.9%

70.4%

-1.4%

68.6%

68.7%

68.9%

16 out of 43 hospitals reached target

Croom (46.9%), RVEEH (51.9%), UHW (56.5%)

Outpatient Waiting List

6,112

4,921

4,419

100,000 50,000 0

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

Waiting List Numbers 132,827

117,557

102,924

89,950

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

18m+

Outpatient Waiting List Total

85,000

580,000

80,000

560,000

65,000

Best performance

84.3%

Inpatient & Day Case Waiting

70,000

Current

86%

6,897

75,000

Current (-1)

150,000

15m+

Current (-2)

85%

10,000

SPLY Change

28 out of 37 hospitals reached target

Inpatient & Day Case Waiting List

5,000

SPLY YTD

OPD

540,000 70,204

66,563

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

Health Services Performance Profile October - December 2019

520,000 500,000 480,000

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

Total

Total SPLY

SPLY Change

>12 Mths

>15 Mths

17,459

17,530

-71

3,344

2,444

42,243

46,350

-4,107

4,514

2,843

59,702

63,880

-4,178

7,858

5,287

2,765

2,350

415

403

225

4,096

3,974

122

856

600

6,861

6,324

537

1,259

825

553,433

516,162

37,271

171,897

132,827

553,433 516,162 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total

Source: Health Service Performance Profile October to December 2019 Quarterly Report 82

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 82

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02/10/2020 12:34

Charts & Tables (as of December 2019)

ED Performance ED Performance

Target/ Expected Activity

Performance area

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

Current Period YTD

Freq

75% Target/ Expected 99% Activity

Freq M

99% 75%

% 75 years within 24 hours within 6 hours

% patients admitted or discharged within 6 hours % in ED < 24 hours 99% M 80% 75% % 75 years within 24 hours 99% M 70% % patients admitted or discharged within 6 hours 60% 63.8% 60.2% 80% 75% 50% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 18/19 63.8% 60.2% Colonoscopy 50% Target/ Dec Jan Feb Aug Sep Oct Nov Dec Performance areaMar Apr May Jun Jul Expected Freq Month 18/19 Activity 70% 60%

Colonoscopy Urgent Colonoscopy – number of

0 M Colonoscopy people waiting > 4 weeks (new) Target/ Bowelscreen – number Performance area Expected Freq colonoscopies scheduled > 20 M Activity working days Urgent Colonoscopy – number of 0 M Routine Colonoscopy and OGD people waiting > 4 weeks (new) 70% M <13 weeks – number Bowelscreen colonoscopies scheduled > 20 M Urgent - number of people waiting working Colonoscopy days (new) Routine Colonoscopy and OGD 70% M <13 weeks 80 60 Urgent Colonoscopy - number of people waiting 40 (new) 0 4 20 0 80 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 60 Month 18/19 40 20 0

Health Services Performance Profile October - December 2019

SPLY YTD

SPLY Change

Current (-2)

Current (-1)

Current

Best performance

Outliers

SLK (91.7%), St Tallaght - Adults (33.5%), Michael’s (88.9%), Beaumont (37.4%), Naas CHI (80.4%) (39.3%) Current Best performance Outliers 11 out of 28 hospitals Naas (88.9%), Mercy 95.8% achieved target (89.4%), UHK (90.1%) SLK St Tallaght - AdultsNaas (33.5%), 8 out(91.7%), of 27 hospitals Mercy (74.6%), 90.2% 89.7% 87% 88.8% 91.5% -1.3% 62.7% 64.6% -1.9% 62.7% 60% 60.2% achieved Michael’s target (88.9%), Beaumont (37.4%), Naas (74.8%), GUH (75.3%) CHI (80.4%) (39.3%) ED over 24 hours % 7511years old or older admitted or discharged out of 28 hospitals Naas (88.9%), Mercy 96.1% 96.5% -0.4% 95.7% 95.1% 95.8% achieved target (89.4%), UHK (90.1%) 10,000 100% 8 out of 27 hospitals Mercy (74.6%), Naas 99% 90.2% 91.5% -1.3% 89.7% 87% 88.8% achieved target (74.8%), GUH (75.3%) 3,212 4,962 90% 5,000 ED over 24 hours % 75 years old or older admitted or discharged 92.9% 1,011 1,776 88.8% 10,000 100% 0 80% 0 99% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 3,212 4,962 Patients 75+ >24 hrs All patients > 24 hrs 90% 5,000 Month 18/19 92.9% 1,011 1,776 88.8% 0 80% 0 DecSPLY Jan Feb MarSPLY Apr May JunCurrent Jul Aug Sep Current Oct Nov Dec Current Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Current Best performance Outliers Period YTD YTD Change (-2) Patients 75+ >24 hrs All patients >(-1) 24 hrs Month 18/19 62.7% Current Period96.1% YTD

64.6% SPLY YTD 96.5%

-1.9% SPLY Change -0.4%

62.7% Current (-2) 95.7%

60% Current (-1) 95.1%

60.2%

209

253

-44

Current 577 Period YTD

SPLY 1416 YTD

SPLY -839 Change

Current (-2) 78

Current (-1) 57

Current 58

209 55.4%

253 59.1%

-44 -3.7%

5 50.3%

25 54.4%

4 55.4%

577 78 1416 -839 BowelScreen – Urgent Colonoscopies

Current Current Current (-1) 54.4% -3.7%(-2) 50.3%

55.4% 59.1% Number deemed 296 315 suitable for colonoscopy BowelScreen – Urgent Colonoscopies Number scheduled over 78 Current 57 Current 20 working days (-2) (-1) Number deemed 296 315 suitable for colonoscopy Number scheduled over 78 57 20 working days

249 58 Current 249 58

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

36 out of 37 hospitals achieved target 8 hospitals have 0 Best performance

UHK (4) Wexford (25), Mater (22), Outliers GUH (5)

36 out out of of 37 37 hospitals hospitals 16 achieved target target achieved 8 hospitals have 0

UHK (4) (11%), UHL Nenagh (29.6%), Tallaght - Adults Wexford (25), Mater (22), (33.1%) 58 GUH (5) Number on waiting list for GI Scopes 16 out of 37 hospitals Nenagh (11%), UHL 12,329 11,137 55.4% 12,000 achieved target (29.6%), Tallaght - Adults (33.1%) 10,000 9,915 Number on waiting list for GI Scopes 8,000 12,329 7,710 11,137 12,000 6,000 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 10,000 <13 weeks > 13 week breaches 9,915 8,000 7,710 47 6,000 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec <13 weeks > 13 week breaches

Health Services Performance Profile October - December 2019

HCAI Performance HCAI Performance

Target/ Expected Activity

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

Freq

Current Period YTD

1.0

M Q

100%

Rate of Staph. Aureus bloodstream infections

0.5

0.9

<1 1.0

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

SPLY Change

Current (-2)

Current (-1)

Current

1.0

1.1

1.0

2.6

2.1

+0.5

2.9

2.4

2.6

74.5%

53.3%

+21.2%

70.2%

74.5%

Rate of new cases of C Difficile associated diarrhoea

1.5 1.0

SPLY YTD

Best performance

Outliers

37 out of 47 hospitals achieved target 27 out of 47 hospitals achieved target

MMUH, Navan (3.5), OLOL (3.3) Mallow (7.2), RUH (6.1), Bantry (5.9)

35 out of 47 hospitals achieved target

12 hospitals did not achieve the target

Requirements for screening with CPE Guidelines 100%

3.1 2.9 2.7 2.5 2.3 2.1 1.9 1.7

2.6 2.1 <2

1.8

50%

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

Month 18/19

Month 17/18

Month 18/19

100% 74.5%

55.3%

Q2 Q3 Quarter 18/19

Delayed Transfers of Care Performance area Number of beds subject to Delayed Transfers of Care

Target/ Expected Activity

Current Period YTD

Freq

≤550

545

Delayed Transfers of Care 750

Source: Health Service Performance Profile -550 650 480 October to December 2019 Quarterly Report 545 550 476

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

www.ihca.ie Month 17/18

Health Services Performance Profile October - December 2019

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 83

SPLY Change

476

Current (-2)

+69

Current (-1)

680

682

Delayed Transfers of Care by Destination Over Under Total 65 65

850

450

SPLY YTD

101

18.5%

346

63.5%

Other

18%

Total

424

121

545

100%

Long Term Nursing Care

545

Best performance Ennis (0), Mullingar, PUH, Mallow, UHK, St. John’s (2)

Outliers SJH (71), Beaumont (55), OLOL, Tallaght- Adults (42)

Total %

306

Home

Current

83 48

02/10/2020 12:34

HCAI Performance

Target/ Expected Activity

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

Freq

Current Period YTD

1.0

M Q

100%

Rate of Staph. Aureus bloodstream infections

0.5

0.9

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

Delayed Discharges

Current (-2)

Current (-1)

Current

1.0

1.1

1.0

2.6

2.1

+0.5

2.9

2.4

2.6

74.5%

53.3%

+21.2%

70.2%

74.5%

Best performance 37 out of 47 hospitals achieved target 27 out of 47 hospitals achieved target

MMUH, Navan (3.5), OLOL (3.3) Mallow (7.2), RUH (6.1), Bantry (5.9)

35 out of 47 hospitals achieved target

12 hospitals did not achieve the target

100%

(as of December 2019) 2.6

Month 18/19

Month 17/18

55.3%

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

100% 74.5%

50%

2.1 <2

1.8

Outliers

Requirements for screening with CPE Guidelines

Charts & Tables

3.1 2.9 2.7 2.5 2.3 2.1 1.9 1.7

<1 1.0

Month 17/18

SPLY Change

Rate of new cases of C Difficile associated diarrhoea

1.5 1.0

SPLY YTD

Month 18/19

Q2 Q3 Quarter 18/19

Delayed Transfers of Care Performance area Number of beds subject to Delayed Transfers of Care

Target/ Expected Activity

Current Period YTD

Freq

≤550

545

Delayed Transfers of Care 750 550 450

SPLY Change

476

Current (-2)

Current (-1)

680

+69

101

18.5%

346

63.5%

Other

18%

Total

424

121

545

100%

Long Term Nursing Care

476

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

Best performance

545

Outliers

Ennis (0), Mullingar, PUH, Mallow, UHK, St. John’s (2)

SJH (71), Beaumont (55), OLOL, Tallaght- Adults (42)

Total %

306

Home

550 545

480

Current

682

Delayed Transfers of Care by Destination Over Under Total 65 65

850 650

SPLY YTD

Health Services Performance Profile October - December 2019

Surgery and Medical Performance Surgery and Medical Performance Performance area Emergency re-admissions within 30 days of discharge Procedure conducted on day of admission (DOSA) Laparoscopic Cholecystectomy day case rate Surgical re-admissions within 30 days of discharge Hip fracture surgery within 48 hours of initial assessment

Target/ Expected Activity

Current Period YTD

Freq

10.3%

10.5%

9.9%

26 out of 34 hospitals achieved target

82%

M-1M

75.4%

74.6%

+0.8%

76.4%

79.1%

78.4%

14 out of 35 hospitals achieved target

60%

M-1M

43.7%

45.3%

-1.6%

43.5%

39.1%

41.2%

≤3%

M-1M

1.7%

1.9%

1.7%

85%

Q-1Q

76.4%

77.4%

75.2%

76.7%

Procedure conducted on day of admissions

10.2% 10.2%

9.9%

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

85% 80% 75% 70% 65%

45.9%

45.4%

40%

41.2% Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Month 18/19

Health Services Performance Profile October - December 2019

3% 2% 1%

100%

75%

80%

Month 18/19

Surgical re-admissions within 30 days

1.9%

Outliers Ennis (17.7%), Columcille’s (14.5%), LUH (14.1%) UHK (64.1%), Sth Tipperary (73.1%), Tallaght- Adults (71.4%) 7 Hospitals that had cases at 0% SLK (3.8%), OLOL (3.3%), Portlaoise (3.1%) UHW (55.6%), CUH (56.4%), OLOL (59.1%)

Hip fracture surgery within 48 hours

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

12 out of 34 hospitals achieved target 35 out of 38 hospitals achieved target 7 out of 16 hospitals achieved target

82% 78.4%

74.9%

Month 18/19

60%

Month 17/18

Best performance

+0.1%

60%

30%

Current

11.3%

Laparoscopic Cholecystectomy day case rate

50%

Current (-1)

11.4%

≤11.1%

Month 17/18

Current (-2)

M-1M

12%

SPLY Change

≤11.1%

Emergency re-admissions within 30 days

10%

SPLY YTD

85%

60%

76.7%

≤3% 1.9% 1.7%

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

Month 18/19

Source: Health Service Performance Profile October to December 2019 Quarterly Report 84

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 84

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Charts & Tables (as of December 2019)

Pre-Hospital Emergency Care Services Pre-Hospital Emergency Care Services Performance area Pre-Hospital

Target/

Current

ExpectedCare Freq Services Emergency Period YTD Activity

Performance area Response Times – ECHO ECHO Response Times – DELTA

SPLY Change

Current (-2)

Current (-1)

Current

Current 79.4% (-2)

Current 79.1% (-1)

Current 75.9%

NorthBest Leinster (80%) performance Dublin Fire Brigade( 78%)

Western Area (69.1%), South Outliers (73.4%) Southern Area(69.1%), (47.3%) South Western Area Western (73.4%) Area (53.9%), Dublin Fire Brigade (33.3%) Southern Area (47.3%) Western Area (53.9%), Dublin Fire Brigade (33.3%)

Best performance

Outliers

Target/ Expected 80% Activity

Freq M

Current Period79.5% YTD

SPLY 79.5% YTD

SPLY 0% Change

80%

79.5% 55.6%

79.5% 57.4%

0% -1.8%

79.4% 56%

79.1% 53%

75.9% 48.9%

North Leinster (80%) North (58.2%), DublinLeinster Fire Brigade( 78%)

55.6% 59.2%

57.4% 52.9%

-1.8% +6.3%

56% 62.5%

53% 64%

48.9% 58.1%

North Leinster (58.2%),

59.2% 97.8%

52.9% 97.1%

+6.3% +0.7%

62.5% 98.4%

64% 97.3%

58.1% 96.2%

43.6% 97.8%

47.1% 97.1%

-3.5% +0.7%

36.8% 98.4%

47.7% 97.3%

45% 96.2%

43.6%Response 47.1%Times-3.5% – ECHO36.8% 90%

47.7%

45%

Ambulance Turnaround Response Times – DELTA 80% M % delays escalated within 95% M 30 minutes Ambulance Turnaround Turnaround Ambulance % delays delays escalated escalated within within 95% M % 95% M 30 minutes minutes 60 Ambulance Turnaround Return of spontaneous 40% Q-1 % delays escalated 95% M circulation (ROSC) within 60 minutes Return of spontaneous Ambulance Turnaround - within 30 40% minutes Q-1 circulation (ROSC) Ambulance Turnaround - within 30 minutes 85%

95% 59.6% 58.1% 95%

65% 85%

51.7% 59.6% 58.1% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 51.7% Month18 Month 18/19 45% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Ambulance Turnaround - within 60 minutes Month18 Month 18/19 45% 65%

100% 98%Turnaround - within 60 minutes Ambulance 98% 100% 98% 96% 98% 94% 96%

97.4% 96.2% 97.4% 96.2% 95%

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 95% Month17/18 Month 18/19 94% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Health Services Performance Profile October - December 2019

Month17/18

SPLY YTD

Month 18/19

Health Services Performance Profile October - December 2019

ROSC

79.7% Response Times – ECHO 85% 80% 90% 80% 79.7% 85% 80% 75% 80% 80% 70% 80% 75% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

55% ROSC

Month17/18 Month 18/19 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Response Times –Month17/18 DELTA Month 18/19

35%

70%

80% 85% Response Times – DELTA 75% 80% 54.7% 85% 65% 54% 48.9% 75% 55% 54.7% 65% 45% 54% 48.9% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 55% 45%

55% 45% 45% 35%

45.1%

48.1%

45.1%

48.1% 40% 45%

45%

Q 17/18

Q2 Q 18/19

Q3 Q4 Q1 Q2 17/18 Call Volumes (arrivedQat scene) Q 18/19 Target/ Current % SPLY Expected Period Var YTD Call Volumes (arrived at scene) Activity YTD YTD Target/ Current % SPLY ECHO 4,940 4,965 0.5% 4,877 Expected Period Var YTD Activity YTD YTD DELTA 129,000 132,775 2.9% 128,574 ECHO 4,940 4,965 0.5% 4,877 DELTA

129,000

132,775

2.9%

128,574

Q3 40% Q3 SPLY change SPLY 88 change 4,201 88 4,201

Month17/18 Month 18/19 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month17/18

Month 18/19

51 51

Source: Health Service Performance Profile October to December 2019 Quarterly Report 86

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 86

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Charts & Tables (as of December 2019)

Mental Health Services Mental Health ServicesCommunity Mental Health Teams Child and Adolescent Child and Adolescent Community Mental Health Teams Target/ Expected Activity

Performance Area

Current Period YTD

Freq

SPLY YTD

SPLY Change

Current (-2)

Current (-1)

Current

Best Performance

Outliers

Admission of Children to CAMHs

75%

83.7%

70.7%

+13%

77.8%

89.3%

90.5%

CAMHs Bed Days Used

95%

95.4%

93.7%

+1.7%

94%

96.9%

CHO1, 2, 4, 5, 6, 7, 8, 9 reached target

CHO3 (84.2%)

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

95%

95.8%

95.6%

+0.2%

97.8%

97.9%

98.6%

CHO1, 2, 3, 5, 6, 7, 8, 9 reached target

CHO4 (91.6%)

2,498

2,327

2,526

-199

2,099

2,158

2,327

212

314

-102

202

195

212

18,831

18,650

+181

1,726

1,700

1,258

11,139

10,796

+343

1,037

972

731

76.3%

79.8%

89.5%

86.5%

CAMHs waiting list CAMHs waiting list > 12 months

18,128 YTD 18,128 FYT 10,833 YTD 10,833 FYT

No of referrals received Number of new seen % of urgent referrals to Child and Adolescent Mental Health Teams responded to within three working days (New KPI)

100%

% offered an appointment and seen within 12 weeks 85% 75%

First appointment within 12 months 100%

83.4% 81%

81.6%

96%

72%

55%

88% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 17/18 Month 18/19

CHO4 (619), CHO6 (412), CHO1 (329) CHO4 (145), CHO1 (39), CHO6 (19)

CHO2 (52.2%), CHO5 (85.7%), CHO7 (90.9%)

CHO1, 3, 6, 9 reached target

Waiting list > 12 months 98.6% 98.5%

97.6%

95%

92%

65%

CHO2 (35), CHO5 (144), CHO7 (144) CHO2 (0), CHO7 (0), CHO9 (0)

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

400 350 300 250 200 150 100 50 0

320

314 212

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

Month 18/19

Health Services Performance Profile October - December 2019

General Adult Mental Health General Adult Mental Health Performance Area General Adult

Target/

Expected Mental Health

Performance Area received Number of referrals Number Number of of referrals referrals seen received % seen within 12 weeks Number of referrals seen

Activity Target/ 43,819 YTD Expected 43,819 FYT Activity 28,716 YTD 43,819 YTD 28,716 43,819 FYT FYT

Outliers

Current 4,152 (-2)

Current 3,738 (-1)

Current 2,887

Best Performance

Outliers

1,862 2,887

28,716 75% YTD 28,716 FYT

M M

72.9% 26,878

72.7% 27,124

+0.2% -246

74% 2,418

74.6% 2,332

72% 1,862

CHO2, 1 & 6 reached target

CHO9 (59.1%), CHO5 (64.7%), CHO7 (64.8%)

75%

72.9%

72.7%

+0.2%

74%

74.6%

72%

CHO2, 1 & 6 reached target

CHO9 (59.1%), CHO5 (64.7%), CHO7 (64.8%)

Target/

Activity Target/ 12,455 YTD Expected 12,455 FYT Activity 8,896 YTD YTD 12,455 8,896 FYT 12,455 FYT

Current Period YTD Current

Freq Freq M

8,896 95% YTD 8,896 FYT

Period 12,423 YTD

SPLY YTD

SPLY Change

Current (-2)

Current (-1)

Current

Best Performance

Outliers

SPLY 12,215 YTD

SPLY +208 Change

Current 1,040 (-2)

Current 1,142 (-1)

Current 853

Best Performance

Outliers

M M

8,921 12,423

8,553 12,215

+368 +208

769 1,040

786 1,142

563 853

M M

94% 8,921

95.2% 8,553

-1.2% +368

92.8% 769

92.8% 786

93.3% 563

75.1% 75% 72%

75%

75.1% 73% 72% 69% 75% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 18/19

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

Best Performance

SPLY +175 Change

2,332 3,738

75%

69%

Current

SPLY 43,505 YTD

2,418 4,152

Adult Mental Health - % offered an appointment and seen 77% within 12 weeks

Month 17/18

Current (-1)

-246 +175

% seen within Health 12 weeks 95% Mand Adult Mental - % offered an appointment seen within 12 weeks

77% 73%

Current (-2)

27,124 43,505

Psychiatry Later Life Performance PsychiatryArea ofof Later LifeExpected

% seen within 12 weeks Number of referrals seen

Period 43,680 YTD

SPLY Change

26,878 43,680

Psychiatry of Later Life

Number of of referrals referrals seen Number received

Freq M

SPLY YTD

M M

% seen within 12 weeks

Performance Area received Number of referrals

Current Period YTD Current

Freq

Month 18/19

Health Services Performance Profile October - December 2019 Health Services Performance Profile October - December 2019

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 88

94% 95.2%of Later -1.2% 92.8% an appointment 92.8% 93.3% Psychiatry Life - % offered and seen within 12 weeks

CHO2, 3, 5, 6 & 9 reached target

CHO7 (71.9%), CHO4 (85%), CHO8 (87.1%)

CHO2, 3, 5, 6 & 9 reached target

CHO7 (71.9%), CHO4 (85%), CHO8 (87.1%)

Psychiatry of Later Life - % offered an appointment and seen within 12 weeks 98% 98% 95% 95% 92% 92%

96.2%

95.9% 95%

96.2%

93.3% 95.9% 95%

93.3% Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 17/18 Month 18/19 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 17/18 Month 18/19 24

Source: Health Service Performance Profile 24 October to December 2019 Quarterly Report

www.ihca.ie

02/10/2020 12:37

 Excluding pre-registration nursing and midwifery interns, the YTD change (+160 WTE) is substantially lower than both December 2018 (+1,133 WTE) and that of the 5 year December trend (+1,099 WTE), albeit the change in the month (+121 WTE) is higher than the 5 year average (+43WTE).  Four of the six staff categories are showing increases this month. Patient & Client Care is showing the largest (+60 WTE) mainly related to Home Helps +31 WTE and Health Care Assistants +13 WTE. Health & Social Care Professionals is +42 WTE (largely owing to an increase in Social Care +21 WTE). Nursing & Midwifery is + 41 WTE (largely due to Staff Nurse/Staff December 2019) Midwife +27 WTE), and Medical & Dental is +20 WTE (largely owing to +14 WTE Medical/Dental Other). Both General Support (-25 WTE) and Management/Administrative (-5 WTE) decreased this month.

Charts & Tables (as of

 Eight of the nine CHOs are showing increases this month, with CHO 2 showing the largest increase (+40 WTE). At a divisional level, Disabilities (+138 WTE), Mental Health (+26 WTE) and Older People (+18 WTE) are showing an increase, while Primary Care is showing a decrease (-50 WTE).

Health Sector Workforce

At the end of December 2019 Health Services employment levels stand at 119,817 whole-time equivalents (WTE).

Overall headlines this month •

When compared with the November 2019 figure (119,532 WTE), the change this month shows an increase of +286 WTE. Excluding pre-registration nursing and midwifery interns the change is +303 WTE. Overall this month’s increase is largely attributable to the growth in nursing and midwifery (+204 WTE, Staff Nurse/Staff  Excluding pre-registration nursing and midwifery interns, the YTD change Midwife), likely related theboth retention of 2018 graduating (+160 WTE) is substantially lower to than December (+1,133 WTE) and that of the 5 year nurses and December midwives.trend (+1,099 WTE), albeit the change in the month (+121 WTE) is higher than the 5 year average (+43WTE). • This month’s growth is considerably lower than the same  Four of the six staff are WTE) showing increases this month. higher Patient & period lastcategories year (+477 albeit it is marginally Client Care is showing the largest (+60 WTE) mainly related to Home Helps than the 5year average of +224 WTE. +31 WTE and Health Care Assistants +13 WTE. Health & Social Care Professionals (largely owingatto+1,960 an increase Social • Year isto+42 dateWTE growth stands WTEinand is Care +21 WTE). Nursing & Midwifery is + 41 WTE (largely due to Staff Nurse/Staff substantially lower compared to the same period in 2018, Midwife +27 WTE), and Medical & Dental is +20 WTE (largely owing to +14 reported at +3,560 a quarterly WTE Medical/Dental Other). WTE. Both On General Supportbasis, (-25trends WTE) and Management/Administrative (-5decrease WTE) decreased this month. to same show a significant when compared  Eight of period the ninein CHOs are showing increases this WTE) month,while with CHO 2 2018 Quarter 4 2018 (+1,361 showing the largest increase (+40 WTE). At a divisional level, Disabilities Quarter 4 2019 (+691 WTE). (+138 WTE), Mental Health (+26 WTE) and Older People (+18 WTE) are • Excluding nursing anda midwifery interns, showing an increase,pre-registration while Primary Care is showing decrease (-50 WTE). the YTD growth is +1,956 WTE. This is also significantly WTE % WTE % WTE WTE changeYTD change change lower WTE when compared to last years’ growth for change Division/ Care Dec Nov Dec since since since since Group December of +3,527 WTE. 2018 2019 2019 Nov Nov Dec Dec 2019

2019

2018

Total Health Overarching findings this +286 month 117,857 key 119,532 119,817 +0.2% +1,960 +1.7% Service • Five of the six staff categories are showing growth this Acute Hospital 58,578 60,004 60,147 +143 +0.2% +1,569 +2.7% Service month, the largest of which is Nursing & Midwifery Ambulance 1,940 -7 -0.4% +46 +2.4% (+103 1,887 WTE). The largest1,933 staff group change in nursing Service Acute Services 60,466 61,944 62,080 and midwifery this month, is

+136 +0.2% +1,614 seen in Staff Nurse/ Staff+2.7% +0.3% however, +56 +0.6% increase is Primary Care lower10,931 10,650 10,599 than that reported in 2018 -50 (+119-0.5% WTE). -331 -3.0% Disabilities 18,621 18,760 +138 +0.7% +500 +2.7% • Of the18,260 remaining staff categories showing growth; Health Older Persons 13,305 13,233 +0.1% -72 -0.5% & Social Care 13,215 Professionals is +78+18 WTE, with Social Social Care 31,564 31,836 31,992 +156 +0.5% +428 +1.4% Care +21 and H&SC other +29 WTE including +16 WTE Health- December Officers. Medical & Dental is Health ServicesEnvironmental Performance Profile October 2019 reporting +22 WTE with Consultants continuing to show month on month growth, at +6 WTE this month. Patient Client Care is reporting +85 WTE this month mainly due Mental HealthMidwife, 9,898 9,954month’s +26 (+2049,928 WTE). This

WTE Nov 2019

117,857

119,532

119,817

+286

+0.2%

+1,960

+1.7%

58,578

60,004

60,147

+143

+0.2%

+1,569

+2.7%

1,887

1,940

1,933

-7

-0.4%

+46

+2.4%

Division/ Care Group Total Health Service Acute Hospital Service Ambulance Service Acute Services

WTE Dec 2019

WTE % WTE % change change change change since since since since Nov Nov Dec Dec 2019 2019 2018 2018

WTE Dec 2018

60,466

61,944

62,080

+136

+0.2%

+1,614

+2.7%

Mental Health

9,898

9,928

9,954

+26

+0.3%

+56

+0.6%

Primary Care

10,931

10,650

10,599

Disabilities Division/ Care GroupPersons Older

WTE 18,260 Dec 13,305 2018 31,564

WTE 18,621 Nov 13,215 2019 31,836

-50 -0.5% -331 -3.0% WTE % WTE % WTE 18,760 change +138 change +0.7% change +500 change +2.7% since since since since Dec 13,233 +18 +0.1% -72 -0.5% Nov Nov Dec Dec 2019 2019 2019 2018 2018 31,992 +156 +0.5% +428 +1.4%

Social Care Community 52,393 52,414 52,546 +132 Health Services Performance Profile October - December 2019 Services Health & Wellbeing 576 574 574 -0 (H&WB) Corporate Health Business Services H&WB, Corporate & National Services

+0.3%

+153

+0.3%

+0.0%

-3

-0.5%

2,859

3,020

3,035

+15

+0.5%

+176

+6.2%

1,563

1,580

1,583

+0.2%

+20

+1.3%

4,998

5,174

5,191

+17

+0.3%

+193

+3.9%

Absence Rates

Rates

Benchmark / Target

Nov 2018

Full Year 2018

Oct 2019

Nov 2019

% Medically Certified (November 2019)

3.5%

4.5%

4.6%

4.8%

88%

Division/ Care Group Community Services Health & Wellbeing (H&WB)

Health Business Services H&WB, Corporate & National Services

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 89

Benchmark / Target Rates

3.5%

Latest monthly figur  November 2019 the equivalent m (October 2019 at 

Over the past fou 4.7% (2016), 4.5%

month at – 6 WTE.

Over the past four years November rates were as follows: 4.3% (2015) and • This month’s growth is seen across all three sectors; HSE 4.7% (2016), 4.5% (2017), 4.5% (2018).

+145 WTE (+0.02%), Section 38 Hospitals +42 WTE (+0.2%) and Section 38 Voluntary Agencies +98 WTE (+0.6%). At a divisional level, Acute Services (+136 WTE), Community Services (+132 WTE) and H&WB, Corporate & National Services (+17 WTE) are all showing growth this month. 82

Source: Health Service Performance Profile October to December 2019 Quarterly Report

www.ihca.ie

Absence Rates

to Health Care Assistants +41 WTE and Home Help +31

•

Corporate

Latest monthly figures (November 2019) WTE, with Management & Administrative WTE. General  November 2019 absence rate stands at 4.8%, higher +4 when compared with the equivalent 2018staff (4.5%), no change fromathe previousthis month Supportmonth is theinonly category showing decrease (October 2019 at 4.8 %). 

W De 20

02/10/2020 12:37

Division/ Care Group

 Four of the six staff categories are showing increases this month. Patient & Community Client Care is showing the largest (+60 WTE) mainly related to Home Helps Services +31 WTE and Health Care Assistants +13 WTE. Health & Social Care Health & Professionals is +42 WTE (largely owing to an increase in Social Care +21 Wellbeing (H&WB) WTE). Nursing & Midwifery is + 41 WTE (largely due to Staff Nurse/Staff Midwife +27 WTE), and Medical & Dental is +20 WTE (largely owing to +14 Corporate WTE Medical/Dental Other). Both General Support (-25 WTE) and Health Business (as of December 2019) Management/Administrative (-5 WTE) decreased this month. Services

Charts & Tables

Operations key findings this month

WTE

Overall this month, Services is showing increase of +136 WTEAcute WTE WTE changeanchange change change Division/ Care Dec Nov Dec since since since since Group Excluding pre-registration nursing and midwifery interns the WTE. 2018 2019 2019 Nov Nov Dec Dec 2019showing 2019 increases 2018 2018 change is +165 WTE. All staff categories are Total Health this month. Nursing Midwifery is the largest (+64 WTE), 117,857and 119,532 119,817 +286 +0.2% +1,960 +1.7% Service likely owing to the retention of graduating nurses and midwives, Acute Hospital 58,578 60,004 60,147 +143 +0.2% +1,569 +2.7% Service with a corresponding increase in staff nurse/ midwife group of Ambulance 1,887 1,940 1,933 -7 -0.4% +46 +2.4% ServiceWTE. Medical & Dental is +1 WTE, Health & Social Care +176 Acute Services 60,466 +0.2% +1,614 Professionals is +26 WTE61,944 (largely62,080 owing to+136 Pharmacy +7 WTE +2.7% Mental Health 9,898 9,954 +26 +0.3% and H&SCP trainees +11 9,928 WTE). Patient Client Care is +25 +56 WTE +0.6% Primary Care 10,931 10,650 10,599 -50 -0.5% -331 -3.0% (largely due to an increase in Health Care Assistants +28 WTE) Disabilities 18,260 18,621 18,760 +138 +0.7% +500 +2.7% with Management & Administrative +7 WTE. Older Persons 13,305 13,215 13,233 +18 +0.1% -72 -0.5% • Excluding pre-registration nursing and midwifery interns, Social Care 31,564 31,836 31,992 +156 +0.5% +428 +1.4% the overall change for Acute Services (+165 WTE) is lower Health Services Performance Profile October - December 2019 than the 5year average trend for December of +200 WTE. Similarly, YTD growth (+1,603 WTE) is considerably lower compared to both 2018 (+2,261 WTE) and the 5-year average December trend (+2,163 WTE). • This months’ increase in WTEs is distributed across four Hospital Groups and CHI, with the largest increase in Dublin Midlands Hospital Group (+52 WTE). Two Hospital Groups, Saolta (-12 WTE) and IEHG (-5 WTE) along with the National Ambulance Services (-7 WTE) are showing a decrease this month. • The change within Community Services this month is an increase of +132 WTE. Excluding pre-registration nursing and midwifery interns the change is +121 WTE. • Excluding pre-registration nursing and midwifery interns, the YTD change (+160 WTE) is substantially lower than both December 2018 (+1,133 WTE) and that of the 5 year December trend (+1,099 WTE), albeit the change in the month (+121 WTE) is higher than the 5 year average (+43WTE). • Four of the six staff categories are showing increases this month. Patient & Client Care is showing the largest (+60 WTE) mainly related to Home Helps +31 WTE and Health Care Assistants +13 WTE. Health & Social Care Professionals is +42 WTE (largely owing to an increase in Social Care +21 WTE). Nursing & Midwifery is + 41 WTE (largely due to Staff Nurse/Staff Midwife +27 WTE), and Medical & Dental is +20 WTE (largely owing to +14 WTE Medical/Dental Other). Both General Support (-25 WTE) and Management/ Administrative (-5 WTE) decreased this month. • Eight of the nine CHOs are showing increases this month, with CHO 2 showing the largest increase (+40 WTE). At a divisional level, Disabilities (+138 WTE), Mental Health (+26 WTE) and Older People (+18 WTE) are showing an increase, while Primary Care is showing a decrease (-50 WTE).

H&WB, Corporate & National Services

% WTE % WTE change change change change since since since since Dec Dec Nov Nov 2018 2018 2019 2019

WTE Dec 2018

WTE Nov 2019

WTE Dec 2019

52,393

52,414

52,546

+132

+0.3%

+153

+0.3%

576

574

-0

+0.0%

-3

-0.5%

2,859

3,020

3,035

+15

+0.5%

+176

+6.2%

1,563

1,580

1,583

+0.2%

+20

+1.3%

4,998

5,174

5,191

+17

+0.3%

+193

+3.9%

Absence Absence Rates Rates

Rates

Benchmark / Target

Nov 2018

Full Year 2018

Oct 2019

Nov 2019

% Medically Certified (November 2019)

3.5%

4.5%

4.6%

4.8%

88%

Latest monthly (November 2019) Latest monthly figuresfigures (November 2019) November 2019 absence rateatstands 4.8%, higher when with  • November 2019 absence rate stands 4.8%, at higher when compared the equivalent month in 2018 (4.5%), no change from the previous month compared with the equivalent month in 2018 (4.5%), no (October 2019 at 4.8 %). 

change from the previous month (October 2019 at 4.8 %). Over the past four years November rates were as follows: 4.3% (2015) and • 4.7% Over the past four 4.5% years(2018). November rates were as follows: (2016), 4.5% (2017), 4.3% (2015) and 4.7% (2016), 4.5% (2017), 4.5% (2018).

Annual Rate for 2018 and Trend Analysis from 2008

Absence rates have shown a general downward trend since 2008. Annual rates are as Annual Rate for 2018 and Trend Analysis from 2008 82 follows: 2008 5.8%



2009 5.1%

2010 4.7%

2011 4.9%

2012 4.8%

2013 4.7%

2014 4.3%

2015 4.2%

2016 4.5%

2017 4.4%

2018 4.6%

The 2018 full year rate is 4.6% higher than the 2017 figure at 4.4%. 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.



Nonetheless, it is important to note that Health Sector absence is not directly comparable to other sectors as the nature of the work, demographic of employees, and diversity of the organisation needs to be recognised. Health sector work can be physically and psychologically demanding, increasing the risk of work related illness and injury. However, these trends are generally inline with international public healthcare organisations.



The latest NHS England absence rate for December 2018 was 4.51%, while the 2017 annual rate was 4.61%. NHS Scotland reported an absence rate of 5.5% December 2017, and a yearly average of 5.39%, up from 5.20% in the previous year. While in NHS Wales, the June 2018 absence rate was 4.8%. As with our international counterparts, sickness absence shows wide seasonal variation throughout the year with the rate lower in summer and higher in winter.



address and m managing the positive and s impact and cos

European Wo

Acute Hospitals

Mental Health Ser Other Agencies

Health service absence rates are detailed in the attached report. Notes: Absence Rate is the term generally used to refer to unscheduled employee absences from the workplace. Absence rate is defined as an absence from work other than annual leave, public holidays, maternity leave and jury duty. Methodology has been updated in-line with instruction laid out by the Department of Public Expenditure & Reform (DPER) to show absence rates based on % lost hours (previously lost WTE) with effect from 1st January 2017. Some previously published figures are restated. The HSE’s National Service Plan 2019 sets absence rates as a key result area (KRA) with the objective of reducing the impact and cost of absence and commits to a national target level of 3.5% for all hospitals and agencies. The HSE continues to review its current sick leave policies and procedures as well as having a range of current supports and interventions to address challenges being encountered in the whole area of attendance management and absence rates through ill health. The objective of all these actions is to enhance the health sector’s capacity to

Health Services Performance Profile October - December 2019

Source: Health Service Performance Profile October to December 2019 Quarterly Report 90

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 90

www.ihca.ie

02/10/2020 12:37

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Charts & Tables (as of December 2019)

Employment Acute, Community, HWB, Corporate, HBS: December 2019

Employment Acute, Community, HWB, Corporate, HBS: December 2019 Dec 2019 (Dec 2018 figure: 60,466)

WTE Nov 2019

WTE WTE % change change WTE Dec change 2019 since Nov since Nov since Dec 19 19 18

Dec 2019 (Dec 2018 figure: 52,393)

WTE % change WTE WTE Dec change change 2019 since Nov since Nov since Dec 19 19 18

61,944

62,080

+136

+0.2%

+1,614

52,414

52,546

+132

+0.3%

+153

Consultants

2,770

0.0%

+124

Consultants

430

436

+1.5%

+29

Registrars

2,945

2,939

0.2%

+154

Registrars

737

+0.1%

+29

SHO/ Interns

2,782

2,789

+0.2%

+52

SHO/ Interns

328

326

0.5%

+1.3%

Medical/ Dental, other

574

588

+14

+2.5%

8,555

8,556

+0.0%

+330

2,068

2,088

+20

+1.0%

+53

Nurse/ Midwife Manager

4,677

4,678

+0.0%

+152

3,189

3,187

0.1%

+29

Nurse/ Midwife Specialist & AN/MP

1,291

1,289

0.1%

+98

690

693

+0.4%

+38

16,409

16,585

+176

+1.1%

+271

Staff Nurse/ Staff Midwife

9,077

9,105

+27

+0.3%

173

Public Health Nurse

1,534

1,532

0.1%

45 97 74

56 98 74

+11 +0 0

+25.3% +0.4% 0.2%

7 +5 +54

216

227

+11

+5.3%

+52

+4.3%

Acute Services

Medical/ Dental, other Medical & Dental

Staff Nurse/ Staff Midwife Public Health Nurse

Community Services

WTE Nov 2019

Medical & Dental Nurse/ Midwife Manager Nurse/ Midwife Specialist & AN/MP

+0.7%

111 198 223

83 195 139

29 3 84

25.8% 1.3% 37.8%

+11 +23 +25

Nursing/ Midwifery Student

533

417

116

21.7%

+60

Nursing/ Midwifery Student

Nursing/ Midwifery other

218

223

+2.2%

+22

Nursing/ Midwifery other

Nursing & Midwifery

23,129

23,193

+64

+0.3%

+603

Nursing & Midwifery

14,763

14,804

+41

+0.3%

Therapy Professions

1,911

1,915

+0.2%

+23

Therapy Professions

3,292

3,298

+0.2%

Health Science/ Diagnostics

4,242

4,239

0.1%

+71

Health Science/ Diagnostics

139

+0.3%

+1.3%

2,687

2,708

+21

+0.8%

+103

339

343

+1.3%

+13

Social Workers

814

818

+0.5%

+2.2%

+11

Psychologists

910

912

+0.3%

Pharmacy

887

894

+0.8%

+59

Pharmacy

103

105

+1.2%

H&SC, Other

138

149

+11

+8.1%

H&SC, Other

371

378

+1.6%

+11

7,608

7,633

+26

+0.3%

+156

8,315

8,357

+42

+0.5%

+69

515

0.1%

+16

619

620

+0.2%

+32

Administrative/ Supervisory (V to VII)

2,292

2,298

+0.3%

+161

Administrative/ Supervisory (V to VII)

1,533

1,528

0.3%

+65

Clerical (III & IV)

6,566

6,568

+0.0%

Clerical (III & IV)

3,735

3,733

0.1%

9,373

9,380

+0.1%

+173

5,887

5,881

0.1%

+52

5,588

5,601

+12

+0.2%

+79

Support

2,541

2,519

0.9%

137

522

523

+0.0%

+20

Maintenance/ Technical

424

421

0.8%

6,111

6,123

+12

+0.2%

+99

2,966

2,940

0.9%

146

Health Care Assistants

5,175

5,203

+28

+0.5%

+196

12,169

12,182

+13

+0.1%

+109

Ambulance Staff

1,832

1,825

0.4%

+43

Home Help

3,538

3,569

+31

+0.9%

+17

161

166

+2.8%

+13

Care, other

2,707

2,724

+17

+0.6%

+56

7,168

7,194

+25

+0.4%

+253

18,415

18,475

+60

+0.3%

+182

Preregistration Nurse/ Midwife Intern Postregistration Nurse/ Midwife Student Nursing/ Midwifery awaiting registration

Social Care Social Workers Psychologists

Health & Social Care Professionals Management (VIII & above)

Management & Administrative Support Maintenance/ Technical General Support

Care, other Patient & Client Care

Preregistration Nurse/ Midwife Intern Postregistration Nurse/ Midwife Student Nursing/ Midwifery awaiting registration

Social Care

Health & Social Care Professionals Management (VIII & above)

Management & Administrative

General Support Health Care Assistants

Patient & Client Care

Page 1 of 3

Page 2 of 3

Source: Health Service Employment Report: December 2019 92

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 92

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02/10/2020 12:37

Charts & Tables (as of December 2019)

Employment by Grade Group: Dec 2019 Employment by Grade Group: Dec 2019 Dec 2019 (Dec 2018 figure: 117,857)

WTE Nov 2019

Overall

119,532 119,817

Consultant Anaesthesia Consultant Dentistry Consultant Emergency Medicine Consultant Intensive Care Medicine Consultant Medicine Consultant Obstetrics & Gynaecology Consultant Paediatrics Consultant Pathology Consultant Psychiatry Consultant Radiology Consultant Surgery Consultant, Other

Consultants

Registrar Senior Registrar Specialist Registrar

Registrars

Interns Senior House Officer

SHO/ Interns Dentists Other Medical

Medical/ Dental, other

Medical & Dental Clinical Nurse/ Midwife Manager Director Nursing/Midwifery, Assistant Director of Nursing/Midwifery

Nurse/ Midwife Manager

Advanced Nurse/ Midwife Practitioner Clinical Nurse/ Midwife Specialist

Nurse/ Midwife Specialist & AN/MP Nursing Bank Staff Midwives Staff Nurse [Intellectual Disability] Staff Nurse [Psychiatric] Staff Nurses [General/ Children's]

Staff Nurse/ Staff Midwife Public Health Nurse

Nursing/ Midwifery awaiting registration Postregistration Nurse/ Midwife Student Preregistration Nurse/ Midwife Intern

Nursing/ Midwifery Student Nursing Education/Clinical Other Nursing/ Midwifery

Nursing/ Midwifery other

Nursing & Midwifery Dietitians Occupational Therapists Orthoptists Physiotherapists Podiatrists & Chiropodists

WTE Dec 2019

408 17 109 11 833 161 197 256 400 293 556 1 3,244 2,331 212 1,202 3,744 730 2,381 3,111 311 426 737

407 17 108 11 833 161 197 259 407 295 553 1

3,250

WTE change since Nov 19

% change since Nov 19

WTE change since Dec 18

+286

+0.2%

+1,960

1 0 1

0.3% 0.1% 1.2%

+0 0 +0 +3 +7 +2 3

+0.0% 0.2% +0.1% +1.2% +1.6% +0.7% 0.6%

+0.2%

+13 0 +11 +1 +39 +4 +16 +9 +33 +10 +19 +1

+154

+0.0% 0.4% 0.3%

+67 +9 +105

751

+6 +1 1 4 4 4 +9 +5 0 +15 +14

+2.0%

+15

10,836

10,857

+22

+0.2%

+390

6,745 941 299 7,985 380 1,616 1,996 28 1,464 1,601 3,013 19,383 25,489

6,746 941 298

+1 1 1 1 +5 4 +0 +3 +1 +0 +5 +194 +204

+0.0% 0.1% 0.4%

+112 +45 +27

1,539 297 295 156 748 295 49 344

2,332 211 1,197

3,740 726 2,390

3,116 311 440

7,984 385 1,612

1,996 31 1,465 1,602 3,018 19,577

25,693 1,537

0.1%

+181

0.5% +0.4%

4 +44

+0.2%

+40

0.0% +3.4%

4 +19

0.0%

+185

+1.2% 0.3%

+75 +61

+0.0%

+136

+10.4% +0.1% +0.0% +0.2% +1.0%

7 21 89 53 +269

28.5% 0.7% 11.2%

+79 +28 +5

+0.8% 0.1%

+98 3

350

2 85 2 17 104 +5 +1 +6

+1.7%

+33

38,102

38,205

+103

+0.3%

+561

572 1,583 35 1,860 70

574 1,599 35 1,851 72

+3 +17 +0 8 +2

+0.4% +1.1% +0.2% 0.4% +2.4%

7 +16 +1 +2 +2

213 293 138

644

300 50

13.9%

+111

+1.5% +2.4%

+31 +2

Page 1 of 3

Source: Health Service Employment Report: December 2019

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Charts & Tables (as of December 2019)

Dec 2019 (Dec 2018 figure: 117,857)

WTE Nov 2019

Overall

119,532 119,817

Speech & Language Therapists

Therapy Professions Audiology Biochemists Clinical Engineering Clinical Measurement Dosimetrists Medical Laboratory Perfusionists Phlebotomists Physicists Radiation Therapists Radiographers

Health Science/ Diagnostics Social Care Social Workers Psychologists

Psychologists Pharmacy

Pharmacy Counsellor Therapists Dental Hygienists Environmental Health Officers HSCP Trainees/ Students Other Health & Social Care Play Therapists/ Specialists

H&SC, Other

Health & Social Care Professionals Executive Management Senior Management (VIII & GM)

Management (VIII & above) Middle Management (VVII) Other Administrative

Administrative/ Supervisory (V to VII) Clerical (III & IV)

Management & Administrative Catering Household Services Other Labs & Associated Other Support Portering

Support

Maintenance Technical Services

Maintenance/ Technical

General Support HCA, Nurse's Aide, etc. Health & Social Care Assistants

Health Care Assistants Home Help Ambulance Control Ambulance Education

WTE Dec 2019

1,105 5,223 72 79 165 381 11 2,036 22 172 191 201 1,233 4,564

1,103

5,234 72 79 164 384 13 2,035 22 173 188 199 1,229

4,558 2,710 1,165

2,689 1,157 1,000 1,000 1,027 1,027 235 59 512 63 121 45 1,036

5,163 37

11,814

5,199 11,805

18,842 879 4,203 385 1,144 1,630 8,242 1,067 114 1,181

0.1% +0.8% +0.7% +0.4%

+0.4% +1.1%

+54 +103 7 +19

+19 +63

+1.1%

+63

+1.1% 0.5% +3.1% +10.5% +2.9% +0.5%

+11 0 +53 21 +0 0

+2.8%

+44

+0.5%

+278

0.3% +0.4%

+9 +86

+0.3%

+95

+0.2% 2.7%

+351 8

+343 95

18,846

+0.0%

+343

877 4,197 385 1,136 1,639

2 6 0 8 +8 8 1 +3 +1

0.3% 0.1% 0.0% 0.7% +0.5%

+19 66 +23 32 +17

+0.1%

8,234 1,066 117

1,182

0.1% 0.1% +2.2%

41 3 +5

9,423

9,416

0.1%

17,115 240 17,355

17,159 237

+44 3 +41

+0.3% 1.3%

+358 53

17,396 3,569

3,538 182 165

180 162

119,532 119,817

Care, other

+21

+0.2% 0.1%

Overall

Patient & Client Care

5 +0 +9 +15 +2 9 +2 +12 1 +7 +22

+0.2%

Page 2 of 3

Community Welfare Officers Other Care Grades

1.2% +0.9% 0.6% +0.8% +17.7% 0.1% 1.0% +0.4% 1.6% 1.0% 0.3%

1 +6 +5 +9 1 +8

WTE Nov 2019

Ambulance Staff

331 1,511

1,842

Dec 2019 (Dec 2018 figure: 117,857)

Ambulance Officers PreHospital Care (Ambulance)

+1,960

0.2%

+78

238 58 528 70 125 46

332 1,505 1,837 5,154 38 5,191

+0.2%

1,065

1,038

WTE change since Dec 18

2 +11 1 +1 1 +3 +2 1 0 +1 3 2 4 6

16,774

1,004

% change since Nov 19

+286

+8 +4 +4 +11 +11 +3 0 +16 +7 +4 +0 +29

1,004

16,696

WTE change since Nov 19

77 1,412 1,835 2 2,903 2,906

25,634

WTE Dec 2019

+31 2 3

WTE change since Nov 19

+0.2% +0.9%

+304 +17

1.0% 1.8%

+21 23

% change since Nov 19

WTE change since Dec 18

+286

+0.2%

+1,960

+1.7% 0.2%

+1 +46

2,926

+1 3 7 +0 +21 +21

+0.7%

+60

25,719

+85

+0.3%

+427

78 1,408

1,828 2 2,924

0.4%

+46

+1.2% +0.7%

1 +61

Source: Health Service Employment Report: December 2019

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082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 95

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Areas Areas of Level of Level 3 Escalation 3 Escalation [NPOG [NPOG oversight] oversight] General: General: Cancer Cancer RapidRapid Access Access Clinics Clinics (Prostate, (Prostate, Lung,Lung, BreastBreast and Radiotherapy) and Radiotherapy) ServiceService Acute Acute Operation Operation s/NCCP s/NCCP

Escalation Escalation level level Date escalated Date escalated ReasonReason for escalation for escalation Responsible Responsible 8May 2015 8May 2015 3 3 Escalated Escalated due todue theto persistence the persistence and breadth and breadth of underperformance of underperformance in Rapid in RapidND AOND AO AccessAccess CancerCancer services services ND CCP ND CCP

Charts & Tables

Improvement Improvement Plan Plan (as of 2019) National National CancerCancer ControlControl Programme Programme Rapid Access Rapid Access Clinics Clinics Performance Performance Review Review andDecember Improvement and Improvement Plan inclusive Plan inclusive of recommendations of recommendations and improvement and improvement plan 2017 plan–2017 2019–to2019 be fully to be implemented. fully implemented. Continue Continue focus on focus the on NCCP the NCCP Rapid Access Rapid Access Clinic KPI Clinic improvement KPI improvement recommendations recommendations for breast, for breast, lung and lung prostate and prostate cancers. cancers. Development, Development, approval approval and monitoring and monitoring of site specific of site specific improvement improvement plans inclusive plans inclusive of demand/capacity of demand/capacity profilesprofiles and trajectories and trajectories for performance for performance improvement. improvement. Hospital Hospital GroupsGroups to maximise to maximise hospitalhospital site compliance site compliance within resources within resources available available to the group. to the group. NCCP NCCP ReviewReview of GP Referral of GP Referral Guidelines. Guidelines. Areas of Level 3 Escalation [NPOG oversight] NCCP NCCP proposed proposed Investment Investment Plans informed Plans informed by bestbypractice, best practice, serviceservice demanddemand and capacity. and capacity. Performance Performance Data Data

Breast Cancer within 22weeks Breast Breast Cancer Cancer within within 2 weeks weeks 90%95.2% 95.2%

90%

Lung Cancer within 10working working daysdays Lung Lung Cancer Cancer within within 10 10 working days 95%

95%

90%

70%

88.9% 88.9% 70%

88.8% 88.8% 70%

70%

50%

50% Dec JanDec FebJan MarFeb AprMar MayApr JunMay JulJun AugJul SepAug OctSep NovOct DecNov Dec

67%

95%

94.9% 94.9% 87.2% 87.2%

67%

Month 17/18 Month 17/18 Month 18/19 Month 18/19

Prostate Cancer within 20 working working days Prostate Cancer within 20 20 working days Prostate Cancer within days

50%

50% Dec JanDec FebJan MarFeb AprMar MayApr JunMay JulJun AugJul SepAug OctSep NovOct DecNov Dec Month 17/18 Month 17/18 Month 18/19 Month 18/19

Radiotherapy within 15 days Radiotherapy within 15 working working days Radiotherapy within 15 working days

90% 90% 90% 90% 90% 90% 90% 90% < 52 weeks for first access to OPD services Waiting Lists: Lists: % of adults children < 15 months an elective inpatient or day case procedure and % ofand people Waiting % ofand adults and children < 15 for months for an88.3% elective inpatient or day case procedure % ofwaiting people waiting < 52 weeks for first access to OPD services 88.3% 75% 75% 85.4% 85.4% 77% Service Escalation level level Date escalated for escalation Responsible 60% 60% Service 77% Escalation Date escalated ReasonReason Responsible 70%for 74.9% 70%escalation 74.9% 77.7% Acute Operations 3 October 2015 Escalated due to the continued growth in waiting lists and waiting times 77.7% Acute Operations 3 October 2015 Escalated due to the continued growth in waiting lists and waiting times ND AO ND AO 54.7% 45% 45% 54.7%

Improvement Waiting Lists:Plan % of adults waiting < 52 weeks for first access to OPD services Improvement Plan and children < 15 months for an elective inpatient or day case procedure and % of people50% 30% 30% 50% Lists: of adults and Jul children 15 action months forDec anfor elective inpatient daycase caseprocedures procedure and %outpatient of people < 52 weeks for first to months OPD % of adults children 15 for Nov an elective - Waiting Implementation ofApr agreed DoH waiting list plans inpatient and orday andWaiting appointments. Dec waiting Jan Feb Mar Apr and May Junaccess Jul< Aug Sep services Oct Dec inpatient or day case procedure and % of people waiting < Dec Jan Lists: Feb Mar% May Jun Aug <Sep Oct Nov

- DecImplementation agreed waiting plans for inpatient and day case procedures and outpatient Dec Jan appointments. Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar AprofMay Jun DoH Jul Aug Seplist Octaction Nov Dec 8 Lung Cancer 8 May Cancer 2015. May Prostate 2015. Cancer ProstateJuly Cancer 2015July and2015 de-escalated and de-escalated from level to Red Black in to March Red March Breast 2016. BreastJuly Cancer 2016. July Radiotherapy 2016.for Radiotherapy September September 2016. 2016. Service Escalation Date escalated Reason escalation Responsible - LungWorking with NTPF ensuring all long waiters (>Black 36from months) arein2016. treated atCancer the earliest practical date. Month 17/18 Month 18/19 MonthMonth 17/1817/18 MonthMonth 18/1918/19 Working with NTPF ensuring all long waiters 36 months) are treated at the earliest practical date. Month 17/18 Month 18/19 (> level Service Escalation Date escalated Reason for escalation Service level DateND escalated Reason for88escalation Health-Operations Health Services Services Performance Performance Profilethe Profile October October -3December - December 2019 2019 88 Acute October 2015 which will Escalated due toaccurate the continued growth in waiting listsEscalation and waiting times AO Responsible Ongoing work between centralised validation unit in NTPF and hospitals provide clean, and up to date waiting lists. Ongoing work between the centralised and hospitals provide accurate and up togrowth date waiting lists. Acute- Operations 3 validation unit in NTPFOctober 2015 which willEscalated due to the continued in waiting Acuteclean, Operations 3 lists and waiting times October 2015ND AO Escalated due to the c Ensure focus onfocus maximising existingexisting capacity. Active management of delayed transferstransfers of care of (delayed discharges) to minimise impact on patient andflow scheduled care. care. Improvement - PlanEnsure on maximising capacity. Active management of delayed care (delayed discharges) to minimise impact on flow patient and scheduled Improvement Plan Improvement Plan Identifying and resources forlist additional capacity options options for and Day Case Waiting Waiting List - - Inpatient Implementation ofsecuring agreed DoH waiting action plans forcapacity inpatient and2020. dayforcase procedures and Outpatient outpatient appointments. Identifying and securing resources forList additional 2020. Implementation of agreed waiting listmonths) action plans for inpatient day case procedures appointments. -and outpatient Implementation of agreed DoH waiting list action plans for inpatient and day case procedures and outpatient a - (Adult Working with NTPF ensuring all longDoH waiters (> 36 are treated at theand earliest practical date. & Child 15m+ ensuring and 18m+) (15m + and 18m+) Performance - Data Working with NTPF all long waiters (>NTPF 36 months) are treated at the earliest practical - date.Working with NTPFwaiting ensuring (> 36 months) are treated at the earliest practical date. Performance Data Ongoing work between the centralised validation unit in and hospitals which will provide clean, accurate and up to date lists.all long waiters NPOG REDIREDI elements DateDate agreed Due Due datedate Status NPOG elements agreed Status - and Ongoing work between the centralised validation unit in NTPF and hospitals which will (delayed provide accurate andbetween upList toimpact date waiting lists. - clean, Ongoing work the(15m centralised validation unit in NTPF and hospitals which will provide clean, accurate Inpatient Day Case Waiting List (Adult & Child 15m+ and 18m+) Outpatient Waiting + and 18m+) - Inpatient Ensure focus on maximising existing capacity. Active management of delayed transfers of care discharges) to minimise on patient flow and and Day Case Waiting List (Adult & Child 15m+ and 18m+) Outpatient Waiting List (15m + andscheduled 18m+)care. 1 1 Improve: RACRAC performance willexisting be monitored byActive NPOG on a on monthly 06.12.17 on-going Ensure focus on maximising capacity. management of delayed transfers of care (delayed discharges) to minimise impact on patient flow and scheduled care. Ensure focus on maximising existing capacity. Active management of delayed transfers of care (delayed disch Improve: performance will be monitored by NPOG a monthly 06.12.17 on-going Identifying and securing resources for additional capacity options for 2020. 132,827 132,827 10,000 150,000 10,000 117,557and Identifying and securing resources for additional capacity options for 2020. - 150,000 Identifying securing resources for additional capacity options for 2020. 117,557 6,897 6,897

6,112 6,112 100,000 100,000 4,921 Performance Data 4,921 2 5,000 Improve: will issue guidance (breast service) to thetosystem including guidance on triage suchsuch that Data 07.05.19 02.07.19 Complete 2 Performance Improve: NCCP will issue guidance (breast service) the system including guidance on triage that 07.05.19 02.07.19 Complete 102,924 102,924 DataNCCP Performance 89,950 5,000 89,950 Inpatient and Day Case Waiting List (Adult & Child 15m+ and 18m+) Outpatient 4,419 performance across all sites is improved. 50,000 50,000Waiting List (15m + and 18m+) all sites is improved. 4,419 & Child 15m+ and 18m+) Inpatientperformance and Dayacross Case Waiting List (Adult Outpatient Waiting List (15m + and 18m+) Inpatient and Day Case Waiting List (Adult & Child 15m+ and 18m+)

Outpatie

132,827 150,000 0Improve: Actions agreed to improve performance, including performance improvement trajectory, 117,557 0 150,000 01 1001.19 on-going Amended 07 11071911 19 132,827 10,000particularly 150,000 0 3 10,000 Improve: agreed improve performance, particularly 10 .19 on-going Amended 6,897 Dec JanDec Feb MarFeb Apr Actions MayApr JunMay Jul Jun AugtoJul Sep OctSep Nov DecNov Dec including performance improvement trajectory, 117,557 Jan Mar Aug Oct Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Oct DecNov Dec 6,112 and Breast services at StatJames’s Hospital will be monitored on a on monthly basis. 6,897 6,897 Dec Jan Feb Mar Apr May Jun Jul Aug Sep 100,000 4,921 in the inProstate the Prostate and Breast services St James’s Hospital will be monitored a monthly basis. 6,112 6,112 5,000 15m+ 15m+ 18m+ 18m+ 102,924 100,000 100,000 4,921 4,921 89,950 15m+ 15m+ 18m+ 18m+ 5,000 5,000 102,924 4,419 89,950 50,000 4 4 Improve: Improvement PlanPlan for University Hospital Waterford is to be completed. 07.11.19 03.12.19 Complete Improve: Improvement for University Hospital Waterford is to be completed. 07.11.19 03.12.19 Complete 4,419 4,419 50,000 50,000 0 Inpatient and Day CaseCase Waiting List (Adult & Child Total) Outpatient Waiting List (Total) 00Outpatient Inpatient and Waiting List (Total) 0 Feb Mar Dec Jan AprDay May Jun Jul AugWaiting Sep Oct NovList Dec (Adult & Child Total) 0 0 Jan Apr May Dec Jan Actions Feb Actions Maragreed Apr May Aug Sepperformance, Oct Nov Dec Dec JanFeb FebMar Mar Apr MayJun JunJul JulAug AugSep SepOct OctNov NovDec Dec 585,000 toJun improve performance, including performance improvement trajectory, at Dec the 07.11.19 Complete 600,000 5 85,000Improve: Improve: agreed toJulimprove including performance improvement trajectory, atMater the Mater 07.11.19 on-going Complete Dec Jan Feb Mar Apr May Jun Jul on-going Aug Sep Oct Nov Dec D 600,000 15m+ 18m+ Inpatient and Day Case Waiting List Outpatient Waiting List 15m+ 18m+ Misericordiae University Hospital will be monitored on a monthly basis. 15m+ 18m+will be monitored on a monthly basis. Misericordiae University Hospital 15m+ 15m+ 18m+ 18m+ 80,000 80,000 550,000 550,000 516,162 516,162 (Adult & Child Total) (Total) 675,000 Improve: NDs NCCP and AO review Improvement PlansPlans and provide an update to NPOG with with regard to to 05.02.20 04.03.20 Inpatient and Day Case Waiting List & Child Total) Outpatient Waiting List (Total) 6 75,000 Improve: NDs NCCP andwill AO will(Adult review Improvement and provide an update to NPOG regard 05.02.20 04.03.20 553,433 70,204 70,204 Inpatient and Day Case Waiting List (Adult & Child Total) Outpatient Waiting List (Total) Inpatient and Day Case Waiting List (Adult 553,433 & Child Total) Outpatie requirements relative to performance, configuration and resources. requirements relative to performance, configuration and resources. 70,000 500,000 66,563 66,563 600,000 500,000 85,000 70,000 85,000 600,000 85,000 600,000 65,000 65,000 80,000 450,000 Dec JanDec FebJan MarFeb Apr Mar MayApr JunMay Jul Jun Aug Jul SepAug OctSep NovOct DecNov Dec 80,000 550,000 80,000 450,000 516,162 Dec JanDec Feb MarFeb Apr Mar MayTotal JunMay Jul Jun Aug Sep Oct NovOct Dec 75,000 550,000 550,000 516,162 Jan Apr Total Total 553,433 Nov Dec Total Jul Aug Sep 70,204 75,000 75,000 553,433 70,204 70,000 70,204 500,000 NPOG REDI elements Date agreed Due date Status Status 66,563 NPOG Date agreed Due date 70,000REDI elements 70,000 500,000 500,000 66,563 66,563 65,000 1 Improve: Improvement plans for patients waiting over 36 months (inpatients, day cases and out-patients) to be 04.06.19 on-going on-goingon-going 165,000 Improve: Improvement plans for patients waiting over 36 months (inpatients, day cases and out-patients) to be 04.06.19 on-going 65,000 450,000 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec monitored on Profile aMar monthly basis Health Services Performance October - December 2019 89 89 450,000 450,000 DecPerformance Jan Feb Apr Jun Jul Aug Sep Oct2019 Nov Dec monitored on aMay monthly basis DecJan JanFeb FebMar MarApr AprMay May Jun Jul JulAug AugSep SepOct OctNov NovDec Dec Dec Jun Health Services Profile October - December Total Total Dec Jan Feb MarTotal Apr MayTotal Jun Jul Aug Sep Oct Nov Dec D Total 10,000 0

NPOG REDI elements Date agreed Due date Status Health Services Performance Profile October - December 2019 90 NPOG Services REDI elements Date agreed Due date Status NPOG REDI elements Health Performance Profile October - December 2019 90 1 Improve: Improvement plans for patients waiting over 36 months (inpatients, day cases and out-patients) to be 04.06.19 on-going on-going 1 monitoredImprove: Improvement plans for patients waiting over 36 months (inpatients, day cases and out-patients) to be 04.06.19 on-going on-going 1 Improve: Improvement plans for patients waiting over 36 months (inpatients, day cases and out-patient on a monthly basis monitored on a monthly basis monitored on a monthly basis Health Services Performance Profile October - December 2019 Health Services Performance Profile October - December 2019

Health Services Performance Profile October - December 2019

Source: Health Service Performance Profile October to December 2019 Quarterly Report 96

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 96

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Emergency Department - % of all attendees at ED who are in ED < 24 hours and % of all attendees aged 75 years and over at ED who are discharged or admitted within 24 hours ofEmergency registration Department - % of all attendees at ED who are in ED < 24 hours and % of all attendees aged 75 years and over at ED who are discharged or admitted within 24 hours of registration Service Escalation level Date escalated Reason for escalation Responsible Service Acute Operations Acute Operations

Escalation Reason forofescalation 3 (re-assigned Jan level May 2015Date escalated Due to the number people continuing to wait in ED for > 24 hours ND AO Responsible 2018) 3 (re-assigned Jan May 2015 Due to the number of people continuing to wait in ED for > 24 hours ND AO 2018)

Improvement Plan - Improvement ImplementationPlan of the Winter Plan 2019/20 with particular focus on demand management, operational flow and egress management. Review demand/supply factors in terms of their impact on available in order to target appropriate at individual hospital sites. - key Implementation of the Winter Plan 2019/20 with particular focuscapacity on demand management, operationalimprovements flow and egress management. Plan-activity and ensure alignment with the Sláintecare strategy tocapacity anticipate and manage demand pressure within agreed resources. Review key demand/supply factors in terms ofImplementation their impact on available in order to targetcritical appropriate improvements at individual hospital sites. Continue focusactivity on patient initiatives suchwith as the the Sláintecare Five fundamentals, SAFER strategy Bundle and Red2Green. Plan and flow ensure alignment Implementation to anticipate and manage critical demand pressure within agreed resources. Integrated working focus with community to improve thethe following; Continue on patient services flow initiatives such as Five fundamentals, SAFER Bundle and Red2Green. Integrated working communitycare, services to support improveand the NHSS. following;  Timely accesswith to transitional home  admission Timely access to transitional care, home support NHSS.  Develop avoidance pathways by providing care and closer to home and improving services for frail elderly in acute hospitals. Colonoscopy Colonoscopy -% of-Improve % people waiting waiting < 13 <weeks weeks following following a toreferral referral for for colonoscopy colonoscopy orimproving OGD OGD and No. and of No. of elderly people waiting >are4hospitals. weeks > 4 weeks forand access for access towhere antourgent an urgent colonoscopy colonoscopy of people Develop admission avoidance pathways bya providing careroutine closer home and services forpeople frail in waiting acute clinical pathways for13 patients admitted ensure thatroutine variances in to average length oforstay, in particular medical patients, monitored reduced feasible.  Improve clinical pathways for patients admitted to ensure that variances in average length of stay, in particular medical patients, are monitored and reduced where feasible. Service ServiceData Escalation Escalation level level Date Date escalated escalated Reason Reason for escalation for escalation Responsible Responsible Performance ED over 24 hours % of 75 year old or older admitted or 9March AcuteAcute Operations Operations 3 (re-assigned 3 (re-assigned Jan Jan9March 2015 2015 Due to Due thetonumber the number of patients of patients waiting waiting greater greater than 13 than weeks 13 weeks for a for routine a routine ND AO ND AO Performance Data ED over 24 hours % of 75 year old or older admitted or discharged within 24 hours of discharged 24 hours registration 2018)2018) colonoscopy/OGD colonoscopy/OGD and on-going andwithin on-going breaches breaches in urgent inof urgent colonoscopies colonoscopies ED over 24 hours % of 75 year old or older admitted or discharged within 24 hours of registration 10,000 Improvement Improvement Plan Plan registration 10,000 100% 4,962 - 3,212 Progress Progress implementation implementation of HSE of Endoscopy HSE Endoscopy Programme Programme ActionAction Plan within Plan within available available resources. resources. Champion Champion extra extra resources resources to address to address additional additional requirements requirements to maintain and improve and improve performance. performance. 99% to maintain 5,000 100% 3,212 4,962 - 1,011 Working Working with relevant with relevant Clinical Clinical Programmes Programmes and supporting and supporting all hospital all hospital sites to sites deliver to deliver colonoscopy colonoscopy services services withinwithin targettarget timeframes. timeframes. 99% 1,776 5,000 90% Development, Development, approval and monitoring and monitoring of Hospital of Hospital Group Group improvement plansplans inclusive inclusive of demand/capacity of demand/capacity profiles profiles and trajectories and trajectories for performance for performance improvement. improvement. 92.9% 0 1,011 approval 1,776improvement 0 90% 88.8% - Dec Continue - JanContinue prioritise to consistent achievement achievement of Dec urgent of urgent colonoscopy colonoscopy and BowelScreen and BowelScreen targets targets withinwithin available available resources. resources. FebtoMar Aprprioritise May Jun consistent Jul Aug Sep Oct Nov 92.9% 0 0 80% 88.8% National - Patients National Acute Acute Operations Operations to engage to engage with the with NTPF the NTPF to leverage to leverage additional additional capacity capacity to support to support continued continued compliance compliance with National with National Service Service Plan and Plan JAG and targets. JAG targets. AllJun patients > 24Sep hrs Oct Nov Dec Dec75+ Jan>24 FebhrsMar Apr May Jul Aug Dec80% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec In - order In order to maximise to maximise compliance with BowelScreen Hospital Hospital Groups Groups to ensure to ensure that 2019 that 2019 hospital hospital level MOUs level MOUs with the with National the National BowelScreen BowelScreen Programme Programme (NBS) (NBS) align with aligncapacity. with capacity. Patients 75+ >24compliance hrs with BowelScreen All patients > targets, 24 hrstargets, 18/19 Dec Jan FebMonth Mar Apr May Jun Jul Aug Sep Oct Nov Dec National National AcuteAcute Operations Operations to engage to engage with NBS with to NBS align to assessed align assessed need/demand/capacity need/demand/capacity goinggoing forward forward and ensure and ensure that MOUs that MOUs are reflective are reflective of output of output withinwithin available available resources. resources. NPOG REDI elements Date agreed Month 18/19Due date Status Hospitals Hospitals to seek to support seek support from the fromNational the National Treatment Treatment Purchase Purchase Fund Fund to treat to long treatwaiters long waiters for routine for routine procedures. procedures. NPOG REDI elements 1 Review: Monthly review of USC performance 02.07.19 Date agreed on-going Due date on-going Status 1 Review: Monthly review of USC performance 02.07.19 on-going on-going Performance Performance Data Data

Urgent Colonoscopy patients greater than weeks (new) Urgent Colonoscopy patients patients greater greater thanthan 4 weeks 44weeks (new) (new) ected net expenditure toUrgent year endColonoscopy including pay management Escalation80level80 Date escalated 60 60 3 (re-assigned February 2016 40 Jan 40 2018) 20 020 0

Number onwaiting waiting list list for GI GI Number Number on on waiting list for forScopes GI Scopes 11,13711,137

12,00012,000 Reason for escalation 10,00010,000 Due to the risks to financial performance within acute hospitals

4 4 0 Dec Jan DecFeb JanMar FebApr MarMay AprJun MayJul JunAug JulSep AugOct SepNov OctDec Nov Dec ss and net expenditureHealth at Hospital Group and hospitalMonth levelMonth to determine reasons for financial surpluses/deficits. 18/19 18/19 Services Performance Profile October - December 2019 0

us actual expenditure in month Health and year to date in relation to direct pay and agency and overtime costs. Services Performance Profile October - December 2019 nhanced financial management focus including additional focus on staffing controls.

9,915 9,915 8,000 8,000 7,710 7,710 6,000 6,000 Dec Jan DecFeb JanMar FebApr MarMay AprJun MayJul JunAug JulSep AugOct SepNov OctDec Nov Dec <13 weeks > 13 week <13 weeks > 13 breaches week breaches

NPOGNPOG REDI REDI elements elements

YTD YTD YTD YTD Review: Review: Endoscopy Endoscopy Improvement Improvement PlansPlans received received to be to completed be completed Actual Budget Variance % €’000 €’000 €’000 Variance Review: Review: National National Endoscopy Endoscopy Improvement Improvement Plan to Plan be to refreshed be refreshed reflective reflective of updated of updated position position Acute Hospitals Care

5,465,323

5,429,785

RoutineRoutine colonoscopies colonoscopies escalated escalated Red to Black Red toinBlack September in September 2015 2015

Health Services Services Performance Performance Profile Profile October October - December December 2019subject 2019 to nce performance meetings toHealth be held with each Hospital Groups and with- hospitals on.

Profile October - December 2019

35,538

92 92

Date Date agreed agreed

Due date Due date

Status Status

07.06.17 07.06.17

on-going on-going

06.08.19 06.08.19

01.10.19 01.10.19

Completed Completed

05.02.20 05.02.20

01.04.20 01.04.20

Financial position: projected net expenditure to year end including pay management

1 1 Review: Review: Monthly Monthly review review of urgent of urgent colonoscopy colonoscopy breach breach data data rojected net expenditure to year end including pay management 2

12,32912,329

Responsible ND AO

0.65%

Date agreed 04.05.16

Due date

Status

on-going

Source: Health Service Performance Profile October to December 2019 Quarterly Report 98

082_96_IHCA Client Section 2021_Charts _ Tables_v7.indd 98

www.ihca.ie

02/10/2020 12:44

Advert template.indd 1 249675_1C_VHI_JM_IHCA_V2.indd 1

08/09/2020 10/06/2020 10:12 10:05

In the management of type 2 diabetes 1

THE POWER TO ACCOMPLISH MORE Multiple benefits* Proven protection†

JARDIANCE is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise 1 - as monotherapy when metformin is considered inappropriate due to intolerance - in addition to other medicinal products for the treatment of diabetes

The most prescribed SGLT2i in Ireland 3 * In addition to glucose lowering, JARDIANCE demonstrated reduction in weight and blood pressure; JARDIANCE is not indicated for weight loss or reduction of blood pressure.1 † EMPA-REG OUTCOME® was a randomised, double-blind, placebo-controlled cardiovascular outcomes trial. Patients were randomised to receive either JARDIANCE 10 mg once daily, JARDIANCE 25 mg once daily or placebo, on top of standard of care. Primary endpoint was 3-point MACE: Time to first occurrence of cardiovascular death, non-fatal MI, non-fatal stroke. 14% relative risk reduction for combined endpoint of cardiovascular death, non-fatal MI, or non-fatal stroke (ARR 1.6%). 2 References 1. JARDIANCE (empagliflozin) Summary of Product Characteristics 2019. Available at: http://www.medicines.ie/medicine/16081/SPC/Jardiance+10+mg+and+25+mg+FilmCoated+Tablets 2. Zinman B, Wanner C, Lachin JM et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-2128. (& Supplementary Appendix) 3. Data on File. Boehringer Ingelheim Prescribing Information (Ireland) JARDIANCE® (empagliflozin) Film-coated tablets containing 10 mg or 25 mg empagliflozin. Indication: Jardiance is indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise: as monotherapy when metformin is considered inappropriate due to intolerance; in addition to other medicinal products for the treatment of diabetes. For study results with respect to combinations, effects on glycaemic control and cardiovascular events, and the populations studied, refer to the Summary of Product Characteristics. Dose and Administration: The recommended starting dose is 10 mg once daily. In patients tolerating empagliflozin 10 mg once daily who have eGFR ≥ 60 ml/min/1.73 m2 and need tighter glycaemic control, the dose can be increased to 25 mg once daily. The maximum daily dose is 25 mg. When used with sulphonylurea or insulin a lower dose of these may be considered to reduce the risk of hypoglycaemia. Renal impairment: The glycaemic efficacy is dependent on renal function. No dose adjustment is required for patients with an eGFR ≥60 ml/min/1.73 m2 or CrCl ≥60 ml/min. Do not initiate in patients with an eGFR <60 ml/min/1.73 m2 or CrCl <60 ml/min. In patients tolerating empagliflozin whose eGFR falls persistently below 60 ml/min/1.73 m2 or CrCl below 60 ml/min, the dose of empagliflozin should be adjusted to or maintained at 10 mg once daily. Discontinue when eGFR is persistently below 45 ml/ min/1.73 m2 or CrCl persistently below 45 ml/min. Not for use in patients with end stage renal disease (ESRD) or on dialysis. Hepatic impairment: No dose adjustment is required for patients with hepatic impairment. Not recommended in severe hepatic impairment. Elderly patients: No dose adjustment is recommended based on age. In patients 75 years and older, an increased risk for volume depletion should be taken into account. Not recommended in patients 85 years or older. Paediatric population: No data are available. Method of administration: The tablets can be taken with or without food, swallowed whole with water. If a dose is missed, it should be taken as soon as the patient remembers; however, a double dose should not be taken on the same day. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Warnings and Precautions: Rare cases of diabetic ketoacidosis (DKA), including life-threatening and fatal cases, have been reported in patients treated with SGLT2 inhibitors, including empagliflozin. Consider the risk of DKA in the event of non-specific symptoms such as nausea, vomiting, anorexia, abdominal pain, excessive thirst, difficulty breathing, confusion, unusual fatigue or sleepiness and assess patients for ketoacidosis immediately, regardless of blood glucose level. In patients where DKA is suspected or diagnosed, treatment should be discontinued immediately. Treatment should be interrupted in patients who are hospitalised for major surgical procedures or acute serious medical illnesses. Monitoring of ketones is recommended in these patients. Measurement of blood ketone levels is preferred to urine. Treatment with

empagliflozin may be restarted when the ketone values are normal and the patient’s condition has stabilised. Before initiating empagliflozin, consider factors in the patient history that may predispose to ketoacidosis. Use with caution in patients who may be at higher risk of DKA. Renal impairment: See under Dose and Administration; Monitor renal function prior to initiation and at least annually. Cases of hepatic injury have been reported with empagliflozin in clinical trials. A causal relationship between empagliflozin and hepatic injury has not been established. Haematocrit increase was observed with empagliflozin treatment. Osmotic diuresis accompanying therapeutic glucosuria may lead to a modest decrease in blood pressure. Therefore, caution should be exercised in patients with known cardiovascular disease, patients on anti-hypertensive therapy with a history of hypotension or patients aged 75 years and older. In case of conditions that may lead to fluid loss (e.g. gastrointestinal illness), careful monitoring of volume status and electrolytes is recommended. Temporary interruption of treatment with empagliflozin should be considered until the fluid loss is corrected. Elderly: See under Dose and Administration; special attention should be given to volume intake of elderly patients in case of co-administered medicinal products which may lead to volume depletion (e.g. diuretics, ACE-inhibitors). Temporary interruption of empagliflozin should be considered in patients with complicated urinary tract infections. Cases of necrotising fasciitis of the perineum (Fournier’s gangrene), have been reported in patients taking SGLT2 inhibitors. This is a rare but serious and potentially life-threatening event that requires urgent surgical intervention and antibiotic treatment. Patients should be advised to seek medical attention if they experience a combination of symptoms of pain, tenderness, erythema, or swelling in the genital or perineal area, with fever or malaise. Be aware that either uro-genital infection or perineal abscess may precede necrotising fasciitis. If Fournier’s gangrene is suspected, Jardiance should be discontinued and prompt treatment should be instituted. An increase in cases of lower limb amputation (primarily of the toe) has been observed in long-term clinical studies with another SGLT2 inhibitor, counsel patients on routine preventative footcare. Experience in New York Heart Association (NYHA) class I-II is limited, and there is no experience in clinical studies with empagliflozin in NYHA class III-IV. Due to its mechanism of action, patients taking Jardiance will test positive for glucose in their urine. The tablets contain lactose and should not be used in patients with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption. Interactions: Use with diuretics may increase the risk of dehydration and hypotension. Insulin and insulin secretagogues may increase the risk of hypoglycaemia therefore, a lower dose of insulin or an insulin secretagogue may be required. The effect of UGT induction on empagliflozin has not been studied. Co-treatment with known

inducers of UGT enzymes should be avoided due to a potential risk of decreased efficacy. Interaction studies suggest that the pharmacokinetics of empagliflozin were not influenced by coadministration with metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin, verapamil, ramipril, simvastatin, torasemide and hydrochlorothiazide. Interaction studies conducted in healthy volunteers suggest that empagliflozin had no clinically relevant effect on the pharmacokinetics of metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, simvastatin, warfarin, ramipril, digoxin, diuretics and oral contraceptives. Fertility, pregnancy and lactation: There are no data from the use of empagliflozin in pregnant women. As a precautionary measure, it is preferable to avoid the use of Jardiance during pregnancy. No data in humans are available on excretion of empagliflozin into milk. Jardiance should not be used during breast-feeding. No studies on the effect on human fertility have been conducted for Jardiance. Undesirable effects: Frequencies are defined as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), not known (cannot be estimated from the available data). Very common: hypoglycaemia (when used with sulphonylurea or insulin). Common: vaginal moniliasis, vulvovaginitis, balanitis and other genital infections, urinary tract infection (including pyelonephritis and urosepsis), thirst, pruritus (generalised), rash, increased urination, serum lipids increased. Uncommon: urticaria, volume depletion, dysuria, blood creatinine increased/ glomerular filtration rate decreased, haematocrit increased. Rare: DKA. Not known: necrotising fasciitis of the perineum (Fournier’s gangrene), angioedema. Prescribers should consult the Summary of Product Characteristics for further information on side effects. Pack sizes: 10 mg; 28 tablets, 25 mg: 28 tablets. Legal category: POM. MA numbers: 10 mg/28 tablets EU/1/14/930/013; 25 mg/28 tablets EU/1/14/930/004. Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prescribers should consult the Summary of Product Characteristics for full prescribing information. Additional information is available on request from Boehringer Ingelheim Ireland Ltd, The Crescent Building, Northwood, Santry, Dublin 9. Prepared in October 2019.

Adverse events should be reported. Reporting forms and information can be found at https://www.hpra.ie/homepage/about-us/report-anissue. Adverse events should also be reported to Boehringer-Ingelheim Drug Safety on 01 2913960, Fax: +44 1344 742661, or by e-mail: PV_local_UK_Ireland@boehringer-ingelheim.com

PC-IE-100827 Date of preparation: June 2020

Advert template.indd 1 Jardiance_JM_IHCA.indd 1 249759_1C_Boehringer HUG4468 Jardiance [IRE] ICHA - 297x210 v2 AW.indd 1

23/09/2020 02/07/2020 12:11 15:21 17/06/2020 11:53

IHCA Diary Pages 2021.indd 1

02/10/2020 10:13

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 2021.indd 2

02/10/2020 10:13

YEAR PLANNER 2021 1 RoI & UK

JANUARY

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

MARCH

FEBRUARY

❋ Holidays

Week 10

6 RoI & UK

3 RoI & UK 31 UK

7 RoI

APRIL

MAY

JUNE

Mon.

Week 1 1

Week 5 1

Week 14

Week 18

Week 23

Tue.

Wed.

Thur.

3 4

Fri.

1❋

Sat.

Sun.

Mon.

Week 2 8

Week 6 8

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 3 15

Week 7 15

Week 12 12

Week 16 10

Week 20 14

Tue.

Wed.

17 ❋

Thur.

Fri.

Sat.

Sun.

Mon.

Week 4 22

Week 8 22

Week 13 19

Week 17 17

Week 21 21

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 9 29

Week 14 26

Week 18 24

Week 22 28

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

IHCA Diary Pages 2021.indd 3

Week 5

Week 11 5 ❋

Week 15 3 ❋

Week 19 7 ❋

Week 24

Week 25

Week 26

Week 27

31 ❋

02/10/2020 10:13

YEAR PLANNER 2021 ❋ Holidays 2 RoI & Scot. 30 UK

JULY

AUGUST

SEPTEMBER

25 RoI

30 Scot.

OCTOBER

NOVEMBER

25 RoI & UK 26 RoI & UK

DECEMBER

Sun.

Week 27 2❋

Mon.

Week 31

Week 40 1

Week 36

Week 44

Week 48

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 28 9

Week 32 6

Week 37 4

Week 41 8

Week 45 6

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week29 16

Week 33 13

Week 38 11

Week 42 15

Week 46 13

Tue.

Wed.

Thur.

Fri.

Sat.

Sun.

Mon.

Week 30 23

Week 34 20

Week 39 18

Week 43 22

Week 47 20

Tue.

Wed.

Thur.

Fri.

Sat.

25 ❋

Sun.

26 ❋

Mon.

Tue.

Wed.

Week 31 30 ❋

Week 40 25 ❋

Week 44 29

Week 48 27

Thur.

Fri.

Sat.

Sun.

IHCA Diary Pages 2021.indd 4

Week 35 27

30 ❋

Week 50

Week 51

Week 52

Week 53

02/10/2020 10:13

THREE YEAR CALENDAR 2020

FEBRUARY

JANUARY Wk M

1 2 3 4 5

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

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

18 19 20 21 22

Wk M

2 9 16 23 30

3 10 17 24 31

23 24 25 26 27

2 9 16 23 30

3 10 17 24

35 36 37 38 39

1 7 8 14 15 21 22 28 29

APRIL F

5 6 7 8 9

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

1 8 15 22 29

2 9 16 23

Wk M

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

27 28 29 30 31

Wk M

2 9 16 23 30

3 10 17 24 31

4 11 18 25

43 44 2 45 9 46 16 47 23/30

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

3 10 17 24

1 8 15 22 29

SEPTEMBER T

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

JUNE

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

Wk M

MAY Wk M

MARCH Wk M

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

39 40 41 42 43

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

14 15 16 17 18

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

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

AUGUST

Wk M

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

31 32 3 33 10 34 17 35 24/31

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

Wk M

NOVEMBER W

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

JULY

OCTOBER

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

Wk M

2 9 16 23 30

DECEMBER 48 49 50 51 52

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

2021 JANUARY Wk M

1 2 3 4 5

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

FEBRUARY

Wk M

2 9 16 23 30

3 10 17 24 31

6 7 8 9 10

2 9 16 23

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

10 11 12 13 14

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

14 15 16 17 18

Wk M

2 9 16 23 30

23 24 25 26 27

2 9 16 23 30

3 10 17 24 31

4 11 18 25

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

1 8 15 22

Wk M

18 19 3 20 10 21 17 22 24/31

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

36 37 38 39 40

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

1 7 8 14 15 21 22 28 29

SEPTEMBER Wk M

1 8 15 22 29

JUNE F

APRIL

MAY W

MARCH

JULY

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

40 41 42 43 44

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

27 28 29 30 31

Wk M

2 9 16 23 30

3 10 17 24 31

45 46 47 48 49

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

49 50 51 52 53

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

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

NOVEMBER 1 8 15 22 29

2 9 16 23 30

3 10 17 24

4 11 18 25

AUGUST

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

OCTOBER

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

DECEMBER T

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

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

2022 FEBRUARY

JANUARY Wk M

1 2 3 4 5

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

Wk M

2 9 16 23 30

6 7 8 9 10

1 7 8 14 15 21 22 28

MAY Wk M

18 19 2 3 20 9 10 21 16 17 22 23/30 24/31

36 37 38 39 40

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

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

IHCA Diary Pages 2021.indd 5

Wk M

2 9 16 23

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

10 11 12 13 14

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

27 28 29 30 31

Wk M

2 9 16 23 30

45 46 47 48 49

1 7 8 14 15 21 22 28 29

JUNE F

Wk M

23 24 25 26 27

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

SEPTEMBER Wk M

MARCH

Wk M

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

14 15 16 17 18

Wk M

2 9 16 23 30

3 10 17 24 31

31 32 33 34 35

2 9 16 23 30

3 10 17 24 31

4 11 18 25

5 12 19 26

6 13 20 27

7 14 21 28

Wk M

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

2 9 16 23 30

3 10 17 24

4 11 18 25

40 41 3 42 10 43 17 44 24/31

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

1 7 8 14 15 21 22 28 29

2 9 16 23 30

3 10 17 24

AUGUST 1 8 15 22 29

NOVEMBER

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

JULY

OCTOBER W

APRIL

DECEMBER

Wk M

2 9 16 23 30

3 10 17 24

4 11 18 25

5 12 19 26

6 13 20 27

49 50 51 52 53

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

2 9 16 23 30

3 10 17 24 31

4 11 18 25

02/10/2020 10:13

WORLD HOLIDAYS FOR 2021 IRELAND New Year’s Day: St Patrick’s Day Observed: Easter Mon: May Bank Hol: June Bank Hol: Aug Bank Hol: Oct Bank Hol: Christmas Day: St Stephen’s Day:

1 Jan 17 Mar 5 Apr 3 May 7 Jun 2 Aug 25 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 18 Jan 15 Feb 31 May 4 Jul 7 Sep 12 Oct 11 Nov 26 Nov 25 Dec

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

1 Jan 26 Jan 8 Mar 2 Apr 5 Apr 26 Apr 3 May 7 Jun 14Jun 4 Oct 25 Dec 26 Dec

CHINA New Year’s Day: 1 Jan Spring Festival Golden Week/Chinese NY: 13-17 Feb Qing Ming Jie: 5 Apr Labour Day: 1 May Dragon Boat Festival: 14 Jun Mid-Autumn Festival: 21 Sep National Day: 1 Oct National Day Hol: 2 Oct - 7 Oct

IHCA Diary Pages 2021.indd 6

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

1 Jan 17 Mar 2 Apr 5 Apr 3 May 31 May 12 Jul 2 Aug 30 Aug 30 Nov 25 Dec 26 Dec

1 Jan 15 Feb 15 Feb 2 Apr 5 Apr 24 May 24 May 21 Jun 24 Jun 1 Jul 2 Aug 6 Sep 11 Oct 11 Nov 25 Dec 26 Dec

1 Jan 11 Jan 11 Feb 20 Mar 29 Apr 3 May 4 May 5 May 19 Jul 11 Aug 20 Sep 23 Sep 11 Oct 3 Nov 23 Nov

02/10/2020 10:13

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 2021.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

02/10/2020 10:13

November 2020 WEEK 48

30 Monday | Luain

NOLLAIG

DECEMBER 2020 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 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

IHCA Diary Pages 2021.indd 8

02/10/2020 10:13

JANUARY 2021 Wk

Mo Tu We Th

1 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

December 2020 NOLLAIG

WEEK 48

03 Thursday | DÃ©ardaoin

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

IHCA Diary Pages 2021.indd 9

02/10/2020 10:13

December 2020 WEEK 49

07 Monday | Luain

NOLLAIG

DECEMBER 2020 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 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

IHCA Diary Pages 2021.indd 10

02/10/2020 10:13

JANUARY 2021 Wk

Mo Tu We Th

1 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

December 2020 NOLLAIG

WEEK 49

10 Thursday | DÃ©ardaoin

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

IHCA Diary Pages 2021.indd 11

02/10/2020 10:13

December 2020 WEEK 50

14 Monday | Luain

NOLLAIG

DECEMBER 2020 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 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

IHCA Diary Pages 2021.indd 12

02/10/2020 10:13

JANUARY 2021 Wk

Mo Tu We Th

1 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

December 2020 NOLLAIG

WEEK 50

17 Thursday | DÃ©ardaoin

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

IHCA Diary Pages 2021.indd 13

02/10/2020 10:13

December 2020 WEEK 51

21 Monday | Luain

NOLLAIG

DECEMBER 2020 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 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

IHCA Diary Pages 2021.indd 14

02/10/2020 10:13

JANUARY 2021 Wk

Mo Tu We Th

1 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

December 2020 NOLLAIG

WEEK 51 Christmas Eve 24 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

26 Saturday | Satharn St.Stephen’s Day

27 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 15

02/10/2020 10:13

December 2020 WEEK 52

28 Monday | Luain

EANÁIR

DECEMBER 2020 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 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

IHCA Diary Pages 2021.indd 16

02/10/2020 10:13

JANUARY 2021 Wk

Mo Tu We Th

1 2

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

January 2021 EANÁIR

WEEK 52 New Year’s Eve 31 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

02 Saturday | Satharn

03 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 17

02/10/2020 10:13

January 2021 WEEK 2

04 Monday | Luain

EANÁIR

JANUARY 2021 Wk

Mo Tu We Th

1 2

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

IHCA Diary Pages 2021.indd 18

02/10/2020 10:13

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 2

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

IHCA Diary Pages 2021.indd 19

02/10/2020 10:13

January 2021 WEEK 3

11 Monday | Luain

EANÁIR

JANUARY 2021 Wk

Mo Tu We Th

1 2

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

IHCA Diary Pages 2021.indd 20

02/10/2020 10:13

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 3

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

IHCA Diary Pages 2021.indd 21

02/10/2020 10:13

January 2021 WEEK 4

18 Monday | Luain

EANÁIR

JANUARY 2021 Wk

Mo Tu We Th

1 2

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

IHCA Diary Pages 2021.indd 22

02/10/2020 10:13

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

January 2021 EANÁIR

WEEK 4

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

IHCA Diary Pages 2021.indd 23

02/10/2020 10:13

January 2021 WEEK 5

25 Monday | Luain

EANÁIR

JANUARY 2021 Wk

Mo Tu We Th

1 2

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

IHCA Diary Pages 2021.indd 24

02/10/2020 10:13

MARCH 2021 Wk

Mo Tu We Th

10 11 12 13 14

February 2021 FEABHRA

WEEK 5

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

28 Thursday | DÃ©ardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

30 Saturday | Satharn

31 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 25

02/10/2020 10:13

February 2021 WEEK 6

01 Monday | Luain

FEABHRA

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

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

IHCA Diary Pages 2021.indd 26

02/10/2020 10:13

MARCH 2021 Wk

Mo Tu We Th

10 11 12 13 14

February 2021 FEABHRA

WEEK 6

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

04 Thursday | DÃ©ardaoin

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

IHCA Diary Pages 2021.indd 27

02/10/2020 10:13

February 2021 WEEK 7

08 Monday | Luain

FEABHRA

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

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

IHCA Diary Pages 2021.indd 28

02/10/2020 10:13

MARCH 2021 Wk

Mo Tu We Th

10 11 12 13 14

February 2021 FEABHRA

WEEK 7

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

St.Valentine’s Day 14 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 29

02/10/2020 10:13

February 2021 WEEK 8

15 Monday | Luain

FEABHRA

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

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

IHCA Diary Pages 2021.indd 30

02/10/2020 10:13

MARCH 2021 Wk

Mo Tu We Th

10 11 12 13 14

February 2021 FEABHRA

WEEK 8

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 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

IHCA Diary Pages 2021.indd 31

02/10/2020 10:13

February 2021 WEEK 9

22 Monday | Luain

FEABHRA

FEBRUARY 2021 Wk

Mo Tu We Th Fr Sa Su

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

8 9 10 11 12 13 14 15 16 17 Notes

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

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

IHCA Diary Pages 2021.indd 32

02/10/2020 10:13

MARCH 2021 Wk

Mo Tu We Th

10 11 12 13 14

February 2021 FEABHRA

WEEK 9

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 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

IHCA Diary Pages 2021.indd 33

02/10/2020 10:13

March 2021 WEEK 10

01 Monday | Luain

MÁRTA

MARCH 2021 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

IHCA Diary Pages 2021.indd 34

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APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2021 MÁRTA

WEEK 10

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

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

IHCA Diary Pages 2021.indd 35

02/10/2020 10:13

March 2021 WEEK 11

08 Monday | Luain

MÁRTA

MARCH 2021 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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APRIL 2020 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 5 15 16

6 7 8 9 10 11 12

March 2021 MÁRTA

WEEK 11

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

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

IHCA Diary Pages 2021.indd 37

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March 2021 WEEK 12

15 Monday | Luain

MÁRTA

MARCH 2021 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 St.Patrick’s Day 8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 38

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APRIL 2021 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 15 16

5 6 7 8 9 10 11

March 2021 MÁRTA

WEEK 12

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30

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

IHCA Diary Pages 2021.indd 39

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March 2021 WEEK 13

22 Monday | Luain

MÁRTA

MARCH 2021 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

IHCA Diary Pages 2021.indd 40

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APRIL 2021 Wk

Mo Tu We Th Fr Sa Su

14 1 2 3 4 15 16

5 6 7 8 9 10 11

March 2021 MÁRTA

WEEK 13

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30

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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March 2021 WEEK 14

29 Monday | Luain

MÁRTA

MARCH 2021 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

IHCA Diary Pages 2021.indd 42

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MAY 2021 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

April 2021 AIBREÁN

WEEK 14

01 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

Good Friday 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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April 2021 WEEK 15

AIBREÁN

APRIL 2021 Wk

14 1 2 3 4 15 16

05 Monday | Luain Easter Monday

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

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

IHCA Diary Pages 2021.indd 44

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MAY 2021 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

April 2021 AIBREÁN

WEEK 15

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

Easter 11 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

IHCA Diary Pages 2021.indd 45

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April 2021 WEEK 16

AIBREÁN

APRIL 2021 Wk

14 1 2 3 4 15 16

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

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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MAY 2021 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

April 2021 AIBREÁN

WEEK 16

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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April 2021 WEEK 17

AIBREÁN

APRIL 2021 Wk

14 1 2 3 4 15 16

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

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

IHCA Diary Pages 2021.indd 48

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MAY 2021 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

April 2021 AIBREÁN

WEEK 17

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

IHCA Diary Pages 2021.indd 49

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April 2020 WEEK 18

AIBREÁN

APRIL 2021 Wk

14 1 2 3 4 15 16

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

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

IHCA Diary Pages 2021.indd 50

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JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

May 2021 BEALTAINE

WEEK 18

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

01 Saturday | Satharn

02 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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May 2021 WEEK 19

03 Monday | Luain May Day

BEALTAINE

MAY 2021 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

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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JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

May 2021 BEALTAINE

WEEK 19

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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May 2021 WEEK 20

10 Monday | Luain

BEALTAINE

MAY 2021 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

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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JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

May 2021 BEALTAINE

WEEK 20

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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May 2021 WEEK 21

17 Monday | Luain

BEALTAINE

MAY 2021 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

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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JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

May 2021 BEALTAINE

WEEK 21

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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May 2021 WEEK 22

24 Monday | Luain

BEALTAINE

MAY 2021 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

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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JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

May 2021 BEALTAINE

WEEK 22

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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June 2021 WEEK 23

31 Monday | Luain

MEITHEAMH

JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2021 MEITHEAMH

WEEK 23

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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June 2021 WEEK 24

07 Monday | Luain June Bank Holiday

MEITHEAMH

JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2021 MEITHEAMH

WEEK 24

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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June 2021 WEEK 25

14 Monday | Luain

MEITHEAMH

JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2021 MEITHEAMH

WEEK 25

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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June 2021 WEEK 26

21 Monday | Luain

MEITHEAMH

JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2021 MEITHEAMH

WEEK 26

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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June 2021 WEEK 27

28 Monday | Luain

IÚIL

JUNE 2021 Wk

Mo Tu We Th

23 24

10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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AUGUST 2021 Wk

Mo Tu We Th Fr Sa Su

31 1 32 33

2 3 4 5 6 7 8

July 2021 IÚIL

WEEK 27

09 10 11 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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July 2021 WEEK 28

05 Monday | Luain

IÚIL

JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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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AUGUST 2021 Wk

Mo Tu We Th Fr Sa Su

31 1 32 33

2 3 4 5 6 7 8

July 2021 IÚIL

WEEK 28

09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

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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July 2021 WEEK 29

12 Monday | Luain

IÚIL

JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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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AUGUST 2021 Wk

Mo Tu We Th Fr Sa Su

31 1 32 33

2 3 4 5 6 7 8

July 2021 IÚIL

WEEK 29

09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

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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July 2021 WEEK 30

19 Monday | Luain

IÚIL

JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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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AUGUST 2021 Wk

Mo Tu We Th Fr Sa Su

31 1 32 33

2 3 4 5 6 7 8

July 2021 IÚIL

WEEK 30

09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

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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July 2021 WEEK 31

26 Monday | Luain

IÚIL

JULY 2021 Wk

Mo Tu We Th

27 28

10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

August 2021 LÚNASA

WEEK 31

29 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

31 Saturday | Satharn

01 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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August 2021 WEEK 32

LÚNASA

AUGUST 2021 Wk

31 1 32 33

02 Monday | Luain August Bank Holiday

Mo Tu We Th Fr Sa Su 2 3 4 5 6 7 8 09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

August 2021 LÚNASA

WEEK 32

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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August 2021 WEEK 33

LÚNASA

AUGUST 2021 Wk

31 1 32 33

09 Monday | Luain

Mo Tu We Th Fr Sa Su 2 3 4 5 6 7 8 09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

August 2021 LÚNASA

WEEK 33

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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August 2021 WEEK 34

LÚNASA

AUGUST 2021 Wk

31 1 32 33

16 Monday | Luain

Mo Tu We Th Fr Sa Su 2 3 4 5 6 7 8 09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

August 2021 LÚNASA

WEEK 34

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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August 2021 WEEK 35

LÚNASA

AUGUST 2021 Wk

31 1 32 33

23 Monday | Luain

Mo Tu We Th Fr Sa Su 2 3 4 5 6 7 8 09 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

August 2021 LÚNASA

WEEK 35

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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September 2021 WEEK 36

30 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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OCTOBER 2021 Wk

Mo Tu We Th

40 41

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

September 2021 MEÁN FÓMHAIR

WEEK 36

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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September 2021 WEEK 37

06 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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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OCTOBER 2021 Wk

Mo Tu We Th

40 41

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

September 2021 MEÁN FÓMHAIR

WEEK 37

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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September 2021 WEEK 38

13 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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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OCTOBER 2021 Wk

Mo Tu We Th

40 41

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

September 2021 MEÁN FÓMHAIR

WEEK 38

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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September 2021 WEEK 39

20 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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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OCTOBER 2021 Wk

Mo Tu We Th

40 41

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

September 2021 MEÁN FÓMHAIR

WEEK 39

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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September 2021 WEEK 40

27 Monday | Luain

MEÁN FÓMHAIR

SEPTEMBER 2021 Wk

Mo Tu We Th

36 37

10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

8 9 10 11 12 13 14 15 16 17 Notes

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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NOVEMBER 2021 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

October 2021 DEIREADH FÓMHAIR

WEEK 40

30 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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October 2021 WEEK 41

04 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2021 Wk

Mo Tu We Th

40 41

Su 3

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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NOVEMBER 2021 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

October 2021 DEIREADH FÓMHAIR

WEEK 42

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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October 2021 WEEK 42

11 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2021 Wk

Mo Tu We Th

40 41

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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NOVEMBER 2021 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

October 2021 DEIREADH FÓMHAIR

WEEK 42

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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October 2021 WEEK 43

18 Monday | Luain

DEIREADH FÓMHAIR

OCTOBER 2021 Wk

Mo Tu We Th

40 41

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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NOVEMBER 2021 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

October 2021 DEIREADH FÓMHAIR

WEEK 43

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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October 2021 WEEK 44

25 Monday | Luain October Bank Holiday

DEIREADH FÓMHAIR

OCTOBER 2021 Wk

Mo Tu We Th

40 41

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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NOVEMBER 2021 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

October 2021 DEIREADH FÓMHAIR

WEEK 44

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 Halloween

31 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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November 2021 WEEK 45

01 Monday | Luain

SAMHAIN

NOVEMBER 2021 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12

November 2021 SAMHAIN

WEEK 45

13 14 15 16 17 18 19

52 20 21 22 23 24 25 26 53

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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November 2021 WEEK 46

08 Monday | Luain

SAMHAIN

NOVEMBER 2021 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12

November 2021 SAMHAIN

WEEK 46

13 14 15 16 17 18 19

52 20 21 22 23 24 25 26 53

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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November 2021 WEEK 47

15 Monday | Luain

SAMHAIN

NOVEMBER 2021 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12

November 2021 SAMHAIN

WEEK 47

13 14 15 16 17 18 19

52 20 21 22 23 24 25 26 53

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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November 2021 WEEK 48

22 Monday | Luain

SAMHAIN

NOVEMBER 2021 Wk

Mo Tu We Th

10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12

November 2021 SAMHAIN

WEEK 48

13 14 15 16 17 18 19

52 20 21 22 23 24 25 26 53

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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December 2021 WEEK 49

NOLLAIG

DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12 13 14 15 16 17 18 19

52 20 21 22 23 24 25 26

29 Monday | Luain

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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JANUARY 2022 Wk

Mo Tu We Th Fr Sa Su

53 1 2

3 4 5 6 7 8 9

December 2021 NOLLAIG

WEEK 49

10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

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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December 2021 WEEK 50

NOLLAIG

DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12 13 14 15 16 17 18 19

52 20 21 22 23 24 25 26

06 Monday | Luain

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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JANUARY 2022 Wk

Mo Tu We Th Fr Sa Su

53 1 2

3 4 5 6 7 8 9

December 2021 NOLLAIG

WEEK 50

10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

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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December 2021 WEEK 51

NOLLAIG

DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12 13 14 15 16 17 18 19

52 20 21 22 23 24 25 26

13 Monday | Luain

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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JANUARY 2022 Wk

Mo Tu We Th Fr Sa Su

53 1 2

3 4 5 6 7 8 9

December 2021 NOLLAIG

WEEK 51

10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

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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December 2021 WEEK 52

NOLLAIG

DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12 13 14 15 16 17 18 19

52 20 21 22 23 24 25 26

20 Monday | Luain

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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JANUARY 2022 Wk

Mo Tu We Th Fr Sa Su

53 1 2

3 4 5 6 7 8 9

December 2021 NOLLAIG

WEEK 52

10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

23 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

25 Saturday | Satharn Christmas Day

St. Stephen’s Day 26 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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December 2021 WEEK 53

NOLLAIG

DECEMBER 2021 Wk

Mo Tu We Th Fr Sa Su

49 1 2 3 4 5 50 51

6 7 8 9 10 11 12 13 14 15 16 17 18 19

52 20 21 22 23 24 25 26

27 Monday | Luain

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 2022 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

January 2022 EANÁIR

WEEK 53

21 22 23 24 25 26 27 28

30 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

01 Saturday | Satharn New Years Day

02 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2022 WEEK 01

EANÁIR

JANUARY 2022 Wk

53 1 2

03 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

5 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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FEBRUARY 2022 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

January 2022 EANÁIR

WEEK 01

21 22 23 24 25 26 27 28

06 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

08 Saturday | Satharn

09 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2022 WEEK 02

EANÁIR

JANUARY 2022 Wk

53 1 2

10 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

5 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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FEBRUARY 2022 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

January 2022 EANÁIR

WEEK 02

21 22 23 24 25 26 27 28

13 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

15 Saturday | Satharn

16 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2022 WEEK 03

EANÁIR

JANUARY 2022 Wk

53 1 2

17 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

5 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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FEBRUARY 2022 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

January 2022 EANÁIR

WEEK 03

21 22 23 24 25 26 27 28

20 Thursday | Déardaoin

8 9 10 11 12 13 14 15 16 17 Notes

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

22 Saturday | Satharn

23 Sunday | Domhnach

8 9 10 11 12 13 14 15 16 17 Notes

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January 2022 WEEK 04

EANÁIR

JANUARY 2022 Wk

53 1 2

24 Monday | Luain

Mo Tu We Th Fr Sa Su 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

4 24 25 26 27 28 29 30

5 31

8 9 10 11 12 13 14 15 16 17 Notes

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

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

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