Health Matters Autumn 2010 by HSE Communications

HEALTH Vol 6 I Issue 3 I Autumn 2010

INSIDE

MATTERS

- Community Oncology - Medical Card Website - Road Safety - HCAI Challenge

National Staff Magazine of the Health Service Executive

Health Matters

Advances in the care of premature babies

H E A LT H Vol 5 I Issue 3 I Autumn 2009

MATTERS National Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Autumn 2010

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 38 92

Vol 5 I Issue 3 I Autumn 2009

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Health Matters 1

Welcome

Welcome... WELCOME TO THE autumn 2010 edition of Health Matters, the national staff magazine of the HSE. We have a variety of interesting articles in this edition which we hope you’ll enjoy. We take a closer look at developments in the care of premature babies. The survival rates of newborn infants have improved from 76 per cent in the 1980s to over 85 per cent today. Consultant Psychiatrist Dr Bobby Smyth dispels some of the myths about so called ‘legal highs’ and talks about the dangers of both legal and illegal highs. We hope you find this issue’s mix of features, interviews, news and updates of interest. Regular updates are available on the staff intranet site http://hsenet.hse.ie or the HSE website www.hse.ie

Sites We Like...

www.irishprematurebabies.com

Thanks to all of the magazine contributors. Enjoy the read! Stephen McGrath, Editor, Head of Internal Communications

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

Did you know? • Research undertaken by the HSE shows that alcohol is a contributory factor in one in three fatal road crashes.

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• One in 16 births in Ireland is classified as a premature birth. • HSE staff member Andrew Flanagan battled jellyfish, ferries and the cold to swim the English Channel in 12 hours, one minute and 55 seconds. • On average, an acute hospital patient uses 490 litres of H2O per day. •T he proportional mortality ratio for suicide amongst vets is four times that of the general population and around twice that of other healthcare professionals. •T he state-of-the-art HSE Primary Care Centre facility which opened in Dublin’s Pearse Street in July cost b7.5m to build and equip. It provides a one-stop-shop for 10,500 people in the local area.

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

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Health Matters 3

news

New CEO commences post C

athal Magee, the new CEO of the HSE, took up his appointment in early September succeeding Professor Brendan Drumm, whose term of office ended in mid August. A native of Kill, Co Cavan, Mr Magee (56), is a former Managing Director of Eircom’s b1.3 billion portfolio of retail businesses that serve the consumer, business, corporate and Government markets. He was also interim Chief Executive of the Group for six months to July 2009. Mr Magee has an extensive record of implementing change and performance improvement in a number of organisations and different environments. He has worked in both the public and private sectors and has demonstrated a high level of achievement and successful engagement with a wide range of interests and stakeholders. Commenting on the announcement of his appointment in May, the Minister for Health and Children, Mary Harney TD said she was delighted that he had agreed to take up the post. The Minister said, “Mr Magee brings a track record of top class management and organisational leadership to our health services. “He has shown total commitment to people and team building in his management roles throughout his career, and I have no doubt that this will be of great benefit to the combined clinical and management leadership of the HSE. I look forward to working with him in continuing to deliver better services for patients at all levels of our health system.”

Previously, he held other senior management posts in Eircom as Managing Director, Eircom Ireland, Managing Director, Business Transformation and as HR Director during 15 years service with the telecoms company. As well as his extensive commercial and business operating experience, he has been a central leadership figure in the extensive transformation and restructuring of Eircom. Early last year, he concluded a major breakthrough agreement with the trade unions to enable the next phase of restructuring of the Eircom business. Prior to joining Eircom, Mr Magee worked for the National Australia Bank Group in the UK and Ireland. He has also worked in a Business Transformation and HR capacity with Bord na Móna from 1988 to 1992 involving business and operational restructuring. His early career was in the health service. He joined the North Western Health Board in 1972 as a clerical officer in the Finance Department. He later moved to the Western Health Board where he was Industrial Relations Manager. He holds a first class honours degree in Management from the IMI and MSc in Organisational Behaviour from Trinity College. He recently stepped down from directorships of VHI Healthcare and the EBS Building Society to take up his new HSE role. Mr Magee is a married father of four with two sons and two daughters. He lives in Co. Wicklow with his wife Rosaleen and their family.

“Mr Magee has an extensive record of implementing change and performance improvement in a number of organisations and different environments.”

4 Health Matters

contents

Contents 92 Updates 93 Cystic Fibrosis Research gives new insight into the Cystic Fibrosis gender gap 94 The INTERSTROKE study Reveals the ten risk factors associated with 90 per cent of risk of stroke

Welcome

3 news New CEO commences post

56 Premature Babies A report on the new developments in the care of premature babies 61 Breastfeeding updates

7 Updates 9

PUBLIC SERVICE AGREEMENT

10 Community Oncology NCCP launches Community Nurse Education Programme 13 Updates 14 Quality and Clinical Care Emma Benton takes up Therapy Professions Advisor role with QCCD 17 HSE 2010 Achievement Awards A summary of the shortlisted projects for this year’s awards 30 News in Brief 38 Legal and illegal highs campaign The HSE’s national campaign on the dangers of legal and illegal drugs 43 Medical Card.ie Paddy Burke, Head of the HSE Primary Care Reimbursement Service, introduces a new online service 44 Our Lady of Lourdes hospital, Drogheda A report on the new ED and CCU facilities 48 Regional News

63 T he importance of breastfeeding Lisa Corbett, Health Promotion Services, on the benefits of breastfeeding for mother and baby

95 Developing a new Investigation Process Cora McCaughan, Head of the Serious Incident Management Team, gives an update on nine consultation and engagement workshops 96

Irish Association of Young People in Care Jennifer Gargan, Director of the IAYPIC, writes about the association's role

98 Updates 99 Health Research

67 Pregnancy and Diabetes A look at the impact of gestational diabetes mellitus on mother and child 70

Suicide Prevention HSE National Office for Suicide Prevention responds to mental health and well-being implications of the economic downturn

74 Road Safety A five-page section on the new drink driving limits, a word from RSA Chairman Gay Byrne and the HSE’s response to the Inishowen crash 82 Taoiseach’s Public Service Excellence Awards 2010 The HSE projects that received this prestigious award 84 Health & Well-Being A range of features on repetitive strain injuries, yoga for your kids, and healthy lunch recipe 90 Hospital Acquired Infections The causes and effects and the HSE’s work in tackling them

101 Waste Efficiencies New Food Waste Regulations and the importance of water conservation 104 Corporate Planning & Corporate Performance (CPCP) National Director, Jane Carolan, on the role of CPCP 105 Me & My Job HSE Paramedic, Thomas Sinnott, fills us in on his daily routine 106 Personal Finance Independent Financial Advisor, Eoin McGee, writes on the mortgage market madness 108 Travel Karen Creed explores the best weekend spa retreats 110 Health Matters Book Club Find out about our latest recommendations worth reading 112 Crossword Fill it in to fill in time…

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Health Matters 7

updates

New Chair of HSE Board The Minister for Health and Children, Mary Harney TD, has announced the appointment of Dr Frank Dolphin as the chairman of the HSE. He succeeds Liam Downey, who has completed two terms as chairman. A native of Birr, Co. Offaly, Dr Dolphin is the chairman of the Rigneydolphin Group, a successful services business he founded in Waterford which employs 1,100. He is also chairman of the Children’s University Hospital Temple Street and a member of the board of governors of the Mater Hospital. He is also a member of the board of governors of Waterford Institute of Technology. He is a Fellow of the Marketing Institute, Associate Fellow of the British Psychological Society and a former President of Waterford Chamber of Commerce. Dr Dolphin has had a varied career working in education, health and business. He attended Presentation College

Birr and University College Dublin, where he completed a PhD in Psychology. Dr Dolphin worked as a clinical research psychologist at the Children’s Hospital Temple Street and later as consulting psychologist to St Joseph’s Clonmel, working with children in residential care. He lectured at Trinity College Dublin and in Waterford Institute of Technology in psychology and consumer behaviour. The Minister said: “Dr Dolphin has highly relevant, wide-ranging experience in his business career, academic accomplishments and work as a clinical psychologist. I have great confidence in his ability to lead the Board of the HSE in

its next phase of development, working with the new Chief Executive, Cathal Magee, and with a growing level of clinical leadership throughout the organisation.”

New Primary Care Centre for Dublin’s Pearse Street A state-of-the-art Primary Care Centre facility opened in Pearse Street in Dublin’s south inner city in July. The Pearse Street facility cost b7.5 million to build and equip and provides a one-stop shop for 10,500 people in the surrounding area. In the locality, 50 per cent more elderly people are living alone than the national average and the number of children in lone-parent families is 2.5 times the national average. GPs and HSE staff at the facility provide physiotherapy, occupational therapy and speech and language therapy, a wound clinic, health promotion and a community welfare clinic. Other services available at the centre include dietary, podiatry, counselling psychology and maternity services.

The launch of the facility was former HSE CEO Professor Brendan Drumm’s last official function. + Pictured at the official opening of Pearse Street Primary Care Centre Speaking at the launch in Dublin’s south inner city is the team of doctors, nurses and ancillary he said: “There is now a staff who provide health care services at the facility with Professor Brendan Drumm, former CEO of HSE very strong appetite for more and more health and chronic disease and minimise the impact social services to be provided locally and of the economic downturn.” fully integrated with hospital services. The Also speaking at the opening, Pearse continued expansion of the primary care Street Primary Care Team GP Dr Niall network during the next two years will O’Cleirigh said: “The opening of the Pearse mean that most people will be able to get Street Primary Care Centre marks the up to 90 per cent of the care they will need culmination of many years of planning and outside hospitals. We must continue to build work by many people. The centre will bring up more community-based service and primary care of the highest order to the recognise that we need to stop spending area and will allow the doctors, nurses and limited resources on the parts of the hospital ancillary staff to expand services. Already service that provide questionable benefits for we have antenatal care and diabetic patients and limits the expansion of urgently shared care services in the centre, and the needed services. This is how we can look psychiatric services are soon to come.” after the growing numbers of people with

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Health Matters 9

psa 2010

Public Service Agreement 2010 – 2014 (PSA)

All parties have an incentive to deliver on the changes involved The health service, in common with all parts of the Public Service, is expected to play its part in implementing the change agenda set out in the Public Service Agreement.

he Public Service Agreement (PSA) includes a programme of modernisation and change in the Public Service and a structure for how public service pay will be restored over the period of the Agreement to 2014. Ratified by the Public Services Committee of the Irish Congress of Trade Unions, the Agreement requires both management and unions to work together to deliver on its potential. In return for Government commitments that there will be no further reductions in pay of serving Public Services, trade unions have given a range of commitments in relation to issues such as redeployment, changes work practices and technologies. The terms of the Agreement provide a basis for stability and progress for the benefit of public servants and citizens. The Government has instructed senior management across the entire Public Service to accord the highest possible priority to implementing the change agenda set out in the Agreement. Mr PJ Fitzpatrick has been appointed Chair of the Implementation Body provided for under the Public Service Agreement 2010-2014. This Body has begun its work and Mr Fitzpatrick set out the role, membership and secretariat of the Body in a recent note to General Secretaries of Government Departments. He said the Agreement presents all of us with a unique opportunity to transform and modernise the Public Service. He added that delivering on this potential will undoubtedly be very challenging for all parties to the Agreement and for all public servants. It would require leadership and drive from all stakeholders. Full engagement

with the drive for change would be necessary if the potential of the Agreement is to be delivered in line with the very challenging timeframe for the pay review in spring 2011.

“He said the Agreement presents all of us with a unique opportunity to transform and modernise the Public Service.” Progress will be reported regularly by the Implementation Body to the Taoiseach and the Cabinet Sub-Committee on Public Service Transformation. Mr Fitzpatrick’s note said savings generated from the implementation of the Agreement and the agreements in each of the sectors will be used to commence the process of addressing the effect on pay of the Financial Emergency Measures in the Public Interest Acts of 2009. He said all parties have an incentive to deliver on the changes involved and by signing up to the Agreement, all parties have committed to working together to implement this Agreement to deliver an ongoing reduction in the cost of delivery of public services. Mr Fitzpatrick concluded by observing that experience of transformational change is that it is delivered more quickly and smoothly when the staff involved, and their

representatives, are engaged in the process at the earliest possible stage. HSE National Director of HR, Seán McGrath advises that the Implementation Body has confirmed the intention to establish a health sectoral sub committee and it is expected that its constitution will be finalised shortly. That Body will be tasked with assisting and facilitating health sector management and unions to work together on a collaborative basis to achieve the implementation of the Agreement. "It is important now that early action be taken by HSE service managers to define the measures required to meet Government, union and public expectations in relation to the delivery on the health sectoral change agenda", said Mr McGrath. He added that HSE’s Corporate HR will be supporting service managers in preparing the detailed proposals required to deliver the efficiencies and savings envisaged. Proposals should address the specific actions to be taken, the timescale for these, the benefits and savings arising and the periods in which they are expected to be achieved. Finally, Mr McGrath concluded that while maintaining legitimate management prerogatives in relation to implementation of policy, delivery of change and organisation of work, managers should engage with staff and their representatives at an early stage in the decision making process and keep the lines of communication open.

10 Health Matters

cancer care

NCCP launches Community Nurse Education Programme in Letterkenny The HSE’s National Cancer Control Programme (NCCP) recently launched a Community Nurse Education Programme in Letterkenny. The initiative brings together the nurse expertise of Letterkenny General Hospital and the community based nurses of the area to expand the level of care that Donegal patients with cancer will be able to receive in their own homes, reducing the necessity for travelling to the hospital.

nce completed and evaluated this pilot project will be rolled out nationally, benefiting cancer patients across the country. The programme is designed to enable patients undergoing cancer treatment – especially those receiving chemotherapy – to receive some of that care in their own homes. Donegal was chosen as the base for the pilot programme because of the skills and expertise of the nursing body at both hospital and community level. Dr Marie Laffoy, Community Oncology Advisor with the NCCP, says: “We knew that in Letterkenny we had the skills and experience of individuals like Janice Richmond (Advanced Nurse Practitioner LGH), Anne Flood (Director of Nursing LGH) and Eileen Quinn (Director of Public Health Nursing, Donegal), who along with the support of management including Sean Murphy (General Manager LGH) and John Hayes (Local Health Manager), successfully collaborated to develop a pilot programme that will expand the level of skills of the community based nurses to benefit patients with cancer.” Dr Marie Laffoy adds: “We know that most patients, where possible, prefer to receive treatment at home. Where it is safe and appropriate for this to occur, we are working to make that happen.” Developed on a pilot basis in Letterkenny, the programme began with eleven public health nurse participants. The six-month

“We know that most patients, where possible, prefer to receive treatment at home. Where it is safe and appropriate for this to occur, we are working to make that happen.”

programme will include classroom-based theory, the development of clinical skills under supervision and the subsequent application in the community. While the PHNs who are participating in this course are already qualified and skilled in a significant range of treatments and procedures, this programme will enable them to expand the range of services they can bring to their clients. Donegal patients receiving cancer treatments currently attend at Letterkenny General Hospital for a range of care, including the management of central venous lines (these are devices fitted to

patients through which chemotherapy drugs are administered). Once fitted these lines have to be maintained and managed, with Donegal patients currently returning on a regular basis to the hospital to facilitate this. However, it is possible for that management to occur at home where PHNs have the skills and expertise. While a small number of nurses currently have those skills, this course will extend that expertise to their fellow nurses and provide them with a standardised programme of skills and significantly increase the complexity of care provided to patients in their own homes. It is anticipated that once the pilot is completed and evaluated, it will, on roll out, also be open to registered general nurses. With the course expected to be completed by December, it is anticipated that Donegal patients will begin experiencing the benefits in the New Year, reducing the number of trips they have to make to Letterkenny General Hospital. Once this programme is completed, it is anticipated that there will be a reduction in the number of times patients are required to travel to Letterkenny General for follow-up care. Many of those attending at present travel to have blood taken for follow up tests. From early 2011, much of this will be carried out by community based nurses. However, they will continue to maintain the important link with their hospital-

Health Matters 11

cancer care

+ Pictured at the launch of the pilot Nurse Education Programme in Letterkenny are: Back Row L-R: Noreen Harley, Assistant Director of Nursing LGH, Anne Gallen, Director of NMPD, Mary McGroarty, ADN Public Health Nursing, Teresa Callaghan, National Cancer Control Programme, Mary Wynne, Acting Director NMPD (Dublin NE), Catherine Cannon, A/Director CNME Donegal, Maeve Gallagher, PHN, Anne Rose PHN, Ann Sweeney, PHN Caroline McLoughlin PHN, Dr Janice Richmond, Advanced Nurse Practitioner LGH, Sean Murphy General Manager, LGH, Sean Diver, CNS LGH, Mary Grace Kelly Oncology LGH, Noreen Rodgers CNS Oncology LGH Front Row L-R: Eileen Quinn, Director Public Health Nursing Donegal, Kitt Crowley, PHN, Rita Doherty, PHN, Dr Marie Laffoy, National Cancer Control Programme, Aileen Henry, PHN Michelle Cunningham PHN, Dr Anne Flood, Director of Nursing and Midwifery LGH based colleagues to allow this collaborative endeavour to ultimately benefit their patients. The public health nurses will be further skilled in identifying complications and where appropriate make urgent referrals back to the hospital. They will also be

“The public health nurses will be further skilled in identifying complications and where appropriate make urgent referrals back to the hospital.”

able to expand the level of care and psychological support they provide. For the hospital, the decrease in the number of patients attending provides an obvious benefit but equally, the development of direct links with the community services underlines the priority that is being given to patients’ needs. For Anne Flood, Director of Nursing at LGH, the programme is a significant development: “The choice of LGH at which to base this initial pilot and the manner in which it has allowed us work with our community colleagues has been extremely worthwhile. We are pleased that Letterkenny was chosen obviously, and delighted that Donegal patients will be the first nationally to benefit.” For Eileen Quinn, Director of Public Health Nursing, the programme underpins the comprehensive and skilful work already being carried out by PHNs and all community based nurses in the county: “Our nurses are committed to providing a very diverse and skilful range of services

and in expanding and developing the level of care they provide, often they are better placed to serve the needs of their clients.” At a national level, this programme has been developed collaboratively with the HSE Office of the Director of Nursing Services. It has been supported by the National Strategic Nurse Reference Group, chaired by Dr Siobhan O’Halloran, and supported by the Department of Health and Children. While it is known that the prevalence of cancer is set to increase over the coming years, the developments in treatments is ensuring that more individuals survive with their quality of life improving. Responding to patient needs and acknowledging the inevitable increase in demand for both hospital and community-based treatments, the NCCP is focusing on the development of programmes like the Community Nurse Education Programme. Further developments over the coming months will include expanding the skills and range of services offered by practice nurses.

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Health Matters 13

updates

Florence Nightingale Centenary Celebration A special event, organised by the Department of Health and Children and the HSE, to mark the centennial year of the death of Florence Nightingale took place in the beginning of September at Dublin Castle. Nurses and midwives came together to reflect on the past century of nursing and midwifery and to celebrate the contribution of Irish nurses and midwives to health care in Ireland and across the world. A special feature of the centenary celebration was the ‘Ceremony of the Lamp’, a ceremonial event in which a replica of the lamp, similar to those used in Florence Nightingale's time, was passed from one generation of nurses to the next. Florence Nightingale (1820–1910) is best known for her role in the Crimean War and for her contribution to the founding of modern nursing. Florence Nightingale died at her residence in London in 1910 at age ninety. She famously wrote that a hospital “should do the sick no harm” and this maxim holds as true today as it did when Nightingale + Sheila O’Malley, Chief Nursing Officer, Department of Health first wrote it in 1859. Like Nightingale, nurses and midwives in Ireland remain and Children and Alice Leahy, Director and co-founder of the committed to the maxim and to the “very elements of what constitutes good nursing.” homeless agency Trust.

Caring for Children with Life-Limiting Conditions Currently about 1,400 Irish children are living with life-limiting conditions and between 350 and 400 children die each year before they reach 18 years. The Centre of Children’s Nurse Education, located at Our Lady’s Children’s Hospital, Crumlin delivers two continuing education programmes funded by the Irish Hospice Foundation. Level A + Pictured (L-R) at a recent Level A Programme held in is a one-day awareness programme, Galway are: Mary B Rice, Practice Development, Intellectual Disability Services, Castlebar; Fiona Woods, Programme Coand Level B, a seven-day continuing ordinator, Irish Hospice Foundation and Centre of Children’s education programme. Nurse Education; Niamh Gantley, CNS Palliative Care, Galway The aim of the Level A programme University Hospitals; and Dr Dympna Waldron, Consultant in is to raise awareness for all Palliative Medicine, Galway University Hospitals. healthcare professionals who provide care for children with life-limiting conditions in healthcare practice settings. Such settings could include community palliative care, public health nursing, neonatal units, general practice, intellectual disability services and voluntary organisations. The Level B programme is a more in-depth programme for registered nurses and midwives directly involved in caring for children with a life-limiting condition. The aim of the programme is to provide participants with the opportunity to acquire additional knowledge, experience, values, beliefs and judgments when providing supportive and palliative care for children with life-limiting conditions and their families. Since 2007, 1,200 nurses, midwives and other healthcare professionals have completed the Level A programme and 97 registered nurses and midwives have completed the Level B programme. The next Level A programme is scheduled for the 2nd November in Dublin and further programmes are scheduled for 2011. For details on either programme contact Fiona Woods, Programme Coordinator. Call 01 409 6605 or email: admin.cllc@olchc.ie

World Spirometry Day – 14th October 2010 World Spirometry Day – Wednesday 14th October – will see professional and patient organisations such as the Irish Thoracic Society and the Asthma Society of Ireland join forces with the HSE to raise awareness of lung health as part of a global campaign for International Year of the Lung. Spirometry is a simple, quick and noninvasive test of lung function and is an important means of diagnosing conditions such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis and cystic fibrosis. Early detection leads to better management of these diseases, improved quality of life and outcomes for patients and a reduction in complications that can lead to hospitalisation and further illness. World Spirometry Day aims to highlight the importance of early diagnosis of lung disease and encourage people with symptoms such as shortness of breath, persistent cough, wheezing or increased phlegm to get their lungs tested. Check www.lunghealth.ie in the coming weeks for details of World Spirometry Day activities nationwide.

14 Health Matters

quality & clinical care

Benton takes up Therapy Professions Advisor role with QCCD The HSE’s Quality and Clinical Care Directorate (QCCD) has appointed Emma Benton to the role of Therapy Profession Advisor. Emma will support clinical programmes involving allied health professionals within the Directorate.

he therapy professionals play an essential role in current health service delivery throughout the patient life cycle. Population projections, higher survival rates, increased incidence of major trauma and advances in medicine are among the many factors that will drive demand for therapy profession services in the future. The Therapy Professions Advisor within the QCCD represents six professions: • Physiotherapy • Occupational Therapy • Speech and Language Therapy • Podiatry • Dietetics • Orthoptics These six professions were grouped together following the publication of the Various Health Professions 2000 report. The report highlighted that although each profession has a wide range of issues, these issues could be addressed by a common set of recommendations. The role of the Therapy Professions Advisor is to support the work of each clinical programme within QCCD and involves the following: • Establishing and maintaining linkages

with the various professional bodies and associations to support the development of clinical care pathways • Sourcing expertise within the therapy profession to assist in the development of clinical pathways to ensure that standards of care are developed in line with the best practice • Advising on relevant professional standards and legislation relating to Health and Social Care Professions • Providing recommendations on the appropriate levels of expertise and work force needs as required for service delivery • Advising on clinical skills availability

“Emma was formerly the Occupational Therapy Manger for Meath Community Services and Our Lady’s Hospital in Navan, Co. Meath.”

Background Emma Benton is currently Programme Co-ordinator with the North East Transformation Programme. Continuing in this role, she will also work as Therapy Professions Advisor to the QCCD. Emma was formerly the Occupational Therapy Manger for Meath Community Services and Our Lady’s Hospital in Navan, Co. Meath. She also worked as Occupational Therapy Manager in St Michael’s House Dublin, as a Resource Officer with the Physical and Sensory Disability Database project, and as an OT with Beaumont Hospital. She holds a BSc in Occupational Therapy from Trinity College, Dublin. Challenge Commenting on her new role Emma said, “Representing six individual professions is challenging as some profession groups are very well established while others are not as well established and may involve smaller numbers of professionals. For example, physiotherapy is quite a bit more complex when compared to a much smaller profession group, such as Orthoptics. “The Therapy Professions welcome the opportunity to participate in the development of the Clinical Care Programmes. As a group they have developed a number of

Health Matters 15

quality & clinical care

documents that support the development of clinical care pathways. Therapists are open to the idea of extended roles in the provision of new models of service delivery, as well as the concept of specialist roles to deliver high level complex care in line with transformation models within the health system.” The Quality and Clinical Care Directorate welcomes the valuable input of the therapy professions. The directorate recognised the importance of their involvement in the development of the Clinical Care Pathways which will be rolled out nationally. The directorate emphasises how critically important it is for the therapists to be engaged in these developments, and welcomes the support

and advice of the representatives on the working groups. As the programmes move toward implementation the support of all concerned will be vital. The Therapy Representatives were nominated by their professional bodies to be members of the various clinical pathway working groups. The main responsibility of the nominee(s) will be to provide professional expertise and advice to assist the National Clinical Programme team in its development and delivery of quality care pathways. This professional expertise and advice may be specific to discipline or on behalf of other disciplines represented by the Therapy Professions Committee.

Therapy Representatives Stroke – Anne Bourke, Physiotherapist Manager, Meath PCCC Rheumatology – Alma Joyce, Occupational Therapy Manager, and Norelee Kennedy, Lecturer in Physiotherapy University of Limerick Orthopedics – Edel Callanan, Physiotherapy Manager, Merlin Park Galway Critical Care – Emma Gorman, Physiotherapist Mater Hospital and Carmel O’Hanlon Dietitian Beaumont Hospital. Care of the Elderly – Alice Gormley, Occupational Therapy Manager, Cavan Monaghan PCCC Acute Medicine – Anne Marie Keown, Physiotherapy Manager Mater Hospital. Palliative Care – TBC Obstetrics and Gynecology – Fiona Dunlevy, Dietitian Coombe Hospital and Marguerite Hogan, physiotherapist Mullingar General Hospital Heart Failure – Catherine Chambers, Dietician St Vincent’s Hospital and Karen Cradock, Physiotherapist St Vincent’s Hospital. Diabetes – Margaret Humphries, Dietitian Cork University Hospital and Laura Kelly Podiatrist Galway PCCC COPD – Susan Curtis, Physiotherapist Naas General Hospital Asthma – Joanne Dowds, Physiotherapist St James Hospital Neurology – TBC Emergency Medicine – TBC

CareWorld Ireland The Care & Support Professionals Working closely with Ireland’s healthcare professionals to help prevent hospital admission & facilitate early discharge

• Quality affordable home care • 24 hour, nurse-led, Irish owner managed • High and low dependency cases • Flexible hours and care plans • From one hour per week to live-in care • In-house training division • All staff Garda vetted and insured Call Deirdre O’Driscoll on

086-4078867 (anytime 24/7)

Or visit our website

www.careworld.ie CareWorld is a member of the INI Healthcare Group www.ini.ie 9 Inns Court, Winetavern St, Christchurch, Dublin 8. Phone: 01-6169747

Congratulations to all nominees of the HSE Achievement Awards from the Quest Diagnostics Ireland team.

www.QuestDiagnostics.ie

Health Matters 17

in association with

The HSE Achievement Awards 2010 in association with Quest Diagnostics were created to recognise and celebrate outstanding work by health and social care staff and ultimately reward best practice and raise standards within the health sector.

o support and acknowledge applicants four Regional Recognition Events were held at the end of August 2010 in Dublin, Tullamore, Cork and Galway. The headline sponsor of the 2010 Achievement Awards is Quest Diagnostics, the world’s leading provider of diagnostic testing, information and services. There are also four regional sponsors. The Sisk Group are the regional sponsors in HSE Dublin North East (DNE). Pinewood Healthcare are the main sponsors in HSE Dublin Mid-Leinster (DML). Zurich are the main sponsors in HSE West, while Complete Telecom are the sponsors in HSE South. There are also four patron sponsors of the event, Vodafone, the RCSI, Dalkia and Aramark. A total of 326 healthcare projects and initiatives from all over the country applied for this year’s Awards.

The awards were open to health service settings directly run or funded by HSE. Applications have been received from clinical services, primary care or social/family support; support services such as catering, portering and security; and management initiatives such as people management processes, information technology or service management initiatives. Speaking about the HSE Achievement Awards 2010 at the Regional Recognition Event in Dublin, the chairman of the HSE Board Dr Frank Dolphin said he was delighted to be able to endorse the Awards which were an important recognition of the work that staff undertake in the care and treatment of patients and clients. Five entries selected from each HSE Region were chosen to go forward to the HSE Achievement Awards 2010 National Event in Dublin’s Mansion House on November 24th when the overall winners

of the HSE Achievement Awards 2010 will be announced. Entries for the Awards were submitted from all four HSE Regions and from both hospital and community healthcare settings. The Awards will be as follows: • The Derek Dockery Award for Overall Best Project with two runners up (three awards) • Best Project from each Region and runner up (eight awards). At their discretion, the National Panel may make additional awards in the form of commendation for projects that excel in particular criteria. The National Co-ordinator for the HSE Achievement Awards 2010 is Denise O’Shea: who can be contacted by email at denise.oshea@hse.ie or tel: 01 635 2048. For photos from the Achievement Awards, see pages 26-29. Please note there are additional photos on the HSE Intranet.

18 Health Matters

in association with

HSE South Sponsored by

Bantry General Hospital and West Cork PCCC West Cork Falls Prevention Service

+ Pictured are Teresa O’Donovan, General Manager, West Cork Community Services; Noreen Lynch, Staff Nurse Rehabilitation Unit Bantry General Hospital; Kevin Murphy, Managing Director Complete Telecom (Regional Event Sponsors), Dr Brian Carey, Consultant Geriatrician Bantry General Hospital, Barry O’Brien, Assistant National Director Human Resources HSE South, Anne Nee, Health Services National Partnership Forum, Joan Browne, CNM2 Bantry General Hospital

Wexford General Hospital Site Infection Surveillance Service

exford General Hospital (WGH) had no formal system of surgical site infection surveillance, unless the surgical site infection (SSI) was caused by an "alert" organism such as Methicillin resistant Staphylococcus aureus (MRSA). • An internationally robust surgical site infection surveillance system (SSIS) was introduced into WGH in 2006 • On average most SSI’s occur between days five and 10 following a surgical procedure. Changing surgical practices with shorter length of stay contributed to the underestimation of the true SSI rate

• Accurate determination of SSI’s required the introduction of a system of post discharge surveillance. A post discharge surveillance system was commenced in WGH in January 2010 • In 2007, our crude SSI rate was 9.0 per cent, in 2008 5.4 per cent and in 2009 the rate is recorded at 4.4 per cent Project Lead: Eithne O’Sullivan, Surveillance Coordinator; Email: eithne.osullivan1@hse.ie Senior Sponsor: Lilly Byrnes, General Manager, Wexford General Hospital

alls in older people are a major public health concern in terms of morbidity, mortality and costs to health and social services. • Considerable difficulties often arise, however, when attempting to deliver high quality medical care to older people living in rural, sparsely populated regions. • This project pioneered a service for the assessment and management of older patients at risk for falling in one of the most rural parts of Ireland. • Using a system that involves intimate cooperation between community and hospital services, high-risk patients are identified and referred for a one-stop, comprehensive falls risk assessment performed by a dedicated multidisciplinary team. • The most up-to-date international protocols and procedures are used to stratify risk and to identify evidencebased, targeted interventions that will significantly reduce the risk of falling and sustaining injuries. • This has allowed frail older patients to benefit from an evidence-based, highquality service close to home in a rural setting where the delivery of healthcare services has traditionally proven difficult or impossible. Project Lead: Dr Brian Carey, Consultant Geriatrician; Email: brian.carey@hse.ie Senior Sponsor: Eleanor O’Donovan, Hospital Manager, Bantry General Hospital

Health Matters 19

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South Lee Community Speech & Language Therapy Conversation Partner Scheme (CPS)

he Conversation Partner Scheme helps create conversational opportunities for people with aphasia (communication difficulties after a stroke). It is based on a model provided by Connect in the UK (www.ukconnect.org). • These clients may be isolated with little opportunity to have conversations outside of the speech and language therapy clinic. This scheme fits with the WHO social model of disability by giving clients with aphasia the opportunity to share their ideas and interests, thus improving their quality of life. • The CPS brings together trained volunteers and people with aphasia who are isolated and who have little opportunity for conversation. • Volunteers are recruited, trained, supervised and supported. Those trained as volunteer conversation partners enter into an agreement to visit a partner with aphasia once a week over a six-month period for one hour a week, with the aim of conversing with that person. • These conversations take place in the client’s home. Project Lead: Kate Dunn, Senior Speech & Language Therapist; Email: kate.dunn@hse.ie Senior Sponsor: Anne Tangney, SLT Manager

North Lee Speech and Language Department and North Lee Community Work Department PCCC The Glen Early Language and Learning Pilot Project

joint initiative of the HSE and Cork City Partnership, which was run on a pilot basis. • The pilot project comprised two parallel interventions which were designed in response to the need to pay more focused attention to speech and language development among young children in The Glen, an area of socioeconomic deprivation in Cork City. • The first was a speech and language development programme for Junior Infant classes in the two primary schools, which was designed and implemented by the Speech and Language Therapy Service of the North Lee HSE-South in collaboration with the schools in the area. • The second programme involved five pre-schools. The programme for pre-schools included two elements: a) Providing the Hanen professional training programme Teacher Talk Series for pre-school staff b) Developing an oral language programme which was implemented by childcare workers in the pre-schools Project Lead: Ronnie Dorney, Principal Community Worker; Email: ronnie.dorney@hse.ie / Anne Horgan, Speech and Language Therapy Manager Senior Sponsor: Deirdre Scully, Local Health Manager, North Lee, North Cork / Aileen O’Neill, General Manager, North Lee

Hospital, community and voluntary disability groups in the Cork Region Informing families of their child’s disability

ollowing the launch of evidence-based Best Practice Guidelines for Informing Families of their Child’s Disability an interdisciplinary, cross-sectoral project was established to pilot the implementation of the guidelines on an integrated partnership basis in the Cork region. • The aim of the project was to improve the experiences of parents who are informed of their child’s diagnosis of disability and to improve support for professionals involved in the communication of the diagnosis. •The project was guided by a Steering

Committee chaired by a parent of two children with disabilities, and was implemented across acute, community and disability service settings in the Cork region. Professionals from medical, nursing and allied health disciplines in a wide range of organisations participated in the project. Project Lead: Alison Harnett, Informing Families Project Coordinator; Email: alisonharnett@fedvol.ie Senior Sponsor: Brian O’Donnell, Chief Executive, National Federation of Voluntary Bodies

20 Health Matters

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HSE West Sponsored by

Galway University Hospital The Galway University Hospital Regional Anaesthetic Facility

+ Front row, L-R: Siobhan Patten, HSE West Area Manager P&D and National HSE Achievement Awards Steering Committee; John Hennessy, HSE West Regional Director of Operations; Cllr Padraig Conneely, Chair of Regional Health Forum West; Anne Hargadon, HSE Achievement Awards Regional Co-ordinator; and Billy Gallagher, Partnership Rep. Back row, L-R: Kevin Little, Act Assistant National Director, HR HSE West; Sheila Lawlor, Shortlisting Team, HSE Achievement Awards; and Bridget McGuane, National HSE Achievement Awards Steering Committee

Roscommon PCCC When Nature Calls! Managing Incontinence in Roscommon

ladder and bowel problems can be distressing, unpleasant, socially disruptive as well as restricting employment, educational and leisure opportunities. A high quality and comprehensive continence service is, therefore, an essential part of healthcare. • This project outlines the continence care model developed across County Roscommon which has significantly improved the continence care for children and adults with bladder and bowel problems. • This was done by redesigning the way services are provided and delivered in all Primary Community and Continuing

Care (PCCC) settings as well as private nursing homes across the county. • Central to the project is the synergy database, an information management system which manages the data derived from clinical assessments. • This system leads to the provision of regular home delivery of appropriate products to clients across County Roscommon, either direct to their own homes, residential care units or private nursing homes. Project Lead: Margaret Tiernan, Continence Advisor; Email: margaret.tiernan@hse.ie Senior Sponsor: Frank Murphy, Local Health Manager, Roscommon PCCC

he facility established in the reception area of the major theatre suite in GUH allows for patients: • To have regional anaesthesia techniques (blocks) performed and by doing so decreases the number of general anaesthetic techniques. • Provide a service for the provision of acute and some chronic pain blocks to either acute post operative patients or patients presenting with painful problems. • Provide onsite teaching of junior doctors, Medical or Nursing students. Project Lead: Dr John McDonnell, Consultant Anaesthetist, Galway University Hospital; Email: johnmcdonnell@gmail.com Senior Sponsor: Dr Noel Flynn, Consultant Anaesthetist, Galway University Hospitals

Health Matters 21

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Mid-Western Regional Hospital Limerick Paediatric High Dependency Unit he need for adequate centralised Paediatric Intensive Care Unit facilities is widely recognised and many studies support the view that centralised paediatric Intensive Care outcome is better than small facilities attached to adult intensive care units. • Prior to the establishment of the paediatric High Dependency Unit, there was no purposebuilt facility with appropriate trained staff in the hospital. • The establishment of the unit has led to the provision of high quality, seamless and comprehensive service organised to encompass the needs of the critically ill child and his/her family. • Care is now provided with a workforce that is highly-skilled and valued to maintain high standards of care through continued education, audit research and evidence based practice/guidelines. Project Lead: Dr Roy K Philip, Lead Clinician for High Dependency Unit; email: roy.philip@hse.ie Senior Sponsor: Mark Sparling Hospital Manager, Mid Western Regional Hospital Limerick

Occupational Therapy Splinting Clinic (Primary Care) Primary Care Occupational Therapy (OT) Splinting Clinic

he clinic offers a weekly service to both paediatric and adult patients who are based in the community who require splints for the upper limb. • The clinic was set up approximately three years ago as response to fellow community and hospital OTs/ Physiotherapists /GPs/PHNs requiring expert advice and follow up on hand conditions. • Initially the clinic was once a month but due to the demand was extended to once a week.

• The clinic is based in Castlebar which is a central location for clients in Mayo. • Instead of the usual route of the PC OT going directly to the client’s home to fabricate a splint they are seen in the clinic. Hence reducing travel expense, waiting lists and time for the rest of the PC OT team. Project Lead: Helen Boyle, Senior Primary Care Occupational Therapist; email: helen.boyle@hse.ie Senior Sponsor: Eileen Kelly, Occupational Therapy Manager

COPE Galway Community Catering COPE Galway Community Catering OPE Galway Community Catering is a positive development dedicated to the provision of nutritional support for Galway’s older people. Our objective is to assist older people to live their lives independently and in their own home if that is their wish. • Cope Galway Community Catering delivers approx 45,000 hot nutritious meals per annum to older people in the City and County. Our team of over 120 volunteers deliver to 14 city routes, and we have two vans bringing meals to two outer lying rural routes. • The service operates from a state-ofthe-art facility in Ballybane which was supported by The Dormant accounts fund to equip, and is fully compliant with HACCAP standards. There are nine part-time employees including an executive Head Chef. A panel of approximately 120 volunteers assist with food preparation and delivery. • Cope Galway Community Catering is a voluntary organisation, which receives funding from the HSE (33%), income from meal receipts (50%), fundraising (12%) and other grants (5%) The application for the HSE achievement award is based on our receipt of the EIQA Q mark in March 2010, at the highest possible level – Emerald. Project Lead: Geraldine Ryan, Executive Chef/Mary Stout Coordinator; Email: communitycatering@ copegalway.ie Senior Sponsor: Jacquie Horan, CEO COPE, Galway

22 Health Matters

in association with

HSE DNE Sponsored by

Beaumont Hospital A “Respiratory Passport” for patients with Chronic Obstructive Pulmonary Disease (COPD)

C +

Dr Frank Dolphin, Chairperson of the HSE Board, Willie Costello (MD Synapse Medical), Brenda McPadden (Ashville Media), Michael Connole (MD Cardiac Services) and John Osborne (MD Sisk Healthcare)

Mater Miserciordiae University Hospital Tracheostomy Grand Round (TGR) he tracheostomy Grand Round was established in March 2009 as a quality initiative to ensure standardising care, continued progress and rehabilitation of patients with a tracheostomy insitu post discharge from critical care. • Prior to the establishment of the grand round, follow up of patients following discharge from critical care was not standardised on the peripheral wards. • A committed team meets weekly incorporating all multidisciplinary team members working with the patient to ensure an integrated progressive management approach. • The ultimate goal is the provision of a high quality standardised service for patients with tracheostomy throughout the hospital with the aim of weaning patients in a systematic way that reflects best practice. Project Lead: Ailbhe Dunne and Una Cunningham; Email: adunne@mater.ie Senior Sponsor: Prof Carol Fitzpatrick, Child Psychiatry Department

hronic Obstructive Pulmonary Disease is an umbrella term to describe a respiratory disease associated with airflow obstruction. Approximately 440,000 people in Ireland have COPD. Currently it is projected to be the top cause of respiratory deaths in Ireland and the third highest cause of mortality in the world by 2020. • In an attempt to improve the quality of care delivery, the quality of life of COPD sufferers and to aspire to achieving the goals of the Health Transformation Programme, an information booklet called a “Respiratory Passport” incorporating an individualised selfmanagement plan was developed by the applicant, who is working as a clinical nurse specialist within a MDT COPD outreach setting. Project Lead: Niamh McCormack, CNMII; Email: niamhmccormack@beaumont.ie Senior Sponsor: Brenda Deering, Senior Physiotherpaist/COPD Outreach Coordinator

Health Matters 23

in association with

Community Services, Local Health Office – Dublin North Central Men’s Health and Wellbeing Programme (MHWP)

he Men’s Health and Wellbeing programme was developed by the Larkin Centre in partnership with Glasgow Celtic Football Club, the HSE and Pfizer Healthcare. The population focussed on were men (30 years plus) living in Dublin’s North Inner City. • This targeted area is characterised by high deprivation with many social factors that impact negatively on health. • The challenge for the MHWP was to devise a formula and programme that would meet the needs of this client group who were particularly difficult to engage. • The model chosen was based on the Well Man Programme established by Glasgow Celtic Football Club and was then tailored for the requirements for men of Dublin’s North Inner City. • The Programme ran for ten weeks and had the following elements: fitness and lifestyle, cookery, health education. The content was: Health Screening, Health Awareness, Cookery, and Soccer. • The MHWP was effective in meeting the objectives of the programme and connecting with the local men. It is viewed as a very genuine and worthwhile example of best practice in how to effectively engage with men (Men’s Health and Wellbeing Evaluation Report–Centre for Men’s Health, Institute of Technology Carlow, May 2010). Contact; Email: phil.dunne@hse.ie / email: mary.martin@hse.ie

Mater Hospital CAMHS (Child and Adolescent Family Service/University College Dublin) Working Things Out Through SPHE n innovative schools-based psycho educational Resource specifically designed to support SPHE Teachers in their youth mental health promotion work with students. • The Resource consists of 9 X Animated DVD-Based representative youth mental health stories, narrated by the young people themselves. • These stories are complimented by a specially-developed Teachers Resource book designed to provide structure lesson-plans for this work. Contact; Email: mike.power@ucd.ie

Physiotherapy Service LHO Dublin North Central Balance Matters for Older People he Falls Management Exercise (FaME) programme is an evidence-based programme which aims to improve older peoples balance and mobility, improve their confidence and prevent falls. • The physiotherapy service ran a pilot programme in collaboration with the community in Marino in 2008. An audit was conducted of the outcome measures and this demonstrated significant improvement in people's balance, mobility, level of confidence and coping abilities in the event of a fall. A focus group was conducted with positive feedback. • The evaluation demonstrated that changing from individual one to one sessions on home visits to a group programme was an effective and efficient way to deliver physiotherapy for this client group. • Working in partnership with a local community group worked well. We adopted this approach again in Ballymun and Millmount, working closely with statutory, voluntary and community groups to run successful FaME programmes in 2009 and 2010. Project Lead: Aine O’Riordan, Senior Physiotherapist/Physio Manager; Email: aine.oriordan@hse.ie Senior Sponsor: Gerry Reid, General Manager

24 Health Matters

in association with

HSE Dml Sponsored by

St James’s Hospital Patient Advocacy Broad

Purpose of Hospital Quality Programme

+ Standing: Oliver Plunkett, HSE Performance and Development, Siobhan Regan, DML Regional Coordinator Achievement Awards 2010, Cllr Simon Harris, Chair of the DML Regional Forum, Mary Gorry, Asst National Director HR, Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership, Denise O’Shea, National Coordinator Achievement Awards 2010, Bernadine Gormley, Pinewood Healthcare and Hanna Bates, Ashville Media Sitting: Heather Merrigan, HSE Kildare West Wicklow, Carol Hicky, Quality Manager St James, Teresa Connole, Anticoagulation Clinical Nurse Manager 2 Tallaght Hospital, Ellen O’Dea Cathedrals Primary Care Team and Yvonne Doyle, Crumlin Hospital

Adelaide and MEATH HOSPITAL incorporating the National Children’s Hospital, Tallaght Development of a Pilot Patient Self-Testing Project in a nurse-managed Anticoagulation Clinic

arfarin is a frequently prescribed high risk medication, requiring ongoing monitoring of drug levels. This necessitates frequent hospital visits, to often overcrowded Anticoagulation clinics, causing inconvenience for patients which can lead to poor compliance with treatment. • A pilot home testing programme for 10 patients was implemented in February 2009. Following development of guidelines and training, a Point of Care testing device was supplied to patients. • These patients now perform INR testing at home on an agreed date and phone in to the Clinical team to receive warfarin dose instructions. • They attend clinic three monthly to facilitate quality control. • They are all very enthusiastic about the programme and delighted with the convenience provided by home testing. Project Lead: Teresa Connole, CNM2; Email: teresaconnole@amnch.ie Senior Sponsor: Bernadette Corrigan, Assistant Director of Nursing

his project aims to develop and promote a hospital programme to improve patient satisfaction. • Develop and create a framework which enables the local community to purposefully interact with the hospital and discuss, debate, feedback concerns, make contributions in relation to existing service provision/delivery methodologies and participate in the development of future services. • Achievement of the above was pursued within a quality paradigm incorporating the following: accreditation, patient advocacy, risk management, clinical audit and performance indicator. Project Lead: Carol Hickey, Quality Manager Senior Sponsor: Ian Carter, Chief Executive Officer

Health Matters 25

in association with

Kildare West Wicklow School Support Team HSE Disability Services

Our Lady’s Children’s Hospital Crumlin

The Kildare West Wicklow School Support Team he Disability Manager had identified a gap in services in respect of children with a diagnosis of Moderate Intellectual Impairment attending mainstream Primary School. • These children received ‘Early Intervention Services’ until they began mainstream school however they did not qualify for Community Speech & Language Therapy intervention. • With the publication of the EPSEN Act (detailing the needs of therapy provision for children with intellectual impairment in mainstream school settings), and government policy promoting ‘integration’ in the Irish Education System, an increasing amount of parents began to choose mainstream education for their children with Intellectual Disability. • The Disability Manager identified this group of children as requiring intervention in a comprehensive way and sought both funding and personnel to work as a team, providing therapy in mainstream schools for children with Intellectual Disability. • A Psychologist, Occupational Therapist and a Speech & Language Therapist were approached to be part of this innovative service, and in 2006, the Kildare West Wicklow School Support Team was born. Project Lead: Carol Cuffe, Disability Services Manager; Email: carol.cuffe@hse.ie Senior Sponsor: Billy Quinn, General Manager, Kildare West Wicklow

The ‘Anyone Can Eat’ tube weaning programme

his is a new and very innovative service development. It is a three week inpatient intensive programme which aims to wean infants and children from their tube feeding to develop full oral eating and drinking skills by the end of the programme. • To ensure children are suitable for tube weaning, i.e. medically stable, appropriate weight and have a safe swallow; prior to admission they attend appointments with the primary consultant, speech and language therapist, dietician and psychologist. • To date, 21 children with a range of medical diagnoses have attended the programme. 20 of these have become full oral feeders by the end of the three weeks. Project Lead: Celia Butler, Senior Speech & Language Therapist; Email: celia.butler@olchc.ie / Carina Kelleher, Senior Dietitician Senior Sponsor: Catherine Cunningham, SLT Manager

Cathedrals Primary Care Team Dublin South City, LHO Key Working Model

mplementation of a key working model and person centred multidisciplinary care planning within a Primary Care Team (PCT), adopting a continuous quality improvement approach. • Identify best practice in this area and establish a model of key working that is transferable across primary care services. • To decrease and share the risks associated with the ongoing management of complex vulnerable clients with high needs and under users of services. Key Contact: Alma Joyce, OT Manager (acting); Email: alma.joyce@sicp.ie Senior Sponsor: Ellen O’Dea, Primary Care Manager

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in association with

+ The Paediatric High Dependency Unit at the MidWestern Regional Hospital was short listed for the national HSE Achievement Awards. Photographed at the Regional Recognition Event in Galway: Jean Moloney, CNM3, Paediatric High Dependency Unit with John Hennessy, Regional Director of Operations, HSE West + A project to introduce a Regional Anaesthetic Facility at Galway University Hospitals (GUH) was short listed for the national HSE Achievement Awards. Photographed at the Regional Recognition Event in Galway (L-R): Mary McHugh, Director of Nursing and Midwifery and Marie Dempsey, Business Manager, Theatres, Anaesthesia and Critical Care Directorate, GUH with John Hennessy, Regional Director of Operations, HSE West

The Primary Care Occupational Therapy (OT) Splinting Clinic in Castlebar was one of five projects in the HSE West area short listed for the national HSE Achievement Awards. Photographed at the Regional Recognition Event in Galway (L-R): Ruth Walsh, Senior Primary Care Occupational Therapist and Helen Boyle, Senior Primary Care Occupational Therapist, Mayo Community Services with John Hennessy, Regional Director of Operations, HSE West

+ The “When Nature Calls” continence management services was one of five projects in the HSE West area short listed for the national HSE Achievement Awards. Pictured at the Regional Recognition Event in Galway (L-R): Frank Murphy, Local Health Manager; Dolores O’Neill, Director of Public Health Nursing and Margaret Tiernan, Continence Advisor, HSE Community Services Roscommon with John Hennessy, Regional Director of Operations, HSE West and Teresa Moore, Nursing & Midwifery Planning and Development Unit, HSE Galway

+ COPE Galway Community Catering was one of five projects in the HSE West area short listed for the national HSE Achievement Awards. Pictured at the Regional Recognition Event in Galway (L-R): Mary Stout, Co-ordinator and Geraldine Ryan, Executive Chef, COPE Galway Community Catering with John Hennessy, Regional Director of Operations, HSE West

+ At the Regional Recognition Event in Galway (L-R): Lorcan Harding, Zurich; Siobhan Patten, HSE Area Manager, Performance & Development; Bridget McGuane, National HSE Achievement Awards Steering Committee; and John Hennessy, Regional Director of Operations, HSE West

Health Matters 27

in association with

+ Oliver Plunkett, HSE Performance and Development, Siobhan Regan, DML Regional Coordinator Achievement Awards 2010, Mary Gorry, Asst National Director HR, Ellen O’Dea Cathedrals Primary Care Team, Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership Facilitator, Denise O’Shea National Coordinator Achievement Awards 2010 and Bernadine Gormley, Pinewood Healthcare

+ Oliver Plunkett, HSE Performance and Development, Siobhan Regan, DML Regional Coordinator Achievement Awards 2010, Mary Gorry, Asst National Director HR, Carol Hickey, Quality Manager St James’ Hospital, Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership Facilitator, Denise O’Shea National Coordinator Achievement Awards 2010 and Bernadine Gormley, Pinewood Healthcare

+ Oliver Plunkett, HSE Performance and Development, Siobhan Regan, Mary Gorry, Assistant National Director HR, Heather Merrigan, Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership Facilitator, Denise O’Shea, National Coordinator Achievement Awards 2010 and Bernadine Gormley, Pinewood Healthcare

+ Oliver Plunkett, HSE Performance and Development, Siobhan Regan, DML Regional Coordinator Achievement Awards 2010, Mary Gorry, Assistant National Director HR, Teresa Connole, Anti-coagulation Clinical Nurse Manager Two from Tallaght Hospital, Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership, Denise O’Shea National Coordinator Achievement Awards 2010 and Bernadine Gormley, Pinewood Healthcare + Oliver Plunkett, HSE Performance and Development, Siobhan Regan, DML Regional Coordinator Achievement Awards 2010, Mary Gorry, Asst. National Director HR, Yvonne Doyle (accepting the Crumlin certificate on behalf of Cecila Butler and Catherine Cunningham) Liam O’Callaghan, Acting Regional Director of Operations, Oliver Smith, Partnership Facilitator, Denise O’Shea National Coordinator Achievement Awards 2010 and Bernadine Gormley, Pinewood Healthcare

28 Health Matters

in association with

+ Pictured at the Achievement Awards DNE Regional Finals in Connolly Hospital, Blanchardstown were: (L-R) Serena O’Brien, Stephen Mulvany Regional Director Of Operations, HSE Dublin North East, Una Cunningham Speech and Language Therapy Manager and Ailbhe Dunne Senior Speech and Language Therapist

+ Niamh McCormack CNM 2 COPD, St Pauls Ward, Respiratory Nursing Centre, Beaumont Hospital and Stephen Mulvany Regional Director Of Operations, HSE Dublin North East

+ Aine O’Riordan Senior Physiotherapist, LHO Dublin North Central, Stephen Mulvany Regional Director Of Operations, HSE Dublin North East and Barbara Rooney Physiotherapy Manager

+ Stephen Mulvany Regional Director Of Operations, HSE Dublin North East and Frances King Research Psychologist, Mater Hospital (representing Professor Carol Fitzpatrick Professor of Child Psychiatry and Mike Power Clinical Psychologist)

+ Mary Martin Manager of Services for Social Inclusion, LHO Dublin North Central, Stephen Mulvany Regional Director Of Operations, HSE Dublin North East and Phil Dunne Development Officer PCCC, LHO Dublin North Central

Health Matters 29

in association with

+ (L-R): Mary Casey, Social Work Manager Cork University Hospital; Kevin Murphy, Managing Director Complete Telecom (Regional Event Sponsors), Margo Fenton, Social Worker Cork University Maternity Hospital (one of the finalists), Barry O’Brien, Human Resources Director HSE South, Gabrielle O’Keeffe General Manager South Lee Local Health Office; Dolores Geary, Health Services National Partnership Forum

+ (L-R): Pictured are Kevin Murphy, Managing Director Complete Telecom (Regional Event Sponsors), Eithne O’Sullivan, Wexford General Hospital (one of the finalists), Barry O’Brien, Human Resources Director HSE South, Anne Nee, Health Services National Partnership Forum.

+ (L-R): Kevin Murphy, Managing Director Complete Telecom (Regional Event Sponsors), Anne Horgan, The Glen Early Language and Learning Pilot Project (one of the finalists), Barry O’Brien, Human Resources Director HSE South, Anne Nee, Health Services National Partnership Forum

+ (L-R): Kevin Murphy, Managing Director Complete Telecom (Regional Event Sponsors), Kate Dunn, Cork South (one of the finalists), Barry O’Brien, Human Resources Director HSE South, Dolores Geary, Health Services National Partnership Forum

30 Health Matters

News // in brief IMB SIGNS MEMORANDUM OF UNDERSTANDING WITH AUSTRALIAN COUNTERPART

+ Pat O’Mahony, Chief Executive, Irish Medicines Board (left), and Rohan Hammett, National Manager, Therapeutic Goods Administration, part of the Department of Health and Ageing, Australia, are pictured signing a Memorandum of Understanding between the two organisations to establish a framework for cooperation in the area of the regulation of medicines, medical devices and healthcare products

Foster Parent wins People of the Year Award

Rio Hogarty was the winner of a special award for Inspiring Mum of the Year at the People of the Year Awards 2010, sponsored by QUINNhealthcare and organised by Rehab. The Awards were broadcast live on RTÉ television in September. Rio was honoured for her energy, generosity and tremendous sacrifice in providing love, encouragement and support, not only to her own two children, but to 140 foster children over the past 40 years. Now 73 years old, she has ensured that many children have been able to benefit from a safe and loving home environment and are in a position to fulfil their own dreams and ambitions.

Puppet Portal Project highly commended A project designed to put a smile on the face of children attending Beaumont Hospital has been highly commended by a major arts award committee. Using latest web technology, the Puppet Portal Project linked 500 children in hospitals in Dublin, Limerick and Sligo. Working together over a 20-week period, the children designed and made puppets, developed stories and performed for each other. The project received was Highly Commended by the judges in this year's Business to Arts Awards in the category of Best Use of Creativity. Marking this achievement, a special Puppet Portal Stage was recently unveiled in Beaumont's St Raphaels Ward. This was created by artists Siobh Clancy and John Dunn in collaboration with patients there and with the support of the hospitals school and its Arts Office. The Puppet Portal project is a partnership between Helium Childrens Arts and Health,

the Centre for Health Informatics at Trinity College Dublin and Kids Own Publishing Partnership. As well as Beaumont, other hospitals closely involved included the Children’s University Hospital, Temple Street, The Children’s Ark Unit, Mid-Western Regional Hospital, Limerick and Sligo General Hospital. Helene Hugel, Director of Helium, explains that multiple hospital attendances, difficult procedures and operations, illness and low energy levels can all take their toll on childrens self esteem. By helping them access and express their own creativity the project helped to transform the hospital experience, she says. Independent evaluation found that the project not alone built self-esteem and reduced boredom, but also enhanced the primary school curriculum being taught in the hospitals, particularly in relation to visual arts, drama and English.

Celebrating the success of the Puppet Portal Project in the Business to Arts Awards (from left) Helene Hugel, Artistic Director, Helium, with Angela Connolly, Patient Services, Marie Keane, Deputy CEO and Avril Carey, Hospital School Principal, all from Beaumont Hospital

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32 Health Matters

News // in brief

Role of Nurse Prescribers in Care of Children Explained An information leaflet developed to inform parents of child patients about nurse and midwife prescribing, is now available to download at www.hse.ie The leaflet was developed by Gill O’Callaghan and Frieda Clinton of Crumlin Hospital, Dublin, on behalf of a working group comprised of health professionals who work in hospitals in Dublin, Mullingar and Kerry. Registered Nurse Practitioners (RNPs) are encouraged to download the leaflet and use it when working with children and their families. To raise awareness of the nurse prescribing initiative in children’s services, the group has also developed a poster, which will be displayed in clinical areas where there is a RNP working. The working group included representatives from the Children’s University Hospital, Temple Street, Dublin; the Adelaide and Meath Hospital Dublin incorporating the National Children’s Hospital; the Midland Regional Hospital, Mullingar, Kerry General Hospital and Our Lady’s Children’s Hospital, Crumlin, Dublin. The initiative was supported by the HSE Office of the Nursing and Midwifery Services Director. Meetings took place via an e-working group and the use of phone teleconference facilities from ten different sites enabled the group to discuss the proposed leaflet, whilst limiting the time staff were away from their clinical services.

The leaflet is child-friendly and its content was adapted from materials already developed for adults. The leaflet about nurse prescribing for children has greater use of bright colours and illustrations and is targeted at parents, carers and guardians. The views of parents and children were sought and the Office of the Ombudsman for Children consulted during the process. They suggested bright colourful pictures, cartoons and short sentences using plain English. Parents suggested “words that were not too difficult for parents to try to explain to their child”. The opinions of play specialists were also sought and they confirmed the importance of colour and simple English, however, they cautioned about the importance of not trivialising children’s care when using cartoons. The National Adult Literacy Association reviewed the leaflet and confirmed that the wording was appropriate. The priority for parents was that their child received appropriate medication without delay. Trained nurses can prescribe certain medications without having to wait for a doctor to do so. In 2007, the Minister for Health and Children extended prescriptive authority to Nurses and Midwives. This required legislative amendments, changes to the Nurses Rules and the development by An Bord Altranais of a regulatory framework for Nurses/Midwives with prescriptive authority.

Dympna Kavanagh appointed Oral Health Lead for HSE Limerick-based dental professional Dympna Kavanagh was recently appointed Oral Health Lead for the HSE. Dympna was formerly HSE Principal Dental Surgeon for the Limerick/North Tipperary area. A graduate of University College Cork Dental School, Ms Kavanagh’s main focus in her new post will be on the implementation of a strategic review of the Dental Services which is currently being finalised. She will work out of both Limerick and Dublin. A native of Co. Tipperary, Dympna holds a PhD in Preventive and Paediatric Dentistry. Following graduation, Ms Kavanagh completed her training in dental public health in Guys Hospital, King’s

College, London, where she worked as a senior registrar and lecturer. As a senior registrar she worked across several health authorities, including East and West Kent, East London and Lambeth, Southwark and Lewisham. Ms Kavanagh returned to Ireland in 2001, taking up a post with the Mid-Western Health Board briefly as a project officer and then as a general manager. She took up the post of principal dental surgeon for the Limerick/North Tipperary area in 2003. In recent years, Ms Kavanagh has also worked in HSE Corporate for the Quality and Risk section of the former Primary, Community and Continuing Care Directorate.

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Health Matters 35

in brief // News HSE Legal Activity Project Report Launched

+ +

Elizabeth Adams (centre) with Siobhan O’Halloran, HSE and Liam Doran, Irish Midwives and Nurses Organisation at her farewell celebration. Elizabeth is to join the staff of the International Council of Nurses (ICN) based in Geneva, Switzerland, where she will serve as Director of the International Centre for Human Resources in Nursing and as the ICN Nurse Consultant focusing on socio-economic issues

Connect becomes first Irish helpline to receive quality standard Phone-based support and counselling service Connect has become the first Irishbased helpline to achieve The Helplines Association (THA) quality standard. THA is a UKbased internationally recognised accreditor of Helpline services. Connect works in co-operation with the HSE’s National Counselling Service (NCS) to provide support and counselling services nationwide. Both services complement each other by cross-referring patients as appropriate, with Connect providing an out of hours telephone-based service alongside the daytime face-to-face counselling provided by the NCS. Receipt of the THA standard follows a full service evaluation in 2009 which recommended that Connect’s opening hours be extended. Connect is staffed by professionally accredited counsellors and was established at the request of abuse survivor groups in 2006. Connect is funded through the HSE and is a registered charity with an independent Board of Directors. Chief Executive Officer, Anne Richardson said: “Connect is delighted to be awarded The Helplines Association’s Quality Standard, particularly as we are the first Irish helpline to receive the award. This award supports Connect’s commitment to providing a high quality and professional service”. Figures released earlier this year showed that the service had a 37 per cent increase in calls during 2009 receiving 8,264 calls compared to 6,020 in 2008 and 4,630 in 2007 following the public focus on the findings of the Ryan and Murphy reports during the year. The 2009 figures showed that three urban counties accounted for almost half of all calls with Dublin (26 per cent), Cork (11 per cent) and Galway (10 per cent) accounting for 47 per cent of calls to the service. The report also revealed that 69 per cent of all callers in 2009 were female. The service is encouraging those in rural areas and men also call the service to avail of support from experienced counsellors. Connect’s first Annual Report covering 2006-2009 will be launched in October 2010. The service is available Wednesday to Sunday, from 6-10pm by calling 1800 477 477. Callers from the UK and Northern Ireland can call 00800 477 477 77. More information at www.connectcouncelling.ie.

Front Row: Tony Leahy, Rita Donovan, Amelia Cox and Martin Rogan Back Row: Anthony Fitzpatrick, Pat Kenny, Martin McMenamin at the launch of the report

A report on Legal activity in respect of the Mental Health Act 2001 for the HSE has been launched. The purpose of the project was to risk manage and minimise, as far as practicable, legal activity involving HSE mental health services arising out of the implementation of the Mental Health Acts 2001 to 2009. This is in the context of providing optimal mental health care to service users. In particular, the project was concerned with how learning from legal judgements on the acts can inform both training opportunities for staff, and policy and procedure development in services involved in the involuntary admission process and supporting structures. The project acquired the part-time commitment of six HSE mental health service staff contributing a range of expertise in training, policy development, administration and the implementation of the Mental Health Acts. A micro-website is to provide health service staff with ready access to training and educational resources, as well as tools to help them maintain competence in dealing with the challenges of providing mental health services in accordance with the requirements of the legislation. This is due to be piloted shortly and will contain a number of e-learning modules on roles related to the act.

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Health Matters 37

in brief // News St James’s Hospital Fun Run +

Dr Colin Doherty, Consultant Neurologist was one of the 685 competitors who took part in the second annual St James’s Hospital Liberties Fun Run in July. The annual 6.5k tour of the Liberties was held to benefit, once again this year, the hospital’s stroke service. Runners recorded exceptional times and the race was won by David Flynn in a time of 19:25. Pat Byrne was second and Mick Traynor third. The women’s race was won by Patrycja Wlodarczyk, with Kate O’Neill in second place and Orla Gormley in third

HSE Community Games deemed a resounding success

New Palliative Medicines Information Service Our Lady’s Hospice and Care Services in Dublin is launching a new national medicines information service called Palliative Meds Info on in September 2010. The pilot national service, provided through the pharmacy department, is funded with the assistance of the Irish Hospice Foundation. As part of this service, anyone working with patients with end-of-life care needs can contact the pharmacists to ask for advice on the best use of medicines for their patient. To contact the service, phone Cliona Hayden, Senior Pharmacist or Eimear O’Dwyer, Chief Pharmacist, on 01 491 2578 or email palliativemedsinfo@olh.ie

HSE Community Games Integration Development Officer Appointed

Danny Doyle of Carlow celebrates scoring the winning goal against Derry in the semi-final of the Boy’s Under-12’s soccer tournament at the HSE Community Games

Athlone Institute of Technology was a centre of excitement and expectations for the HSE Community Games National Finals in August, 2010. Some 3,000 children participated in a number of cultural and sporting activities. They were supported by over 600 volunteers and organisers, as well as family members and friends, who came to offer their support and encouragement to all of the children participating. Over 200,000 young people from all over Ireland take part in the HSE Community Games qualifiers and finals every year, making it an essential part of the Irish summer. Dr Nazih Eldin, Head of Health Promotion, Dublin North East, said: “We know that young people who are regularly active have improved fitness and muscular strength, stronger bones and lower weight than their inactive peers. Research has also shown that physical activity contributes to their psychological well-being by reducing anxiety and depression and enhancing self-esteem. In events like the HSE Community Games, children find a social environment that can promote a spirit of social interaction, cooperation and friendship.” Every year, the HSE Community Games partnership aims to promote healthy living across all aspects of everyday life including being active, eating well, awareness of the risks of alcohol consumption and the dangers of tobacco. Further information is available on www.littlesteps.eu HSE Health Promotion staff were on hand at the HSE Community Games to provide helpful tips for eating well and being active. For more information about HSE Community Games visit www.communitygames.ie or www.hse.ie.

HSE Community Games has appointed Caitríona Reynolds as Integration Development Officer. “As Integration Development Officer it is my vision that the HSE Community Games will play its role in helping people from all corners of the country to feel, and be a part of the community in which they live, and that opportunities are available to all irrespective of national origin, skin colour, ethnicity, religious belief, membership of the Traveller community, age, gender, sexual orientation or disability”, Caitríona said on her appointment.

38 Health Matters

campaign

Legal or illegal highs are major health risks The HSE has unveiled a new national campaign on the dangers of legal and illegal drugs. The campaign is seeking to raise awareness of the dangers and significant negative mental and physical health effects that can be caused by these psychoactive substances.

‘L

egal or illegal highs’ and ‘head shop or herbal highs’ are names given to psychoactive substances (drugs) that may be on sale in Ireland through shops that sell drug-related products (head shops, hemp shops). They can also be bought on the internet. These drugs are sold as alternatives to drugs such as cannabis, ecstasy, cocaine, LSD, amphetamines and heroin.

“These drugs are sold as alternatives to drugs such as cannabis, ecstasy, cocaine, LSD, amphetamines and heroin.”

Along with recent legislation introduced by the Government prohibiting the sale or supply of psychoactive substances, this public awareness campaign forms an important part of tackling what has become a serious public health issue. There are major risks to people’s mental and physical health as a result of taking these substances. This campaign provides important information for young people and their parents in relation to these substances and the risks associated with them. The campaign features a number of important messages which illustrate the ill-effects that can be caused by these substances. Legal or illegal highs can cause paranoia; impotence; kidney failure; heart

Pictured are representatives from Youth Work Ireland with Pat Carey TD, Minister for Community, Equality and Gaeltacht Affairs at the launch of the new HSE national campaign on the dangers of legal and illegal drugs

problems; seizures, death or make you act like a fool – they’re anything but safe. These messages featured on radio ads, in cinemas, washrooms in bars and clubs and at festivals over the summer. Alice O’Flynn, HSE Assistant National Director for Social Inclusion, said: “The risks to people’s mental and physical health as a result of taking these substances are very real. Changes in legislation have helped to limit the sale and supply of these substances, however, there are always other means by which young people will come into contact with drugs – whether through friends or online. This is part of a multi-pronged approach to tackling this issue which is putting young people at risk and causing anxiety to families throughout the country. As part of this, the HSE has an important role to play in informing the public about the risks around legal and

illegal highs. This campaign lets young people and parents know that legal or illegal highs are anything but safe and it provides important information for them in relation to these substances. We want to ensure that information and supports are available also to parents to help them understand the dangers associated with legal and illegal drugs and how they might encourage and support their teenagers to avoid them.” The website www.drugs.ie has been updated to include new information in relation to the campaign and legal and illegal highs including information resources for young people and parents/guardians. The HSE Drugs Helpline on 1800 459 459 is also available to support the campaign. The HSE National Drug Awareness Campaign will also tie in with initiatives at community level co-ordinated by the local and regional Drugs Task Forces.

Health Matters 39

campaign

The Truth about Head Shops In the last year or so, we have seen the emergence of a new problem in our society with the proliferation of retail outlets known as head shops. These outlets have been engaged in the sale of a range of unregulated psychoactive substances. This trade has operated behind a veil of technical legality, with products marketed as ‘legal highs’. This approach gives the impression that they are safe to use, thus enticing people, including teenagers and young adults, to purchase them from a ‘high street’ shop. Dr Bobby Smyth, Consultant Child and Adolescent Psychiatrist in substance misuse, dispels myths about so called ‘legal highs’ and talks about the HSE Drugs Public Awareness Campaign.

head shops Head shops have existed in Ireland for the past couple of decades. They were primarily located in Dublin city centre. They greatly increased in number during 2009 and early 2010 as they began to sell a vast range of new and potent products. The type of drugs that they started to sell fitted into four broad categories. Firstly, there were drugs which were designed to mimic the effect of cannabis, which contained both dried plant material and synthetic chemicals that have the exact same effect as cannabis. They were smokable products. Secondly, they began selling a broad range of “party pills”, which contained synthetic chemicals that had an effect similar to that of ecstasy. Thirdly, and most notoriously, they were selling powder products, often advertised as “bath salts”. These products contained synthetic chemicals, which have a psychological effect very similar to cocaine or amphetamines. Most belonged to the cathinone class of drug, mephadrone being the most commonly encountered chemical. Lastly, they sold a range of synthetic and natural drugs which have a hallucinogenic or LSD type effect. However the problem has not gone away. Fortunately, drug users themselves are beginning to recognise the dangers of these products, and their use appears to be diminishing substantially.

In June 2010, the General Scheme of the Criminal Justice (Psychoactive Substances) Bill was published which provided for: the sale or supply of substances which are not specifically proscribed under the Misuse of Drugs Acts, but which have psychoactive

“They were primarily located in Dublin city centre. They greatly increased in number during 2009 and early 2010 as they began to sell a vast range of new and potent products.”

effects, for human consumption will be a criminal offence. This Scheme gives appropriate powers to the Garda Síochána and the Courts to intervene quickly to prevent outlets from selling these products. New psychoactive substances can quickly emerge, therefore, the Scheme provides the Gardai with a response to deal with the supply of new psychoactive substances as they emerge.

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Health Matters 41

campaign

Our mental health services witnessed a large number of admissions relating to use of these drugs. Users of these drugs have also experienced significant physical problems. More common physical problems include excessive sweating, palpitations and urinary incontinence or retention. There are also concerns that many of these chemicals can cause seizures. Although most of chemicals sold in the head shops have been in existence for a decade or two, they have never undergone testing in humans. Consequently, little is known about their short-term side effects and almost nothing is known about their medium and long-term risks.

The Scheme operates in addition to the Misuse of Drugs Acts controls. The activities of head shops are being closely monitored on an ongoing basis by An Garda Síochána and Revenue’s Customs Service, with a view to ensuring that no illegal substances are being sold.

why were people concerned? The drugs sold in the head shops have quickly demonstrated themselves to be unsafe. Users of these products have experienced a broad range of unpleasant and occasionally dangerous adverse effects. The most common type of problem experienced by users has been psychological. People have experienced episodes of profound paranoia and confusion, while others have experienced very problematic anxiety symptoms. Although these psychological problems pass in a matter of hours in most cases, some individuals have experienced ongoing psychological symptoms lasting many days and weeks. People with pre existing psychiatric disorders appear to be particularly prone to these unwanted psychological effects and many relapses have been precipitated by use of these drugs. Consequently, emergency departments were dealing with large numbers of people presenting in distressed and disturbed states, especially at weekends.

interventions

In addition to the broad government response through changes in legislation, there have been responses to this issue on a number of other levels. Users of these drugs have been presenting to Addiction Services across Ireland. At the Youth Drug and Alcohol (YoDA) Service in Tallaght, use of head shop products has been a feature of the substance abuse problem of about 25 per cent of the young people accessing this service in 2010. Use of these drugs often occurs in combination with other substances such as alcohol or cannabis. Adult addiction services have also witnessed widespread use of these drugs among their clients. It was striking how popular these drugs were among heroin dependent drug users attending the Drug Treatment Centre Board in Dublin. From a service provider perspective, the treatment approach utilised within the Addiction Services to manage people with cocaine or cannabis problems such as motivational interviewing, cogitative therapy, harm reduction approaches and systemic therapy are all relevant to this new category of drug. Given that these drugs will continue to be available, if not on the high street then on the black market or online, the messages of the HSE campaign around the dangers of legal and illegal highs remain of great

“The drugs sold in the head shops have quickly demonstrated themselves to be unsafe. Users of these products have experienced a broad range of unpleasant and occasionally dangerous adverse events.” importance to the public. This information campaign targets both users of these drugs and parents to ensure there is greater awareness of the facts associated with these substances. Many people have been under the impression that these drugs were somehow safe because they were sold in shops and were not illegal. The core aim of the campaign is to challenge this misconception and to give people accurate information. To this end, the HSE is delivering public information messages on radio and television and has produced leaflets on head shop drugs. The HSE has also developed specific information on this topic on a substance misuse website which can be accessed at www.drugs.ie While this problem has not gone away, these multiple interventions appear to be yielding dividends. While hard figures are difficult to obtain, the numbers of people presenting to emergency departments, mental health services and addiction services due to problems caused by these drugs appears to be falling.

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Health Matters 43

ONLINE SERVICE

+ Patrick Burke, Head of the HSE’s Primary Care Reimbursement Service (PCRS) with Prof Brendan Drumm, former CEO of the HSE at the launch of www. medicalcard.ie, the new HSE website, which incorporates the new Online Medical Card Application process as well as other user friendly services

Medical Card.ie Paddy Burke, Head of the HSE Primary Care Reimbursement Service, introduces a new online service with 15 day turnarounds for Medical Cards and GP Visit Cards

he HSE has launched a new online Medical Card/GP Visit card application service that will see a 15-day turnaround for medical card applications. Using www.medicalcard.ie, members of the public can check online if they qualify for a Medical Card/GP Visit Card by following some simple steps. The same service can also be used by HSE staff – those working in medical card offices and elsewhere – to see if a client will qualify for a medical card based on income. Applicants, who qualify based on income, can then prepare their application online and submit it directly with the supporting documents. Fully completed applications will be fast tracked and cards will be issued within 15 days. At the launch, Paddy Burke emphasised that the service is a valuable addition to existing application services. ‘In the past, people had to make a written application to find out if they were eligible, a process that could have taken months. Now, people can find out it they will get a medical card or a GP Visit Card online in minutes.’ He said he hoped to receive constructive feedback from our own staff, from users and from advocacy groups to improve upon the website over the coming months.

Medicalcard.ie has four key functions as follows: Apply for a medical Card or GP Visit Card Status of Application – using the unique reference number now provided to each applicant when their application is received, people will be able to track the status of their application by text message advising the application is ‘in progress’. Status of Card – users can determine the eligibility status of any medical card. This service is typically used by primary care contractors such as Doctors, Pharmacists and HSE staff to check the current eligibility status of a medical card. Contact Us – a feedback facility for members of the public to provide feedback and ideas to HSE. It also provides follow up and enquiry services for all those whose card application is being processed centrally by PCRS. All enquiries will be responded to within 48 hours. Where an application is being processed by a Local Health Office, the user will be provided with contact details for their Local Health Office where they can get further information on their application.

Approximately one out of every 10 applicants for a medical card does not meet the income guidelines, but other personal health circumstances may deem that applicant eligible. These applications are much more complex and will still be required to go through to the Local Health Office in the normal way. The launch of www.medicalcard.ie is part of the HSE’s ongoing plan to provide a more responsive and cost-effective medical card service. The tax payer will save approximately b10 million per annum as a result of the centralization of medical card application processing in the ‘back office.’ In addition to the new PCRS website, phone line and text service, the ‘front of house’ service for medical cards will remain in the HSE’s Local Health Offices around the country. In our Local Offices, the public will be able to get information on eligibility, advice on how to apply, assistance with making an application etc. Local Health Offices have access to the central database and the online application tracking resource so as to answer questions and queries from the public quickly and efficiently. Check out www.medicalcard.ie today.

44 Health Matters

development

New Emergency Department

opens at Our Lady of Lourdes in Drogheda A

new Emergency Department opened at Our Lady of Lourdes Hospital in Drogheda in June, 2010. The new purposebuilt Emergency Department cost b11.5 million and is approximately 1,300 square metres in size and is three times the size of the old Emergency Department. The Department has two main entrances, a separate entrance for ambulance and stretcher-borne trauma and a separate entrance for the 'walking wounded', which assists in both prompt registration and immediate assessment of patients in line with clinical conditions.

“In 2009, more than 48,000 patients attended the Emergency Department in Our Lady of Lourdes Hospital which includes over 12,000 paediatric patients.” In 2009, more than 48,000 patients attended the Emergency Department in Our Lady of Lourdes Hospital which includes over 12,000 paediatric patients. The new Emergency Department has a designated paediatric area so all paediatric patients presenting to the new Department are assessed and treated in a child friendly environment. This area has the expertise of paediatric medical, nursing and allied health

professional staff. Sick children and their parents/carers no longer have to share a crowded waiting or clinical area with adult patients suffering from trauma or chronic illness as they can wait in the children’s waiting room – a bright and welcoming room, with wipe able walls, toys, television and separate toilet/baby changing area. The new Department also offers better facilities for adult patients in attendance. Adult patients are allocated to one of three distinct assessment and treatment areas; the Minor Injuries Department, the Major Treatment Department and the Resuscitation Area.

There is a dedicated x-ray facility located in the emergency department which allows for immediate access to diagnostics. Conor Egleston, Consultant in Emergency Medicine, said: “This new Emergency Department is a wonderful development for the Hospital and for the first time patients will be treated in purpose built facilities. We are particularly pleased that children will no longer have to share the same area as sick adults, and maybe witness serious injuries, or people being resuscitated. However the issue of emergency department overcrowding must be resolved. This is not a problem which is unique to the North East."

Health Matters 45

development

Opening of new Coronary Care Unit Our Lady of Lourdes Hospital announced the opening of a state of the art new Coronary Care Unit (CCU) in September. The new Unit occupies the top floor of the new building that includes the new Emergency Department. The total construction cost of the entire new building was in the region of b24m and the cost of equipping the new Coronary Care Unit was b1.2m. This forms an important part of the overall plan for development of acute hospital services in the North East. In 2009, in excess of 377 patients were treated in the CCU in the hospital. The expanded unit will allow for enhancement of cardiology services and will meet the increased demand created by the reorganisation of acute hospital services in the North East.

The CCU is central to the provision of high quality care to acutely ill cardiac patients suffering from conditions including myocardial infarction, acute coronary syndromes, arrhythmia and heart failure. Emergency cardiac procedures such as pacemaker insertion can also be performed in an x-ray equipped cardiac procedure room that is part of the unit. The CCU has eight fully equipped suites for individual patient occupancy with en-suite facilities. In addition, there are five rooms for step down patients requiring less intensive care. The new Unit is approximately 1,150 square metres in size and signifies a major increase over the existing department. All CCU beds are served by a suspended pendant that is the latest in hospital technology. Each room

has a sliding glass door to allow maximum patient visibility from a central nursing station. All infection control guidelines have been complied with in the design of the new unit. This expansion will facilitate provision of an enhanced service for cardiac patients in the North East. It builds on the recent appointment of a second cardiologist to the hospital and will be followed by rollout of a 24/7 primary angioplasty service in the near future. Complimenting the work of the hospital staff, Margaret Swords, Group General Manager, said that cardiac services at Our Lady of Lourdes Hospital are provided by a highly experienced multidisciplinary team comprising medical staff, nursing staff, allied health professionals and support staff.

Profile: Our Lady of Lourdes Hospital O

ur Lady of Lourdes Hospital is part of the Louth Meath Hospital Group and provides a general acute hospital service to the catchment area of Louth, Meath and north Dublin. In addition, a number of regional services are based at the 354-bed hospital (InPatient 325 and Day 29) as follows: • Emergency Medicine – Trauma Centre • Palliative Care The range of acute services is as follows: • General Medicine • General Surgery • Obstetrics/Gynaecology • Paediatrics including Neonatal services • ENT • Orthopaedics • Oncology • Urology • Dermatology

• Day Services • Out-patient Services • Pathology Services

“Our Lady of Lourdes Hospital is part of the Louth Meath Hospital Group and provides a general acute hospital service to the catchment area of Louth, Meath and north Dublin.”

• Radiology Services • Physical Medicine Services • Speech and Language services • Social work • ICU/CCU

Emergency Department At present, the department of Emergency Medicine is spread across three sites, Our Lady of Lourdes Hospital Drogheda, Our Lady’s Hospital Navan and the Louth County Dundalk. Our Lady of Lourdes Hospital Drogheda sees patients of all ages with all emergency presentations. The Emergency Department team in Our Lady of Lourdes Hospital consists of three consultants, four registrars, six SHOs and three advanced nurse practitioners. There is excellent access to cross-sectional imaging. There is a comprehensive education programme for middle grades and SHOs. The new department in the

46 Health Matters

DEVELOPMENT

hospital is the most modern purpose-built ED in the country with separate adult majors, adult minors, paediatrics and resuscitation room.

Trauma & Orthopaedic Surgery The Orthopaedic and Trauma Service is a regional service serving the Louth/ Meath and Cavan/Monaghan areas. A regional orthopaedic trauma and elective service is provided by seven Consultant Orthopaedic Surgeons. Adult elective surgery is provided in Our Lady’s Hospital, Navan. Trauma Orthopaedic and Paediatric services are provided at Our Lady of Lourdes Hospital, Drogheda. This is an affiliated teaching hospital to the Royal College of Surgeons with the undergraduate teaching led by Consultants.

Surgery There is a joint department of Surgery between Our Lady of Lourdes Hospital, Drogheda and Louth County Hospital, Dundalk. All traumas are dealt with at Our Lady of Lourdes Hospital and all day and intermediate elective surgery at Louth County Hospital. There are seven Consultant Surgeons; special interests include Gastrointestinal (GIT) and Paediatric Surgery. The hospital is an approved training hospital and is affiliated to the Royal College of Surgeons, Ireland. Hospice Principles Our Lady of Lourdes Hospital is participating in a national Irish Hospice Foundation programme established to mainstream hospice principles in hospital practice. It focuses on four key themes of Integrated Care; Communication; Dignity and Design and Patient Autonomy.

+ Pictured L-R: Dr Doiminic Ó Brannagáin, HSE Clinical Director, Louth Meath Hospital Group, Margaret Swords, Group General Manager, Louth Meath Hospital Group and Dr Paul Keelan, Consultant Cardiologist at the opening of the new Coronary Care Unit at Our Lady of Lourdes Hospital, Drogheda

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Dublin north east // News

Grandchildren’s Day at Lusk Community Unit + Aibhne Hogan taking part in ‘Fling a Ring’ at the recent ‘Grandchildren’s Day’ at Lusk Community Unit

Lusk Community Unit for Older Persons in North County Dublin recently held their first ‘Grandchildren’s Day’, when family members were invited to take their children to visit their grandparents and take part in a fun-filled day. Some staff members took along their own children, who are frequent visitors, to enjoy the special day. The games and activities organised by staff included; face painting, balloon making, parachute games and fling-a-ring. Many of the clients were able to sit outside and enjoy watching the children take part in the various activities in the games garden. The games garden has a rubber surface which provided a perfect base for the children to play in a safe environment. Celine Daly, Acting Activities Co-Ordinator said: “The day was a great success and provided a wonderful family event for the clients to spend time with their grandchildren and other family members. All the children enjoyed the day and we hope that relatives visiting their family members will be encouraged to also take their children along on a regular basis”.

Health Promotion Initiative encourages schools to “fly the flag” Dr Nazih Eldin, Head of Health Promotion in Dublin North East recently presented the ‘Health Promoting Schools Yellow Flag’ to the Holy Family Special School in Cavan. The Schools Health Promotion Committee and the entire staff have embraced the concept and developed a robust and comprehensive Health Promoting School Programme which is now embedded in their schools policy and culture. This has included training for all staff in the concepts and principles, Staff Fitness Challenge Programme, Oral Health Training Workshops, Healthy Eating Policy Development, Physical Activity Audit, First Aid/CPR Training, July Primary Teachers Summer Schools and SPHE/RSE Resource Provision. This initiative is offered to all schools in the region and to date 130 schools are involved. On successful completion, they will join St Joseph’s, Muirhevnamore in Louth and in Meath Scoil Oilibheir Naofa, Kilcloon, St Dympna’s, Kildalkey, Carnaross NS and St Mary’s in Enfield who have also been presented with the ‘Health Promoting Schools Yellow Flag’ as an acknowledgement of their completion of the programme, ongoing commitment to keep health on the school agenda and continue promoting physical, social, spiritual and emotional health of the entire school community.

+ Pictured (L-R): Dr Nazih Eldin, Head of Health Promotion; Isobel Lord, Vice Principal; Mairin McInerney, Health Education Officer (Oral Health); Paul McManus; Fr Owen Collins; Mary Sheanon, Senior Community Dietitian; Joan Crawford, Senior Health Promotion Officer; Marian Foy; Catherine Farrell, School Principal; and in the front student Fintan O’Reilly

Community Groups trained to host Sports Day The Health Promotion Department in Dublin North East teamed up with Meath Local Sports Partnership to pilot a new programme to revive Sports Days for the Community. The aim of the programme is to build on the capacity of the community by educating and training those interested in organising a Sports Day. The programme commenced with an open invitation to attend an Information Night followed by an expression of interest form. Once groups achieve all programme criteria, they then go forward to participate in the ‘Get Ireland Active Community Sports Day Workshop’. The workshop entails a minimum of three members from any one group attending a four-hour theoretical and practical session covering topics such as planning and organisation; insurance; event management and participation in a range of team and individual races. Each group must also commit to attending Child Protection ‘Code of Ethics’ training and ensure they have a qualified First Aid Officer on duty. Yvonne Gilsenan, Health Promotion Officer said: “This year's pilot programme in Co Meath was a great success, promoting community spirit and inclusion for all.”

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Dublin north east // News

Local schools take part in hygiene poster competition Our Lady of Lourdes Hospital in Drogheda recently held a Hygiene Awareness Day for all staff working in the hospital. To extend awareness of the importance of hand hygiene in hospitals to the wider community, the hospital held a poster competition which was open to local schools in the area. The theme of the competition was ‘Clean Hands Saves Lives’. Some 300 children participated in the competition, which was judged by local Drogheda artist Richard Moore, along with members of the hospital's hygiene team. Ejiro O’Hare Stratton, Nursing Support Services Manager and member of the Hygiene Services Team said: “The Hygiene Services Team is delighted with the level of interest shown by the local schools and by staff of the hospital, whose children also took part in the competition. The event was a great success with a large number of staff across all disciplines taking part. The children’s posters will be displayed throughout the hospital to remind staff and visitors of the importance of hand hygiene in the hospital.” The winners of the three age groups were Orla Reilly, Brookville, Drogheda (13-18 years); Cliodhna White, Presentation National School, Drogheda (8-12 years); and Ciara O’Brine, Ballapousta National School, Smarmore (7 years and under).

Orla Reilly, one of the winners pictured with her poster

Peace Garden at St Mary’s Hospital, Castleblayney

+ Susan McGoldrick, Director of Nursing and David Funcheon, Lord Mayor of Castleblayney are pictured with residents Eileen Hand, Patrick Clarke, Lucy Brennan, Ellen Williamson, Isobel Mullen, Ester Dunne and Dan McElearney at the official opening of the Peace Garden at St Mary’s Hospital in Castleblayney Staff and residents of St Mary’s Hospital in Castleblayney recently celebrated the official opening of their community Peace Garden. The garden was developed as part of the ‘Growing in Peace Project”, which aims to build positive relations among all the communities within the Castleblayney and Mid-Monaghan area. Leo Kinsella, Local Health Manager, Cavan/Monaghan said: “I would like to congratulate all those involved in this wonderful project and to thank the staff and all those who have sponsored and worked so hard to get this garden ready, which has lots of fruits and vegetables growing in it. The garden, which is between two of our residential units, will add a great sense of worth to those involved and enhancement to the daily lives of the residents at St Mary’s.”

End of Life Care Project in Long-Stay Community Nursing Units In 2008, Una Molloy, St Francis Hospice commenced a quality initiative to improve End of Life Care (EOLC) in Lusk Community Unit, Claremont Residential Services and Cuan Ros in North Dublin. The project funded by the Irish Hospice Foundation aims to look at the processes, structures and outcomes related to the provision of EOLC and to identify ways of improving EOLC in the last year of life to the residents. This involved carrying out an audit of documentation related to EOLC in the last 48 hours of life, establishing focus groups, interviewing staff, distributing questionnaires, and establishing death reviews in each unit where staff are invited to remember the resident and the care prior to death is discussed. This has been hugely valuable as a learning tool for staff and also as a means of staff support. Study days have also been devised to include the issues around EOLC that staff in the units identified as needing further education. The project will be completed in October and a report will be available which may be of assistance to other units wishing to embark on a similar project. For further information contact Una Molloy, Project Nurse, St Francis Hospice, Raheny; Email: umolloy@sfh.ie

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South // News CUH Campus goes Smoke Free + CUH staff involved in introducing the smoke free campus Clare Jones, Health Promotion, Dr Barry Plant, Respiratory Consultant and Marie J McCarthy, Services Manager

Well done to colleagues at Cork University Hospital (CUH) campus for introducing a smokefree policy starting this summer. Smoking is no longer permitted anywhere on the hospital grounds such as entrances, walkways, internal roads, bus shelters, car parks etc. The smokefree policy will ensure a healthier, safer and cleaner environment for all. A CUH staff and patient survey conducted before going smoke-free identified that 73 per cent of patients and 64 per cent of staff (including smokers) were supportive of the policy. Dr Barry Plant, Respiratory Consultant, CUH said: “Introducing the Smoke-Free Campus policy in CUH supports those who want to stop smoking. When it comes to the health gains; giving up smoking greatly improves the chances of patients recovery, which is the aim of being in hospital, the infection rates after surgery are decreased and, there is an 80 per cent increase in quit rates for those who smoke when they are in a smoke-free environment.” Tony McNamara, CEO of CUH outlined how the hospital is taking its responsibility around health promotion and illness prevention very seriously: “Hospitals and health systems are working to encourage patients to adopt healthier tobacco-free lifestyles in order to decrease the incidence of smoking-related disease. All patients are informed of the policy in advance of their admission to hospital and, when admitted, patients who smoke will be offered free Nicotine Replacement Therapy (NRT), as well as referral to our free Smoking Cessation Service, provided by the the HSE's Health Promotion Department. Staff can also avail of free NRT and smoking cessation services. While smoking has not ceased entirely there is definitely a noticeable decrease in the numbers smoking on the grounds. Thanks to all staff for assistance with introducing the policy and those who are ensuring that it is implemented.

Mercy University Hospital Goes Wireless Mercy University Hospital (MUH) has transformed its telecoms infrastructure with the help of AirSpeed Telecom, replacing a combination of aging technologies with a cost-effective, flexible licensed wireless network which provides secure access for each of the hospital’s key off-site locations. MUH staff who are physically located off the main hospital campus constantly log into the hospital’s main network to access patient, clerical and financial data.

The new licensed wireless technology now offers them better access to all data and images at the speeds and reliability of the main campus. For example, if a consultant needs to access high-resolution patient imagery (PACS), he or she can now do so without needing to return to the main hospital campus. Given the current budgetary constraints, it is important to note that this innovation and transformation was effectively cost neutral for the hospital.

New Service for Kerry Patients with Long Term Illness An exercise and education programme to help people with long-term lung conditions is now available in Kerry. The ‘Pulmonary Rehabilitation’ exercise and education class, is a joint initiative between Kerry General Hospital and the HSE’s Community Services in Kerry, will see patients will long-term lung conditions such as Chronic Obstructive Pulmonary Disease (COPD), avail of this service in Kerry for the first time (previously patients had to travel to Cork). Pulmonary rehabilitation is an evidence-based programme of exercise and education aimed at improving the quality of life of patients with long term lung conditions. The course has been proven to increase a patient's exercise tolerance, decrease their breathlessness and cut the number of hospital admissions with chest infections. The eight-week course is coordinated by a physiotherapist with input from a clinical nutritionist, occupational therapist, pharmacist, smoking cessation officer and public health nurse. Access to the programme is by GP or consultant referral. For queries, contact Julie Cournane, Senior Respiratory Physiotherapist, Kerry General Hospital, Tralee on tel: 066 719 9773.

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South // News Cardiac Catheterisation Laboratory officially opened at Waterford Regional Hospital + Minister for Health and Children, Mary Harney TD pictured with the Cardiac Catheterisation Laboratory team of Waterford Regional Hospital, during her official visit to open the facility in July

The Minister for Health and Children, Mary Harney TD officially opened the Cardiac Catheterisation Laboratory at Waterford Regional Hospital in July. The HSE has designated WRH as the Regional Cardiology Interventional Centre for the South East. Outlining developments to Minister Harney as she officially opened the Lab, the HSE’s Network Manager for the Hospital Group South East Richard Dooley said: “Just over 2,000 patients have been treated and some 3,000 procedures carried out since the lab opened in May 2008 at a capital investment of b2.7million. These patients would otherwise have had to travel to either Cork or Dublin to avail of this service. Patients here in the South East presenting with a heart attack are seen and treated immediately, which results in early recovery. The plan is to extend this service so that patients will have access 24-hours a day, seven days a week.” The Minister went on to visit three other initiatives at WRH which have been recognised as significant contributors to improved patient treatment or therapy at WRH. General Manager of WRH, Patricia Sullivan briefed the Minister on how care systems have also been aided by the development of the Age-Related Day Care Unit, the Rheumatology Day Ward and the new Waterford Healing Arts Trust premises at the hospital.

developMENT OF “fit walk” programme in communities in South Tipperary In a demonstration of how the HSE is working with other agencies in society to promote healthy living, staff recently joined with the South Tipperary Sports Partnership to develop a “fit walk” programme in the communities in that area. Supported by the Sports Council and the relevant local authority, the Sports Partnerships are committed to ‘making a difference’ to the people of their locality through the development of sport and increasing participation in physical activity. Staff at the Cardiac Rehabilitation Unit in South Tipperary General Hospital (STGH) worked with the South Tipperary Sports Partnership (STSP) to initiate a “fit walk”

programme during the months of April and May. The aim was to develop a communitybased, long-term exercise programme for patients who have completed Cardiac Rehab Phase 3 in STGH. A qualified exercise instructor delivered the six-week programme (1.5 hrs/wk) and participants were taken through the fundamentals of mobility and resistance, taught good posture and the techniques of stride and power walking were also incorporated. A total of 63 participants signed up for the course, with workshops taking place in Cashel and Clonmel. The final workshop in the programme concentrated on 14 of the participants,

LEAP Education and Training facility officially opened in Carlow

+ The award-winning LEAP Centre, developed by the HSE and the Delta organization in Carlow The HSE joined staff and 90 adults with intellectual disabilities who attend the Delta Centre in Carlow, in celebrating the official opening of their new LEAP Education and Training facility in July by Minister for Social Protection Éamon Ó Cuiv TD. The LEAP (Learning, Education, Activity and Progress) facility is built on land owned by the HSE at Strawhall in Carlow. The HSE licensed the Delta organisation to build and operate the facility there and the full b1.8 million costs of construction and equipping were met from the HSE’s Capital Development Plan. The HSE continues to fund the Delta organisation under Section 39 of the Health Act. In 2010, this funding will come to b2.4 million. Meme Architecture and Design and Blackstairs Developments were appointed. The project came in ahead of time and on budget. At the RIAI Irish Architecture Awards, the Centre was “Highly Commended” for “Best Accessible Project” and “Commended” in the Health Building category,”

+ Participants in the HSE and South Tipperary Sports Partnership’s “Fit Walk” programme before a route in Clonmel who had expressed an interest in “Walking Leader” training. It is hoped that former patients can take ownership of exercise groups in their own communities.

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west // News

New Transitional Living Unit in Sligo In May, John Moloney TD, Minister for Disability and Mental Health, officially opened a Transitional Living Unit in Sligo for people with an Acquired Brain Injury. The Acquired Brain Injury Service, a partnership between HSE West and Acquired Brain Injury Ireland (ABI Ireland) supports people with a brain injury in Sligo, Leitrim and West Cavan to return to independent living. The service provides support and assistance to enable each individual to develop their full potential, retain maximum independence and improve opportunities for full inclusion into the community.

+ L-R: Steve Orme, Regional Manager, ABI Ireland; Caroline McGrath, Senior Clinical Psychologist; Teresa O’Boyle, Local Services Manager; John Moloney TD, Minister for Disability and Mental Health; Barbara O’Connell, CEO, ABI Ireland; Pat Dolan, Local Health Manager; Phil McGoldrick, Case Co-ordinator; Rosemary Dillon, Senior Occupational Therapist and Sister Mary Henry, Physical and Sensory Service Manager

Members of Traveller Community in Ballina Graduate as Community Health Workers

Dara Calleary TD, Minister for Labour Affairs, was a guest speaker at a graduation and award ceremony in Ballina, Co. Mayo, where five members of the Traveller community were presented with FETAC Level 3 Certificates and FÁS certificates in Community Health Advocacy. The event was organised by Mayo Travellers Support Group and the HSE’s Regional Traveller Health section. Mayo Travellers Support Group is funded by the Traveller Health Unit, HSE, and the course was funded by FÁS. The local VEC also contributed greatly to the success of the programme. The three-year course has prepared them to act as advocates for better health standards in the Traveller Community, and they have also trained in Primary Health Care, covering a wide range of topics in all areas that impact on the health of a community.

+ Back row, L-R: Michael Tobin, General Manager PCCC HSE West; Cora Staunton, Primary Health Care Co-ordinator Castlebar Mayo Travellers Support Group; Marion Cusack, Adult Literacy Organiser Ballina Mayo VEC; Ray Kelly, Assistant Manager Community Services FÁS; Winnie Maughan, Community Health Worker Mayo Travellers Support Group; Jim Power, Management Committee Mayo Travellers Support Group; Vivienne Fitzmaurice, Primary Health Care Co-ordinator Mayo Travellers Support Group; Councillor Peter Clarke, Acting Mayor Ballina; Minister for Labour Affairs, Dara Calleary TD; Carmel Burke, Management Committee Mayo Travellers Support Group; Pippa Daniel, Community Development Worker Mayo Travellers Support Group; Donna Muldoon, Community Health Worker Mayo Travellers Support Group; Lena Collins, Community Health Worker Mayo Travellers Support Group Front row, L-R: Ailish Houlihan and Norita Clesham, Management Committee Mayo Travellers Support Group; Geraldine Glendon, Local Training Initiative Coordinator FÁS; Mona Munyikwa, Co-ordinator Mayo Travellers Support Group; Sandra Judge, Primary Health Care Co-ordinator Ballina Mayo Travellers Support Group; Maggie Maughan, Community Health Worker Mayo Travellers Support Group; Margaret Sweeney, Community Health Worker Mayo Travellers Support Group; Mary Syron, HSE Regional Coordinator Traveller Health

Launch of Newsletter and Pottery Exhibition Service users of the Limerick Mental Health Rehabilitation Service recently held an exhibition of their pottery and craft work, which coincided with the launch of their newsletter at the Rehabilitation Centre, St Joseph’s Hospital. The focus of these projects is mental health recovery through creative activities and community participation. These projects represent service user-led initiatives which integrate personal experience, peer support and community participation. Co-operation between service users, statutory and voluntary agencies has demonstrated the power of community activity in working towards mental health recovery on many levels.

+ L-R: Senior Occupational Therapist Niamh Wallace with Ger Lynch at the pottery exhibition

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west // News HSE West Ambulance Officers made Honorary Clinical Fellows of NUI Galway +

Back Row, L-R: Nora Murphy, Galway Head Injury Support Group; Sharon Deering, Training Unit Manager, The Carers Association; Chris Faherty, Galway City Carers Support Group; Michelle Harrison, Manager, Carers Department, HSE West, Galway. Front Row, L-R: Bernie O’Brien, Alzheimer Society Carers Support Group; Paddy Jordan, Galway Head Injury Support Group; Norah Coyne, Lifeskills Consultant and Tutor

+ The three HSE West Ambulance Officers who were made Honorary Clinical Fellows of NUI Galway photographed at the University (L-R): PJ Commins, Vincent O’Connor and Gabriel Glynn with Dr Gerard Flaherty, Lecturer in Medical Education and Clinical Skills, NUI Galway. In recognition of their contribution to the undergraduate teaching programme at NUI Galway, three Ambulance Officers from the HSE West region have been made Honorary Clinical Fellows of the University. The Ambulance Officers, Gabriel Glynn, Vincent O’Connor and PJ Commins, were involved in establishing and delivering an innovative special study module in Pre-hospital emergency care to second year NUI Galway medical students under the direction of the University’s Dr Gerard Flaherty, Lecturer in Medical Education and Clinical Skills and Coordinator of the Special Study Module programme. The Pre-hospital emergency care module provides students with basic

training in immediate care such as basic life support and spinal immobilisation. The students are also given an opportunity to accompany paramedic crews on routine and emergency calls in the capacity of supervised observers. Commenting on the success of the Pre-hospital emergency care module, NUI Galway’s Dr Gerard Flaherty said: “Feedback from the module has been overwhelmingly positive to date and has been the most popular choice for second-year students." Chief Ambulance Officer, HSE West, Paudie O’Riordan said: “The Ambulance Service places great value on the relationship that has built up over the two years with our colleagues in the School of Medicine at NUI Galway.”

Carers take part in Workshop for National Carers Week A Workshop dedicated to Stress Management hosted by the Carers Association and the Carers Department, HSE West, was held in Galway to provide Carers with the tools and techniques to practice and live with peace and well-being. The Stress Management Workshop was approved by Government with support from the Dormant Accounts Fund and taught by Norah Coyne, Lifeskills Consultant and Tutor. The Workshop also gave carers the opportunity to meet other carers. There are almost 161,000 Carers in Ireland and Galway has the third highest proportion with 9,252 Carers (Census, 2006). Figures, recently released indicate that Ireland’s fulltime Family Carers work more than three times longer than the average employed worker, providing in excess of five thousand (5720) hours of care per year to family members. This corresponds to 110 hours care per week or close to 16 hours caring per day (Source CSO).

IT Students raise funds for Dermatology Department at Sligo General Hospital The Friends of Sligo General Hospital, along with the Hospital’s Dermatology Department, would like to extend their appreciation to the Carpentry, Electrical and Toolmaking Apprentices from the IT in Sligo, who successfully raised €9,890 towards the purchase of a mole mapping machine for the Department. The mole mapping machine will help in the diagnosis of malignant melanoma, as the system can identify melanoma early, thus improving survival rates.

+ The Friends of Sligo General Hospital and staff from the Dermatology Department, Sligo General Hospital, accepting a cheque from apprentices at Sligo IT

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News // Dublin mid-leinster + Dr Deena Ramiah, Local GP; Frank Mills, HSE General Manager; Catherine Hanley, Public Health Nurse; Minister Mary Harney TD; Gerry O’Neill, HSE Local Health Manager; Roseanne Duffy, Physiotherapist and David Tully, HSE TDO Primary Care Services

Naas General Hospital Launches Act F.A.S.T Campaign

Minister Welcomes Launch of four Primary Care Teams for Clondalkin Mary Harney TD, Minister for Health and Children, launched four new Primary Care Teams for Clondalkin recently and referred to the event as “another milestone in the life of the Clondalkin Health and Social Care Network”. The four new teams will work with the existing team from the Dunawley/Deansrath area in forming the Health and Social Care Network for the area. The Clondalkin Primary Care Teams aim to provide easier access to health services for people in the area. The services include: physiotherapy, occupational therapy, public health nurses, social workers and network services such as dietetics, mental health services, psychology, and speech and language services which, coupled with excellent GP participation, provides Clondalkin and the surrounding areas with a very comprehensive service. The Primary Care information leaflet was also launched at the event. The leaflet outlines the work of the team and the range of services now available to the communities. If you require a leaflet, please contact David Tully at (01) 620 6310.

HSE and External Services Co-operate to Safeguard Children

+ At the Keeping Safe Accreditation Ceremony Back row, L-R: Maria Larkin, Child Care Manager; Fionnuala Greening, Course tutor; Sandra Neville, Diocese of Meath; Majella Loftus, HSE Children and Families Services National Office; Charney Weitzman, Course Co-ordinator and Tutor; Front row: Finola Colgan, Mental Health Ireland; Máire Whelan, National Learning Network; Anne Murray, HSE Limerick; and Helen O’Connor, Irish Wheelchair Association At a recent ceremony in Tullamore, nine trainers who completed the Keeping Safe

Training for Trainers programme were awarded certificates of credit in Child Protection Training – Delivery and Evaluation and Child Protection Training – Theory and Skills. A further 16 participants who also completed the Keeping Safe Disability Awareness Training for Trainers programme were awarded certificates in Child Protection Training – Disability Awareness. ‘Keeping Safe’ child protection training aims to assist organisations to raise awareness of issues of child protection. It also gives those in organisations working with children a firm grasp of the various components that are involved in the development of a child protection policy, in line with the documents Children First and Our Duty to Care. The cooperative model used in the Midlands is now being rolled out nationally, with four further Training for Trainers programmes planned across the HSE, and supported by the office of Phil Garland, Assistant National Director Children and Families Services.

+ Staff at Naas General Hospital attending the F.A.S.T. Campaign day In May, the Naas General Hospital stroke team rolled out the Act F.A.S.T campaign across Kildare to reduce death and disability from stroke. The Act F.A.S.T. campaign, the biggest ever run by the Irish Heart Foundation, is expected to have a huge impact on stroke outcomes by getting more people to recognise key warning signs and seek emergency treatment when the disease strikes. In 2008, 61 people died out of more than 140 people who were treated for a stroke in Kildare. Nationally, almost 2,200 people died in the same period from around 10,000 cases of stroke. Racehorse trainer and TV presenter Ted Walsh officially launched the campaign, which had brief presentations from the Naas General Hospital management team, the Irish Heart Foundation and the stroke multidisciplinary team. The Kildare campaign also included a Stroke Awareness Day in the local Boots Pharmacy, run by the Naas Hospital stroke team. It was promoted via local radio and newspaper media. The F.A.S.T. acronym has been developed to inform the public about the key symptoms of a stroke: Face – has their face fallen on one side? Can they smile? Arms – can they raise both arms and keep them there? Speech – is their speech slurred? Time – Call 999 if you see any of these signs.

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News // Dublin mid-leinster Irishtown and Ringsend Primary Care Team Shortlisted for O2 Ability Awards

Cathedrals Primary Care Team Launch Team Brochure

+ L-R: Minister for Enterprise, Trade and Employment, Batt O’ Keeffe, Gerry O’Dywer, Regional Director of Operations HSE, Danuta Gray, 02, Ellen O’Dea, Primary Care Manager, Caroline Casey, Kanchi HSE Dublin South City LHO successfully participated in the recent O2 Ability Awards 2010 programme and achieved the status of Ability Company in the Environmental Accessibility category for their work in Irishtown and Ringsend Primary Care Centre. HSE Dublin South City LHO was shortlisted in this category based on the high standard of their application form, which was verified by the Kanchi and PricewaterhouseCoopers Assessment team through an onsite assessment as part of the O2 Ability Awards 2010 programme. From the design stage of the centre, Dublin South City LHO have focused on Irishtown and Ringsend Primary Care Centre being a hub to provide barrier-free access to healthcare to the local community. The primary care team have a brochure outlining the accessible elements of the centre, such as textpad technology, hearing loops and accessible transport options to the centre. Irishtown and Ringsend Primary Care Centre has been shortlisted for other awards and was a finalist in the 2010 Crystal Clear Literary Awards. It was also awarded the Royal Institute of Architects Best Accessible Project award in 2009. To contact Irishtown and Ringsend Primary Care Team call 01 660 8629.

UrgING People to Think FAST The Tullamore Stroke Team are calling on people to think F.A.S.T. in support of the Irish Heart Foundation F.A.S.T. Campaign which was launched in May this year. In Ireland, stroke accounts for 7.2 per cent of all deaths. To support this campaign, an information stand was set up in the foyer of the hospital in June. The purpose of the day was to + Clare Brennan, SHO, Stacey Daly, Speech and raise awareness of stroke and promote the Language Therapy, Michelle Crowley, Physiotherapy, Dr F.A.S.T. assessment for people to recognise John McManus, Consultant Stroke Physician, Cliona McCormack, IHF, Sharon Maher, Clinical Nurse Specialist signs of stroke. People were encouraged Stroke, Christine Burke, Physiotherapist, Sinead Boyd, to visit the information stand and meet the Clinical Nurse Manager, Edel Rigney, Occupational stroke team and the consultant. Therapist and at the back Pharmacist Oisin ÓhAlmhain Consultant Physician Dr John McManus said: “Time is of the essence when you are dealing with a suspected stroke patient. The earlier patients are assessed and treated after onset of symptoms the better the potential outcome."

Back Row, L-R : Dr Keith Perdue, Grafton Medical; Carol Kelly, Mercers Medical; Bernie Lea, Community RGN; Denis Hand, Porter; Ellen O’Dea, A/ Primary Care Manager; and Dr Alan O’Donohoe, Mercers Medical Front Row, L-R: Laura McGrath, Homehelp organiser; Solomon Popoola, Senior Physiotherapist; Una Fitzsimons, Public Health Nurse; Rose Nkomo, Senior Occupational Therapist; Helen Dolan, Community RGN; Margaret Gibney, Home-help organiser; Niki Byrne, Community RGN; and Patricia Treacy, Public Health Nurse

The Cathedrals Primary Care Team in the Dublin south inner city hosted a public information event in June at the Carmelite Centre on Whitefriar Street. At the event the Cathedrals Primary Care information brochure was launched. The brochure outlines the work of the team and the range of services now available to the 11,000 people in the Whitefriar/ Aungier/Bride Street area. The Cathedrals Primary Care Team is comprised of GPs, practice nursing, physiotherapy, public health nursing, occupational therapy, home-help services, counselling psychology, dietetics and community welfare, who provide an easy access point to local health and personal social care services and support for chronic illnesses in a fully integrated way. For further information on the team visit www.sicp.ie/en/primaryCareTeams/ CathedralsPCT/ or contact Acting Primary Care Manager Ellen O’Dea. Email: ellen.odea@hse.ie Tel: 01 408 4308.

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premature babies

New developments in the care of premature babies In keeping with international trends, the survival rates for premature newborn infants to discharge home have improved from 76 per cent in the 1980s to over 85 per cent today writes Dr Martin White, Consultant Neonatologist and Director of Paediatrics and Newborn Medicine at the Coombe Women and Infants University Hospital and Our Lady’s Childrens Hospital, Crumlin.

eonatology is the speciality of paediatric medicine providing care for newborn infants. Neonatal intensive care units in the Republic of Ireland were first developed in the late 1960s, primarily to provide care for infants born with complications of rhesus haemolytic disease and jaundice, but they soon became leaders in care for prematurely born infants. There are now eight neonatal intensive care units based within maternity units in the Republic of Ireland. Delivery of infants less than 37 weeks gestation, which is the accepted definition for prematurity, was just under six per cent of all infants born at the Coombe Women and Infants University Hospital, in the most recent annual reports published in 2007-2008. Approximately 5.4 per cent of all births of infants in our hospital were born between 28 and 36 weeks gestation, but only 0.4 per cent were born less than 28 weeks gestation. Infants born less than 1.5kgs birth weight are a key group, good audit and critical analysis of outcomes are central to development of evidence-based care. There have been considerable advances in the care of premature babies since

the 1980s and today this is still a great speciality to work in. Irish neonatal centres contribute to the Vermont Oxford Network (VON) Database, which audits outcomes for infants born less than 1.5kgs and above 500gms. The Irish neonatal mortality survey for all newborn infants has also shown considerable improvements. VON includes other international neonatal intensive care (newborn medicine intensive care) units throughout Europe and North America. VON gives comparative data comparing Irish units and their outcomes

“Successful administration of antenatal steroids to the mother of a premature infant, provided the drug is given more than 24 hours in advance of the birth, significantly reduces the severity of respiratory disorders.”

with our colleagues internationally looking at key performance indicators including survival, infection and other complications of prematurity. The recently established Irish Perinatal Epidemiology database in Cork also collects comprehensive data for all obstetric and neonatal outcomes. In keeping with international trends, the survival rates for premature newborn (born less than 1.5 kilogramme birth weight) infants to discharge

+ Dr Martin White, Consultant Neonatologist and Director of Paediatrics and Newborn Medicine at the Coombe Women and Infants University Hospital and Our Lady’s Hospital, Crumlin in Dublin home have improved from 76 per cent in the 1980s to over 85 per cent today. The commonest complication of prematurity, and an interesting area of development in care, has been in management of respiratory problems. Successful administration of antenatal steroids to the mother of a premature infant, provided the drug is given more than 24 hours in advance of the birth, significantly reduces the severity of respiratory disorders. Respiratory Distress Syndrome (hyaline membrane disease) is a disease of prematurity where the lungs are under developed. Antenatal care has greatly improved according to the annual reports for the major neonatal intensive care units in Ireland. Our obstetric colleagues have been very successful in providing antenatal steroids to mothers of infants at risk of premature delivery. Antenatal steroids dramatically reduce Respiratory Distress Syndrome in the baby; also it almost halves the rate of severe intraventricular (intracranial)

Health Matters 57

premature babies

“At the Coombe Women and Infants University Hospital, similar to other neonatal units, parents of premature infants or inpatients recently discharged meet regularly with other parents and staff to discuss issues.”

haemorrhage. In the 1980s, an infant born prematurely requiring mechanical ventilatory support could anticipate being on a ventilator for a period of five-seven days. With the development of Surfactant medicine administration in the late 1980s, the duration of ventilation significantly reduced to an average of 48-72 hours. Newer developments in the area of non-invasive ventilation using nasal prong devices (where the endotracheal tube can be safely removed and ventilatory support provided by these prongs) now enable us to place these babies on non-invasive ventilation early within the first 24 hours. Complications such as Pneumothorax, a relatively common complication in the mid-1980s prior to the development of Surfactant therapy, has reduced from between 10-20 per cent in very premature infants in the mid-1980s to three per cent today. Not all prematurely born infants (very low birth weight, less than 1.5kg) require ventilatory support, but VON data shows that approximately 65-70 per cent of infants will require Surfactant, a liquid medication administered via the endotracheal tube in the first few days of life to improve lung function. We can expect almost 90 per cent of infants born at less than 1.5kgs will need nasal CPAP (non invasive ventilation) at some time. Of

these infants, 68 per cent will require full ventilatory support. VON data estimates 10-25 per cent of these small premature infants will require high frequency oscillatory ventilation, a sophisticated treatment for lung complications. Nutrition is another area that has also seen marked improvement. Early introduction of expressed breast milk feeds has reduced the complication of Necrotising Entrocolitis and less than eight per cent of infants less than 1.5kgs will now develop this complication. This is where the intestine becomes inflamed and feeds must be discontinued for a period, maintained on intravenous feeding. Neonatal nursing has seen the exciting development of clinical nurse midwife specialists. Advanced neonatal nurse practitioner development has further progressed nursing roles within neonatal and perinatal care. Advanced neonatal nurse practitioners in conjunction with Neonatologist medical specialists and our newborn medicine/nursing colleagues have developed evidence based care guidelines. There is ongoing audit and research looking at key performance indicators such as infections, complications such as Pneumothorax, intraventricular haemorrhage and there is considerable cooperation among the Irish neonatal units and presentation of annual reports from intensive care units using the VON data. The National Neonatal Transport Programme has operated since 2001. The team provides safe comprehensive care for ill infants requiring transfer from referring hospitals to the major maternity units in the Republic of Ireland and to the paediatric

intensive care units at Our Lady’s Children’s Hospital Crumlin and the Children’s University Hospital Temple Street, Dublin. It operates a seven-day week service and accepts transfers between 9am-5pm. However, once accepted, 54 per cent of these infant transfer transports complete after 5pm. Nursing and medical transport staff are provided by the three Dublin maternity hospitals, the team includes dedicated ambulance personnel support from the HSE. This transport service has been highly successful and there have been proposals for a number of years to extend this service throughout the 24-hour period. Internationally such transport services would usually provide a 24-hour, seven-day week service. We hope that this broadening of cover for the whole 24-hour period will happen soon. Support groups including parents and staff have developed in recent years. When an infant is born below 29 weeks gestation, we can anticipate that the infant will remain within the neonatal intensive care unit/Special care baby unit for approximately 10-12 weeks. This means that the parents of a premature infant can anticipate a prolonged hospital stay. At the Coombe Women and Infants University Hospital, similar to other neonatal units, parents of premature infants or inpatients recently discharged meet regularly with other parents and staff to discuss issues. This also allows a valuable opportunity for communication and feedback to medical, nursing and other staff on the care provided.

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premature Babies

Neonatal Parent Support Group All parents who have had a baby in the neonatal unit at Dublin’s Coombe Hospital are welcome to attend the Neonatal Parent Support Group drop-in group. The group is very much parent led thus allowing for frank and open discussion facilitated by the professional team, writes Barbara Whelan, Clinical Midwife Specialist at the hospital.

he Neonatal Parent Support Group in the Coombe Women and Infants University Hospital was established in 2006 and continues to provide a very valuable service to parents whose babies have been or are in the Neonatal Unit. The need for such support for parents and families was initially recognised from discussions with parents following the baby’s discharge and it is also well identified from articles on parent’s experiences of having a premature baby in a Neonatal unit. Following discussion with the multidisciplinary team, each of whom had identified the need for implementation of this service initiative we aimed to provide consistent monthly meetings at a suitable time in a convenient location. The team comprises of a Clinical Midwife Specialist (Barbara Whelan) with responsibility for discharge planning and follow up services, Medical Social Worker (Denise Shelley) Developmental Physiotherapist (Margaret Mason) and Nurse Tutor (Patricia O’Hara) who has many years experience in the neonatal setting. With a nucleus of these four people we felt that there would be sufficient expertise for suitable facilitation

+ Parents and their children attending the Coombe’s neonatal parent support group with team members Barbara Whelan, Clinical Midwife Specialist and Patricia O’Hara, Nurse Tutor and also to allow the group run regularly even during periods of leave. The group meets on the second Saturday of each month. Parents do not have to remember dates and can decide at short notice to attend. Light refreshments are provided. The meetings are never cancelled. All parents who have had a baby in the neonatal unit are welcome regardless of the length of stay that the baby had. They are free to attend as often as they wish and it is up to the parents to decide when to exit the group. This is a very cost effective group to run, as minimal resources are required. With committed and experienced staff the goals are easily achievable, providing real value for money in the health service. The principal resource is the commitment of the team. The meetings are quite informal and it has emerged over time that this is the best approach. They are very much parent led

thus allowing for frank and open discussion facilitated by the professional group who may address issues that are raised. Feedback from parents is very positive and encouraging. There is a great deal of personal satisfaction for the team as we have discovered more about the impact on families of sick newborns and therefore have been able to ameliorate some of the negative effects on families in this situation. The pre-discharge planning process for these families has been greatly enhanced following the parental feedback to neonatal staff. This group demonstrates how a good idea became a great innovation and one that could be easily replicated to help and support many families. For more information please contact: Barbara Whelan, Clinical Midwife Specialist, mobile: 087 797 1508.

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premature babies

Amelia’s Story By Mandy Daly

ollowing a pregnancy marked with unexplained bleeding from week 13, which culminated in a placenta abruption at the end of week 25, our daughter, Amelia Faith McDermott was born on October 8th 2006. Amelia was born 15 weeks early and weighed 780grams. Amelia was ventilated for four weeks and was on Bi-Pap, breathing apparatus to help increase air to the lungs and CPAP (method of respiratory ventilation) for a further five weeks. She was also tubefed for 10 weeks. Amelia suffered numerous infections, required eight blood transfusions, underwent several MRIs, lumbar punctures, ultrasounds, had a Patent Ductus Arteriosus and developed MRSA. Her skin was so fragile it broke down and bled, her lungs had to be suctioned several times a day to maintain her airways and her eyes were fused for two weeks after her birth. She suffered

apnoeas several times a day and had to be resuscitated on many occasions. She developed a haemangioma (an abnormal build up of blood vessels in the skin or internal organs) and has lost her toe nails on her left foot and continues to suffer from this condition as well as suffering from Chronic Lung Disease. We were unable to hold Amelia for the first four weeks of her life and it was only after seven weeks that she was removed from the critical list and we were told that we would be bringing our little miracle home in the future. She was hospitalised for 12 weeks. Amelia has required physiotherapy, occupational therapy and speech therapy to date and continues to be monitored by specialists. Despite her traumatic birth and incredible challenges Amelia continues to amaze us with her strength and courage and we thank God for every day we have with her.

+ Amelia Faith Mc Dermott, born on October 8th 2006, 15 weeks early and weighing 780 grams; and Right: Amelia (age 4 ½) with her Mum, Mandy Daly and Dad, John Mc Dermott

“We were unable to hold Amelia for the first four weeks of her life and it was only after seven weeks that she was removed from the critical list and we were told that we would be bringing our little miracle home in the future.”

60 Health Matters

premature BABIES

New Voluntary Support Group for Families with Premature Babies One-in-16 births in Ireland are classified as premature births. This means that over 4,000 families are faced with the birth of a premature baby (CSO). To support these families during this journey and in the months and years afterwards, a new voluntary support group called Irish Premature Babies has been launched, writes Mandy Daly and Mary O’Sullivan of Irish Premature Babies.

fter leaving the Neonatal Intensive Care Unit (NICU) with a second premature baby, Allison Molloy felt that there was not enough information or support available for parents when they have a premature baby in Ireland. In December 2009, she decided to try and address these issues and founded Irish Premature Babies. Since then, 10 more parents who have lived the premature birth experience (in Ireland and abroad), and who wish to promote the welfare of families with premature children, have volunteered their time to join Irish Premature Babies. One in 16 births in Ireland are classified as premature births – this means that over 4,000 families are faced with the birth of a premature baby (CSO). A premature baby is a baby born before 37 weeks gestational age, with those born before 28 weeks (twelve weeks or more early) being defined as ‘very preterm’). These babies can weigh as little as half a pound, the weight of a small packet of butter, and be so small that you can literally hold them in the palm of your hand. Many of these babies start their lives being whisked away to NICU. Then depending on how early the baby is born, they can face days, weeks or months in hospitals. The birth, NICU and post

+ L-R: Eimear Giblin, Olayinka Kokumo, Allison Molloy (Chairperson), Mandy Daly (General Secretary/Family Support Manager), Ken Fegan (Treasurer) of Irish Premature Babies discharge can all be a very emotionally and physically exhausting time for families of premature babies. With this in mind, the group set up the website www.irishprematurebabies.com for families to access information pertaining to medical issues relevant to premature birth, feeding issues, entitlements, free discounts and read stories of other premature experiences. The group also offers access to a ‘Buddy System’, which offers oneto-one support for families. The system comprises of a substantial network of parents, ranging from parents with babies born at 24 weeks, parents whose babies have ongoing medical problems to those whose children have not survived. All offer support to families new to the premature experience via the mediums of email, telephone, texting and face-to-face chats. They also run ‘meet and greet’ sessions for families in Dublin and Cork throughout the year, and hope to expand this nationwide. Furthermore, the group has commenced fundraising both for the NICUs and for much-needed services. Mandy Daly, the group’s Family Support Manager, says: “In the long term, we hope Ireland would

replicate the services available in other European countries where for example, families have access to emergency accommodation for the duration of their baby’s stay in hospital and access to specialist neo-natally trained nurses to do home visits (as premature babies can go home still requiring medical aid such as oxygen or tube feeding).” She continues, “This is in addition to regular access to lactation consultants (feeding a premature baby has added complications) and regular access to counsellors, as the premature journey can be a difficult one, where postnatal depression or post-traumatic stress can often result.” To increase awareness of both prematurity and the organisation, the group launched an awareness video in June 2010, is holding an exhibition in September and has also produced leaflets and posters which are available to be distributed to Health Centres or other information points by contacting Mandy Daly or Mary O’Sullivan, Committee Members of Irish Premature Babies. Tel: 086 345 8931 Email: info@irishprematurebabies.com

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Breastfeeding update

HSE Breastfeeding Initiative wins Health Literacy Award A HSE Breastfeeding Steering Committee, led by Senior Community Dietician Sarah Mumford, was the winner of the Health Promotion category in the Crystal Clear MSD Literacy Awards for the project ‘Milk it, Much Ado about Nothing’ which encouraged discussion and debate on breastfeeding through the use of drama. The project was one of seven winning initiatives selected from more than 120 entries. The aim of the Crystal Clear MSD Literacy Awards is to recognise anyone working in the healthcare arena, who is making real efforts to ensure that their communications with the public are “crystal clear” and easy to understand. The purpose of the project was to engage population groups, including those with low literacy skills, in discussion and debate around all aspects of breastfeeding. The HSE Committee staged the show ‘Milk it, Much Ado about Nothing’ during Breastfeeding Awareness

Week. Some 160 people viewed the performance, which was based on real life stories from breastfeeding mothers. The audiences were then invited to identify social and other barriers to breastfeeding in the scenes and to develop solutions to these barriers through role play. The feedback from audiences was positive, and many who saw the play saying that the performance had raised general awareness about breastfeeding. A DVD of the play has been recorded as a health promotion tool for future use. For further information contact: Sarah Mumford, Senior Community Dietitian and Chair of the Breastfeeding Steering Committee at: Tel: 01 274 4372 or sarah. mumford@hse.ie

(L-R) Ciara O’Rourke, Director of External Affairs in MSD, Sarah Mumford, HSE Senior Community Dietitian and Chair of the Breastfeeding Steering Committee (Dublin South East, Dublin South & Wicklow LHO areas) and Inez Bailey, Director of National Adult Literacy Agency (NALA) at the Crystal Clear MSD Health Literacy Award 2010

National Breastfeeding Week 1st-7th October 2010 National Breastfeeding Week is about highlighting the supports and information available to women who wish to breastfeed successfully. The main aim of the campaign is to raise awareness of the health benefits of breastfeeding and promote breastfeeding. To mark National Breastfeeding Week from 1st -7th October 2010, the HSE will focus on raising awareness of the various breastfeeding support services available to expectant and new mothers. The HSE has a range of support materials available for women considering breastfeeding, including its breastfeeding website www.breastfeeding.ie, a breastfeeding calendar, a ‘Feeding Your Baby’ leaflet and the Breastfeeding Support Network Card – a wallet-friendly card providing details of help and support for breastfeeding mothers. All materials can be obtained in maternity hospitals, HSE health promotion departments and health centres. The resources can also be accessed through www.breastfeeding.ie or the HSE

Infoline on 1850 24 1850. HSE public health nurses run regular breastfeeding groups around the country which expectant and breastfeeding mothers can attend for support and the opportunity to meet other mothers. In addition, other health professionals including midwives, GPs, practice nurses and dietitians provide one-to-one information and support for expectant and breastfeeding mothers. Expert breastfeeding support is also provided by voluntary organisations such as La Leche League of Ireland and Cuidiú-Irish Childbirth Trust, which hold regular motherto-mother support group meetings, as well as providing telephone support and one-to-one information on request. As part of National Breastfeeding Week, a series of events will take place around the country to inform and educate people as to the benefits of breastfeeding for mother and baby, as well as giving information on how any problems that maybe encountered can be overcome.

When it comes to expressing breast milk efficiently, we admit our pump comes a close second. Our manual breast pump is so effective that it’s clinically proven to express more milk than a hospital electric breast pump.* That’s because it has soft massage cushions to mimic your baby’s suckling and stimulate your natural milk flow. www.philips.ie/AVENT

* Based on a clinical trial comparing the milk expressed per breast over a fixed 20 minute time period, with the Philips AVENT Manual Pump versus the Egnell Ameda Elite double electric pump.

Health Matters 63

breastfeeding

The Benefits of Breastfeeding – GREAT FOR MUMS AND for babies! Becoming a new parent is a very special and life-changing time for everyone. All parents want to do what’s best for their baby. Breastfeeding can contribute significantly to the future health and well-being of babies and their mothers writes Lisa Corbett, Health Promotion Services HSE West.

vast scientific literature demonstrates the substantial health, social and economic importance of breastfeeding. Its benefits range from significant protection against short-term infections, to protection against major chronic diseases like diabetes, heart disease and obesity. There are advantages to breastfeeding for even a short period; however, increasingly, research is demonstrating the positive effects of breastfeeding are dose-related, which means that the improved health outcomes are associated with longer breastfeeding duration. These benefits can last for many years after breastfeeding has ceased. Thus, to exploit these health advantages the World Health Organisation, the Department of Health and Children and the HSE recommends exclusive breastfeeding of infants for the first six months, after which mothers are recommended to continue breastfeeding, in combination with suitably nutritious and safe complementary foods (solids) until their children are two years or older.

“Attending a breastfeeding class or breastfeeding support group before the birth can make a huge difference, both in knowledge and confidence.”

Findings from the National Infant Feeding Survey (2008), undertaken on behalf of the HSE by Trinity College Dublin, showed that only 55 per cent of participants put their baby to the breast after birth. Although this has risen from a breastfeeding initiation rate of 47.5 per cent in 2005, it compares poorly with other European countries. Rates of up to 99 per cent have been reported in Norway, 97 per cent in Switzerland, 83 per cent in Italy and 78 per cent in England. Ireland has the lowest breastfeeding rate in Europe and Europe has the lowest breastfeeding rate of any global region. Although breastfeeding is the natural choice, it is a skill that needs to be learned

by a mother and her baby. Attending a breastfeeding class or breastfeeding support group before the birth can make a huge difference, both in knowledge and confidence. Antenatal classes also include a breastfeeding class. Local mother-tomother support groups such as La Leche League and Cuidiú also provide information and support.

Breastfeeding provides the perfect food for babies For a long time, it was thought that formula milks were almost as good as breast milk. Research now shows that this is not so. Breast milk is much easier to digest and there are ingredients in breast milk that cannot be reproduced in artificial formula milks. Antibodies passed from the nursing mother to her baby can help lower the occurrence of many causes of ill health for the baby. Breast milk is specially designed for babies, so they can grow and develop to their full potential. Breastfeeding also provides instant food when babies are hungry and instant comfort when babies are upset. Breastfeeding means better health for babies A breastfed baby is less likely to get sick with gastro-enteritis, ear, chest and kidney infections. Research has shown that even one month of exclusive breastfeeding can give protection against allergic food intolerance and respiratory allergens in

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Health Matters 65

children up to 17 years old. Breastfeeding also gives some protection from asthma and eczema. Babies fed milk other than breast milk before four months of age are at significantly increased risk of asthma. The relative risk of a child developing non-insulin dependent diabetes if they are formula-fed is 2.4 times that of a breastfed child. Babies who have been breastfed are also said to be less likely to become overweight and have better mental development; their teeth are straighter because breastfed children have better mouth formation. Later in life, their risk of suffering from high blood pressure and heart disease is also lower.

Breastfeeding does not only benefit your baby, there’s a lot in it for mothers too! Most women who breastfeed get their figures back quicker and easier following the birth. By breastfeeding, mothers reduce their own risk of getting breast cancer, ovarian cancer and osteoporosis later on. Once established, most women find breastfeeding very convenient and enjoyable. It is much easier to get out and about with a breastfed baby. Due to the immunities and antibodies passed onto infants through their mother’s breast milk,

breastfed infants are sick less often than infants who receive formula.

…and Partners Partners are an invaluable support to a successful breastfeeding experience. One of the reasons often given for bottle feeding is so that dad/partner can be a part of the experience. A quote from La Leche League says, “A father does not need to feed his baby to form a close, loving bond; however, he does need to spend time holding, loving, playing with, and just being with his baby.” Research has shown that women who reported supportive partners were ten times more likely to initiate breastfeeding than those who perceived their partners as ambivalent or negative. Clearly the potential for breastfeeding to improve health and prevent disease has yet to be fully realised in Ireland. We are moving in the right direction as our breastfeeding rates are improving. The promotion of breastfeeding must be aimed at girls, boys, men and women of all ages as everyone in society can influence attitudes in favour of breastfeeding. Further information can be found on www.breastfeeding.ie.

A mother's experience - MARY'S story “I was determined to breastfeed our baby from the beginning; my sisters and friends had breastfed their children. It looked easy and very handy. I had also been sold on the fact that they seemed to be able to eat what they wanted and lose weight at the same time. Doubts began to creep in when the midwife in the hospital said, ‘You might have to give that child a bottle as he is not latching on'. We persisted but the latching remained an issue. We would almost get there, but not quite. I began to express milk with the hospital pump; this made me feel a lot better in that I knew exactly what he was getting. This was a big thing for me. I pumped as much as I could as well as trying to breastfeed. We supplemented with some of the too-easily available formula. We came home from the hospital and I sent my partner out to rent a hospital-grade pump. We persisted with trying to sort out the latch and called a couple of lactation consultants, one of whom came to the house. The public health nurse also called. They all tried to help but we never really mastered the latch. Gradually, I lost the energy to persist and I expressed breast milk exclusively. It made me feel a bit better in that at least he was getting the benefits of breast milk. We did this for nine months. I was delighted we managed to stick with it for so long. Part of me still regrets that we didn’t manage to breastfeed ‘properly’ but it just didn’t happen. If I was doing it again, I would try harder to get better help.”

A mother's experience NUALA'S story “I knew that choosing to breastfeed was choosing to give my baby the best possible start in life. I was so pleased that within minutes of giving birth to my son I was able to put him to my breast. I couldn’t believe that this little baba was mine and he was happily sucking away. However, I didn’t realise it was a skill to be learnt by both mam and baba, so I have to admit the first couple of weeks were difficult and even included a bout of mastitis. But with lots of help we eventually perfected ‘the latch’. However despite the rocky start, I have to say breastfeeding is the business. I have a healthy, happy baby; each feed only takes a couple of minutes; when we go out and about all I have to remember are nappies; many shops now have nursing rooms; and if the baba wakes at night, a quick feed and he is back sound sleep within minutes. Luckily, we have yet to thread the floorboards in the darkness of night with an upset baby. Breastfeeding was also a quick-fire way for me to get back into my ‘skinny’ jeans! When we went on holidays to France, our son was five months old, and all we had to pack for him were clothes and toys. We didn’t have to worry about sterilisers and bottles etc. When the plane took off and landed I just gave him a breastfeed and he had no problem with the air pressure in the cabin. We also made a lovely set of new friends by attending the local breastfeeding support group. The majority of the other mams I met at this support group are still exclusively breastfeeding too and our babies are hitting the year old mark. Nothing beats the sense of satisfaction that you are getting your baby off to a flying start!”

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Health Matters 67

diabetes

Pregnancy and Diabetes Eoin P Oâ&#x20AC;&#x2122;Sullivan and Fidelma Dunne from the Department of Medicine at NUI, Galway consider the impact of gestational diabetes mellitus on mother and child.

estational diabetes mellitus (GDM) is defined as abnormal glucose detected for the first time during pregnancy. It therefore does not include women with known pre-existing type 1 or type 2 diabetes. The significance of a diagnosis of GDM lies in the fact that it is associated with a triad of adverse outcomes for mother and child. In addition to macrosomia, neonatal complications including jaundice, hypoglycaemia and shoulder dystocia have been observed. Secondly, these children are at a significantly increased risk of impaired glucose tolerance obesity and type 2 diabetes in later life. Finally, mothers with a history of GDM have an estimated seven-fold increased risk of developing type 2 diabetes in later life. These more long-term complications show that GDM can affect the health of mother and child for many years into the future, and is not a transient benign phenomenon.

Diagnosis of GDM The prevalence of GDM varies depending on the population studied and diagnostic thresholds used, but rates of up to 14 per cent have been reported. Up to recently, there were a number of different diagnostic criteria for GDM proposed by different international groups. This lack of uniformity was due to a number of factors, foremost among them the lack of consensus over whether hyperglycaemia below that required for a diagnosis of diabetes was associated with adverse maternal and foetal outcomes in pregnancy. This question was addressed by the recently-published Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. The authors found a positive linear correlation between adverse pregnancy outcomes and maternal glucose levels even at glucose values that would previously have been classified as normal.

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maternity &

AWARDS 2010 The maternity & infant Awards, now in their third year, celebrate the very best in baby related products and services as voted by you the parent. Our People Awards have also increased this year; honouring mums, dads and grandparents, in addition to child heros and midwives amoungst others. The maternity & infant Awards take place this November, if you have a touching story or would like nominate in our People Awards log on to www.maternityandinfant.ie/awards Each person who nominates in our people awards will be entered into our FREE PRIZE draw to win lots of fantastic prizes!

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Health Matters 69

diabetes Following the publication of this study, it was clear that new diagnostic criteria were necessary and, earlier this year, the International Association of Diabetes and Pregnancy Study Group proposed new diagnostic criteria for diabetes in pregnancy. Using these criteria, ‘overt’ diabetes is diagnosed when fasting glucose is greater than 7.0mmol/L or random glucose is greater than 11.1mmol/L (the latter requires symptoms to be present or alternatively confirmation with a fasting glucose). Table 1 shows the glucose cut-offs, with one or more requiring to be equalled or exceeded on an oral glucose tolerance test (OGTT) for a diagnosis of GDM to be reached. It is expected that these new lower cut-offs will have the effect of increasing the number of women diagnosed with GDM.

Table 1

Screening for GDM Similar to previous diagnostic criteria, there is also a lack of consensus of how, when, and who to screen for GDM. Screening can be done by measurement of fasting or random glucose; a glucose challenge test (glucose greater than 7.8mmol/L one hour after 50g oral carbohydrate is regarded as abnormal and a formal 100g OGTT should be performed); or 75g or 100g OGTT. There are a number of risk factors for GDM. Individuals can be classified as very high risk in the presence of obesity, a history of GDM or large babies, polycystic ovarian disease, strong family history or glycosuria. The American Diabetes Association suggests such individuals should be screened at the first prenatal visit. At 24 to 28 weeks gestation, there is significant debate as to whether universal or selective screening should be performed. Some argue that the risk is sufficiently low enough in normal BMI women under 25 years of age who are not of an ethnic minority associated with

“Individuals can be classified as very high risk in the presence of obesity, a history of GDM or large babies, polycystic ovarian disease, strong family history or glycosuria.” diabetes and have no history of GDM, previous poor obstetrical outcome and no family history as to obviate the need for screening in this population. Such an approach would clearly reduce the potentially significant costs of screening. Others, however, argue in favour of universal screening, citing practical difficulties in identifying and documenting risk factors in the large numbers of women who routinely attend busy antenatal clinics and the distinct possibility of missing a significant number of women who develop GDM despite the absence of these traditional risk factors. Currently, in Ireland, there is no universal screening policy for GDM, and local practice differs significantly.

Treatment of GDM Intensive management of GDM has been shown to reduce maternal and foetal morbidity, and a recent study has shown benefits in the treatment of women even with mild degrees of hyperglycaemia. Treatment of GDM consists initially of dietary modification and frequent self-monitoring of pre and post-prandial glucose. If there is persistent elevation of pre and post-prandial glucoses of greater than 5.5mmol/L and greater than 7.0mmol/L, insulin therapy is usually instigated if practical. Following delivery, insulin resistance drops dramatically and treatment can usually be discontinued. All women who are diagnosed with GDM should undergo an OGTT six to 12 weeks post-partum to ensure resolution to normoglycaemia. ATLANTIC DIP In order to audit clinical practice, determine prevalence, observe complications and

guide future policy on the management of GDM in Ireland, ATLANTIC DIP (Diabetes In Pregnancy) was established in 2005. It is a partnership between five antenatal centres on the Atlantic coast – University Hospital Galway; Letterkenny General Hospital, Co. Donegal; Sligo General Hospital; Portiuncla Hospital, Ballinasloe, Co. Galway and Mayo General Hospital, Castlebar. As an initial step, the ATLANTIC DIP network established an electronic link between centres using DIAMOND (Hicom, Woking UK), a Diabetes Clinical Information system for data collection. DIAMOND is hosted at the central location as a secure service. Data captured in the peripheral clinics is consolidated in real time within the central DIAMOND database and made available in anonymised form for analysis and reporting. One of the aims of this study was to establish the prevalence of GDM within the catchment area. In order to investigate this, universal screening for GDM was offered to all women by means of the performance of a 75g oral glucose tolerance test (OGTT) at 24 to 28 weeks. A wide variety of maternal and foetal outcomes were measured and compared between women with and without GDM. A total of 12,466 women were identified and invited to enrol in the study, 5,487 of whom completed the study. Overt diabetes was found in 3.4 per cent, with a further six per cent having impaired glucose tolerance, giving an overall prevalence of GDM of almost ten per cent. We also identified significant adverse maternal and foetal outcomes associated with the presence of GDM (submitted for publication).

Summary GDM is common and is associated with significant adverse short and longterm complications for mother and child. Recent studies showing adverse outcomes associated with glucose levels hitherto thought of as normal and the accompanying change in diagnostic criteria will likely increase the number of women diagnosed. Identifying and diagnosing these women during and after pregnancy will impose further time and financial burdens on the provision of diabetes care in Ireland.

70 Health Matters

FOcus

Suicide Prevention

HSE/National Office for Suicide Prevention responds to mental health and well-being implications of economic downturn.

he current economic recession in Ireland has resulted in a significant decline in economic activity and rising unemployment. The recession has led to substantial declines in personal salaries, rises in personal debt along with a drop in personal investment and pension portfolios. The psychological impact of the economic recession on public health is likely to lead to a reduction in mental well-being, increases in mental health problems, and rises in levels of substance misuse, relationship breakdown, increased social isolation and increased risk of suicidal behaviour. People who are unemployed are two to three times more likely to die by suicide than those in employment. Research has examined how economic crisis affect mortality rates over the past three decades within 26 countries in Europe. It estimated that every one per cent increase in unemployment was associated with 0.8 per cent rise in suicide at ages less than 65 years. The greatest increase is among young males. However, the evidence does demonstrate that social protection programmes along with other public health interventions can counteract rises in suicide mortality rates during economic downturns. Public health interventions that are likely to have an impact include: • Public awareness media campaigns on mental health and well-being • The provision of training and information on suicide prevention for frontline services working with those affected by unemployment and financial pressures • Early identification and referral to health services for those suffering from mental health problems • Community-based mental health promotion programmes

In 2009, the HSE/National Office for Suicide Prevention (NOSP) commenced an action plan aimed at assisting frontline staff within organisations supporting individuals and families impacted by the economic downturn. The plan is working to deliver actions from ‘Reach Out- The national strategy for action on suicide’ in partnership with workplaces, relevant agencies and the voluntary sector. It was built on existing work being undertaken at a national and regional level on suicide prevention and mental health. This programme is ongoing in 2010 and continues to be strongly supported by the HSE regional suicide prevention officers. A summary of the work completed to date is described below.

‘Look after your mental health in tough economic times’ The NOSP published two information resources (an Information Leaflet and a Wallet Information Card) entitled ‘Look after your mental health in tough economic times’ and printed and distributed over 250,000 copies of both through agencies and health service providers. The resources outline information on mental health and wellbeing along with simple steps we can undertake to support a friend, colleague or family member we are concerned about. The resources list support services available to the public. A guideline document for workplaces on how to respond to people at risk of suicidal behaviour was published and a total of 1,250 copies have been

+ L-R: Geoff Day, Director, HSE National Office for Suicide Prevention, Dr Justin Brophy and Prof Rick Price at the launch of an Information Leaflet and Wallet Information Card as part of the Look after your Mental Health in Tough Economic Times initiative

Health Matters 71

focus

distributed among key frontline services including the Department of Social Welfare Offices, FAS, Citizens Information Centres, and EAP services. In addition, some agencies have adapted the guidelines to meet their own needs e.g. The Money Advice and Budgeting Service (MABS). The NOSP has worked extensively with local and regional media to highlight the above resources and how the general public can access them online or directly from the HSE.

Targeted Suicide Prevention Training Training on suicide prevention for services providing advice and support to the public has been a key target for the NOSP since early 2009. Over the last twelve months, many frontline services staff including FÁS, MABS and Citizens Information Centres have undertaken both the ASIST and safeTALK suicide prevention training provided by HSE regional suicide prevention offices. Ongoing work with these services is planned for the remainder of 2010 and into 2011. +

“People who are unemployed are twothree times more likely to die by suicide than those in employment.”

Winning New Opportunities programme The NOSP has part funded a pilot of the Winning New Opportunities (WNO) programme that has been undertaken along the HSE West. The pilot commenced in 2009 and is coordinated by the HSE West health promotion department in partnership with key agencies have worked together to ensure the implementation for the pilot. Winning New Opportunities is a job search programme targeting people who are unemployed. It was developed to help people who are unemployed to find work and cope

Prof Rick Price, Susan Kenny, NOSP, Justin Brophy and Geoff Day, HSE National Office for Suicide Prevention at the launch of an Information Leaflet and Wallet Information Card as part of the Look after your Mental Health in Tough Economic Times initiative

with the challenges of unemployment and looking for a job. WNO is an internationally recognised mental health promotion programme for those who are unemployed and seeking work. The programme is a two-and-a-half day job-seeking skills course that has been proven to build participants resilience against personal setbacks and improve employment rates. Participants who complete the course have been shown to have lower rates of depression four months later. The Winning New Opportunities (WNO) programme is designed to maximise participants’ skills to effectively seek new jobs and opportunities through a facilitated and interactive, group learning approach. Three ‘train the trainer’ programmes for WNO have been coordinated and delivered across the HSE West. At present, 48 trainers have been trained in the programme. Initial evaluation of the programme completed by NUIG has shown that the participants have responded very positively toward the programme.

Results indicate that there is a notable increase in the participants’ confidence levels after participating in the programme. Participants were more confident in relation to being able to perform job seeking tasks and overcoming setbacks. Participants reported very positive perceptions towards the WNO intervention and the learning process with over 87 per cent of the participants feeling enthusiastic about job seeking, seeking out other opportunities and feeling hopeful about the future. A final more detailed evaluation of the pilot including mental well being outcomes will be complete in October 2010. Discussions are underway with key partner agencies on further roll out of the programme across other HSE area. For further information, contact the National Office for Suicide Prevention on 01 635 2179 or email info@nosp.ie. The information leaflet and wallet card can be ordered on: www.healthpromotion.ie.

72 Health Matters

Suicide prevention

New initiative promotes

positive mental health for vets The Veterinary Assistance Programme, a confidential support service available free of charge to all veterinary professionals and their families in Ireland, was officially launched in July by the Minister for Mental Health and Disability, John Moloney TD.

esearch shows that veterinary professionals report a high level of psychological stress and are known to be at increased risk of death by suicide, when compared with the general population. The proportional mortality ratio for suicide amongst the veterinary profession is four times that of the general population and around twice that of other healthcare professionals.

â&#x20AC;&#x153;The Veterinary Assistance Programme (VAP) aims to promote positive mental health and to provide crisis response at times of extreme stress.â&#x20AC;? The Veterinary Assistance Programme (VAP) aims to promote positive mental health and to provide crisis response at times of extreme stress. The development of this programme is supported by the HSE, the National Office for Suicide Prevention (NOSP), the Samaritans, as well as the various veterinary organisations - Veterinary Ireland, Veterinary Council of Ireland, Irish Veterinary Nurses Association, Veterinary Officers Association, Veterinary Defence Society, UCD Veterinary Medicine, VetNI and IFP Media (Irish Veterinary Journal).

Health Matters 73

Suicide prevention

Speaking at the launch of the programme, Minister Moloney congratulated the veterinary profession on its approach towards mental health promotion, and for the work it was undertaking to counter the stigma attached to such issues as suicide and self harm. Referring to the 'See Change' campaign, Ireland’s new national partnership to reduce stigma and challenge discrimination associated with mental health problems, which will be organising events in communities around the country from September, the Minister spoke about the need to be open about the challenges stigma presented. The Minister expressed the hope that as the veterinary profession was able to come forward in such a positive manner to address the issues of mental health and the stigma attached, so to would other groups in the community follow this lead, and take their own positive steps in this direction.

“The proportional mortality ratio for suicide amongst the veterinary profession is four times that of the general population and around twice that of other healthcare professionals.” In 2008, the Irish Veterinary profession recognised that in order to address the issue of psychological stress, solutions had to come from within the profession. Facilitated by Donal Connolly, a former President of Veterinary Ireland, an All-Island Working Group was established to look at ‘Stress in the Veterinary Profession’, involving delegates from veterinary representative, educational, support and

regulatory bodies. The HSE/National Office for Suicide Prevention, the HSE West/ Regional Suicide Prevention Office and the Samaritans were also invited to participate in this Working Group, out of which a proposal was developed in 2009 for a Veterinary Assistance Programme, provided by the Irish Veterinary Benevolent Fund. The Veterinary Assistance Programme became operational in March 2010 and it consists of a 24-hour Freephone Professional Counselling Helpline; access to Face-to-Face Professional Counselling; anonymous or “low-stigma” online Professional Counselling accessed through email and real-time “Live Connect”; and a dedicated “Wellnet” internet website, containing over 5,000 articles and resources on health, wellbeing, parenting, finances, legal information, consumer rights and workplace issues. The Veterinary Assistance Programme will be heavily promoted to the Veterinary Profession throughout the year. Speaking at the launch, Donal Connolly, who initiated work on the programme, stated ‘International evidence demonstrates that as a society and individuals, we can influence and look after our own mental health and well being. The veterinary profession has today made a significant beginning in providing a confidential

assistance program directed at the entire veterinary profession, their partners and families, rather than targeting only those in psychological distress’. In 2009, the HSE/NOSP provided funding towards the establishment of the Veterinary Assistance Programme. The NOSP supported the initiative as it specifically relates to the implementation of actions from ‘Reach Out: The national strategy for action on suicide prevention’. The programme provides the NOSP with a model of good practice for supporting and intervening with professions who work in isolation and who have been shown to be at risk of mental health problems and suicidal behaviour. Furthermore through their work, veterinary professionals often engage with individuals who may be at risk of suicide. Therefore by increasing awareness among the veterinary professionals on mental health and well being, this would allow vets to act as gatekeepers themselves within their communities, and so be able to assist others with understanding who may be in need of support. For more information on the veterinary assistance programme contact Susan Kenny, National Office for Suicide Prevention on 041 686 0712 or by emailing training@nosp.ie.

74 Health Matters

road safety

We Must Redouble Efforts to Make Roads Safer In July, we had a truly dreadful weekend on our roads. Ten lives, many of them young lives, were lost – eight alone in a single collision in Co. Donegal, says Gay Byrne, Chairman of the Road Safety Authority.

ur deepest sympathies are not only with the families of the bereaved who lost their loved ones in July but indeed with the families of the 114 victims of road crashes so far this year. While it is understandable that people will want answers following such a tragedy, it is important that we allow the Gardaí to conduct their investigations and not rush to judgement. In the meantime, I hope that this appalling loss of life will serve as a reminder to us all that our lives are suspended by the thinnest of threads. Nobody ever believes it will happen to them but tragedy can strike anywhere at any time on the roads. Life is fragile and using the roads is the most dangerous thing we do. We need to remember this every time we set out on a journey. What we must not do is lose heart or give up on our efforts to make our roads safer. We have a choice. We can throw in the towel or we can stand our ground and face the challenges ahead. I for one am determined to face this challenge. I would ask you to do the same by doubling your

efforts. Ask yourself, is there anything I can do to improve the way I use the roads? + Gay Byrne, Chairman of Road Safety Authority If we all improved the way we behave on the roads a little it would make a big difference. While young drivers remain a high-risk group, the vast majority are sensible and responsible drivers. Deaths among 17-24 year old drivers over the period 1998-2009 have dropped by over a third. A range of measures aimed at educating and equipping young drivers with the necessary skills for safe driving have been introduced in recent years. The provisional licence system was reformed, replaced with a new ‘Learner Permit’, and now all learner drivers must be accompanied by a fully qualified driver at all times. used by community groups and sporting The Driving Instruction Industry has been organisations around the country. Added regulated. This, for the first time, guarantees to this, are the life-saving efforts of the a high standard of tuition for learner drivers Gardaí, local authorities and the National across the country. Road Authority. As a result of their actions, Unprecedented numbers of learner drivers communities are safer. have been tested in the last number of Nobody can guarantee that we will not years. This has certainly improved driving have a weekend like that July weekend standards. In addition, learner drivers now again. In fact, the sad reality is that we have timely access to a driving test with probably will. But with your help we can national average waiting times less than 10 ensure that we never return to the dark weeks. The introduction of a new Graduated days when we turned on the radio on a Licensing System will also improve the way Monday morning to hear of yet another inexperienced drivers learn to drive. horrific weekend on our roads. Education plays a vital role and the RSA’s road safety resources are being taught Please stay safe on the roads and expect at pre-school, primary, secondary, and the unexpected. third level. Our resources are also being

“The Driving Instruction Industry has been regulated. This, for the first time, guarantees a high standard of tuition for learner drivers across the country.”

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Health Matters 77

road safety

HSE supports reduction of legal limit for drink driving T

he Road Traffic Bill 2009 has been signed into law and comes into effect shortly. One of the provisions of the Bill is to lower the legal Blood Alcohol Concentration (BAC) level for drinking and driving for the current limit of 80mgs to 50mgs (for qualified drivers) and 20mgs (novice and professional drivers). The aim of this Bill is to improve road safety, save lives and reduce serious injuries on our roads. Drinking any amount of alcohol impairs a driverâ&#x20AC;&#x2122;s ability to drive safely. There is strong evidence from the international literature that reducing the legal limit will act a deterrent to drinking and driving.

â&#x20AC;&#x153;Drink driving is still a serious issue in Ireland. Research undertaken by the HSE has shown that alcohol is a contributory factor in one-in-three fatal crashes and that one-in-two drivers killed on the roads.â&#x20AC;?

Other countries that have reduced the legal limit have seen a significant fall in deaths and injury. At the current legal limit in Ireland of 80mgs/100mls, a driver is six times more likely to be involved in a crash. The World Health Organisation has called for all countries to reduce their legal limits to 50mgs/100mls or lower. Ireland is one of only three EU countries

with legal limits above 50mgs/100mls. The United Kingdom and Malta are the only other two countries with legal limits higher than 50mgs/100mls. Drink driving is still a serious issue in Ireland. Research undertaken by the HSE has shown that alcohol is a contributory factor in one-inthree fatal crashes and that one-in-two drivers killed on the roads, where a blood alcohol level was available, had a blood alcohol level of 50mgs/100mls or higher.

Dr Declan Bedford, Specialist in Public Health Medicine stated that: "Any amount of alcohol impairs driving and increases the risk of a crash. Reducing the legal limit will act as a general deterrent to drinking and driving, and will save lives and reduce injuries and disability; the sooner the legislation to reduce the limit is introduced and implemented the more lives will be saved."

78 Health Matters

road safety

HSE Response to Road Tragedy in Donegal One of the worst traffic accidents in the history of the State took place in Inishowen, Co. Donegal, in July. Eight men lost their lives, seven of them under the age of 23, and the eighth, a man of 66, was killed in the head-on collision while driving home after his regular Sunday night at bingo. The HSE moved immediately to offer care and support to the Inishowen community in the aftermath of this traumatic event.

response team, incorporating psychologists, counsellors, a mental health promotion officer, adult mental health service staff, social work staff and NoWDOC coordinator and administration support, was set up to coordinate a rapid and short-term HSE response to the tragedy. A key aim of the HSE response was to work in partnership with the community and voluntary sector to present a cohesive and coordinated response on the ground. Anne Sheridan, Mental Health Promotion Officer for Donegal, says: “It was important that we, as HSE staff, along with the other statutory and voluntary bodies, moved quickly as we needed to put the short-term support services into place immediately. The families that had been directly affected by this tragedy needed to know that the appropriate professionals and services were available to them. We also offered support to the frontline responders who were at the scene of the accident and exposed to the full awfulness of such a tragic event.” A support line was set up the day after the accident and leaflets were distributed to youth centres and to dedicated ‘drop in’ centres which were run by voluntary and community organisations locally in the Inishowen peninsula, specifically in Clonmany and Buncrana. However, according to Anne, many of the people directly affected were mainly in their early twenties, and they were the hardest to reach as they are no longer in school and

“There was a lot of concern expressed throughout the community for the wellbeing of these young people following the event.”

don’t tend to access HSE or voluntary services. There was a lot of concern expressed throughout the community for the wellbeing of these young people following the event. Angela Flavin, Senior Clinical Psychologist, adds: “Young people may not readily go to a GP for advice or support, but we’ve found that the internet supports that were established are being widely used, and in fact young people were downloading the information provided on how to cope following the traumatic death of a friend. We are also examining other ways to get the message across to young people, as not all of them have access to the internet either. In particular, we are looking at the possibility of sending text alerts to mobile phones as a means of communicating with

Members of the response team, L-R: Angela Flavin, Senior Clinical Psychologist; John Hayes, Area Operations Manager Donegal; Caroline McElhinney, NoWDOC Call Centre Supervisor; John Mc Cardle, Assistant Director of Nursing, Mental Health Service; Eamonn Sweeney, Assistant Director of Nursing, Mental Health Services, Donegal; Louise Callaghan, Administrative Support; Anne Sheridan, Mental Health Promotion Officer; and Emmet Murray, Senior Clinical Psychologist

Emmet Murray, Senior Clinical Psychologist, who operated the mobile phone support line in the aftermath of the accident

Health Matters 79

road safety

“In the weeks following the tragedy, the HSE Response Team has continued to liaise closely with the community and voluntary sector in Inishowen.”

the younger community in Inishowen. In the weeks following the tragedy, the HSE Response Team has continued to liaise closely with the community and voluntary sector in Inishowen. As well as the support measures put in place for as long as they are needed, meetings were held with ASIST-trained community members in the area to strengthen alertness in the community. The emphasis was on providing outreach care to the families, as well as prioritising people who needed to be referred and fast-tracked into the healthcare system. A full review of the HSE response is to be undertaken and learning will be mapped to inform any future trauma response. A strong request was made via the community and voluntary sector for a long-term multiagency strategic response in the event of such a tragedy happening in the future, and this process is now underway. Both Anne and Angela stress the importance of a national approach in developing a critical incident model, pointing out that there are opportunities to share resources and streamline responses such as information and support lines. They both agree that the cooperation of the Local Health Manager Donegal (now Area Operations Manager Donegal), John Hayes, in releasing staff and resources was key to the smooth operation of the response, and they would recommend that this be done for every critical incident. They also say that

the willingness of HSE staff to go the extra mile during the initial stages of the response was both inspiring and crucial.

Response Measures put in Place Support to families directly affected In the immediate aftermath, a system for providing information was activated within Letterkenny General Hospital to ensure that families had easy access to information, for example, details of post-mortems and removals. A system of follow-up support was put in place and proactively offered to all families directly impacted by the tragedy. Support to Front Line Responders The response team identified the various professionals and members of the public who were present at the scene of the accident, including ambulance staff, GPs, hospital staff, fire service, clergy and Gardaí, and ensured that appropriate and evidencebased support was provided. Information/Support Line An information and support line was set up on the day after the fatal accident for anyone concerned about themselves or someone close to them. The phone line remained open for 24-hours a day, seven days a week over the first three weeks, and was manned by psychologists, mental health service staff and other suitably trained health care staff. The information and support line was scaled down after the initial three weeks, and continued on this basis for a period of time. Details of the support line were widely advertised in the community of Inishowen. Partnership with Statutory, Community and Voluntary Groups on the Ground Links were established with key community and voluntary groups, such as BCCS (Buncrana Community Combatting Suicide) and the Clonmany Youth and Community Resource Centre. It was also decided to set up ‘drop-in centres’ for young people in the local community in partnership with these organisations.

Information Leaflets A number of information leaflets were developed which aimed to normalise the emotions and reactions that can be expected following a trauma, and providing practical coping strategies. Information resources were particularly targeted at young people, parents and health professionals. Packs of leaflets were distributed to all GPs, public health nurses and clergy in the area, and leaflets were also provided to the drop-in centres. Internet-based Support It became clear early on that young people were searching the internet for information on ‘how to cope when a friend dies’ and ‘how to deal with tragedies in Inishowen’. Information resources were provided to SpunOut. ie, Talk Buncrana and Unwind Your Mind facebook pages to support the searches and provide practical information and reassurance to young people. Reaching out to Vulnerable People A number of potentially vulnerable people were identified and their care needs were met by appropriate HSE staff. There was awareness that there may be further vulnerable people identified as time went on and an agreement by key HSE services to respond quickly to requests for support. Meeting with GPs A meeting took place with GPs in the Inishowen area to discuss the main issues and concerns following the road deaths, and how they could respond effectively.

80 Health Matters

road safety

Get Streetwise for Back to School! I

t’s back to school time and the RSA advises parents to put road safety on the check list. Specifically, Noel Brett, the CEO of the Road Safety Authority said, “We are asking parents and guardians to consider including high visibility clothing, bicycle helmets and other life saving road safety gear on their ‘back to school’ shopping lists and to make sure their kids are streetwise about road safety before they go back to school”, He added, “Demonstrate good road safety behaviour at all times as your child will learn from your example. So if your children walks or cycles to school, take them on the route in advance and make sure they know where they are going. If they travel by car or bus, make sure they know how important it is to put their seatbelt on at all times.” Mr Brett also had a message for teachers: “We would also ask teachers to consider including a road safety lesson from the RSA’s road safety resources in their classes. There’s ‘Be Safe’ for primary level, which includes the Safe Cross Code, and at the secondary level there is a new Junior Cycle resource entitled ‘Streetwise’. The new Transition Year programme is available to schools. Mr Brett said, “While the number of children killed or injured on our roads has declined, tragically one child fatality is one too many. The RSA is trying to improve

safety for children on our roads through campaigns such as the child car seats campaign ‘Check it Fits’ and the ‘Seatbelt Sheriff’, ‘Hi Glo Sliver’ campaigns which are specifically targeted at parents and younger road-users. But today, we are calling on parents, guardians and members of the community to also do their part. Teach your child the importance of road safety. Set them an example – your child will learn from what you do, so make sure you always demonstrate good road safety behaviour.”

The Road Safety Authority is providing the following ‘back to school’ advice for parents and children: Travelling by Car • All children should be restrained when travelling in a car • Select a restraint that is based on your child’s weight and height and is suitable for the type of car • Remember that it’s safer if children travel in the rear of a car • Never leave a child alone in a car Walking to School • Small children should not cross roads alone. They cannot decide how far away a car is or how fast it is going

• Walk the route to school with them in advance • Children walking on country roads should wear reflective armbands and bright clothing • If there is no footpath, walk on the righthand side of the road facing oncoming traffic and keep as close as possible to the side of the road • Show your child how to cross the road by example. Choose safe places to cross (for example: footbridges, zebra or pelican crossings, lollipop lady/man or junior school warden patrol) and take the time to explain why those places are best

Travelling by Bus • Teach children to take special care getting on or off a bus or mini-bus • While waiting for a bus, children should stand well off to the side of the road • Before crossing the road children should wait until the bus has moved off so that they can see clearly in both directions • If seatbelts are fitted, they must be worn Cycle Safety • Make sure children are highly visible by wearing a reflective belt and bright clothes • Wear a bicycle safety helmet on all journeys • Check that the bicycle’s brakes, lights, reflector and bell are in good working order.

HSE Magazine_188x130mm_hi res.pdPage 1 19/02/2010 16:05:00

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82 Health Matters

AWARDS

Taoiseach’s Public Service Excellence Awards 2010 A total of six HSE projects received awards at the Taoiseach’s Public Service Excellence Awards in July 2010.The biannual Awards aim to showcase and celebrate public service projects that make a particular difference to the way the citizen can avail of services. The Awards promote innovation and excellence. Two of the winning projects will be chosen to represent Ireland at the sixth Quality Conference for Public Administrations in the European Union – or 6QC for short. 6QC will take place in Austria in late 2010.

An overview of the winning projects Independent Nurse and Midwife Medicinal Product Prescribing In order to prescribe, a nurse or midwife must have more than three years experience, have successfully completed the dedicated course on nurse and midwife prescribing and must be registered with the Nursing Board as a RNP. The first independent evaluation report into the Nurse and Midwife Prescribing found that the first phase of Nurse and Midwife Prescribing has been successful and is of benefit to patients and staff across the healthcare system. There are 186 nurses and midwives throughout the country who have completed the education requirement and the registration process with An Bord Altranais, and are actively prescribing medicinal products in clinical practice areas.

Anne McHugh, Clinical Nurse Manager 2, collects award from Taoiseach Brian Cowen TD for ‘Sexual Assault Care’

Certificates.ie This website was launched in November 2009 and enables clients to purchase certificates of birth, adoption, death, stillbirth and marriage online from any internet connection in Ireland or abroad. The new website also makes it easier for adopted persons and parents of stillborn children to purchase their certificates online like all other customers, rather than apply separately to the GRO who hold these registers. This new facility will alleviate any unnecessary upset caused to customers due to the separation of the registers.

Dr Siobhán O’Halloran, Nursing Services Director, collects award from Taoiseach Brian Cowen TD for ‘Medical Product Prescribing’

Sexual Assault Care – A project by the HSE to develop care and services for patients who disclose recent rape or sexual assault. The project was developed by staff in Letterkenny General Hospital, with the aim of providing an appropriate environment for treatment of patients who disclose recent rape or sexual assault, meeting staff educational needs, addressing guidelines for practice and ensuring the provision of a dedicated service.

Denis Prior, Superintendent Registrar, Civil Registration Service, collects award from Taoiseach Brian Cowen TD for ‘Certificates.ie’

Health Matters 83

AWARDS

An overview of the winning projects ‘Bridging the Gap’ Intermediate Care Service County Roscommon The ‘Bridging the Gap’ Intermediate Care Service is a short-term service provided, in the patient’s own home, by a multi-disciplinary team for those who need help to recover from an illness or an injury. The multi-disciplinary team comprises a manager, nurses, physiotherapist, home helps, occupational therapist and secretary. A 2009 survey of clients showed that 92 per cent were + Marie Gunning, Castlerea Team Manager, collects award very satisfied with the Intermediate from Taoiseach Brian Cowen TD for ‘Bridging the Gap’ Care Service, with 94 per cent expressing improvement in their quality of life through the intervention of the service. Clients highlighted the importance of being able to stay in their own home, their personal satisfaction in regaining independence, greater confidence, increased functional mobility, empowerment, motivation and encouragement in social interaction in the community.

Let someone know- a mental health campaign by the HSE National Office for Suicide Prevention. This project is to promote awareness of mental health issues and to encourage young people to talk about their problems. Reach Out – the National Strategy for Action on Suicide Prevention – sets out 26 action areas to address the tragedy of suicide. Of these, action area 10 aims to reduce stigma and promote mental health. This has been initiated through a general awareness campaign started in 2007 using TV/radio advertising, a dedicated Bebo page, outdoor advertising and production of a booklet Your Mental Health. Also, www.letsomeoneknow.ie was developed and supported by a new Bebo page, mobile phone contact, TV, cinema and outdoor advertising in youth-friendly locations. A number of voluntary organisations are also “cobranding” with the HSE to reinforce the ‘Let Someone Know’ message.

+ Prof Jonathan Hourihane, Professor of Paediatrics, Cork University Hospital collects award from Taoiseach Brian Cowen TD for ‘Communicating Sensitive Information’ Informing Families of their Child’s Disability – Best Practice Guidelines: the Cork Implementation Project This project developed guidelines and practices for the disclosure to parents of their child’s disability. The guidelines help professionals and staff to impart the information clearly and effectively in supportive and sensitive ways. This helps to support families who have difficulties in coming to terms with the news. The aim was to deliver the news in more humane and supportive ways, in order to reduce stress for parents/families. It also serves to minimise the risk of litigation that can sometimes occur if disclosure is badly handled.

The Taoiseach’s Public Service Excellence Awards are organised as part of the Transforming Public Services (TPS) programme. One of the central aims of the TPS programme is to ensure that the citizen – the customer – is at the centre of the Public Service. Further information on the Transforming Public Services programme is available at www.onegov.ie.

Geoff Day, Director of the National Office for Suicide Prevention collects award from Taoiseach Brian Cowen TD for 'Let Someone Know'

84 Health Matters

Health & well-being

Repetitive Strain Injury In terms of repetitive strain injury, prevention is infinitively better than cure writes Anita Young, Senior Physiotherapist LHO Dublin South City, HSE Dublin/Mid-Leinster.

What is repetitive strain injury? Repetitive strain injury (RSI) is an umbrella term used to describe a range of painful conditions of the muscles, tendons and other soft tissues. It includes conditions, such as carpal tunnel syndrome, tennis elbow, tendonitis and bursitis. It is usually related to a job, but it can also be caused by leisure activities and sports. Those at risk of developing RSI include office and computer workers, construction workers, plant and machine operators and musicians. Some studies have shown that psychosocial factors, such as psychosocial distress, monotonous work or employees having poor working conditions or using bad work practices are also associated with the development of repetitive strain injury. What causes repetitive strain injury? RSI is usually caused by repetitive and frequent tasks, such as typing and over-using a computer mouse. Other contributing factors include working in an awkward or tiring position, adapting a static posture and having to use significant force when carrying out a task. Signs and symptoms of RSI The symptoms of RSI may include pain, numbness, weakness, tingling and loss of movement of affected joints. These symptoms usually develop gradually over time. Initially they may only occur when carrying out the specific repetitive task and ease when resting. If a RSI is left untreated however the symptoms may increase in severity and duration. Early diagnosis and treatment is imperative to ensure a full recovery. How to avoid a RSI In terms of repetitive strain injury, prevention

is infinitively better than cure. RSI related pain and disability can be prevented by making simple changes to your work habits.

Some tips to help prevent RSI: • Change your position regularly. Alternate between sitting and standing every 20-30 minutes. • Move your neck, shoulders and arms at intervals during the day • Maintain correct posture when working to minimise stress and strain on joints. This means sit facing straight ahead with screen approximately arm’s length away and eyes at the same height as the top of the computer screen. Keep feet flat on the floor or on a foot rest and keep legs uncrossed • Adjust the backrest of your chair so that you can lean back against it comfortably Make sure your lower back is supported • Do not cradle your phone between your shoulder and ear. Use a headset if you spend long periods on the phone • Place your mouse within easy reach and ensure your forearm is supported on the desk. Keep your wrist in a relaxed, neutral position • At break times leave your desk and walk around. Go for a brisk walk at lunchtime as it will help to relax your muscles and joints What to do if you suspect you may have a RSI? If you work at a desk, get your work station evaluated by a Display Screen Assessor (DSE) who has been trained in ergonomic assessment. This assessment is particularly important for staff who

are experiencing pain when using their workstation or those who use a workstation for longer than an hour at a time. Contact your local health and safety section for further information. If you are suffering from RSI symptoms attend your GP and/ or chartered physiotherapist for pain relief, treatment and advice.

Health Matters 85

YOGA

Yoga: The Ultimate Learning Adventure for Kids The Occupational Therapy Paediatric Community Service in Sligo/Leitrim is using yoga to assess and treat children, as part of an innovative collaborative project with the Sligo Sport and Recreation Partnership.

isa McGill and Shona Gallagher, Occupational Therapists responsible for supporting children and families as part of their work in the Occupational Therapy Paediatric Community Team in Sligo/Leitrim and west Cavan have identified yoga as a new way of delivering interventions in a community setting. “The goals, aims and benefits of yoga are similar to occupational therapy goals and approaches in assessment and treatment. Yoga teaches children movement, co-ordination, postural control and respiration ability, attention and concentration skills and increases confidence in their own abilities, decreases anxiety and helps to build self-esteem,” says Shona. Shona identified a trained yoga instructor to work with on a pilot project, the aim of which was to assess the benefits of yoga from an occupational therapy perspective. Bernie Burke, a qualified yoga instructor and holistic therapist with a background in secondary school teaching, agreed to facilitate the group. “The children stretch, breathe, relax and enjoy the many benefits of yoga in fun and playful ways. It is an

experience that helps the child to learn about his or her own body, mind, environment and creativity,” says Bernie. “Children who practice yoga develop strong, limber and healthy bodies; increase focus, concentration and attention span; acknowledge their special gifts and strengths; relax and sleep better; cope with stress more effectively; and fill up with vital energy. The end result for the children is that they feel great. The yoga breath calms and energises at the same time and is of great benefit to children with special needs,” she added. Lisa and Shona contacted Shane Hayes, Sports Inclusion Disability Officer with Sligo Sport and Recreation Partnership, to help develop the pilot. The Sligo Sport and Recreation Partnership works in partnership with statutory agencies, sports clubs, community groups, facility providers, parents, schools and disability services to increase participation in sport and physical activity by people of all ages and abilities throughout Co. Sligo. The partnership agreed to support the group by offering advice and partial funding. The six children who participated in the pilot had moderate co-ordination difficulties, generalised delay and all attend mainstream school. Prior to the pilot, the children had been assessed and

were receiving individual occupational therapy treatment. The hour-long sessions, which ran for six weeks, took place in a HSE therapy clinic and parents were asked to pay a small donation in order to cover remaining costs. Lisa McGill said, “The pilot yoga group was a huge success; the participating children enjoyed the sessions, the feedback from parents was positive and other multidisciplinary team members expressed a wish to be involved. We then received further referrals for other children who would benefit from yoga.” A yoga exercise booklet and summary of the pilot was given to parents of the participating children, so they could see the progress their child made and help them to continue to use yoga at home. Based on the success of the pilot, two further 10-week groups have been scheduled for 2010/2011 with part-funding from Sligo Sports Partnership. If you would like any further information on the project or are interested in setting up a similar project in your area, please contact Shona Gallagher or Lisa McGill, Senior Paediatric Occupational Therapists, HSE West Community Services. email: shona.gallagher@hse.ie. For more information on Sligo Sport and Recreation Partnership go to: www.sligosportand rcreation.ie

86 Health Matters

Healthy Eating

Lunch with Punch

Eat well at work for balance, vitality and strength, writes Jacqueline Strawbridge.

lthough your job is in the health sector, it is very easy to neglect your own wellbeing as you rush from a busy day at work to a hectic home life. Giving yourself the gift of a delicious, nutritious lunch or snack will help to keep you healthy and energised. Firstly, make your own food to bring with you before you go into work. It seems obvious, but this simple task can fall by the wayside, even though eating well is one of the most important things you can do in your day. If you like, you could tie in with what you are having for dinner the night before, making extra to bring in the next day. A leftover dinner will serve you better than a snack on-the-go brought from the canteen or nearby shop. Planning is the foundation of a healthy meal. This means making a list and shopping for basic essentials, such as brown rice or whole-wheat pasta, pulses (think cannellini, pinto or azuki beans, or good old chickpeas and lentils) and nuts and seeds. Having these nutritionally dense foods to hand is the basis for a powerpacked snack; add abundant vegetables and fruit to the mix and you’re ready to take on the world. Don’t worry too much about recipes – simply use them as guidelines. Food is a pleasure for all the senses, so embrace creativity. Mix colours and textures. Experiment with flavours. Try herbs and spices you haven’t used before. Choose a grain, some vegetables and some seeds, nuts or pulses and throw them together whatever way you like. You will soon build up a favourite repertoire of tasty, healthy dishes.

Eat Right • Sit down to eat • Chew well • Focus on your food – enjoy it • Try not to read, text or work whilst eating. Relax!

Store-cupboard Basics • Seeds – Try pumpkin, sesame, sunflower and ground flax • Nuts – Pecan, cashew, walnuts and almonds for starters • Wholegrains – Quinoa, brown rice, rolled oats, cous cous, barley, millet • Pulses – Chickpeas, butterbeans, red kidney beans, cannellini – there are loads of different varieties • Spices – Try allspice, cayenne pepper, cumin, cinnamon, clove, fennel and mustard seeds, nutmeg, paprika, turmeric; keep experimenting • Sea Salt and Black Pepper – Don’t skimp on quality – try Maldon Sea Salt, or even better, natural grey sea salt, available in any health food store • Other condiments – For beautiful dressings, try extra-virgin olive oil, sesame, walnut or flaxseed oil, balsamic, Japanese rice vinegar, shoyu

RECIPE: Brown Rice with Haloumi, Roasted Walnut and Peach

This recipe is for one, but you can expand as needed. Measurements need not be precise – if you like Haloumi cheese, throw in more, same with walnuts and peaches.

Ingredients

50g organic short-grain brown rice 1 ripe peach, or apple 80g walnuts Handful of thyme 3-4 slices of Haloumi cheese 1 teaspoon Japanese rice vinegar or similar 1 tablespoon walnut oil or similar sea salt and black pepper pinch cinnamon or allspice

Method

• Cook the rice and leave to cool, meanwhile roast the walnuts on a baking tray at 200°C for 15 mins. For extra flavour, try sprinkling sea salt on the walnuts or shoyu before roasting. • Fry or grill the Haloumi cheese (this cheese is wonderful, you can do so many things with it!) with a bit of thyme, then cut into cubes.

• Cut the peach into cubes – I love them juicy and fresh, but you can also grill them for a variation. • Chop up the roasted walnuts. • Assemble the rest of the thyme with the brown rice, peach, haloumi and walnuts. • Add rice vinegar, walnut oil, salt and pepper, cinnamon and mix thoroughly.

Health Matters 87

Healthy Eating

What’s in Season?

Make sure the vegetables and fruit you include in your meal are in season, locallygrown and preferably organic. But equally, don’t stress if they’re not – eating any fruit and vegetables is great, just make sure you wash them well. For autumn try beetroot, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, kale, peppers, leeks, pak choi, parsnips, blackberries, apples or raspberries. If you shop at farmer’s markets, then you’ll be buying what’s in season. Add delicious, fresh herbs for divine flavour and an extra nutritive kick: for autumn try parsley, sage or thyme.

Brown Rice Brown Rice is a fantastic staple to add to your diet. It is rich with B vitamins, manganese, selenium, iron and fibre, and is a wonderfully calming and stabilising food. White rice has none of these benefits, so steer clear. If you have leftover brown rice, use it in the morning for an impromptu porridge to fire you up for the work day: add whatever you like. Try a sliced banana, a good pinch of cinnamon, some roasted seeds and organic whole milk or rice milk. Delicious!

Parsley Sprinkle this over everything. It’s got three times as much Vitamin C as oranges and twice as much iron as spinach. It contains potassium, calcium and folate, as well as being rich in Vitamin A. It’s also helpful for kidney and bladder inflammation, as well as having cancer-busting potential – it contains monoterpenes, which are thought to have cancerdelaying properties, especially with breast tumours. If that doesn’t convince you, eat it anyway, simply because it is delicious!

RECIPE: Italian-style Chickpeas with Roasted Kale and Mixed Seeds Ingredients

1 can of organic chickpeas (or dried – just soak them overnight) A good handful of flat-leaf parsley Juice of 1 lemon Extra-virgin olive oil A bunch of kale A handful each of sunflower, pumpkin and sesame seeds Sea salt and black pepper Shoyu

Method

• Place the seeds on a baking tray, sprinkle with shoyu and roast for 15 minutes at 200C. It’s a great idea to make extra, store them in a jar and sprinkle over salads (or anything you like!) for extra punch • On a separate baking tray, place the kale, throw some olive oil and salt and pepper on it, and roast until crispy. You can also steam it or boil it. If you boil it, don’t throw away the nutrient-packed juice, but use it as a base for soup • Rinse the chickpeas and put them in a bowl with the chopped parsley, lemon juice, plenty of salt and pepper and a good glug of olive oil • Once the kale and seeds are roasted, mix them together and season • Serve on the side with the marinated chickpeas, and if you like, a big hunk of crusty wholegrain or rye bread

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Health Matters 89

sporting passions

Sporting Passions Health Matters talks to Dr Andrew Flanagan, Executive Chemist, Galway University Hospitals, who battled jellyfish, ferries and the cold to swim the English Channel in only 12 hours, one minute and 55 seconds. The first question has to be why did you decide to set your sights on swimming the English Channel? Swimming the Channel was something I’d been thinking about for a while. In 2004, I swam it as part of a team with six other group members. This gave me the impetus to swim the Channel on my own. I also wanted to raise money for the Royal National Lifeboat Institution (RNLI). The RNLI gives a lot of security and safety cover for our sea swimming activities. What training or preparation did you undertake beforehand? I’ve been sea swimming since I was eleven years old and have done various sea swims in Ireland, Australia and the USA. I aimed to swim 3,000 metres (120 lengths in a 25m pool) a day. I also tried to maintain a healthy diet and I eliminated alcohol. Congratulations on completing the swim in such a good time, what kept you motivated during the 12 hours? I had great support from my wife Michelle Cuffe and my pilot Alison Streeter (‘Queen of the Channel’, who has swum it in a world record of 43 times) monitored my condition constantly. At a micro level, I just broke the swim down into half an hour blocks. I would drink an energy drink, take a break for 30 seconds and then put my head down and swim for another 30 minutes. At a macro level, I knew I had to keep going because I was raising money for charity. What were the sea conditions like when you made the crossing? The swim began at 3am from Shakespeare Beach in Dover, England. The sea temperature was about 17°C and was a little choppy. Luckily, the cold wasn’t a problem for me as I had trained in the Atlantic Ocean from April, when the sea

temperature was 8°C, with no wetsuit! I did get stung quite a bit by jellyfish at first but that’s just a fact of sea swimming. By the time the sun came up, the sea had calmed and I could clearly see the escort boat ‘Roco’, piloted by Alison with my support crew including Michelle and my friend Julieann Galloway. However, after 11 hours of swimming the sea conditions got tougher, the tide that had been helping me started to run directly against me. This combined with the intense burning pain in my shoulders made the last 2,000 metres to the finish point on Cap Griz Nez in France very tough going.

Was there a point a point when you thought you might not complete the crossing? While I was swimming part of me kept saying that I wouldn’t make it to the finish, that the pain in my shoulders was too much. There were other channel swim attempts going on at the same time, a Canadian female solo swimmer gave up after 5-and-a-half hours from the cold. But the memories of all the training I had done

and the generosity of sponsors and the sacrifices of those who had helped me get this far inspired me to keep going.

What went through your mind when you had completed the swim? The first feeling was relief that it was over! Once the pain and soreness subsided, I had a great sense of achievement, especially as I had completed the crossing in a very respectable time. Are you currently training for another sporting event or challenge? I am back training everyday now and while I would consider doing another endurance swim, I am not sure I would swim the English Channel again as I would rather do another endurance swim some place else. I am aiming to raise b5,000 for the Galway inshore RNLI Lifeboat and the website for my charity collection is www.mycharity.ie/event/andy_flanagan_ rnli_swim/

90 Health Matters

infection

Healthcare Associated Infection and Antimicrobial Resistance Dr Pat Doorley, National Director Health and Patient Information and Dr Kevin Kelleher, Assistant National Director, Health Protection, write about the causes and effects of Healthcare Associated Infections and the HSE’s approach to controlling them.

hen a person contracts an infection while receiving medical treatment in a hospital or other health care setting, it is known as a Health Care Associated Infection (HCAI). Commonly recognised examples of HCAI include Methicillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile. Some HCAIs are caused by organisms that have developed resistance to common antibiotics. This antimicrobial resistance (AMR) together with the problem of HCAI, challenges every health system in the world. HCAI and resistant organisms give rise to avoidable illness, death and cost. They are, therefore, a key patient safety issue. Furthermore, preventing the development of resistant organisms and prevention of HCAI are cost effective and save money and bed days. A major study carried out in hospitals in the UK and Ireland in 2006 showed that five per cent of patients surveyed had a HCAI. Risk factors included: • Intravenous drugs and feeding • Urinary catheters • Mechanical ventilation • Recent surgery • Antibiotic therapy

There are two fundamental ways of tackling the problem:

HSE ‘SAY NO TO INFECTION STRATEGY’ targets for 2007 – • Reduction of HCAI levels by 20 per cent over five years • Reduction of MRSA rates by 30 per cent over five years • Reduction of antibiotic consumption by 20 per cent over five years

• Preventing the spread of HCAI – hand hygiene is the single most effective measure here • Preventing the development of resistant organisms by promoting more appropriate use of antibiotics

Actions being taken to tackle HCAI and AMR The ‘SAY NO TO INFECTION’ Strategy identified a number of key actions which are being implemented: Public involvement and education: public information campaigns have been conducted on hand hygiene and antibiotic usage and we are working with a patient representative group in order to ensure that we take their views into account. Healthcare worker education and training: educational materials including training DVDs and an e-learning programme have been developed for healthcare workers and health service managers; infection control training is now mandatory for all new employees. Implementation of standards and guidelines, including audit: SARI (Strategy in Antimicrobial Resistance in Ireland) guidelines have been developed in many areas and are being implemented and monitored. These guidelines include prevention and management of intravenous catheter infection and antibiotic stewardship in hospitals. Audits of the MRSA guidelines and Hand hygiene protocols will be undertaken and the results will be published. HIQA Infection Prevention and Control Standards have been published and are being implemented in key areas of infection control. Following the last HIQA audit, Quality Improvement Plans were established with better performing hospitals supporting those which needed more improvement. Self assessment against the standards is

1 2 3

ongoing throughout 2010 in facilities across the system. HIQA will periodically conduct external assessments, based on the finding of the self assessment. Enhancing surveillance of HCAI: existing surveillance programmes have been strengthened and new programmes are being implemented including C. difficile surveillance. Irish long term care facilities will participate in a European prevalence study of HCAI in long term care (HALT study) in 2010. A European prevalence study of HCAI in acute hospitals is planned for 2011. Improving prescribing of antibiotics: SARI guidelines on antibiotic stewardship in hospitals have been developed and are being implemented. A GP education programme is being led on behalf of the HSE by a Professor of General Practice. Developing human and physical resources: SARI guidelines on infection control-related building requirements for acute hospitals have been published. Strengthening leadership, governance and management of HCAI: The national HSE HCAI Governance Group provides leadership across the HSE. Roles and responsibilities have been clarified and managers across the system now have more explicit responsibilities for prevention and control of HCAI.

5 6 7

Progress against Targets MRSA bloodstream rates have dropped by about 40 per cent since 2007. Antibiotic consumption rates which had been increasing annually in both hospitals and general practice have now decreased by five per cent. The major prevalence study planned to take place in the next year will indicate progress on the prevalence of all HCAIs. Other indicators such as the consumption of hand gel (up by 250 per cent) and the number of infections from Clostridium (down about 50 per cent

Health Matters 91

infection

Main areas of work for HCAI Group in 2010 • Ensuring care bundles are in place - a ‘care bundle’ is a collection of evidence based interventions that should be applied to the management of a particular condition for example management of peripheral vascular catheter. The bundle aims to tie together into a cohesive unit all the procedures that must be adhered to for every patient, every time. All the tasks are necessary and must all occur in a specified period and place. • Implementing HIQA standards • Finalising the e-learning programme and making it available to all healthcare staff. • Undertaking national hand hygiene audits and publishing the results. Further developing Antimicrobial Stewardship programmes in all hospitals and in the community. GP education programmes are being undertaken through the Continuing Medical Education tutor system and include audits of GP antibiotic prescribing, with feedback to improve quality of prescribing over 18 months) have shown significant improvement. However, the numbers of certain HCAIs such as Entercoccus Faecalis have increased. Since the launch of the HSE “SAY NO TO INFECTION” Strategy in March 2007, measurable progress has been made in reducing HCAI, making our hospitals and other healthcare facilities safer for patients. However, we must not become complacent as much remains to be done. Key drivers for this improvement in the organisation have been: • The explicit responsibility assumed by managers • The increased contribution of clinicians from a much wider variety of specialties • A significant change in the culture of the organisation HCAI will remain a major challenge for the foreseeable future, so we must ensure that these organisational drivers are intensified and continue to implement the specific measures aimed at preventing and controlling HCAI.

HIQA Infection Prevention Control Standards Below are the twelve HIQA Infection Prevention Control Standards. The standards apply to all health, social care facilities in Ireland: Governance and Management Infection Prevention and Control is effectively and efficiently governed and managed Infection Prevention & Control Structures, Systems & Processes Structures are in place to effectively implement the Infection Prevention & Control service Environment and Facilities Management The physical environment, facilities and resources are managed to minimise the risk of infection to service users, staff and visitors Human Resource Management All staff, including Infection Prevention and Control staff, are selected, recruited, trained, educated and managed in order to prevent and control the spread of infection Information and Communication Management Infection Prevention and Control data and information collected, sorted, processed, monitored, responded to and reported in a timely, efficient and accurate manner

1 2 3 4 5

Hand Hygiene Hand Hygiene practices that prevent, control and reduce the risk of the spread of Healthcare Associated Infections are in place Communicable / Transmissible The spread of communicable/ transmissible diseases are prevented, managed and controlled Device related Infections Device related infections are reduced and prevented Microbiological Services Microbiological services are available in a timely and effective manner to support Infection Prevention and Control services Outbreak Management Infection Outbreaks are detected, managed and controlled in a timely, efficient and effective manner in order to reduce and control the spread of infection Surveillance Programme Healthcare Associated Infections and antimicrobial resistance are monitored, audited, and reported through a systematic surveillance programme Antimicrobial Resistance There are systems in place to reduce and control Antimicrobial Resistance

7 8 9

10 11 12

92 Health Matters

updates

film competition LAUNCHED The HSE marked World Elder Abuse Awareness Day in June with the launch of its Open Your Eyes campaign, which aimed to highlight the issue of elder abuse among the general public. As part of the campaign, the HSE has launched a short film competition on elder abuse in August entitled ‘Open Your Eyes – Open Your Lens.’ In 2009, there were 1,870 referrals of elder abuse to the HSE Elder Abuse Services. There are indications, however, that there is significant under-reporting of elder abuse. International studies suggest that abuse can be experienced by up to five per cent of the over 65 population – in terms of Ireland, this would translate to up to 23,000 older people suffering abuse. There may be a number of reasons for under-reporting abuse. One of these may be a lack of awareness of what abuse is and how it can be reported. To combat

this, the HSE is undertaking a significant public awareness campaign including radio advertisements, information leaflets, wallet-friendly cards and an elder abuse public awareness DVD. One of the key projects to raise awareness of Elder Abuse is the Open Your Eyes to Elder Abuse short film competition. + Phyllis Talbot of Active Living from Ballyfermot and George Hook, There are two broadcaster and member of competition judging panel competition categories; one category is open to full time students Details of the competition rules are and the other to the general public. Each available on the HSE website category has a 1st prize of b1,000; 2nd prize www.hse.ie. The closing date for entries is October 29th 2010. of b500 and 3rd prize of b250.

three-year Health Planning Every three years, the HSE prepares a Corporate Plan, which sets out our strategic priorities for the following three years. This plan is of central importance to everyone involved in providing health and personal social services. This year, we will be preparing the third Corporate Plan covering the years 2011 to 2013. The completion of the plan involves a review of where we are as an organisation and where we want to be within a given timeframe. It identifies specific areas of focus to achieve those objectives and outlines how we will measure that achievement. In short, our Plan will outline our strategy and the changes that we will need to make during our ongoing journey towards a modern and sustainable health service. In preparation for the development of the Plan, we embarked on a comprehensive consultation process with a wide group of stakeholders to ensure substantial input from those involved in the provision of services. This consultation process commenced in April, with a workshop in the Royal College of Physicians of Ireland, hosted in conjunction with the Forum of Irish Postgraduate Medical Training Bodies. This workshop targeted clinicians and senior managers, whereas another workshop that followed in May, in Farmleigh House, Dublin, targeted regional and corporate services. Feedback from both workshops was extremely positive with one delegate saying “thank you for the opportunity to contribute” while another stated that there is an “absolute need to understand where we are going and what the blockages are”. The general feedback highlighted the importance of giving people the opportunity for their voices to be heard and influence change, both of which are important

+ Pictured at the Health Planning workshop held in Farmleigh House, Phoenix Park Dublin were (left to right): Dr Joe Devlin, Director of Quality, Safety and Risk, Jane Carolan, National Director, Corporate Planning and Corporate Performance and Dr Leo Kearns, Chief Executive Officer, Royal College of Physicians of Ireland factors in energising and empowering people to strive for the achievement of our shared goals. The consultation process continued over the summer, with valuable meetings taking place with national leads and corporate support. Work will continue in the coming months, as we endeavour to meet with as many different groups as possible by the end of the year, including external bodies. Every staff member has a unique experience and perspective, and if you would like to input directly into the preparation of the next Corporate Plan you can email cpcp@hse.ie. All submissions are very welcome.

Health Matters 93

research

Research gives new insight into the Cystic Fibrosis gender gap By Prof Gerry McElvaney, RCSI and Beaumont Hospital.

ith the highest incidence of Cystic Fibrosis (CF) in the world, Ireland is at the forefront in research into this lifethreatening and life-shortening inherited disease. The incidence of CF in Ireland is 1:1461 births, with one out of every 19 Irish people carrying a CF gene. This is much higher than other European or North American populations. Now research undertaken at Beaumont Hospital has shed new light on one important aspect of the condition which will hopefully lead to improved therapies for female CF patients. It has long been known that female sufferers have poorer survival rates, poorer lung function and are more susceptible to lung infections than their male counterparts. Normally, a protective layer of fluid defends the lungs from infections. However, in people with CF (PWCF) this layer is unusually thin and it becomes even thinner in females at those times in their menstrual cycles when their levels of oestrogen are high. This makes them even more prone to pick up infections

than they are already. What we have now discovered, however, is that not alone do increased levels of oestrogen increase susceptibility to infection in PWCF, it also interferes with their defence mechanisms against infection – a genuine “double hit”. This is because oestrogen inhibits the release of the chemical signal IL-8, which in turn is needed to trigger an influx of white blood cells into the lungs to fight infection when cells are attacked by bacteria. This reduced response to infection, combined with a greater likelihood of acquiring an infection in the first place, which are both caused by high oestrogen levels, goes a long way towards explaining why females with cystic fibrosis have more aggressive disease, particularly with the onset of puberty. Our hope is that these important findings will contribute to narrowing the gender gap in cystic fibrosis outcomes by identifying new potential targets for treatment. These could include stabilisation of oestrogen levels or

more aggressive use of infection prevention strategies at the times when oestrogen levels are at their highest. The joint first authors of the paper on this research, recently published in the American Journal of Respiratory and Critical Care Medicine, are Dr Sanjay Chotirmall, Specialist Registrar in Respiratory Medicine in the Respiratory Research Division of the Royal College of Surgeons in Ireland at Beaumont Hospital, and Dr Catherine Greene. The research has additionally been recognised by the Faculty of 1000 Biology, an online research service that highlights the most interesting papers published in the biological sciences as recommended by distinguished faculty. Other members of the research team include: Irene Oglesby, Dr Warren Thomas, Prof Shane O’Neill, Prof Brian Harvey and myself, Gerry McElvaney. The research was supported by the Higher Education Authority PRTLI Cycle 4 through a Molecular Medicine Ireland Clinician-Scientist Fellowship Programme and by philanthropic donations from the Irish CF Research Trust.

MoneyCounts.ie Wins INNOVATION Award The fifth Saint John of God Innovation Awards took place in June 2010. These awards celebrate the creativity and energy that staff brings to their work and the difference they make to service users’ lives. According to Anna Plunkett, Director of Programme Development at St John of God Community Services, the initiative has added benefits in terms of allowing staff across the organisation to learn from and share information from each other. This year some 27 entries were received in the following three categories: communication supporting/developing partnerships; and staff and service users education and development. The overall winner for 2010 was MoneyCounts.ie, a free to access web package developed by St John of God Carmona Services in partnership with MABS (Money Advice and Budgeting Service). While it was designed to help people with intellectual disabilities manage their finances, it can be used by anyone who needs a simple guide to budgeting and money.

Audrey Carroll and Mary Walsh of Saint John of God Carmona Services with Brother Stanislaus Neild, OH.

94 Health Matters

STROKE

Ten Risk Factors Associated with Stroke The INTERSTROKE study, co-conducted by Prof Martin O’Donnell, Galway University Hospitals, and recently published in ‘The Lancet’, identified a total of 10 risk factors (including high blood pressure, smoking, and waistto-hip ratio) associated with 90 per cent of the risk of stroke.

he background to the study was that the contribution of various risk factors to the burden of stroke worldwide was unknown, particularly in countries of low and middle income explains Prof Martin O’Donnell, Department of Medicine at Galway University Hospitals. We aimed to establish the association of known and emerging risk factors with stroke and its primary subtypes, assess the contribution of these risk factors to the burden of stroke, and explore the differences between risk factors for stroke and heart attack. Professor O’Donnell, along with international colleagues, undertook a standardised case-control study between March 2007 and April 2010 to establish the association of traditional and emerging risk factors with stroke in countries of high, middle, and low income. Participants were recruited from 84 centres in 22 countries, such as Argentina, Australia, Brazil, Chile, Ecuador, India, Peru, Sudan and Uganda. The findings from the INTERSTROKE Study, which is the first ever large standardised case-control study in this area, suggested that ten risk factors are associated with 90 per cent of the risk of stroke included: history of hypertension (high blood pressure), smoking, waist-tohip ratio (abdominal obesity), diet, lack of physical activity, lipids (fats), diabetes mellitus, excessive alcohol consumption, psychosocial stress and depression and

heart disorders. The study also suggests that targeted interventions that reduce blood pressure and smoking, and promote physical activity and a healthy diet, could substantially reduce the burden of stroke. Professor O’Donnell says: “Stroke is the second leading cause of death worldwide, and the leading cause of acquired disability in adults in most regions. Countries of low and middle income have the largest incidence of stroke, accounting for more than 85 per cent of stroke mortality worldwide, but few reliable data are currently available to identify risk factors for stroke in most of these regions.” Welcoming publication of the study in the Lancet medical journal, Professor Eamon Mulkerrin, Consultant Physician/ Geriatrician, University Hospital Galway, said: “This study, the largest of its kind to date, provides clear evidence of the ten most important risk factors which together account for 90 per cent of all strokes worldwide. The top five risk factors involve

simple lifestyle factors, such as obesity and smoking as well as diet and, most importantly, high blood pressure. The study will act as a guide to all doctors involved in stroke prevention and Martin and his colleagues are to be hugely commended. It is very exciting to have one of our colleagues in Galway produce research which has such relevance to healthcare on a worldwide basis.” The investigators are currently undertaking Phase 2 of INTERSTROKE, which will include Ireland and aims to including 20,000 participants. This second phase will determine the importance of risk factors within different regions, different ethnic groups and within stroke subtypes. In addition, the association between genetics and risk of stroke will be studied.

Health Matters 95

process

Developing a new Investigation Process for the HSE The Investigation Process Working Group was commissioned by the HSE Senior Management Team in 2009 to standardise, simplify and strengthen investigation processes within the HSE. Cora McCaughan, Head of the Serious Incident Management Team, gives an update on the nine consultation and engagement workshops held in May and June.

national working group was set up in 2009 to develop a high-quality investigation process for the Health Service Executive. Currently, there are a range of policies and procedures within the HSE which involve a need to carry out investigations. The Investigation Process Working Group was commissioned by the HSE Senior Management Team in 2009 to standardise, simplify and strengthen investigation processes within the HSE. It is also working to identify if a single, standardised method of investigation could be useful to the HSE, and to propose an investigation model and implementation plan if so. A series of nine consultation and engagement workshops with staff and with service users took place across the HSE in May and June in Galway, Kilkenny, Cork, Limerick, Tullamore, Ardee and Dublin. Attendance was excellent, with participants invited from service users and a range of staff groups: Investigators, Risk advisors/managers, Health and Safety Officers, HR managers, Hospital managers, LHO managers, Doctors, Nurses, Health and Social Care Professionals, Support staff, Union Representatives. Eight of these workshops included HSE employees and service users, and one of the workshops was for service users alone. Over 320 staff and service users attended the workshops where they made a highly positive contribution to the HSE investigation process work. Workshop questionnaires and evaluations indicated that participants had a lot of views and experiences to offer to inform

“The Investigation Process Working Group was commissioned by the HSE Senior Management Team in 2009 to standardise, simplify and strengthen investigation processes within the HSE.” the investigation process work, and that participants found the workshops to be helpful in ensuring that their views and experience inform this important work. The workshops were arranged by the Investigation Process Working Group which is chaired by myself, Cora McGaughan from the Quality and Clinical Care Directorate. The workshop group is sponsored by Dr Joe Devlin, QCCD and it includes two service user representatives, Rebecca O’Malley; and Cathriona Molloy from Patient Focus. Professor Brian Toft, Professor of Patient Safety at Coventry University is the external independent expert advisor to the group. The working group has linked with HSE Staff who: have a lead role in numerous HSE polices with an element of investigation

associated with them including: • The HSE incident and serious incident management policy and procedures including the Incident Management Toolkit. • Your Service Your Say Policy and Procedures. • Good Faith Reporting Policy. • Health and Safety Investigations. • Children First Investigations and the HIQA Guidelines for the investigations of incidents of death and serious harm to children in our care. The working group has also commenced consultation and engagement with staff and service users and a range of other external stakeholders including the Department of Health and Children; HIQA; the Health and Safety Authority and the Forum of Health and Social Care Regulators. The next step is for the working group to analyse the high quality feedback made by staff and service users at the consultation and engagement workshops and then to meet again with the leaders of the numerous HSE processes with investigative components followed by consultation and engagement with the Unions. Following this, the working group hopes to finalise a draft HSE investigation process document and pilot this in the autumn when the learning from this pilot project will inform the final report of the working group to the HSE Management Team.

96 Health Matters

young people

The Irish Association of Young People in Care (IAYPIC) For young people in care, the most common issues for referral are not being listened to; not being involved in decisions about their care; placement breakdown; or uncertainty about a placement move, aftercare and family contact. The Irish Association of Young People in Care (IAYPIC) works with and for children and young people who are currently living in care or who have had an experience of living in care writes Jennifer Gargan, Director of IAYPIC.

he Irish Association of Young People in Care (IAYPIC) was set up in 1999 by a group of interested professionals and young people to promote young people’s participation and raise awareness of the issues affecting young people in care. The organisation advocates to affect positive change in the lives of young people who experience being in care working at both national and local levels. In order to achieve this, IAYPIC works directly with young people and also with professionals, practitioners and foster carers. Initially supported by Barnardos, IAYPIC became an independent organisation with its own governance and management structure in 2004 and moved to its current premises in Smithfield. IAYPIC’s independence is central to its ability to advocate on behalf of young people with care experience. Since 2004 the work of the organisation has developed considerably. We now have two Children’s Rights and Participation Officers, funded by the HSE Dublin North East. In 2007, with the support of the Vodafone Ireland Foundation, an Aftercare Support Network was set up. The Aftercare Advocacy and Support project is now funded by the HSE. These two programmes offer independent advocacy, advice and information to young people currently in care, and those who have left care. In 2008, we were fortunate to be granted funding from the Atlantic Philanthropies. This funding has enabled IAYPIC to carry out a strategic planning

“Since 2004 the work of the organisation has developed considerably. We now have two Children’s Rights and Participation Officers, funded by the HSE Dublin North East.”

process and to employ a Research Officer and an Advocacy and Policy Officer.

Independent advocacy and support for young people in care Referrals to our Advocacy and Support services come directly from young people themselves, from social workers, residential care workers, aftercare workers, foster parents, family members and other agencies. For young people currently in care the most common issues for referral are: not being listened to not being involved in decisions about their care, placement breakdown or uncertainty about a placement move, aftercare and what type of contact they may have with their family.

IAYPIC have set up a Forum for Young People in Care in partnership with the HSE in Dublin North, to work to give young people in foster care a voice through identifying and discussing issues of importance to them. A key element of the Forum, is that the HSE will be using the forum’s feedback, where possible, to influence training, practice and policy in the future. For those who are leaving or have already left care the issues are somewhat different. They include concerns about moving on from care, accommodation, not having aftercare support as well as looking for advice and information about legal and welfare rights. The Aftercare project also provides a Traineeship programme for young people over 18 who have had care experience. The aims of the programme are to: • Provide the trainees with a supported employment experience • Give them an opportunity to share their experiences with policy makers, service providers, carers and other service users • Help them gain skills, confidence and experience • Provide them with training and qualifications to enable them to access further education or employment

Research programmes Issues raised by young people themselves through our direct advocacy work inform all research initiatives.

Health Matters 97

young people Current projects include: Care planning This is a piece of primary research on young people’s experience of the care review process. The purpose of this research is to get a better insight into young people’s experiences of the preparation and follow up work done with them in relation to care reviews, as well as their experiences of attending care review meetings. The study aims to interview twenty young people, aged 15 to 17 years of age from both residential and foster care. This research will identify potential ways for practitioners to promote young people’s meaningful participation in the care review process. This project will be carried out using participatory research methods, which is an innovative approach and will involve young adults with care experience (aged 18+) taking part in conducting some aspects of the research.

“This research is being undertaken in partnership with the HSE in north Dublin. It involves tracking outcomes for approximately 65 young people aged 17-18 years who are leaving care.”

Aftercare This research is being undertaken in partnership with the HSE in north Dublin. It involves tracking outcomes for approximately 65 young people aged 17-18 years who are leaving care. Issues covered in the research questions include accommodation, education/training, employment, financial support, social support, general health and welfare and will also include interviews with young people to obtain their views on the supports received when leaving care.

On completion of these and other research projects we will be publishing reports of our findings which will be available on our website.

Advocacy and Policy programme The Advocacy and Policy programme initiatives are also informed by the issues identified by young people themselves. The aim of this broader advocacy work is to lobby for change and to impact on policy and practice at local, regional and national level. We have prioritised a number of areas to focus on in 2010 including Aftercare, the Children’s Rights Referendum, Implementation of the Ryan Report recommendations and foster care. Challenges IAYPIC, along with many other organisations in the community and voluntary sector, is facing many challenges at the moment. As a result of the Ryan and Murphy Reports awareness of the needs and rights of young people in care to have a voice has resulted in increased demand for our Advocacy services in all HSE regions.

We are currently only funded to provide services to young people in the HSE Dublin North East. However, we have worked with young people all over the country. One of our key strategic goals is to develop our individual Advocacy services on a national basis so that all young people can have access to independent support, advice and information. Given the current economic constraints, maintaining services at current levels will be difficult and securing resources to develop our Advocacy services nationally will be challenging. Another continuing challenge for IAYPIC is gaining access to young people in foster care and ensuring that they are made aware of IAYPIC. We continually strive to find ways of engaging with these young people by working in partnership with the HSE, social workers, foster parents and other professionals and organisations who are involved in the care of these young people. If you would like to find out more about IAYPIC, please contact us on: Tel: 01 8727 661. Email: info@iaypic.ie Website: www.iaypic.ie

L-R: Dr Marion Witton, Chief Inspector, Social Services, Health Information and Quality Authority with Jennifer Gargan, Director of IAYPIC at the recent launch of the ‘Children’s and Young People’s Experiences of Health Information and Quality Authority Inspections’

98 Health Matters

updates

Essential Guide to Neurological Care Published ‘The Future for Neurological Conditions in Ireland’ produced by the Neurological Alliance of Ireland (NAI) brings together a wide range of stakeholders to provide an essential guide to neurological care in this country. In her foreword to the report, the Minister for Health and Children, Mary Harney TD recognises the importance of neurological care, identified by the World Health Organization as the greatest challenge facing health systems in developed countries worldwide. Over 700,000 people in this country are living with neurological conditions such as migraine, stroke, dementia, epilepsy, acquired brain injury, multiple sclerosis and Parkinson’s disease. This figure is set to increase to 860,000 within ten years. The aim of the NAI report ‘The Future for Neurological Conditions in Ireland: A Challenge for Healthcare; an Opportunity for Change’ is to contribute to a greater understanding of the challenges facing neurological care in Ireland and to call for a strategic focus on implementing solutions to these challenges. The report highlights the significant demands on neurospecialist services. It recognises that there is a critical need to address the current situation. The report notes that Ireland has a unique opportunity to develop a health service that can respond

to the needs of people with neurological conditions. It says that a number of key factors have the potential to significantly improve the quality of life of these individuals and their families, factors such as the expertise and commitment of a range of service providers, the benefits of increasing research to inform best practice in neurological care, and a legislative framework which identifies and promotes the needs of those with disabling + Pictured at the launch with Minister for Health and Children, Mary Harney conditions. The report calls for TD, are Dr Colin Doherty, Consultant Neurologist, St James’s Hospital, Dublin and newly appointed Clinical Director of the National Epilepsy Programme, the prioritisation of a national and Anne Winslow, Chair of the Neurological Alliance of Ireland programme for neurological care in order to provide the strategic direction, leadership, that the purpose of the programmes was to and ongoing investment required implement solutions known to improve quality, to deliver the standard of care people with access and cost. These programmes are neurological conditions need and deserve. currently in planning phase with implementation Speaking at the launch, Dr Colin Doherty, due in 2011. Dr Doherty stated that the headline Consultant Neurologist at St James’s Hospital, goals are: to save a life a day every day in stroke; Dublin and Clinical Director of the National to render an extra 8,000 patients seizure-free Epilepsy Programme with the HSE Quality nationally in epilepsy; and to effectively end and Clinical Care (QCC) Directorate, outlined neurology outpatient waiting lists. recent progress on neurological services. Three The report is available for download free from programmes have been developed by QCC on the NAI website www.nai.ie. epilepsy, stroke and neurology. He commented

+ Pictured at the Excellence in Public Relations Awards 2010, at which the HSE won Best Public Sector category for the media relations campaign to publicise the HSE National Counselling Service following the publication of the Murphy Report were: Paul Connors, National Director Communications Mary Gleeson, National Press Office Kirsten Connolly, Head of Press and Media Rachel Mooney, Director Counselling Service

Health Matters 99

health research

Tackling decline in motor skills in young children over the school year Physiotherapist, Dr Amanda Connell, has shown that children’s motor skills deteriorate over the school year, but that early intervention with short periods of targeted, physical exercise can help reverse the decline. She describes her road to discovery, which included validating a short questionnaire that will actually help identify development problems in children earlier. Her work was funded by the Health Research Board.

monitored more than 200 first and second class pupils at the start and at the end of the school year. I found that about one-in-nine children had significant motor skills problems at the start of the year, but that this number increased over the year. To find out if physical intervention would help, I divided the children into two groups. One group received no intervention, and a second group took part in eight, 20-minute movement classes mid-year. I was able to prove that the small amount of targeted physical activity does make a significant difference in reducing the number of children with motor skill difficulties in a classroom. Among the children who had no special intervention, there was a further decline in motor skills with more than onein-four indicating a potential problem by the end of the year- the equivalent of almost eight children in a class of 30. Meanwhile those who received the movement classes fared much better, and only one-in-seven experienced a decrease in motor skills, equal to approximately 4.5 children in a class of 30.

Because poor motor skill ability is linked to low educational attainment and problems with behaviour and social skills, this can increase distress and anxiety among children. So in terms of tackling childhood development issues this is an important discovery that needs to be applied in practice. Children with, or at risk of developing behavioural, social and motor skills problems, face a long wait for assessment. The assessments are expensive and children loose valuable time waiting when they could be receiving support. Early identification and intervention can also significantly improve the child’s prognosis and reduce the need for extended late intervention and the associated costs. This means it is essential that we have reliable tests in order to accurately identify children at risk quickly. To help with early identification of children at risk from development problems, I validated of a simple, reliable questionnaire, which takes about five minutes to answer and is completed by both a parent and a teacher. They simply review a set of

statements on different aspects of the child’s daily life. For example; is the child helpful if someone is hurt, upset or feeling ill? Or are they easily distracted, does their concentration wander? Wherever we ran the questionnaires, we got an 80 per cent response rate, which is phenomenal. For comparison, a 40 per cent response rate would be typical for most similar surveys. This not only increases the reliability of the findings, but shows the test is easy to use. As well as helping specialists accurately identify the children who need further assessment and intervention, what became clear to me throughout the project was the potential for parents, schools and health professionals to work together to improve children’s education and health. It could also help reduce the number of children needing specialist intervention at a late stage for development problems as well as save time and money. Dr Amanda Connell is a Health Research Board Fellow in the Department of Physiotherapy at the University of Limerick.

Health Research Board The HRB funds research that will strengthen evidencebased health care. We support research in health and social care through a range of awards and activities. • Fellowships • Research infrastructure • Research design and support services • Projects and programmes

• Clinical trials networks • Access to the Cochrane Library • Training events for health researchers and managers

To make sure you know when funding becomes available: Sign up for alerts about new award schemes at http://www.hrb.ie/about/rss-e-mail-alerts www.hrb.ie Better Research • Better Evidence • Better Services • Better Care

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Health Matters 101

waste efficiency

Water is Wonderful… W

hat is the one thing that all healthcare patients and employees use on a daily basis? The answer is water. Healthcare facilities are dependent upon clean water to maintain hygiene, provide clinical care and a comfortable environment for patients. At this time of year, it is easy to forget the water shortages experienced in parts of Clare, Cork, Dublin, Donegal, Galway, Leitrim, Sligo, Tipperary and Wexford during last winter’s freezing temperatures. At that time, we were all wondering how these locations had water shortages at the end of one of the wettest winters in decades! The answer is leaks, and water wastage. Many Local Authority water treatment systems operate at full capacity, so even if the raw water storage reservoirs are full their capacity to produce clean drinking water is limited. More predictable are the annual water shortages during the summer months. This summer, most western counties – Donegal, Sligo, Galway, Clare – experienced water shortages because Local Authority water supplies were not able to meet summer demand. A recent Forfas Report on water treatment capacity, predicted that the following locations would have routine water shortages from 2013 onwards; Athlone, Dublin, Galway, Letterkenny, Limerick, Tralee, Waterford, and Cavan. Healthcare facilities are one of the largest consumers of water in the community. Figures from the UK indicate that on average each acute hospital patient uses 490 litres of water per day, while each healthcare employee uses about 90 litres of water per day. Water consumption in long-stay healthcare facilities is half that of acute hospitals which provide more water intensive services. Local Authorities recently introduced volume-based water and wastewater charges, which provide a clear incentive for healthcare facilities to reduce wastage.

But combined water/wastewater charges vary greatly, with the highest charges of b2.71 per metre cubed in Wexford and cheapest charge in Galway city at b1.10 per metre cubed. (1000 litres = 1 m3).

What can healthcare facilities do to reduce water costs? Metering is the best way to verify how much water is supplied, and where or when that water is used. Where is the water meter? Are water readings taken to verify Local Authority water invoices? Is the water meter checked on a quarterly basis by the Local Authority? Water leak detection studies indicate that the majority of the water leaks (58 per cent) occur on consumer pipe work from the meter onwards. So leak detection is vital, as even pinhole leaks will waste lots of water if undetected. The easiest way to figure out if a building has a leak is to turn off the water and check if the meter is still running. Turning off water is not always possible in a healthcare facility, but there are leak detection companies available that can identify underground leaks using specialist equipment and advise on water conservation in general. It is worthwhile to sub-meter departments where water consumption is likely to be high, for instance a Boiler house, Canteen, Sterilie Services, Laundry, Dialysis, etc. But in all departments, worthwhile water savings can be made without compromising patient care using low cost modifications to toilets, urinals, baths and showers. A leaky toilet can waste more than 2,500 litres of water per day which can cost b2,500 per annum, well worth repair or replacement. Urinals can be programmed with auto flush valves, and low flow showers (eight litres/minute) installed where patient needs allow, use less than half the water of baths. In Catering facilities approximately

20 litres of water is used for each meal served, so it is important to operate all dishwashers, pot washers with full loads using eco wash cycles. It is possible to fit spray heads or flow regulators to taps without compromising hygiene, for example, using WRAS approved www.wras.co.uk water conservation fittings. A leaky tap can waste over 1,500 litres of water per day which cost over b1,500 per annum. It is important to encourage employees to report water drips and leaks to maintenance. Any healthcare facility can implement low cost water conservation techniques. Each Local Authority Sanitary Services Engineer should be able to advise on leak detection and water conservation that can be implemented in a healthcare facility. Local Authorities need to implement water conservation as much as the health service does. For further information, please email: helen.maher2@hse.ie or phone 021 492 7210.

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waste efficiency

Reducing Food Waste Dermot Cunningham, Eileen O’Leary, and Mairead Creedon, Clean Technology Centre, Cork Institute of Technology talk about the Food Waste Regulations and the Reduction of Food Waste in the Healthcare Sector.

he Environmental Protection Agency (EPA) is funding a Green Healthcare Initiative. One part of this initiative is to examine and reduce food waste production. The Clean Technology Centre (CTC), at Cork Institute of Technology (CIT), has been contracted to carry out this food waste survey. CTC is engaging with some 15 healthcare facilities, in this regard. Initial results have identified the significance of food waste, and many opportunities to reduce it. This can result in substantial savings for the sector. Not only does reducing food waste save money, but it also helps Ireland in meeting its international commitments. New food waste Regulations have been introduced in Ireland to help meet these commitments, and the reduction of food waste is an essential element in the overall process.

Food Waste Regulations In order to implement the EU landfill Directive, Irish Regulations are in place to assist the diversion of commercially generated food waste from landfill. On a phased basis, specified premises will not be allowed to dispose of food waste to landfill, instead: • All food waste arising on the premises will need to be segregated and kept separate from other waste and contaminants’ • Such segregated food waste will have to be treated in an authorised treatment process either: – on-site or, – collected by an authorised collector, – brought by the producer to an authorised facility. Where a local authority has already implemented separate food waste collection there is no change; for all other areas, the requirements are being implemented on a phased basis: • For specified premises since 1st July 2010, except, for specified premises where food waste produced is less than

50kg per week, since 1st July 2011 but only if a written declaration to this effect was sent to the local authority before 1st July 2010. Where a separate food waste collection service is available to producers of food waste, such producers must: (a) not put food waste in the residual waste collection (b)not use macerators to send food waste to sewer

• The cost of transporting food. • The cost of storing the food. • The cost of preparing and cooking the food (staff costs, energy costs). • The cost of disposing food waste. It is a conservative estimate that each kg of food waste costs b2. So, disposal of one tonne of food waste equates to losing b2,000. Reduction or prevention is the best option in reducing food waste. It’s simple – if you do not produce the waste you will not have to dispose of it!

“Reduction or prevention is the best option in reducing food waste. It’s simple – if you do not produce the waste you will not have to dispose of it!”

Sources of catering food waste In catering facilities in general, proper food stock management (ordering minimum stock, rotating stock) is an important area for minimising catering food waste. However, in the specific case of the provision of meals to patients in the healthcare sector, the most significant aspect for food waste reduction is portion control. This is not just in relation to the amount of food served per plate, but for facilities where meals are plated at the ward level, the quantities of food sent up from catering. The following are the key sources of food waste in the hospital sector: • Food prepared but not served • Portion sizes being too large for the patients concerned. This is particularly true for sick or elderly patients • Menu design, for example, the automatic provision of bread with every breakfast or every tea • Patient not needing/receiving their meal, through either attending procedures, fasting, or having been discharged

Specified premises include hospitals, nursing homes, etc., where food is prepared on the premises. More detail on the exact provisions of the Regulations can be found in the frequently-asked-questions document prepared by the Department of the Environment, Heritage and Local Government (www.foodwaste.ie)

Food Waste Costs Food waste is a waste of valuable resources. When disposing of food waste everyone generally only thinks of the cost of disposal itself. There are a number of other costs that should be included when estimating the cost of disposing of food waste: • The initial purchase cost of raw ingredients.

One of the most important issues in waste prevention is the training and motivation of staff. All staff must be made aware of the procedures and steps that should to be taken: • Top management must be committed to making resources (staff hours, equipment, advertising etc.) available • Chefs must be responsible for the

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implementation and management of any improvement options in the kitchen and associated areas • Where possible, a green team of staff members from all sections of the company (chefs, prep staff, purchasing, waste management, etc.) should be set up. • Staff should be encouraged to provide suggestions on possible improvement options • Staff should be made aware of improvements and savings made. By seeing the actual improvements made staff are motivated and encouraged to make further savings Food waste arises from many areas along the chain from food purchase to final disposal of the waste; these areas include: • Purchasing • Storage • Preparation • Cooking • Menus • Serving • Post-cooking storage • Re-use • Treatment

Reducing food waste Within the healthcare sector, several main factors for food waste reduction have been identified and these are: • Portion control • Better communications between wards and kitchen • Reduction in the quantities and methods of delivering bread portions to patients • Careful planning of the purchase and presentation of ‘condiments’ such as salt, sugar, butter, jam, etcetera, to patients Savings from food waste prevention It is estimated from surveys that as much as b150-b200 per bed per year can be saved by reduction of food waste. This equates to between b15,000 and b150,000 for small and large hospitals.

Case studies With the advent of the Food Waste Regulations, for the first time for many areas, the actual quantities of food waste arising can be seen. Prior to this, for most areas of the country, food waste was somewhat invisible, being either disposed of with household waste to landfill or macerated and sent to drain. West One community hospital in the West of Ireland reduced their food waste from over seven bins (140 litres) per week to two-and-a-half bins per week. This reduction was achieved by the catering department through; reduced quantities of food sent to the ward kitchen, portion control, and closer liaison with wards, for example, a five-day requisition sheet is used to track ward kitchen ordering of bread and similar items. Dublin Similarly, a Dublin acute hospital reduced its food waste arising in its main building from eight bins per week (240 litres) to one bin per week. The main changes implemented by the catering staff involved reduced quantities of food being sent to the wards for plating up, reduced portion sizes, daily checks with wards by catering staff regarding patients discharged and patients fasting, and working with their supplier to reduce meat portion size. This hospital had previously automatically issued bread with every breakfast and tea. Now, for

breakfast, a certain quantity of toast is prepared in the ward kitchen instead. In addition, staff bring sliced brown and white pans on the trolley, and issue where requested. Apart from reduced food waste, this has the added benefits of reduced washing of plates and fresher bread (compared to that which has been sitting on plates for a time or wrapped in cling film). In one of the elderly care wards, the hospital piloted issuing soup mid-morning as an option with tea or coffee, rather than with the main lunch meal itself. It resulted in more food being eaten, less waste and was introduced across the rest of the hospital as a result.

South An acute hospital in the South has achieved a reduction of 42 per cent in the waste arising on patient trays per meal, following a pilot implementation of changes. These changes involved reduced portion sizes per plate, automatic issuing of a ‘small’ portion where size has not been specified, reduced scoop size for dishing out food, and a change in the automatic provision of bread with breakfast and tea. Through the ongoing work in the healthcare sector being funded by the Environmental Protection Agency, it is anticipated that benchmarks can be developed showing average and best practice, in terms of food waste quantities arising for acute and community hospitals on a bed day unit basis.

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performance management CORPORATE PLANNING AND CORPORATE PERFORMANCE High quality planning, monitoring and measurement of services is a fundamental requirement of the HSE, ensuring effective governance and accountability within the health service and also allowing the HSE to evaluate its processes in order to learn, adapt, change and improve, writes Jane Carolan, National Director of Corporate Planning and Corporate Performance (CPCP).

PCP has four functions that work across all Directorates and Functions to support governance, planning, monitoring and measurement within the HSE: • Corporate Code of Governance • Planning • Performance Measurement • Reporting Business Intelligence

Code of Governance The Health Act, 2004 sets out the legal requirements for the HSE regarding its code of Governance. This comprises of a suite of inter-related documents that together form the Framework for Corporate and Financial Governance. This was published in 2009. Good governance is recognised as being evolutionary in nature and should be responsive to changes in the business environment. It was agreed that the suite of documents would be kept under regular review and would be updated as required. Responsibility for oversight of the implementation and the updating of the Code of Governance lies with CPCP. Planning Planning is an integral part of the process of management. It identifies needs, sets specific goals, develops objectives and maps out a plan as to how these objectives will be accomplished. CPCP acts as a hub within the HSE for the planning process, playing a central role in the compilation and publication of the HSE’s Corporate Plan, the annual National Service Plan and HSE Annual Report. Under the Health Act 2004, the HSE is required to prepare a formal three-year plan, known as the HSE’s Corporate Plan. The current Corporate Plan covers the years 2008 to 2011 and sets out what the HSE seeks to achieve during that timeframe. The next Corporate Plan is currently being developed.

The National Service Plan is published each year, and contains information on the type and volume of service activity that is needed in order to deliver health and social care to the people who use our services. It includes performance and activity measures which can be tracked to see if this is being achieved. In developing the plan, service managers reflect the type of service that is known to give good results, the level of service that is required to meet estimated need, and the resources that are available in the year. The annual National Service Plan is the means by which the HSE implements its Corporate Plan on a year by year basis. CPCP is responsible for co-ordinating the input to this annual plan from across the organisation and bringing the different submissions together so that they give a complete picture for the senior management team, the HSE Board and the Minister. An Annual Report for the HSE is also produced and published each year to give an overview of activity in the HSE in the preceding year.

Performance Measurement and Reporting In order to evaluate, and ultimately improve our services, we need to accurately measure how they are working. Timely and comprehensive reports about how our services are performing against targets enable HSE staff and managers to increase service efficiency and effectiveness. CPCP provides key performance reports to the Performance Management and Control Committee (PMCC) which provide a view of performance and support decisions on remedial action required to meet financial, HR and activity targets. Continuously reviewing and monitoring the HSE’s strategies and organisational performance is the key function of Performance Measurement.

As part of the performance measurement process the following key documents are compiled and published: • Corporate Plan Report (report against HSE Corporate Plan) • Performance Report (monthly report against HSE National Service Plan) • HealthStat (monthly report at hospital and LHO level based on operational metrics)

Business Intelligence Business Intelligence is a process that collects, integrates, analyses and presents business information to support better business decision making. The HSE’s Business Intelligence Unit (BIU) gathers and maintains a central repository of service data from all hospital and community based health services nationwide. Extensive amounts of data are collected, collated and validated by the specialist analysts within this Unit. This data, together with analysis, is used in performance monitoring reports (for example. Performance Report, Integrated Services Performance Contract, etc.), which influence the HSE in taking both operational and strategic decisions. As part of business intelligence, CPCP support the gathering and collating of other relevant data which informs planning, for example the Greater Dublin Emergency Department (ED) study. It is also involved in scoping and developing required data sets, for example Out Patient Data Quality project, ED Patient Experience data set, Colonoscopy data set, Child and Adolescent Mental Health Services (CAMHS) data set. Further information is available on the HSE Staff Intranet. Go to HSE Central and select Corporate Planning and Corporate Performance.

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employees

Me and

My Job... Name: Thomas Sinnott Job title: HSE Paramedic Base: Loughlinstown, Co. Dublin

The job itself is also very satisfying. Knowing that I have helped a patient or colleague can be very rewarding. IF YOU COULD CHANGE ONE THING ABOUT YOUR JOB WHAT WOULD IT BE? Shift work. I am not really a night owl so I’m not keen on working the night shift.

HOW LONG HAVE YOU WORKED WITH THE HSE? I’ve worked for the HSE for 37 years. I was employed as an attendant in St Columcille’s Hospital before becoming a paramedic.

WHAT’S YOUR FAVOURITE BOOK AND WHAT DID YOU LIKE ABOUT IT? Billy Connolly’s Autobiography. Firstly, I like the comedian anyway. Secondly, it was great to read about his life and how he grew up to become the comedy legend that he is.

DESCRIBE YOUR JOB IN FIVE WORDS Unpredictable, rewarding, stressful, sociable and challenging.

WHAT’S YOUR FAVOURITE FILM AND WHAT DID YOU LOVE ABOUT IT?

WHAT’S YOUR AVERAGE WORKING DAY LIKE?

The Quiet Man. The storyline is excellent and the panoramic scenery throughout the film is breathtaking.

Being a paramedic, we do not have the luxury of an average work day. Every day is completely different from the previous day. As a paramedic, you never know when you will receive a call, where you will be sent on a call or what injuries will greet you when you arrive. WHAT DO YOU LOVE ABOUT YOUR JOB? The social element of the job is second to none. On a daily basis, I have interactions with both my colleagues and the public.

WHAT’S THE MOST MEMORABLE THING YOU HAVE EVER EXPERIENCED? The birth of both my daughters Deborah and Gwen, and that they both graduated as nurses. They both have travelled the world and have seen many things. Also the birth of our first grandson, Harry Óg, he is a great joy to us. From a work perspective, the one that sticks out in my mind is when my colleague and myself went on a call to a

house where a mother was giving birth to twin boys. It was very nerve wracking but all went well. When we transported the mother and the twins to Holles Street hospital she asked us what our names were and she said she was going to call them Tommy and Gerry! WHAT’S THE BEST ADVICE YOU’VE EVER RECEIVED? Don’t go to bed on an argument. My mother told me this on the night before my wedding. I’m glad to say, I’ve been married to Patricia now for 31 years. FAVOURITE SPORTING MEMORY? Ireland beating Romania on penalties in Italia ’90. It brought a feel-good factor to the country (something we could all use again). WHO HAS INSPIRED YOU THE MOST? My two daughters. As Deborah and Gwen have grown up, they have encouraged me to expand my horizons through travel and also take on further responsibilities in work. PET HATE? People who don’t use pooper scoopers. TOP THING ON YOUR DREAM LIST IF YOU WON THE LOTTO? After ensuring that all my family were looked after, I would purchase a Range Rover.

106 Health Matters

finance

Mortgage Market Madness Decoded The mortgage market has now changed beyond recognition from the dizzy heights we witnessed up until late 2007, writes Eoin McGee.

t a lender conference several years ago, the head underwriter for one of the main institutions described the bank’s lending policy. It was fairly straightforward. Provided you had an income, they believed that you could afford to use about 45 per cent of that income to service a mortgage. They worked back from there. So, based on your age they calculated how many years the loan could be over, then taking 45 per cent of your income they calculated how big the loan could be. Obviously there were other factors. For example, having other loans, credit history, the value of the property, being an employee or self-employed. But in reality, at the time, most issues could be overcome. If they couldn’t overcome certain issues you could always borrow the money from a sub-prime or, as they were called by the Irish lenders, a specialist bank. Specialist banks allowed those selfemployed to certify their own income. That meant that you could tell them what your earnings are and they more or less believed you. You did have to provide certain documentary evidence but basically if the salary was in line with what the lender believed to be in accordance with that profession it went through. Whether the bank was a so-called ‘specialist’ bank or a ‘high-street’ lender, I think our underwriter mentioned earlier summed up the attitude of the time. He explained that the banks were open for business, they were keen to get the business before anyone else got their hands on it and therefore when assessing an application they were “looking for reasons to lend”. So have times changed at all? In a word, yes. The effect of the credit crunch was that banks stopped lending to each other. Where they did, they lent at very high rates.

This really put a tight squeeze on the banks resources and ultimately their ability to lend money out to customers.

“Specialist banks allowed those self-employed to certify their own income. That meant that you could tell them what your earnings are and they more or less believed you.” I think the change can be best described by a telephone call I had early in the start of all of the current difficulties. Coincidently, it was with the same lender our underwriter mentioned earlier hailed from, and I was talking to the same underwriting team he came from. I was arguing a case on behalf of a client and I was told, “Eoin, to be honest our funding levels are quite limited so therefore we are being very selective about who we will lend to”. He then went on to say – wait for it – “we are looking for reasons not to lend”. What a shift in attitude. Believe me, it is an accurate description of how the mortgage market has been. Each lender produces a calculator that allows a broker to input their clients’ details. This calculator will give an indication as to how much the bank would be willing to lend that individual. Traditionally they were accurate, if the client qualified on

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Finance

the calculator and provided there were no unforeseen circumstances, such as bad credit, the loan got approved. These calculators are still used but are literally for guidance purposes only, this is because when you submit the case it is scrutinised so much for “reasons not to lend”. There is anecdotal evidence throughout the industry where cases are being declined for obscure reasons, for example banks saying no because the client had an online betting account which was paid into from their current account, or bank statements being scrutinised for bounced direct debits, unpaid fees and referral charges. All these things had a bearing in the past, but usually a case would not be declined because somebody missed a direct debit to the Satellite TV provider. The major difference between now and then is the spread between what a client qualifies for from different lenders. I had a case recently where, using the calculators, one bank would lend a client of mine b93,000. Whereas when we shopped around a different bank, he would give the same client, with the same income and secured against the same house, in excess of b350,000. So what suggestions would I have for someone looking to buy a house for the first time or someone who was looking to trade up? Firstly make sure your bank statements are very clean for the last six months. Try and stay out of the overdraft. Set up a savings account and save at least the mortgage repayment on a month-to-month basis. If you’re-trading up and already have a mortgage, work out what the difference is between your current mortgage and the new one and start saving that for a period of 6-12 months. Speak to someone early on about getting a mortgage even if you don’t think you’ll buy for some time you may be able to get an idea of how much you may be able to borrow. If you don’t use someone independent to do it for you be sure to shop around yourself, not just for the best rate but consider things like the options on a mortgage. Do they allow payment breaks, interest only periods or even overpayment options? What is their recent history in relation to interest rates? How do their existing customer rates compare

to the rates they offer to new customers they are trying to attract? Getting a mortgage is not just about handin-cap hoping you get the money, lenders are fussy about who they lend to and you as the client should also be fussy about who you are willing to give the business too. If you are considering getting a new loan, don’t hold back. Try and get the mortgage. The mortgage market is in a better position now than it was six or 12 months ago so you may be pleasantly surprised.

Lending Frenzy When the lending frenzy was at full flow, banks could quite easily borrow money at the then European central bank rate with a margin on top of at time 0.1-0.3 per cent. So if the ECB rate was two per cent, they could borrow money for around 2.1-2.3 per cent. They were all keen to get your business so lenders started to offer tracker rates. In some cases, there are customers who managed to get tracker rates of 0.45 per cent above the ECB, so if ECB was two per cent the customer started paying 2.45 per cent. These customers will always only pay 0.45 per cent above whatever the current ECB rate is. This is a fantastic deal, particularly when you consider the banks are currently paying about 0.7 per cent above ECB for the same money. This is why the tracker has died, never to return. If you have one keep it, regardless of incentives or offers are thrown at you. If you are attracted to fixing your loan seek independent professional advice from someone other than your lender.

Eoin McGee is the owner of Prosperous Financial Services, an independent firm regulated by the financial regulator as a multi-agency intermediary and mortgage intermediary. He has over 10 years experience giving advice to both individuals and companies in relation to their finances, he can be contacted on eoin@prosperous.ie 045 841 738 or 087 6 44 55 33.

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weekend breaks

Wish Upon a Spa For a weekend break that will guarantee you returning home refreshed and revived, a spa retreat is the perfect option, writes Karen Creed Playing Lord and Lady Best known for hosting the Ryder Cup and attracting high-profile celebrity guests, it is easy to see why a venue like The K Club is enticing for a special weekend break. An entrance that boasts an expanse of rolling greens leads to a luxury manor house that boasts all the facilities a celebrity would be well used to. When the most basic type of room looks like a superior, it doesn’t take a detective to work out that luxury is a priority here. Most visitors are likely to play golf as well as indulge in some pampering during their stay. Keeping in mind the need to offer more services in recessionary times, The K Club has diverse pastimes to attract a mix of guests, from wine-tasting to fishing. In the spa

you can warm up with a visit to the outdoor hot tub before taking a swim in the crystal clear pool. Even without a spa treatment, the leisure centre is a treat with steam room and sauna. However if you do opt for one of their signature facials, you will not only leave with your face glowing but your head feeling fresh after an Indian head massage, your hands soft from a deep massage and your neck and shoulders completely free of tension. Ensure you take part in the tour of the wine cellar – complete with free glass of champagne – and enjoy dinner in one of the two restaurants on site with plenty of delicacies to please the palate. The ‘One Night K Club Getaway’ costs from b230

per adult sharing and includes bed and breakfast in a Superior room and dinner in The River Room Restaurant from the Table D’hôte evening menu. Call the K Club on 01 601 7200 or visit www.kclub.ie

For the city slicker The g hotel is not just for design fanatics or boutique hotel lovers. It is a haven for those who like to be wrapped in a cocoon of comfort in the knowledge they are a stone’s throw from the bustle of an eclectic city. With all the pinks and purples, you might think this hotel is simply a girl’s haven. It is definitely female focused in its colour scheme, but male guests won’t feel left out, especially when they see the bedrooms, kitted out with all the latest mod cons. The effect of the g is infectious from check-in. The ground level is like a scene from Alice in Wonderland with the bright colours, quirky furnishings and psychedelic carpets. While the beds will guarantee you slumber like a baby, stepping into the hotel’s spa will ensure you unwind even further with pampering in all shapes and forms. From back scrubs to pedicures and deep tissue massages to skin brightening facials, this spa has won countless awards. Its dimly lit swimming pool is particularly appealing to guests who are somewhat body conscious. The g likes to stand out in many ways, and it is obvious that it sticks to this throughout, from the cocktail list to the dinner menu at Matz. This boutique hotel is best catered to couples and groups, but unlike some high-class venues that raise their noses to kids, the g hotel has a one-for-all policy. Stay at the g from b80 per person per night. For bookings visit www.theghotel.ie or tel 091 865200.

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weekend breaks

A breath of fresh air The idyllic setting of the Ritz Carlton Powerscourt is the prime attraction for those passionate about the countryside, but this five-star hotel will also ensure that spa fans experience something incredibly special. The spa area is dimly lit, allowing for complete privacy and chill out time in opulent surroundings. There are all sorts of pools and rooms to encourage you to detox, while the treatments are designed to re-invigorate and replenish tired souls. Outside the spa, afternoon tea is one of the highlights, only to be beaten by the lavish dinner in their restaurant Gordon Ramsay at Powerscourt. Given its scenic location amid mountains, waterfalls, and rolling greens, the hotel encourages guests to get out and about whilst making the most of the hotel’s services. The list is innovative – from the bike and picnic rides to the guided walks and scenic trails. Nearby day trips are ideal for those who have not visited this part of Wicklow. As well as the spectacular countryside setting, the service leaves you with no doubt that you are staying or visiting somewhere incredibly special. The summer glow day spa at Ritz Carlton costs b139 and includes five treatments, healthy lunch at the Spa Café and full use of the exclusive facilities, use of a luxury robe and slippers are included throughout your day. To book call 01 274 8888.

Spa breaks abroad

Beauty and the Brooklodge As you drive through Aughrim village, you might think countryside beauty doesn’t get much better than this. Drive a little further and you will be proved wrong as you fall upon the paradise grounds of Brooklodge. Located in Macreddin Village, Brooklodge has already earned itself a reputation for its first-class spa and award-winning organic restaurant, The Strawberry Tree. With pampering and gourmet cuisine guaranteed, one might find this is enough to ensure a rewarding weekend break. However, there is much more to Brooklodge than just wonderful food and spa treatments. There is an 18-hole golf course, walks and trails

through lush countryside, bikes available for guests to use, and a lounge bar that has the comfort of a living room but a menu that would compete with any New York bar. In the spa, the expert therapists will design each treatment to suit your requests and afterwards make sure to take the time to enjoy the thermal suite. With an outdoor hot tub, spray jets throughout the pool area and indoor Jacuzzi, steam room and sauna, you can happily while away an afternoon in this haven of comfort. There are currently halfprice offers on rooms and spa treatments at Brooklodge. Visit www.brooklodge.com or call

Ibiza is flanked by many luxury spa resorts but Atzaro is one of the most charming, set around various pools with various masseuses at its helm. Allow yourself to fall into their expert hands as they work their magic and afterwards you can relax in their Buddha themed gardens, soaking up the sun with healthy fruit smoothies to cool you down. Visit www.atzaro.com Budapest is often referred to as a big bathtub as it has sulphuric waters that bubble up from the thermal springs below the city. This asset alone makes it one of the best places in the world for a good soak. Visit the Széchenyi bath for a mud bath and massage. Check out www.szechenyibath.com The staple of Finnish living is the sauna, the original hot and cold therapy with attitude. Some of the more remote and reputable are located on Helsinki’s nearby islands which require a taxi boat to get to. The average cost of entrance is b10 and after you body is cleansed, relax with a Finnish massage. Visit www.beautyfarmhotel.com

110 Health Matters

book reviews

Health Matters Book club

From fact to fiction and cookery to comedy, here are our favourite reads of the moment, writes Niamh Lynch

ith most of your summertime ‘mustreads’ successfully ticked off your list, Health Matters Book Club brings you a new bundle of books to satisfy your literary needs throughout autumn. As always we want to hear your thoughts, be sure to join us on facebook at www. facebook.com/healthmattersbookclub, giving us your opinion on our choices, taking part in our competitions and offering your suggestions on what you think others would enjoy!

Anyone for Me? − Fiona Cassidy From the author of Anyone for Seconds?, Fiona Cassidy heartwarmingly uses her experience of adoption to bring us her latest offering, Anyone for Me? Meet feisty, fun-loving Ruby Ross − 34 years old, mad red hair, mad (in general), adopted and searching for answers …like, precisely whose genes are responsible for the mad red hair? She’s impulsive, compulsive and unaware of what she’s about to unleash in her quest for the truth. Isobel Ross is larger than life (despite being a serial dieter) and lives in a picturesque cottage in Donegal in the grounds of a manor-house hotel − but why are the new hotel-owners so keen to get rid of her? She’s harbouring secrets from the past and fiercely protective of her adopted daughter Ruby. Can she stop the wilful Ruby from opening a nasty can of worms? Throw in Ruby’s forthcoming nuptials to the lovely Luke, a bling-loving

bridesmaid in the shape of her best friend Frankie, a wedding planner called Gabriel who wears more make-up than the brideto-be and you have chaos. Add to the mix a dusty box found by chance which leaves many questions unanswered, and you have a bewildered and rather ferocious Ruby asking: is there Anyone for Me?

The Guinnesses − Joe Joyce The Guinnesses is the story of a family who created one of the world’s great brands and made its way from middle-class merchants into the highest levels of aristocratic society. Along the way, the Guinnesses were involved in many controversies, like a 19th-century sex scandal, the murders of four of their employees in the west of Ireland and financial scandal during the 1880s. The society pages of some newspapers decided that the ‘Guinness curse’ explained a series of family tragedies, including sudden deaths, accidental drug overdoses and suicides. The array of Guinness businessmen, politicians, eccentrics and socialites has filled financial, current affairs and gossip columns for generations; from the Godfearing founder, Arthur Guinness, through to the early death in 1992 of Benjamin Guinness, the last of the family to sit on the board of the company. Joe Joyce’s compelling, racy and epic biography tells the full story of the family for the first time. With this year's Arthur's Day festival fresh in everyone's minds, what better time to

brush up on your knowledge of the family behind our national brew?

The Help − Kathryn Stockett Currently gracing the top spot on Eason’s Top Ten Bestselling Books, The Help is a humorous, poignant and hopeful story of three women who are about to take one extraordinary step. Twenty-two-year-old Skeeter has just returned home after graduating from Ole Miss. She may have a degree, but it is 1962, Mississippi, and her mother will not be happy until Skeeter has a ring on her finger. Aibileen is a black maid, a wise, regal woman raising her seventeenth white child. Something has shifted inside her after the loss of her own son, who died while his bosses looked the other way. Minny, Aibileen’s best friend, is short, fat, and perhaps the sassiest woman in Mississippi. She can cook like nobody’s business, but she can’t mind her tongue, so she’s lost yet another job. Minny finally finds a position working for someone too new to town to know her reputation. But her new boss has secrets of her own. Seemingly as different from one another as can be, these women will nonetheless come together for a clandestine project that will put them all at risk. Why? They are suffocating within the lines that define their town and their times. And sometimes lines are made to be crossed.

Health Matters 111

book reviews Catherine’s Italian Kitchen − Catherine Fulvio

Following last year’s hugely popular RTÉ TV show, Catherine Fulvio brightens up autumn again by bringing some Italian flavour to Irish kitchens. Coinciding with her new TV series on RTÉ 1 in September and October, this book is her personal collection of recipes, gathered through her Italian friends in Sicily and her Wicklow cookery school. Containing over 100 recipes, the book reflects Catherine’s warm and no-nonsense style cooking, the vibrancy of Sicilian cooking and the heartiness of Roman fare along with delicious tasty treats from Tuscany, Naples and Venice. Why not take some of the delectable food you see on RTE this September right into your own kitchen, by cooking up a storm with Catherine’s fantastic new book? Buon appetito!

The Road − Cormac McCarthy

By the winner of the Pulitzer Prize for fiction in 2007, this is the story of a father and son walking alone through burned America, heading through the ravaged landscape to the coast. It was hailed by Andrew O’Hagan as “the first great masterpiece of the globally warmed generation. Here is an American classic which, at a stroke, makes McCarthy a contender for the Nobel Prize for

Literature …An absolutely wonderful book that people will be reading for generations.” Harvey Weinstein’s film version was released in January of this year, with an all-star cast including Viggo Mortensen, Charlize Theron, Guy Pearce and Robert Duvall, and introducing major new young talent, Kodi Smit-McPhee, with a soundtrack by Nick Cave and Warren Ellis. If you have already experienced this epic story on the big screen, it is certainly worth revisiting this masterpiece in book form. However, if you have yet to see the film, then by all means keep walking past the DVD store and straight to your nearest book shop; as this is one story that should first be experienced in its original form. “You will read on, absolutely convinced, thrilled, mesmerised. All the modern novel can do is done here.” Alan Warner, The Guardian.

Overheard in Dublin Rides Again − Gerard & Sinead Kelly

From the über-popular Overheard in Dublin website, comes the book Overheard in Dublin Rides Again, which is jam-packed with over 500 more ‘overheards’ from the hilarious site. “I was getting on a busy Luas one day, just having gotten off the train. There were two young girls, maybe 11 or 12, holding on to one of the poles near a door. Just as the Luas stopped two guys were pushing past the two young girls and one of them said to the other ‘Jaysus, that tram is wedged’. One of the girls looked to the other with a shocked face and gasped, ‘What did he just call you?’.” For this and many more comical ‘overheards’, pick yourself up a copy of theis hilarious book.

Pieces of My Heart − Sinead Moriarty

Sinead Moriarty is fast becoming one of Ireland’s best-read authors. With her sixth and latest book Pieces of my Heart, she takes on the serious issue of anorexia, which she treats in an informed and sensitive way, clearly having done her research. The book explores all the frustrations and heartache parents and siblings go through, and pays due attention the potentially fatal impact of this disease. The modern woman is a Jill-of-all-trades: wife, lover, mother, daughter, friend, fixer and boss. It’s never-ending. Ava is juggling a life that seems to have too many pieces. First, there are her chalk-and-cheese daughters, Alison the angel and Sarah the tearaway. Then there’s husband Paul. Unfortunately, he seems more interested in work than home − which might explain why her sex life is practically on life support. That certainly can’t be said about her Viagra-popping Dad, a loveable rogue who is determined to grow old disgracefully. She would envy her best friend Sally, sassy single singleton-about-town, if she didn’t know that behind her polished exterior Sally is as vulnerable as a kitten. Somewhere in there is Ava herself, trying to do her best for all of them but lately feeling like she’s running on empty. But that’s before she notices Alison is in deep trouble. Now she knows there’s no such thing as empty − not if she is to hold on to the most precious pieces of her heart. For more great book reviews, discussions and news, join the Health Matters Book Club on Facebook at www.facebook.com/ healthmattersbookclub.

112 Health Matters

crossword

Fill it in to Fill in time

by Zoë Devlin

ACROSS 1And 6 down. Conference in centenary year of this great nurse (8,11) 5 Cuts or stabs (6) 10 Official or crone who investigates deaths (7) 11 He used to be doubly late, now RSA Chairman (5) 12 Religious system of Muslims (5) 14 Not changed – like an elder Aunt! (9) 15 In a stiff manner (7) 16 Contains carpals, metacarpals and phalanges (4) 19 Inflammatory skin disease (4) 21 Could a lab cope with this inert medication? (7) 24 Medication that soothes injured skin (9) 25 Well matched…having same value (5) 26 Small fleshy lobe at back of soft palate (5) 27 17th century. Italian astronomer and mathematician (7) 29 Lowering them is one of RSA’s priorities (6) 30 Plumbing fixture (5-3) DOWN 1 Persons who shoe horses (8) 2 Branch of medicine concerned with cancer (8) 3 Organ which detects sound (3) 4 Time period elapsed since death of 1 across/6 down (7) 6 See 1 across 7 Circulars or handbills (6) 8 Weapons found in north Co Dublin town (6)

Scribble box

9 10

19 22

9 Examined by spirometer (6) 13 Application for this entitlement to health services now possible online (7,4) 17 Our Olympic hammer thrower works in this Dublin hospital (8) 18 Further action to increase or enhance treatment (6-2) 20 Healthy vigour or force (6)

21 Bone in lower limb – even a tall ape has one! (7) 22 Sensations received by olfactory perception (6) 23 System which protects against disease (6) 28 Corrosive alkaline substance (3)

CHILD CAR SEAT

EXCUSE

KNOW THE LAW on child car seats

Every year too many children are killed or seriously injured on our roads – often because they are not properly restrained when travelling in a car. The law has been changed to afford children greater protection when travelling in cars. Under the EU law all children under the age of 11/12 must be in an appropriate child car seat. No exceptions, no excuses. It’s your responsibility as a parent, grandparent or guardian to ensure that the child car seat you buy is not just appropriate for their age, height and weight but that it also conforms to EU safety standards. So make sure you visit www.rsa.ie/childsafetyincars - understand the new law and give your child the best protection possible.

Check It Fits Road Show Date: Saturday 9th October Sunday 10th October Monday 11th October Tuesday 12th October Wednesday 13th October

Location: Blackpool, Cork Ennis, Co. Clare Castlebar, Co. Mayo Carrick-on-Shannon, Co. Leitrim Letterkenny, Co. Donegal

Time: 10:00am to 5:00pm 12:00pm to 6:00pm 10:00am to 5:00pm 10:00am to 5:00pm 10:00am to 5:00pm

Coming Soon

NEVER PUT A REARWARDFACING SEAT IN THE FRONT SEAT IF THERE IS A PASSENGER AIRBAG!

Rearward-Facing Baby Seat

Forward-Facing Child Seat

Booster Seat

Booster Cushion

Weight For babies up to 13kgs (29lbs) Approximate Age Range Birth to 12-15 months

Weight 9-18kgs (20-40lbs) Approximate Age Range 9 months - 4 years

Weight 15-25kgs (33-55lbs) Approximate Age Range 4-6 years

Weight 22-36kgs (48-79lbs) Approximate Age Range 6-11/12 years

Select a child car seat that is suitable for the child’s WEIGHT and HEIGHT. Do not use age as a guide. For Further Information: The ‘CHILD SAFETY IN CARS’ booklet and DVD are both available FREE to order by telephone LoCall 1890 50 60 80 and online www.rsa.ie/childsafetyincars

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