Health Matters Autumn 2012 by HSE Communications

H E A LT H Vol 8 I Issue 3 I Autumn 2012

INSIDE - NeoNatal Network - Capital Developments -A lcohol Consumption - Social Media

MATTERS National Staff Magazine of the Health Service Executive

sanctuary in art

Marie Fallon speaks about empowerment through art

H E A LT H

8 I Issue 3 I Autumn 2012

MATTERS

onal 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

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 18

120

127

Vol 5 I Issue 3 I Autumn 2009

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HEALTH MATTERS 1

CONTENTS 66 MENTAL HEALTH LEGISLATION 66 PRIMARY CARE 70 REGIONAL NEWS 93 STRONG TO THE CORE Why Pilates classes are proving so popular in towns and cities throughout Ireland. 94 CRISIS PREGNANCY PROGRAMME A new study on migrant women’s attitudes toward fertility, motherhood and sexual health services in Ireland. 98 AUTUMN GARDENING

5 PATIENT PRIORITY PLEDGE A new initiative to improve the patient experience at Harold’s Cross.

29 VALUE FOR MONEY A study on the cost effectiveness of providing comprehensive acute care.

6 SANCTUARY IN ART Featuring Dublin-based artist Marie Fallon.

31 OPEN HOUSE

100 EXCELLENCE AWARDS The Taoiseach presented awards at a special ceremony held in Dublin Castle.

35 QUIT CAMPAIGN

102 NEWS IN BRIEF

36 CLINICAL PROGRAMMES

104 NOVEL IDEAS

38 MAKING A DIFFERENCE With volunteer group Immunisation 4 Life.

106 FREEZE FRAME

8 NEW NEONATAL NETWORK Improving services to women and their babies. 11 FLU SEASON

109 EATING WELL INTO THE FUTURE 12 SOILSE MARKS 20 YEARS 20 years of providing educational and therapeutic programmes for people recovering from addiction. 15 CHILDREN AND FAMILIES New standards for the protection and welfare of children. 16 REAL CHANGE The second annual progress report of the Croke Park Agreement. 18 OPEN DISCLOSURE Angela Tysall and Ann Duffy explain their work on Open Disclosure.

40 GOVERNANCE The appointment of Tony O’Brien as Director General designate.

110 NATIONAL BREASTFEEDING WEEK 112 SUICIDE PREVENTION

43 SOCIAL MEDIA The importance of online awareness. 44 HOMECARE PACKAGES The HSE recently concluded a comprehensive procurement process for the provision of new homecare packages. 57 OUTSIDER ART Featuring the art of Christy Browne.

115 ACADEMIC FELLOWSHIP 117 PERSONAL FINANCE 120 MOUNTAIN RESCUE Two Irish doctors were among the first on the scene of an avalanche that claimed the lives of nine people on Mount Maudit.

58 MAKING EVIDENCE MOBILE Download mobile apps for resources available through www.hselibrary.ie.

123 MENTAL HEALTH ALIENATION

125 A DAY IN THE LIFE

22 CAPITAL DEVELOPMENTS

61 RESTRAINT REDUCTION Network to help information on restraint use and reduction.

24 ALCOHOL CONSUMPTION A survey looks at whether Irish levels are too high?

62 MENTAL HEALTH MATTERS Reducing the stigma attached with mental health at the Volvo Ocean Race.

127 SPORTING PASSIONS

20 CHILDREN’S WOUND CARE Healthcare professionals are working together to develop resources.

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124 DIARY OF AN INTERN

126 GETTING TO KNOW YOU

128 COMPETITIONS

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2 HEALTH MATTERS

WELCOME …to the autumn edition of Health Matters, the national staff magazine of the HSE. In this issue we look at the appointment of Tony O’Brien as Director General designate for the HSE in July. Mr O’Brien took up his new post in August following the departure of HSE Chief Executive Cathal Magee. Elsewhere, we learn from the Crisis Pregnancy Programme about a new study on Migrant Women’s Attitudes toward Fertility, Motherhood and Sexual Health Services in Ireland. We take a closer look at the Mental Health Matters Campaign which featured at the Volvo Ocean Race Festival in Galway in the summer. We also feature Trish Coady, a diabetes nurse who’s in training for the Dublin City Marathon in October and we talk to HSE staff member Suzanne Kirwan who recently won both the qualifier and the championship final at the AIRC National Showjumping Championships. Finally, we take a look at the Per Cent for Art Scheme and artist Marie Fallon whose work will be seen in HSE buildings shortly. We hope you find this issue’s mix of features, interviews, news and updates of interest. For more regular updates, check our staff intranet site, http://hsenet.hse.ie, or the HSE website, www.hse.ie.

Sites we like...

www.letsomeoneknow.ie

www.yourdrinking.ie

Stephen McGrath - Editor Head of Internal Communications

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

www.breastfeeding.ie

Did you know? • A pint of lager has 200 calories and to burn this off you would need to walk for 50 minutes or swim for 30 minutes • There has been a 44 per cent decrease in the number of births to teenagers since 2001 • Over 800,000 people flocked to Galway for the Volvo Ocean Race in June

www.yourmentalhealth.ie

• More than 500 people develop active TB every year in Ireland • Over 300,00 viewers tuned into RTÉ’s From Here to Maternity featuring CUH

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 5

our lady's hospice

Patient Priority Pledge A new initiative aims to improve the patient experience in Our Lady’s Hospice in Harold’s Cross, Dublin.

unique patient-focused initiative, the Patient Priority Pledge, was launched in Our Lady’s Hospice by RTÉ’s Claire Byrne in June. The Patient Priority Pledge aims to improve the patients’ experience when they are being cared for within Our Lady’s Hospice and Care Services. The new initiative highlights the importance of implementing the core values of dignity, compassion, justice, advocacy and quality in everyday life at the hospice. It sets out the values and behavioural standards expected from staff and aims to renew and improve the patients’ experience.

+ L-R: Avril Tupas, Practice Development Nurse; Sheila Sullivan, Senior Physiotherapist; Linda Kearns, Assistant Director of Nursing, Our Lady’s Hospice Harold’s Cross; RTÉ’s Claire Byrne; and Mary T. Carroll Ward, Manager.

Step Into my World The pledge and its goals have been designed into a poster format that will be displayed outside each unit so that patients and residents will know what to expect when they are being cared for in Our Lady’s Hospice. As part of the initiative, the staff, members of the board and members of the public are being invited to ‘step into my world’ and experience life through the eyes of the patients. The aim is that this will build a greater understanding of the patient’s position. STAFF CARD The Patient Priority Pledge has been translated into a pocket-size card and all staff are being asked to carry the card, which holds reminders of the full realm of patient care. The Quality Team have been working with patients and residents of the hospice to inform them of all elements of the initiative. In conjunction with the pledge, eight key performance indicators are completed by the Nursing Department every month. To keep abreast of best practice and expert knowledge, both at home and internationally, ‘champions groups’ have been put in place. They then report back to

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+ L-R: Linda Kearns, Assistant Director of Nursing Our Lady’s Hospice, Harold’s Cross; Sr Frances Dolores Martin, resident patient; RTÉ’s Claire Byrne; and Pauline Newnham, Director of Nursing, Harold’s Cross, Dublin their teams with updates from their selected area of expertise, including areas such as infection control and person-centered care (dementia). Head of Nursing and Quality Pauline Newnham, who has 20 years’ health service experience, said: “People coming through our doors can experience all ranges of emotions that may be traumatic. From the very first welcome, we need to reassure patients and their families that their

needs will be met,” says Newnharm. This pledge paves the way for excellence in patient care across all services and is strongly supported by Dr Michael Shannon, the HSE’s Office of the Nursing and Midwifery Services Director.

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6 Health Matters

per cent for arts

Sanctuary in Art For Marie Fallon, empowering others is one of the enduring pleasures of the profession, writes Conor William O’Brien.

t has long been said that the great pleasure of teaching is to imbue the student with a knowledge or skill they did not previously possess. It is due to this feeling that the teaching of art has become a passion for Dublin artist Marie Fallon, whose work has been displayed in hospitals across the county. Art runs in the family for Fallon; her father was a scenic artist who worked for the Abbey Theatre. Growing up, it was forever a constant presence in her life, and she has been refining her craft from a very young age. Fallon pursued and honed this passion further with classes at NCAD before studying under Dublin artist Phelim Donfield. She cites Johannes Vermeer – with his contrasting use of darkness and light – as her favourite artist and a key influence on her work. Like the Dutch maestro, she employs oil in the creation of her works, appreciating their longevity and the vivid colours they bring to the canvas. “I think it’s a very forgiving medium,” she explains of her preference for oil over water colours. “And I explain this to my students. If things don’t work out with water colours, it’s in the bin and that’s it, but with oils you can come back to the subject again, maybe even a month later and continue. I also love the strong sense of colour I get with oils.”

Tranquil Atmosphere The Vermeer influence manifested initially in a series of still-life’s Fallon composed for an exhibition in Skerries, but she gradually progressed to painting landscapes, influenced and inspired by scenes within her locality. “I live in Malahide and I paint all along the coast: Skerries, Howth and Fairview.” Not surprising given her seaside Dublin location, Fallon found herself drawn to harbours, and they remain the subject of many of her paintings. Viewing harbours as a source of sanctuary, she decided to make them the core subject of series of paintings for the HSE for which she has been commissioned. She greatly appreciates the

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need for art in hospitals to help generate a tranquil atmosphere, and from the feedback she has received she maintains that paintings of familiar scenes are just what nervous patients need to settle their hospital fears. “People are going in for appointments. They may be worried, and they may have relatives with them who may be bored to

say the least! I have a painting of Howth in Beaumont Hospital and the feedback has been terrific. One gentleman rang me only last week and told me that his Dad is going for a series of tests in Beaumont, and every time he goes into the hospital he stops and talks about Nichol’s, a shop by Howth harbour.”

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Health Matters 7

per cent for arts

“So I build their confidence and give them a taste of art, and if they’re with me for a while I try to convince them to do a little bit of photography, pick something they’d like to paint and we’ll work from there.”

‘Things that are familiar.’ I’ve worked off the feedback I’ve received from visitors or patients in hospitals.” When asked how she tackles teaching patients with basic skills in art, she says: “A lot of them come into art afraid; they’ve maybe had bad experiences in school where teachers have told them ‘you’re no good’. So I build their confidence and give them a taste of art, and if they’re with me for a while I try to convince them to do a little bit of photography, pick something they’d like to paint and we’ll work from there. One woman did a portrait of her brother who died a long time ago, and that was great for her to have achieved that. Everybody has a particular story, and I’ll deal with it in a way I feel is appropriate.”

Sense of Achievement Fallon arrived at teaching somewhat by accident. A friend – who was teaching at Lusk Adult Education Centre – asked her if she would be willing to teach there. She accepted, reluctantly at first, but has gone on to teach in adult education now for over 12 years and is adamant about the benefits it brings both for herself and her students, particularly her pupils within the hospital system. “I really enjoy it,” she insists. “You can see people who are not particularly confident or have been quite ill and then suddenly they start growing. Before you know it, they’re being discharged and they have a new craft. I encourage them to take up art when they leave the system and a lot of them have. When they produce their first painting and I try to get it framed, I say to them, ‘Now – you have come this far. Out you go and start doing classes.’ The sense of achievement is fabulous to watch. I do it for enjoyment with them, and it’s fantastic. It really aids their recovery, their self-esteem and their self-confidence.” Marie is also involved with a group of four long-term residents at the Willowbrook unit at St Ita’s who she has worked with over the last two years and an art exhibition is taking place in early October. Marie comments: “I wish to thank Caroline Coakley for looking after the framing. All the staff and clients are really looking forward to the exhibition.” To view or purchase Marie’s work, visit www.dublinpaintingandsketchingclub.ie, www.laninchartgallery.ie or www.gallery4.ie.

Scenes of the Familiar Fallon spends three days a week working for the mental health services – St Ita’s Psychiatric Hospital and day hospitals in Swords, Balbriggan, Coolock, residential unit Bymer and the admissions unit in Fairview – where she teaches patients to paint. For the purpose of the hospital lessons, she abandons oils in favour of acrylic paints, which dry quicker and leave no smell. She begins by showing her students the basics of drawing before bringing in blown-up photographs for them to paint. “When I realised my paintings were going to be in a health environment I asked people I work with who have been in hospital, ‘What kind of art would you like to see in a hospital?’ and they said,

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2/10/12 15:21:31

8 Health Matters

neonatal

Premature Babies to Benefit from new neonatal network A new neonatal network aimed at improving services being provided to women and their babies, particularly in relation to premature babies, was launched recently by Professor Michael Turner, National Programme Director for Obstetrics and Gynaecology.

he regional network includes the Rotunda Hospital in Dublin, Our Lady of Lourdes Hospital in Drogheda and Cavan General. Maternity and neonatal services in this region are provided on the three hospital sites, with approximately 15,000 deliveries per annum. The hospitals have agreed common protocols, standards, clinical guidelines and pathways of care for the newborn: a joint approach to clinical audit, incident reporting and clinical training, professional development across the network and the exchange of sessions for clinical and administrative staff between the units.

Working Together The network has standardised the care pathways for extremely premature babies; infants less than 27 weeks’ gestation will be transferred from Our Lady of Lourdes Hospital and Cavan General to the Rotunda. Once stable, these babies will be returned to Drogheda and Cavan until they are ready to go home. Infants between 27 and 30 weeks’ gestation from Cavan will be transferred to Drogheda for initial care and, once stable, they will be returned to Cavan to complete their care. In addition, there will be a co-ordinated approach between obstetricians, neonatologist and midwives to ensure that mothers presenting at Our Lady of Lourdes or Cavan General in early labour with an anticipated pre-term birth are transferred ahead of delivery/in utero wherever possible to the Rotunda. Evidence has shown that the outcome for these vulnerable babies is better if they are delivered in the unit where they will receive ongoing care and at a centre which has the appropriate critical mass of activity. Speaking at the launch, Dr Sam Coulter Smith, Master of the Rotunda Hospital,

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+ Back row (L-R): Valerie Anglinn, Staff Midwife, Rotunda Hospital; Dr Sam Coulter Smith, Master of the Rotunda Hospital; Colette McCann, Manager for Women and Children’s Services, Our Lady of Lourdes Hospital, Drogheda; and Dr Alan Finan, Clinical Director, Women and Children’s Services in the North East. Front row (L-R): Evelyn McAdam, Manager Special Care Baby Unit, Cavan General Hospital; mum Evelyn Treacy and her new baby; and Margaret Philbin, Director of Nursing, Rotunda Hospital at the launch of DNE Neonatal Network.

said: “This is a fantastic quality initiative and a real step forward for the quality of care that premature babies receive in the North East region. It’s a really good example of hospitals working together in a group and also a fantastic example of how a network approach to access to subspecialty needs can be provided when clinicians sit down together to find solutions in this challenging economic climate.” Dr Alan Finan, Clinical Director, Women and Children’s Services in the North East, commented: “This model of care is recognised internationally as the best way to manage prematurity. The network represents a major change in our current practice and I acknowledge the flexibility and support provided by clinical staff and

regional management which has made this happen. We see the neonatal network model as a critical component of a larger strategy to integrate and standardise high-quality maternity and neonatal care in the region.”

Protocols Since January 2011, staff from each of the neonatal units attend quarterly educational and training meetings which are held on a rotational basis at one of the hospitals where they have an opportunity to share their knowledge, discuss common topics and go on hospital rounds. As a result of these meetings it was agreed to formalise arrangements and agree protocols to standardise the care provided for very premature babies.

2/10/12 15:21:38

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HealtH Matters 11

flu season

don’t Forget your Flu JaB the ﬂu season is almost here and for most of us, the ﬂu is a horrible experience with up to ten days of fever, headaches, muscle pain and utter misery.

s unpleasant as catching the flu virus is, in time, most of us recover without any major lasting negative effects. Unfortunately, some people are at risk of complications of the flu. these risk groups include people aged 65 years and over, those with other long-term conditions such as chronic heart or lung disease or diabetes, and all pregnant women. For them, flu can cause devastating illness or even death. seasonal flu vaccines have been safely providing protection from flu to millions of people across the world for more than 60 years. any side effects are usually mild and serious side effects are extremely rare. the flu vaccine cannot give you the flu as it does not contain any live flu virus.

hIgh rISk groupS a seasonal flu vaccine is the only protection against the flu and people in the risk groups, along with all healthcare workers and carers who look after the ill and the elderly, need to get the vaccine every year. the flu vaccine is recommended for healthcare workers to protect them from getting the flu and to prevent the spread of flu to family and patients. the last thing healthcare workers want to do, whether working in a hospital or in the community, is to put patients or loved ones at risk. the flu vaccine may not provide sufficient protection for some of the risk groups, so it important their healthcare workers and carers are vaccinated. Healthcare workers should contact their line manager or occupational health department to arrange for vaccination. preventIon IS key the Hse’s dedicated immunisation website, www.immunisation.ie, provides details on the seasonal flu vaccine along with answers to any questions people may have about flu. Information leaflets are available for downloading and are also available in

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GP surgeries, pharmacists and Hse local health offices. Information is also available from the Hse Infoline on 1850 241 850. a ten-second flu shot is far better than

ten days of misery, or worse, serious complications of flu. Your patients will thank you for getting the flu vaccine. Don’t get or give the flu this year.

2/10/12 15:21:59

12 Health Matters

addiction

Soilse Marks 20 Years Health Matters takes a closer look at Dublin city centre-based service, Soilse, which recently marked 20 years of providing educational and therapeutic programmes for people who are in recovery from addiction.

oilse’s main objectives are to break the spiral of addiction, dependency and social isolation and to motivate recovering drug users to realise their full potential. Soilse (which means light in Irish) defines addiction as dependence on any legal and/ or illegal drugs which harm the physical, mental, emotional and social wellbeing of the individual, group or society. The organisation deals with addiction by applying an adult learning methodology. Since its foundation, hundreds of people with addiction problems have been through Soilse FETAC-accredited educational programmes. In 2010, some 97 participants presented 395 portfolios to FETAC and the majority of Soilse participants have gone on to live drug-free, independent and fulfilled lives. Recovery is Possible To mark Soilse’s 20-year milestone, the service held a three-day programme of events at which participants exhibited their abilities and achievements, highlighting that recovery from addiction is possible. Speaking about Soilse’s role in rehabilitation, Head of Services Gerry McAleenan said: “We contribute to and work to implement national policy on drug rehabilitation; pursuing best practice standards in assessment, care planning, case management and interagency involvement, as well as pioneering research on how education contributes to the development of recovery capital.” Launching the anniversary celebrations, the Minister for State, Department of Health with responsibility for Primary Care Roisin Shortall TD said: “Drug use does not have to be a life sentence. It is vital that people who are struggling with addiction problems can access the kinds of services offered by organisations like Soilse so that they can ideally achieve a stable drug-free lifestyle.”

A Celebration The theme for the celebratory day was ‘Celebration of Creativity’ and it included

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+ Roisin Shortall TD, Minister for State with responsibility for Primary Care, signs Soilse’s recovery wall. an art exhibition launched by artist Robert Ballagh and drama and poetry readings showcasing the participants’ creative abilities. Robert Ballagh summed up the importance of creativity in Soilse. He commented: “Here, creativity seems to be an integral part of the project and that reality sings out to us all around the walls here today.” A Soilse Recovery Cup soccer challenge was also organised during the anniversary celebrations. Some 24 teams of service users from across Dublin took part and the games were followed by a presentation by Alan Matthews, Manager of Shelbourne Football Club. The theme for the final day was called ‘Recovery is Contagious’, at which four former Soilse service users spoke about their pathway through recovery. There was also a recovery wall where participants could post their personal

messages during the three-day event. Professor Joe Barry of Trinity College Dublin, a specialist in public health medicine, chaired the symposium. He remarked that securing recovery from addiction was the main challenge ahead. Martin Keane, Social Research Manager, Health Research Board, gave a research overview of the international context for recovery. Soilse’s role in recovery was summed up by a former participant who said: “Going through Soilse opened up new doors and options. It allowed me to look at things that were important to me at every level of my life: detoxing off methadone, getting drug-free; addressing broad health needs like dentistry, diet, and stress; and exercise to live healthily. It also allowed me to change my thinking and to value the potential I have.”

2/10/12 15:22:13

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2/10/12 15:22:19

INFECTION PREVENTION SOCIETY Conference 2012

1–3 October Liverpool

Working together to improve hand hygiene Hand hygiene compliance continues to be a contributing factor to healthcare associated infections.1 Ecolab’s NEW Hand Hygiene Compliance Education Program has been developed to support our customers in improving hand hygiene within the hospital. Our Healthcare Managers are fully trained in WHO methodology, and are committed to providing excellent service, outlined in our annual Service Charter. They will work with you to plan and implement our unique ﬁve step program which is customised to help support you in meeting your annual KPIs:

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Founded on the World Health Organization’s Multi-Modal Strategy, the Program incorporates WHO assessment and training tools and provides an independent validation of hand hygiene compliance within your hospital.

FREE WARD AUDIT Ecolab are offering a free, no obligation audit of a single ward or department, to demonstrate the beneﬁts of the Program and how Ecolab can help improve hand hygiene within your hospital.

To arrange your audit, speak to your Ecolab Healthcare Manager or call:

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Compliance Education Program available exclusively to Ecolab hand hygiene customers.

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in support of

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Health Matters 15

children and families

New Standards for the Protection and Welfare of Children Child protection is the process of protecting individual children identified as suffering, or likely to suffer from, significant harm as a result of abuse. The Health Information and Quality Authority (HIQA) recently published the National Standards for the Protection and Welfare of Children.

aving published the new standards, HIQA will access the wider performance of HSE children and family services – or successor agency – as a service provider, in relation to its statutory functions to provide adequate care and protection to children, under Section 3 of the Child Care Act, 1991 and its statutory duties under Children First. The standards will also guide the HSE’s, or successor agency’s, response to child protection concerns and how these concerns are managed.

Accessible Information The standards are designed to follow a child’s journey within the child protection system to ensure that his or her safety and welfare is being protected. Along that journey, children will be supported through a range of measures. These should include providing accessible information,

©istockphoto.com/DeanMitchell

2 17:00

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timely access to the appropriate services, effective risk-based screening of child referrals, good case assessment and planning to ensure that appropriate services are made available to children as required, the taking of timely action to protect children at risk of harm, working with and sharing information with other agencies in the child’s interest and ensuring appropriate records are kept and maintained securely. The full standards, along with a guide to the standards, and an audio version are available from www.hiqa.ie. These national standards have been developed through a structured process aimed at reflecting best practice in social care regulation in Ireland and abroad. They are based on key principles which guide services on how to protect children and promote their welfare and are grouped according to six key themes as follows:

 Child-centred services  Safe and effective services L eadership, governance, and management  Use of resources  Workforce  Use of information

“The standards are designed to follow a child’s journey within the child protection system to ensure that his or her safety and welfare is being protected.” Benchmarking These standards are now in force. Children and Family Services have been preparing for their introduction by liaising with HIQA regarding the timing and process of inspection, by raising awareness among practitioners and managers and by benchmarking current practice against the new standards. A series of regional workshops will be facilitated by the National Specialist for Child Protection in the coming weeks to help local teams identify their strengths and weaknesses prior to the commencement of the HIQA inspection process. Paul Harrison, Head of Policy and Strategy, said: “Child welfare and protection is our core business and we welcome the standards as a helpful contribution to continuous improvement in this importance area.” For further information, see www.hiqa.ie.

2/10/12 15:22:25

16 Health Matters

croke park agreement

Real Change The second annual progress report of the Croke Park Agreement (Health Sector) was published in June 2012. In addition to a report on progress, there is also an update on savings and productivity achievements.

Work Practices Work practices have changed significantly with the introduction of the extended working day, revised rosters and the movement of care services into the community. For example, within

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Radiography Services, the implementation of the extended working day and changes in rosters have resulted in estimated savings of s2.25m per annum. Also, within Laboratory Services, revised terms for the provision of working outside of normal hours have resulted in estimated saving of s7m per annum. Within Older Persons Services, long-stay units are being reconfigured and community nursing units have been established at St Mary’s Cork, Ballincollig, Dingle, Tralee, St Joseph’s Raheny, Navan and Loughrea. And in our Disability Services we have seen the movement of service users with disabilities from congregated settings to community settings. Significant Achievements Some significant achievements include the continued implementation of the Clinical Care Programmes as follows:

“Activity levels have been maintained and have increased above Service Plan 2011 targets in some areas, despite a reduction in the budget of s683m (4.85 per cent) for 2011, compared with 2010.”  A cute Medicine Programme: A minimum of 70,000 bed days have been saved, equating to savings of

©istockphoto.com/Henrik5000

he real success of the Croke Park Agreement, officially known as the Public Service Agreement (PSA), has been to allow health services to continue to be delivered against a backdrop of everincreasing budget and staffing reductions. In recent months in particular, the Agreement has greatly assisted the health sector in coping with a significant concentrated loss of staff as a result of the ‘grace period’ retirements. The Agreement has also facilitated engagement between management and staff on difficult and challenging agendas and helped to bring about real change. Redeployment is evident across the entire sector. Rosters have been revised and work practices have changed. The report shows that good progress has been made in delivering on commitments in the Health Sector Action Plan. Activity levels have been maintained and have increased above Service Plan 2011 targets in some areas, despite a reduction in the budget of s683 million (4.85 per cent) for 2011, compared with 2010. There has been a reduction of 2,855 in the workforce for the period from the beginning of April 2011 to the end of March 2012. An estimated 4,500 staff have been redeployed and this has helped the health service to meet the challenge of reducing budgets and a reduced staff complement. Adaptability and flexibility on the part of management and staff has been the key to the ability of the health service in continuing to deliver during and after the concentrated loss of staff resulting from the end of grace scheme retirements.

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Health Matters 17

croke park agreement

©istockphoto.com/skynesher

are workforce planning, nursing, clinical, standardisation, allied health professionals and support grades/benchmarking. Working groups, comprising key personnel from the health sector, have been set up for each of these areas. The National Implementation Body has decided that future PSA reporting will be on an annual basis. The next report will thus be on progress on implementation and financial savings from April 2012 to December 2012. It is envisaged that this next report will encompass a report on progress on the six key areas in the Health Sector Action Plan 2012, as outlined above, along with reports on progress and financial savings across all health sector service areas. The Health Sector Action Plan 2012 can be viewed at www.hse.ie/go/crokepark.

approximately s63m and implemented in 12 hospital groups.  E mergency Medicine: 19 Clinical Tools and guidelines complete and live or in pilot. Some 15 more are progressing and theatre utilisation has improved by up to 90 per cent. Nine hospitals have been trained in productive theatre processes. Chronic Disease Programmes Stroke: Six new stroke units have been established with a designated stroke ward and stroke register operational in nine sites.

“The implementation of the Action Plan continues the reform agenda provided for in the Croke Park Agreement and represents a major challenge to the health services over the course of the year.”

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Outpatient Programmes  D ermatology: A target of a 30 per cent increase in outpatient attendance has been exceeded to 34.6 per cent.  N eurology: There was a 9 per cent increase in activity in outpatient departments, compared to 2009 levels.  R heumatology: There was a 37.7 per cent increase in new and return rheumatology outpatients treated, compared to 2009 levels. Value for Money Value for money (VFM) savings of s178m was achieved, including savings of s80m in the procurement function through price reductions and efficiency initiatives. New Health Sector Action Plan The Health Sector Action Plan 2012 is designed to support the delivery of the HSE’s 2012 National Service Plan by facilitating the fast-tracking of measures required to deliver essential health and personal social services across the country within the context of further reductions in funding and staff numbers. The implementation of the Action Plan continues the reform agenda provided for in the Croke Park Agreement and represents a major challenge to the health services over the course of the year. To ensure delivery, robust implementation plans are being developed in six key areas where the operating model has to be fundamentally changed. These key areas

Additional Progress

 M ental Health Services – ongoingimplementation of Vision for Change with the establishment of community mental health teams and appropriate community-based care to replace long-stay wards and hospitals.  C hildren and Family Services – management/staff association constructive engagement ongoing to facilitate the establishment of the new Children and Families Agency fromJanuary 2013.  Primary Care – 403 primary care teams in operation and holding clinical team meetings.  Hospital Support Services – SupportStat system for measurement and benchmarking of support services implemented.  C entralisation of Services – MedicalCard service centralised. Three key HR shared services now in place: National Recruitment Service, National Pensions Management and National Personnel Administration. New HSE national capital process implemented in finance shared services.  A dministration rationalisation – programmes of rationalisation and cost reduction in administration are in evidence in every setting via new work practices and technology.

2/10/12 15:22:33

18 Health Matters

national advocacy unit

Open Disclosure In October 2011, the HSE and State Claims Agency with the support and endorsement of the Medical Protection Society (MPS) commenced a national pilot project to develop training and supporting materials on open disclosure. Angela Tysall and Ann Duffy were assigned as project leads and a national project team was established. Here, they explain their work on Open Disclosure.

pen disclosure is “an open, consistent approach to communicating with patients when things go wrong in healthcare. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event.” – Australian Commission on Safety and Quality in Health Care In January 2007, Mary Harney, Minister for Health and Children established the Commission on Patient Safety and Quality Assurance. One of the Commission’s tasks was to “develop clear and practical recommendations which would ensure

the safety of patients”. In July 2008, it completed the report, Building a Culture of Patient Safety. It was published in August 2008 and was approved by the Government in January 2009. One of the key recommendations of the report was the development and support of a culture of open disclosure, to patients and their nextof-kin, following an adverse event resulting in harm to a patient.

“In addition to an event itself, how we personally manage it has a deep effect on all those involved – patients, their families and staff.”

Important Approach Dr Philip Crowley, National Director, Quality and Patient Safety described the importance of open disclosure. “As professionals, working in health and social care services,

+ Angela Tysall, Project Manager, HSE and Ann Duffy, Project Manager, State Claims Agency, who are working to develop training and supporting materials on Open Disclosure.

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Health Matters 19

national advocacy unit we are not infallible. Our desired outcome for patients, service users and their families is not always the final outcome. There are many variables in our work and sometimes things go wrong. In some instances, our actions may have impacted on the end result, but not always,” says Crowley. “In addition to an event itself, how we personally manage it has a deep effect on all those involved – patients, their families and staff. The importance of staff support and the debriefing of staff involved in an adverse event is vital. “When things go wrong, if we ignore or avoid communicating with patients and service users, they often feel the need to engage in alternative processes to source answers. These may include the complaints or incident management process, freedom of information requests, or litigation. These processes – which can often be perceived as negative, time consuming or costly – may in turn, impact on the healing or wellbeing of patients and service users, their families and staff,” continues Crowley. “Research has shown that people are better able to deal with an adverse outcome if we take the time to express regret where appropriate, acknowledge what went wrong, examine why it happened and outline what we are doing to ensure it does not happen again. More importantly, as individuals, we are reassured that we acted with integrity, took the right and ethical action and were truly professional. The work on open disclosure is more than a pilot, it is a change management project that requires a cultural shift. However, the benefits are significant for all who provide or use our services,” the National Director concludes.

Pilot Management The national project leads identified two pilot sites: the Mater Misercordiaie University Hospital, Dublin and Cork University Hospital, Cork city and commenced working with them in October 2010. In preparation for the pilot project, the project leads asked both sites to complete a staff patient safety pre-culture survey. They then prepared a project proposal. The proposal assisted the pilot sites to take a structured change management approach towards implementing in line with international best practice and in keeping with the principles of open disclosure. The responsibilities of the pilot sites were

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broken down into the following categories: preparation, leadership, local policy, visibility, support for staff and patients, training, audit and evaluation.

Training and Resources The concept of open disclosure can leave staff feeling vulnerable. As part of the pilot, training and assistance were provided for doctors and other healthcare professionals to support them in engaging in the open disclosure process. During the pilot, the following training was provided:  I nformation sessions on open disclosure and the pilot project were provided for staff  H alf-day workshop programmes were delivered to all staff identified by the pilot sites as lead disclosers or those who would be assisting staff and patients during the disclosure process. The national project leads developed a draft guidance document, a practical workbook and reference folder based on the Irish healthcare system, using predominately Irish healthcare system case studies. Some training materials were also provided by the MPS. The reference material is evidencebased and a workshop evaluation tool was developed and used for both the information and training sessions. Legislative Basis The merits of open communication/ disclosure are endorsed by health service providers, insurance companies and professional bodies throughout the world. A consultation paper by the Law Reform Commission in 2008 recommended that

“a statutory provision be considered which would allow medical practitioners to make an apology and explanation without these being construed as an admission of liability in a medical negligence claim”. While Ireland currently has no protective legislation to assist the open disclosure process, it is envisaged that this status will change in the near future. It is anticipated that the upcoming Health Information Bill will contain provisions in it, affording some degree of protection for healthcare personnel. Angela Tysall, Project Manager, says: “In order for this project to succeed, leadership at senior level, hospital CEO/General Manager and Clinical Director is critical. Equally, the identification of a local project lead at each pilot site, the release of staff for training and attendance and use of the process by staff is vital. “The pilot project has demonstrated that the identification of project leads Deirdre O’Keeffe and Celia Cronin, CUH and Catherine Holland, MMUH, were instrumental in driving, highlighting and supporting the project and assisted in implementing the proposal and training,” adds Tysall.

What happens next? The project leads are currently developing a national guidance document and national policy on open disclosure. The roll out of this guidance and training for other healthcare organisations has commenced and will continue into 2013. If you would like more information on this project, please contact Angela Tysall, Project Manager. Tel: (074) 918 9013; Email: angela.tysall@hse.ie.

“In our experience, many complaints arise from poor communication. Once you have established the facts, we advocate a policy of full and open communication. An explanation may be all that is needed to reassure a patient and avoid any escalation. A wall of silence after an adverse incident can provide formal complaints and legal action. If it is clear that something has gone wrong, an apology is called for, and it should be forthcoming. Contrary to popular belief, apologies tend to prevent formal complaints rather than the reverse. We can advise you on how to handle such a situation if you are concerned.” – MPS Members’ Handbook Have you ever been involved in a healthcare incident where something went wrong? Perhaps it was the result of an error, perhaps not. You may have been the staff member, the patient or an observer. Do you remember how the event was managed and how you felt at that time? Did you know that when things go wrong at least 98 per cent of patients want to be told the truth? -– Hobgood et al 2005, Mazor et al 2004

2/10/12 15:22:45

20 Health Matters

children's wound care

Challenges and Solutions Healthcare professionals from the three children’s hospitals in Ireland are working together to develop and share resources and knowledge on the care of children’s wounds. Carol Hilliard reports.

©istockphoto.com/sjlocke

here is a lack of child-focused research to guide healthcare professionals in the management of children’s wounds and many of the guidelines and available resources are based on adult wounds. It is well known that there are often inconsistent practices in relation to children’s wound assessment and management. Furthermore, children are not little adults and the nature of their wounds and their healing differs in many ways to adults. In 2008, the Children’s Tissue Interest Group (CTIG) was formed. The group is composed of healthcare professionals from the three children’s hospitals in Ireland – Our Lady’s Children’s Hospital, Crumlin; the Children’s University Hospital, Temple Street; and the National Children’s Hospital,

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Tallaght. The aim of the group is to develop and share resources and knowledge on the care of children’s wounds. When the group first met, it found that there was little information available which related specifically to children’s wound care. A search of research databases and a simple internet search yielded several wound classification charts. ADULT-FOCUSed These charts show pictures of wounds and give information about the appropriate wound care products for individual wounds. However, these were adult-focused and contained a large number of pictures of pressure ulcers and diabetic wounds, neither of which is commonly seen in children’s healthcare.

One reason why the group had difficulty locating child-focused wound classification charts is the legal and ethical issues around photographing children. These challenges may be off-putting to healthcare professionals, causing them to steer away from developing resources. Similarly, when the CTIG searched for wound assessment tools for children’s wounds, little information was found. The wound assessment tools which were located were designed for adults and tended to focus heavily on the types of wounds seen in adult healthcare. The risk factors which delay wound healing in children are also relevant to adults, including: poor nutrition, anaemia and impaired mobility.

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HealtH Matters 21

children's wound care However, adults may have other clinical problems which delay wound healing but are not relevant to children, including smoking, peripheral vascular disease and hypertension. development oF reSourCeS the first step in the development of wound care resources for children was designing a wound assessment chart which healthcare professionals could use to objectively assess the wound, the risk factors specific to the child, the presence of infection and the condition of the skin around the wound. this wound assessment tool also allows healthcare professionals to also plan the care of the wound in one document. this helps to improve communication by providing a rationale for the care and dressing choice for a wound. It also encourages staff to use the same wound care terminology which promotes consistency and improved patient care. the next step in the project was the development of the wound classification chart. the group developed a picture library of children’s wounds, for which it obtained parental consent for use in education and publication. It then identified the most commonly seen wound-bed types in children and developed a classification chart which included a picture of each wound type and then outlined the care of the wound and the appropriate type of wound care product to use. the purpose of this chart is to promote consistent and standardised care of children’s wounds.

CHILDREN’S WOUND ASSESSMENT TOOL (use a separate tool for each individual wound) Factors which may delay wound healing

Affix Addressograph if available

Please tick 9 all that apply and refer to relevant careplan

Name: ………………………………………

HCR No: ………………

Address: …………………...........................

DOB: ___ / ___ / _______

Reduced mobility F Poor Nutrition F Anaemia F Multiple trauma F Incontinence (inappropriate for age) F Other (please specify) F ………………………………………………………………….

…………………............................ …………………............................ Ward / Dept: …………………………….

Gender: M / F

Weight: ________ kgs Height: ________ cm

Consultant: ………………………..

Any allergies or sensitivities (wound specific): Yes F

Date measured ___ / ___ / ______ No F

……………………………………………………………………………………..…… Multidisciplinary Team Referrals (Please indicate date sent): Dietician:

Please mark the location of the wound

___ / ___ / _____

Infectious Diseases:

Occupational Therapy:

___ / ___ / _____

Others: …………………. ___ / ___ / ____

Physiotherapy:

___ / ___ / _____

……………..…. ___ / ___ / _____

___ / ___ /_____

Photograph(s) taken:

Yes F No F

Wound Swab performed: Yes F N/A F (following initial assessment) Types of wounds (tick 9 appropriate wound) Surgical Traumatic wound Pressure Ulcer (Grade ______ ) Lesion (please specify) ________________________________ Burn / Scald please indicate if: superficial; superficial partial thickness; partial thickness; full thickness; mixed thickness. Other (please specify) ________________________________

Please indicate type of wound (using list opposite)

Wound :

Please describe type / cause and location of wound________

Initial Wound Assessment Pain score (1-10) Use e.g. Faces Scale / VAS / FLACC

Wound Dimensions

length cm width_ cm depth cm

Wound Tissue Type

Epithelialising (pink) Hypergranulation (bright red) Sloughy (yellow /green) Necrotic (black) Granulating (red)

Exudate

Plan Peri-wound skin

None /low Healthy/intact Moderate Dry/scaling High Erythema Fragile Oedematous Macerated

Drain: Yes F No F Type __________ To be removed __ / ___ / ___ Sutures: Yes F No F To be removed __ / ___ / ___

Signs of infection

Primary Dressing

Secondary Dressing

Plan Frequency of dressing change.

Sign & Grade

Increased pain Increased exudate Increased odour Heat Pyrexia Other ……………..

Assessment Date:___ / _____ / 20____ Time: ___ : ____ Signature of Nurse: __________________________ Grade: ________ Ward / Dept ____________________________

Co-signature (if required): ______________________ Grade: ________

Subsequent changes to plan of care

Please complete this section if there is a change in the type or frequency of dressing change. Date & Time

Rationale for change to the plan of care or other relevant information …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… …………………………………………………………………………………… ……………………………………………………………………………………

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Primary Dressing

Secondary Dressing

Plan Frequency of dressing change.

Sign

to complement the tools the group developed a dressing selection template, which the three children’s hospitals adapted to reflect the wound care products used in their service. this document is used in conjunction with the wound classification chart and can be updated as required. ImplementAtIon oF reSourCeS these tools were introduced in the three children’s hospitals and CtIG audited and evaluated them. Based on the feedback from nursing, medical staff and health and social care professionals, the group made some changes to the documents and re-audited them. to date, the feedback has been very positive about the wound care resources. staff indicated that they feel more comfortable and informed when making decisions about children’s wound care. Communication about the management of children’s wounds has improved between staff as the plan of care and the rationale are clearly outlined. this has reduced the number of dressing changes that a child may previously have required if the plan of care was not clearly detailed. the wound care resources have also contributed to improved interdisciplinary communication about the wound care product which suits both the wound and the child. In addition, the tools have helped to promote communication between hospital and community services. a copy of the wound assessment tool with the plan of care is sent with a child who is being

discharged home for wound management in the community. Community services will then have up-to-date information about the condition and management of the wound, and can then plan care accordingly. ShArIng the reSourCeS the CtIG want to make these resources available to healthcare professionals working in other children’s units around Ireland. to launch the resources, a conference was held in February 2012 which was attended by staff from children’s services nationally. topics addressed on the day included managing pain in children, how to use the assessment tools, the differences between wound care in children and adults and the role of nutrition in children’s wound care. the CtIG are happy to share the wound care resources with any service that wishes to use them. they can be sent in electronic format along with a presentation explaining how to use the documents. Carol Hilliard is Nursing Practice Development Co-ordinator at Our lady’s Children’s Hospital, Crumlin, Dublin 12 and can be contacted at (01) 428 2884 or by email at carol.hilliard@olchc.ie.

CASe Study a three-year-old boy was admitted to hospital with an area of cellulitis on his chest and swelling on the left side of his neck. there was broken skin over the swelling and there was pus draining from the area. the child was admitted to hospital and diagnosed with chickenpox. Wound swabs and blood cultures showed group a streptococcus and an additional diagnosis of necrotising fasciitis was made. the child was prescribed multiple intravenous antibiotics. the neck wound was initially assessed as sloughy using the wound assessment tool. the objective was to remove the slough and manage the exudate. the subsequent assessment and wound care plan is outlined in table 1 (far left). We used the wound classification chart (left) to determine the appropriate dressing products for the various stages of healing was used and the wound had healed fully within three weeks.

2/10/12 15:22:54

22 Health Matters

capiTal developments

Taking a closer look at Linn Dara

Photography: Ros Kavanagh

The new Linn Dara Child and Adolescent Mental Health Facility at Cherry Orchard Hospital provides modern mental health services for young people aged two to 18 years of age.

he new facility amalgamates a number of existing satellite departments with varied user groups and staffing requirements and is central to the HSE’s Vision for Change mental health programme. The principle philosophy of the brief was to provide an inviting, open, community-based building with an overriding emphasis on a safe child and adolescent environment. The design aimed to provide a distinct and inviting building, empathetic to children and adolescents with very particular needs. Preliminary sketches illustrated how the building could consist of a number of wings that contain the separate functions of the brief, while providing interconnectivity through a shared, common foyer that provides the desired level of security. Initial analysis and sketch proposals established principles that sought to create therapeutic environments; key aspects included natural light and ventilation, maximising exposure to the magnificent view of the mountains, the use of highquality interior design and art installations, interaction with the peripheral landscape, green roof terraces, integrated winter gardens and courtyards which could provide safe havens where patients and staff can have time to themselves. The design pays particular regard to the

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need for autonomy of each department. This is denoted by the use of discreet dedicated entrances and individualised colour schemes which animate the architectural façade, the organically themed interiors, Buttercup Suite, Lily Suite, Clover Suite and Bluebell Suite. The building’s form and materiality are derived from the desire to ground the facility in its natural landscape environment; its playful form and vivid colour are perceived through a canopy of existing trees. Like a fallen leaf, and its autumnal colours, the building sits peacefully in its parkland setting.

Safety Requirements The completed design prides itself on the subtlety with which the atypical safety requirements common to mental health facilities have been discretely incorporated within the design, resulting in a building that is devoid of institutional presence, a normal yet safe building. The building’s playful massing, the use of natural daylight and ventilation and the opportunity to maximise views combine to create an environment to aid the efficacy of treatment provided. Careful attention to scale, colour, detail and materials has resulted in a facility that is as inviting to children as the surrounding flowers and fallen leaves that inspired the initial concept.

Judges at the recent WAN World Architecture Awards noted the vast improvement in how mental health is catered for in design. The new Linn Dara Child and Adolescent Mental Health Facility by Reddy Architecture + Urbanism was one of the two mental health projects to make the last 32 of these prestigious international awards.

“The design aimed to provide a distinct and inviting building, empathetic to children and adolescents with very particular needs.” Dorota Nieznanska, Project Manager, HSE Estates Dublin Mid-Leinster, said: ‘’The design delivers a welcoming and cheerful facility; it was the envy of psychiatrists from throughout Europe during a recent visit to the building.’’ The mother of a boy using the facility said: “My son attends the Buttercup Clinic in Cherry Orchard CAMHS. I was blown away by the new premises on our first visit this week. You and your team should be so proud!”

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Health Matters 23

capital developments

Ballyfermot and Palmerstown Primary Care Centre

Photography: PM Photography

Ballyfermot and Palmerstown Primary Care Centre is provided by the HSE as part of the Primary Care – A New Direction policy. The building is intended to act as a one stop shop to the local communities. It is part of the healthcare infrastructure within the area, facilitating the development of an integrated approach to care delivery involving the community, general practitioners, HSE professionals and other service providers.

he centre will provide consultation, assessment and rehabilitation and includes a day activities centre and a day hospital for patients and a homecare team. St Vincent’s Early Childhood Development Service, run by the Daughters of Charity, is located in a freestanding crèche provided by the HSE as part of the development. The complex, located on Ballyfermot Road, consists of a three-storey Primary Care Centre and a single-storey crèche, separated by a new sunny and landscaped semi-public entrance court. The same materials are used imaginatively on both buildings to offer variety in scale, detail and fenestration.

Range of Care The centre is unique in offering all the range of outpatient mental health care in a primary centre. The innovative layout provides access and privacy to a range of care options. Attractive large terraces at

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first floor level, clad in creamy white brick, offer external spaces for relaxation during therapy. The low-energy design is a first for the practice in using KNX technology and LED lighting in the concourse for future flexibility in a public healthcare facility. Also provided are free night cooling, a BMS and weather station to control ventilation, solar panels, use of greywater and biodiversity in planting and microclimates. The planting complements the colours of the building. The garden and playgrounds in the crèche provide a paved area for tricycles and outdoor classes, a rubber-floored equipped playground and a garden hut for play. The ground is sculpted to provide hills and planting is varied to offer variety in massing and biodiversity. Elsewhere, planting offers low maintenance, scent and colour selected to complement the building colours. Trees of four to five metres provide a good start on a vertical accent, and native slips will provide a

good screen with the neighbours in a short time.

An Appropriate Location Services with the heaviest footfall, or those requiring direct access to vehicles such as primary care and therapy are located on the ground floor. The concourse allows for initial clear contact at reception and then space for dispersal and orientation. It gives direct access to the lifts and to the departments on each side at the various levels. The double volume concourse opens onto a small central courtyard, maximising daylight to the rooms and resulting in a compact plan form, minimising long corridors and allowing easy but subtle supervision. It is an appropriate location for exhibitions, displays and demonstrations as part of promotion of health and wellbeing. The day hospital and day centre are located on the first floor and offices and staff areas on the top floor.

2/10/12 15:23:33

24 HEALTH MATTERS

ALCOHOL

IS OUR ALCOHOL Consumption Level Too High? More than four out five people (85 per cent) believe that current levels of alcohol consumption in Ireland are too high according to the results of a new survey, Alcohol: Public knowledge, attitudes and behaviour, published recently by the Health Research Board (HRB).

he survey, conducted and analysed by Ipsos MRBI, sought to measure Irish people’s knowledge, attitudes and behaviours in relation to alcohol consumption, marketing and the selling of alcohol and current and potential responses to alcohol-related health and social harms. The HSE Health Promotion Unit has a National Health Awareness campaign on alcohol, supported by an informative website, www.yourdrinking.ie. It is hoped the findings will help to support and inform the units’ ongoing work. The survey findings show very few people understand what a standard drink is – a measure containing ten grams of alcohol – for example, one glass of beer, one pub measure of spirits, or 100ml of wine. Only one in ten (9 per cent) of people know the recommended maximum number of standard drinks that they can safely consume in one week: 14 for women and 21 for men. Of the 1,020 people surveyed, three in every four people (73 per cent) believe that Irish society tolerates high levels of alcohol consumption. A considerable majority (72 per cent) of the people surveyed say that they know someone who, in their opinion, drinks too much and 42 per cent of this group say that this person is an immediate family member.

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THE MAJORITY SUPPORT: • Labelling alcohol containers to include calories, alcoholic strength, ingredients and health warnings (82 per cent to 98 per cent) • Introducing further measures to deal with alcohol and driving (84 per cent to 94 per cent) • Restricting certain types of alcohol advertising (57 per cent to 80 per cent) • Introducing minimum pricing (58 per cent) and seeking contributions to pay for social and health consequences resulting from excess alcohol use from the people who drink alcohol (61 per cent to 71 per cent)

“The survey findings show very few people understand what a standard drink is – a measure containing ten grams of alcohol – for example, one glass of beer, one pub measure of spirits, or 100ml of wine.” PRICING AND AVAILABILITY Three in five people (58 per cent) support a minimum unit price for alcohol. Support

is highest among those aged between 35 to 64 years at 65 per cent. However, 21 per cent of people would not support this action, with lack of support highest (33 per cent) among the 18 to 24 age group. Three quarters of those surveyed purchase alcohol in supermarkets. The survey revealed that it would take a price increase of 25 per cent or more to get 67 per cent of people to decrease the amount that they purchase. For example, a 25 per cent increase on an average bottle of wine priced at s6.99 would increase its price to s8.74 and 67 per cent of people (who would buy it at s6.99) would buy that bottle less often. Overall, 25 per cent of the people who shop in supermarkets would buy more alcohol if the price of alcohol was to decrease, notably 50 per cent of 18 to 24-year-olds claim they would buy more. Those aged 18 to 24 years are most likely to respond to promotions and price reductions with almost two-thirds (65 per cent) saying that they buy more when alcohol is on special offer or when the price is reduced. Dr Jean Long at the Health Research Board says: “These results indicate that young people’s purchasing of alcohol is most influenced by pricing”

ADVERTISING AND SPONSORSHIP People strongly support a variety of advertising restrictions, including: • Adverts being limited to the product and not the person who consumes the brand (78 per cent) • No alcohol advertising at the cinema for movies rated 17 years and under (80 per cent) • No alcohol advertising on TV and radio before 9pm (76 per cent)

©thinkstockphoto.com/pixland

REDUCING CONSUMPTION Three in every five (58 per cent) do not believe the Government are currently doing enough to reduce alcohol consumption and almost four in five (78 per cent) people think the Government has responsibility for introducing public health measures to address alcohol consumption. People’s responses to survey questions indicate support for implementing a number of

the individual measures in the recentlypublished Report of the Working Group on a National Substance Misuse Strategy for alcohol.

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HealtH Matters 25

alcohol HEALTH AT A GLANCE 2011: OECD INDICATORS

Litres per capita (15 years and over)

Change in consuption levels 19802009%

Netherlands

9.4

-18%

New Zealand

9.3

-21%

Greece

9.2

-19%

France

12.3

-37%

OECD

9.1

-9%

Portugal

12.2

-18%

9.0

-38%

Austria

12.2

-16%

Slovak Republic

Czech Republic

12.1

+3%

Korea

8.9%

n.a

United States

8.8

-15%

Estonia

12.0

n.a

Chile

8.6

-21%

Luxembourg

11.8

-14%

Canada

8.2

-23%

Hungary

11.8

-21%

Italy

8.0

-52%

Slovenia

11.5

n.a

Sweden

7.4

n.a

Russia Fed

11.5

+45%

Japan

7.4

+4%

Ireland

11.3

+18%

Iceland

7.3

+70%

U.K.

10.2

+9%

South Africa

7.2

+17%

Poland

10.2

-11%

Norway

6.7

+12%

Switzerland

10.1

-25%

Brazil

6.2

+188%

Denmark

10.1

-14%

Mexico

5.9

+74%

Australia

10.1

-25%

China

4.4

+159%

Spain

10.0

-46%

Israel

2.5

-11%

Finland

10.0

+27%

Turkey

1.5

-17%

Germany

9.7

-32%

India

0.7

+47%

Belgium

9.7

-28%

Indonesia

0.1

-25%

OECD Country

From the steering Group report on a National substance Misuse strategy, February 2012, published by the Department of Health. the OeCD Health at a Glance report included details of the per capita alcohol consumption in 2009 across 40 OeCD countries, as well as the change in consumption patterns since 1980. the change reported for Ireland shows an increase of 18 per cent over the 19 years. Ireland’s per capita consumption in 2009 was 11.3 litres per adult (15+ years), which was tenth highest out of the 40 countries surveyed in 2009. the OeCD average consumption for 2009 was reported as 9.1 litres per adult.

• Banning of advertising on social media (70 per cent) • Banning of alcohol adverts on billboards and bus stops (57 per cent) a ban on the alcohol industry sponsoring sporting and musical events is supported by 42 per cent and 37 per cent of people respectively.

heAlth And SoCIAl CoStS a Hse-commissioned report showed that in 2007, the health-related costs of alcohol were s1.2 billion. Of those people

HM Iss8.3 p1-52.indd 25

surveyed, 61 per cent believe that those who drink alcohol should contribute to health-related costs, 42 per cent believe the alcohol industry should contribute, with 27 per cent supporting state taxes contributing these costs. the same study showed that public disorder-related costs in 2007 also amounted to s1.2 billion. When asked, 71 per cent surveyed said that individuals who drink alcohol should contribute, 30 per cent believe the alcohol industry should contribute, while 22 per cent support a state contribution through taxation.

the survey results indicate strong support for additional measures to address drink-driving. “this report provides evidence that the public thinks that our alcohol consumption is too high and that they support the Government to introduce public health measures to reduce alcohol consumption in Ireland,” added Dr long.

“for example, a 25 per cent increase on an average bottle of wine priced at s6.99 would increase its price to s8.74 and 67 per cent of people (who would buy it at s6.99) would buy that bottle less often.”

CAlorIe guIde: Use the calorie guide below to count your calories on a typical night out.  Pint lager 200 calories  Pint stout 170 calories  Pint cider 210 calories  longneck cider 122 calories  longneck alcopop 220 calories  Medium glass wine (175ml) 130 calories  Pub measure vodka, gin, brandy, whiskey: 80 calories  Pub measure cream liqueur 120 calories And how long would it take to burn-off those calories? One pint of lager, you would need to:  Walk for 50 mins  swim for 30 mins  Dance for 35 mins  Play golf for 1 hour and 20 mins  Do aerobics for 32 mins For more information on alcohol consumption, visit www.yourdrinking.ie.

2/10/12 15:24:04

26 Health Matters

RESEARCH feature

OPEN Wide and say AHH A Health Research Board-funded dental project has helped to identify potential cost savings and service efficiencies for older patients.

The Shortened Dental Arch Gerry studied treatment options for filing those spaces and found that using a concept called the Shortened Dental Arch led to improved patients’ quality of life, nutritional status, and was more cost effective than traditional removable dentures. Gerry explains: “Researchers working in the Netherlands previously found that elderly patients can function well without a complete set of top and bottom teeth. Patients can function very adequately with just ten teeth on the top and bottom. With the shortened dental arch concept the aim is to only replace these strategically important teeth towards the front of the mouth with what’s called fixed bridgework. This is a permanent replacement tooth that is glued to the teeth next to it. This works both aesthetically and functionally, with the added bonus that it is easy to maintain; you just brush it like a normal tooth. This approach has been endorsed by the World Health Organisation who has stated that a goal for oral health should be that adults retain for life a healthy, functioning set of teeth without the need for a removable denture. Dentures can have a negative effect on the remaining teeth because patients are often unable to clean them properly, so they build up plaque causing gum disease and decay in adjacent teeth.

HM Iss8.3 p1-52.indd 26

©istockphoto.com/choja

ith people living longer and retaining their natural teeth, the vast majority of older patients in Ireland currently receive partial dentures to replace their missing natural teeth. Dr Gerry McKenna, a lecturer in Prosthodontics and Oral Rehabilitation in University College Cork was recently honoured with an international prize for his Health Research Board-funded study on dental replacement strategies in elderly patients. Dr McKenna was part of the first intake of HRB Scholars in Health Services Research.

We’ve completed a cost benefit analysis, comparing the delivery of both treatment options. This included time, labour, and materials, along with maintenance costs and the shortened dental arch comes out around 50 per cent cheaper per patient than conventional removable dentures. This should be of great interest to policymakers because at the minute, while most elderly patients are eligible for dentures under the medical card scheme, fixed bridges like those used in this study are not covered.” The findings from Gerry’s HRB-funded research project called ‘Developing evidence based oral healthcare for older Irish adults’ recently won the prestigious Hatton Award (Senior Clinical Research) from the International Association of Dental Research.

+ Dr Gerry McKenna

2/10/12 15:24:10

Health Matters 27

RESEARCH feature

Catering to Your Health “The HRB is committed to funding practical projects like these which clearly demonstrate the impact that health research can have on people’s health and the way patient care is delivered, as well as delivering potential cost savings for the healthcare system.”

Hospital staff contribute to study on fat, sugar and salt intake.

iona Geaney, a PhD research student at the HRB Centre for Health and Diet Research carried out the research in cooperation with the catering departments in two public hospitals in Cork. Fiona explains,“With modern lifestyle and work practices, a lot of people are dependent on out-of-home eating. This has the potential to lead to food choices that might not be in our best long-term health interests. “We know that poor diet, too many calories and not getting enough exercise are all bad for our health. We also know that conventional information and educational campaigns about healthy eating are relatively ineffective at changing behaviour. So we wanted to see if a structured catering initiative could be used to promote healthy, or at least healthier, food choices at work. We carried out a two-year pilot study in two public hospitals in Cork. “The catering initiative involved making some relatively simple changes to menus and practices at one hospital, while making no changes in the second hospital. The changes included limiting high salt products such as gravy mixes and stock cubes, replacing high-salt processed meats with low salt options like turkey, chicken and fish and providing extra salad and vegetable options at no extra cost. Desserts were made fruit-based and salt cellars were removed from tables and replaced with small sachets at the counter. The changes were largely cost neutral, although that wasn’t strictly part of the survey. “A sample of fifty random employees from each hospital who consumed at least one main meal in the hospital staff canteen daily took part in the study. We compared

HM Iss8.3 p1-52.indd 27

HRB CEO Enda Connolly + Fiona Geaney the employees’ dietary intakes and found that employees in the hospital that made the changes had lower intakes of total fat, saturated fat, sugar and salt, and they also consumed fewer calories. “This pilot study suggests that this type of catering initiative sustained over a relatively long period could positively influence long-term food choices at work and at home. “Since the results of this pilot were published in the Journal of Public Health Nutrition, we’ve had great interest from a number of companies who are eager to participate in a new larger study in a range of workplace settings which is due to start later this year. We hope that the results from this study will influence public health nutrition policy, motivate the food industry to provide healthier food choices and reduce the overall burden of diet-related disease in Ireland.”

+ Enda Connolly.

2/10/12 15:24:17

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3/10/12 14:16:48

HealtH Matters 29

mental health

value For Money a study undertaken by the kildare/west wicklow Community Mental Health Service found that it is more cost-effective to provide comprehensive acute care in a community setting, when compared with the cost of admission to a modern acute setting.

he study was launched in May by Kathleen lynch tD, Minister for Disability, equality, Mental Health and Older People. Ireland’s national mental health policy, A Vision for Change, is focused on a modern service model which is predominantly based in the community. the Kildare/West Wicklow Mental Health service provides a community-based service designed to meet the needs of the service users. the team consists of psychiatrists, a homecare nursing team, clinical nurse specialists, a day hospital nursing team, clinical psychologist, occupational therapist and a mental health social worker/family therapist. the study used the available financial data to compare two busy mental health sectors to illustrate the economic benefits of the comprehensive community-based model. Martin rogan, assistant National Director for Mental Health services, commented: “It may be difficult to replicate this in some parts of the country, but there is a real opportunity here to show how a homecare team can radically reduce admission rates and provide a better quality services at a lower cost.”

the prInCIpAl FIndIngS Were: Comprehensive community care can be provided at a lower cost than inpatientoriented care and at an enhanced level of quality to inpatient-oriented care Comprehensive community care is demonstrated to fit much more closely with the guidelines described in the Vision for Change report than inpatient-oriented care and is shown to provide a realistic, achievable and sustainable alternative to inpatient-oriented model of care. Comparative economic analysis is a feasible and effective tool in exploring issues of quality and cost-effectiveness in different models of care.

HM Iss8.3 p1-52.indd 29

+ l-r: Pat Gibbons, Consultant Psychiatrist (co-author); Martin rogan asst Nat. Director, Mental Health; Kathleen lynch tD, Minister for Disability, equality, Mental Health and Older People; edward Meaney, accountant Hse, (Co-author).

neW ApproACh Dr Pat Gibbons, Consultant Psychiatrist, said: “the challenge for service providers has been to convert to a more personcentred approach in today’s context of limited resources. the current report contributes to the debate by establishing that high-quality care can be delivered in a community setting in a cost-effective manner.” On the basis of these conclusions, the following recommendations were made: • Available resources for mental health care should be invested primarily in comprehensive community-based services, along the lines laid out in a Vision for Change. this will require continuing the process of shifting both resources and mind-sets from in-patient delivered to community-delivered models of service. • National performance indicators, which

reference care in the community, as well as inpatient care, should be established. • The lack of a standardised national database of service demand, delivery and quality limits the extent to which the findings can be generalised to other mental health services nationally. a database of service demand, as well as of the quantity, quality and cost of service provision, should be established so that service resources can be planned in a rational way based primarily on patient need. It is recommewnded that further comparative economic analyses be carried out to explore how different models of delivery perform in terms of value for money.

2/10/12 15:24:27

30 Health Matters

mental health

©ThinkStockphoto/iStockphoto

Case Study Liam*, who has schizophrenia, feels strongly that the community-based care he received helped him to come to terms with his diagnosis. ‘‘Mental health sickness and how it is dealt with should be on the same footing as physical health and its treatment. It’s all about dealing with it in the community. If only the stigma could be lessened around how mental health is perceived then a better understanding would help people who suffer with this, their families and friends,” he said. Liam, who is from Leinster, was diagnosed with schizophrenia three years after what he calls his first ‘episode’. Schizophrenia is a complex mental health problem which can manifest itself in a number of ways. Each individual will experience a range of symptoms, and not everyone will have them all. Schizophrenia affects thinking, feeling and behaviour. Nearly one in 100 people will experience schizophrenia in the course of a lifetime and one in four people suffer with a mental health issue. Without Celbridge Mental Health Day

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Hospital, Liam feels he would have “suffered longer”. He adds: “These types of settings act as a good halfway house for people who may be in hospital for long periods and need to readjust to a more routine setting before going home. They are also suited to a feeling that you are being treated as a normal person with an illness that just happens to be psychological. “Day hospitals should be introduced wherever possible. Everything comes into question when I’ve had my episodes. The first time it happened, a work colleague brought me home. I was under a lot of pressure at work and there were also some personal relationship difficulties,” notes Liam. “I was having jumbled thoughts that everyone was out to get me or knew things about me and that what was happening in my work and private life was public knowledge. I removed myself from the situations I felt uncomfortable in and went to stay with family while I saw a consultant psychologist. I was put on a small amount of medication for a short space of time. Life resumed to normality then for around three years.”

Liam was diagnosed with schizophrenia when he had his second episode. He says: “When the second episode occurred, I was brought to Naas General Hospital and I stayed there overnight. That was the only time I was admitted. People were afraid I was going to harm myself, but I never thought that would happen. It was then that I was diagnosed with schizophrenia. “It was through my time at Celbridge Day Hospital that I became more comfortable and understood more about what was happening to me. It is like going to work as you are there for several hours per day. You get to meet other people and you can empathise with them. You are monitored all the time by a nurse and meet with a psychiatrist every other day. It has helped me, my family and friends to understand what happens and what tell-tale signs to look out for. “My last bout of sickness was last year and now I am on ongoing medication. But I can honestly say that I’m feeling the best I have in a long time,” concludes Liam. * Liam is not his real name.

3/10/12 10:35:46

Health Matters 31

open house

A Celebration of Architecture Open House Dublin is the biggest celebration of architecture in Ireland and is presented by the Irish Architecture Foundation. This year, the event will run over the first weekend in October. Health Matters reports.

Photography: PM Photography

+ Primary Care Centre.

ver one weekend in October (5th to 7th), buildings of all types and periods open their doors to more than 27,000 citizens and visitors, allowing them to explore the architecture of the capital, with special tours by hundreds of dedicated professionals and enthusiasts, completely for free. On the Saturday, two recently-completed buildings for the HSE in Inchicore will open their doors to the public: the Community Nursing Unit by Cullen Payne Architects and the Primary Care Centre by RKD Architects. Both buildings are innovative new healthcare buildings and Open House Dublin offers a unique opportunity to the public to experience these buildings, with free tours led by the building architects. Commenting on the design of the Primary Care Centre, Dorota Nieznanska of HSE Estates, said: “The brief that we set our architects was very challenging. We wished to incorporate a derelict, protected structure into the design for

HM Iss8.3 p1-52.indd 31

+ Primary Care Centre. our new Primary Care Centre. The result has been astounding. They have created a building, which is modern, bright and spacious, yet also effortlessly meshes the protected structure into the new build elements. “We love the variety of spaces that have been created and how each of the disciplines accommodated all have a sense of place and togetherness. The building is very popular with our patient groups and staff and we refer it to all of our designers as an example of how a centre should be laid out.”

Architecture Alive Open House is a simple but powerful concept: buildings of architectural quality, many of which are not normally open to the public, open their doors over a weekend completely for free. Founded in London in 1992 by Victoria Thornton, Open House has become a high profile international event that raises awareness

“Both buildings are innovative new healthcare buildings and Open House Dublin offers a unique opportunity to the public to experience these buildings with free tours led by the building architects.” of the value of good design in cities across the world. Cities such as New York, Melbourne, Barcelona and Helsinki all participate in Open House.

2/10/12 15:24:47

32 Health Matters

open house

Open House Dublin has adopted a theme every year to respond to topical issues in the built environment. ‘Architecture Alive!’ is the title and theme of this year’s event and is an exploration of the vitality of Dublin through its architecture, and the people who experience it. Cities are fluid, they have the capacity to live, grow and develop and the organisers want us to think about the impact buildings have on our lives and how they shape our environment and us. Healthcare buildings such as the Community Nursing Unit and the Primary Care Centre play a particular role in this. Why not enjoy Open House Dublin this year? To find out more about the event with full listings of this year’s programme, see the website of the Irish Architecture Foundation: www.openhousedublin.com, sign-up for foundation’s newsletter or follow on Facebook and Twitter.

Community Nursing Unit and Primary Care Centre, Inchicore The project combined the two new building types on a single site at St Michael’s Estate in Inchicore, which is being regenerated by Dublin City Council. All that remains of Richmond Barracks, which once occupied the land, is a row of three undistinguished listed buildings that separate it from the rest of the regeneration area. RKD Architects master-planned the site and located the Primary Care Centre to the north and placed the community nursing unit, designed by Cullen Payne Architects,

HM Iss8.3 p1-52.indd 32

+ Primary Care Centre. along the eastern boundary. They reserved space for a memorial garden and set aside the remaining protected structures for future use by Dublin City Council as a library and museum dedicated to local history.

Primary Care Centre The Primary Care Centre is arranged around south facing landscaped courtyards and gardens to humanise the scale of the building and offer opportunities for safe outdoor activities. Facilities include GP, dental, addiction, physiotherapy, mental health, social work, community nursing and community welfare services. Standardisation of key rooms in the building extends their use throughout the day and creates flexibility in how they can by used for various clinical activities. An underground car park frees as much of the surface of the site as possible for communal activities.

Photography: PM Photography and Darran Egan.

“The design of the community nursing unit creates two environments: first, the best circumstances in which patients can recuperate; second, the most favourable working conditions for the staff that care for them.”

Community Nursing Unit The design of the community nursing unit creates two environments: first, the best circumstances in which patients can recuperate; second, the most favourable working conditions for the staff that care for them. The building comprises two parts: to the north, a prayer room, treatment suite, catering kitchen and ancillary facilities; to the south, an entrance hall, staff facilities and the residential accommodation, which consists of 25 bed spaces per floor, mainly in the form of single bedrooms with en suite bathrooms. Nurses’ stations are located at the entrance to the residential accommodation, close to a number of multi-occupancy rooms for use by residents who require more intensive care, and service rooms are clustered around them.

+ Community Nursing Unit.

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HealtH Matters 35

Quit campaign

Quit PlanS – 15,000 Sign uP the HSe’s Quit campaign recently began a new phase. Here, Margaret O’Brien tells her story.

+ Margaret O’Brien at the launch of a new phase of the QUIt campaign in august.

he Hse began a new phase of the QUIt campaign in august, featuring the personal story of 18-year-old Margaret O’Brien from Kilkenny. Margaret’s mother, Jackie, was a long-term smoker and was diagnosed with lung cancer at the age of 45. sadly, Jackie passed away only a year after her diagnosis, in the summer of 2010.

quIt plAn smoking is the single biggest cause of illness, disability and death in Ireland, killing over 5,500 people here each year. the Hse’s ongoing QUIt campaign encourages smokers to try to quit. Over 15,000 people have now signed-up for an online QUIt plan since the campaign started in June 2011. From Irish and international evidence, we know that of all those who try to quit, approximately 5 per cent will use an online support of this kind. as such, 15,000 QUIt plans represents a total of about 300,000 smokers in Ireland

HM Iss8.3 p1-52.indd 35

who have made an attempt to quit since the campaign began. this represents nearly one-third of the total number of smokers, and a 200 per cent increase on the number of smokers who are actively trying to quit from the previous year.

Support Margaret has had the support of her dad, John, in taking part in the QUIt campaign. In her QUIt film, she talks about her mum; what she misses most about her and how, although she knew smoking was harmful and could lead to cancer, she would also have thought, ‘No one could be that unlucky.’ Describing the impact of her loss, she says: “It’s not just for a day, it’s not just for a month – it’s for the rest of my life that I'm without her.” since its launch last year, the QUIt campaign has been focusing on one key fact – one in every two smokers will die of a tobacco-related disease. the campaign

has shown marked and sustained increases in the numbers of people seeking help to quit.

IF you Would lIke to try to quIt SmokIng:  Visit www.Quit.ie and sign-up for an online QUIt plan  Contact a Hse smoking cessation service near you – see www.Quit.ie  Contact the National smokers’ Quitline on Callsave 1850 201 203 to talk to an advisor  Join the ‘You Can Quit’ Facebook page, where hundreds of quitters are chatting and giving each other support – www.facebook.com/ Hsequit  Contact your GP, pharmacist or dentist; they are a good source of information, advice and support

2/10/12 15:25:32

36 Health Matters

clinical Programmes

Stroke Care Staff Aim for Excellence Health service staff that care for people affected by strokes are set to benefit from a new staff training programme aimed at improving their knowledge, skills and confidence.

he Stroke Care Foundation education programme for all healthcare staff has been developed by the Stroke Education Steering Group, a subgroup of the National Stroke Clinical Care Programme Working Group. This interdisciplinary group facilitates nursing and therapy professionals to work together on the development of the education programme and the aim of the group is to develop a national foundation education programme suitable for all staff that care for patients affected by stroke.

Learning Together The programme aims to promote excellence in stroke care amongst all healthcare staff working with people affected by stroke by improving their knowledge, skills and confidence. Such care must be informed by current best evidence and practice-based lifelong learning. The programme adopts a blended learning approach with two main components. An online learning programme which addresses the core competencies for caring for the patient affected by stroke. The e-learning resource has been developed by the Scottish government to enhance education for healthcare staff, throughout the world, working with people affected by stroke. It is aimed at healthcare staff who may: • Be new to stroke care, such as rotational staff or those new in post • Wish to refresh/extend their existing stroke knowledge • Care for a variety of patients including stroke patients • Have limited access to other stroke specific training Once a participant has completed the 20 core competencies online and gained the associated certificate, they may then apply to attend the taught programme.

HM Iss8.3 p1-52.indd 36

+ L-R: Emma Benton, Therapy Professions Advisor; Imelda Noone, Advanced Nurse Practitioner in Stroke Care St Vincent’s University Hospital; Prof. Peter Kelly, Consultant Stroke Neurologist, Director of the Stroke Service at the Mater University Hospital; Joan Gallagher, National Clinical Programmes Liaison, ONMSD; and Caitriona Greene, Special Co-ordinator, Regional Centre, HSE South East. The provision of this education will be facilitated by the designated stroke trainer/ facilitator in the area/stroke care network, in collaboration with the Centre of Nurse/ Midwifery Education and the local stroke care multidisciplinary team. This programme will reinforce the online learning and allow for additional education, group discussion and practical demonstrations. Currently this is designed as a two-day facilitator-delivered taught programme. The National Stroke Programme recognises it may be possible to deliver this locally in different ways (e.g. ward-based or session-by-session over a period of weeks). The duration of the programme could also be tailored to the needs of different staff depending on their role. The programme was piloted and evaluated by multidisciplinary teams in St Vincent’s University Hospital, Dublin and the Centre of Nursing and Midwifery Education in Waterford.

A ‘Train the Trainer Day’ was held in Dr Steevens’ Hospital at the end of August. Imelda Noone, Advanced Nurse Practitioner in Stroke and Lead Clinical Nurse on the National Stroke Programme, said: “There has been a very positive response from all healthcare staff throughout the country and we are delighted that we have been able to facilitate this blended learning. This programme enables staff to have the knowledge to educate at local level to improve knowledge skills and confidence in relation to stroke care to ensure equitable care for all stroke patients and their families. Sincere thanks to the whole multidisciplinary team who have been involved in the development and delivery of the programme.” Details of the Stroke Education Programme are available on the HSE website, www.hse.ie/eng/about/Who/ clinical/natclinprog/stroke.html.

2/10/12 15:25:38

Health Matters 37

clinical programmes

Stroke Register to Provide Valuable Data Patient safety, quality assurance of services and accurate health information are key issues for the chronic disease programmes in the Clinical Strategy and Programmes Directorate.

+ Suzanne Walsh (right) with Prof. Peter Kelly, Consultant Stroke Neurologist, Director of the Stroke Service at the Mater University Hospital (left).

support to hospital staff implementing the register.

Partnership The first Irish stroke register is a collaboration between the HSE National Stroke Programme and the HIPE Unit in the Economic and Social Research Unit (ESRI). The implementation of the stroke register is overseen by a National Stroke Register Interim Implementation Group. The group comprises representatives from the national stroke programme, ESRI, Irish Heart Foundation Council on Stroke and stroke register users. Philip Dunne from ESRI and Paul Marsden from Department of Public Health in Tullamore provide training and

Stroke Registers The key principles of the HIPE Stroke Register are: • The ability to provide real-time data. • The participation of all Irish hospitals in the public healthcare system to avoid bias, which is recognised to occur if only some patients or hospitals participate. •T o optimise the use of existing information technology through the alignment with existing clinical and information technology structures and to maximise the involvement of existing clinical, administrative, and ICT personnel employed within the health service. However, it is recognised that additional investment is likely to be required to fully realise the benefit of a national stroke register. • To align with developing standards under HSE and the Health Information Quality Authority (HIQA). • To be feasible with available resources

he establishment of a stroke register, as one of the HSE National Stroke Programme work streams, gives due recognition to the need to monitor and evaluate routine stroke care in hospitals. Up until now, research on different aspects of stroke care (acute and therapeutic interventions), population-based studies (estimating stroke prevalence) and once-off local and national stroke audits (process, outcomes and costs) formed the basis of our knowledge of stroke care in Ireland.

HM Iss8.3 p1-52.indd 37

or those which may be realistically expected to be obtained in the near future. A register which requires existing healthcare personnel to obtain and perform computerised data entry of large numbers of variables, or to perform multiple assessments or late follow-up assessments of individual patients is unlikely to be feasible for implementation. • To be capable of allowing valid within and between-country comparisons between individual Irish hospitals and between Ireland and other international registers by the development of key quality indicators. While international standardised quality indicators for stroke care have not been agreed, the national stroke register is cross-referenced and aligned to key data items collected in international stroke registers.

Implementation A stroke portal on the HIPE system was developed by Philip Dunne in ESRI. In agreeing the first dataset, particular attention was paid to basic variables recorded in Irish stroke audits and international stroke registers. The portal was piloted in the Mater University Hospital in April/May 2011. By the end of September 2011 the register was rolled out in Sligo General Hospital, Naas Hospital, St James’s Hospital, St Vincent’s University Hospital and Beaumont Hospital. At the end of 2011, these six hospitals were invited to give their views and feedback on the register and the dataset. This feedback was considered by the National Stroke Register Interim Implementation Group and changes were made to the dataset. The revised dataset came into use on January 1st 2012. By the end of June this year, 17 hospitals were implementing the stroke register, with a target of 80 per cent by the end of the year. Further information on the stroke register can be obtained from Paul Marsden, Researcher, Department of Public Health, Tullamore. Email: paul.marsden@hse.ie.

2/10/12 15:25:44

38 Health Matters

immunisation

Making a Difference Immunisation 4 Life is a group of volunteer health professionals from the west of Ireland, many of whom currently work or have worked with the HSE.

he group came together in 2009 to organise immunisation programmes and child health clinics for children aged under five years in the poorer countries of the world and to provide teams in emergency and developing situations to support existing charities and NGOs. The group consists of experienced Public Health Nurses and Doctors, with Dr Kevin Connolly (former Consultant Paediatrician, Portiuncula Hospital Ballinasloe) as Medical Director. In addition to Dr Connolly, founder members include Maura Moran (PHN Headford), Carmel Whiriskey (RM, RG, Loughrea), Corrine Mannion (RM, Galway) Katherine Farrell (PHN, Barna), Marilyn Kelly (Asst. Director of Public Health Nursing, Galway) Dr Mary Fitzgerald (Senior AMO, Galway) Dr Kathryn Chambers (AMO, Galway), Mary Holian (former PHN, Tuam) and Maeve Gacquin (Senior Dietician, Galway Clinic).

“She had previous experience volunteering with an NGO in emergency situations in Africa and recognised that there was huge goodwill and experience in the west of Ireland that could be used to help those living in the developing countries.” NERI Clinics In 2011, Immunisation 4 Life created a partnership with a well-established charity in Zambia called the NERI Clinics

HM Iss8.3 p1-52.indd 38

+ A child being weighed as part of the screening for malnutrition at the nutrition clinic in the Linda Province, Lusaka, Zambia in June 2012.

(www.nericlinics.org), which has a busy primary healthcare clinic in the Linda province on the outskirts of the capital, Lusaka. The NERI Clinics are managed by two Irish GPs and are run by qualified health professionals from Zambia. To date, Immunisation 4 Life has undertaken three trips to the NERI Clinics, involving 21 volunteers. The average trip lasts for ten days and the volunteers travel on their own time, taking holidays from work and paying for the trip themselves.

Nutritional Status Maura Moran is one of the driving forces behind the group. She had previous experience volunteering with an NGO in emergency situations in Africa and recognised that there was huge goodwill and experience in the west of Ireland that could be used to help those living in the developing countries. She says: “I knew from my experience in Africa before I started working with the HSE that there were children and families living in very difficult circumstances and that we have such abundance here that it would take very little

to make a huge difference in other people’s lives. I was lucky that I met like-minded people and together we started this charity. “In addition to looking at immunisation we are also very interested in providing support to address the problem of malnutrition, which isn’t just a case of lack of food, but rather lack of appropriate food. On one of our early trips to Zambia, we surveyed the nutritional status of children under five years of age in the Linda province and found that 2 per cent were severely malnourished and 17 per cent had moderate malnutrition,” adds Maura.

Severe Malnutrition This has serious short and long-term implications for the health and wellbeing of these children and in order to address the problem, the development of a nutritional programme was needed. This involved recruiting and training the community health workers to screen for malnutrition and then to assist in running a weekly nutrition and under five-year-olds clinic where moderately malnourished children attend for extra feeding or supplementary feeding. Up to 150

2/10/12 15:25:56

Health Matters 39

immunisation “Without this clinic many of the children with severe malnutrition would be referred to the University Teaching Hospital in Lusaka where they would be admitted for at least eight weeks.”

+ Immunisation 4 Life volunteers with NERI Clinics staff in June 2012. Back row (L-R) Maeve

children attend this weekly clinic at any one time where they are monitored for progress until they have achieved the ideal weight for their height and maintain it for four weeks. Maura comments: “Without this clinic, many of the children with severe malnutrition would be referred to the University Teaching Hospital in Lusaka, where they would be admitted for at least eight weeks. A family member – usually the mother – has to stay with the child, which is disruptive to family life and could compromise the wellbeing of other children at home. And also, unfortunately, the mortality rates are very high at 30 per cent. It is too soon to gather data on the success of the nutrition clinics we have developed,

but we know that we are able to provide the necessary care to these children in their community without the disruption that a hospital stay would cause. “We are also committed to providing a rapid response to provide vaccination programmes in emergency situations such as refugee camps, conflict situations and natural disasters. As a dynamic, flexible and motivated group of professionals, our priority is to implement a successful vaccination programme which will benefit thousands of children. We have a special interest in the measles vaccination, but are willing to participate in any vaccination programme that will help save lives,” notes Maura.

Gacquin, Senior Dietician, Galway Clinic; Stephanie Coen, Midwife, Galway University Hospitals; Maura Moran, PHN, Galway; Katherine Farrell, PHN, Galway; Hilary Lane, PHN, Cork; and Dr Kevin Connolly, Consultant Paediatrician. Front row (L-R): NERI Clinics staff Sr Barbra Banda, Gift Mwale, Tenford Banda, Harriet Chongo, Philip Mubanga, Sr Gienala Kaluba and Sarah Franklin.

“We are just at the start of a long journey, but already we have seen the difference we can make, which spurs us forward. We have recruited volunteers who are highly qualified with relevant medical and nursing experience and we have developed our clinical and administration guidelines. We can offer expertise in immunisation and child health to NGOs and governments and we support the Millennium Development Goals through education, participation and collaboration with local agencies and relevant groups,” concludes Maura. For further information on Immunisation 4 Life, visit www.immunisation4life.com or call (093) 36867.

©istockphoto.com/parema

+ A child being weighed as part of the screening for malnutrition at the nutrition clinic in the Linda Province, Lusaka, Zambia in June 2012.

HM Iss8.3 p1-52.indd 39

2/10/12 15:26:18

40 Health Matters

governance

director general designate Minister for Health Dr James Reilly TD announced the appointment of Tony O’Brien as Director General designate for the HSE last July. O’Brien took up his new post in August and will formally assume the position of Director General once new governance legislation is passed by the Oireachtas.

ollowing the departure of former HSE Chief Executive Cathal Magee in August, Tony O’Brien became Deputy Chief Executive of the HSE. O’Brien will remain in that position until the governance legislation is passed, at which time he will formally become the Director General and the post of Chief Executive will cease to exist. In the meantime, as Director General designate, he is working closely with all relevant figures in the HSE in preparing for the new Directorate structure which is being established under that legislation.

Measureable Improvements Until his new appointment, Tony O’Brien was the Chief Operating Officer of the Special Delivery Unit for a year, was the Chief Advisor to the HSE on the implementation of the National Cancer Control Strategy and was also the Project Director for the National Plan for Radiation Oncology and the Director of BreastCheck. Announcing the appointment as Director General designate for the HSE, Minister Reilly said: “Tony O’Brien has demonstrated, in a range of different areas, a capability of implementing progress. As Chief Operating Officer of the Special Delivery Unit he has worked with stakeholders across the country to put in place measurable improvements. I am satisfied that Tony O’Brien has the qualities needed to drive the essential reform required to ultimately end our two-tier health system. He also has the strategic ability to manage an enhanced architecture of financial control now being placed in the HSE.” The Minister added: “I would like to assure the staff of the HSE that the changes we intend to implement will result in a health service you can be proud of. I have full confidence that Tony O’Brien can lead the organisation through a period of

HM Iss8.3 p1-52.indd 40

significant change. And I am also confident that Government reforms will lead to a better service for patients and a better environment for staff to work in.”

Career Profile: Tony O’Brien Tony O’Brien is married with two children and lives in County Louth. He is Irish, with his family hailing from Connemara, County Galway. From July 2011 to July 2012 he was Chief Operating Office of the Special Delivery Unit in the Department of Health. From May 2011 to December 2011 he was Director, National Directorate, Clinical Strategy and Programmes in the HSE. O’Brien has held a number of posts in the cancer area: C hief Executive Officer, National Cancer Screening Service from January 2007 to May 2011 D irector, BreastCheck, the National Breast Screening Programme from September 2002 to May 2011 D irector, CervicalCheck, National Cervical Screening Programme from January 2007 to May 2011 P ositions he has held in the HSE National Cancer Control Programme (NCCP) are: A ssociate Director from October 2010 to May 2011  I nterim National Director from February 2010 to September 2010 D eputy Director and Chief Operating Officer from November 2007 to February 2010 C hief Advisor to the HSE on the implementation of the National Cancer Control Programme from May 2006 to Nov 2007. H e also worked as Project Director of National Plan for Radiation Oncology from February 2006 to November 2007 T ony O’Brien was Chief Executive of the Irish Family Planning Association from December 1991 to August 2002. He was

+ Tony O'Brien, Director General designate. also Chief Executive of the UK Family Planning Association from May 1995 to April 1996.

“In the meantime, as Director General designate, he is working closely with all relevant figures in the HSE in preparing for the new Directorate structure which is being established under that legislation.”

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HealtH Matters 41

governance HealtH ServiCe exeCutive (governanCe Bill 2012) bACkground the Programme for Government sets out a clear vision for the health services and the Government is committed to developing a universal, single-tier health service, which guarantees access to medical care based on need, not income. Central to this is greater accountability for the Hse to the Minister for Health and the Department of Health. that process has been ongoing since the Minister announced major changes in the composition of the Hse Board in april 2011 and signalled that the Board structure would be replaced. ImpACt oF the bIll the Health service executive (Governance) Bill 2012 was published on July 18th. the Bill provides for the abolition of the Board of the Hse under the Health Act 2004 and the putting in place of a new governance structure. the Board will be replaced by a Directorate, headed by a Director General and with strengthened accountability arrangements for the Hse. It is important to note that the legal status of the Hse under the Health Act 2004 does not change under the Bill and Hse employees will remain employees of the Hse. purpoSe oF the bIll the Programme for Government also commits to the eventual dissolution of the Hse as the healthcare reform programme advances. the Directorate structure is

therefore an interim measure, intended to put in place a more direct line of accountability between the Hse and the Minister during what will be a transitional period as the health reform programme progresses further. the aim is to have a clear focus on service management during this transitional phase.

CompoSItIon oF the dIreCtorAte Under the Bill, the Directorate will consist of a Director General and other appointed directors. to offer flexibility and allow the size of the governing structure to adapt to changing circumstances, the Bill does not specify a fixed number of members for the Directorate, but instead provides for a maximum of seven and a minimum of three members. hoW the dIreCtorAte WIll Work the Directorate will be accountable to the Minister for the performance of the Hse’s functions, as well as its own. as Chairperson, the Director General will account to the Minister on behalf of the Directorate in regard to how the Hse’s functions are performed. He or she will do this through the secretary General of the Department of Health. In anticipation of the legislative changes, the Minister intends that the Hse will recruit and appoint heads of health and wellbeing, hospitals, primary care, mental health and social care. the new

governance and management structures will allow for reorganisation of services to prepare the way for the wider introduction of ‘money follows the patient’ and the ultimate introduction of Universal Health Insurance.

FIg 1

New HSE Governance Structure

FIg 2

CAthAl mAgee StepS doWn Cathal Magee announced his intention to step down as CeO of the Hse in July. Communicating his decision to Hse staff, he said: “It has been a privilege to work as Chief executive Officer of the Hse over the past two very challenging years. I am proud to have worked in an organisation with such skilled and dedicated staff members who work tirelessly for their patients and clients in often very difficult circumstances. In times of uncertainty that change brings, I would earnestly request that we

HM Iss8.3 p1-52.indd 41

remain focused on our primary objective of delivering quality healthcare to the public.” When announcing the appointment of tony O’Brien, Minister reilly also thanked Cathal Magee for his commitment to the health service and acknowledged his contributions, including maintaining safe health services against the greatest of challenges: major reductions in funding, a significant exodus of staff and a moratorium imposed due to “our fiscal difficulties”.

+ Cathal Magee.

2/10/12 15:26:30

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HM Iss8.3 p1-52.indd 42

2/10/12 15:26:37

Health Matters 43

social media

ONLINE AWARENESS A social and digital media policy and guidance for HSE employees was agreed and published recently. Fidelma Browne, HSE National Communications, outlines some dos and don’ts that are included in the guidance document.

©istockphoto.com/tumpikuja

ver two million people in Ireland now have a Facebook profile, and most of them use it on a weekly or daily basis. This is only one of a range of websites that allow visitors to establish a profile and enter into debate, comment and conversation online, like Youtube, Twitter, Pinterest, news sites like the Journal.ie and many more. Everyone is entitled to explore and engage in social media communities in a personal capacity, at a level at which they feel comfortable. As time passes, more and more people will link together in this way, and many social media sites will continue to allow you to register personal information, like your hometown, education, likes, interests – and details of your employer. If you choose to identify yourself as a HSE or health services employee on social media profiles, or in your comments on personal topics within social media sites, it is important to use common sense and be aware of the nature of your comments and their possible consequences. Patient privacy, data protection requirements and our basic duty of care all still apply in comments that are made while off-duty and online.

RESPONSIBILITY As a healthcare worker or a person working within the health system, people with whom you connect online may take health-related decisions based on your comments – so there is a particular responsibility on you to think carefully before you post. So remember when using social media in your personal time: 1. All HSE employees are public servants. Our role and our work is to serve and care for the public and ensure that health and personal social services are delivered to the best possible standards. Be respectful of all individuals, races, religions and cultures; how you conduct yourself in the online social media space

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not only reflects on you – it is a direct reflection on your professionalism, your clients and your employer. 2. Think before you post. Anything you post that is inaccurate, unfair, or breaks patient privacy or data protection standards will ultimately be your responsibility. 3. B e conscious when mixing your business and personal lives. Online, your personal and business profiles are likely to intersect. The HSE respects the privacy of all employees, but you must remember that clients and colleagues may have access to the online content you post. Keep this in mind when publishing information online that can be seen by more than friends and family, and know that information originally intended just for friends and family can be forwarded on very easily. 4. K now that the internet is permanent. Once information is published online, it is likely to be part of a permanent record,

even if you remove or delete it later. You can read the full text of this policy and guidance on www.hse.ie/go/ socialmedia, and if you have any queries on digital and social media issues, please contact the National Communications Directorate on (01) 635 2620 or email digital@hse.ie.

“Everyone is entitled to explore and engage in social media communities in a personal capacity, at a level at which they feel comfortable.”

2/10/12 15:26:39

44 Health Matters

homecare packages Approved homecare providers must meet new minimum required standards The HSE recently concluded a comprehensive procurement process for the provision of new homecare packages. The 26 approved providers, appointed under the tender process, have committed to meeting new minimum required standards and the tender process is a first step in an overall plan to raise standards of homecare provision.

The First Step Clients approved for homecare packages can now choose their service provider from the list of approved providers in their area. The selection of a provider will follow a homecare package assessment process. Information on the approved providers for each area is available on the HSE website and from local health professionals. The tender is the first step in a strategic plan which will ultimately lead to a homecare service which is underpinned by legislation, regulation and independent inspection. Kathleen Lynch TD, Minister of State for Disability, Equality and

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©Thinkstockphoto.com/istockphoto.com

nhanced homecare services have, to date, been provided through a mix of HSE direct provision, grant aided voluntary organisations and private organisations with a variety of locally agreed arrangements. This national tender will contribute to the regularisation of the current situation of procuring enhanced homecare services for new homecare package recipients. The procurement process applies to new homecare packages (personal and essential domestic care) approved after the commencement date of July 1st 2012 and applies only to the elements of enhanced homecare that the HSE is not in a position to provide directly. Each Local Health Office area now has four approved providers available to provide service to clients locally. Noel Mulvihill, Assistant National Director, Older Persons, HSE, stated that: “It is important to emphasise that existing arrangements for clients already receiving a homecare package will not be affected by these new arrangements. These 11,000 clients will continue to receive services from their current provider.”

Older People, has indicated that the government plans to introduce legislation and regulations for the homecare sector in 2016 and the new minimum standards will support the approved providers in reaching the National Standards for Safer Better Healthcare (HIQA) approved by the Minister for Health in May this year.

Implementation The HSE plans to introduce the National Quality Guidelines for Home Help Services later this year. The guidelines, when implemented, will be applicable to HSE direct provision, voluntary organisations and the private sector providing HSEfunded homecare services, including home help and homecare packages. They are very similar to the standards required within the tender framework and this is part of our overall plan to incrementally improve standards over the coming years. This will

help to assure the public that all service providers who are benefiting from public funding must reach new higher standards of care. The HSE will tender for homecare services again next year so that all parties will have the opportunity to tender again. In this way, it is anticipated that service quality will be improved incrementally. The HSE would like to reassure all older people and their families that if they have any concerns regarding their care arrangements, they should raise their concerns with their local public health nurse, case manager or their local health office. The details of the approved service providers are available on www.hse.ie. Go to ‘Services List’, select ‘Older People’s Services’, click on ‘Benefits and Financial Entitlements’ and then ‘Home Care Packages’.

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Health Matters 45

homecare packages

©Thinkstockphoto.com/istockphot.com

Standard Operating Procedure The HSE held national briefings in February and June this year to ensure that all relevant staff were aware of the new arrangements. The National Guidelines and Procedures for Standardised Implementation of the Homecare Package still apply. However, a national standard operating procedure was developed to ensure that the approved provider list is used in accordance with the tender. This document is available on the HSE intranet. Go to ‘Care Groups Hub’, select ‘Older Persons’ and click on ‘Home Care Packages Scheme’. The procurement process assists the HSE in establishing new minimum standards with which successful tenderers must comply if they are to supply newly approved HSE-funded homecare packages. This will require successful service providers to deliver uniformly defined standards of care through appropriately trained and qualified staff to defined care plans.

©Thinkstockphoto.com/istockphoto.com

Higher Standards For the first time, the HSE has required all staff involved in the provision of homecare packages to be fully-trained to the full eight modules FETAC level 5 award, or be in the process of completing it, during the lifetime of the service agreements. The ultimate future aim is for all care staff to be appropriately qualified to FETAC level 5 award. Adherence to the standards will be monitored at local level through service level agreements, which will initially be for a period of one year. The providers will be monitored and assessed on their performance based on the minimum standards required in the tender process. It is important to note that all current service providers for both home help and homecare packages are also expected to reach minimum standards of care and these are monitored at local level through service audits and reviews of individual care plans. The tender process has introduced higher standards to improve the quality of care on a consistent and nationwide basis.

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Clients’ Needs Adrienne Jordan, Homecare Package Case Manager, Dublin South West, said: “The tender is a positive step forward in developing the service. I am delighted to be part of the national steering group which developed the tender and the element of choice enables a more equitable partnership between the families and the HSE in the decision-making of the delivery of the care plan.” Adrienne said local administrative staff have commented on the administration improvements, due to the new streamlined process of using four approved providers. Jackie Gibson, Interim Director Public Health Nursing, HSE West, Limerick, said: “From a nursing perspective; we are confident that the care delegated to the homecare worker to meet the client’s specific care needs is being delivered to improved standards”.

HomeCare Packages Scheme The Homecare Packages Scheme (HCP Scheme) was formerly introduced by Government and implemented across the HSE in 2006. The objectives of the HCP scheme are to:  Facilitate timely discharge of older people from acute hospitals  Reduce inappropriate admissions of older people to acute care or residential care  Reduce pressures on emergency departments  Support older people to continue to live or return to live in their own community  Support carers so that they may be able to continue to provide care for older people The scheme is flexible to allow the individual client care needs to be met within resources available.

Queries If you have additional queries please contact your Area Specialist for Older Persons: HSE Dublin Mid-Leinster: Brenda Hannon (brenda.hannon@hse.ie) HSE Dublin North East: Roisin Maguire (roisin.maguire@hse.ie) HSE West: Paschal Moynihan (paschal.moynihan@hse.ie) HSE South: John Linehan (JohnG.Linehan@hse.ie)

2/10/12 15:27:03

COMMERCIAL Profile

Homecare Reshaping the Delivery of Community Care The challenges facing all healthcare providers, whether it be statutory or private, is how to provide more for less. Homecare Independent Living is dedicated to tailoring its services to deliver an integrated care solution and ensuring that all of these services have a positive impact on local communities. With the unprecedented financial challenges facing the country, Homecare Independent Living has been reshaping its services to deliver an integrated care solution to the HSE.

Enhancements to Core Services Since its launch 17 years ago, Homecare have always responded well to challenges. Over the past two years their conventional domiciliary homecare services have been enhanced with their Community Response Team and Assisted Discharge Service. This has enabled people to be discharged from hospital much earlier. Through ‘on the ground’ Nurse and Care teams, they can commence service often within an hour of a call being made.

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Investment in staff and technology The company has invested over £2 million in technology, training and motor vehicles to enhance its services. Managing Director, Mairead Mackle, says: “We are working with partners to create a ‘complete’ solution, which will give people choices about staying at home, where possible, for their care. Given that technology will play a huge part in the delivery of healthcare in the future, we believe it’s the working together of both

the professional and the practical side that will offer the real solutions for people, especially for it to be done at scale.” This investment in staff and technology is part of a continuing commitment to develop Homecare’s community care services so they can handle the complexity of a chronic illness or a person with moderate or severe learning, physical or mental health difficulties. Their integrated solution, comprising of Health and Social Care professionals, is their solution to the HSE as they seek to respond to the

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Health Matters 47

COMMERCIAL PROFILE

+ Mairead Mackle worsening financial situation. Homecare work in partnership with the HSE and their good working relationship has led to the development of creative and relevant service solutions over the years. The latest innovations ensure that costly acute services stays are prevented and in turn, savings are made which prevent bed blocking.

Services Offered The Homecare team provides services which positively impact on the major social issues including Domiciliary Care, Housing, Social Care and Nursing Services. Their services are all about enabling people to stay in their own homes and through the integration of the company’s services, it provides a cost-effective solution to the community. Homecare takes pride in the continuing development of its specialist teams who can provide a range of services to the community, be it Tracheotomy, Peg Feeding or Personal care – they have the staff to deliver all levels of complexity. Housing and Care Model Homecare’s Housing and Care model is unique due to the flexible and swift response of a professional team with years of experience. Houses can be adapted if necessary to suit the needs of tenants and located in areas of need within walking distance of all amenities. Homecare’s strength is that they complement the professional health services and have the infrastructure to support and respond to the needs of their clients.

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Nursing Care within the Home Their recent development of nursing services further demonstrates the integrated care model, and not only does Homecare support intensive domiciliary care, but enables more continuing healthcare to be undertaken in the home. They can now offer Continuing Care to people suffering from illnesses or accident, spinal cord injuries, acquired brain injuries and to people that are ventilator dependent. Intermediate Care at home is also supported, covering Tracheotomy Management, Oxygen Therapy, Renal Care, Stroke Rehabilitation and Multiple Sclerosis. Palliative Care is also offered to help improve the quality of life for patients and their families. Providing treatments for pain relief, while delivering high-quality care with dignity, gives the person the choice to remain at home and offers respite to the family. Cases such as Cardiac/Respiratory Diseases, Cancer and Neurological Diseases benefit greatly from this service.

“Good relationships make all the difference and I believe it is how people are dealt with that’s vital; respect, understanding and good communication still go a long way.”

complement the professional services in the Health Service in that, at any given time, where necessary we have the infrastructure on the ground enabling us to respond within a very short space of time.” All staff go through training in NVQ L2 to L4 and Fetac L5. The team also provides training to a number of outside companies and organisations, including the HSE. With the right environment, care can become a career for people. The company has recently revamped their recruitment website at www.homecareindependentliving.com/ jobs – they are dedicated to attracting the right people who will deliver their services through the company’s core values of Integrity, Commitment, Accountability, Respect and Enthusiasm (iCare).

Restricted Budgets Should Not Mean Poor Delivery of Services Mairead Mackle concludes, “Obviously, we are working with a restricted budget, but a restricted budget should not mean poor delivery of services. In a lot of cases the key is letting people know what’s possible and what’s not from the outset. Good relationships make all the difference and I believe it is how people are dealt with that’s vital; respect, understanding and good communication still go a long way. Also people need to have realistic choices and then they or their families can supplement those services if they so choose. Choice, access and quality of services should be there for people.”

Company Background Quality is of Upmost Importance Quality has always been Homecare’s focus and as people are their most valuable asset, they achieved ‘Investors in People’ and ‘Excellence through People’ awards, as well as accreditation through RQIA. They constantly measure and benchmark their services through partnerships with other companies across Ireland and in the UK. Mairead Mackle states, “Everything we do is process driven to improve both customer satisfaction and efficiency of our response. We have set up a seven-day week ‘customer service centre’ based at our HQ. Our strength is that we can

Homecare’s main areas of work are domiciliary care, temporary and longterm housing, nursing and support services which help prepare people for independent living. Its wide range of clients include older people, families, patients recovering from surgery, people with addictions, single and young parents, and young people leaving care. You can contact Homecare Independent Living on: (042) 932 4688 or by email: enquiries@ homecareindependentliving.com Visit www.homecareindependentliving. com for further information.

2/10/12 15:27:07

48 HealtH Matters

commercial feature

Private HoMe Care Why prIvAte home CAre? Private Home Care has been providing integrated homecare support services to the Irish market for over 23 years to all ages with varying needs and abilities – from one hour per week to 24/7 live-in care. a nurseled organisation, they are committed to best practice recruitment, compliance and methodology. the main goal of Private Home Care is to provide clients and service users with high-calibre integrated homecare services of the highest quality in a cost-effective manner. With an unmatched reputation for high levels of care, putting the clients and service users’ welfare first, their motto is ‘we care for others as we would like to be cared for ourselves’ – standing by this motto by assisting people with daily activities in their own home and encouraging independence. Private Home Care is part of Cpl resources Plc. prIvAte home CAre experIenCe In their years’ experience, Private Home Care’s offering goes beyond professional expertise to respect, empathy and companionship – the cornerstones of their reliable and personal service. at Private Home Care, care is taken to listen and understand each individual requirements and match homecare workers to their specific needs and personalities. each client and service user has a dedicated Client administrator who manages their file, which is routinely monitored and updated according to the clients’ and service users’ needs. they are conscious that they are entering people’s homes and lives, sometimes in vulnerable circumstances; therefore confidentiality is a constant feature of their service. Private Home Care has an extensive, live database of healthcare workers with an integrated network of offices across the entire country in Dublin, Cork, limerick and Galway. FetAC level 5 provIder Private Home Care, in conjunction with their partner company CPl resources PlC; are a registered FetaC provider, registered to deliver all modules within the Healthcare

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support (DHsXX) Major award level 5 and the Health service skills (DHssX) Major award level 5.

InnovAtIon, quAlIty people, SyStemS And ComplIAnCe Private Home Care is committed to innovation within the homecare arena. the quality of their service is underpinned by the quality and professionalism of their people and the discipline within their systems and processes. substantial investments have been made in internet, front-office and back-office technology. this streamlining and automation of processes allows the Private Home Care team to focus on interfacing with clients, service users and homecare workers, while maintaining all required processes and systems. Private Home Care holds IsO: 9001 accreditation for all systems, policies and procedures. they also have a dedicated FetaC plan as part of their training and Development Plan for all new homecare workers, and facilitate all long-standing carers in the recognition of Previous learning, to achieve an award in FetaC level 5 major award (8 modules). Home Care support Workers have proven caring experience with references to validate experience, are Garda vetted, with up-todate people handling certificate and have or are working towards FetaC level 5 training. Private Home Care tailor their service as required for each service user. staff they

deliver include; homecare workers, nurses, therapies (includes physical, occupational, speech etc.) and nutritional. they are IsO accredited, offer fully completed accredited training for all Private Homecare staff, and provide full and complete integration of service offerings with clear ‘single points of contact’.

ServICeS InClude • Personal Care • Short-Term Care • Practical Care • Companionship Care • Palliative Care • Post Hospital/Operative Care • Long-Term Care • Live-In Care • Care to all ages including elder care • Tracheostomy • Neurological Care • IV/IM Antibiotics • Dementia Care • Disability Care • Physiotherapy and Occupational therapy • Transportation If you would like any more information about Private Home Care services or have any questions please feel free to visit www.privatehomecare.ie or phone their head office on (01) 621 9101.

2/10/12 15:27:12

HealtH Matters 49

header here

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2/10/12 15:27:16

50 Health Matters

Commercial Feature

Bluebird Care

Leading the Care Revolution in Ireland New and improved standards in Homecare Services from the HSE coupled with increased demand from a growing population for care is putting the spotlight on the homecare sector in Ireland.

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ÂŠistockphoto.com/Yuri_Arcurs

luebird Care has always had stringent care standards in place, working to the UK Care Commission standards. The HSE have now implemented a new national standard for the provision of home support for older people, in effect since July 1st. Bluebird Care has been appointed as an approved HSE home care service provider in multiple locations and will work with existing and new HSE clients requiring home care services under the Homecare Package Scheme. The new HSE regulations outline appropriate recruitment procedures, Garda vetting, training, protection of older people and medication management policies. Operations Director with Bluebird Care Eddie O'Toole, says: â&#x20AC;&#x153;We are enthused by our appointment as an approved home care provider by the HSE, but even more welcoming of national uniform standards which will raise the standard of home care in Ireland. In an unregulated marketplace it is vital that high standards are set with providers critically assessed to meet and indeed exceed standards. This latest step has to be welcomed and we look forward to working with HSE clients nationwide to improve standards even further.â&#x20AC;? Bluebird Care has also recently partnered with Irish Times Training in conjunction with Frontline Training to deliver internationally recognised qualifications through the FETAC accreditation system. Figures provided by the Carers Association suggest that in order to manage the current carer to disabled population ratios, Ireland will need an additional 44,829 carers by 2021. Entering the Irish market five years ago, Bluebird Care now have 18 offices nationwide and

are reacting to the increased demand in the broader home care industry. Bluebird Care provide a broad range of home care including care of older persons; care of adults and children with physical disabilities, intellectual disabilities and sensory impairments; child care; dementia care; palliative care, acquired brain injury; spinal injuries; pre and post-operative care; live-in care; personal care; respite care; and specialist personal assistants to support rehabilitation and re-enablement.

Corporate Social Responsibility They are also conscious of their corporate social responsibilities, working closely with Age Action on promoting positive ageing, active ageing and advocating greater opportunities and services for the elderly in society.

Bluebird Care has also partnered on some innovative partnerships, which have a wider health and social inclusion remit. Blood Bikes is an inventive scheme set up by a team of motorcycle enthusiasts in Galway. It is a voluntary and free service providing emergency transport of blood products, patient records, drugs and other medical requirements usually between hospitals and blood transfusion banks in the western region. Bluebird Care made the charity's vision a reality by purchasing their first blood bike. See bloodbikewest. ie. Dublin-based charity Vantastic provides accessible door-to-door transport services for the elderly and the disabled and six of their vans are supported by Bluebird Care. See vantastic.ie. For more information on Bluebird Care, visit www.bluebirdcare.ie.

3/10/12 15:20:58

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52 Health Matters

Commercial Feature Comfort Keepers The Number One Ranked Provider of Top Quality Home Care by the HSE IN 24 lhos Comfort Keepers is one of Ireland’s most trusted homecare providers. A family owned and run company it has grown slowly over the years, constantly reinvesting to enhance the quality of the care it provides.

anked the number one provider of quality enhanced homecare by the HSE in the 24 LHOs that it operates in, Comfort Keepers clients are assured that all of their 800 qualified carers are fully trained, background checked and managed by Comfort Keepers. Bob Power, Managing Director of Comfort Keepers, says: “Our mission is to care for each person as though they were a member of our own family and from this we decided long ago to invest in highquality care provision so that we could continuously offer high quality homecare. Comfort Keepers are unique in the industry in that we have a state-of-the-art tele-monitoring system, provide in-house FETAC training to all our carers, and are the only homecare provider to be awarded

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ISO9001, Healthmark and QMark.” Comfort Keepers has invested in carer monitoring systems that ensures that care is alway provided on time and for the lenght of time specified. The carer logs in using a freephone number which links into Comfort Keepers 24-hour call centre to verify that the carer has arrived in the house and leaves at the time specified. “We are continuously looking for new ways to improve our service to our clients, and to this end we were delighted that 95 per cent of our clients would and have recommeded Comfort Keepers to a friend in a recent survey.” (May 2012, based on 48 per cent response rate). Comfort Keepers operates 15 offices throughout the country and differentiates itself from its competitors by ‘its person

centred’ ethos – providing not just a service, but an all-encompassing companionship to clients, treating them as if they were a member of their own family. Comfort Keepers were ranked number one for quality enhanced homecare packages in all areas it covers including; Dublin all LHOs, Cork North and South Lee, North Cork, Limerick, Galway, Kilkenny, Carlow, Wicklow, Waterford, Wexford, Cavan, Meath, Louth, Monaghan, North Tipperary, Kildare, Laois and Offaly. Comfort Keepers is an active supporter of the ‘Make Home Work’ initiative – a comprehensive strategy that actively strives to facilitate more people to live independently in their own home as they age. For more information visit www. comfortkeepers.ie or call 1850 818 100.

3/10/12 15:22:16

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Call Today 1850 818 100 2/10/12 16:19:50

54 Health Matters

Commercial Feature

irish homecare services (IHCS) Delivering care in the home Irish HomeCare Services (IHCS) is a leading provider of domiciliary homecare within the Irish market, led by Managing Director Sally Murtagh.

HCS is delighted to have been selected by the HSE as one of four service providers for all areas within Dublin North East and Dublin Mid-Leinster. Since the company was established in 2005 it has developed and expanded and now has an active staff of over 300, which includes care staff and administrative support. Previous to the recent HSE tendering process the company has been established service providers for homecare on behalf of the HSE across Louth, Meath, Cavan, Monaghan, Dublin, Laois, Offaly, Longford and Westmeath. Care is delivered by trained HomeCare Workers who receive an intensive Induction Programme and ongoing accredited training. All new care

workers either hold or are working towards a FETAC Level 5 Healthcare qualification or equivalent. IHCS also has its own training company; Irish Healthcare Training Institute; which became an accredited centre for FETAC in 2009, supporting the training needs of its care staff while also delivering external courses. As IHCS celebrate their seventh anniversary they have recently received the Q Mark Award for Quality Management Systems, which is an acknowledgement of the quality service they provide.

Service Delivery Model The aim of Irish HomeCare Services is to work with service users to assist with their

care needs while maintaining and increasing their independence as far as possible. Care delivery in the home is supported by supervisors who assess all new referrals and monitor and supervise care workers. Co-ordinators are allocated a defined geographical area and are the main liaison with the HSE. The Clinical Governance Manager plays a key role ensuring quality within the service and works closely with all staff developing policies and procedures to guide practice. The view of the IHCS is that it is a privilege to be chosen by an increasing number of people as the provider allowed to enter their home and support them to remain there with as much independence as possible.

home instead senior care You matter because you are you and you matter to the end of your life. We want you to live until you die.

hile medical healthcare is necessary in dealing with illnesses, a holistic home care service not only cares for a person’s physical needs, but also their social, psychological and spiritual needs. This gives a person the happiness, independence and confidence to want to keep on living their life. Home Instead Senior Care was founded in Ireland in 2005 on the mission of enhancing the lives of older people. Since then it has forged strong relationships with the HSE and Department of Health. Home Instead Senior Care take a personal and holistic interest in clients’ lives by developing a close partnership with clients and their families to help transform lives. They only hire one in 20 CAREGiver applicants, give them careful training and support, and specifically match them to like-minded clients.

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Working with the HSE Having won multiple awards for quality, systems and service and delivering 3.5 million hours of care to the HSE in the past seven years, Home Instead Senior Care will continue to provide extensive levels of care hours through each of their local offices to the HSE local health areas. All Home Instead Senior Care offices nationwide were approved by the recent HSE tender based on their high standards and professional infrastructure. This is testimony to their mission of enhancing the lives of older people, enabling them to live happy, healthy and independent lives in their home for longer than otherwise possible. What makes Home Instead different is that each of their 20 offices around the country are locally-owned and run by people from each community –

people who are committed to and take responsibility for providing the most trusted, personalised and professional care to older people in their own community.

A Community Resource The holistic approach to care in the community has led Home Instead to develop a number of guides, education evenings, training and booklets to support older people, their families and people in the community who assist and support older people. For instance, they publish an annual ‘Irish Pensioners Handbook’ with local directories, older persons organisations and old age pensioners entitlements. For more information on Home Instead Senior Care visit www.homeinstead.ie or call 1890 930 847.

3/10/12 15:24:15

There’s no place like home

• • • • •

Personal Care & Practical Care Day & Night Sits Palliative Care / End of life support Dementia Care / Challenging Behaviour Convalescence / Respite in the Home

Address: Irish Home Care Services Upper Commons Thomas St. Castleblayney Co. Monaghan

Dublin Office: 01 847 1690 Offaly Office: 057 932 5010

www.irishhomecare.ie Email: info@irishhomecare.ie

The Irish School of Homeopathy Health Education for Life at Milltown Park College, Dublin since 1989 and at Cork City since 2000. We are fully accredited by the Irish Society of Homeopaths, the regulating body of Homeopaths in Ireland. www.irishhomeopathy.ie Workshops Dublin, Cork and Galway ‘Get Started in Homeopathy’ 1 Day Introduction 50 – dates at website ‘Homeopathy & Nutrition’ Short course commences every spring Four-Year Professional Training Course (held at weekends) Commences at Milltown Park, Dublin 6 - every September Commences at Brú Columbanus, Cork City – September 2012 Clinic at Milltown, Dublin and Bru Columbanus, Cork Available to the public as part of our student training programme, you can attend the student clinic at reduced rates. Visit website for dates and more details. www.ish.ie

Contact Angie Murphy

01 8682581 info@ish.ie www.ish.ie

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Tel: Monaghan Office: 042 975 4751

“I discovered a career in homeopathic heath care was definitely for me” Anne Collins worked as a civil servant several years ago but found that it was no longer what she wanted to do. She went back to college and studied to be a Homeopathic Practitioner and now practises from two holistic centres in Athy and Naas. Angie Murphy of the Irish School of Homeopathy asked Anne what were her reasons behind changing her profession. “I had always been good at listening to people and enjoyed their stories, but my job did not fullfil this urge to care or nurture in me. I was also interested in a holistic and natural way of living, following a healthy diet since I was young. The reason I choose homeopathy in particular as the area of healthcare I chose to work in was because as a teenager I suffered from a repetitive digestive complaint, and after attending a Homeopath the complaint did not return and I never looked back. I now work part time as I have a young family and being self-employed has enabled me to construct my working day around my family’s needs. I know now that I am definitely a people person and being a Homeopath is very satisfying – it is wonderful to meet such diverse and interesting people from every sector of society and age group and to care for their health needs; it is a privilege and such a welcome change from my previous career, and I am loving it.” The study of homeopathy does not need to start at professional level like Anne. You can also attend introductory workshops at our School of Homeopathy or with your local Homeopath. For more information contact: Angie Murphy, Administrator, Irish School of Homeopathy: Tel: 01 8682581 | Email: info@ish.ie | Web: www.ish.ie Anne Collins, Registered Homeopath: Tel: 087 6187338 | Web: www.glosnahouse.com To find a registered Homeopath contact the society of Homeopaths: www.irishhomeopathy.com

2/10/12 16:20:27

aimed at influencing the consumer to be salt aware. In being more salt aware, we increasingly omit salt at the table and in cooking. also, we become more educated as consumers to actively select low-salt foods, which significantly impacts on What has been done? achieving change in the food industry. Many agencies have undertaken to the Hse is also playing a part in influence the levels of salt in our food, dietary salt reduction by contracting such as the Food safety authority of for low-salt bread as a first step, and Ireland (FsaI), who have worked with in 2010 new contracts for a number of the food sector to promote reformulation other foods will be agreed. In 2009, the of bread, soups, sauces, sausages and Hse commissioned the Public analyst rashers among others. also, academic laboratory to survey the salt levels in bread institutions have targeted the research purchased for patients and staff. Hse needed to overcomeapplicants technical and for the following Accepting six PG certificates contracted bread was one of the lowest otherwith barriers. innovative and flexible delivery: salted breads on the market, being seven Other initiatives such as safe Food’s to 13 per cent lower than the agreed salt campaign, ‘shake the Habit’ and Irish reductions with FsaI. Heart Foundation promotions are it is lower in salt and increased public awareness of the need to omit added salt and choose low-salt products whenbuying food.

DML Training, The Lodge, Johnstown Ave., Kilpedder, Co. Wicklow Home Care Advice & Training Service Patient Moving & Handling Training Specialists • We are leaders in training carers in safe manual handling/ patient moving and handling practices. • We provide all the required equipment such as hoist, sliding sheets etc. for training in providers’ own premises. • Alternatively we provide training in central locations around the country to which providers can send carers for training. Recognition, Prevention & Reporting of Elder Abuse • Our training course is based on the HSE DVD “Open Your Eyes to Elder Abuse in your Community” and encourages care staff to examine current attitudes to the elderly in our society and the possibility of abuse. Care Staff Induction/Refresher Training • It is mandatory under employment legislation that all staff be given induction training. • This training covers employment practices, rules, regulations and conditions. Documentation • Comprehensive assessments and care plans covering all aspects of client care. • Staff Documentation: Staff Handbook Employment Contracts • Audits/Risk Assessments

“almost 80 per salt is ‘hidden’ increasingly pro food that we e and processed make up about cent of the hid in our diet.”

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HealtH Matters 57

mental health

outSiDer ART christy browne is a resident in erkina house, rathdowney, co. laois – a community residential facility run by the local mental health services. his art therapist angela Delaney encouraged him to take up painting and, four years on, he is a national competition winner and exhibitor. Arlene Crean reports.

s a health service, we are always looking at ways to dismantle the stigma of mental health. We look to our service users who continue to guide us on how best to provide a service which is responsive to their needs and which, in so far as possible, normalises the existence of care and support services for the mind. the Mental Health services in laois are helping to lead this agenda by providing patient-centred services which focus on alternative treatments such as art therapy.

heart of the community erkina House is set in the centre of rathdowney. It is this location at the heart of the community that clinical nurse manager Paddy Cleary feels is the testament to why the patients in this facility are doing so well. “Mental health issues are often on the margins of society. It was pointed out that it is no coincidence that mental health units are often built on the outskirts of towns. erkina House, however, is built in the middle of the town and it’s going to stay that way,” says Paddy. Christy Browne has been in erkina House for two years and over the last five years he has attended the link Centre at st Fintan’s campus. It is here that his lifelong interest in visual art has been allowed to flourish and grow. angela Delaney, Clinical Nurse specialist in art therapy Interventions at the link Centre, said: “Using art as a therapeutic tool is one aspect of the programme being offered through the rehab/recovery Community Mental Health service in the link Centre. We find art therapy can provide a supportive space for reflection on mental health issues. the creative process allows clients address concerns in a positive, non-clinical environment that encourages and facilitates empowerment on the road of recovery.” the artist’s first experience of mental health issues came in the 1970s when

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+ Christy Browne surrounded by colour in the art studio of erkina House.

he was treated at the county’s st Fintan’s Hospital, located in Portlaoise. But it was a stroke he suffered in 2008 which prompted a long journey of recovery, in which art played an integral part.

art against stigma the stroke meant Christy could not play musical instruments and he turned his attention to the realm of visual arts, which last year saw him gain national recognition by winning a national competition at the art against stigma exhibition held in the Phoenix Park’s Farmleigh estate. But now his journey is gaining further recognition as laois County Council arts office hosted his 24-piece sojourn exhibition

in association with the Hse. Gallery director and the artist’s cousin Kevin Kavanagh was on hand to officially open the exhibition. He likened the work of Christy to ‘outsider art’. “the characteristics of outsider art are that the artist would have no formal art education and there can also be elements of mental illness. the person’s art has a place,” says Kevin. Christy’s recent exhibition is the culmination of four years of work, which he modestly explains: “I just start with an idea and try to share my journey, body and soul.” His interaction with art as a therapeutic tool to improve his health and wellbeing shows that a simple yet responsive care plan can make all the difference.

2/10/12 16:20:41

58 HealtH Matters

library services

making eviDence mobile Did you know that you can now download mobile apps for many of the resources available through www.hselibrary.ie? this means that you can check the latest evidence and guidelines quickly and easily even when you don’t have access to a Pc.

he UK National Institute for Health and Clinical excellence recently launched a new app which provides quick and easy access to all NICe guidance and recommendations. the NICe Guidance app can be downloaded from apple’s istore or through Google Play. Guidance is arranged by clinical or public health topic and sections can be bookmarked or emailed for easy access. the app also receives automatic updates to ensure that users can access new guidance as soon as it is published by NICe.

meDline anD cinahl on the move Medline with full text and CINaHl with full text can be accessed through your smartphone using the ebscohost app. simply follow the ebscohost iPhone and android applications link at the bottom of the Medline or CINaHl web pages available through www.hselibrary.ie. after downloading the app, it must be authenticated via a verification email which is sent to your device. What’s neW in the nejm? the New england Journal of Medicine can be viewed in full text through www.hselibrary. ie, but you can also access a selection of content using the NeJM this Week app. NeJM this Week is a free iPhone and iPod touch app that provides access to recent articles and a selection of images, audio and video. you can download the app directly from the itunes store. resuscitation council uk aPP iresus provides rapid access to the very latest resuscitation guidelines algorithms and is continuously updated as new evidence is published. the iresus app is currently in the top ten medical apps and can be downloaded free of charge on itunes. raDiology 2.0 radiology 2.0 is an iPhone app for basic

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emergency medicine Ct imaging. It was developed by Dr Daniel Cornfeld, an assistant Professor of Diagnostic radiology at yale University school of Medicine and Mohammed Kaleel from saba University. the app contains information on the imaging of common emergency Department presentations serving as a useful introduction for non-radiologists and trainees to er imaging pathology.

aPP overloaD? there are thousands of healthcare apps for mobile devices, including calculators, PubMed apps, drug reference apps and more. It can be hard to figure out which ones

are worth downloading. to help you decide, you can read independent reviews of medical apps written by medical professionals at http://www.imedicalapps.com.

but What if there’s no aPP? If your favourite evidence-based resource does not have a mobile app available, or else requires a separate personal subscription fee, don’t worry! Most databases and journals, including BMJ and NeJM have mobile-friendly versions of their websites that will automatically be detected when you access the site using a smartphone. this allows for streamlined, fast browsing – even when you don’t have a separate app.

suPPort library irelanD Week 2012 library Ireland Week takes place from November 12th to 18th. For more information on the events and activities taking place, contact your local Hse library.

2/10/12 16:20:57

BOOST YOUR CAREER PROSPECTS WITH A CIPD QUALIFICATION FROM THE IPA The IPA offers Human Resource (HR) and Learning & Development Practitioners the opportunity to develop practical skills whilst covering all aspects of HR and/or Learning and Development theory and practice. Successful completion of any of our Foundation Level Programmes is a pathway to gaining the new professional CIPD Associate level of membership (Assoc CIPD)*. Our three Foundation Level Programmes are: CIPD Foundation Level Certificate in HR Practice

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Range of membership benefits Health Manager journal Annual conference Forum for Manager series Regional meetings Training and FETAC qualifications HMI online learning centre Infection control & people handling training DVDs Organisational support Discussions, surveys and research

For more information contact Rosemarie at rosemarie@hmi.ie Health Management Institute of Ireland (HMI) Heather House Sandyford Business Park Dublin 18

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T: +353 1 297 4070 F: +353 1 293 9816 E: info@hmi.ie W: www.hmi.ie

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2/10/12 16:21:04

Codex offiCe ProduCts Codex secures HSE National Contract for stationery supplies

he Irish office products market is recognised by industry insiders as one of the most competitive in Europe, and with the arrival some years ago of global and international players the prognosis for Irish companies in this industry was not good. However one Irish company has set the pace nationally having been awarded the HSE stationery contract in association with the National Procurement Service. From humble beginnings on the North side of Dublin in 1979 Codex has risen to become the largest Irish owned office supplies company in Ireland. Employing over 60 staff and operating from a 30,000 sq. ft facility it can now supply some of Ireland’s largest businesses.What sets Codex apart from other competitors in the market? Managing Director Brendan Murphy states: “Its all about the customer and what they require, because we have come from humble beginnings, ‘a local stationer’, if you will, we understand that a personal approach to managing our customers spend is needed and never more so than in today’s climate. This approach has served us well, and as we have grown our business we have taken this simple approach and adopted it to larger and more complex customers.” HSE National Contract Codex Office Products is proud to have added

the HSE to its portfolio of accounts. Brendan Murphy states “the HSE has represented an enormous challenge for us, not least the need to deliver to thousands of locations throughout the country. Working closely with HSE Procurement our implementation team is meeting and overcoming challenges every day as we roll the contract out to all areas of the country. Our service offering to the HSE requires us to tailormake solutions in different parts of the country, from desktop delivery in certain locations to pick and wrap solutions

in others. As the HSE is changing we have had to adapt to these changes, integrating with several procurement platforms, so that the changeover remains seamless throughout.” Expertise With such a wide variety of products and indeed service offerings, Codex has seen its expertise called upon on more than one occasion. “We are so pleased to have some of the industry’s brightest and most experienced account managers on our team. They can draw from a wealth of knowledge,

and advise HSE customers on all their stationery requirements. Codex is now looking forward to building up its working relationship with the HSE and flying the flag for Irish business in the process.

www.codexltd.com Phone: (01) 88 22 022 Freefax: 1 800 307 300

Codex Ltd is supplied by and works in association with Brother Ireland, Leitz, Robert Horne Group and Antalis. HM Iss8.3 p53-112pg.indd 60

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Health Matters 61

restraint reduction

Network to Help Information on restraint use and reduction A new network of health professionals working in Older Persons Services has been set up to share best practice information on restraint use and reduction. Clinical Nurse Manager Florence Horsman Hogan reports.

dvances in care of the older person services during the last 15 years have been really impressive. We now have Consultant Geriatricians, Psychogeriatricians, Clinical Nurse Specialists, Allied Health Professionals; all providing more specialised and enhanced care on a community, as well as long-term, care basis. Now, more than ever, care of the older person services are attracting a very credible and progressive workforce. While the instigation of the HIQA standards for older persons in residential care is proving to be challenging, it’s also invigorating and rewarding. At present in Ireland, over 11 per cent of the population are over 65 years. This is predicted to reach 15 per cent by 2021. One of the areas now receiving particular attention is ‘restraint’.

restraint Restraint is defined as ‘any physical, chemical or environmental intervention used, specifically to restrict the freedom of movement – or behaviour perceived by others to be anti-social – of a resident designated as receiving care in an aged care facility’. Equipment requested by an individual for their safety, mobility or comfort, or drugs used to treat specific diagnosed conditions, are known as enablers. Intent is the key to defining a device or medication as a restraint/enabler. Historically, devices such as bed rails and lap belts have always been perceived as beneficial in falls prevention. Indeed, there are cases where a person will request them because of a fear of rolling, slipping or sliding from their beds/wheelchairs. Perhaps more evidence is needed to illustrate their worth in injury prevention. However, there is a good deal of evidence to show that injuries can occur from bed rails due to entrapment, climbing

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+ Florence Horsman Hogan, Clinical Nurse Manager.

over or sliding under. It is incumbant on us professionals to assess for safe use, provide credible alternatives and increase awareness in the whole area of restraint use and reduction.

IRRIG A number of like-minded healthcare professionals have recently come together to form the Irish Restraint Reduction Interest Group (IRRIG). This is a knowledge-sharing pool of (at present) 47 facilities nationwide, representing approximately 2,800 beds (HSE/Voluntary/Private facilities), with the specific aim of highlighting the whole area

of restraint use and safe reduction. We feel there is a need for more sources of information about restraint reduction to inform best practice and the group seeks to assist in the sharing of knowledge about this important area. Members of the group feel part of a proactive entity, where they are enabled to work more confidently in this area. Each facility is responsible for how it uses any information given and contact is by simply emailing questions or requests. To find out more about the Irish Restraint Reduction Interest Group (IRRIG), email fhorsmanhogan@eircom.net.

2/10/12 16:21:23

62 Health Matters

mental health

Mental Health Matters at the Volvo Ocean Race Festival The Volvo Ocean Race returned to Galway this summer. With an estimated footfall of 800,000 people, it presented an ideal opportunity to promote positive mental health in an attempt to reduce the stigma that surrounds it.

“Vision for Change would endorse this philosophy, as it asserts that greater contact with individuals with mental health problems, particularly through shared tasks, has been shown to reduce prejudice.”

t is acknowledged that stigma is often one of the barriers that prevent people from seeking help. Stigma is a negative label which causes isolation, exclusion, marginalisation and hurt. It occurs as a result of lack of knowledge, discrimination and prejudice. As Bill Clinton once said, “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” Michael D. Higgins in his inaugural presidential address stated that “a confident people is our hope, a people at ease with itself, a people that grasps the deep meaning of the proverb ‘ní neart go cur le chéile’, which means there is no strength without unity. Vision for

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Change would endorse this philosophy, as it asserts that greater contact with individuals with mental health problems, particularly through shared tasks, has been shown to reduce prejudice.” The event was created in partnership with the HSE West Mental Health Department and by working with key mental health agencies. Each day, the HSE West staff worked alongside statutory and voluntary mental health organisations, including the National Office of Suicide Prevention, Suicide or Survive, Samaritans, Reach Out, Inspire, Grow, Social Inclusion Unit (Galway city), Galway Community Forum, Shine, Mental Health

Reform, Amnesty International, National Service User Executive, Mental Health Ireland, Headstrong, Jigsaw, Positive Mental Health Galway, National University of Ireland Galway, Aware, Galway City Council and Console. This showcased the excellent work being done by the various groups and also offered choice for anyone needing help. The green ribbon, which is recognised internationally as a symbol of supporting mental health, was adopted for the campaign and visitors to the tent were encouraged to wear a green ribbon sticker to raise the profile outside of the tent. VIPs visiting the tent were given a green ribbon pin and asked to wear it with pride. The outgoing mayor of Galway city handed over the green ribbon to the incoming mayor along with the chain of office to new mayor Terri O’Flaherty who wore the ribbon for her official photoshoot when taking up the office.

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Health Matters 63

mental health “Visitors were brought on a journey through the tent, with a virtual living room and a wall of positive mental health, where visitors were invited to post a contemplative, inspirational or aspirational comment to help us build positive mental health for Galway.”

In June Hildegard Naughton, Mayor of Galway, launched the Mental Health Matters campaign in the Jigsaw Building. This initiative was a collaboration between Galway Mental Health Services and See Change, the national stigma reduction organisation. This promoted the working in partnership ethos and brought diversity to the project.

Getting the Message Out The Mental Health Matters campaign was rolled out in one of the tented units at the Volvo Ocean Race village and provided an interactive experience for visitors. Visitors were brought on a journey through the tent, with a virtual living room and a wall of positive mental health, where visitors were invited to post a contemplative, inspirational or aspirational comment to help us build positive mental health for Galway. The response was amazing and really captured the imagination of the people, as over 8,000 postcards designed as bricks were completed by those who visited; in particular, the participation of young people was remarkably positive, as their comments would suggest that the younger generation do not stigmatise mental health issues. It is our aim to compile a booklet

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with a sample of all the comments along with the many images captured during the week. Our core messages were that mental health problems can affect one in four people and at any time. If people are prepared to open up, others will listen and respond with empathy. However, ultimately we advised that the GP should be the first point of contact for anyone experiencing emotional or psychological distress. Over the course of the week, more than 16,000 people supported the campaign. Many well-known celebrities, sportspeople and politicians pledged their support or visited the tent in the race village, including the President of Ireland Michael D. Higgins and his wife Sabina, An Taoiseach Enda Kenny, Galway hurlers David Collins and Joe Canning, Galway football captain Finian Hanley, musicians Daniel and Oisin McCloskey from the Kanyu Tree, as well as tenor Sean Costello, Aisling Baker (who represented Westmeath at the Rose of Tralee Festival) and Billy Lawless, who was the first recipient of the new Diaspora Award. The Leinster rugby branch and the Kilkenny county board also showed their support by providing the Heineken Cup and the Liam McCarthy for display during the campaign. Connacht rugby players David Nolan, Andrew Browne, Mike Kearney and John Muldoon posed for photographs with many of the visitors to the tent. We were also paid a visit by one of the sailing crews that took part in the race. The Galway GAA players and Connaught rugby players also provided video clips for the HSE website page dedicated to the campaign. Check out the materials and photos online at www.hse.ie by typing ‘Mental Health Matters’ into the search box. Over the course of the campaign, the local radio station CEO and broadcaster Keith Finnegan of Galway Bay FM came onboard as a supportive partner in promoting positive mental health and reducing stigma. Both Galway GAA and Connaught rugby got involved and provided continuous support from their organisations and players. This led to media coverage in local papers and websites to highlight the issues of stigma and improving positive attitudes to mental health.

It was encouraging that people would openly discuss their experiences and overall the feedback received to date has been extremely positive. This demonstrates that to address stigma, mental health needs to be at the heart of the community.

If you are considering organising a similar event, these learnings may be of assistance: • Liaise with HSE Communications Department as soon as possible and complete a planning application. The Communications Department will guide and provide the campaign with the required publicity and equip you with the information and skills to best promote the event. • The need for energetic, enthusiastic and committed volunteers is essential. • It is useful to have an attraction to raise the profile. Our busiest day was when we had the Heineken Cup. • A wallet card, rather than the traditional leaflet, proved to be a very effective way of distributing information. • Working in partnership helps to spread the cost and raise awareness of what is available. • Keep any themes simple and repetitive. • Having an interactive experience which is not time consuming or too demanding will work – in our case it was the Wall of Positive Mental Health.

CONTACT Ciaran Lynch, A/Assistant Director of Nursing Loughrea/Athenry. Email: ciaran.lynch@hse.ie. Kieran McMahon, A/Assistant Director of Nursing Ballinasloe. Email: kieran.mcmahon@hse.ie.

2/10/12 16:21:35

64 Health Matters

mental health

+ Catherine Cunningham, Galway Roscommon PCCC Manager, gets into the spirit of the campaign and volunteers to sticker passers-by.

+ Kieran McMahon, Sabine Higgins, President Michael D. Higgins and Ciaran Lynch at Mental Health Matters campaign.

+ Gerry Blake, Galway Mental Health Services, signs-up the Pirate King to the campaign.

+ Gerry Blake, Kieran McMahon, Ciaran Lynch and Catherine Cunningham welcome the Heineken Cup to the tent.

+ Pierre is all cheered up after writing on the Mental Health Wall.

+ John Killeen, CEO of the Galway Volvo Ocean Village, places a message on the wall.

+ Brian Walsh TD, An Taoiseach Enda Kenny TD, Ciaran Lynch HSE and Sean Kyne TD.

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2/10/12 16:23:19

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66 Health Matters

mental health

Mental Health Legislation Health Matters reports on the HETAC Accredited Level 8 Special Purpose Award, a professional development programme which aims to facilitate participants in furthering their knowledge and understanding of mental health legislation and its application to practice. The programme is due to commence this autumn.

he programme is a standalone module which leads to a ten-credit special purpose award at level 8 on the National Framework of Qualifications. Validation with the Higher Education and Training Awards Council (HETAC) occurred following completion of a rigorous validation process. HETAC is the qualifications awarding body for third-level education and training institutions outside the university sector. It is planned that the first programme will commence in autumn 2012 and is open to professionals working in mental health services nationwide. Members of the Mental Health Act Training Group (MHATG) in collaboration with colleagues from the Regional Centre for Nursing and Midwifery Education, Tullamore, Co. Offaly developed the programme.

Programme Aim The aim of this professional development programme is to facilitate participants to further develop their knowledge and understanding of mental health legislation and its application to practice, thus enhancing the provision of safe, personcentred care which is legislation compliant and responsive to the needs of service users in the mental health services. Learning Outcomes On successful completion of the programme, participants should be able to:  Critically review national and international policy developments underpinning contemporary mental health services.  Critically examine mental health legislation, including regulations, rules, codes of practice and addenda.  Apply knowledge of mental health legislation to the admission of persons to approved centres.  Critically evaluate the risk management process required to ensure the safety of

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+ L-R: Course facilitators Anthony Fitzpatrick, Mary Doolan, Amelia Cox and Malachy Feely.

the patient, staff and other stakeholders involved in the admission of a patient to an approved centre.  Critically appraise the professional and legal requirements pertaining to documentation and patient records, including all communication and consultation with other members of the multidisciplinary team.  Critically examine the protection of the rights and interests of the service user, as identified under mental health legislation.

Programme Structure The programme is of five days duration and is provided over ten to 12 weeks. Entry Requirements Applicants must be currently working as part of the multidisciplinary team in the mental health services, i.e. registered nurses actively registered with An Bord Altranais, registered medical practitioners actively registered with the Irish Medical Council, clinical psychologists, social workers and occupational therapists actively registered with their respective registration boards.

CONTACT Further information is available from Mary Doolan, Programme Coordinator. Tel: (057) 935 8752/935 8750; Email: mary.doolan@hse.ie or secretary.cne@hse.ie.

“The aim of this professional development programme is to facilitate participants to further develop their knowledge and understanding of mental health legislation...”

2/10/12 16:23:21

Walk your way

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3/10/12 14:43:15

68 Health Matters

primary care

Confident Communicators This year, speech and language therapists Patricia Collins and Patricia O’Connor completed their tenth annual week-long summer camp in Galway for children who stammer. Patricia Collins tells Health Matters why these summer camps are so beneficial.

ur primary goal for the children is that they will become confident, competent communicators. Our group motto is, ‘It’s okay to stammer’. Most children have grown up to believe that it’s not okay to stammer and parents, family members and teachers often try to help the child by telling them to stop, take a deep breath and start again, or by telling them to think about what they want to say first and then speak slowly. This ‘help’ often results in the child becoming more self-conscious, which can make the stammering worse. Many children who stammer have never met another child with the same problem and they often feel very isolated and frustrated because they feel they are different from everybody else. In this group, everyone stammers, and children begin to feel safe talking about their stammer and how it affects them. On the first day, the children and their parents learned about open stammering.

Understanding Stammering The children and their parents also learned to use voluntary stammering (VS), which is slow controlled repetition (frog words) or prolongation (snake words) of the first part of a non-feared word. We played lots of frog and snake word games and prizes were given to the best users of frog and snake words during games. The children threw themselves heartily into these activities and sometimes the competitive atmosphere was quite intense. Patricia

O’Connor and I, together with Caroline and Teresa (speech and language therapy students) also had to use VS throughout the week. The children happily monitored this and decided what punishment to use if we failed! For parents, using VS allows them to understand what stammering is like for their child. During the parent sessions we discuss their feelings before, during and after using VS and their awareness of the listener’s reactions. Every day, we ventured out into the world armed with our willingness to openly stammer and our resolve to use VS. The children learn through these experiences that it’s okay to stammer, that the listener reaction is usually not as bad as they thought it might be and that people will usually wait until they have finished speaking. As part of this camp, we also took part in drama and encouraged each child to be involved as actors or narrators. All of the children volunteered to be included in one or both roles. This is a big deal for most of these children as they often shy away from this in school because they are embarrassed by or fear stammering. They showed great courage in performing for the parents and families on the last day and some of the parents were very emotional as they had never seen their child perform in front of a group. Our summer camp parents and children will meet up again to foster the strong bonds that these families have developed with each other. Parents told us that they felt supported and more knowledgeable about their child’s stammering and that using the VS has been a real eye opener. They said that it was wonderful to meet with other parents whose children stammered and that they had noticed a big change in their children’s confidence as speakers. They all described the summer camp as a wonderful experience.

©Thinkstockphoto.com/pixland

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This means that they are encouraged to allow themselves to stammer openly in front of the group, rather than trying not to stammer. Open stammering helps the children to learn about their own type of stammering, to become desensitised to the moment of stammering and to see it as something they can learn to control or modify, rather than seeing stammering as something outside their control.

2/10/12 16:23:35

Health Matters 69

primary care

Mayo Men on the Move M

ore than 100 men from Mayo are taking part in a physical activity programme called ‘Mayo Men on the Move’, which is a HSE-funded initiative co-ordinated by the Mayo Sports Partnership. The programme is also supported by Croí, the West of Ireland Cardiology Foundation and Midwest Radio. The programme is running in the Ballina, Westport and Claremorris areas. As an initial target, all of the men came together to complete a 5k walk and fun run at Lough Lannagh, Castlebar. Initially, information evenings were held in three locations where men enrolled for the programme and received a free health check. The programme targeted men over 35 who were physically inactive. Local leaders in the three towns support the programme and lead the physical activity programmes twice weekly at each location. The programme is being formally evaluated, with the men’s health data being updated at week eight,

week 16 and again towards the end of the programme. It is hoped that this initiative can be further extended to other locations once the formal evaluation of the project has been completed. Charlie Lambert, Sports Partnership Co-ordinator, complimented all of the

participants for their remarkable dedication to the programme to date and paid tribute to the local leaders in the three towns for making the programme so successful. For more information on the programme, please contact the Mayo Sports Partnership at (094) 904 7025 or visit www.mayosports.ie.

New Pulmonary Rehab Programme T

he North Mayo Primary Care Team recently completed a pilot exercise and education rehabilitation programme for people with long-term lung conditions. The pulmonary rehabilitation exercise and education programme was developed as a joint initiative between Consultant Physician at Mayo General Hospital Dr Cyril Rooney and his team and was delivered by the North Mayo Primary Care Team. Ten patients with long-term lung conditions, such as chronic obstructive pulmonary disease (COPD), were carefully selected from Killala, Crossmolina, Lahardane and Ballycastle and they have successfully completed the first ten-week community-led programme in Mayo. Prior to this, patients would have been placed on a waiting list and had to travel to Mayo General Hospital to participate in a COPD rehabilitation programme. A pulmonary rehabilitation programme involves a dynamic active collaboration among the patient, family and healthcare providers. Evidence-based support for pulmonary rehabilitation in the management of patients with chronic respiratory disease

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has grown tremendously, demonstrating reduced breathing difficulties, increased exercise performance and better healthrelated quality of life. Emerging literature is also beginning to reveal its effectiveness in reducing healthcare costs. Public health nurse Paula Duggan, community registered nurse Margaret Sheerin and physiotherapist Brian Ruane co-ordinated the ten-week course. The course involved a combination of teaching, counselling and behaviour

modification techniques to promote selfmanagement skills and self-efficacy. The programme incorporates weekly sessions of exercise, education and relaxation and all participants were encouraged to carry out their own programme at home and keep a daily record in an exercise diary. For further information about the COPD rehabilitation programme, contact Laurence Gaughan, Primary Care Development Officer. Tel: (094) 904 2509.

+ Back row (L-R): Michael Gallagher; Seamus Jordan; Brendan Ruttledge; James Muldowney; PJ Garrett; and Brian Ruane, Physiotherapist. Front row (L-R): Margaret Sheerin, CRGN; Kathleen Lynn; Josie Irwin; Dr E. Fitzgerald, GP; and Paula Duggan, PHN.

2/10/12 16:24:06

70 Health Matters

News // Dublin north east

Rotunda is re-designated as Baby-Friendly

+ Senior audiological scientist David Clarke simulates an ear examination on audiologist Joe Fields.

Advances in Audiology Service Provision

+ Pictured at the presentation of the award were (L-R): Maura Lavery, Lactation Specialist Midwife; Aisling Bhreathnach, Lactation Specialist Midwife; Margaret Philbin, Director of Midwifery and Nursing; Siobhan Hourigan, HSE National Breastfeeding Co-ordinator; Pauline Treanor, Secretary General Manager; Sam Coulter-Smith, Master; and Genevieve Becker, National Co-ordinator for the Baby-Friendly Hospital Initiative.

The Rotunda was recently presented with an award to recognise its re-designation as a baby-friendly hospital. The Rotunda was the first maternity hospital in Dublin to get the National Baby-Friendly Hospital Award in 2006 and has maintained this status while working towards re-designation. The baby-friendly hospital initiative (BFHI) is a global project of the WHO and UNICEF which recognises that implementing best practice in maternity services is crucial to the success of programmes promoting breastfeeding. The successful implementation of the ‘ten steps to successful breastfeeding’ ensures the hospital supports and promotes informed parental choice through the provision of appropriate, accurate, unbiased information and discussion with women and their partners.

A purpose-built audiology suite recently opened in Cootehill’s newlydeveloped Community Services Centre, having moved from its previous location in Darley Health Centre. The community audiology service in Cavan/Monaghan is staffed by David Clarke, Senior Audiological Scientist and audiologists Joe Fields and Tracy Allister, with administrative support from Dolores McGill. The service for the North East region is currently led by David Clarke and his team and delivered on a HSE area basis. As well as providing audiology clinics on a weekly basis at the other audiology centres in the North East area, the staff provide two to three adult clinic sand one paediatric audiology clinic in Cootehill.

James Connolly Garden Opens One of the internal courtyards at Connolly Hospital in Blanchardstown has been redeveloped to create the new James Connolly Garden. First-year BSc horticultural students from the Institute of Technology Blanchardstown (ITB) designed and reconstructed the courtyard as part of their course work under the guidance of academic staff from ITB and Karl Dalton, Environmental Manager at Connolly Hospital. Mary Walshe, Hospital Manager, said: “We are delighted with the collaboration

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+ Pictured at the opening of the new garden were (L-R): Paul Bell, Health Division SIPTU; Mick Lawlor, Chief Shop Steward, SIPTU; Jack O’Connor, President, SIPTU; Joan Burton TD, Minister for Social Protection; Philip Hughes, student; Ciarnad Ryan, Lecturer in Horticulture, ITB; Richard Conroy, student; and Mary Walshe, Hospital Manager.

between our environmental department and the ITB. We wish to thank SIPTU for their support in enabling the moving of the

bust of James Connolly from within the hospital to be a centre-piece in the new garden.”

2/10/12 16:24:30

Health Matters 71

Dublin north east // News Special occasions for residents at St Mary’s Hospital

New Genito-Urinary Medicine Clinics Commence

+ Resident Betty O’Sullivan presents a piece of artwork to President Michael D. Higgins on his recent visit. On the left is Dolores Bond, Assistant Director of Nursing.

Last June, the residents at St Mary’s welcomed two special visitors. The President of Ireland, Michael D. Higgins, visited his ‘nearest neighbours’ where he met with a large number of residents and staff who gathered in Teach Cara Community Nursing Unit for the special occasion. The President viewed the residents’ artwork and the 50-bed facility. Delegates from the FIRE project who were visiting the hospital for the end of programme celebration also met the President. St Mary’s has participated in this two-year international research project. At the beginning of June the Archbishop of Dublin, Dr Diarmuid Martin, celebrated mass at the hospital in preparation for the Eucharistic Congress which took place in Ireland this year.

+ Staff supporting the HSE DNE GUM clinics. L-R: Ann McMahon, Staff Nurse, Louth County Hospital; Dr Justin Low, Consultant in Genito-Urinary Medicine, Monaghan Hospital and Louth County Hospital; Bernadette McArdle, Clinical Nurse Manager, Monaghan Hospital; Prof. Samuel McConkey, Head of International Health and Tropical Medicine, HSE DNE; and Imelda Lynskey, Medical Officer, Monaghan Hospital.

Two new sexual health or genito urinary medicine (GUM) clinics recently commenced in the North East – one in Monaghan Hospital and one in Louth County Hospital, Dundalk. These clinics offer local access to testing and treatment for people with sexually transmitted infections (STIs). Funding for these new clinics was secured by the Cooperation and Working Together (CAWT) cross border health partnership and from the European Union’s INTERREG IVA programme. These free and confidential services are provided by Dr Justin Low, Infectious Diseases Consultant, with the support of medical, nursing, pharmacy and administrative staff. Additional GUM clinics in Louth County Hospital and Our Lady of Lourdes Hospital, Drogheda will commence in coming months.

Olympians for a Day

+ Participants representing HSE Odin’s Wood Day Care Centre who won the challenge on the day. Front row (L-R): Clients Maureen Carolan, Mary Moore, Paddy Dargan and Sister Vera Lennox. Back row (L-R): Pauline Wall, Odin’s Wood staff member; Paula Bermingham, Manager; Margaret Guthrie, Healthcare Assistant; and Maureen McCormac, volunteer.

Up to 60 older people with varying levels of ability/disability from three day care centres in Finglas met for their own Olympic Challenge. The participants from

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Odin’s Wood (HSE), Nethercross (Respond) and Clareville (Dublin City Council) ranged in age from 69 years to 91 years. Thirteen teams took part in the challenge, each team

represented a country and was dressed accordingly on the day. Countries taking part included Ireland, France, Lithuania, Turkey, Spain, USA, China, Greece, Mauritius, Germany, Poland Russia and Scotland. The teams also included a staff member or volunteer from each of the centres, who provided assistance on the day. The activities they competed in included golf, bowling, rings, basketball, bean bag toss, shooting, hoops, horse shoes, floor darts, ten-can shootout and roll-a-ball. All of the older people live at home in the community with the support of the day care centres, Meals on Wheels and public health nursing service, home help and homecare packages. The day care centres provide the older people with a hot meal, personal care and a stimulating programme of activities.

2/10/12 16:24:43

72 Health Matters

News // Dublin north east

Reconfigured Regional Rheumatology Service

+ L-R: Lorraine Cooney, Clerical Officer; Dr Rasha Brier, Registrar; Dr S. A. Ramakrishnan, Consultant Rheumatologist; Martina Carolan, CNS Rheumatology; Catriona Stafford, Staff Nurse Rheumatology; Petrina Donohue, Senior Physiotherapist; and Carol Manibo, Staff Nurse.

Our Lady’s Hospital NAVAN delivers a regional specialty rheumatology service for the North East area. The service has recently been reconfigured to deliver better outcomes for arthritis patients in the region. The rheumatology team is led by consultant rheumatologist Dr S. A. Ramakrishnan and is supported by a rheumatology registrar, two specialist nurses, a senior physiotherapist and an occupational therapist. Dr Ramakrishnan’s job description was reconfigured in September 2011 to address the waiting list initiative; he now practices rheumatology as a single specialty. There are four new patient rheumatology clinics and two review patient clinics per week. As part of the Rheumatology National Clinical Programme, Rachel Clerkin commenced her post as a Clinical Specialist Physiotherapist in Musculoskeletal Triage at Our Lady’s Hospital in May. Working closely with Dr Ramakrishnan, this initiative aims to improve pathways between primary care and acute services and facilitating efficient access to rheumatology, orthopaedics, physiotherapy and other services.

Playground in North Dublin becomes Tobacco-Free A playground in Rivermeade near Swords became the second public playground in Fingal to become tobacco-free. Jean Molloy, Health Promotion Officer for Tobacco Control, said: “We approached the local school and + Dr Nazih Eldin, Head of Health Promotion, HSE Dublin North East is pictured schoolchildren were with children from Mary Queen of Ireland National School sporting their asked to design a poster ‘Smoke-Free Happy Me’ T-shirts at the launch of the tobacco-free playground. ‘Why my playpark should be smoke-free’. The winning poster is now on permanent display at the playground as a reminder to all who use the facility.” Dr Nazih Eldin, Head of Health Promotion, said: “When children see adults smoking in a family-friendly place it normalises smoking, making children more likely to try cigarettes.” Since this initiative was first piloted in 2011, it has proven to be highly successful and well supported by the families using the playgrounds.

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+ Glamorous glove competition winner Louise Howell, whose mum is a nurse in the special care baby unit, is pictured with her winning marigold.

Clean Hands Save Lives Campaign To promote the importance of hand hygiene and to highlight the ‘Clean Hands Save Lives’ campaign, staff from Health Promotion and Infection Control held a number of awareness events at Our Lady of Lourdes Hospital, Drogheda. Additionally, they ran a 'glamourous glove' competition whivh was open to children. The aim of this year’s events was to increase hand hygiene awareness, particularly in relation to technique and also the appropriate glove use. This was achieved by using the new Surewash hand hygiene training system. This computerised interactive system allowed staff and visitors to learn the correct way to clean their hands and then to assess themselves to see if they cleaned their hands properly. Rose Byrne, Health Promotion Manager at Louth Hospital Group, said: “We were bowled over by the level of creativity and talent displayed by entrants and gave a prize for the best dressed marigold! The gloves were displayed at the health promotion corner and proved to be of great interest to staff, patients and visitors to the hospital.”

2/10/12 16:25:07

Health Matters 73

Dublin north east // gallery

+ Pictured at the launch of the Co-operation and Working Together (CAWT) cross border health Annual Report (L-R): Cathal Magee, former Chief Executive Officer, HSE; Martina Ralph, Transformation Development Officer, HSE Dublin North East; Stephen Mulvany, Regional Director of Operations, HSE Dublin North East; and Dr Ambrose McLoughlin, Secretary General, Department of Health.

+ Representatives of the Primary Care Teams in Coolock, Beaumont, Darndale and Portmarnock are pictured at the Expo 2012 Information Fair held in the Northside Civic Centre, where they provided advice and information on the services the teams provide in the locality. L-R: Sylvia Kennedy, A/Director PHN; former Lord Mayor Andrew Montague; Ann Hughes, PHN Portmarnock PCT; Helen Coyne, PHN Beaumont Coolock PCT; Niamh Lohan, PHN Darndale PCT; and Binta Obola, Primary Care Social Worker, Coolock and Beaumont Coolock PCT.

+ Mayor of Cavan Des Cullen and country singer Big Tom are pictured with clients, family members and staff at the official opening of the new sensory garden at the Sullivan Centre for the Elderly in Cavan. The garden, which was funded by voluntary donations, is located in the central courtyard of the 21-bed dementia unit and provides a therapeutic space where residents can relax and enjoy the sensory experiences that it provides.

+ St Oliver’s Hospital in Dundalk, which provides services for older people, celebrated its 25th anniversary last July. The residents, relatives, staff and invited guests enjoyed an afternoon of celebrations to mark the occasion. Pictured are Kay O’Keefe, present Director of Nursing with Mary Gaughran (centre) and Maureen Roddy (right) – two of the former Directors of Nursing at the event.

+ HSE DNE staff are pictured at the CAWT Connect programme graduation presentation. Back row (L-R): John Bruton, Eilish McKeown, Rosarii Mannion, Jessica O’Malley, Paul Fitzgibbon and Eileen Maguire. Middle row (L-R): Thelma Pentony, Kevin James, Irene Harris and Martina Ralph. Front row (L-R): Frances Haigney and Susan Kenny. In total, 72 senior health and social care managers drawn from across all of the CAWT partner organisations completed the programme, which aims to help staff improve their ability to set goals, work through obstacles, make decisions and improve relationships.

+ Physiotherapist Majella O'Reilly is pictured giving advice to members of the public at a recent information event held at Our Lady of Lourdes Hospital. The event was held to coincide with World Physical Therapy Day which provides an opportunity for physiotherapists from all over the world to raise awareness about the importance of keeping fit and mobile throughout life.

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3/10/12 10:40:50

74 Health Matters

News // Dublin mid-leinster

Reignite the Spark The positive impact of the arts on health and wellbeing has been evident recently in the Dún LaoghaireRathdown area.

veryone has a right to access and experience the arts to enhance their day-to-day lives. This is the ethos of a joint partnership programme centering around arts and health by the HSE Health Promotion Service Dublin South East/Wicklow and Dún Laoghaire-Rathdown (DLR) County Council Arts Office which commenced in 2007. The Arts and Health Partnership believes mental and physical wellbeing is enhanced by the power of creativity. From intergenerational drama, dance in the community to storytelling through clay, participants, staff and visitors alike have given the term ‘arts and health’ more meaning. The launch of Reignite the Spark provided a snapshot of the arts and health programme. It highlights the activities, achievements and talents of participants to date. These include staff and residents from:  Dalkey Community Unit and Day Care Services for Older Persons  Coiscéim Residential Care Unit, Mental Health Services  St Joseph’s House for Deaf and Deaf Blind Adults  St Joseph’s Centre, Day Care and Outreach Services for Older Persons with age-related illness

Maximising Engagement Actress and Bealtaine Festival ambassador Geraldine Plunkett launched the booklet and this was followed by a performance and screening of new intergenerational works by young people from Dún LaoghaireRathdown’s youth arts programme and Dalkey Community Unit Day Care. Bealtaine promotes opportunities for greater participation by older people in society through partnerships. Inclusion of older persons, those with disabilities physical, intellectual, sensory and mental health illness, as well as long-term conditions, such as dementia are traditionally hard to reach groups. To maximise

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engagement, these projects actively facilitated the needs of each participant, each care setting, their staff and facilitators. The aim is to make creativity intrinsic to life within residential and day care, enhancing quality of life, self-esteem and improving overall health and wellbeing for all taking part.

Sense of Achievement Everyone has a right to access and experience the arts to enhance their day-to-day lives. Reignite the Spark details participants’ individual experiences indicating that they gained a great sense of achievement through their creations and reconnect with and discovered creative skills and abilities. Siobhán Mangan, Senior Health Promotion Officer, said: “The Health Promotion Service believes in the benefits of creativity through the arts to health and wellbeing. This project has allowed all participants access to and experience of the arts to enhance their day-to-day life within residential care and the wider community. “It has normalised opportunities for young people, older people, those with

disabilities and mental health illness and to actively participate in the cultural life of their local area. They interact in a way that allows them to share experiences, knowledge, skills, creative practice, build crossgenerational friendships and reinforce generational bonds ensuring that creativity is intrinsic to all their lives.” The HSE and DLR believe that good quality arts opportunities can make an enormous contribution to quality of life and health. They enhance communication and relationships and allow self expression, self esteem and morale to exist, which in turn have a ripple effect on the wider community. It is vital that work of this kind from the participants, creative practitioners and staff be recognised and sustained. Máire Davey, Assistant Arts Officer, DLR, added: “Dún Laoghaire-Rathdown County Council view the arts as an important service that contributes to the quality of life for those that live in, work in and visit the county. The arts and health partnership is vital to ensure that all members of our community have opportunities to engage with the cultural life of the county.”

+ Geraldine Plunkett, Bealtaine Festival Ambassador, and Ann Foley at the official launch of Reignite the Spark, an Arts and Health document which was held in HSE Dalkey Community Unit.

2/10/12 16:25:53

Health Matters 75

Dublin mid-leinster // News

open window For those in hospitals, nursing homes, community and long-term residential care centers, contact with family, friends and the outside world can help them through each day.

+ Bobby Kelly viewing the OpenWindow at Maynooth Community Care Unit.

new service called OpenWindow is being offered by Vivartes. OpenWindow is a web-based platform designed for care settings that allows the easy sharing of photographs and video messages with residents, keeping them connected to family and friends. Residents also have access to a library of nature videos that have been selected to reduce levels of anxiety. In an initial project funded by Kildare County Council Arts Service and the Arts Council, OpenWindow is now installed in four centers in Co. Kildare: Maynooth Community Care Center, Craddock House Nursing Home, St Vincent’s Hospital Athy and St Raphael’s Celbridge.

Evolving Process Involved in this project is artist Denis Roche, who was approached by Professor Shaun McCann, a consultant hematologist. Patients were unhappy that they had very little to look at, and that is when Denis decided to get involved. “This has been an evolving process. I made a proposal to the hospital and through funding from the Irish Cancer Society, the Vodafone Foundation and the hospital, the project was initiated,”

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+ Denis Roche and Prof. Shaun McCann supporting the OpenWindow initiative.

explained Denis. “This is a developing process and people are thinking differently about using the arts in a clinical, community, older persons and mental health setting. People are using it in the way it was meant, they are actively uploading photographs and using it in a group context. It’s being used in a very directed way, such as with people with dementia and Alzheimer’s disease.” Residents have been enjoying photographs and video messages sent by family overseas, which keeps them connected and stimulated and these messages initiate memories and conversation. The project has been running in Maynooth Community Care Center since February of this year.

About OpenWindow OpenWindow is displayed via a projector or a large screen television and is controlled by a touchscreen device. Each resident has their own private account that ensures that photographs and video sent by family reach them directly. Selected video artists contribute to an ever-expanding video library that helps to reduce levels of anxiety. OpenWindow was the subject of a fiveyear clinical trial conducted in St James’s

Hospital in the National Bone Marrow Transplant Unit, Dublin. Research results showed a clinically significant reduction in levels of anxiety amongst patients who had access to the service and an improvement in health-related quality of life. This service was initially developed to relieve their sense of isolation, anxiety and depression. The results were published in the magazine, Psycho-Oncology, in December 2011. In the Le Chéile Centre in St Vincent’s Athy, OpenWindow is being used to develop a video library specifically for residents with Alzheimer’s disease. In Maynooth, families and activity coordinators have been uploading ‘life-book’ photographs to OpenWindow. A comprehensive art in health programme can be developed through implementing OpenWindow. Experience has shown that many opportunities exist for collaboration with local artists, galleries and museums. According to Denis, it is hoped that the project will be rolled out to other nursing homes and community care settings in Kildare, Dublin and Blackrock hospice. It is also hoped to have it rolled out in other national hospitals. For further information, visit www.openwindow.ie.

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76 Health Matters

News // Dublin mid-leinster

Awards for Tullamore Hospital Pharmacists

+ Final touches being put to Finding Ouroboros.

EVE Artists’ Group Installation A novel way of dealing with unwanted waste went on show at Electric Picnic. The artists’ group from EVE Estuary, a training centre for adults with learning disabilities, based in Swords, Co. Dublin, has been working in collaboration with onsite artist Rachel Kiernan for a number of years. Their work, Finding Ouroboros, featured at Electric Picnic, set on the 600-acre estate at Stradbally Hall in Co. Laois, for three days and was also shown at the Knockanstockan three-day event, which is an independent music and arts festival held annually beside the Blessington lakes in Lacken, Co. Wicklow. The installation consisted of three major interlinking elements, which were adorned

by smaller works of art. It was constructed entirely out of recycled materials and found objects and was lit through the use of solar powered fairy lights. Rachel Kiernan explained: “Raising awareness of how recycled materials can be modified into works of art, to express something other than their original raison d’être is what we are trying to do.” HSE Eve is a programme within the HSE, whose primary ethos is to provide community-based, recovery-orientated programmes for adults who experience mental health difficulties across 21 locations in HSE Dublin North East and Dublin Mid-Leinster.

New unit for Clonskeagh It is essential that HSE services respond effectively and efficiently to meet the needs of our ageing population. Matching this is the new Clonskeagh Community Nursing Unit. Ideally located within the 13.7-acre HSE campus, the unit was officially opened by Minister for Health James Reilly TD recently. Up to 11 per cent of the population in the HSE Dublin South East/Wicklow area are over 65 years of age. Just one-third of the population live within the immediate Dublin South East area, where the age profile is slightly higher than the national average, and has 12 per cent over 65 years of age. The new Community Nursing Unit provides state-of-the-art facilities comprised of single, double and four-bedded accommodation. In addition, there is room to accommodate family members who may wish to stay with their relative at times. Services are provided in a multidisciplinary context and this includes nursing and care staff, medicine, physiotherapy, occupational therapy, speech and language therapy and support staff. The unit is staffed to care for those with the most heavily dependent clinical needs. Currently, there are 81 residential placements and nine respite places in operation.

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Pharmacists from the Midland Regional Hospital at Tullamore – Lisa Kelly, renal dialysis pharmacist and Shirley Armitage, Birr CNU clinical pharmacist – won awards for their work at the annual HPAI conference recently. Joan Peppard, HPAI President and head of pharmacy in the Midland Regional Hospital Tullamore, explained that, “Pharmacists play a vital role in the Irish healthcare system by working with their hospital colleagues in a collaborative multidisciplinary way. I am especially delighted that two of my colleagues in the pharmacy department in the Midland Regional Hospital Tullamore were prizewinners at the conference.” Lisa Kelly received first prize for her audit of medication use and associated cost savings in the renal dialysis department. Oisín Ó hAlmhain accepted second prize on behalf of Shirley Armitage from Birr for her work in the Community Nursing Unit in Birr. This clinical pharmacy service supports the Birr Community Nursing Unit in meeting the Health Information and Quality Authority (HIQA) National Quality Standards for Residential Care Settings for Older People in Ireland. The HPAI annual conference highlighted the high level of research in the sector, with 98 poster presentations submitted for appraisal.

+ Lisa Fagan is presented with her award at the HPAI Annual Conference by Pat Norris, Baxter Healthcare Ltd.

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Dublin mid-leinster // gallery

+ Shane Lafferty, winner of two medals at the European Transplant Games in Croatia during the summer.

+ L-R: Athletes Declan Guing (Edenderry), Shane Lafferty (Athlone) and Niall McAuliffe (Portlaoise) who participated in the seventh European Transplant and Dialysis Games in Zagreb, Croatia last summer. Declan won gold in the ball throw and a bronze medal in bowling, Shane won gold in bowling and Niall won gold in darts and silver in bowling.

+ A sample of work on show at a recent art exhibition in Tallaght Hospital.

+ Pictured at the naming of Midlands Regional Hospital Portlaoise as a baby-friendly hospital were (L-R): Fiona Moore, CNM, Special Care Baby Unit; Berna Keating, CNM Paediatric Unit; Dolores Booth, Divisional Nurse Manager Maternity Unit and Paediatric Unit; Jacqueline McNulty, Hospital Manager; Dr Genevieve Becker, National Coordinator of the Baby-Friendly Hospital Initiative in Ireland; Maureen Nolan, Director of Nursing; Terry Cotter, Clinical Midwife Specialist/Lactation; and Dr Miriam Doyle, Consultant Obstetrician/Gynaecologist.

+ L-R: Cllr Ivan Keatley; Michael Knowles, General Manager, HSE; Patricia Kelly, Manager; Helen Dreelan, DON; Martin Heydon TD; Cllr Mary Oâ&#x20AC;&#x2122;Sullivan; and Jack Wall TD pictured with Health Minister James Reilly TD during his recent visit to St Vincentâ&#x20AC;&#x2122;s Hospital, Athy. + Kathleen Adams (centre) with her daughters Kathleen Egan and Anita Durkin enjoying the tenth birthday celebrations at Maynooth Day Care Centre.

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78 Health Matters

NEWS // SOUTH Minister Hogan opens refurbished Paediatric Unit + Minister Hogan met parents William and Rhona Dempsey with Jack, Sam and Ken Hearn, as well as Denise Large with Hannah. Also pictured are (L-R): Dr David Waldron, Consultant Paediatrician; Mayor of Kilkenny Cllr Seán Ó hArgáin; Nurse Dolores Delaney; GM Anne Slattery; DoN Helen Butler; AM Anna Marie Lanigan; and Play Therapist Mary O’ Donovan.

A d421,000 UPGRADE of the paediatric department/19-bed children’s ward at St Luke’s General Hospital Carlow/Kilkenny was officially opened by Phil Hogan TD, Minister for the Environment, Community and Local Government. The Friends of St Luke’s General Hospital kindly donated d75,000. The unit features a 24-hour Paediatric Assessment Unit (PAU) providing specialist care to children from infancy to adolescence. The refurbishment enables shared care for paediatric haematology and oncology patients with Our Lady’s Hospital Crumlin, facilitating young children for treatments and monitoring closer to home with the support of family and local specialist health professionals. The Minister also launched a paediatric services information booklet produced by the St Luke’s Paediatric Focus Group in conjunction with ‘Children in Hospital Ireland’ clinical and administrative personnel.

Capital Funding for Mental Health in Kerry Capital funding has been approved for two mental health facilities in Kerry. s2 million has been granted to construct a four-bed-high observation unit and associated refurbishment works in Kerry General Hospital’s Acute Unit. The new facility will provide an appropriate environment for patients. Some s1.2m is being allocated in 2012 to commence planning and construction. The second development that will commence in 2012 is a 40-bed replacement residential unit in Killarney, comprised of four ten-bed purposebuilt residential facilities. The unit will enable the closure of St Finan’s Hospital and cater for its remaining residents in the hospital, as well as others who require long-term residential care into the future. The total funding allocation for the project is s6 million, of which s200,000 is approved for 2012 for the design and associated planning fees, with a view to completing construction in 2013.

New facilities at fermoy community hospital A NEW WARD AND CORRIDOR were recently opened at Fermoy Community Hospital. The Dochas Ward is a 30-bed unit catering for older people who require continuing, convalescent, respite or palliative care. The ward comprises of single, twin and fourbedded rooms with associated en suite facilities, creating a homely environment. The Ward can be accessed through the newlyconstructed glass corridor known as the Croi corridor. There has been ongoing redevelopment at Fermoy Community Hospital in recent years. The construction of an additional 30-bed unit, Cuisle, was completed in 2009. The 12-bedded Sonas Ward was refurbished during 2011. Expenditure on the redevelopment works to date has been s5.78m, with s0.46m being provided by St Patrick’s Hospital (Fermoy) Fundraising Association. All units (Dochas, Cuisle and Sonas) now meet HIQA standards for residential care for older people.

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+ Current and former staff at the opening were (L-R): Elma Coleman, Sadie Russell, Vera Noonan, Sheena O’Brien, Phyllis Noonan, Paddy Kenny and Catherine Fouhy.

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South // News South Tipperary Therapy Services Centre Officially Opened

Tralee Community Nursing Unit Opens

+ L-R: Minister Jimmy Deenihan TD, Mary Shea, Director of Nursing Tralee CNU, and Michael Fitzgerald Area Manager HSE Kerry.

+ L-R: Cllr Liam Ahearne, Chair of the Regional Health Forum South; Anna Marie Lanigan, Area Manager, Carlow-Kilkenny/South Tipperary; Chris Monahan, General Manager, Carlow, Kilkenny/South Tipperary Community Services; Carol Moore, Area Co-ordinator, Disability Services South Tipperary; and Cllr Darren Ryan, Mayor of Clonmel.

The HSE South's Tipperary Therapy Services Centre – located in the grounds of St Luke’s Hospital in Clonmel – was officially opened by Cllr Liam Ahearne. The centre is a single base for disability services, which were previously provided from several locations. The initial refurbishment was completed in 2011, when community therapy services relocated to the building. The services incorporated in the completed centre include occupational therapy, physiotherapy, psychology, speech and language therapy, community paediatrician, liaison nursing services and administrative support. The building is designed to ensure that therapy rooms are closer to the entrance, thereby allowing improved access for clients, their families and carers. Other off-site therapists and services have access to the treatment rooms and the Brothers of Charity services attend for multidisciplinary team assessments. In addition, pre-school and school placement meetings are provided, which involve personnel from the education sector.

Jimmy Deenihan TD, Minister for the Arts, Heritage and the Gaeltacht, officially opened Tralee Community Nursing Unit (CNU). The new unit replaced the Dinish and Loher wards in Kerry General (KGH), which were no longer adequate to meet modern day standards of care. Tralee CNU was built at a cost of s9.4 million, providing enhanced residential care for people in the region. The new facility provides continuing care for the local people of Tralee who can no longer live independently in their own homes and require long-term residential care. A wide range of community therapy services, such as occupational therapy, speech and language therapy and physiotherapy is also available in the unit. Both the architecture and interior décor in the new unit lends itself to a homely welcoming environment for residents, families and staff. It is bright, spacious and there are plenty of landscaped garden areas.

RTÉ Airs Second Series of From Here to Maternity From here to maternity, the popular observational documentary series which gives a fascinating insight into life at Cork University Maternity Hospital, was aired over the summer on RTÉ 1. Preliminary figures show that over 300,000 people watched the six-part series each week. The series provided ‘no holds barred’ footage, featuring the joy of a new birth, tempered with the fear and emotional drama as a new life sometimes hangs in the balance. Different aspects of maternity care were featured in each episode and the programme illustrated the professionalism and expertise of staff in CUMH and how they provide a caring environment for mothers, babies and their families. Cork University Maternity Hospital is the city’s only maternity hospital, where more than 9,000 babies are born every year at one of Ireland’s busiest maternity hospitals. Sincere thanks to all staff members that assisted in making this wonderful series.

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80 Health Matters

NEWS // SOUTH

Nursing students gain experience during pilgrimage

Wexford’s Person of the Month Award

+ L-R: Louise Kinsella, Talbot Hotel; Lesley Leech, SJCH; Lulu Hiney, Friends of St John’s; Debbie Donnelly, SJCH; Teresa Casey, Friends of St John’s; Mary Ellen Doyle, SJCH; Lillian McKenna, Volunteer Co-ordinator; John McKenna, Lillian’s husband; Deirdre Lang, DoN; Cllr Sean Doyle; and Alan Corcoran, South East Radio.

+ First row (L-R): Jane Shepard, Eimear O’Hanlon, Niamh Wickham, Deirdre Chapman, Katie Ryan and Kate Rankin. Second row (L-R): Marie Stapleton, Leanne Colgan, Orla Hogan, Rosanne Byrne, Sara O’Neill, Natalie Mockler, Angela Colgan, Shirley Hennessy and Aine Ryan. Third row (L-R): Marie McSweeney, Michelle Wright, Aine O’Donnell, Samantha McGuire, Hannah Carey, Michelle Brennan and Mairead Kelly. Back row (L-R): Aoife O’Brien, John Robinson and Cathy Condon.

TWENTY-FIVE third-year students of BSc/General Nursing at Waterford Institute of Technology (WIT) on clinical placements at Waterford Regional Hospital (WRH) and other healthcare facilities in the South East travelled to Lourdes recently to provide medical back up for 100 ill participants in the annual Waterford and Lismore diocesan pilgrimage. Deirdre Chapman, Clinical Placement Co-ordinator at WRH who helped organise the trip and travelled to France with the party, was delighted that the students’ time in Lourdes counted as clinical placement time in their degree course. Deirdre says: “Over recent years, there has been a younger age profile of nursing students facilitated at WRH and elsewhere in the South East. This is our second year to run this initiative and we had enthusiastic participation. The pilgrimage featured clients the HSE serve from day-to-day and we were very impressed with the dedicated, professional approach displayed by these nursing students. I saw them embrace the whole spirit of Lourdes, in caring for the patients and making sure their trip was as comfortable as it could be.”

St John’s Community Hospital (SJCH) Enniscorthy had a surprise visitor recently. South East Radio’s Morning Mix presenter Alan Corcoran arrived to present the county’s prestigious Person of the Month award to Lillian McKenna. Having worked in the St John’s building as a Community Employment Scheme supervisor, Lillian retired three years ago, but remains a permanent feature, working voluntarily to co-ordinate a volunteer programme. Staff at St John’s nominated Lillian for the award in recognition of her ongoing efforts to make the hospital a more comfortable place for residents, visitors and staff.

New Consultants Join CUH’s Acute Medical and Assessment Unit THREE NEW ACUTE medical physicians – Dr Pat Barry, Dr Akbar Zulequernain and Dr Josie Clare – have joined Dr Jennifer Carroll lead acute medical physician and her team in the acute medical unit (AMU) at Cork University Hospital. These appointments, which were supported by the HSE’s national clinical care programmes, will enable staff to develop policies and procedures to ensure the acute medical service progresses as a model of care locally and nationally. Teaching and quality care initiatives are an integral part of the AMU. The AMU opened in January 2011 with 23 short-stay medical beds and had a significant effect on improving patient flow and length of stay for medical patients in its first year of operation, resulting in a two-day reduction in length of stay and 20,000 bed days saved annually. In January 2012 the unit was extended to include an acute medical assessment unit with 13 trolleys for same day assessment and diagnostics. A further 20 inpatient acute medical beds were opened in April 2012, bringing the total inpatient acute medical capacity to 43.

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+ L-R: Dr Pat Barry, Dr Jennifer Carroll, Dr Josie Clare and Dr Akbar Zulequernain.

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South // GALLERY

+ Cllr Jim Townsend (centre), the newly-elected Chairman of the Regional Health Forum South, pictured at the recent AGM of the Forum with: (L-R) Anna Marie Lanigan, HSE Area Manager, Carlow-Kilkenny/South Tipperary; Pat Healy, Regional Director of Operations, HSE South; Cllr Liam Ahearne, outgoing Chair; and Cllr Mary Hanna Hourigan, new Vice Chair.

+ The recent occupational therapy awareness week at St Luke’s GH in Kilkenny was an opportunity for HSE professionals to engage with patients, families, visitors and hospital staff on a range of subjects from grant provision, falls prevention and management of hospital discharges into the community. Pictured at their interactive stand were (L-R): Eoin O’Brien, Rosie Scully, Siobhan Murphy, Catherine O’Keeffe and Tom Bryan.

+ L-R: Inez Bailey, Director NALA; Máire O’Leary and Martin Grogan, Health Promotion HSE South; and Dr Neil Boyle, Managing Director MSD at the 2012 NALA MSD Health Literacy awards. HSE South’s Busy Bodies Adolescent Development Programme teacher pack reached the finals in the ‘Best Health Promotion Project’ category.

+ Construction has recently begun on a two-storey extension at Mallow General Hospital. This build will feature a Medical Assessment Unit with six treatment areas and two isolation rooms on the ground floor. An endoscopy suite on the second floor will have two procedures rooms, a first-stage recovery lounge, a discharge lounge and a decontamination room. Architect's image pictured.

+ Bridget Keating, Mary T. O'Sullivan, Margaret Burns, Mary O'Sullivan, Bridie Sugrue with multi-task Attendants Kathleen Cronin, Geraldine McCarthy and Karen Masterson displaying recent artwork completed in the Day Centre at Caherciveen Community Hospital.

+ The Stroke Unit in South Tipperary General Hospital and representatives of the Irish Heart Foundation combined to exhibit at this year’s Clonmel Family Health Festival, a free event staged at the town’s Main Guard building. Visitors to the HSE room were offered advice, a free risk assessment and blood pressure check. Nurse Specialist Gemma McLoughlin is pictured in the Main Guard with Paramedic Joe O’Donoghue.

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News // west

Hi-Vis Vests for Cardiac Rehab Patients The Cardiac Rehab Programme at Mayo General Hospital has teamed up with the Road Safety Department of Mayo County Council to provide hi-vis vests for cardiac rehab patients to make walking safer on the county roads after they are discharged from hospital. As part of the cardiac rehabilitation programme, patients are encouraged to walk as a form of exercise, so the provision of the hi-vis vests should make them clearly visible when they take to the paths and roads of county Mayo. Ann Marie Brown, Cardiac Rehab Coordinator at Mayo General Hospital, says: “The Cardiac Rehabilitation Programme is a continuous process commencing in hospital following an acute cardiac event, and it continues on discharge into the community. The programme is designed to help heart patients recover quickly and improve their overall physical and psychological wellbeing. An important part of this recovery programme is for the patients to walk as a form of exercise, so to ensure the safety of these patients we have

+ A group of cardiac rehab patients wearing the new hi-vis vests pictured with Charlie Meehan, General Manager, Mayo General Hospital. Anne Marie Brown and Vera Tuohy, Cardiac Rehab Staff, MGH; and Noel Gibbons, Road Safety Officer, Mayo County Council at the Cardiac Rehab Centre, Castlebar.

teamed up with Mayo County Council to provide them with hi-vis vests.” Noel Gibbons, Road Safety Officer at Mayo County Council, says: “We are delighted that cardiac rehabilitation patients will receive these vests, because it helps

to hammer home our ‘Be Safe, Be Seen’ message. We all need to make the extra effort to be seen while walking or cycling, particularly in areas without street lights and we are also asking motorists to be vigilant while driving on the road at nighttime.”

Elderly Care Day Centre Development at Borrisokane, Co. Tipperary

+ At the contract signing for the construction of a new Elderly Care Day Centre in Borrisokane, Co. Tipperary were (back row) L-R: Pat Quinlivan, O'Brien Builders; Margaret Flannery, Edward Cotter Partnership; Zita Pearce, HSE; and Jim Ryan, HSE. Front row (L-R): Victor Lowe, OCMA Architects; Terence O'Brien, O'Brien Builders; and Joe Hoare, Estates Manager, HSE.

The HSE has awarded a contract to O’Brien Builders & Civil Engineering Contractors in Co. Clare for the construction of a new elderly care

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day centre and associated works at Borrisokane, Co. Tipperary. The elderly care day centre in Borrisokane will be constructed on HSE land adjacent to and

linking with the existing primary care centre. The facility will accommodate a variety of treatment, therapy, training rooms and associated support rooms that provide therapeutic and social activities for the clients, including: physiotherapy, occupational therapy, chiropody, laundry, along with the promotion of social contact among the elderly and the provision of social stimulation in a safe environment for older people, thus relieving caring relatives. This centre will serve the extreme north of the county where there is a high elderly population. Works commenced on site in July 2012 and are due to be completed by June 2013. The project represents an overall capital investment of s1.35 million by the HSE.

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west // News

Ultrasound Machine Donation to ICU at Galway

+ L-R: Kevin Clarkson, Consultant Intensivist; Christine Sheehan, Practice Development Nurse, Critical Care; and Dr John Bates, Consultant Anaesthetist, Galway University Hospitals with the ultrasound machine donated to the hospital.

A FAMILY, who wish to remain anonymous, have donated an ultrasound machine to the Intensive Care Unit (ICU) at Galway University Hospitals, where a member of the family was successfully treated for H1N1 influenza induced acute respiratory distress syndrome, a life-threatening illness, last year.

The H1N1 surge, which hit Ireland during December 2010 and January 2011, put unprecedented pressure on ICUs in the country. The Intensive Care Unit at GUH was operating at 120 per cent capacity during the surge, with nursing and medical staff working additional shifts to cope with demand.

Professor John Laffey, Consultant Anaesthetist at GUH, said: “The donation of the ultrasound machine was an extremely generous gesture by this family. This ultrasound machine enables us to carry out complex procedures at the bedside, such as tracheostomy insertion or insertion of tubes into veins. This is a major advance as the device is small and portable, yet the high-resolution picture it provides allows us to see important structures under the skin in real time.” Dr Kevin Clarkson, Consultant Intensivist and Chairman of the Medical Board of GUH, commented: “We see almost 1,400 patients in the ICU area every year and the majority are admitted because of severe lung and systemic organ failure. Many of the patients are gravely ill and we have trained specialist nurses and doctors dedicated solely to get these patients back to health as quickly as possible. It is not always possible due to the nature of some patients’ illnesses, but medical and technological advances such as the new ultrasound machine make it possible to more safely care for patients and save more people’s lives every year.

Day Care Laser Treatment for Prostate THE UROLOGY SERVICE at Roscommon Hospital commenced in May, and in June was expanded to include day care treatment for prostate enlargement, using laser technology called photosensitive vapourisation of the prostate (PVP). The use of PVP to treat benign prostate hyperplasia was pioneered in Ireland by Syed Jaffry, Consultant Urological Surgeon at Galway University Hospitals, who is running the day care surgery and clinics in Roscommon Hospital. Mr Jaffry spoke of the significance of the new treatment at the hospital. He states: “This is a very exciting development for Roscommon Hospital and the people of the west of Ireland. The PVP treatment involves the use of a laser, is minimally invasive and provides immediate symptom relief with minimal side-effects. The procedure usually takes 20 to 40 minutes and patients are able to go home on the same day.”

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+ On the first day of clinic for the new Urology Service at Roscommon Hospital were (L-R): Marie Cooke, A/Clinical Nurse Manager2; Dr Aine Ní Chonchubhair, Consultant Anaesthetist; Syed Jaffrey, Consultant Urological Surgeon; Dr Mark Quinlan, Registrar; and Mairead Rogers, A/Clinical Nurse Manager1.

Elaine Prendergast, General Manager at Roscommon Hospital welcomed the new service to the hospital. “Not only is this a new service for the hospital, it was also an opportunity to acquire new state-of-the art equipment, including the most up-to-date

laser model. We have provided training for the nursing staff involved and we are confident that this is just one of the many developments that we can excel in due to the focus on day care surgery that we can offer at the hospital,” says Prendergast.

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84 Health Matters

News // west

Smoke-Free Campus Launched in Limerick

+ As part of the World No Tobacco Day, staff welcomed a ‘Clearing the Air’ garden which was placed in the centre of the main reception area of the Mid-Western Regional Hospital Dooradoyle.

The Mid-Western Regional Hospital Group introduced the smoke-free campus policy in May. The introduction of this new policy is also in line with the Mid-Western Regional Hospitals’ designation as one of the eight regional cancer centres in Ireland. The policy will apply to all staff, patients, visitors, contractors and anyone who

enters the hospital buildings or grounds and will ensure a healthier, safer and cleaner environment for all and better health outcomes for patients and staff. As flowers and plants are natural cleansers of the air, we have chosen the orange gerbera flower as the symbol for our ‘Clearing the Air’ campaign. The gerbera

itself has been identified by NASA and Dr B. C. Wolverton to be an air-filtering plant, removing chemicals from the air, such as benzene and formaldehyde and also biproducts of cigarette smoke. The orange gerbera symbolises Clearing the Air on the hospital campus for both patients and staff, supporting a healthy, caring and working environment. On May 31st, World No Tobacco Day, a garden was placed in the centre of the main reception area of the Mid-Western Regional Hospital, Dooradoyle. The garden, designed by community artist Olivia Donovan, was filled with a spread of multicoloured gerbera’s made by the children from the Children’s Ark. On the day, we invited members of the pubic to make there own flower and to give support to the initiative.

New Glenties Primary Care Centre Minister for Health, Dr James Reilly TD, officially opened the new Glenties Primary Care Centre in May. Glenties Primary Care Centre, located in the town centre, represents a s1.7 million investment by the HSE in providing healthcare in the region. It features a GP practice with a range of HSE health professionals, including public health nursing, dentistry, physiotherapy, speech and language therapy, occupational therapy, dietician, addiction service and chiropody. All of the HSE services at the centre will be available to the population of the area, including those attending other GP practices. HSE Estates North West managed the design, construction and procurement of the project in line with the HSE’s national strategy to develop purpose-built primary care centres. The main contractor was Boyle Construction, Letterkenny and the architects were Rhatigan architects of Sligo. Welcoming the new development, John Hayes, HSE Area Manager at Donegal, stated: “We are delighted to officially open

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+ Pictured at the opening of the new Glenties Primary Care Centre were (L-R): Karen O’Donnell, Medical Secretary; Dr Mirelle Sweeney, GP, Ardara; Tracey Doherty, Practice Nurse; Dr Michael Cooke, GP, Glenties; Dr James Reilly, Minister for Health; Pat ‘The Cope’ Gallagher MEP; Deputy Dinny McGinley TD; Michelle Cunningham, PHN Glenties; and Helena McCafferty, Practice Manager.

this new primary care facility, which will greatly enhance the delivery of services within the area. This new primary care centre will allow people in the area to access a range of primary care services within the one building. We look forward to developing more in the coming years.” The staff at the new centre includes the GP practice of Dr Michael Cooke and locum

GP Dr Cormac McPolin. The HSE staff providing a service at the primary care centre consists of public health nurses, dieticians, occupational therapists, physiotherapists, dental surgeons, dental hygienists, speech and language therapists, chiropodists, addiction counsellors and administration staff. There will also be facilities available for visiting services.

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west // gallery

+ Bridget and Michael Langan, Ballycastle, Co. Mayo presented a cheque for s1,936 to the Oncology Comfort Fund, Mayo General Hospital. Pictured at the presentation of the cheque are (L-R): Madeline Gallagher, Clinical Nurse Specialist; Deidre Allen, Oncology Nurse; Michael and Bridget Langan; Mary Hannigan, Advanced Nurse Practitioner; Joan Nestor, Oncology Nurse; Breege O’Donnell, Support Staff; and Elaine Bruton Byrne, Oncology Secretary.

+ Demonstrating new high-definition equipment at Portiuncula Hospital Ballinasloe for minimally invasive or laparoscopic surgical procedures were (L-R): Chris Collins, Consultant Surgeon, Portiuncula Hospital and Galway University Hospitals; John Donovan, Surgical Directorate Sales Manager, MED Surgical; and Eddie Myers, Consultant Surgeon, PHB and GUH.

+ Members of the Surgical Team at Roscommon Hospital who will be treating up to 160 additional patients per month as part of the expansion of the Endoscopy Service at the hospital. L-R: Dr Martin Bell Surgical, Senior House Officer; Liam McMullin, Consultant Surgeon; Thomas Carr, Theatre Porter; Tapas Chatterjee Chattopadhyay, Surgical Registrar; Hailey Leech, Theatre Nurse; and Marie Cooke, A/Clinical Nurse Manager 2, Theatre.

+ The Galway University Hospitals teen parents support programme 2000-2011 report was launched at the hospital in June. L-R: Imelda Ryan, Project Worker, Teen Parents Support Programme; Ciara Keogh, parent and NUI Galway Midwifery Student; and Tony Canavan, Chief Operating Officer, Galway and Roscommon University Hospital Group.

+ Liz Neville, Staff Officer and Judith McLucas, Business Manager from the Laboratory Medicine Directorate, UHG, presenting a cheque for s1,000 to Mary MacLynn, Co-director of the Galway Diocesan Youth Services (GDYS). The money was raised by staff of the Laboratory Medicine Directorate at a recent laboratory social event. GDYS is a network of support services for young people in Galway city (www.gdy3.org).

+ Margaret Brennan from Creeslough in Co. Donegal was the first patient to receive surgery through the new vascular service provided at Letterkenny General Hospital. L-R: Zola Mzimba, Consultant Vascular Surgeon, Western Trust; Joan Frisby, Clinical Nurse Manager, Day Services, Letterkenny General Hospital; Margaret Brennan, patient; Michelle Kavanagh, Staff Nurse; and Sean Murphy, General Manager, Letterkenny General Hospital.

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2/10/12 16:30:01

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www.beckmancoulter.com Email: infoie@beckman.com HM Iss8.3 p53-112pg.indd 86

Our vision is your success

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Health Matters 87

commercial feaTure: Lab technologies

Working in partnership Beckman Coulter is well placed to help meet the challenges facing the Irish healthcare system, with a proven track record of improving quality and reducing the cost of care. Health Matters speaks with Leanne Annereau from Beckman Coulter about how their products supply critical information for improving patient health.

eckman Coulter develops, manufactures and markets products that simplify, automate and innovate complex biomedical testing. Their diagnostic systems, found in hospital laboratories in Ireland, produce information used by physicians to diagnose disease, make treatment decisions and monitor patients. Leanne Annereau, Marketing Manager for the northern region of Europe, says: “At Beckman Coulter, every aspect of what we do is based on the principles of LEAN. It is through these principles that we produce high-quality products and drive technology innovations. Better products and technologies help provide better patient care.”

Innovations When asked about the progression of lab technology, Annereau points to the move towards automated instrumentation as key. “Recently, what’s evolved within pathology is more automation, and the number of labs seeking automation has increased considerably over recent years. Greater automation is required as staffing levels are reduced. At Beckman Coulter, not only are we the world’s leading supplier of laboratory automation, we are continually developing new technologies and novel tests to help laboratories to improve patient care.” An example of a new test is the Prostate Health Index (PHI). The new PHI test is more specific in detecting prostate cancer than the previous prostate specific antigen (PSA) and has shown a 31 per cent reduction in unnecessary biopsies and finally provides a new solution and screening tool for men and their physicians. “The benefit of this test is that it provides men with another option to screening methods, lowers healthcare costs and prevents over diagnosis and treatments,” comments Annereau. Another new technology, the DxN automated molecular analyser, will be launched by the company next year. “The

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DxN automated molecular analyser is expected to help accelerate the migration of molecular diagnostics and genetic testing to hospital laboratories by bringing these high-cost, labour-intensive and complex tests in-house,” notes Annereau. “Laboratory technology is evolving rapidly and this is a significant step forward. Simplified processes leading to improved patient care.”

Challenges Throughout the world healthcare systems are challenged with how to cope with an increased demand for their services. The health service in Ireland is facing a particularly challenging time and Beckman Coulter is well suited to meet the challenges Ireland faces. “What’s happening in Ireland is representative of what’s happening in many places around the world. The country has an ageing population amid an economic crisis and there is a demand for a high-quality healthcare service at a lower cost, but with fewer resources available at hospitals,” says Annereau. “We’re more than just a supplier now and we provide many ancillary services to our laboratory customers. In addition, we work with the laboratories to implement LEAN principles to eliminate waste, simplify processes and reduce costs.”

Pathology Network Beckman Coulter has a strong commitment to Ireland, with two manufacturing facilities in counties Clare and Galway, and also has partnerships with research institutions in Ireland for research and development. “In anticipation of the changes which are occurring in pathology in Ireland we held a workshop last November at our Co. Clare facility, titled ‘Establishing a Pathology Network’ where international speakers relayed their experiences of the greater cooperation between smaller and large laboratories with the goal of gaining efficiencies and cost savings, despite a reduction in staffing and an increase in workloads. The event was very wellattended by senior management of Irish laboratories. Pathology in Ireland is facing challenging times ahead. Beckman Coulter is an experienced company with products, processes and people to support and serve the laboratory through these challenges,” concludes Annereau. For more information visit www.beckmancoulter.com or email infoie@beckman.com.

2/10/12 16:30:28

www.syntec.ie

Prof. Dr. Axel zur Hausen Chair, Department of Pathology Maastricht University Medical Center :

The market demand for more efﬁcient histopathology laboratories continues to increase. We at Sakura have been listening to the market and are equipped with a solution: SMART Automation, the Tissue-Tek® premium product line. Tissue samples are diagnosed faster, better and more efﬁciently with our premium products. SMART Automation is based on LEAN & SIX Sigma principles. For further information, please visit us at www.smartautomation.com/maastricht.pdf

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3/10/12 17:35:30

Health Matters 89

commercial feature: lab technologies

Faster Diagnosis of Cancer The market demand for more efficient histopathology laboratories continues to increase. Syntec are pleased to introduce the Sakura Finetek Smart automation products to the Irish market, which will result in faster turnaround times in histopathology and lead to fast patient diagnosis and treatment. Here, Professor Axel zur Hausen explains the benefits these products have had in Freiburg and Maastricht.

alignant tumours can be diagnosed within a few hours without any concessions to quality. “The processing time of tissue is dramatically reduced, resulting in less unnecessary waiting time for patients,” says Professor Axel zur Hausen, Chair of the Pathology Department at Maastricht University Medical Centre. Due to the recent acquisition of a new continuous rapid tissue processor and the reorganisation of the workflow, the waiting time for tissue diagnoses in zur Hausen’s laboratory has reduced significantly. The system that enables Maastricht to produce a faster diagnosis is the TissueTek Xpress x120 Continuous Rapid Tissue Processor. Zur Hausen was first introduced to this innovative system in 2005 when he was Deputy Director of the Institute of Pathology, University Hospital Freiburg, Germany. “The Director at the time was looking for a faster and leaner way to work. When visiting a pathology lab in the USA, he became very impressed with the Xpress.” A few months later the Xpress was also installed in Freiburg. Initially, zur Hausen was quite sceptical: “I have to admit that I wasn’t enthusiastic at all. I hadn’t heard of this technology before and felt that it would involve a lot of extra work. We were one of the first to start working with this new technology in Europe. We wanted to be absolutely sure that the results were completely reliable, so we spent a full two years researching the same tissues in combination with the traditional method. Time and time again, it turned out that the results of both methods were the same, except that the results of the new method were available much sooner.” When the system was up and running, the scepticism in Maastricht quickly subsided, just as it had in Freiburg. “It became clear that the quality of the results

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was definitely comparable to that of the past, except that now only a fraction of the time was needed.” Zur Hausen explains how this is possible: “The most important difference compared to the traditional method is that the tissue processing no longer needs to be done overnight in batch mode. After receiving the tissue specimen, the specimen is in many cases ready to be examined by the pathologist within two to three hours.”

Leaner Workflow The reduced turnaround time means that patients do not need to be kept in suspense for longer than necessary. The lab technicians also profit from a leaner workflow: “Psychologically seen, it is an improvement that we no longer have big stacks of specimen to process. In

addition, it decreases the chance of making mistakes: you can imagine that the odds of interchanging are bigger when there are 40 cassettes on the table than when there are just three.” Hospitals can also benefit from a faster way of working, says zur Hausen: “A quick and reliable diagnosis implies that treatment can be started sooner. In addition, there will be more time to make a diagnosis or to consult with a colleague when in doubt. Gaining time is essential, especially when it concerns diseases that need immediate treatment. In addition, a lot of money can be saved and waiting lists shortened when we are able to predict sooner if a certain treatment is going to work, as hospital beds won’t be occupied longer than necessary.” Visit www.syntec.ie or call Ray Sinnott on (01) 861 2100 for more information.

3/10/12 15:09:29

90 Health Matters

COMMERCIAL FEATURE

Occupational Heath Service Provider receives ISO 9001 Employment Health Advisers provides clients with a wide variety of services for managing business risk, health and safety, medical assessments, pre-placement health screening, health surveillance, management referrals, and absence management.

mployment Health Advisers (EHA) is a value driven occupational health services company, established in Ireland in 1992. Since then it has grown and now provides services not only throughout the island of Ireland but also as far overseas as the Middle East. The Irish offices are located in Cork, Dublin, Waterford, Limerick, Galway and Ballina, allowing full geographical provision of occupational health services. EHA has clients from all business sectors including healthcare, pharmaceutical and chemical industries, IT and technical support companies, financial and professional organisations, local government and public service sectors, as well as food processing and retailing sectors.

Investment in People The core belief behind EHA’s business model is that people are the most important resource of any organisation, no matter what size or sector the business operates in. Many organisations pay lip service to this concept, but it is EHA’s belief and experience that it is those organisations that really do invest in their staff that will develop and continue to thrive. Part of this investment is in staff wellness, and EHA with its unique mix of talent and experience, are uniquely placed to assist organisations to achieve their goals on the path to workplace wellness.

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EHA distinguishes itself by providing a personal service to its clients as this leads to significantly improved customer satisfaction. The company also has particular specialist expertise in certain areas such as aviation, diving, impairment assessment, environmental risk assessment and offshore medicine.

Tailored Software Technology EHA has also been to the forefront of developing tailored software technology to assist in areas such as management of sickness absence, OMEGA – an online referral system for health assessments, e-ergonomics software, and occupational health quality management systems software. The company recently made two new appointments to the roles of client relationship manager and quality manager. ISO 9001 Status In late 2011, EHA became the first national occupational health service provider to be awarded ISO 9001 by the NSAI. ISO 9001 is for all organisations, large or small, and covers all sectors, including charities and the voluntary sector. Operating to a single set of quality assured standards and procedures has ensured that EHA has developed a reputation for expertise, excellent service and reliability. There are many other benefits for EHA in achieving

ISO 9001 certification, including greater success with tenders, preferred contractor status, reduced costs and re-work, improved customer satisfaction and loyalty, increased profitability, and competitive advantage. Commenting on the development, Maurice Buckley, CEO of the National Standards Authority of Ireland, said: “Certification to the international management system standard, ISO 9001, from the NSAI, now places EHA in a unique position, to combine best business management practices with their occupational health expertise, and deliver tangible improvements in work place attendance and occupational wellbeing.”

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EHA is a specialist occupational health and hygiene practice providing tailored occupational health and industrial hygiene solutions to suit the needs of individual organisations. Our client base and the calibre of our consultants provides a broad range of experience across many industries. Our Consultants are registered specialists in occupational medicine and are members of the Faculty of Occupational Medicine, Royal College of Physicians of Ireland. Employment Health Advisors Ltd., Block B, Heritage Business Park, Mahon industrial Estate, Blackrock, Cork Tel: +353 (0)21 453 6000 Fax: +353 (0)21 453 6016 Email: reception@eha.ie www.eha.ie

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2/10/12 16:30:45

“ My favourite sport is camogie. It is an Irish sport and I have to wear a helmet. It’s cool. What is your favourite game?”

Breda* (aged 15) and her family sponsor Fanta (aged 14) in Uganda with Plan Ireland

“ Hello from Ireland, Mr. Obama, the President of America, visited my village last month. He shook my hand and said ’is feidir linn’. It means yes we can in Irish. What language do you speak?”

‘

Oisin*, aged 7 and 1/2. Oisin and his family from Co. Offaly, sponsor Rosalie from Atakpame in Togo with Plan Ireland

“ My husband and I love gardening and this morning our first white rose came out to say hello. I took a photo and have enclosed it with this letter. I hope you like it.” School teacher, gardening enthusiast and amateur photographer Geraldine*. Originally from Limerick but living in Swords, Geraldine sponsors 5 year old Ruben in Mozambique with Plan Ireland

“I received the photographs of you and your mother today. I placed them on the fridge in my apartment. You have grown up so much from the first photos I received and you look healthy. I hope you are happy.” Grainne*, shop assistant and mother of two, sponsors Teeka (aged 6) from Timor Leste with Plan Ireland.

*Names of sponsors and sponsored children have been changed for child protection, data and privacy reasons.

www.plan.ie 1800 829 829

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CHY15037

CHILD SPONSORSHIP: THE RIGHT PLAN TO END POVERTY

2/10/12 16:30:46

ine*. nsors eland

Health Matters 93

pilates

Strong to the Core Pilates classes are running in towns and cities throughout Ireland. Why is Pilates proving so popular? Instructor and enthusiast Louise Lynch, owner of Pure Pilates makes the case for this form of exercise.

ilates is a programme of exercises designed to strengthen and protect core muscles around the midriff. The discipline takes its name from Joseph Pilates, a German, who spent most of his life in New York working as a physical trainer and healer from the mid-1920s to the mid-1960s. He worked from a studio in the city where he evolved the Pilates method of exercise, invented Pilates exercise equipment and trained students.

Muscle Strength Pilates exercises strengthen the core muscles that help to keep our backs strong. It’s a form of exercise that is suitable for all ages and all levels of ability. Joseph Pilates began to develop the floor exercises that evolved into the Pilates we know today as far back as the outbreak of World War I, so Pilates is not a fad. It has been around as a structured set of exercises for more than 50 years. It is a very safe form of exercise when taught in the correct way. The breathing element of the exercises can be very relaxing and lots of people attend Pilates classes for that reason. People can also gain strength and flexibility from Pilates and that’s a big reason why sports people and teams, such as Manchester United’s Ryan Giggs and the Leinster rugby team, partake in Pilates. While Pilates can be practised as a gentle form of exercise, it can also be a more intense workout. We recommend that beginners sign-up for a six-week programme. After completing two sixweek programmes, participants can really begin to feel and see the benefits. While working in the sport and leisure industry, I trained as a Pilates instructor to an advanced level with the National Training Centre and then began to teach it through my job. I have been teaching Pilates now for nearly ten years and five

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+ Pilates enthusiast Louise Lynch.

years ago I set up my own business, Pure Pilates, as I enjoy teaching this form of exercise so much.

Benefits People of all ages and backgrounds attend Pilates classes. Within the last year, I have worked with members of the Irish Army based at McKee Barracks in Dublin and I have also taught Pilates to the pupils of two Dublin primary schools. Some surgeons take part in Pilates classes, as they spend so much time on their feet, which can be tough on their backs. Some physiotherapists and radiologists from Dublin hospitals attend our classes, as they know of the benefits to be gained from this form of exercise. If someone comes to us having had an illness or injury, we would advise them to talk to their GP or physiotherapist about commencing Pilates.

Our classes cater for all levels, from beginner to advanced, as well as pre and post-natal, and mum and baby classes. We have lots of people who work shifts in our classes. We’ve set up a programme where they can swap morning and evening classes to suit their schedules depending on their shifts and this might suit some health workers. Before taking a Pilates class, you should check that the instructor is suitably qualified and is specifically providing Pilates exercises, as opposed to a general fitness class. Pure Pilates runs exercise classes in north Dublin in Raheny, Drumcondra and Swords. You can contact Louise at 087 683 0547 or visit www.purepilates.ie. Facebook: facebook/purepilatesireland; Email: info@purepilates.ie. For further information about Pilates contact the National Training Centre at www.ntc.ie or call (01) 882 7777.

2/10/12 16:30:58

94 HealtH Matters

updates

criSiS PregnancY Programme Health Matters looks at a new study on migrant women’s attitudes toward fertility, motherhood and sexual health services in ireland. We also report on the decrease in the number of births to teenagers since 2001 and the launch of a new think contraception campaign. MIGraNt WOMeN’s sexUal HealtH the new study focuses on four communities within the overall migrant and minority ethnic community in Ireland – Chinese, Nigerian, Polish and Muslim. 81 women aged between 18 and 30 years were interviewed on their experiences, views and needs in relation to sexual and reproductive health. the research shows that while migrant women share many perspectives with Irish women in how they feel about fertility, sex and motherhood, there are some notable differences. Migrant women described closer control and monitoring of female sexual behaviour by parents and communities in their countries of origin than they perceived to be the case in Ireland. there were lower levels of sexual health knowledge and many reports of inconsistent use of contraception, leading to increased risk of crisis pregnancy and sexuallytransmitted infection. there were also high levels of variation in the knowledge and experiences of migrant women of sexual and reproductive health services in Ireland.

“the study findings provide an important direction for service providers and policymakers in terms of making sure migrant women know the services that are available to them.” there were clear and distinct patterns in how women from the different groups viewed and accessed the Irish healthcare system and sexual and reproductive health

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services. some women interviewed in the study still prefer to use healthcare services within their own communities or even their own countries of origin, either because they believe Irish healthcare will not fully meet their needs, or because they do not know about the services available to them or how to access them. Often this resulted in women establishing no contact with local sexual and reproductive health services, leaving them at risk of being unable to avail of such supports and services locally if the need arose. the Chinese women interviewed in this study reported self-diagnosing medical conditions and managing health issues using a combination of medicines brought from home or bought over the counter. this entailed buying contraceptives in bulk when on a return visit home, asking someone in China to post contraception, ordering contraceptives over the internet or acquiring contraception from someone in one’s own network outside of the health service. the women from Poland reported retaining very strong connections to their home country, including their health service providers in Poland. a striking feature of Polish women’s accounts was the expectation that all sexual health matters would be dealt with by a gynaecologist, rather than by a general practitioner within the primary healthcare system. this caused some Polish women to see the Irish maternity system as less specialised, though others preferred the Irish maternity system. Polish women also obtained medical supplies, including contraceptives in Poland for use when in Ireland. In contrast, the young Muslim women in the study were mostly second-generation migrants and were integrated into the Irish health system through their families. Participants in this group referred to how cultural silences and a sense of shame in relation to sexuality inhibited them asking a GP about sexual health services. Cost

featured as a barrier for those who did not have a medical card in their own right or were not willing to trust the family GP with keeping their consultation regarding sexual issues confidential. Dr stephanie O’Keeffe, Director of the Crisis Pregnancy Programme, said: “the study findings provide an important direction for service providers and policymakers in terms of making sure migrant women know the services that are available to them and ensuring that women experience culturallysensitive care when they access any part of the healthcare system. there are a number of resources that will be useful to healthcare staff in making their service more culturally sensitive. the Hse Intercultural Guide provides practical information to health and social care providers on culturallyappropriate healthcare. the emergency Multilingual aid supports health and social care providers to communicate more effectively with patients and service users in emergency or non-elective situations.” all of these resources are available at http://www.hse.ie/eng/services/Publications/ services/socialInclusion. a full copy of the report is available on www.crisispregnancy.ie.

2/10/12 16:31:02

Health Matters 95

updates

Relax – Johnny’s got you covered T

he HSE Crisis Pregnancy Programme has launched a new sexual health promotion campaign to encourage consistent use of contraception among sexually active young adults. The new phase of the Think Contraception campaign will use TV sponsorships, on-the-street promotion, poster and digital advertising and social media connections to promote its key message: that when it comes to risk of STIs or unplanned pregnancy – Johnny’s got you covered. Research commissioned by the HSE has shown that 20 per cent of 18 to 25-yearolds did not report consistent use of contraception in the last year, (ICCP, 2012).

Johnny will encourage young men and women, the vast majority of whom have had sexual intercourse by the time they reach 25, to plan for, and consistently use condoms to protect against unplanned pregnancy and sexually transmitted infections. Dr Stephanie O’Keeffe, Director of the Crisis Pregnancy Programme, outlines the approach taken to this year’s campaign. “Think Contraception has proven to be effective and popular, particularly with young adults, and we want to build on that success to ensure our messages stay fresh and keep working. We also wanted to extend the campaign this year to directly address both contraception and sexually

transmitted infections.” During the latter half of 2012, Think Contraception will sponsor the Republic of Telly on RTÉ 2 and Take Me Out on TV3. The sponsorship stings will feature a new character called Johnny, who will help get our messages across in a new and entertaining way. Johnny represents the safety and reassurance of using a condom, but we also think that his particular enigmatic charm and sharp sense of style adds a little extra something to our sponsorship stings. Johnny will also be appearing at public events and festivals and you can keep up with him on his Facebook page at www.facebook.com/thinkjohnny or on Twitter @thinkjohnny.

Decrease in the number of births to teenagers The latest birth statistics released by the Central Statistics Office (CSO) show that the number of births to teenagers decreased from 2,019 in 2010 to 1,720 in 2011. Since 2001, the number of births to teenagers has declined from 3,087 in 2001 to 1,720 in 2011. This equates to a decrease in the birth rate from 20 per 1,000 females aged 15 to 19 in 2001, to 12 per 1,000 females aged 15 to 19 in 2011. Speaking about the figures, Dr Stephanie O’Keeffe, Director of the Crisis Pregnancy Programme, said: “It is welcome that

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we are continuing to see a decline in the number of births to teenagers. This year, for the first time, we have evidence from a number of sources that indicates why the birth rate for teenagers has declined – there have been improvements in sex education, the age of first sex is stable at 17 years of age for men and increased slightly for women to 18 years of age. 90 per cent of young people are using contraception when they have sex for the first time and 80 per cent of young people use contraception every time they have sex.”

2/10/12 16:31:32

96 HealtH Matters

commercial feature

groWing buSineSS Pasante is now well-established within the irish healthcare system with their brand of high-quality sexual health products on offer throughout the country.

asante, an independent healthcare company, had their first branded condoms launched more than 12 years ago. since then, they have increased their range and the company has expanded into one of the fastest growing condom companies and their condoms are widely available throughout Ireland. Having established itself as a trustworthy condom company, Clear sign branded pregnancy tests were launched. Pasante now offer a range of midstream and dip and read pregnancy testing kits. Pasante Clear sign pregnancy tests guarantee over 99 per cent accuracy during early stages of pregnancy, are easy to read and are perfectly suited for home use. the result is

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ready to read as early as one minute. Pasante Healthcare is not just a supplier of its own branded product ranges (including condoms, lubricants, oral dams and pregnancy test kits), but an exclusive distributor of the world’s fastest HIV1 and HIV2 rapid anti-body INstItests. the INstI state-of-the-art rapid HIV test offers advanced diagnostic technology at your fingertips. In-vitro qualitative detection of antibodies to human immunodeficiency virus type 1 (HIV1) and type 2 (HIV2) guarantees accurate results in just 60 seconds. It is the world’s only proven 60-second test for HIV/aIDs. Unlike current lateral flow tests, which can take between 20

and 40 minutes to yield a result, INstI uses biolytical’s unique flow-through technology, rendering results in less than one minute with 100 per cent sensitivity and 99.8 per cent specificity during the ClIa clinical trial. Now that the INstI test is ClIa waived, healthcare providers will be able to deliver reactive or non-reactive results to individuals with unparalleled speed and accuracy in all patient settings, including public health clinics, correctional facilities, and outreach clinics. Known for innovation and service, Pasante Healthcare has now firmly established itself as a top quality brand you can trust.

2/10/12 16:31:43

WE DON’T WANT TO SAVE CHILDREN’S LIVES Children’s lives shouldn’t need saving from entirely preventable causes. Every day tens of thousands of children worldwide die needlessly from illnesses such as measles, tetanus and diarrhoea. UNICEF wants you to help prevent these deaths. We believe that one child dying is one too many. We believe in zero and we desperately need your help. Call 01 878 3000 or visit unicef.ie today to give your support.

Believe in zero. HM Iss8.3 p53-112pg.indd 97

2/10/12 16:31:43

98 Health Matters

plantmarket

Autumn Gardening Autumn planting can bring a richness of colour and cheer with autumnal colours, winter bedding and early spring flowers to follow, with only a little effort put in now. While there’s not as much to do in the ornamental garden at this time of the year, if you have a fruit or vegetable patch, you’ll be busy reaping the rewards of harvest. It’s also time to get out and start planting spring-flowering bulbs for next year.

Sandy Soil: If you have very sandy soil that is quickly leached of nutrients, then the more soil conditioner you can add, the better. Mix it into bare soil or use it as a top dressing around existing plants. Those of you that are gardening on free-draining soil (be it sandy, stony or gravelly) will see the benefits of a wet summer. Summer rain is vital to how well such gardens perform. Clay Soil: For clay soil it can be hard work digging organic matter into the

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arly autumn is generally cool and gusty and the days are noticeably shorter. Good soil conditions for growing are essential to good plant growth. Never more so is this true after such a wet summer. Good plant growth is dependent on healthy roots, and healthy roots are totally dependent on healthy soil. A soil rich in organic matter provides food for beneficial soil organisms such as worms, which in turn work their magic by mixing and improving the soil. The best way to improve a soil is to dig in plenty of rich organic matter. This can be well-rotted compost, farmyard manure or soil conditioner, all of which are usually available from your local garden centre. Dig these in thoroughly, breaking up any large clods of clay. Spread soil conditioner or farmyard manure over the surface of the dug area and work it into the soil with a fork. Soil conditioner contains a high proportion of organic material mixed together with a generous proportion of farmyard manure. These natural materials will absorb and hold water in the soil and improve its structure, providing essential air pockets for drainage and for the roots to breathe. The high organic content also encourages the activity of beneficial soil-dwelling organisms, including worms. Herbaceous border will benefit hugely from this action and return a bountiful harvest in seasons to come.

topsoil. It can be invigorating and a great way to exercise, so it is best to do it gradually. When planting new plants use plenty of planting compost in the hole and back-fill with plenty more mixing it into the soil to create a gradual change from compost to soil in the vicinity of the roots. Chop up large clumps of clay and leave it on the soil surface to be baked by the sun, it can then be crumbled and mixed with farmyard manure. Dig the garden in late autumn and leave the clods of clay for the frost to break up. Organic Gardeners: Organic gardeners can choose organic vegetable-growing compost to improve their soil and add vital structure and organic matter to support healthy plant growth. Organic farmyard manure is also ideal for conditioning the soil and adds vital nutrients and water-holding organic matter to garden areas where heavy feeders deplete soil nutrients quickly, such as the vegetable plot or rose beds.

For general soil improvement, or to replace exhausted or spent topsoil, use specially selected and sterilised topsoil that is graded to ensure the very best results in the garden. The coming winter may seem like a dark and barren time of the gardening year, however, if you act now, there is a range of colorful and distinctive winter flowering trees, shrubs and bulbs to help brighten up this season. Many fragrant varieties are available; with all varieties providing much needed colour and ornamental value in the winter. You can create a preview of spring indoors and enjoy the intoxicating fragrance of hyacinths and the dramatic blooms of amaryllis (Hippeastrum), ‘paper white’ daffodils and other bulbs over Christmas and New Year. These bulbs are readily available and easy to grow in just a few months and will make fabulous table displays, not to mention great presents for friends and family.

2/10/12 16:31:53

Health Matters 99

plantmarket

So how do you grow bulbs for Christmas table displays? To have hyacinths in flower for the Christmas period, make sure you buy bulbs labelled ‘prepared’. You may wish to wear gloves when handling the bulbs as hyacinths can cause skin irritation. The simplest compost to choose is bulb fibre, especially if the container has no drainage holes. Alternatively, soil-based or soilless compost can be used, provided it has a good, open texture and is moisture-retentive but free-draining. It is not necessary to use a fertiliser-rich growing medium or to feed the bulbs after planting. Wet the fibre or compost first and place a layer in the bottom of the bowl or pot. Set the bulbs on the fibre or compost. They can be close together, but not touching each other or the sides of the container. Fill around the bulbs with more fibre or compost, leaving about 1cm between the compost surface and the container rim to aid watering. The tops of the bulbs should just be showing at the surface. The next step – ‘forcing’ the bulbs to flower at Christmas After planting, the bulbs need a dark and cool period (ideally 9°C/48°F) to encourage the development of a good root system. Place the potted bulbs in a black polythene bag and stand them in a cellar or dark corner of a shed or garage. Check regularly and water if there are signs that the growing medium is drying out or that the vase needs topping up.

Bowls or pots without drainage holes should be tipped on their sides for a while after watering to allow the excess to run out.

Here are a few tips for bringing the bulbs into flower: Your bulbs need to be at a certain stage of development before they can be brought inside for display. Here are some guidelines: •W hen roots have developed and the shoots are 4 to 5cm long, the pots can be brought indoors. • I nitially, bring pots into a cool room away from bright light to allow the leaves to green up. •T hen move them close to a window in warmer surroundings • Do not stand them in a draught, or close to a source of artificial heat, such as on a shelf above a radiator. • A humid atmosphere is preferred. Stand pots and vases on shallow trays filled with gravel that is kept moist, but with the water level below the base of the pot. • If the leaves develop faster than the flower buds, move the pots to a cooler place and cover them again to keep them dark for a day or two, but no longer than this or the leaves may begin to turn pale. •D on’t forget to check regularly if the pots need watering or the vases topping up. Now with all the possibilities that autumn brings in the garden, there’s no reason to feel that the coming winter is a ‘dark and barren place’. Take action now and enjoy the spring feeling of new life and all that the spring feeling has to offer.

Plantmarket is one of 22 services provided by the HSE’s Eve network, which offers a range of community-based training and work services for people with mental health difficulties in Dublin, Wicklow and Kildare. Plantmarket Garden and Training Centre is located at Blake’s Cross near Lusk in north Dublin and is open to the public on weekdays from 9am to 4.30pm (Monday to Thursday) and from 9am to 3.30pm (Friday).

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2/10/12 16:32:09

100 Health Matters

awards

Taoiseach’s Public Service Excellence Awards In June, the Taoiseach presented Public Service Excellence Awards to 20 projects from across the public service at a special awards ceremony held in Dublin Castle.

he awards ceremony was preceded by a showcase conference in Dublin Castle Conference Centre, where the successful projects were presented and exhibited. Some 190 applications were received and assessed by the awards selection committee. The successful projects from the health sector were:  The HSE, for ‘the National Early Warning Score and COMPASS Education Programme’ – a project that improves the safety record in our health services  Sacred Heart Hospital, Roscommon for their project ‘Dementia Care – The Eden Alternative’ aimed at improving residential care settings for older people  Bantry General Hospital for the delivery of a high-quality acute stroke service in west Cork and south Kerry  Beaumont Hospital for its project on ‘Information Management for Better Patient Care’ – the development of a web-based electronic patient record used for supporting clinical care of people with epilepsy

way. For patients, it now means there is a standardised approach to safe, more efficient and effective quality care for patients. Ireland is the first known country in the world to agree a national early warning score. For more information, visit www.hse. ie/go/nationalearlywarningscore.

Early Warning Score and COMPASS Education Programme A Public Service Excellence Award was presented to the HSE, for ‘the National Early Warning Score and COMPASS Education Programme’, which is a work-stream of the National Acute Medicine Programme. The implementation of the programme represents the most radical change seen in a generation of healthcare. Patient safety and quality are central to the delivery of healthcare and recent evidence identified that a systematic approach to early detection and management of patients, whose condition deteriorates, improves outcomes. Early warning scores have been developed to facilitate early detection of deterioration by categorising patients’ severity of illness, prompting a medical review at specific trigger points, while escalating care in a planned

Sacred Heart Hospital Project A project by the HSE to transform the care culture and environment in the Sacred Heart Hospital, Roscommon, won a 2012 Taoiseach’s Public Service Excellence Award. The award-winning project at the Sacred Heart Hospital was adopted from the Eden Alternative, a worldwide care philosophy designed to de-institutionalise and transform the culture and environment of long-term residential care. At the core of Eden is the empowerment of both residents and staff, giving them a strong voice in the direction of facility life. While this is not a new concept, it focuses on a different way of thinking, promotes flexibility and ultimately helps residents to ‘live in the moment’. This culture change across Sacred Heart commenced with a series of education sessions, including all aspects

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+ L-R: June Burgess, Regional Co-ordinator, Eden Alternative; Mary Butler, Assistant Director of Nursing, Sacred Heart Hospital Roscommon; Taoiseach Enda Kenny; Julie Silke-Daly, Director of Nursing, SHH; Paul Bailey, Eden Alternative; Tim Stevens, Clinical Nurse Manager, SHH; Matt Dalton, Resident Family Representative; Mary Shanthini, Senior Occupational Therapist; and Cora Mugan, Activity Therapist, SHH.

of dementia care, with staff at all levels, and has simultaneously led to significant reductions in the incidence of falls, use of benzodiazepines and staff absenteeism. Speaking prior to the award ceremony, Catherine Cunningham, Area Manager at Galway/Roscommon PCCC Services, stated: “This award offers a unique opportunity to celebrate the success of people working together to provide such a positive impact on people’s lives every single day. We are very pleased with the innovative and creative developments that have taken place within our services to merit these prestigious awards.”

“We are very pleased with the innovative and creative developments that have taken place within our services to merit these prestigious awards.”

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Health Matters 101

awards

+ Dr Brian Carey, Consultant Geriatrician at Bantry General Hospital, receiving his award from An Taoiseach Enda Kenny.

Acute Stroke Unit at Bantry General Hospital The Acute Stroke Unit, which is the first of its kind in Cork and Kerry and one of the first such units in the country, admits more than 100 patients with acute stroke annually. The four-bed specialist unit was set up in 2009 without any extra staff by reorganising existing resources within the hospital. Welcoming the award, Dr Brian Carey, Consultant Geriatrician at Bantry General Hospital (BGH), said: “My colleagues and I are very proud to receive this award and welcome this significant acknowledgement of our work in BGH. Since the unit was established, it has led to substantially improved patient outcomes, reduced length of stay and enhanced patient access to multidisciplinary team members and CT scanning. The unit now uses the most upto-date protocols to deliver a high-quality, evidence-based acute stroke service in a geographically challenging area. The care of patients in the Stroke Unit involves a team of health professionals and I want to take this opportunity to thank them for their consistent dedication to the care of our patients.” The acute stroke unit is located beside the Rehabilitation Unit to allow for a seamless transition between acute care and rehabilitation. Since its inception, the unit has facilitated the safe and efficient

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provision of thrombolysis, the potentially life-saving clot-busting treatment in acute stroke for the first time to a rural, isolated population. This treatment is so timesensitive that if patients from the region had to travel to Cork city for it, they would arrive too late to receive it. Ten per cent of patients received this clot-busting treatment at Bantry General Hospital in 2011, an outstanding achievement in a rural area, given that UK hospitals average rates are less than five per cent.

Beaumont Hospital’s Epilepsy Research Department

Beaumont Hospital won an award for its development of an innovative web-based Electronic Patient Record (EPR). The new web-based EPR, which has been adopted by the HSE to support the National Epilepsy Programme, makes patient information available to all healthcare providers, regardless of geographical location, which allows for an integrated service that is more responsive to the needs of epilepsy patients. Epilepsy is a chronic neurological disease that affects up to 37,000 people in Ireland. The research project entitled, Information When and Where Needed for Safe and Effective Patient Care, looks at aligning people, processes and technology in order to facilitate an integrated EPR. The new EPR system exploits information communication technology (ICT) to enhance quality and safety of chronic disease management while being cost efficient. The project was funded by the Health Research Board and was carried out over five years from 2005 to 2010. Mary Fitzsimons, Project Co-ordinator in Beaumont’s Epilepsy Research Department, said: “We are delighted to be awarded Taoiseach’s Public Service Excellence Award. There is no other comparable epilepsy EPR in the world and this new system is leading the way forward in terms of providing effective management for chronic diseases. The benefits of the new system are not only see improvements of healthcare delivery at patient level, but also play a role in monitoring and evaluation of the performance of epilepsy services.”

+ Back row (L-R): Mary Dunne, IT Dept Beaumont Hospital; Patricia O’Byrne, Business Analyst; Jarlath Varley, Evaluation Researcher; Brendan Dunleavy, Software Engineer; and Paula Corr, Epilepsy Nurse Specialist. Front row (L-R): Sunny Chan, Irish College of General Practitioners; Norman Delanty, Consultant Epileptologist; Kathryn McCormick, Neurology Secretary; An Taoiseach Enda Kenny TD; Mary Fitzsimons, Programme Director; Lucia Navazalopes, Software Engineer; Maire White, Advanced Nurse Practitioner; and Gus Mulligan, Financial Controller.

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in brief // News

Liberties Fun Run

Junior doctors from St James’s Hospital are pictured with elite athlete Kate O’Neill warming up for the St James’s Hospital Liberties Fun Run which took place in July. Some 997 runners, joggers and walkers entered the fourth annual 6.5k road race around Dublin’s Liberties, which started and finished in the grounds of the Irish Museum of Modern Art/Royal Hospital, Kilmainham. The hospital’s Department of Physiotherapy conducted the pre-race warm-up and provided post-race massages for all participants. Well done to all involved in raising much-needed funds for the hospital.

New System Driving Quality A new Incident Information Management System (IIMS) is assisting the HSE to drive quality and safety improvement throughout the organisation. The system manages all information relating to incidents and has now been rolled out at national and regional level. Over the coming months, the system will be further developed and implemented at area and local health service levels. The IIMS system is one of the first modules to be implemented among a larger suite of quality modules that are at various stages of development. Together, these modules will form a Quality Management System, incorporating systems to support complaints management, risk registers, standards and medical device alerts. Commenting on the development of the system, Cora McCaughan, Director, Serious Incident Management Team, said: “This is a significant step forward in enabling the HSE to communicate, manage, analyse and learn from incident information more effectively.”

Service-User Engagement at Temple Street An innovative new programme of service user engagement at Children’s University Hospital (CUH), Temple Street aims to support organisational development and shape the delivery of patient services. Since late 2010, the Executive Management Group at Temple Street has been working with specialist organisation – Corporate Community – to put in place a programme of service user engagement that aims to inform interaction with all hospital stakeholders, both internal and external, ultimately improving overall services, efficiencies and patient care. Initiated by the Board of Directors of the hospital, the programme is chaired by Director of Nursing, Suzanne Dempsey. To date, the process has involved reaching out to patients, parents, staff and broader stakeholder groups, such as patient organisations, to gather feedback on what good engagement would look like for them. Mona Baker, acting CEO and chair of the Executive Management Group, explained: “As part of the process, we have broadened communication and dialogue with parents and families. It is very much a partnership approach and will allow management to listen, but also to be challenged.”

Touch Rugby Best of luck to HSE staff member, Grainne Leach, manager of the Irish Men’s over-40s touch rugby team who are representing Ireland in the Touch Rugby European Championship in Italy. Four teams from Ireland are travelling to Italy to represent Ireland in the European Championships. Dubliner Grainne, who plays out of Terenure RFC, got involved in playing touch rugby after she had her arm amputated in an accident some years ago. She says: “Touch rugby is a unique sport where men and women can play side-by-side at an international level. We are hoping that through our participation at the 2012 European Touch Championships and our hosting of the Home Nations next year in Dublin, we can highlight touch rugby as an accessible sport for Irish men and women of any age.” If you’re interested in finding out more about touch rugby you can contact Grainne at Grainne.Leach1@hse.ie.

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+ Mona Baker, Acting CEO, Temple Street Hospital.

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News // in brief

Mater staff embrace Cycle-to-Work Scheme

+ Staff nurse Otilia Stan is pictured with her new bike alongside Martin Hughes, General Services Manager; Barry McKenna, Sustainability Officer; and Frank Duff of Duff Cycles.

Since its launch in March 2009, the Cycle-to-Work scheme has been enthusiastically availed of by the staff of the Mater Hospital. The 500th bike was purchased recently in Duff Cycles by staff nurse Otilia Stan. Otilia joined the hundreds of other staff members who are enjoying the health and economic benefits of cycling. The number of staff cycling to work in the Mater is now over three times the national average. In addition to the Cycle-to-Work scheme, the hospital has long recognised the need for a proactive approach to promoting cycling. A ‘pool bike’ scheme, free bike maintenance courses, on-site bike repair service, periodic cycling promotions and a significant increase in bike parking have all contributed to an impressive 233 per cent increase in the number of staff commuting by bike. And there is more good news to come for cyclists. The advent of the completion of the new Mater Adult Hospital will see an additional 140 bike parking spaces, shower and changing facilities in close proximity to the bike parking and another Dublinbikes station at the entrance.

Institute of Occupational Health and Safety seminars The Institution of Occupational Health and Safety (IOSH) are organising two halfday seminars in Dublin this autumn. Both seminars are taking place in the Ashling Hotel, Parkgate Street, Dublin 8.

Working together for risk prevention On October 23rd, the ‘Working Together for Risk Prevention’ seminar will focus on safety leadership, safety promotion and staff involvement. The event, which runs from 9.15am to 12.30pm, is free for IOSH members, although non-members are also

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welcome. Registration begins at 8.45am. Biological agents On November 20th, the ‘Biological Agents’ half-day seminar will focus on biological safety, including implementing the new Sharps Directive, occupational blood-borne exposures and biological agent risk assessments. The event, which runs from 9am to 1pm, is free for IOSH members, although non-members are also welcome. Registration begins at 8.30am. To book places, email catherine.daly@ iosh.co.uk or call/fax (01) 620 6785.

+ Dr Joanne Cuddihy.

Dr Cuddihy realises her Olympic Dream Well done to Irish medic and athlete Dr Joanne Cuddihy, who finished fifth in the semi-final of the women’s 400m at the Olympic Games in London. The 28-yearold from Kilkenny City Harriers is the Irish women’s record holder over the distance. Dr Cuddihy finished fourth in her heat in a time of 52.09 seconds behind Francena McCorory of the US, Great Britain’s Christine Ohuruogu and Joy Sakari of Kenya. She went through to the semi-final as the fastest runner-up. Her semi-final was won by American Sanya Ross-Richards in a time of 50:07 seconds and Dr Cuddihy moved up a place in the final straight to finish fifth in a time of 51.88 seconds. Dr Cuddihy, who formerly worked at Galway University Hospitals, also anchored the Irish women’s 4x400m team who finished in sixth place in their heat with a time of 3:30.55 seconds.

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104 HealtH Matters

recommended books

noVel ideAS thiS autumn Health Matters takes a look at some good options currently on the shelves for all you bookworms. steve jobs: the exclusive biograPhy By Walter Isaacson

rom bestselling author Walter Isaacson comes the landmark biography of apple co-founder steve Jobs. In Steve Jobs: the exclusive Biography, Isaacson provides an extraordinary account of Jobs’ professional and personal life. Drawn from three years of exclusive and unprecedented interviews Isaacson has conducted with Jobs, as well as extensive interviews with Jobs’ family members, key colleagues from apple and its competitors, Steve Jobs: the exclusive Biography is the definitive portrait of one of the greatest innovators of his generation.

stories would be much more exciting, and that frightening people was far more thrilling. In this novel, the world according to Oliver twisted is simple. Vampyres feed on the defenceless, orphans are sacrificed to hungry gods and if a woe-begotten catches your scent it will hunt you forever. On the advice of a corpse, Oliver flees his ghastly orphan life to seek his destiny in the dark streets of old london town, despite the perils of the woe-begotten zombie-infested journey. there he meets the shadowy Dodger, the evil old soul-stealer Fagin, and the menacing Bill sikes, who is more beast than man. But will Oliver twisted be the world’s salvation, or its downfall?

oliver tWisteD By J. D. Sharpe

chris brasher: the man Who maDe the lonDon marathon By John Bryant

uthor J. D. sharpe grew up in london, went to Oxford and for a whole summer thought about becoming a police officer, so he worked at New scotland yard. J. D. finally decided that writing horror

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ne of the most remarkable – and controversial – sporting figures in British history, Chris Brasher piled unique achievement on unique achievement. It was Chris Brasher who, along with Chris

Chataway, paced roger Bannister to break the four-minute mile. then he won his own Olympic gold medal in the steeplechase at the 1956 Olympics. Probably best known now for founding the london Marathon, Chris went on to become one of the founders of the modern sports of fell-running and orienteering. at the Observer, he also effectively invented modern sports feature writing. Chris Brasher was also a highly controversial individual: irascible, domineering – a good friend but a bad enemy – and above all a hugely competitive man who had to win in everything he did. Now, John Bryant, who knew Brasher well as a friend, has written the extraordinary story of this impossible and amazing man’s life.

the Promise By Lesley Pearse

ondon, 1914. Belle reilly finally has the life she’s dreamed of thanks to a devoted husband in Jimmy and the hat shop she’s wanted to own since she was a

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recommended books

child. But as the storm clouds of World War I begin to gather, Belle’s already turbulent life is to change in ways she never imagined possible. When Jimmy enlists in the army and leaves for the battlefields of ypres, her world is shattered and she realises she can no longer stand by and watch, she must volunteer to help the wounded. But her work as a red Cross ambulance driver in France throws her into the path of etienne, the enigmatic man who played a significant role in her childhood, and Belle finds herself torn agonisingly between forbidden passion and loyalty to a good man. But the past returns to haunt her present in other – more unpleasant – ways and Belle’s character is put to the test like never before. Can she survive this most brutal of wars with her spirit intact? and will destiny finally lead her to lasting happiness even while war rages all around?

washing up), you’ll find the answers here. any situation, any problem, these are recipes you can come back to time and time again for delicious dinner solutions. after all, making home cooking both simple and enjoyable is what rachel does best. easy Meals contains 180 familyfriendly recipes for any night of the week. and even better, as well as being mouthwateringly delicious, they are simple enough for even the most novice of cooks. this book is full of ideas and recipes that you can rely on to help you tackle the most common meal-time problems; when your fridge is empty, when you’re short on time, that use five ingredients or less or can be cooked in one pot, even delicious dinners you can serve up without so much as turning on the oven. Finally! a cookbook that truly understands the way your life works. easy Meals is an essential kitchen companion. Bestselling cookery writer rachel allen was brought up in Dublin and studied at the prestigious Ballymaloe Cookery school. today, rachel is an international tV chef and a frequent guest on BBC’s Saturday Kitchen; she is also a journalist, mother and a teacher at Ballymaloe. easy Meals is rachel’s eighth cookery book.

coming through DePression: a minDful aPProach to recovery By Tony Bates

r tony Bates is Founder Director of Headstrong, the National Centre for youth Mental Health in Ireland. Prior to this he worked as Principal Clinical Psychologist at st James’s Hospital in Dublin and has more than 30 years’ experience in the area of mental health. this book has been written for all who suffer from depression and for those who are close to the depressed person, be they partner, child or friend. the effort to alleviate the pain of depression in a loved one inevitably fails and the most well-intentioned interventions of friends and spouses can leave all concerned feeling helpless and alienated. While intended primarily as a guide to recovery for the sufferer, it is also written with the relatives and friends of the sufferer in mind in the hope that it can make sense of what can be a difficult problem to grasp from the ‘outside’. Understanding of the problem by all who are affected can act as a bridge between people who feel isolated by depression and those who care about them. Part one explains what happens when someone gets depressed and what kinds of experience cause depression. Part two focuses on a step-by-step recovery plan to overcoming depression and part three considers what has been learned in the past ten years about staying well and preventing relapse.

easy meals By Rachel Allen

n her new book, bestselling tV cook rachel allen shares her ultimate fast and easy family recipes. you can always trust rachel to help you get a delicious and doable dinner on the table. Whether the cupboards are bare or you just want a fabulous meal without the fuss (or the

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106 Health Matters

recommended films

FREEZE FRAME Fancy a night out at the flicks? The tail-end of 2012 has much to offer film-lovers, from action thrillers to 3D animated films. Here, we suggest some cinematic gems for your viewing pleasure. Hotel Transylvania Release date: October 12th. Hotel Transylvania is an animated comedy where Dracula (voiced by Adam Sandler) throws a bash at the sumptuous resort, which has been human-free since 1898, to celebrate his daughter Mavis’ 118th birthday. Dracula invites some of the most famous monsters, like Frankenstein’s Monster and his wife Eunice, Murray the Mummy, Wayne and Wanda Werewolf, Griffin the Invisible Man, Bigfoot, The Blob, and other monsters to the party. Dracula doesn’t have everything his own way, however, when someone falls for Mavis during the celebration. Dracula must protect and rescue Mavis from falling in love with him before it’s too late. The film is directed by Genndy Tartakovsky and features the well-known voices of Adam Sandler, Selena Gomez, Cee Lo Green and Steve Buscemi.

Ruby Sparks Release date: October 12th. Ruby Sparks is a Zoe Kazanwritten romantic comedydrama film directed by Jonathan

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Dayton and Valerie Faris. It stars Paul Dano as a struggling novelist whose fictional character, Ruby Sparks comes to life. A twist on a familiar fantastic premise, this film promises to be a hot indie comedy. The Little Miss Sunshine directors have created have created another feel-good success here. The central characters, the young novelist Calvin Weir-Fields (Paul Dano) and freespirited Ruby (Zoe Kazan) work perfectly together and the chemistry onscreen is there for all to see.

The Perks of Being a Wall flower Release date: October 12th. A film adaptation of a novel of the same name, The Perks of Being a Wallflower stars Logan Lerman, Emma Watson and Ezra Miller, and was directed by the novel’s author, Stephen Chbosky. The producers – John Malkovich, Lianne Halfon, and Russell Smith – sought to hire Stephen Chbosky to adapt the film in a way only he knew how and Chbosky wrote an adapted screenplay about what it’s like to grow up in high school. More intimate than a diary, Charlie’s (Logan Lerman) letters are singular and unique, hilarious and devastating. We may not know where he lives. We may not know to whom he is writing. All we know is the world he shares. Caught between trying to live his life and trying to run from it puts him on a strange course through

uncharted territory. The world of first dates and mixed tapes, family dramas and new friends. The world of sex, drugs, when all one requires is that perfect song on that perfect drive to feel infinite. Through Charlie, Stephen Chbosky has created a deeply affecting coming-of-age story, a powerful story that will spirit you back to those wild and poignant roller coaster days known as growing up.

On the Road Release date: October 12th. This eagerly anticipated film adaptation of Jack Kerouac’s cult classic novel is bound to create a stir upon its release. The film is directed by Walter Salles and stars Sam Riley as Sal Paradise and Garrett Hedlund as Dean Moriarty and has been produced by Francis Ford Coppola with a massive budget of $25 million. The story is based on the years Kerouac spent travelling through the US in ‘40s with his friend Neal Cassady and other interesting figures. Everyone is captivated by the two main characters and the two men are kept company by colourful girlfriends and they travel across the American landscape. But their adventure changed the American counterculture and writing as we know it today. Nearly fifty years after it was first published, On the Road sells more than 100,000 copies a year, is read on the roads of every country in the world, and simply has a massive cult following.

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recommended films

Frankenweenie Release date: October 17th. After the death of his beloved dog Sparky, young Victor cleverly harnesses the power of science to bring him back to life. Victor tries his very best to hide his creation, but Sparky escapes and unintentionally causes mayhem in the town. Frankenweenie is the first black-andwhite stop-motion film to be released in IMAX 3D. The comedy-horror film, directed by Tim Burton, is a remake of his own 1984 short film of the same name. Similar to the 1984 version, it is a homage to the 1931 film Frankenstein, based on Mary Shelley’s book of the same name. Skyfall Release date: October 26th. Believe it or not, Skyfall is the twentythird spy film in the James Bond series. Daniel Craig’s third performance as James Bond looks like it will deliver the goods, with excellent actor Javier Bardem playing Raoul Silva, the film’s villain. After an operation in Turkey ends in disaster, James Bond is missing in action and presumed to be dead and M becomes the subject of a government review over her dealing of the situation. In a time of need, Bond reappears and seeks out Raoul Silva, a dangerous villain claiming a personal connection to both of them. But as Silva travels from London

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to the South China Sea, Bond soon finds his loyalty to M challenged over past secrets. The film is directed by Sam Mendes and was written by John Logan, Neal Purvis and Robert Wade. Skyfall could prove to be the biggest blockbuster on 2012.

The Sapphires Release date: November 2nd. The Sapphires is an Australian dramacomedy film based on the 2005 stage play of the same name. Directed by Wayne Blair and written by Tony Briggs and Keith Thompson, the film is about four Australian indigenous women: Gail (Deborah Mailman), Julie (Jessica Mauboy), Kay (Shari Sebbens) and Cynthia (Miranda Tapsell). The women are discovered by a talent scout (Chris O’Dowd), and form a music group called The Sapphires, travelling to Vietnam in the late-‘60s to sing for troops during the war. Though set at the time of increasing calls for Aboriginal rights, the play takes these issues seriously but in a way that doesn’t detract from its fun and humour and adds to its entertainment value. Gangster Squad Release date: November 9th. Gangster Squad is an upcoming crime film directed by Ruben Fleischer and written

by Will Beall. The story revolves around LAPD detectives who are attempting to keep Los Angeles gangster-free during the 1940s and ‘50s. The elite LAPD unit is tasked with keeping Mickey Cohen and other mafia bigwigs out of Los Angeles – a dangerous and onerous task. Josh Brolin, Ryan Gosling, Nick Nolte, Emma Stone, and Sean Penn combine to make an all-star cast. In the wake of the 2012 Aurora shooting, the film’s release was delayed in the US. A few days later, it was reported that the theatre scene from the film will be either removed or placed in a different setting, since it is a crucial part of the film.

People Like Us Release date: November 9th. Directed by Alex Kurtzman in his directorial debut, the film stars Chris Pine, Olivia Wilde, Elizabeth Banks, Michelle Pfeiffer, and Jon Favreau. Sam (Chris Pine), a struggling corporate barterer in New York, is in trouble after one of his deals violates federal law, and the Federal Trade Commission threatens him with investigation. Sam's boss tells Sam to bribe federal officials at Sam's expense. Returning home, Sam learns that his estranged record-producer father, Jerry, has died in LA of cancer. After flying home to LA, he stays with Hannah at Jerry's house and has a tense reunion with his mother Lillian (Michelle Pfeiffer). Single-mother Frankie (Elizabeth Banks) is a recovering-alcoholic and bartender. Sam realises that Frankie is his half-sister. A film largely about forgiveness, Sam asks for acceptance as her sibling. Check People Like Us out this November.

2/10/12 16:33:53

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ely health Matters ad 188x130mm ART.indd 1

27/09/2012 12:49

car & home insurance now even easier with AXA EasiPay EasiPay allows many health care employees to pay their motor and home insurance premium directly from their salary over 10 months at no extra cost. You can also get up to 10% discount on your motor insurance (new or renewal) and free 24 hour breakdown assistance.

Whatâ&#x20AC;&#x2122;s more, employees on the Easipay scheme can get 10% off a new home insurance policy or â&#x201A;Ź30 off your home renewal. AXA customers can also save money on new and used cars, holidays and lots more. Just visit www.axaplus.ie.

For more information and to find out if your employer is part of the EasiPay scheme drop into your local AXA Insurance branch or call us on 1890 600 600

Terms and conditions apply. Free Motor Rescue Plus breakdown cover is available to existing customers at next renewal. AXA Insurance Limited is regulated by the Central Bank of Ireland. (248X AD)

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redefining

standards

redefining

standards

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healthy eating

Eating Well into the Future An innovative project entitled ‘Eating Well into the Future’, representing a collaboration between the HSE and the Third Age voluntary group, was launched in June by Darina Allen of Ballymaloe Cookery School. As one of Ireland’s best known chefs, Darina Allen believes that good food, good health and good farming practices are an inseparable part of the same process. Malnutrition Malnutrition is an increasing challenge among older people, with recent research showing that a staggering one in three people admitted to hospital from home are deemed to be at risk of malnutrition. Community dieticians have taken steps to address this by developing a structured approach with healthcare professionals in the management of malnutrition in the community. Many of the causes of malnutrition have been shown to be modifiable. The Eating Well into the Future programme has been specifically developed to address the social and psychological issues and challenges associated with poor eating and malnutrition risk. Although genetic and medical factors do play a part, adopting a healthy lifestyle can be influential in preventing the nutritional decline and deterioration associated with aging. Cooking Research shows that social factors, such as difficulties with cooking, shopping and living alone can contribute to malnutrition in older people. Addressing these issues and having a preventative approach was identified as important by the Third Age Foundation and the HSE and this led to the development of the Eating Well into the Future programme. This programme is underpinned by the principles of: • Empowerment – enabling the individual to gain an understanding and control over their health and lifestyle • Capacity building – improving the individual’s problem-solving capability to enhance their health The ethos of the Third Age Foundation is about encouraging older people to keep as well as possible and to be well-informed

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+ L-R: Corina Glennon-Slattery, Community Dietitian Manager, HSE Dublin Mid-Leinster; Cara Cunningham, Senior Community Dietitian, HSE, Dublin Mid-Leinster; Darina Allen; Dr Sharon Kennelly, Senior Community Dietitian, HSE, Dublin Mid-Leinster; Dr Joe Clarke, HSE Clinical Strategy and Programmes, Primary Care Lead; Mary Nally, CEO, Third Age Foundation; and Irene Cunningham, Acting Community Dietitian Manager, HSE, Dublin North East at the launch of Eating Well into the Future.

“Addressing these issues and having a preventative approach was identified as important by the Third Age Foundation and the HSE and this led to the development of the Eating Well into the Future programme.”

Eating Well into the Future is designed to be delivered in a peer education format. A peer-led approach fosters a safe supportive environment for participants to discuss nutritional problems and issues. The programme will address a variety of topics that will equip participants to: • I dentify potential nutritional concerns at an earlier stage • Explore practical solutions to these concerns • Be informed on available services in the community and how to access them. For more information on this project, contact Cara Cunningham, Senior Community Dietician, Clonbrusk Resource Centre, Athlone, Co. Westmeath. Email: cara.gray@hse.ie.

about their health. Their members have informed the development of the programme and also have provided the first ‘batch’ of peer instructors.

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breastfeeding

Good Health Begins with Breastfeeding ‘Good Health Begins with Breastfeeding’ is the theme of National Breastfeeding Week 2012, which takes place from October 1st to 7th.

BELOW EUROPEAN AVERAGE It is very good news for Ireland that our breastfeeding rates are continuing to increase. However, they remain below the European average of 89 per cent. The most recently published ESRI figures on breastfeeding on discharge from hospital report that, in 2010, 54.1 per cent of babies were breastfed on discharge from maternity hospital, with 46.2 per cent exclusively breastfeeding. Looking at these figures another way, the rate of artificial feeding is reducing with 46 per cent of babies artificially feeding on discharge in 2010, an improvement from 58 per cent artificially feeding in 2001.

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“Breastfeeding is a public health priority in Ireland and we must continue our efforts to promote and support breastfeeding,” says Siobhán Hourigan, National Breastfeeding Co-ordinator. “Breastfeeding is a rewarding experience and it is important that women are supported to breastfeed their babies, so that more women are assisted to start to breastfeeding and to continue to breastfeed for longer.” Women need support and helpful information, especially in the early days when they are starting to breastfeed their newborn baby, while making the transition from maternity care to home.

INFORMATIONAL SUPPORT A UCD study exploring barriers for those families least likely to breastfeed, including younger mothers and those experiencing economic disadvantage, highlights the need for practical, as well as informational support. ‘How to latch the baby on to the breast, understanding the baby‘s signals and needs, knowing when the baby is feeding enough and thriving, and understanding the potential problems in breastfeeding and knowing where to go to get help,

are vitally important skills and lessons. However, these lessons and skills are no longer being passed on from mother to daughter, and support must be sought from outside persons or agencies.’ (McGorrian et al, 2010).

REAPING THE REWARDS When breastfeeding is established, women can enjoy all the rewards of breastfeeding as it becomes more enjoyable and easier for mum and baby. It is a very special time with baby and it is so convenient when feeding at home or out and about. The best time to start to find out more about breastfeeding is during pregnancy. The HSE’s online resource – www.breastfeeding.ie – contains lots of information for expectant and breastfeeding mothers, including a listing of support groups by county, information leaflets for download, factsheets for health professional and a questions and answers section. Details of support groups are also available by calling 1850 24 1850. Support groups are provided by Public Health Nurses, La Leche League (www. lalecheleagueireland.com) and Cuidiu (www.cuidiu-ict.ie).

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he focus will be on promoting awareness of the importance of breastfeeding for health, and on providing information on supports available to expectant and new mothers. Breastfeeding protects the health of babies and their mothers in the short and long term. Breastmilk gives babies all the nutrients they need for the first six months of life and protects them from infection and disease. Breastmilk is the complete food for babies for the first six months of life and it is recommended that women can continue to breastfeed as other foods are introduced for up to two years or longer. Children who are not breastfed have an increased incidence and severity of many childhood and adult illnesses. Children who are not breastfed have an increased incidence and severity of gastro-intestinal infections, ear infections, respiratory infections, asthma, eczema, diabetes and obesity in later childhood. Breastfeeding helps to protect mothers from breast and ovarian cancer, cardiovascular disease and diabetes. Expectant families need information on the importance of breastfeeding for their baby’s health and for their health also.

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2/10/12 16:34:10

112 Health Matters

suicide prevention

Emergency Tools for Dealing with Self-harming Patients A pilot scheme aims to train emergency department staff to better deal with patients who have self-harmed. Georgina O’Halloran reports.

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s a crisis nurse in the emergency department of a big city hospital, Rose Lynch has first-hand experience of treating people who arrive at the facility following deliberate self-harm. Between them, Lynch and the other crisis nurse at Cork University Hospital (CUH), Sylvia Quinlan, see all individuals after they come through the emergency department having attempted suicide or engaged in self-harm, from overdoses to attempted hangings, gunshot injuries to drownings. Lynch, who has worked in the role since September 2001, says that sometimes such patients can feel ignored, dismissed and embarrassed in the emergency department. “If there is a serious endeavour to kill themselves and they are left sitting there for an hour, they feel no one cares,” she says. “Sometimes they say they feel dismissed or they have heard someone saying, ‘Here they are again’.” Consultant psychiatrist at CUH, Dr Eugene Cassidy, says that emergency department staff sometimes don’t find it easy to address the needs of patients who self-harm. “My own evidence of emergency department staff is [of] an extremely positive and compassionate group who work under tremendous pressures. Individuals who have presented following self-harm have specific needs, which are mental health needs, which the emergency department don’t always feel able to deal with.” But it is hoped a new training programme, which targets all non-mental health emergency department staff, including doctors, nurses and care staff, will change that. The pilot programme – which will run in a number of hospitals in Cork and Kerry, including CUH and the Mercy University Hospital, Cork – will be delivered by senior psychiatric nurses,

aims to improve the skills, knowledge and confidence of staff in dealing with patients who have self-harmed or who are suicidal. It is a joint project between the National Suicide Research Foundation (NSRF) and Cassidy, and is funded by the National Office for Suicide Prevention. Lynch, one of the trainers, says one aspect of the programme involves providing staff with information on suicide and supplying them with a set of questions to help broach difficult subjects, such as whether the patient feels suicidal or not. “We’re encouraging the staff to talk to the patients about what they have done. If people open up and respond to empathy, they are more likely to engage,” she says. “Sometimes it’s like the elephant in the room; no one talks about it. It’s important to see the human side,” says Lynch, who

“If there is a serious endeavour to kill themselves and they are left sitting there for an hour, they feel no one cares,” she says. “Sometimes they say they feel dismissed or they have heard someone saying, ‘Here they are again’.”

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suicide prevention

describes the incidence of self-harm as “huge”. Over the past 12 months she has noticed an increase in the number of men who are cutting themselves. “The cutting is much more violent than in women… a lot of anger is turned in on themselves.” The need has never been greater to develop a response to patients who engage in deliberate self-harm. According to figures from the National Registry of Deliberate Self Harm, there was a 96 per cent increase in the rates of self-harm presentations to emergency departments among men in Cork city between 2007 and 2010 and a 35 per cent increase in women. Nationally, in 2010 (the most recent figures available) there were almost 12,000 presentations at emergency departments due to deliberate self-harm, involving 9,630 individuals – with a 25 per cent increase in the numbers of men who engaged in self-harm between 2007 and 2010, and a 10 per cent increase in the numbers of women who engaged in selfharm over the same period. “It’s a significant problem nationally and it’s a significant problem here in the region,” says Cassidy. “Having presented at an emergency department having self-harmed is the single biggest risk factor for future completion of suicide,” he says. The programme also seeks to maximise the number of individuals who receive a

“It’s a significant problem nationally and it’s a significant problem here in the region,” says Cassidy. “Having presented at an emergency department having self-harmed is the single biggest risk factor for future completion of suicide.” detailed mental health assessment and follow-up treatment. According to statistics from the registry, 17 per cent of people who presented at emergency departments nationwide following deliberate self-harm in 2010 left before they had received a psychiatric assessment. Director of research at the NSRF, Dr Ella Arensman, says there is international evidence that people who self-harm are still not being treated appropriately in emergency departments. “Either they don’t receive the attention and the care that

is required, or there is also evidence that staff may even give out statements that could be embarrassing or painful to the patients,” says Arensman. “If people are treated in a negative way by emergency department staff, it can result in the patient leaving the emergency department without being assessed,” she says. “The risk of repeated self-harm is higher in those who leave without being assessed. We just want people to be more aware of risk factors and also to feel more comfortable in working with people who have self-harmed.” Arensman says it is hoped that the programme will lead to a reduction in the number of cases of self-harm and suicide in the region. “If there is greater awareness among emergency staff of the signs of highrisk repeated self-harm, especially patients using highly lethal methods of self-harm, this will contribute to both a reduced risk of selfharm and of suicide. If we see that following training, people have more knowledge, have a more positive attitude and have greater confidence in working with people who have self-harmed, then we have a case to roll it out nationally.” This article is reproduced with the kind permission of The Irish Times.

2/10/12 16:34:31

“We cannot add days to a child’s life, but we can add life to a child’s day!”

Make-A-Wish® Ireland has one simple aim - to grant the wishes of children aged between 3 and 17 years living with a life-threatening illness. A wish granted is true magic for the child providing respite from their normal routines of hospitals, doctors and treatment. Since its inception in 1992, Make-A-Wish in Ireland has granted wishes for over 1,300 special children and helped them realise their greatest wish and experience the hope, strength and joy each wish provides. In doing so it provides long-lasting and happy memories for the whole family, whatever the future may hold. As an increasingly well respected and popular children’s charity, Make-A-Wish is fully committed to providing the maximum level of care and enjoyment for children and their families. This is achieved through a combination of professionalism, attention to detail and sensitivity; nothing is too much trouble for the Make-A-Wish team.

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Wishes fall into 4 categories: I wish to have … I wish to go … I wish to meet … and I wish to be … Make-A-Wish receive no government funding and rely totally on the generosity of the general public, corporates, groups and associations. This is why we are appealing to you today to show your support for this wonderful charity. We would be delighted to hear from you, as there are many ways you can get involved with us – in your community, local school or place of work. Join us – so together, we can make a difference. Please contact us on 01 2052012 or email irene@makeawish.ie for more information on how you can get involved. Registered in Ireland: Make-A-Wish® Foundation Ltd 365449. Charity Registration No. CHY 15267

2/10/12 16:34:32 27/09/2012 12:00:13

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2:00:13

STEPPING STONE TO STANFORD Dr Colin Lenihan, who was awarded the Richard Steevens’ Scholarship to complete a fellowship in transplant nephrology at Stanford University, tells Health Matters his story.

scholarship

t the end of my specialist training in nephrology, followed by a PhD in translational research in Ireland, I was given the opportunity to complete a fellowship in transplant nephrology at Stanford University with the much appreciated support of a Richard Steevens’ Scholarship. Stanford is one of the top US universities and is situated a short drive south of San Francisco in the heart of Silicon Valley. It is first and foremost a research university, with postgraduate students outnumbering undergraduates nearly five to one, and grant income exceeding $1.2 billion in 2011. Transplantation is the best form of renal replacement therapy in terms of both longevity and quality of life. It gives patients with end-stage kidney disease the chance to live a normal life. There are currently more than 400 people on the renal transplantation waiting list in Ireland. Unfortunately, transplantation is not available to all suitable patients due to a shortage of organs. In addition, while huge progress has been made with antirejection medications, current regimens still increase the risk of infection and cancer and contribute long-term to kidney transplant failure.

Paired Donation The transplant department at Stanford is at the forefront of developing strategies to overcome both of these problems. Around half of the transplants performed in the unit are from living donors, which circumvents the long waiting times for deceased donor kidneys. The numbers of living donated kidney transplants are maximised here by the use of paired donation. This means that if an individual is willing to donate, but is incompatible with their relative, that they can donate their kidney to another patient in return for an organ for their relative from a suitable donor.

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In a similar, but more complex exchange, donor chains take advantage of altruistic donors, allowing them to spark a long string of donor-recipient pairs that often span multiple transplant centres and timezones. It has been very impressive and educational to witness the computation and logistical effort involved in planning these chains and ensuring that every link in the chain is successfully completed.

Organ Rejection As well as a lack of organs, a significant proportion of patients, who would otherwise benefit from a renal transplant, are unsuitable due to a high antibody titre which puts them at very high risk of organ rejection. Stanford runs a busy desensitisation programme that aims to eliminate a patient’s undesirable antibodies and permit subsequent living or deceased donor transplantation. In addition, a variation of the desensitisation programme permits successful transplantation across the blood group barrier, which again expands the pool of potentially viable donorrecipient pairs.

“Transplantation is the best form of renal replacement therapy in terms of both longevity and quality of life. It gives patients with endstage kidney disease the chance to live a normal life.”

Immune Tolerance The most exciting aspect of the renal transplantation programme at Stanford is the immune tolerance induction programme. The goal of tolerance induction is to achieve

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116 Health Matters

scholarship

hospitals and that people and their health problems are the same the world over. Overall, my experience has been extremely positive and I am very grateful for having had this fantastic opportunity.

rejection-free transplantation with no immunosuppressant medication. In the Stanford protocol, published in the New England Journal of Medicine, the kidney transplant recipient is given total lymphoid irradiation post-operatively followed by an infusion of the donor bone marrow cells. Patients are monitored for the persistent presence of both recipient and donor white blood cells and have their immunosuppressants slowly tapered and stopped. To date, eight patients are maintained successfully without any antirejection medications.

Challenges My training here has also encompassed the renal management of other solid organ transplants. Stanford has large lung, heart and liver transplant service, which all bring their unique challenges. I gained valuable experience in the evaluation of patients for multi-organ transplant listing and the management of simultaneous heart-lungkidney and liver-kidney transplants. Superficially, hospital medicine is very different here to Ireland, with a greater integrated use of information technology and a rapid turnover of inpatient beds. Hospital stays are short and many treatments that would traditionally require hospital admission are performed either at home or as an outpatient. This frees up

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The Dr Richard Steevens’ Scholarship is managed by the HSE’s Medical Education and Training Unit and is awarded annually to sponsor doctors to train in novel areas of medicine which are limited or unavailable in Ireland and to bring the skills learned back to the Irish health service. For further information, email met@hse.ie.

“I gained valuable experience in the evaluation of patients for multi-organ transplant listing and the management of simultaneous heart-lungkidney and liver-kidney transplants.”

inpatient beds for acute medical treatment and empowers the patient to take control of their own health. Stanford doctors are extremely accessible to their patients with Stanford’s ‘My Health’ system, allowing individuals to check their results and communicate with their doctors online. In addition, the Stanford electronic medical record system allows doctors to access all their patients’ files online and eliminates the frustrating paper trail of patient notes. However, what has struck me the most is the similarity between Stanford and Irish

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Health Matters 117

personal finance

The Borrowers Borrowing money in Ireland today? It is probably fair to say, getting a loan at the moment is difficult. Whether you’re looking for a mortgage, a personal loan or a credit card the criteria and application process has changed in the last several years. Eoin McGee reports.

he plain truth is the banks don’t have the money to lend out. They are desperately trying to reduce their loan book, while improving the status of all of the loans they currently hold. The number of mortgages in arrears of greater than 90 days has doubled in the last 18 months from 19,000 to 40,000. Along with this, repossessions are up too, with approximately 500 in the last 12 months alone. Banks are also nervous with the unemployment figures. What is frustrating, however, is that when trying to get lending for clients, the banks paint everybody with the same brush. They look at the figures as I have described them above, negatively. How about considering the unemployment in this country and of total repossessions, two-thirds of them were not court ordered, but were either abandoned properties or voluntary surrenders. Interestingly, on a pro rata basis, for every time a judge in this country orders a repossession, a judge in the UK will order 15. So how has all this filtered down to the person who wants to borrow money? No matter what type of loan you are looking for,

consider the following: in absolute contrast to four or more years ago, the banks have had a complete shift in attitude in relation to giving out money. They are now ‘looking for reasons not to lend to an applicant’. With this in mind, is it possible to borrow money? The answer is, yes.

“The plain truth is the banks don’t have the money to lend out. They are desperately trying to reduce their loan book, while improving the status of all of the loans they currently hold.”

Car Finance The car industry is doing quite well and it is still relatively easy to get car finance. There are several reasons for this. Some car manufacturers have introduced their

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118 Health Matters

personal finance

own finance companies. For example, Volkswagen Bank now offers lending to their customers to buy cars from them. The rates are extremely competitive and the lending criteria is reasonable. Another primary reason for this is that this type of lending has a direct impact on the economy; it creates and keeps jobs and it should be part of any government strategy to support the motor industry. When the taxpayer injected cash into these banks, it was for the purpose of job creation. Don’t underestimate the impact of government pressure on banks to lend and this is a form of lending the banks are happy to do as the security is readily recoverable if things go wrong.

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consider switching your card to another provider and avail of ‘free’ money for an introductory period. For example, Tesco credit cards offer eight months interest-free on credit transfers. By switching your current loan and clearing the balance within the specified period, you will have availed of free money for that period of time. Where the card companies hope you will fall down is that you will either spend on the card in the meantime or you won’t clear the balance on time. This would soon become costly and is something that you should definitely avoid.

Personal Loans There was a time when you could go to your bank and get a loan for just about anything. You might want to go on holiday, clear the credit card after the holiday, or you might just want to top up your bank balance. That was no problem, in fact sometimes you didn’t have to ring the bank; they rang you. Personal loans are still available, but now they are only available for specific purposes. Clearing off the credit card using a personal loan is now a no-go, unless the credit card is with the bank who is giving you the loan. It is unlikely the bank manager will allow you to borrow for a holiday, but if you do manage to get a loan for such a purpose, consider the costs before you draw it down. The interest you pay on that loan will most likely pay for Christmas next year.

Credit Cards News reports recently announced that Bank of America is selling its credit card business MBNA. This one credit card company was responsible for a complete shake-up in the Irish credit card market and in general they have revamped how money is lent on credit cards in this country. MBNA issue their own cards, but are also behind some other big brand credit cards too. If used properly, these are an excellent source of cheap credit. If you have a balance on a loan for example, or a credit card balance that you believe you can pay off in a short period of time,

“There was a time when you could go to your bank and get a loan for just about anything. You might want to go on holiday, clear the credit card after the holiday, or you might just want to top up your bank balance.”

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personal finance

“It is probably inaccurate to say that they keep moving the goalposts. A fairer reflection would be to say there are no goalposts, let alone lines on the pitch. Gone are the days I could give reasonable confidence to a client that their loan will be approved if we submit it.”

do, it is inevitable that the response will be a request for some piece of information that was not requested before. It is probably inaccurate to say that they keep moving the goalposts. A fairer reflection would be to say there are no goalposts, let alone lines on the pitch. Gone are the days I could give reasonable confidence to a client that their loan will be approved if we submit it. It is difficult to say who will get a loan and probably easier to say who won’t. Needless to say if the industry you work in is unstable, if you haven’t got a good deposit behind you or if you have any blip on your

credit history, it is probably most likely you will not be considered. An indication of how far things have moved is in the numbers. Between 2005 and 2008 there were 673,000 mortgages drawn down, 39 per cent of these were people switching from one lender to another. Several lenders today won’t even consider applications for people who want to switch.

So in this difficult environment, consider these top ten tricks to getting a mortgage:

1. Your bank account has to stay well inside the positive 2. If you have an overdraft facility, stay Money lenders out of it Quite simply, don’t go there. If you already 3. If you have loans already, it is most have, you need to talk to somebody likely you will have to clear them first professional about getting out of that trap. 4. Avoid large direct debit commitments This is probably the fastest growing and 5. If you have an online betting account, easiest way to get credit. The providers stop using it are sometimes unlicensed and the cost of 6. When buying a house you need credit is often exorbitant. to have at least 20 per cent of the purchase price Mortgages 7. Every month you should be putting If you feel now is the right time to buy for the savings away the equivalent of the first time, well then be prepared for the loan new loan repayment process. Submitting a mortgage application 8. If either applicant is self-employed, is an onerous task at the best of times, but they will need at least two years’ right now it is like pulling teeth. You will be profitable trading accounts dealing with service teams where staff have 9. Keep your credit rating clear, any blip been drained away to more important areas and you will find it very difficult in the banks, such the arrears collection HEALTH 10. Use an independentOF professional to department. funded research guide you through the process If often takes long periods of times to get A snapshot of HRB responses toofsubmissions and when youin easily understood language, the latest The Picture Health 2011 report describes,

PICTURE

PICTURE OF HEALTH

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 ten years’ experience giving advice to both individuals and companies in relation to their finances. Email: eoin@prosperous.ie; Tel: (045) 841 738 or 087 644 5533.

A snapshot of HRB funded research

developments in health research supported by the Health Research Board (HRB).

This year’s edition shows the active involvement of dentists, doctors, midwives, nurses, physiotherapists, psychologists, social workers, statisticians, and others in Irish health research, alongside the more traditional academic researchers. www.hrb.ie

PICTURE

NEW HRB RESEARCH LEADEROF AWARDS PICTURE HEALTH

PICTURE OF HEALTH

Publication available from 1st December 2011 to build Population Health and Health Services Research HRB launches five-year award scheme Keep in touch with the HRB: leadership capacity in Ireland.

PICT

OF HEALTH

A snapshot of HRB funded research

OF HE

A snapshot of HRB funded research

www.hrb.ie

ofto Health 2011 report describes, in easily understood Successful candidates willThe be Picture expected build research capacity, develop partnerships andlanguage, the latest developments in health research by the Health Research (HRB). A supported snapshot of HRB funded Board research translate research evidence into policy and/or practice. www.twitter.com/hrbireland This year’s edition shows the active involvement of dentists, doctors, midwives, www.facebook.com/hrbireland nurses, physiotherapists, psychologists, social workers, statisticians, and others in Irish health alongside more traditional academic researchers. http://www.hrb.ie/about/rss-e-mail-alerts more research, information visit:thewww.hrb/grants Interested? For www.hrb.ie

The Picture of Health 2011 report describes, in easily understood language, the latest Better Researchin Better Evidence Better Services Better Care developments health research supported by the Healthfrom Research Board2011 (HRB). Publication available 1st December •

•

Keep in touch with the HRB: This year’s edition shows the active involvement of dentists, doctors, midwives, www.hrb.ie nurses, physiotherapists, psychologists, social workers, statisticians, and others in Irish 119 health research, alongside the more www.twitter.com/hrbireland traditional academic researchers. HM Iss8.3 p53-112pg.indd 2/10/12 www.hrb.ie

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120 Health Matters

mount maudit avalanche

Mountain Rescue Two Irish Doctors, who had been climbing on Mont Maudit in the Mont Blanc area of the French Alps last July, were among the first on the scene of an avalanche that claimed the lives of nine people.

r Paul MacMahon, Senior Consultant Paediatrician at Waterford Regional Hospital and his son Dr Peter McMahon, a Radiographer at Dublin’s Mater Hospital, were two of the individuals who assisted in the rescue effort in Mont Blanc. They provided comfort and supplies to the injured, while awaiting a helicopter to achieve the difficult task of landing at 14,000ft altitude.

Late Developer Dr Paul MacMahon said it was a completely random event, as he put a context to the disaster: “Once above 10,000ft in this glacier-like environment, it’s as intense an operation as walking in space. There is one guide to every two climbers, your party is roped together and one’s concern is resilience. The very last thing on one’s mind is so rare an occurrence as an avalanche and its aftermath. It’s a bit like driving your car to Dublin; you’re not expecting that a major pile-up will present itself at a point along the road.” Dr MacMahon, a native of Letterkenny, Co. Donegal, describes himself as a “late developer” in climbing. He joined the Comeragh Mountaineering Club in Waterford in the 1990s and progressed to

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completing the Irish Four Peaks Challenge, featuring Carrauntohil in Kerry at 3,405ft. Dr MacMahon has subsequently climbed higher peaks in Britain and on the continent, including some with his son Peter – who also developed a keen interest.

Loose Ice Speaking about the terrible events of July 12th, he says: “There were 28 people in total on the mountain that day. Earlier that morning, we shared breakfast before the first group of nine set out on the climb at

2am. We were lower down the mountain about 5.30am, on the same upward route as those tragically killed. In the intense wind and snow, we did not witness the avalanche. The first we knew was when a guide came down from above to explain what had happened. “It is believed that a giant slab of ice loosened from a rock and caused the avalanche to crash down on the first group of nine, killing seven of them instantly. Mobile phones worked to varying degrees, but we knew the rescue to get the injured off the mountain would take some time,” states Paul. “As doctors, we offered to trek further up with the guide and see what we could do. It took the best part of an hour to reach an area where it was clear and now there had been nine fatalities. We did our best to console the injured and keep everyone focused on the rescue helicopter arriving. It reached us about 7.30am. One of the guides was keeping a photographic account, which is how our images were recognised in the international media.” In keeping those who died in his thoughts, Dr Paul MacMahon feels the slow pace dictated by his group’s experienced Slovenian guide may have made a significant difference on the day. Dr MacMahon admits that his family has not been too keen on him resuming his climbing any time soon!

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your stories

Mental Health Alienation Kapil Sharma, a regular contributor to Health Matters, is a Senior House Officer in Psychiatry. Here, he tells us why he opted for this specialisation.

n the past, physicians who specialised in the treatment of mental illness were referred to as ‘alienists’. An archaic term now, but still one that holds a lot of meaning for this often misunderstood, highly-stigmatised and relatively unpopular speciality of psychiatry. I have just begun my new life as a psychiatry trainee. When I started medical school, I had never considered it as a career and it was only after rotating as a student that my mind opened to the idea. I was always interested in ‘the human experience’ and the sources of knowledge on this subject are vast, from textbooks in psychology, psychiatry or philosophy to literary novels. At the best of times, it is an onerous task to understand your own mind, so treating and managing other people with psychopathology can be very challenging, but equally rewarding. To quote Martin Roth (Professor of Psychiatry, Cambridge University 1977 to 1985), “Psychiatry is the most human of the sciences and the most scientific of the humanities”. This quote resonated with me when I first read it and continues to do so now.

Therapeutic Relationship In some ways, psychiatry is ‘alien’, especially relative to my past year spent as an intern. The shift from hospital medicine to a speciality that is becoming more community-based can be uncomfortable. One does rely more heavily on laboratory and radiological investigations in a hospital environment, while my new job affords me more time to communicate with my patients and to really get to know their history. In fact, ‘history’ is more apt in describing the psychiatric interview, as it is necessary to obtain a patient’s full narrative over multiple sessions, thus building a strong therapeutic relationship over time. The aphorism, ‘listen to your patient, they are telling you the diagnosis’ applies to psychiatry more than

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any other specialty. But psychiatric issues do not exist in a bubble; patients have medical and surgical issues which need constant monitoring and vigilance.

Stigma I feel alienation is really felt by the patients; the stigma associated with a diagnosis of mental illness is a most unfortunate aspect of the specialty. It is palpable in the interactions I have with people in clinics. In psychiatry, medications are only one branch of a multi-stemmed approach to dealing with mental illness. A multidisciplinary team involving psychiatrists, psychologists, nurses, social workers and counsellors all engage to provide individualistic

management dealing with biological, social and psychological factors that affect the patient. The multi-faceted approach is one of the key things that appealed to me; the consequences of an illness or disease go beyond simple measures that are tested for in laboratories. They deeply impact on a person’s sense of self. If someone has a heart attack, their primary concern isn’t what people are going to think. They get on with the ordeal of treatment and rehabilitation and that is exactly what people with a mental illness should focus on as well. They and their families should concentrate on the many evidence-based treatments that are available that can drastically improve quality of life.

+ Kapil Sharma, Senior House Officer in Psychiatry.

2/10/12 16:35:30

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your stories

DIARY OF AN INTERN Laura Lenihan speaks to Health Matters about her active role at Portiuncula Hospital in Ballinasloe and how she is coping with her new routine.

hen I was first asked to write this article, I wasn’t sure where to start. So I decided the best way to explain my life as in intern was to ‘paint a picture’. Imagine me now; I’m in the boardroom of Portiuncula Hospital in Ballinasloe. It’s 9pm on a Thursday and I’ve just finished an extended day working from 8am to 9pm. So far this week I have attempted to write this article four times, and every time I have failed because I have just been too busy. While Monday was, thankfully, quiet at work, when I got home I had so much personal stuff to catch up on – I worked 70 hours the previous week – and I just hadn’t had a chance to sit at the computer. By 10pm I was wrecked and had fallen asleep on the couch. Tuesday was another extended day and after working for 13 hours straight with one quick dinner break I went home and went straight to bed. Wednesday was another hectic day on the surgical service in Ballinasloe and so when I eventually got out at well after 7pm, I’m sure you can imagine where I ended up? Bed!

Bedding In It seems that my whole life now revolves around work and bed. Don’t get me wrong, I’m not complaining and I’m certainly not looking for sympathy, but my days have gone from enjoying the summer sunshine, to a gruelling schedule of long days and nights working on the wards. My parting words in the last article written as a medical student were, “I’m glad to say that I have finally (I hope) found my place in the world,” and now, two months into my new life as a doctor, I can rest assured that my hopes were answered. I have indeed found my place in the world. The hustle and bustle of a Co. Galway hospital is a far cry from my previous job in London in the fashion world, but helping people and seeing their health improve makes it all worthwhile.

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Offering Opinions While the work of an intern could be described as nothing more than a glorified secretarial position, there are thankfully some breaks from the tedious paper-pushing when we actually get to see patients and make real-life medical decisions. I’ll never forget my first ‘ta-da’ moment. It was during a busy weekend on call and I was called to review one of our patients who just wasn’t feeling right. When I went to speak with her I knew something was wrong and after listening to her chest I made the executive decision to order a chest x-ray. Much to my delight (or dismay, depending on what way you look at it) she had developed quite

serious pneumonia, which I had somehow managed to diagnose. After consultation with the medical registrar (as surgeons we don’t know much about chest problems so we have to get a consult on everything nonsurgical) we started her on antibiotics and she began to improve slowly over the next few days. For the last four years I have spent most of my time sitting behind a desk learning about all these clinical problems and now I am finally on the front line tackling them head on. Whether it’s diagnosing a chest infection or simply prescribing someone painkillers to help them through the night, each job is as important as the next – even the paper-pushing ones.

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A Day in the Life Trish Coady works as a Diabetes Nurse in Cork University Hospital. Trish took the time to tell Health Matters a little bit about herself and her work.

“The role of the diabetes nurse is to facilitate patient empowerment and selfcare in the management of their diabetes through education and ongoing support.”

have been working full-time as a Diabetes Nurse for about six years. I love my work now as much as I did when I first started in the area. I turned 30 this year and I’ve been in a relationship for the past nine years – marriage and starting a family are on the cards in the near future. I’ve been busy, both personally and professionally, for the last five years. We built our own home in beautiful Ardmore, Co. Waterford and I completed my postgraduate diploma in Diabetes Nursing and my master’s in Clinical Practice in University College Dublin. Recently, I also just completed the Certificate in Nurse Prescribing in University College Cork. I see myself as a hard-working, driven, dedicated and loyal person, open to almost anything. In the Diabetes Day Care Unit where I work, there are six diabetes nurses. I work full-time and do all my hours in four days. The role of the Diabetes Nurse is to facilitate patient empowerment and self-care in the management of their diabetes through education and ongoing support. It is important for us to try and improve patients’

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perceptions and understanding of diabetes in order to be able to follow the lifestyle of their choice. My main focus is on inpatient diabetes management, ward staff education and patients who require dialysis. I also participate in nurse-led diabetes clinics, outpatients’ clinic, insulin pump therapy and run a group education programme for newly-diagnosed type 2 diabetics bi-monthly called DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed Diabetics). My day starts at 8am. The answering machine and emails are the first things to be checked. A phone service is available from Monday to Friday for patients and is checked regularly throughout the day. If I am not covering any clinics, my day is spent reviewing inpatients referred to me by the endocrinology teams based on urgency and discharge dates. I also liaise a lot with primary care staff, e.g. PHN, GP and Practice Nurses for those patients who need more support when at home. Over the years, I have constantly battled with my weight. Last year it reached an

all-time high for me at 95.3kg. Work did become uncomfortable, especially as I would educate a lot on diet, activity and lifestyle – practise what you preach and all that. There is a strong history of type 2 diabetes in our family also, so that worry was also in my mind. Over the last year I have done everything from walking, spinning, aerobics classes and gym programmes. I also had two big motivators – climbing Macchu Picchu in Peru and being bridesmaid for my sister. So now, to date, I am five stone lighter and I feel all the better for it. My confidence and energy levels have dramatically improved and I am much happier again at work. In recent months, I entered a competition by Spar Ireland to be trained to run the Dublin City Marathon in October and I was chosen to represent Waterford in this. We have the support of fitness expert Karl Henry and nutritionist Paula Mee. I have also built this training into my daily routine. Anyone can follow my training plan and progress at http://spartan.spar.ie/blog/ author/57. Any questions or comments are more than welcome. I will also be fundraising in support of 3T’s Turning the Tide of Suicide and Diabetes Ireland. My advice to people who want to lose weight is, “If I can do it, anyone can do it.”

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Getting To Know You Irene O’Brien is an Outreach Nurse for Children with life-limiting conditions in Dublin North East – a job she has held since June 2011. Here, she tells Health Matters about her working day. How long have you worked as a Children’s Outreach Nurse? It’s a new post, the second appointment out of eight national outreach nursing posts approved to provide additional support to families and professionals caring for children with life-limiting conditions. I trained as a paediatric and general nurse in Our Lady’s Children’s Hospital, Crumlin and James Connolly Memorial Hospital, Blanchardstown, before working as a staff nurse in Crumlin for over 20 years. I spent many years caring for sick children in their homes through the Jack and Jill Children’s Foundation and four years ago I completed my degree in nursing and a post-graduate diploma in palliative care. Can you describe the work you do? My post acts as a bridge between paediatrics and specialist palliative care. Being discharged from hospital can leave parents feeling isolated. The families of very sick children need immense support and we work closely with our communitybased colleagues to ensure a co-ordinated approach to the children’s care. We also act as an informed resource and educator for professionals unfamiliar with the children’s conditions. Parent’s confidence in the professionals caring for their children ultimately contributes to reduced levels of stress. My direct link with the paediatric consultants and relevant hospital professionals can also be reassuring. Outside home visits, I link with families at outpatient appointments or as inpatients. For some families, caring for their child at home would not be possible without homecare nursing support. I help to devise care plans to ensure continuity of care among the professionals caring for children at home. What kind of children do you look after? I have linked with about 30 families in the

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+ Irene O’Brien, Outreach Nurse.

North East since the outreach nurse post commenced and expect further referrals. The children generally suffer from lifelimiting conditions ranging from malignant conditions, organ failure, congenital conditions, incurable progressive disorders or neurological disorders. The children are aged from newborn infants up to 18 years. The ultimate goal is that all families of children diagnosed with a life-limiting condition should have access to an Outreach Nurse. While dealing with the shock of a devastating diagnosis, parents often need a lot of support in learning skills such as tube-feeding to enable them to care for their child at home.

What were you most surprised at when you started your job? I was new to the North East. Despite linking with multiple disciplines, the Outreach Nurse works in isolation of a primary team network.

However, my colleagues within both the acute and community settings have helped me immensely. It has been enlightening to be a part of the collaborative teamwork among community disciplines that provides the best possible care for sick children within limited resources.

What’s the hardest thing about your job? It’s probably the constraints of the present health system – limited access to homecare support and respite care is a source of much distress for families. Caring for your sick child is the hardest job imaginable. Professional support and respite provision is essential, but for many families it’s just not available. Budget constraints and lengthy approval processes for essential equipment, supplies and financial allowances are frustrating and put immense strain on parents’ coping resources.

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SPORTING PASSIONS HSE staff member Suzanne Kirwan recently won both the qualifier and the championship final at the AIRC National Show Jumping Championships on her horse, My Casino Royale. How did you get involved in showjumping? I am a member of the Association of Irish Riding Clubs (AIRC) and it’s a great way to try your hand at different disciplines of riding at a level that suits you and your horse’s ability. What is your training routine? My horses are based with Fiona Kelly at her livery yard and training facility in Maynooth. It is really through her that I have become more interested in showjumping in that she has put a huge amount of time and effort into finding me suitable horses for my level of riding. In late 2007, I bought my horse, Bartok, who is a Connemara horse and a true gent with a cheeky personality! I haven’t really looked back since then, and in 2010 I took on a second horse, My Casino Royale. Both horses really enjoy jumping; you can tell by their pricked ears when they know jumping is on the agenda. What is your sporting highlight to date? I am having a very good run this year with My Casino Royale. We have been well placed in the AIRC showjumping and dressage leagues in my region during the spring and early summer. This year, I decided to take my chances at the National Showjumping Championships in Mullingar – and won. I was really thrilled and there was much celebrating that evening with friends and family. What do you love about showjumping? I love the adrenaline buzz while going over a jump. Also, I am constantly learning and the yard where I am based has a number of really good young riders. It’s amazing to watch the way they ride and train. Who’s your sporting hero? I have some memories of Harvey Smith and

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he was a character and possibly one of the reasons showjumping was so popular in the sixties and seventies. There are a number of professional riders that I admire and I think, right at this moment, members of the British eventing squad like William Fox Pitt and Mary King are great role models.

delivery of our health services. I work closely with other team members in reviewing the performance of different parts of the HSE and voluntary organisations. We produce audit reports which are aimed at helping managers plan, organise and deliver services as efficiently and effectively as possible.

How long have you worked in Stewart’s Hospital? I have been based there since 2000. It’s a lovely environment with great facilities. I am currently working in Quality and Patient Safety Audit Services, which conducts audits to support quality and patient safety in the

Is showjumping a good sport for children? I think involvement in caring for and learning about animals while having fun is great for children once they are old enough. It’s lovely to see children and young people taking responsibility for their horses and ponies.

3/10/12 10:43:07