Health Matters Spring 2010 by HSE Communications

HEALTH Vol 6 I Issue 1 I Spring 2010

INSIDE - CERTIFICATES.IE - GP EXERCISE REFERRAL PROGRAMME - KIDNEY TRANSPLANT - PENSIONS

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

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

MATTERS National Staff Magazine of the Health Service Executive

HEALTH matters ROLLING OUT Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Spring 2010

FILMLESS X-RAY SERVICES

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 27

Vol 5 I Issue 3 I Autumn 2009

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15/03/2010 12:37:03

More expertise. More opportunity.

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Graduate opportunities for nurses, midwives and other health professionals at UCD Study at the UCD School of Nursing, Midwifery & Health Systems in 2010 and enhance your professional knowledge, clinical and research skills and your professional career prospects. Our courses include:

Graduate Research Training Programme Masters (MSc) by Research Doctor of Philosophy (PhD)

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Multi-Professional Programmes Graduate Diploma/MSc (Palliative Care) Graduate Diploma/MSc (Care of Older People) Graduate Certificate in Clinical Leadership Professional Certificate in Psycho-Oncology

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Master’s Programmes in Nursing MSc (Nursing) Majors: Nursing, Applied Health Care Management MSc (Nursing) Education MSc (Nursing) Advanced Practice MSc (Nursing) Advanced Practice (Prescribing Pathways: Medication & Ionising Radiation) Graduate Diploma in Nursing/MSc (Nursing) Clinical Practice

Graduate Diplomas in Nursing Cancer Nursing (Adult, Breast Care, Children’s, Colorectal), Critical Care Nursing, Diabetes Nursing, Emergency Nursing, Paediatric Critical Care Nursing, Paediatric Emergency Nursing, Rheumatology Nursing, Heart Failure, Peri-operative Nursing.

Graduate Certificates Advanced Practice, Nursing Education, Prescription of Medication, Prescription of Medication and Ionising Radiation.

Professional Diplomas Professional Diploma in Prescription of Ionising Radiation.

Professional Certificates Advanced Health Assessment, Cancer Nursing (Adult, Breast Care, Children’s Colorectal) Breast Care Nursing, Leadership and Strategic Management in Health Systems, Clinical Judgement and Pain Management, Management of Age-related Bone & Joint Disorders, Management of Chronic Illness Across Contexts, Community Nursing: An Applied Approach, Heart Failure, Pathophysiology of Rheumatic Disease, Prescription of Medication, Prescription of Ionising Radiation, Palliative Care (Child and Family).

Graduate Foundation Modules Theoretical Bases of Nursing, Research Methodologies.

UCD Irish Centre for Nursing & Midwifery History Opportunities to undertake a research master’s degree or a PhD in association with the UCD Irish Centre for Nursing & Midwifery History are also available. For further information visit: www.ucd.ie/icnmh or contact ruth.geraghty@ucd.ie Holders of the Graduate Diploma in Nursing may apply to complete the MSc (Nursing) Clinical Practice over 1-year by part-time mode. Holders of a graduate diploma in one specialist area may complete a graduate certificate in another specialist area.

Applications can be made online and flexible payment options are available. Apply by 31 May 2010 at: www.ucd.ie/apply For full details of the wide range of research training and taught graduate courses visit www.ucd.ie/nmhs or phone 7166490/7166491/7166499. Most graduate diploma programmes and some professional certificate programmes are offered in association with one or more of the following academic teaching hospitals: Mater Misericordiae University Hospital; Our Lady’s Hospice, Harold’s Cross; St Vincent’s University Hospital; Our Lady’s Children’s Hospital and The Children’s University Hospital. Minimum numbers apply to some taught graduate programmes.

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15/03/2010 12:37:04

HEALTH MATTERS 1

WELCOME

WELCOME... WELCOME TO THE spring 2010 edition of Health Matters, the national staff magazine of the Health Service Executive. This spring issue has a ‘green’ theme, where we focus on what we can do while working in our hospitals and other healthcare facilities to help the environment. We have examples of energy saving and waste recycling initiatives in various parts of the country. We hope you find this issue’s mix of features, interviews, news and updates of interest. For more regular updates check out our staff intranet site http://hsenet.hse.ie or the HSE website www.hse.ie

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

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

Did you know? • Energy costs in health facilities nationwide represent a significant annual expense for the HSE, amounting to more than c80 million across all sites.

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• It is estimated that savings of more than 30 per cent can be achieved by sites that introduce low energy lighting and control systems. • A new national purchasing system is saving some large hospitals 40 per cent of their electricity costs. • The government scheme to encourage people to cycle to work is now being extended to all HSE employees. • If you smoke 20 cigarettes a day, you will spend c3,102.50 every year on your habit (based on c8.50 for a pack of 20). That is c59.50 every week; c263.50 every month; c3,102.50 every year and c15,512.50 over five years.

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• Last year (for the period January to November) the HSE Information Line received 154,381 calls, up 44 per cent on the same period in 2008.

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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12/03/2010 17:17:05

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Model shown for illustrative purposes. CW version only available in 1.6l diesel. 1.4 litre petrol; Fuel Consumption and Emission figures: 6.1l/100km extra urban cycle, CO2 145g/km.

For more information please visit www.hyundai.ie

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10/03/2010 12/03/2010 12:42:38 15:12:33 02/03/2010 16:12:58

2:42:38 6:12:58

Health Matters 3

CEO's message

MESSAGE FROM THE CEO W

hile our Emergency Departments (EDs) take up a relatively small part of our overall budget (approx. 10 per cent) our performance in this area is often used as a barometer of the health of the service as a whole. When the HSE was established in 2005, the majority of EDs faced serious difficulties. Initially the conventional wisdom was that the solution to these difficulties was to build 3000 more acute hospital beds. Based on what was happening in health services across the world I had no confidence that this approach would be effective. I explained to people at the time that it would be like putting new faster trains on a faulty rail track and expecting train journey times to get shorter. The solution was to first fix the track not put more pressure on an already defective track. Applying this metaphor to EDs, we had to address the processes that were causing the delays for patients; delays in access to diagnostics, delays in patients seeing senior clinical decision makers, patients occupying acute beds when they should be at home and so on. From audits carried out in 2007, and repeated in several hospitals during subsequent years, we found that up to 40 per cent of patients in acute hospitals on a particular day do not need to be there – 43 per cent of these were there simply because they were waiting to see a doctor or other clinician such as a physiotherapist. Many were in hospital just because they were waiting for an ultrasound or x–ray. We also know that people can, with no explanation, spend much longer in some hospitals than in others for the same procedure. Adding more beds without addressing these underlying problems would in fact make things worse. In many hospitals and community services across the country staff have made important changes to the way they work. In October 2006 only about 30 per cent of EDs were admitting all patients within 24

HM Iss6.1 p1-70.indd 3

hours. By December 2009 this figure had improved almost three fold to 85 per cent. We have also revised down this 24 hour target to 6 hours for discharge or admission. Two thirds of hospitals are meeting this 6 hour target; many regularly have no patients waiting for admission. A number of hospitals (5-6) have unacceptable admission delays and these hospitals are being focused on to eliminate such delays. The progress made in most hospitals is the result of the work of ED consultants, nurses and wider hospital clinicians and managers in changing medical, nursing and management practice. Where delays persist, they are not a reflection of how ED Consultants or staff work but instead, point to changes that are still needed in some hospitals in how patient care journeys are planned and delivered within that hospital. The achievements of Waterford Regional Hospital, which incidentally has the second busiest ED in the country, in becoming the first hospital to achieve an overall green light from HealthStat is one very visible example of what is being achieved. You may at times feel frustrated that the quality of the services you provide is not fully appreciated. However, this is the nature of change – once a problem is resolved it is forgotten and replaced by other issues that require improvement. I want to commend you for your contribution to transforming the way we do things right across our health and personal social services. Our transformation programme has been and is about improving access to quality services for the public. I encourage you to take a moment to reflect on the successes that have been achieved in your area and perhaps discuss with your colleagues how you can build on them to improve further the services you provide to your community.

“In October 2006, only about 30 per cent of EDs were admitting patients within 24 hours. By December 2009, this figure had improved almost three fold to 85 per cent. We have also revised down this 24 hour target to six hours for discharge or admission. ”

Professor Brendan Drumm, CEO, Health Service Executive

12/03/2010 15:12:36

4 Health Matters

contents

Contents 91 SPORTING PASSIONS Karen Nugent on winning at camogie 92 IRISH HOSPICE FOUNDATION CEO Eugene Murray writes for Health Matters 95 KIDNEY TRANSPLANTS It has been a record year for organ donation 98 SOCIAL MEDIA Find out what Web 2.0 is all about 1

WELCOME

MESSAGE FROM THE CEO

7 PANDEMIC Update on Swine Flu 9 AWARDS 2010 HSE Achievement Awards 11 MEDIATION SERVICE Jim Fleming reports on the progress thus far

36 NATIONAL COUNSELLING SERVICE The response following the Murphy Report 40 HUMAN RESOURCES Gerry Flynn says dialogue needed after income cuts 42 HIV IN IRELAND Screening could be money well spent

12 UPDATES

44 COVER STORY Details on the launch and roll out of the National Integrated Medical Imaging System

14 DIABETIC CARE New standards of care

47 GREEN MATTERS Health’s green agenda

16 IN BRIEF News briefs from within the HSE

55 REFORM New model of service delivery

20 COMMUNITY SUPPORT The HSE’s response to the flood crisis

59 REGIONAL NEWS

22 READERS’ SURVEY Results of the Health Matters survey 24 NEW WEBSITE Update on www.Certificates.ie 27 SUPPORTING TEENAGERS Focus on teenage pregnancies 32 ELDER ABUSE The important work of the National Centre for the Protection of Older People 34 C hildren and Families Phil Garland plots the way forward

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71 GREEN FINGERS Male cancer patients go gardening 73 ORAL HEALTH Improvements in public health dentistry over the last two decades 74 HEALTH & WELL-BEING A new section on fitness and diet

101 CYCLING News on the Cycle to Work scheme 102 PROCUREMENT Supplier Charter launched 104 PENSIONS A five-page special report 110 HEALTH RESEARCH BOARD The many benefits of research 112 EDUCATION NCI's Alumni Association and news on scholarships awarded recently 113 NEW DEVELOPMENT New simulation technology 114 Royal College of Surgeons RCSI Institute of Leadership 119 TRAVEL Three must-see European cities 122 BOOK REVIEWS A taster of five new Irish novels 123 KIDS Fun activities for kids 124 WIN! Great competition prizes to be won

83 OPERATION TRANSFORMATION Dr Eddie Murphy's experience in the popular RTÉ show

127 CROSSWORD Fill it in to fill in time…

87 EXERCISE Development of the National GP Exercise Referral Programme

128 ME AND MY JOB Brendan Cuskelly on his daily routine as Maintenance Manager

12/03/2010 17:08:33

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12/03/2010 12/03/2010 17:08:34 13:49:46

Distance Learning Opportunities at NUI Galway We know that busy healthcare workers need flexible options for professional development. That’s why we offer a range of part-time, distance learning courses in a multi-disciplinary learning environment. You can either: 1. Dip your toe in the water with a single module, such as: • Effective clinical teaching • Minor surgery & essential dermatology in general practice • Evidence based primary care • Clinical update modules in primary care: Infectious Diseases, Diabetes, Cardiovascular Disease, Women’s Health, Respiratory Disease 2. Accumulate modules toward a certificate, diploma or masters in: • Primary Care • Clinical Primary Care Closing date: 21st May 2010 • Clinical Teaching Further details: E: mary.byrne@nuigalway.ie T: 091-495205 www.nuigalway.ie/general_practice/education.html “The course to date has been just fantastic, a whole new learning curve.”

“Its application to everyday work in my practice made it very rewarding.”

“Lecturers friendly and approachable and had a genuine interest in student learning and our thoughts and ideas.”

“The online interactions fostered deeper thinking and understanding as well as practical applications.”

Maximise your Career Potential at the University of Limerick As a leading centre for health services management education the Kemmy Business School at the University of Limerick is pleased to offer three courses in Health Services Management to support health sector professionals in developing their managerial potential. CERTIFICATE IN MANAGEMENT (NFQ LEVEL 6) This one year skills based programme equips participants with the skills to manage themselves, their work and the people they work with more effectively. It provides a sound introduction to management for those wishing to build upon their experience. DIPLOMA IN HEALTH SERVICES MANAGEMENT (NFQ LEVEL 7) This one year programme is suitable for both public and private sector candidates and focuses on identifying and integrating fundamental principles of management in the context of a changing healthcare environment. BACHELOR OF ARTS IN HEALTH SERVICES MANAGEMENT (NFQ LEVEL 8) This programme is aimed at developing the managerial competencies required by managers working in the Health and Personal Social Services in Ireland. Participants pursue this programme in order to develop their knowledge and skills in management to help them negotiate and drive the transformational environment within the Irish Health Sector. For further details and an application form contact:

Breda Ahern or Brid Henley, Management Development Unit, Kemmy Business School, University of Limerick. Tel: 061 202 915 or 061 202 665. Email: Breda.Ahern@ul.ie or Brid.Henley@ul.ie

Courses Commence at the end of August 2010

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12/03/2010 15:12:50

Health Matters 7

Pandemic

Swine Flu

Vaccination Update In our last issue of Health Matters we reported on the Swine Flu vaccine. This issue, we follow up with an update on Swine Flu and the vaccination programme rolled out by HSE staff nationwide, by Dr Pat Doorley, National Director of Population Health

he emergence of the new flu virus last April, and the subsequent declaration of a global pandemic by WHO required a response on a scale unprecedented in the Irish Health Services. The response varied with the evolution of the pandemic and involved surveillance, co-operation with other countries, intensive efforts to contain infection, treatment of those infected and their close contacts, and a Mass Vaccination Programme. The Swine Flu Vaccination programme is now in its final phase, where Swine Flu vaccine is being made available to children in schools and also to the general population through HSE clinics nationwide.

Current Situation The rates of illness in the community have been decreasing since last October and are now at a low level. The National Crisis Management Team has been stood down, but we need to continue the vaccination programme because the unpredictable nature of Pandemic viruses means that we could experience another wave of infection. We are now evaluating the work done over the last ten months and planning for a possible second wave of this flu or any other pandemic virus. Mass Vaccination Programme The Mass Vaccination Programme possibly represented the biggest logistical exercise ever undertaken in such a short time, in the history of the State. Since we started it, at the beginning of November 2009, we have moved through the critical target groups, and to date, approximately 900,000 people have been vaccinated. This represents about 50 per cent of those

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offered the vaccine and over 20 per cent of the entire population. These figures compare very favourably with other EU states and we are very grateful to everyone who took part in making this campaign such a success. By the end of March, all primary and secondary schools will either have been visited by vaccination teams, or the children will have been invited to come to a HSE clinic. Anyone who has not yet been vaccinated has been advised to come to a HSE clinic for their vaccination before the end of March 2010. Other mechanisms for members of the general population put in place by the HSE include offering vaccine to large companies and organisations that are in a position to offer vaccination to their staff through in-house occupational health facilities.

Vaccination Pregnant women from 14 weeks to six weeks after birth have been reminded that vaccination against swine flu is still very important and available through GPs, HSE Clinics and some maternity units. Women who will be in late pregnancy in the autumn, or who are considering becoming pregnant this year, are advised to think ahead and get vaccinated now. Challenges At a time when the HSE was rapidly advancing the Transformation agenda, and operating in a changing economic environment, managing the Pandemic presented many challenges. These included: •P lanning and responding to a rapidly evolving situation.

• Logistical challenges at every stage in getting vaccine from the port of arrival to GP surgeries and Mass Vaccination Centres. • The challenge of communicating with the public, health professionals and others through various media. • The ongoing re-deployment of over 1,000 staff without the possibility of recruiting replacements. • Evolving scientific knowledge and guidelines, and constant updating of planning assumptions and other factors, which necessitated complex scenario planning.

EFFECTIVE RESPONSE I would like to personally thank and commend the many hundreds of our staff who have participated in Ireland’s response to this unique event. From the initial outbreak response, through to the time when we saw the highest ever level of flu recorded, with over 30,000 people falling ill each week, to the delivery of a mass vaccination campaign – we have shown our ability to respond effectively to a crisis, and to do so with calm and authority. The public and media perception of HSE response has been highly positive and many people have responded with appreciation, through comments, calls and emails of thanks to our vaccine clinic staff. The response has been an unprecedented effort in collaboration, where staff willingly took on work which involved new challenges, and in many cases sustained continued long hours of work. While we have more work to do in order to complete the vaccination of school children and the general population, and not doubt much to learn from our review, everybody who has participated in any way, in the response to the Swine Flu Pandemic can take pride in what has been achieved.

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12/03/2010 15:12:54

Health Matters 9

Awards

Applications invited for 2010 HSE Achievement Awards Applications are now being invited for the 2010 HSE Achievement Awards. The awards are open to health service settings directly run or funded by HSE.

he HSE Achievement Awards were created to recognise and celebrate outstanding work by health and social care staff. The HSE held regional and national competitions in 2007 and 2008 and now, after a gap of one year, the Awards are back, commencing in 2010 and becoming an annual event on the HSE calendar. A revised process has been created for the Awards making the application and selection process more user-friendly, simplified and attractive for applicants. All initiatives that support the delivery of health and social care services in any way are open to apply. These may include any service provided directly to the public including clinical services, primary care or social/family support; support services such as catering, portering and security; and management initiatives such as people management processes, information technology or service management initiatives. The Awards process for the 2010 competition will be built on six criteria:

• Integration will assess the extent to which your project supports healthcare workers and professionals, regardless of whether they are hospital or community based, to work together in teams, planning and delivering care seamlessly. Your project should show evidence of enabling and encouraging this integrated way of working. • Experience will assess evidence that the project has addressed and impacted on quality of service, patient/service user safety, and care. It will also assess compliance with Health and Safety Legislation. Your project should clearly identify improvements that you have achieved for patient experience, quality of care and patient safety. • Engagement will assess the degree to which the project has considered the needs of the patient/service user in its design and implementation. In addition, it will assess the degree to which the project has created channels that ensure involvement

of, consultation with and input from internal and external stakeholders, including, but may not be limited to, patients/service users, staff, unions and partnership processes and principles. • Transferability will assess the potential for the learning from the project to be replicated to other parts of the health services. • Efficiency will assess how the project has created a more streamlined approach to service delivery and delivered increased efficiencies/resource savings. • Unique Features will allow applicants to highlight unique features of their project that may fall outside the other criteria.

Application Process A new simplified application form will be completed by all projects. Application forms are available on the Change Hub, located at www.hseland.ie, the HSE’s online resource for learning and development. Applicants are requested to submit completed forms to the Change Hub in order to make the process as paperless as possible, lowering administration costs. The closing date for applications is June 3rd 2010. For further information or assistance with the application process please contact your regional HSE Human Resources Department. Shortlisted projects will be evaluated by a National Selection Panel comprised of representatives from the HSE, Partnership, patient/service user advocacy groups and independents. The awards process will be managed by a National Coordinator and governed by a Steering Group drawn from across HSE.

The Community Nutrition and Dietetic Service from the Health Promotion Department in HSE South was the overall winner of the Achievement Awards in 2008. The Corkbased service developed an education programme for diabetics. Pictured at the 2008 awards ceremony were Larry Walsh, former Director of the National Health Services Partnership Forum; Freda Horan, Community Dietitian Manager; Dr Karen Harrington, Senior Community Dietitian and Yvonne O’Brien, all Health Promotion with Professor Brendan Drumm, CEO of the HSE.

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National Event A national awards presentation ceremony will be held in autumn 2010; details to be finalised and confirmed. The Awards will be as follows: • The Derek Dockery Award for Overall Best Project with two runners up (three awards) • Best Project from each Region and runner up (eight awards). At their discretion, the National Panel may make additional awards in the form of commendation for projects that excelled in particular criteria.

12/03/2010 15:51:00

ROYAL COLLEGE OF SURGEONS IN IRELAND, FACULTY OF NURSING & MIDWIFERY AND SCHOOL OF NURSING COURSES 2010-2011 The Faculty of Nursing & Midwifery and School of Nursing has delivered post-graduate nursing and midwifery education since establishment in 1974. Programmes range from certificate level to PhD, from level 8-10, with a close alignment to clinical practice. An innovative Blended learning approach, employed in 2009, uses two or more distinct methods of delivering education including face-to-face teaching ‘offline’ and computer-mediated teaching ‘online.’ Combining the two learning environments uses the benefits of each, resulting in greater accessibility to learning. • • • • • • •

Beneﬁts of blended learning Allows for greater ﬂexibility in how, when and where students study Reduces travel time and expenses Meets the educational needs of a clinically diverse nursing body with broader course content Achieves a more acceptable work life balance Face-to-face tuition supports online learning Discussion forum ensures that students are fully supported

THE FOLLOWING RCSI/NUI ACCREDITED EDUCATION PROGRAMMES ARE OFFERED COMMENCING IN SEPTEMBER 2010. PhD Fellowship in Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland (FFNMRCSI) MSc (Research) MSc Nursing MSc Nursing (Advanced Leadership) MSc Nursing (Advanced Nurse Practice) Certificate in Nursing (Advanced Nurse Practice)

Certificate in Nursing (Ionising Radiation X-Rays) Post Graduate Diploma/MSc in Nursing

Post Graduate Diploma/MSc in Nursing

Post Graduate Diploma/MSc in Nursing (Pain Management) BSc Nursing BSc Nursing Management Certificate in Nursing (Clinical Research) Certificate in Nursing (Nurse Prescribing) Access to BSc Nursing programme Pathway to Post Graduate Diploma

incorporating modules for advanced nurse practice

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Post Graduate Diploma/MSc in Nursing (Infection Control Nursing)

Post Graduate Diploma/MSc in Nursing (Respiratory Care in Nursing Practice)

STAND ALONE MODULES IN:

IN ASSOCIATION WITH THE ROYAL VICTORIA EYE & EAR HOSPITAL:

Nursing Research Appreciation; Teaching & Assessing in Clinical Practice; Communications and Interpersonal Skills in Nursing; Personal and Professional Development; Infection Control Nursing (Microbiology); Principles of Infection Control; Managerial Issues in Infection Control; Critical Issues in the Assessment and Management of Individuals with Leg Ulceration; Critical Issues in the Assessment and Management of Individuals with Diabetic Foot Ulceration; Critical Issues in the Assessment and Management of Individuals with Pressure Ulceration; Critical Issues in the Assessment and Management of Individuals with Lymphoedema; CervicalCheck, The National Cervical Screening Programme; Reflection, Clinical Judgement and Decision-Making; Advanced Management and Strategy; Advanced Leadership (Professional and Clinical); Clinical Supervision and Mentorship; Quality Assurance in Health care Delivery in a Multicultural Environment.

Post Graduate Diplomas/MSc in Nursing: (Ear Nose and Throat Nursing)/ (Ophthalmic Nursing)

IN ASSOCIATION WITH CONNOLLY HOSPITAL BLANCHARDSTOWN: Post Graduate Diploma/MSc in Nursing: (Gerontological Nursing)

IN ASSOCIATION WITH CAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL: Post Graduate Diploma/MSc in Nursing: (Orthopaedic Nursing) IN ASSOCIATION WITH THE NATIONAL MATERNITY HOSPITAL, THE ROTUNDA HOSPITAL, THE COOMBE WOMEN AND INFANTS UNIVERSITY HOSPITAL AND OUR LADY OF LOURDES HOSPITAL, DROGHEDA: Post Graduate Diploma/MSc in Nursing: (Neonatal Intensive Care Nursing)

IN ASSOCIATION WITH BEAUMONT HOSPITAL: Post Graduate Diplomas/ MSc in Nursing: (Intensive Care Nursing)/ (Coronary Care Nursing)/ (Emergency Nursing)/ (Neuroscience Nursing)/ (Operating Department Nursing)/ (Oncology Nursing)/ (Gerontological Nursing)/ (Renal Nursing)

IN ASSOCIATION WITH OUR LADY’S CHILDREN’S HOSPITAL, CRUMLIN: Post Graduate Diploma/MSc in Nursing: (Peri-operative Children’s Nursing)

The opportunity exists to progress to MSc following completion of Post Graduate Diploma programmes. Applicants to Post Graduate Diploma programmes must have a minimum of 6 months post registration experience. The student must also be working in the specialist area of the programme. Application forms are available from the website www.rcsi.ie/nursing, Or from: Administration, Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2. Tel: (01) 402 2445/2206/2202, Fax: (01) 402 2465, E-mail: facnurs3@rcsi.ie, Website: www.rcsi.ie/nursinginfo Closing Date for receipt of applications is Friday 14th May 2010.

Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2 HM Iss6.1 p1-70.indd 10

12/03/2010 15:13:04

Health Matters 11

Follow up

Positive results for Mediation Service Last year the HSE broke new ground by becoming the first public service organisation to introduce a staff mediation service. Jim Fleming reports on how the service has progressed since its launch.

ven though the mediation service was only launched in June 2009, some 66 cases were undertaken during the year in the four HSE regions as follows: Dublin Mid Leinster (12), Dublin North East (34), South (8) and West (12). The initial results from 2009 are very positive for mediation. From the total of 66 mediations carried out, 41 were successful and three were partially successful. Given that 12 cases only went as far as the initial pre-mediation discussion and did not go on to mediation this gives a success rate of approximately 80 per cent. Mediation was used most in cases of alleged bullying and harassment. This has clear implications for further awareness training and management training requirements. In a time of rapid organisational change it is not surprising that role clarity also figured prominently. Other reasons given for mediation were issues about work performance and work changes. Cases were spread across both the hospital and primary care sectors. The

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apparent lack of cases reported in the voluntary hospital sector is worth investigating and similarly few cases were reported for the Intellectual Disability sector. It is clear from the returns that women have utilised mediation as a conflict resolution mechanism in greater numbers than men, even allowing for the male/female ratio. On initial viewing it appears that men do not seem to use mediation to resolve issues with other men but are more willing to use mediation in conflict with women. Budgetary concerns experienced during 2009 had a significant influence on locations chosen for mediation. Only four cases took place away from health service premises. While savings achieved in this manner are very important it is also important that it does not compromise the achievement of the required environment necessary to achieve a successful outcome. The vast majority of mediations involved two people. This reinforces the value of mediation as a conflict resolution mechanism, particularly at an early stage when most conflict starts in a small way with two people. The ability to get in quickly and informally and give mediation an opportunity to resolve conflict before it becomes formalised and draws in other parties is important. From a value for money perspective, the ability to resolve workface conflict at an early stage has a number of positive outcomes: • I t allows people to resolve interpersonal issues in an informal, private setting away

from the glare of third parties. • It saves the cost of subsequent third party interventions. • It eliminates management time normally required for preparation for and participation at labour court hearings. • It avoids the usual IR fallout associated with post hearing implementation issues. • It avoids third party costs involving legal advice and legal representation at Tribunals, etc. The introduction of internal mediation facilities within the greater health and social care services has been completed during 2009 in line with the recommendations from the Review Group for the Dignity at Work policy. The broad acceptance of the service, even in the short time since the launch, is proof of the power of partnership to achieve change where it originates from a felt, shared need across all stakeholders. However, it is clear that the benefits of Mediation are not fully understood across the Health and Social Care Sector. The National Mediation Steering Group has agreed a communications programme for 2010 to address this issue. You can access the full 2009 Mediation Report on the staff intranet site http:// hsenet.hse.ie. Visit Working in the HSE and go to Mediation Service.

Jim Fleming is an Assistant National Director of the HSE (Human Resources).

12/03/2010 15:51:31

12 Health Matters

Updates Medical Devices and Equipment Management Policy A Medical Devices and Equipment Management Policy for the HSE has been developed by the Quality and Clinical Care Directorate’s Office of Quality and Risk. The policy is being implemented by a team led by Brian Gilroy, National Director of Integrated Services and Reconfiguration. This policy has been developed to minimise the risk of harm to service users and employees associated with the acquisition, use and ongoing support of

Medical Devices/Equipment; to clearly define and designate the roles and responsibilities for the management of Medical Devices/ Equipment in the HSE; to ensure that the HSE complies with all relevant legislative standards, recommendations, and vigilance systems of the Irish Medicines Board and to set out a statement of standard and supporting criteria based on a model of internal control for use in managing medical devices/equipment within the HSE.

Stephen Lynch, Assistant Head of Logistics and Inventory Management; Marie Kehoe, Area General Manager for Quality and Risk, HSE South, and Ger Flynn, Head of Clinical Engineering, Cork University Hospital.

Standard procedure for policy development In addition a procedure has been developed to standardise the development of all HSE Policies, Procedures, Protocols and Guidelines (PPPGs) across all Directorates. Documents and guidance notes can be viewed on the HSE Staff Intranet (http:// hsenet.hse.ie). Go to the Search Box and key in document numbers OQR029; OQR030; OQR031. An inventory of many of the PPPGs currently being used throughout the country has been developed and this is also available on the Intranet. If you wish to add any PPPGs that you have developed to this inventory please email the name of the PPPG and your name and contact details to denise. mccarthy@hse.ie. For further information about the implementation of policies and procedures email: mariet.kehoe@hse.ie or phone: (087) 263 2781.

Drinking Water and Health The safety of drinking water has a direct influence on the health of consumers. In Ireland the provision of safe drinking water is a complex process, involving different agencies and professional groups. The HSE has a key role in assessing and advising on potential risks to human health arising from contaminated drinking water. This important role has a statutory basis within the framework of legislation that governs drinking water provision. HSE services involved with drinking water are the Environmental Health Service, Public Health Departments, Health Protection Surveillance Centre, Microbiologists, laboratory and dental services, and emergency planning structures. The responsibility for the provision of safe drinking water rests with Water Services Authorities (ie City and County Councils), Committees of Group Water Schemes and those who individually provide their own drinking water. The Environmental Protection Agency has supervisory authority over the Water Services Authority where the latter is the water supplier, while the Water Services Authority has supervisory powers

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over private water supplies. The EPA publishes an annual report on drinking water quality in Ireland. The HSE National Drinking Water Group has produced guidance documents to assure consistency of approach from and between HSE staff of different professional backgrounds who are involved with drinking water safety. ‘Drinking Water and Health, a review and guide. HSE 2008’ is a resource for HSE Public Health Departments and Environmental Health Service who deal with drinking water issues. The document covers a wide range of topics, including legislation, roles and responsibilities, information exchange within the HSE and between the HSE and other agencies, risk assessment for protecting human health, surveillance of waterborne illness, outbreaks, deliberate release and fluoridation. You can view the document on the HSE website www.hse.ie. Select Publications and go to Health Protection and Public Health. A second document has been prepared in 2010: ‘Guidelines proposed by the HSE

Members of the HSE’s National Drinking Water Group Front Row (L-R): Ray Parle, Tessa Greally, Beth Ann Roch, Margaret O’Sullivan, Patricia McDonald. Back Row (L-R): Andrew Curtin, Heidi Pelly, Paul McGuinness.

as a template document between HSE and Water Services Authorities for dealing with exceedances and incidents in water supplies’. This document is intended to facilitate a standardised framework nationally for dealing with microbiological, chemical and indicator exceedances and incidents in drinking water. It can be incorporated in the Drinking Water Incident Response Plan (DWIRP) of the Water Services Authority. The document has been developed by the HSE National Drinking Water Group and in consultation with the City and County Managers’ Association (CCMA).

12/03/2010 15:13:15

Health Matters 13

Updates

HSE Service Plan 2010 The HSE Service Plan 2010 is now available on www.hse.ie and the HSE Intranet.

he Plan outlines the organisation’s targets for hospital, community and primary care services and details how it plans to maintain access to appropriate treatments and services for patients and clients during 2010 despite current resource pressures. It is the framework which outlines how this year the HSE will deliver acute hospital, community and related social services within its budget of c14,070 billion. Other than some changes to the delivery of hospital based care, the same level of service as 2009 will be maintained in 2010 within the context of health service reform, a rapidly changing economic environment and a climate of reducing resources. Speaking about the Service Plan in early February, Professor Brendan Drumm, CEO of the HSE, said “Our challenge this year is to keep on enhancing the quality of the services we provide which can only be achieved by improving our effectiveness and in so doing, reducing costs. “From a service point of view we will continue to reorient services away from bringing people into hospital for care they should get on a day case basis and in community facilities. A high hospital admission rate is not a logical measure of the effectiveness of a modern health service. Given the worry and inconvenience hospitalisation can create for patients and their families, we need to continue to lower admission rates and we should only admit patients when there is no better clinical alternative. This is the standard of care we would all want for ourselves," said Professor Drumm. “A significant number of people who visit EDs do so for treatment associated with their chronic illness which requires interventions such as intravenous antibiotics or simply monitoring and observation. With

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more active chronic illness management at primary care level, supported by fast track and direct access to a consultant opinion when it is needed, these ED visits, which often lead to admission, can be avoided. “I am particularly pleased that during the year we will be completing the development of 1,200 very high quality residential beds for older people and new Primary Care Centres for 47 Primary Care Teams. These developments will greatly support our shift to the community. We plan to have almost 400 Primary Care Teams in place by year end”, he concluded.

“From a service point of view we will continue to reorient services away from bringing people into hospital for care they should get on a day case basis and in community facilities.”

Fundraising Golf Event A staff golf outing will take place at the Heritage Golf and Spa Resort, Killenard, Co Laois on Friday, April 30th 2010. A draw on the day will be made for the ENT Zambia Fund, established by surgeon Kieran O’Driscoll who is involved with a clinic in Zambia where he performs operations twice a year. Timesheet all day • Cost c70 (coffee on arrival, golf and dinner.) • Competition 18-hole singles stableford (three ball). • Token prizes – the experience of the beautiful Seve Ballesteros designed golf course is a prize itself! To Book a Time For details on how to book a time go to the HSE staff Intranet http://hsenet.hse.ie Go to News & Events and select Diary Dates and then April 2010’.

12/03/2010 15:13:18

14 Health Matters

Diabetic care

Integrated Diabetes Care points the way forward Co-ordinating the actions of trained GPs and secondary care specialists can provide improved care to a substantial number of diabetic patients writes James Conway, Assistant National Director with the HSE’s Integrated Services Directorate and Dr Orlaith O’Reilly, HSE Director of Public Health based in Kilkenny.

he most important chapter of care during the life of a person with diabetes is the adequate prevention of complications through achieving increasingly strict levels of glucose control, control of blood pressure, control of cholesterol and other factors in diabetes. Diabetes patients should not have to wait until complications have occurred in order to be referred for specialist care. Specialist referral and input should occur at diagnosis so that the diabetes patient is provided with adequate care as soon as the condition is identified. A model for Integrated Diabetes Care, developed by the HSE’s Diabetes Expert Advisory Group, points the way forward in the management of diabetes patients. Under the joint chairs of Dr Graham Roberts, Consultant Endocrinologist, Waterford Regional Hospital and Dr Damien Doyle, GP, Carnew, Co Wicklow a sub group was convened to develop the model of care. Under the model, there is a spectrum of services available to the patient, ranging from primary prevention services, self care, and primary care services, including scheduled GP visits to underpin good practice models of care for the patient’s specific illnesses. In addition, the GP draws on the services of the rest of the primary care team and the primary care network to focus on the particular clinical or social problems. Other services such as screening and community intervention team services can be accessed by the primary care team as appropriate.

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Community and voluntary services are needed to provide support to patients in their own communities. Secondary care services are further developed to allow for specialist clinics, integrated care systems and appropriate services for patients presenting with complex health issues. Patient care plans are developed on an integrated care basis between participating clinicians to identified patients needs. Patients with stabilised disease are managed in programmes reflecting this model of care, largely in the primary care setting. Patients with more complex

disease receive increased levels of specialist care. A selection and approval process for patient entry into the system of integrated care and an annual system of review for continuation with input from both the participating specialist and general practitioner in accordance with an agreed care plan are in place. Underpinning this spectrum of clinical care is a complementary programme of patient support. Many patients become the main manager of their own chronic disease and it is primarily their success in controlling the disease by lifestyle choices and/or medication which determines the severity and control of the disease and subsequent progression/management experience. Patient support programmes advocate patient self care. The programmes are built around the patient and tailored to his/her particular level of complexity and take account of potential risk factors. The development of this model of integrated diabetes care was in the context of major transformation in the health services with the reorientation towards care in the appropriate setting which was predominantly primary care. This reorientation also reflected the core concepts of chronic disease management. The new structural unit to enable the delivery of the integrated model of care for Diabetes as identified in the first report of the Diabetes EAG was Managed Clinical Networks which would ensure that care is planned, structured, shared and integrated.

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Health Matters 15

Diabetic care

Current Practices There are a number of current practices across the country that are providing services to individuals living with diabetes in a structured manner and include the following: • Midlands Structured Diabetes Care Scheme • South Inner City Partnership – Dublin • Diabetes Interest Group (DIG) Cork • HSE West – Sligo/Leitrim • East Coast Area Diabetes – HSE Dublin Mid-Leinster • Dublin Watch – HSE Dublin North East

and chronic complications. Nationally agreed clinical guidelines and protocols of care will be mandated by the HSE for use throughout the system. Local Consultants, GPs and other Clinicians working in diabetes will be consulted as to how best to have these standards implemented in their own areas. A major task of the Diabetes Programme will be to build on the previous work of the EAG and examples of good practice which already exist around the country. The focus of the programme will be on agreeing standards of care, ensuring implementation and monitoring service outcomes.

“The development of this model of integrated diabetes care was in the context of major transformation in the health services with the reorientation towards care in the appropriate setting.”

These practices will be augmented by the ongoing development of Primary Care Teams, and further integration between Primary and Secondary Care. This provides unique opportunities for the teams to utilise this integrated model for its agreed service delivery. This approach has been reinforced by the recent performance indicators contained in the primary care section of the National Service Plan 2010. The development of the Integrated Services Directorate with the seamless management of primary and secondary services is a further enabler to utilise this model and enable the service consumer to reap its benefits. One of the recommendations from the Diabetes Expert Advisory Group for the delivery of this model was the development of national clinical leadership. This concept is being progressed within the Quality and Clinical Care Directorate. The National Director for Quality and Clinical Care has set up a National Programme for Diabetes. One of the immediate aims of the Programme is to implement nationally an integrated diabetic service between Primary and Secondary Care, to improve diabetic control thereby reducing both acute

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12/03/2010 15:13:27

16 Health Matters

News // in brief Quality and Safety Webinar Conference Webinar Technology will be used for the first time to deliver the 2010 Irish Health Services Quality and Safety Conference to health service employees in more than ten regional centres around the country. This unique and innovative approach for delivery of the 2010 conjoint conference will make it possible for health professionals to attend a national conference from a local location or provide them with an opportunity to attend the main part of the conference from any internet or internet linked computer. The theme of the conference is Integration: People at the heart of service delivery – governing through integration for safer, quality services. The conference will focus on the important topic of integration in a practical way. It will examine how integration can provide safer quality services to service users while highlighting the contributing role of service providers. The conference will be addressed by experts that will include service users and healthcare professionals. The keynote speaker will be Anne Carrigy, Director, Serious Incident Management Team, HSE. A Panel Discussion linking Dublin with the ten regional centres will be chaired by John Bowman, journalist and broadcaster. Nine organisations are working collaboratively and in partnership with HSE ICT Services, to deliver this innovative conference on May 13th, 2010 from the boardroom in Dr Steevens’ Hospital, Dublin to regional centres in Cork, Galway, Kerry, Kildare, Kilkenny, Limerick, Louth, Manorhamilton, Offaly, Sligo and Waterford. The conference will be of significant importance to those who have responsibility for policy making, health service planning, clinical and managerial professionals, healthcare education providers, contracted providers of health and social care services and patient advocacy groups. Further information on the conference is available at www. qualityandsafetyconference/2010.ie.

Joint Conference Planning Partner Organisations: The nine organisations involved are: HSE (Office of Quality and Risk); Health Services National Partnership Forum; Healthcare Risk Managers’ Forum; Irish Health Promoting Hospitals; Institution of Occupational Health and Safety; Irish Clinical Audit Network; Irish Public Bodies Mutual Insurances Ltd; Irish Society for Quality and Safety in Healthcare and Patient Focus. As part of the conference the organising committee is now calling for abstracts for posters to be considered for display at the regional conference venues. Guidelines and application details are available on the conference website www.qualityandsafetyconference/2010.ie.

ARAMARK Healthcare Innovation Awards 2010 The ARAMARK Healthcare Innovation Awards endeavour to recognise and merit innovation in the provision of healthcare. This is the third year of these awards which have been established to broaden awareness of the need to constantly improve standards of care and patient safety in Irish Healthcare – http://www.healthawards.ie/

Award categories include: • Pfizer Outstanding Achievement Award in Healthcare • Healthcare and Social Care Professional • Healthcare Commentator/Journalist • Care/Support Initiative • Innovation in Quality of Service Delivery

• Public-Private Healthcare Collaboration • Healthcare Technology or Product Innovation • Advocacy • Patient Safety Initiative • Health Promotion Project

The closing date for nominations is Wednesday April 3rd, 2010.

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ISQua members invited to register for Paris Conference ISQua, the International Society for Quality in Health Care, is now inviting its members to register for its 27th International Conference to be held from October 10th - 13th, 2010 in the Marriott Rive Gauche Hotel, Paris. Founded in 1985, the Society is a non-profit, independent organisation with members from over 70 countries. ISQua works to provide services to guide health professionals, providers, researchers, agencies, policy makers, patients and consumers, to achieve excellence in healthcare delivery, and to continuously improve the quality and safety of care. With support from the Department of Health and Children, HSE and HIQA, ISQua’s international office relocated from Australia to Ireland in 2008 and is based in Dublin. ISQua’s core programmes include: • An annual international conference attended by over 1,000 people from across the globe • Production of “The International Journal for Quality in Health Care” published by Oxford University Press • The ISQua International Accreditation Programme which promotes quality improvement through the process of accreditation. This programme certifies accreditation, external evaluation and standards setting bodies against international principles and standards. • Educational Opportunities The theme of the Paris Conference will be ‘Quality Outcomes: Achieving Patient Improvements’. Society members can network online with like-minded individuals, receive a discount on conference registration fees and six issues of the International Journal for Quality in Health Care including full on line access with search facilities and links to other relevant journals. For further information on membership and the 2010 Conference visit www.isqua.org or email isqua@isqua.org.

12/03/2010 15:13:29

Health Matters 17

in brief // News Sixth National Healthcare Conference: Managing Change through Innovation This year’s National Healthcare Conference takes place on March 25th in the Burlington Hotel, Dublin. A host of distinguished speakers from Ireland and abroad will offer delegates a valuable insight into all aspects of the Irish health service and key healthcare systems throughout the world. The event will have two themes ‘Managing Change through Innovation’ and ‘Managing Healthcare in Challenging Times’. Minister for Health and Children, Mary Harney TD is scheduled to deliver the opening address and due to participate will be Brian Gilroy, HSE National Director Corporate Services. Offering an international perspective on ‘The Top 10 Medical Innovations for 2010” will be Irish-born Dr Brian Griffin, Head of Innovation and Cardiologist at the Cleveland Clinic in the US and Managing Director of Cisco Internet Business Solutions Group (IBSG), Connected Health Practice, Kevin Dean, will investigate where technology is taking us. Addressing the global Pandemic of Swine Flu will be Chief Medical Officer of the Department of Health and Children, Tony Holohan, while Deirdre Foley-Woods will discuss the future trends in healthcare reform and the opportunities therein. To register your interest or to request further information, please email admin@ nationalhealthcare.ie, phone (01) 700 8508 or visit www.nationalhealthcare.ie.

First Nurse Prescribers in Addiction Services Claire Loomes and Jane Bridgeman recently became the first Nurse Prescribers in the Drug Treatment Board in Dublin. Congratulating the two, Sheila Heffernan, General Manager of the Board, said their graduation was a great achievement for the service and for the future potential of addiction treatment in Ireland. She said expanding prescriptive authority to nurses has real potential to enhance patient care and deliver on HSE Transformation Programme priorities. Dr John O’Connor, Clinical Director at the Board said he was confident that the development would assist the Board in ensuring that it develops appropriate responses to emerging needs within existing resources. Maureen Flynn, HSE Assistant Director of Nursing, Office of the Nursing Services Director said the Board had played a vital part in taking on the pioneering role of the introduction of Nurse Prescribing in Addiction. This was truly an important advancement and a great achievement. Sheila Heffernan also said that the board as a specialist provider of treatment services over the last 40 years, recognised the complexity of addiction and the multifaceted approach that was required and that there was no one solution that worked for everyone. “Our range of services, specialist teams and dedication to excellence has positioned us perfectly to become the first to introduce nurse prescribing in addiction nationally,” she concluded.

+ Drug Treatment Centre Board staff and a HSE representative pictured at a recent event to mark the graduation of the first Nurse Prescribers: Back Row (L-R): Eamon Keenan, Consultant Psychiatrist in Substance Misuse; Claire Loomes, Registered Nurse Prescriber; Dr John O’Connor, Clinical Director; Jane Bridgeman Registered Nurse Prescriber; Mary Egan Pharmacist; Seamas Noone, Clinical Operations Manager. Front Row (L-R): Maureen Flynn, Assistant Director of Nursing and Midwifery HSE; Sheila Heffernan General Manager; and Christina Murtagh Clinical Nurse Manager.

Disability Census 2010 Under the Disability Act 2005, the HSE is obliged to meet a target so that at least three per cent of employees are people with disabilities. HSE has a legal obligation under the Act to promote and support the employment of people with disabilities and people with disabilities currently

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make a significant contribution to the organisation. As a public sector employer, HSE is legally required to confirm, on an annual basis, the number of people with disabilities it employs. A census of HSE employees is currently being undertaken to establish the number of people with a disability employed in the

organisation. Area Equality Officers are collecting and collating this information. A copy of the declaration form is available on the HSE staff intranet site along with guidance on how to complete it. All employees are encouraged to complete the survey to ensure that the HSE can meet its statutory obligations.

12/03/2010 15:52:43

Are You Using the Latest Technologies In Patient Care? Physiotherapists: Offer Your Patients Cutting Edge Rehabilitation

Introducing the TheraTrainer • Bio feedback - displays the current muscle tone in comparison to the muscle tone at the beginning of training • Symmetry training – monitor activity on each side of the body – useful for stroke patients • Detailed analytics of each training session, can be printed to show progress over time

Public Health Nurses and Midwives: Minimise Pain For Your Neonatal Patients

Introducing the Carital Neo • Minimises pressure caused pain • Prevents pressure sores for immobile premature infants • Womb substitution system facilitates correct positioning

Want to learn more? Get your FREE guide ‘7 Innovative Healthcare Products for 2010’ by sending an email with your name, position and address to innovation@beechﬁeldhealthcare.ie To arrange for one of our healthcare advisors to demonstrate either of these products in your own clinic then call 057 868 2304 now, we’ll even bring the coffee and biscuits.

These innovative healthcare products are brought to you exclusively by Beechfield Healthcare. Unit A15 National Enterprise Park, Portlaoise, Laois Tel: 057 8682304

www.beechﬁeldhealthcare.ie

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10/03/2010 15:13:35 11:58:58 12/03/2010

1:58:58

HealtH Matters 19

In BrIEF // News NEW GUIDE TO RISK MANAGEMENT IN MENTAl HEAlTH A GUIDANCE DOCUMENT on risk Management in Mental Health services was published recently. It is designed to support mental health services in adopting a systematic approach to risk assessment at all levels and across all disciplines, thus enabling risk management to be embedded in day to day practice. the guidance is aimed at all those working in and accessing the Hse who have an interest in improving patient safety and quality of mental health services. this includes clinical staff, managers, risk advisors/managers, as well as service users, their relatives and carers. It is designed to be multi-purpose and it can be used by clinicians as a reference source for clinical risk management. It can also be an information source on approaches to risk management for service users. the document can guide the mental health service manager in working on a service-wide risk management process and it can be used by a multidisciplinary team in working with managers to develop a risk

at the launch of the Guidance Document on risk Management in the Mental Health services were: Martin Rogan, Dr Conor O’Neill, Dr David Vaughan, Tony leahy, Una McCarthy, Dr Ailis Quinlan, David Gaskin, Dr Margaret O’rourke, Pauline Gill and Debbie Dunne.

management process, or in discussing the care of an individual service user. the document was produced by a working group under the chairmanship of local Health Manager David Gaskin. the group included a clinical director, director of nursing, risk advisers from within Hse mental health services and a number

of external expert advisers including an academic, a service user representative, and a Clinical Indemnity Scheme representative. this document was produced for use by staff working in or with mental health services, as well as mental health service users and their families and carers. It is available on the HSE staff Intranet.

DEVElOPING SKIllS IN VENEPUNCTURE AND CANNUlATION A NATIONAl PROGRAMME for the education and training of nurses and midwives in the skills of Venepuncture and Peripheral Intravenous Cannulation has been developed by the Office of the Nursing Services Director, in order to standardise the service offered to patients across the Hse. two elearning modules are available on www.Hseland.ie for nurses and midwives, in the skills of Venepuncture and Peripheral Intravenous Cannulation. learner Handbooks are available, outlining the skill pathway to obtain competence in both skills in the work environment. a Guiding Framework for education, training and Competence Validation in Venepuncture & Peripheral Intravenous Cannulation for Nurses and Midwives (2009) has been published by the Office of the Nursing Services Director, which offers a standardised framework for the delivery of the education and training for Venepuncture and Peripheral Intravenous Cannulation. It also standardises the competence validation process and certification of competence achievement, allowing for the transferability of skills across the Hse.

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the guiding framework supports nurses and midwives, healthcare managers and educators to implement venepuncture and peripheral intravenous cannulation in their organisations and to ensure that patients throughout the country can benefit from the same high standard of care and quality of service. National Clinical Policies in both Venepuncture and Peripheral Intravenous Cannulation have been developed for both the adult and the child, for the Hse, which can be adapted locally. all documents are available to download from the HSE website (www.hse.ie) in the publications section. this is a welcome initiative for nurses and midwives and patients alike as the service strives to meet and address patient’s needs at the bedside. For more information about Venepuncture and Peripheral Intravenous Cannulation contact Anne Gallen, Director of Nursing, Midwifery Planning and Development, Iona House, Main Street, Ballyshannon, Co. Donegal. Call (071) 982 2106 or email: anne. gallen@hse.ie

12/03/2010 15:13:46

20 Health Matters

HSE Support

Winter Flooding

Crisis

The HSE has an important role in responding to people in crisis and unforeseen events which adversely affect the lives of entire communities. Bernard Gloster, a Local Health Manager in HSE West looks back on a particularly challenging period for the HSE in the closing months of 2009.

arge areas of the west and midlands of Ireland were thrust in to chaos and uncertainly last winter when record amounts of rainfall led to flooding on an unprecedented scale. From Cork to Leitrim, Roscommon to Athlone, Galway to Clare and Limerick, whole areas were

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faced with flooding that brought hardship and misery to local communities. Parts of Sallins in Co Kildare and Donnycarney in north Dublin also experienced unexpected flooding. The response to flooding as an event is led by the local authorities and their

crisis management structures. Over a particularly difficult four-week period last winter the HSE staff played a significant role in responding to the emergencies.

Community Welfare Through our Community Welfare Service we provided three key supports. In the immediate event we assisted our local authority colleagues in the identification and provision of emergency accommodation. When temporary accommodation was in place there were additional needs to be catered for such

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Health Matters 21

HSE Support

thing’ by having the right people in the right place at the right time.

+ Main picture, left: an ariel shot of the extensive flooding in Ballinasloe, and right: Defence Forces helping local people during the flooding in South Tipperary.

as the supply of clothing and extra food costs. Many people were literally forced to leave their homes in what they were standing in. Such was the extent of the damage and devastation caused that some of our Community Welfare Officers are still supporting many people affected through the administration of the government humanitarian support scheme.

“The impact on people who have to suddenly abandon their homes and their ability to cope with disaster varies widely.”

Medical Assistance While the floods thankfully didn’t cause serious injury, some of those who had to leave their homes required medical assessment and support. Typically this would involve people with chronic or long term illnesses who may have lost medicines or prescriptions or about whom there was some level of concern. Our own Area Medical Staff, GPs and GP Co-ops all played their part when called upon.

Environmental and Public Health Information to the public and direct support services to HSE teams responding to floods was critically important from these sources. Flood water is often contaminated and flood damage and damp can affect health, particularly where there is vulnerability or underlying illness.

Psycho-Social Supports The impact on people who have to suddenly abandon their homes and their ability to cope with disaster varies widely. In some cases those leaving their homes knew that it would be many months before they would be able to return. From the individual to community level one could sense the range of feelings from at best inconvenience to at worst total devastation. Again through our professional staff in psychology, mental health, social work and counselling the HSE could and did provide key supports.

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Ambulance Service At the initial point of flooding where evacuation is required the HSE ambulance services provide assistance often supported by the Army, Civil Defence and NGO services. This was not just important in the communities affected by floods, but also in HSE run facilities affected such as nursing homes and mental health residences. During the response to the flood the HSE showed itself to be not only capable of having a plan and executing it but yet again there was repeated testament to the commitment and dedication of staff to turn in at night and weekends, and ‘do the right

Cold Weather 2009 ended and 2010 began with the coldest and most sustained icy weather in memory for a generation. Acute hospitals saw more fractures and lacerations in 24 hour periods than they often saw in two week periods. Road traffic and pedestrian conditions were truly treacherous. There was also an increasing challenge for community staff as there appeared to be no end in sight. Getting key personnel such as Public Health and Palliative Care Nurses and Home Helps to vulnerable people was an increasing concern in many areas. GP Co-ops in some cases reported two hour call times to what would have routinely been 30 minutes. Looking back on our response to this difficult time for people, perhaps our greatest learning is that vulnerability and isolation is not confined to people far up windy country roads and hills, but was also evident in estates in many towns and cities. All in all, when we look back on the closing months of 2009 we can see that what we planned to do and set out to do was more than added to by unforeseen events, emergencies and crises. We know that we have more to learn and that we can improve our processes but I can honestly say that I found firsthand evidence that many of our staff did a superb job and deserve our thanks and support.

+ Relief efforts in County Clare.

12/03/2010 15:14:07

22 HealtH Matters

survEy rEsults

HEAlTH mATTErS rEADErS’ SurvEy more than 350 Health Matters readers recently took time out to respond to our on-line survey designed to gauge your reaction to our new format. Health Matters editor Stephen Mcgrath summarises the responses received.

articles and features and will be reviewing this after each issue. also it appears that some readers are not aware of our easy to read online digital edition available by email and on the Hse Internet and Intranet sites. This edition contains an email a friend facility making it easy for staff to distribute the magazine electronically as they wish. We welcome some of the very valuable suggestions made by readers about possible content and focus. We will be looking at these over the coming months. some problems with distribution were also highlighted and we will be endeavouring to improve in this area also.

t was great to receive your feedback without which we could never improve our output. the format has changed from a more newsletter style publication to one that provides greater insight into key programmes across the entire health services and also highlights some of the great work carried out by our staff. In general readers have welcomed the new format and many had positive comments to make. some readers queried the cost of the magazine and didn’t seem to be aware that the advertising revenue now being generated pays for the design, print and distribution costs of the magazine. taking the step of seeking advertising revenue to support our staff magazine is not an ideal scenario – however, it was taken following much careful consideration. We are conscious of balancing the amount of advertising with the number of

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PoSitiVe CoMMentS the new design of the magazine received an overwhelmingly positive response from readers, with many stating that the magazine is easier to read in the new A4 format.

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Health matters cov is4new.indd 1

+ the new A4 format and design have been well received by readers.

+ stephen McGrath, editor. articles on practice development were welcomed, and the positive aspect of many articles was also praised. One respondent felt that the magazine helped to promote networking and sharing of information. the survey told us that the vast majority of respondents (96 per cent) were aware of the magazine and that almost 70 per cent had read the latest edition. 82 per cent of respondents liked the new design of the magazine, and 88 per cent felt that there were articles of interest to them and to their colleagues. there were several requests for more articles about the realities of the daily working lives of staff in hospitals or other frontline services. some readers wanted us to highlight specific services such as cardiac rehabilitation, day hospitals for the elderly and social work. One respondent called for more multidisciplinary clinical information while another comment said there were too many photographs of staff attending

27/11/2009 17:21:02

12/03/2010 15:14:23

Health Matters 23

Survey results

openings and not enough of service users. One reader asked for consistent updates on Transformation and the Integrated Services Programme. There was also a request for more information about HSE National Directors, their roles and responsibilities and a chart of the organisation structure. Another reader called for more information about voluntary and statutory organisations and the services they provide. Other readers requested articles about: •N ursing, midwifery and service developments •S taff benefits, tax information and pensions • Internal educational opportunities • Projects to improve patient care • The work of therapists • Staff profiles

• Patient Safety • Regular HR features • Book reviews • Mental Health A number of readers made it clear that they dislike articles they perceive to be self congratulatory or self promoting. There was a request for more people stories – one reader asked for more articles about clerical/ administration, community welfare, freedom of information and home support services staff. A reader also said authors must have credibility in order to be taken seriously. A big thank you to all those who participated in the online survey and we will endeavour to improve the publication during the year in response to your feedback. Email your views to: internalcomms@hse.ie

“We welcome some of the very valuable suggestions made by readers about possible content and focus. We will be looking at these over the coming months.”

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12/03/2010 15:14:27

24 Health Matters

Online services

Certificates.ie www.certificates.ie is the HSE’s new online ordering system for birth, death and marriage certificates. Dennis Prior, Superintendent Registrar, HSE Eastern Area Civil Registration Service explains how the new online service was developed.

he HSE has developed a new online ordering system for birth, death, marriage and other certificates that is now available on www.HSE.ie and www. certificates.ie. The new service went live just before Christmas and will receive a Taoiseach’s Public Service Excellence Award for 2010. Using this website, which has been developed in-house by the HSE’s ICT Web Services Team, anyone can now purchase certificates of a birth, death, marriage, adoption or still-birth from the comfort of their home, 24 hours a day, using a Laser or Credit Card. Certificates are posted to the client within five working days and issued at the standard price plus postage costs. In the short time since it has been live it has been used to process nearly 2,000 certificate applications, yielding great benefits for clients and staff and demonstrating a clear demand for this new service.

Most orders to date (83.3 per cent) had delivery addresses in Ireland, however over ten per cent were from the United Kingdom, two per cent from the USA and just under one per cent from Australia and France. Some 97 per cent have been processed in less than five days and interestingly, certificates.ie is also being used for genealogical purposes, with three per cent of all orders relating to life events from the 19th century. We estimate that during the site’s first year nearly 20,000 certificates will be ordered online. This project has been transformational in nature, involving changes to work practices through a team-based approach. We have seen the true value of examining our own way of doing business and using our own internal resources – IT expertise, staff initiative and cross-public body partnership – to create a beneficial new service at almost zero capital cost to the exchequer.

This initiative has involved a team-based approach utilising the skills, opinions and expertise of a wide-base of staff, from clerical staff on the phone system and searching for certificates through to the ICT section and staff of the Office of the General Register. Winning a Taoiseach’s Award shows all of the team involved that this type of approach to conducting public business is welcomed at the highest level and I would like to thank and commend all involved in this project for their contribution.

Benefits to the Public The benefits to the public are many including: • The ability to order online from any location worldwide, 24 hours a day, seven days a week. • Orders processed from 19 different countries, with over ten per cent from the United Kingdom, two per cent from

“Using this website, which has been developed in-house by the HSE’s ICT Web Services Team, anyone can now purchase certificates of a birth, death, marriage, adoption or stillbirth from the comfort of their home, 24 hours a day, using a Laser or Credit Card.”

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Health Matters 25

online services

“Winning a Taoiseach’s Award shows all of the team involved that this type of approach to conducting public business is welcomed at the highest level.”

the USA and just under one per cent from Australia, France and Canada. Orders have been received from locations as diverse as Martinique, South Korea and New Zealand. • Considerable time and cost savings to clients – from clients overseas avoiding phone or postal fees, to the domestic clients who don’t need to attend in an office in person, saving time, travel and associated costs. • Turnaround is quicker, particularly for clients who applied by post previously, with over 97 per cent of successful searches being completed in less than five working days. • Accessibility – still-birth and adoption certificates can be ordered online – previously applications had to be made to the Office of the General Register in Roscommon.

Benefits for the Civil Registration Service •T he system was designed by a project team which involved staff of the CRS and a significant amount of testing was conducted prior to the launch. This has meant that the system itself is very userfriendly and simple to use. •T he previous manual system has been replaced by a predominantly online system which involved significant work-flow analysis and business re-engineering. •T ime savings on phone queries have resulted in the capability to better manage the workload.

Visit www.certificates.ie and see for yourself!

TRINITY COLLEGE The University of Dublin

Faculty of Health Sciences Suitably qualified candidates are invited to apply for the following programmes commencing in Autumn 2010. M.Sc./PG Dip Programmes • M.Sc. in Nursing/ PG Dip in Professional Nursing Studies (Options in Clinical Health Sciences Education & Advanced Clinical Skills in Emergency Nursing are available). • M.Sc. in Midwifery/ PG Dip in Professional Midwifery Studies (An option in Clinical Health Sciences Education is available) • M.Sc./PG Dip in Gerontological Nursing (in association with St. James’s Hospital) • M.Sc./PG Dip in Cancer Care (in association with St. Luke’s Hospital, Rathgar) • M.Sc./PG Dip in Mental Health (in association with the National Forensic Mental Health Service) • M.Sc./ PG Dip in Mental Health – Child, Adolescent and Family Strand (in association with St. Patrick’s University Hospital) • M.Sc./PG Dip in Palliative Care (in association with St Francis Hospice, Raheny)

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•

PG Dip in Clinical Health Sciences Education • We are currently developing an MSc in Dementia and an MSc in Clinical Research, subject to College approval, which we hope to advertise in due course for a September 2010 start. Successful completion of programmes with a Clinical Health Science Education component allows nurses and midwives with a Masters degree to apply for registration with An Bord Altranais on the Nurse Tutor Register. Postgraduate Diploma in Specialist Nursing Specialities General Nursing • Accident & Emergency Nursing • Cardiovascular Care Nursing • Haematology Nursing • Intensive Care Nursing • Orthopaedic Nursing • Peri-operative Nursing - Anaesthetic / Recovery - Paediatric - Surgical • Promoting Enablement in Persons with a Physical Disability • Renal Nursing

Associated Health Service Providers Adelaide & Meath Hospital, Dublin, Incorporating the National Children’s Hospital (AMNCH)-Children’s University Hospital, Temple StreetConnolly Hospital-Learning Disability Services in the Dublin Region-Naas General Hospital-Psychiatric Services in the Dublin Region-St James’s Hospital-St Luke’s Hospital-St Mary’s Hospital, Phoenix Park. Higher Diploma in Children’s Nursing/ R.C.N. (Post-Registration) (in partnership with The National Children’s Hospital, AMNCH, Tallaght) Postgraduate Applications Information: Closing date for receipt of completed applications for all postgraduate programmes: 12 April 2010. Applications for all postgraduate programmes must be submitted on-line at www.pac.ie For further information on all programmes please contact: The School of Nursing & Midwifery, 24 D’Olier Street, Dublin 2. T: (01) 896 2692; E: nursing.midwifery@tcd.ie

Or visit our website: www.nursing-midwifery.tcd.ie Postregistration Undergraduate Programmes • Access to Degree Programme (Nursing or Midwifery) (approximately 50% of this programme is delivered through e-learning) • Bachelor in Nursing Studies • Bachelor in Midwifery Studies Closing date for receipt of completed applications: 12 April 2010. For further information and application forms please contact: Admissions Office T: (01) 896 1133/3664 E: admissns@tcd.ie Research • Ph.D. Funding opportunities may be available. For information, contact the School as above.

12/03/2010 15:53:44

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HM Iss6.1 p1-70.indd 26 210980-FC-HSE-Abbey-PG.indd 1

12/03/2010 15:14:30 10/03/2010 14:40:15

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Health Matters 27

Support

New initiatives support

teenage parents

Teenage girls give birth to just over 2,500 babies annually in Ireland – about 3.5 per cent of all live births. The importance of providing special support and information to teenagers and their birth partners is increasingly being recognised by health professionals.

he b4 u decide campaign encourages teenagers to make healthy, responsible decisions about relationships and sex. The campaign also provides information for parents, teachers and youth workers. In this feature we also highlight two initiatives in Co Louth designed to support teenage parents – the Young Mums Programme and the Father Focus Project.

Before You Decide The HSE Crisis Pregnancy Programme (formerly the Crisis Pregnancy Agency) recently launched this new education and information. Youth workers and people working with young people and their families will find www.b4udecide.ie a useful information source on relationships and sexual health. The development of the initiative was overseen by an Advisory group including; Janet Gaynor, HSE West; Frances Shearer, Department of Education and Science; Deiniol Jones, National Youth Council of Ireland; Rita O’Reilly, Parentline; Enda Saul, HSE Crisis Pregnancy Programme; and Orla McGowan, HSE Crisis Pregnancy Programme. The website, www.b4udecide.ie has attracted tens of thousands of visitors since its launch. It contains information on the age of consent, contraception, STIs and crisis pregnancy as well as quizzes, polls and interviews with young people discussing subjects such as peer pressure and healthy relationships. Visitors to the website can also watch interviews with professionals including Maire Morrisey, Project Manager,

HM Iss6.1 p1-70.indd 27

+ Cliona Ni Chiosain, star of TG4’s ‘Aifric’ at the launch of the “b4udecide.ie” campaign.

12/03/2010 15:14:35

28 Health Matters

Support

Squashy Couch Youth Café, Waterford; Dr David Gibney, GP, Ballymun Family Practice; Sandra Delamere, Advanced Clinical Nurse Practitioner, GUIDE Clinic, St James Hospital, and Counsellor Conor Brennan. Caroline Spillane, Director of the HSE Crisis Pregnancy Programme said: “We have consulted with a large number of teenagers, parents and people with experience of working with young people regarding relationships and sexuality education. We would like to continue updating the website and rolling out the campaign to teachers, youth workers and teenagers in 2010. We would be delighted to hear from anyone who would like to become involved with us on this initiative; whether it would be to review materials, suggest content or provide links with young people who may like to become involved.” ‘Leave it til Later'/Delay training will be delivered by the National Youth Council of Ireland (NYCI) with funding from the Crisis Pregnancy Programme at 14 locations nationwide in 2010. Training courses are available free of charge to those working with young people in a youth work, outof-school or non-formal education setting and will explore the concept of delaying early sex among young people. Materials are being developed for youth workers and teachers and will be available later this year. To get involved with the ‘b4 u decide’ initiative contact Orla McGowan of the Crisis Pregnancy Programme at (01) 814 6292 or omcgowan@crisispregnancy.ie For more information on ‘Leave it till Later’/Delay training courses, contact Lisa or Elaine at NYCI on (01) 478 4122 or visit www.youth.ie There are many services around the country that provide support and assistance to young parents, these include a variety of projects such as: • Teen parents support programme (TPSP) – operates a number of services around the country, contact Margaret Morris, the National Co-ordinator on (01) 670 0167. • Treoir – provides resources and information for young parents who are not married including the information pack for parents. • CURA – offers a post natal support service for young parents that is currently being offered in three centres at present (as a

HM Iss6.1 p1-70.indd 28

+ Una O’Brien with a group of young people attending the Young Mums Programme antenatal class.

“www.b4udecide.ie has attracted tens of thousands of visitors since its launch. It contains information on the age of consent, contraception, STIs and crisis pregnancy.” pilot project in Kerry, Cork and Galway). • “ The Real Deal” – is a peer education project delivered by community training centres that is available in specific regions. •B arnardos/TPSP North Wexford – operates a service that supports those who provide support to teenage parents, such as grandparents in the North Wexford Region. •T eenage Health Initiatives – are personal development services delivered by Foroige youth services. For more information on any of these projects, please contact Sarah Ryan, HSE Crisis Pregnancy Programme, sryan@ crisispregnancy.ie.

Young Mums Programme Una O’Brien, a staff midwife at Our Lady of Lourdes Hospital in Drogheda, describes how Young Mums Programme their is making a difference. Our Antenatal Education and Parentcraft Department initially focused on improving our services for the teenage population attending our Unit. Previously there was nothing that particularly enticed the teenage population to attend our classes and the uptake from that group was generally poor. We decided to develop a programme with teenagers and young parents as the main focus – one that would provide information to assist them in their everyday lives. Initially I focused on improving my own knowledge and performance and attended a number of study days and workshops that offered advice in setting up parentcraft education and teenage classes. In order to share my knowledge within the hospital I developed standards and guidelines for staff involved in providing the ‘Young Mums and Young Dads’ classes. Staff and student midwives are also encouraged to attend the teenage class to update their skills in teaching antenatal education. Our aim was to develop, through evidence based practice and innovation, an education

12/03/2010 15:14:42

Health Matters 29

Support

programme involving and appealing to teenagers and their birth partners. With the help of colleagues in the IT Department and using the Maternity Information System we developed a system to identify the teenager/young person from first point of contact with the hospital's services. We alert the teenagers about the antenatal classes by text message. Young mums were consulted about the best way to translate the alerts into text format. We also put into practice a number of simple ideas to make the classes more attractive to teenagers. We provide a light, healthy lunch to people attending these classes promoting healthy eating. The participants also receive a small gift such as nail varnish or mobile phone charms. Other improvements we have introduced include new materials and educational tools for the classes such as updated DVDs, visual aids and music. A new email address for teenagers and young people to access the parentcraft department has also been created and supplied. We were assisted by the midwifery and nursing staff in the Unit and encouraged by medical and clerical staff. GPs in the region are encouraged to recommend the antenatal classes to the teenagers attending their surgeries. In addition the Social Work department worked closely with us to develop an information pack. All of the changes implemented have greatly increased attendance at the classes which are up 90 per cent on previous years. I am pleased with all that has been achieved and happy that we have increased attendances with innovative thinking. The classes are educational and I believe the information provided is helpful and useful for the teenagers during their pregnancies and after they give birth. Evaluation of the service is also extremely important and we have developed a form to garner feedback from the participants to assist us in identifying necessary service changes based on their needs. I am also planning to invite teenage mums and their partners back for a reunion to give feedback about their care so that they can help us to further improve the services.

HM Iss6.1 p1-70.indd 29

“With the help of colleagues in the IT Department and using the Maternity Information System we developed a system to identify the teenager/ young person from first point of contact with the hospitals services.” Una O’Brien has won a number of awards for her work. In November 2008 she was awarded first prize at the RCSI/Our Lady of Lourdes Hospital ‘Excellence in Midwifery and Nursing Awards’ for innovation on services to Young Mums. In October 2009 she was awarded first prize for the Poster Competition at the All Ireland Cross Border

Annual Midwifery Conference. In November 2009, she was also prize winner at the National Council of Nursing and Midwifery 9th Annual Conference held in Croke Park, Dublin.

Ellis Briggs, who attended the Young Mums Programme, said “I really enjoyed the antenatal class and got good advice about pain relief. The special breathing and relaxation exercises were a great help to me when I had my baby Ollie.”

+ Una O’Brien, staff midwife at Our Lady of Lourdes Hospital in Drogheda with parents Ellis Briggs and Karl Gaynor and their baby boy Ollie.

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Health Matters 31

Support

+ Pictured at the Launch of the Father Focus Project (L-R) Fiona Larthwell, Administration Manager, Crisis Pregnancy Agency; Colin Fowler, Men's Health Forum in Ireland; Fiona Kearney, Family Support & Child Welfare Services, HSE Louth Primary, Community and Continuing Care (PCCC); Joanne Murphy, Programme;Leader, Teen Parents Support Programme and Jim McGuigan, Child Care Manager, HSE Louth PCCC.

Father focus Project The Father Focus Project, a unique project aimed at teenage fathers, was developed by the Louth Teen Parents Support Programme (TPSP) and funded by the Crisis Pregnancy Programme. Joanne Murphy, Programme Leader, Louth Teen Parent Support Programme, explains how the project came about and the importance of such an initiative. The project aims to increase awareness and engagement of young men in order to support their partners during pregnancy and parenting. The need for the Father Focus Project was identified by our work with children and families within the TPSP in Co Louth. Fatherhood for many of the men we are in contact with can be a positive turning point and as service providers this is a pivotal time to engage and connect with teenage fathers to support that. The Father Focus Project includes an Information Booklet for Young Fathers offering practical advice on key issues for new dads, the changes that fatherhood will bring, how the baby will change and grow and information on fathers’ rights. A Resource Pack for professionals working with young fathers that covers topics such as

HM Iss6.1 p1-70.indd 31

parenting, child development, relationships, budgeting and legal entitlements and also looks at how teenage fathers can access support services. A Key Findings Report was also developed which will assist project staff in planning support services for young fathers. During the research phase of the project, fathers consistently said they felt excluded from counselling, family support and teen parent programmes. It was felt that support services were women’s services. One of the resource packs aims is to support men to deal with their emotions at the time of the crisis so that they are better positioned to support women and their children. No matter what the circumstances, the role of the parent is a difficult one and it’s vital that all parents are aware of the supports that are available. The focus during and after the pregnancy is very often on the mother and we hope that projects such as Father Focus will provide a valuable resource to help new fathers to support their partner in parenthood and to become comfortable in their new role as father. The majority of young people supported in the TPSP programme are young mothers. Young fathers face numerous obstacles in participating in the lives of their children. Research has shown that young fathers being involved in the lives of their children brings enormous benefits to the

“One of the resource packs aims is to support men to deal with their emotions at the time of the crisis so that they are better positioned to support women and their children.” children, the young fathers themselves and also the young mothers. The overall plan is to circulate and pilot test the resource material we have developed within Louth. A training programme will be offered to staff so that practitioners can have the opportunity to try out the materials and provide feedback to the project staff. The Information Booklet for Young Fathers will be distributed to relevant healthcare and community settings. For further information on all materials developed and training programmes please contact Joanne Murphy, Programme Leader, Teen Parents Support Programme at (041) 987 5273.

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32 HealtH Matters

rEsEarCH

NEw cENTrE To coNTrIbuTE To rESEArcH oN

tHe aBUse OF OlDer PeOPle The National centre for the Protection of older People (NcPoP) aims to develop a knowledge base of Irish and international research, and education and training resources on the occurrence, prevalence, detection and response to the abuse of older people. dr attracta lafferty, centre Director, outlines the importance of its work.

ith funds from the Health service executive, we were given the opportunity to set up and establish a National Centre for the Protection of Older People. the Centre was established in response to the problem of elder abuse and to the recommendations made by the Working Group on elder abuse in the report ‘Protecting Our Future’. We are focusing on a programme of research examining elder abuse in Ireland, which will result in research outputs contributing to the development of policy and practice in relation to elder abuse. We are fortunate to benefit from a collaborative interdisciplinary research team at the Centre, which gives particular strength to our work as it brings together a unique combination of expertise from nursing, sociology, social work, public health, law and economics. In November 2009, the NCPOP was officially launched by the Minister for Health and Children, Mary Harney tD, at University College Dublin.

HM Iss6.1 p1-70.indd 32

iMPortanCe oF the work oF the Centre While undertaking a number of research projects, our primary focus for this year is to conduct a national prevalence study of elder abuse where we plan to interview 2,000 older people. this will provide us with, for the first time in Ireland, a baseline

“While undertaking a number of research projects, our primary focus for this year is to conduct a national prevalence study of elder abuse where we plan to interview 2,000 older people.”

figure for the prevalence of elder abuse. International research indicates that between one and four per cent of over-65s experience some form of abuse in the community. that equates to somewhere between 5,000 and 21,000 older Irish people experiencing abuse at any one time. this type of research is vitally important in informing and underpinning the response strategy to elder abuse in Ireland, particularly as the older population is estimated to increase from about 468,000 to approximately 1.4 million by 2041. We feel that these figures are important as there is the risk that the rate of elder abuse will increase in tandem with these figures. at the Centre, we are also engaging in other areas of research such as exploring the feasibility of researching the experiences of abused older people, which would provide the older person with an opportunity to have their voice heard. this piece of research would give us a valuable insight into the coping skills and support

12/03/2010 15:15:08

Health Matters 33

Research

needs of abused older people. We are also examining models of service provision adopted by other countries in response to elder abuse. Findings will contribute to the development of effective strategic approaches and best practice in dealing with elder abuse in Ireland. In arriving at directions for best practice, the Centre will draw on international research and developments in the field of elder abuse and will expand and build on existing national and international collaborations with leading researchers in the field.

The future of the Centre We believe that the Centre has a fundamental role to play in the prevention, detection and management of elder abuse and is fast becoming a much needed primary resource for research and information on elder abuse in Ireland, benefiting those working with, or having contact with, older people in areas of health and social care, law and financial services as well as organisations representing older people and older

“We feel that the Centre has a fundamental role to play in the prevention, detection and management of elder abuse and is fast becoming a much needed primary resource for research and information.” people themselves. Information and online resources are made available through our dedicated website www.ncpop.ie. The Centre sits in a unique and advantageous position, as few such similar Centres exist elsewhere where research conducted focuses solely on elder abuse,

which will contribute to the national and international body of work on the protection of older people. Although we are beginning to build much needed baseline knowledge on elder abuse in the Irish context, we believe that future work of the Centre (funding dependent) could provide much needed information on risk factors, perpetrators, institutional elder abuse and on support services needed for victims of elder abuse. Research of this kind is essential in taking a coherent, well-informed integrated response to elder abuse. As Minister for Health and Children, Mary Harney TD, acknowledged at the official launch of the Centre, good work is being done, but greater progress is needed. “While there is more work to be done in this area, we have a good foundation in place from which the service can be developed further.” For more information about the Centre and its work, please visit www.ncpop.ie.

+ The group pictured here attended the official launch of the National Centre for the Protection of Older People (NCPOP). Included in the photograph are Minister for Health and Children, Mary Harney TD; Professor Desmond Fitzgerald, Vice-President for Research, UCD and Frank Murphy, Local Health Manager (HSE West) and Chair of the National Elder Abuse Steering Committee.

HM Iss6.1 p1-70.indd 33

12/03/2010 15:56:23

34 Health Matters

Childcare

Working with Children and Families – the way forward Social workers, public health nurses, care workers, managers, politicians, voluntary agencies and the media all need to work together in the best interests of children, writes Phil Garland, National Care Group Manager for Children and Families.

hild Protection must always be an area of high priority for health and social services and has been the focus of significant media attention in recent weeks. There is no doubt that there are major areas within Children and Family Services that need to be improved upon but there is also plenty of evidence that very good work is going on around the country. One of the great difficulties we face is that good work rarely gets reported on in the media and failures tend to dominate the front pages and the airwaves. “Protecting the HSE at all costs, with a multitude of cover ups and the systemic creation of a veil of secrecy” – This is the false perception that some members of the public, media and politicians have about the HSE – especially in relation to the field of children and families services. This is the context within which all of us who work within Children and Families Services have been coming to work every day. From a practitioner’s perspective, one of the core principles of social work practice is respect for privacy, and the client’s right to confidentiality. This means that the sharing of a client’s personal information is inevitably limited – especially in the public domain. However, the restriction of such information and limited publication invariably leads to a public perception that the HSE is hiding something. Confidentiality can be wrongly interpreted as a smokescreen to hide

HM Iss6.1 p1-70.indd 34

behind and the public perception can sometimes be that the entire organisation of the HSE and its staff are part of a coordinated mechanism of secrecy and cover ups. The last few weeks have really put this concept of secrecy into the minds of the general public. The tragic deaths of

“Frontline staff are pressured – probably more so than ever before. However, the motivation of thousands of committed staff certainly tells me that the system may need improving but it is certainly not broken.” children whilst in the care of the State have been played in the media. Full accounts have been demanded and children’s rights have been temporarily brushed aside. The rationale has been the demand for accountability and transparency of State

services. I understand that politicians and the media are doing their day job and have pushed these very issues. The reality is that frontline staff and managers in the HSE are striving in the same direction. We are pretty much on the same page. Frontline staff are pressured – probably more so than ever before. However, the motivation of thousands of committed staff certainly tells me that the system may need improving but it is certainly not broken. The areas where improvements are required include the quality of care of separated children seeking asylum; inconsistency in social work practices; how we look after children in care; fostering services and assessments and waiting lists. There are also areas where very high standards are being achieved. A few weeks ago, I was at the National Awards for Services to Children and Young people 2010. The winner of the category of Effective Practice and Interagency Working was HSE in Letterkenny, Donegal – a great example of exemplary practice. We need to stay focused on the best outcomes for children. • Every child in care should have an allocated social worker who the child can really talk to. Not most of them – every single child. • Every child in care should have a care plan that is meaningful and the child is

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Health Matters 35

Childcare

fully part of the plan. Not most of them – every single child. • Every case that is referred to a duty team should get an initial assessment very quickly. Not some of them – every single case. • Every foster family should be fully assessed and registered. We need to build an effective system where the best outcomes for children are at the very heart of what we do. In particular, we need to strive to protect those children who are at risk of abuse and neglect. If we create this new reality then transparency and accountability will be a natural part of how we do our business and the core product will be that children are safe and families are nurtured. In order to achieve this and stay focussed on the best interests of children and their best outcomes we need to do this together; social workers, public

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“We need to build an effective system where the best outcomes for children are at the very heart of what we do. In particular, we need to strive to protect those children who are at risk of abuse and neglect.”

health nurses, care workers, managers, politicians, voluntary agencies and the media. We all need to be focussed on the same direction and supporting each

other to move forward in the same way. The quality and the experience of our core staff who work with children and families is extremely high. Bringing everyone together will make the difference for every child. Within the HSE, we have the ability and the responsibility to make a lot of these changes. We now have an identified new structure for childcare services that will provide for streamlined and standardised arrangements. New standardised processes will be rolled out in each area. There will be one national childcare information system within two years. New practices are being piloted (Differential Response Mechanism). This will mean that all cases coming in will be assessed swiftly by a multidisciplinary team. Most of the cases will be immediately referred to family support services to get early interventions established. The changing of structures will take time because we need to work this through with everyone together. The changes of processes will be rolled out this year, so will a new implementation of Children First, the National Guidelines for the Protection and Welfare of Children. Raising the bar on fostering, care plans, special care and high support, new social work posts (200+) are all targets for 2010. Much of this is already underway. Standard systems and processes will make it easier for frontline staff and free them up to get on with the day job – making a difference. That means being freed up to manage the daily risks. We need to stay in that space of risk management rather than stepping back. We won’t always get it right, but if the risks are taken in the best interests of children the support is and will be there. We need to stay together and be the champions for children despite the criticisms we receive. The biggest prize of all is to make Ireland a really safe place for children. So, keep the faith, be prepared for ongoing change and let’s do it together. Together we will change the landscape for children in Ireland and in time the perception of the HSE will be of an organisation and staff committed to protecting children and families at all costs.

12/03/2010 15:15:17

36 Health Matters

counselling service

High quality service response follows Murphy Report publication The HSE National Counselling Service experienced a surge in demand for its services following the publication of the Ryan Report in May 2009. Rachel Mooney explains how the Service used this experience to prepare for and respond to the publication of the Murphy Report six months later in November 2009 (The Ryan Report dealt with an inquiry into abuse of children in institutions while the Murphy Report concerned a Dublin Archdiocese Commission of Investigation).

hen the Ryan Report was published, we provided a front line service to survivors of abuse and we experienced a 70 per cent increase in our referral rates. We had a 116 per cent increase in referrals from clients who reported that they were abused whilst in institutional care. 80 per cent of these clients made contact with us for the first time. This surge in referrals has had a serious impact on our ability to respond given our finite resources. The Directors of Counselling and staff met and reflected on the impact of the Ryan Report on our service and used an action learning and evidence-based approach to prepare for the publication of the Murphy Report and support our client group and the general public. A Helpdesk Model was devised and we invited collaboration from other agencies working with survivors of childhood

NCS Conference The National Counselling Service 10th Anniversary Conference entitled ‘Transforming the Shadows’ will take place on September 14th 2010 in Dublin Castle. The main speakers will be Richard Bowlby and Dr Felicity de Zulueta. The overarching theme of the conference is to promote a message of hope by highlighting the transformative role that counselling and psychotherapy can bring to the lives of individuals who have been impacted by traumatic experiences in childhood. The day will also include a wide range of clinical presentations by counsellor/therapists working in the NCS and will provide a unique opportunity to share in the professional knowledge and expertise accrued in the NCS over the last ten years. There will also be a service user perspective presentation (Continuous Personal Development credits may be available for attending counsellors and therapists from professional organisations). For further information please contact Anne Doheny on (057) 932 7140/1 or Anne.Doheny@hse.ie.

HM Iss6.1 p1-70.indd 36

abuse. We made a connection with the Department of Justice so that we would be advised at the earliest opportunity when they anticipated the Murphy Report would be published. We developed a partnership approach with Faoiseamh, Connect, the Dublin Rape Crisis Centre and One in Four. We provided a Helpdesk, which was staffed by qualified clinicians who provided a triage service to callers. Helpdesk Advisors were given specialist training by service providers to enable them to provide up to date and accurate information to callers. The Helpdesk was available from the day the Murphy Report was published for 12 days (8am - 2am). The decision to provide service for these hours and number of days was based on our data following the Ryan Report. We provided the following: • A dedicated freephone call centre • A dedicated page on our website, which could be accessed directly from the websites of our partners as well as the HSE website • Contact information was made available via press, television and radio • Radio and television interviews were conducted to advertise the Helpdesk Service at primetime viewing and listening By creating this Helpdesk Model, we were able to provide an immediate service to callers with a human voice at the end of the phone. The Helpdesk Advisors directed callers to the most appropriate service for their needs at the time and these ranged from telephone counselling, advocacy

12/03/2010 15:15:21

The faster, lighter PC protection Have you ever imagined what would happen if all personal data stored on your computer got compromised? The fourth generation of ESET software provides you with advanced protection utilising the unique ThreatSense technology. Engineered to disarm threats even before they strike, our fastest solution ever features increased precision, barring even the most sophisticated of cyber threats from your system. You can see for yourself. Download a free 30-day trial from www.eset.ie or contact our healthcare partner Helix Health www.helixhealth.com

HM Iss6.1 p1-70.indd 37

12/03/2010 15:15:22

Oxygen - it’s life-critical. But are you administering it safely? BOC’s FireSafeTM Flowmeter enhances staff & patient safety through a range of innovative features: Static Control Electrostatic charge causes traditional flow indicators to stick. The FireSafeTM Flowmeter dissipates electrostatic charge using an internal discharge element, thereby ensuring flow accuracy. Precision Float A precision float rotates horizontally in the gas stream, providing an accurate reading & visual confirmation that gas is flowing. FireSafe™ Nozzle In the event of fire, the FireSafeTM nozzle immediately closes off, much like a fuse, thereby arresting the flow of oxygen. FlowSafe Valve If the flow tube breaks - from raising a bed etc - the FlowSafe valve automatically shuts off, thereby preventing the further flow of oxygen into the ward.

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10/03/2010 15:15:24 12:36:56 12/03/2010

2:36:56

Health Matters 39

counselling service

â&#x20AC;&#x153;The Helpdesk Advisors directed callers to the most appropriate service for their needs at the time and these ranged from telephone counselling, advocacy services, information about face-to-face counselling services and a general listening service.â&#x20AC;?

talk with a counsellor as soon as possible and for those callers who were very upset and not sure what service would be best for them at the time. The Helpdesk Advisors had received special training to respond appropriately to the callers and assist them in determining their needs. By using a collaborative approach with colleagues in the HSE who had the expertise we required we worked efficiently to deliver a high quality appropriate service to the public. This Helpdesk provided value for money because our partners have Service Level Agreements with HSE and are providing services that complement the work of the HSE NCS.

Rachel Mooney is Director of Counselling in HSE Dublin MidLeinster. She can be contacted at rachel.mooney@hse.ie.

services, information about face-to-face counselling services and a general listening service. The calls were directed to services that were available at the time of the call so this minimised stress and frustration for callers, particularly those in distress who needed to

The HSE National Counselling Service welcomes calls from adults who have experienced abuse in childhood. Contact details are as follows: HSE Area Freephone Number HSE Dublin North East (North Dublin & Meath) 1800 234 110 HSE Dublin North East (Navan, Cavan, Louth & Monaghan) 1800 234 117 HSE Dublin Mid-Leinster (South Dublin, East Wicklow) 1800 234 111 HSE Dublin Mid-Leinster (West Dublin, West Wicklow & Kildare 1800 234 112 HSE Dublin Mid-Leinster (Laois, Offaly, Longford & Westmeath) 1800 234 113 HSE West (Galway, Mayo & Roscommon) 1800 234 114 HSE West (Limerick, Clare & North Tipperary) 1800 234 115 HSE West (Donegal, Leitrim, Sligo) 1800 234 119 HSE South (Waterford, Wexford, Kilkenny, Carlow and South Tipperary) 1800 234 118 HSE South (Cork & Kerry) 1800 234 116

HM Iss6.1 p1-70.indd 39

12/03/2010 15:15:25

40 Health Matters

human Resources

Dialogue needed following income cuts Our health service faces new challenges of maintaining morale and motivation after the series of income cuts imposed through last year’s government decisions writes employment specialist, Gerald Flynn.

+ Gerald Flynn – employment specialist with Align Management Solutions.

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he health sector has come through many challenges over the past five years with successes in community care, cancer treatment and primary health services. A new challenge is the personal one of retaining individual motivation on lower net incomes. Employment specialists see significantly reduced earnings as damaging the ‘psychological contract’ that lies at the basis of most employment relations. In many employments, people would respond by taking whatever opportunities are open to them to find an alternative job either here or abroad. The health service is somewhat different in that most of the 105,000 people working in the sector also have a commitment to patient services, which is often much stronger than mere ‘customer focus’ in the private sector. There is frequently more of a team focus, which knits the capabilities of different people in ensuring patient well-being, than is found among those who operate in individualist roles.

The ‘psychological contract’ In these challenging times, the call for effective people management has never been louder. HR managers are amongst those on the frontline when it comes to maintaining that delicate employer/ employee relationship and trust – the so-called ‘psychological contract’ – and delivering high performance in a period where reduced incomes, potential redundancies and other belt-tightening measures may become fairly common, even in the public service. The extensive negotiations on modernising and improving efficiencies in the public service – from education and justice to health and local authority sectors – late last year may provide a basis for rebuilding public services in tandem with improved exchequer finances.

“While economic data may suggest some recovery on the way, employees report plunging job satisfaction levels as well as falling standards of living over the last six months.” This bleak picture is painted by the Chartered Institute of Personnel and Development (CIPD) based on its employee outlook surveys. CIPD Ireland director, Michael McDonnell said that “despite the resurgence in the stock market and the gradual appearance of economic green shoots, the ‘real’ economy as experienced in people’s dayto-day lives has yet to witness any signs of recovery, with people under increasing pressure both at work and in their personal finances. Employees are more than twice as likely to say their personal standard of living has worsened over the last six months, as they are to say it has improved.” At the same time the CIPD net employee job satisfaction score has dipped substantially from 46 plus to 37 plus since early in 2008.

falling Job satisfaction Mr. McDonnell added that the fall in job satisfaction, which has been marked across both the private and public sectors, has been accompanied by an increase in the proportion of people reporting they are under excessive pressure at work – either every day or once or twice a week – rising to 42 per cent from 38 per cent last year. He said that “employees are also more likely to say that they have seen increases in stress and conflict at work, as well as bullying by line managers as a result of the recession.” This is a common feature in many workplaces according to the research by the CIPD personnel managers’ institute. It calls on us all to be aware of the added stresses and to try to avoid it impacting on patient services or in how we interact with colleagues.

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Health Matters 41

Human resources

“The fall in job satisfaction, which has been marked across both the private and public sectors, has been accompanied by an increase in the proportion of people reporting they are under excessive pressure at work” The reality is that HSE managers have no more influence on government policies than do the trade unions leaders so we have to maintain our morale and consider the improvements in health services which lie ahead after the worst cuts or ‘adjustments’ are absorbed.

Flexibility at work One positive outcome is that we now have a general picture of the agreed transformation of public services envisaged by all those who are focused on delivering quality health services through flexibility and further capital and current investment over the coming years. My work with many private sector organisations over the past decade has witnessed the depressing impact of compulsory job cuts, abandonment of defined benefit pensions, reduced core pay rates and longer shift roster patterns. They have often been accompanied by voluntary departures even when thirdparty interventions by the Labour Relations Commission and Labour Court, and trade union accommodations, helped soften the worst impacts. The challenges and changes which Aer Lingus, Waterford Crystal, Guinness, Iarnród Éireann, Halifax and many other organisations have all faced over the past 15 years will be echoed in the health

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+ Michael McDonnell, Director of CIPD Ireland says “job satisfaction and personal finances are under stress.”

sector. With a skilled and professional workforce and unions that have already proposed a path for ‘transformation’ to enhance services and value for taxpayers, we can already see land ahead over troubled waters. This is why engagement is always more fruitful in securing productive improvements for patient services than trying to prevent the inevitable changes which lie ahead. I have met many painters who tried to prevent the introduction of the roller brush; printers who resisted computerised type-setting; and dock workers who pledged to fight to the death against the use of containers – all in vain. Bearing in mind the importance of engagement, and as people try to cope with tighter budgets and pay cuts, it would seem prudent for an organisation like the HSE to become actively involved in an engagement programme and employee attitude surveys. Gerald Flynn is an employment specialist with Align Management Solutions and an adviser to CIPD Ireland – gflynn@ alignmanagement.net

12/03/2010 15:15:51

42 Health Matters

Report

HIV is better managed but there is also a growing cause for concern There is good news and bad news on HIV and AIDS in Ireland, reports Professor Samuel McConkey.

he good news is that improvements in the treatment of HIV have dramatically reduced the numbers of people developing AIDS. Diagnosis of HIV is no longer the near certain death sentence it once was and people with HIV can lead fulfilling long and healthy lives. The new therapies work extremely well. A recent audit undertaken by the Department of Infectious Diseases at Beaumont Hospital, one of six specialised clinics in the country, has found that 93 per cent of HIV positive clients on treatment had well-controlled viral loads, which puts them at very low risk of AIDS. The Department conducts two or three clinical audits each year, and selects the activities to audit based on severity of risk associated with that factor: likelihood of the activity and severity of consequences were it to occur. This is a basic quality risk management system, which is being developed in 2010. Once acquired, the HIV virus cannot be eradicated entirely but it can be managed to such an extent that the risks of acquiring AIDS is very low. The numbers of people dying as a direct result of HIV infection is also now extremely small. The bad news, however, is that the number of people being diagnosed in Ireland with HIV continues to rise. Some 400 to 500 people now test positive each year and in the first six months of 2009 there were 210 new diagnosis of HIV. Of these, men having sex with men (MSM) accounted for 41 per cent, while

HM Iss6.1 p1-70.indd 42

intravenous drug users (IDU), who catch it by sharing needles, accounted for 10 per cent. The biggest category at risk, however, is also far and away the least aware and least informed. Just under half (47 per cent) of newly diagnosed cases involve heterosexuals infected through unprotected sex, whether in Ireland or abroad. This is the group least prepared

“Once acquired, the HIV virus cannot be eradicated entirely but it can be managed to such an extent that the risks of acquiring AIDS is very low. The numbers of people dying as a direct result of HIV infection is also now extremely small.” and least expecting the diagnosis, which they typically find shocking, devastating and life changing. How many people in Ireland are already HIV positive is unknown. The asymptomatic phase can be extremely long – over 20 years – and the infection can be passed on unknowingly to many sexual partners during this time. A study undertaken in the Rotunda maternity hospital, for example, which tested patients over a number of years,

indicated that up to one in every 200 women in Dublin North City may be HIV positive. Migration is a risk for several diseases including HIV. During the years of the Celtic Tiger, there was a large influx of people from abroad, mostly young and well travelled, who are likely to have brought with them HIV at the rates of their countries of origin, some of which are very high. In parts of southern Africa, for example, a fifth of all adults are HIV positive. People seeking political asylum come with a range of infections including HIV, as well as post-traumatic stress, depression, anxiety and other conditions. The main reception centre for new arrivals into Ireland is at Balseskin at St Margarets in North Dublin. Here clients are offered various health supports, including voluntary screening for infection. At Beaumont we provide medical care to those who have infections. Beaumont’s specialist clinic currently sees about 80 newly diagnosed HIV patients a year – double the number of only a few years ago and about a fifth of the total of new patients nationally. Improved screening of the entire population would facilitate better identification and treatment of people who are HIV positive. In the US, people who go to ER are offered screening. Within Ireland, free screening is already provided for such diseases as tuberculosis and syphilis, recognising the value to the community of rapid identification to prevent their spread. The same should apply to HIV, especially as new treatments do mean that its spread, especially by asymptomatic patients, can be decreased. Increased opportunistic screening amongst GPs and hospital doctors,

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Health Matters 43

Report

particularly in A&E in Ireland would also help to achieve earlier diagnosis. A survey of 100 recently-HIV-diagnosed clients attending Beaumont found that 66 per cent had presented to a healthcare setting, such as an Emergency Department or GP, within the past two years with a range of symptoms consistent with HIV. Had these been screened at the time diagnosis might well have been made that much sooner. In the early days of treating HIV, patients often found it difficult to adhere to the necessarily strict regimen of tablets which involved a multiplicity of drugs several times a day. Since then, however, development of a once-a-day fixed dose combination tablet has revolutionised treatment and made it easier to take for patients. However, the virus is well able to mutate if this HAART regime is not followed consistently and will develop lifetime resistance to it. In the specialist clinics, multi-disciplinary staff – pharmacists, nurses, social workers, also the secretary and doctors – teach clients tools and tricks to help them to meet the demanding adherence necessary before treatment begins. At Beaumont, we have adopted a holistic approach, with social workers looking at such issues as accommodation, for example, while pharmacists and nurses help to educate clients on how to maintain therapy regimes. Many clients, particularly asylum seekers, have experienced serious traumas and need psychiatric support. Some 70 per cent of asylum seekers have post-traumatic stress symptoms and 40 per cent have depression. Each of the members of the multidisciplinary team is committed to a quality management system, which we are developing, with external help, in 2010. According to the Euro HIV Index 2009, published last October, Ireland ranks 10th of 29 countries in terms of the care of and conditions provided for people living with HIV/AIDS in Ireland. Index Director Dr Beatriz Cebolla has noted that although Ireland performed consistently across all the measures comprising the index, there was room for improvement in all of them. Looking to the future, there is a widely held view amongst infection specialists that, subject to the availability of the

HM Iss6.1 p1-70.indd 43

“Looking to the future, there is a widely held view amongst infection specialists that, subject to the availability of the necessary resources, increased HIV screening would prove highly cost effective.” necessary resources, increased HIV screening would prove highly cost effective. A study undertaken in British Columbia found that every additional dollar spent on early diagnosis and treatment saved $2 on the higher levels of care required as a result of later diagnosis. So screening and HIV treatment are cost saving in the long run. The cost of screening kits is only a few euros each, against the cost of HAART therapy for HIV positive patients, which is approximately c10,000 per patient each year for their entire lifetime. Education of at risk groups, especially heterosexuals, on the perils of engaging in sex without using condoms, is also vitally important in any effort to contain the spread of this infection. While some useful steps are proposed under new Department of Education and Science guidelines on a social, personal and health education, these tend to be nonprescriptive and are, in any event, a voluntary component.

How to maintain a tablet regimen: • Link tablet taking to a habitual daily activity; take the tablet first. • Always do things in sequence. Ever get emails supposed to have an attachment but find it is missing? Avoid doing that yourself by creating the attachment before you type the word attachment in the email. In just the same way, create a sequence of events which begins with taking tablets, for example, at the start of making breakfast each morning. • Keep spare pills with you at all times and in convenient locations – a wallet or purse, the glovebox of the car – so if your plans change you still have tablets to hand no matter where you find yourself. • Use the alarm on your watch or phone to remind you when it is time to take the next tablet. • Take extra care during unusual times; weekends, holidays, funerals, etc. • Ask a friend to remind you daily. • Learn and practice for a month with vitamin tablets, so errors don’t matter. • Fix other issues first before starting, e.g. homelessness, depression, domestic security, disclosure, IV drug use, alcohol, chaotic lifestyle. • Fill a pill box once a week, so you know for sure which day’s tablets you have taken. • When a missed dose occurs interrogate yourself, like an air accident investigator, to see what went wrong and how to prevent it next time. • Good strong relationships with providers of care help.

Professor McConkey leads the Infectious Disease and Tropical Medicine services at Beaumont Hospital and is Head of the Department of International Health & Tropical Medicine at the Royal College of Surgeons. He is a founding member of the Infectious Disease Society of Ireland and a board member of AIDS Care Education and Training Ireland.

12/03/2010 15:15:52

+ Professor Neil O'Hare, HSE NIMIS Project Lead; Professor Brendan Drumm, CEO, HSE and Dr Niall Sheehy, Consultant Radiologist, St. James's Hospital and Lead Radiologist, NIMIS Project.

Roll out of the National Integrated Medical Imaging System (NIMIS) In our last issue, Professor Neil O’Hare outlined the progress to date of the HSE’s National Integrated Medical Imaging System (NIMIS). In February 2010, the HSE announced more details about the roll out of the project.

HM Iss6.1 p1-70.indd 44

IMIS will be installed in 35 hospitals with an investment of over c40m over three years, starting in 2010. The system will make Ireland's radiological services 'filmless' and enable secure and rapid movement of patient image data throughout the health service. Around 25 per cent of Irish hospitals have already moved to a 'filmless' system where all images are captured, stored and examined using computers rather than printed film – a technology called Picture Archive and Communication Systems and Radiology Information Systems (PACS/RIS). NIMIS will introduce PACS/RIS into the remainder of Irish hospitals and will enable sharing of patient data between all hospitals through a national image archive. The ability of health professionals to share patient imaging data will reduce the loss

of medical images and ensure that the patient's information is available rapidly where and when it is needed, at every stage of a patient's journey. All of a patient's prior and current images will be available electronically in the radiology department, out-patient clinics, hospital ward and results can be quickly sent back to the patient's GP if required. Professor Neil O'Hare, HSE NIMIS Project Lead, explains what NIMIS will deliver: “Images will no longer be trapped on film in one location. NIMIS will enable a patient's diagnostic imaging to be available to all appropriate clinicians, when and where it is needed. Patient images will be available at all times to radiologists, surgeons in operating theatres, on-call doctors in their homes and experts in centres across the country.” According to Dr Niall Sheehy, Consultant

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Health Matters 45

cover story Radiologist at St James' Hospital and Lead Radiologist for the NIMIS Project, “Existing radiology information systems are increasingly unable to cope with the demands of modern complex diagnostic imaging. This can affect the quality of care and in some cases impair patient safety, which is why the implementation of NIMIS is so important.” The first phase of hospitals for the installation of the system has been selected. Beaumont Hospital, Sligo General, St Luke's Hospital in Dublin, and the Mid-West Region – starting in Dooradoyle have been selected for the first phase of the NIMIS roll-out. The second phase hospitals are Waterford Regional Hospital, Our Lady's Hospital for Sick Children in Crumlin, Our Lady of Lourdes Hospital in Drogheda and the Mater Hospital. After a central design and configuration phase, it is hoped to have the first hospitals live by the end of 2010. More information about the implementation of NIMIS can be found at www.hse.ie/go/nimis

Background information about NIMIS Medical imaging technology over the last ten years has moved to a point where all new medical imaging systems now acquire their images digitally. They are designed to operate optimally in a digital PACS-available environment. Internationally the installation of PACS/RIS solutions has grown substantially. This is because of the well proven benefits PACS/RIS solutions deliver and because the technology has matured to the point where large installations can take place with rapid returns on investment. Picture Archive and Communication Systems (PACS) store, manage and display a patient’s images electronically removing these risk factors. When integrated with Radiology Information System (RIS) and Voice Recognition capabilities, the resulting solution provides the required functionality to significantly re-engineer and improve the radiology imaging service. In August 2007, the HSE-initiated the National Integrated Medical Imaging System (NIMIS) Project. In August 2008, the HSE went to tender for the selection of a vendor to install the specified system into all hospitals that currently do not have such systems.

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How will it affect me? Radiology Staff The installation of PACS/RIS will have a major impact on the way the radiology department works and on how individual members carry out their role within the department. There are a large number of benefits and changes resulting from a good PACS/ RIS installation. These include: • Faster delivery of medical images to the radiologist for reporting. • Full availability of relevant examinations and reports, along with the current images, i.e. no lost or misplaced images and reports. • No more film to produce, transport around the department /hospital; match with previous images; and file away for later referral. • Requests for diagnostic tests placed electronically ensuring the required clinical information is available (and readable!) to both the radiographer and radiologist at the time of the examination. • Availability of a large range of image processing tools to allow maximum diagnostic information to be obtained from the image. • A reduction in the time to generate a report on the requested procedure; • A reduction in errors caused by multiple entries of patient and exam details. The required information will only need to be entered into the system once, reducing some of the administrative tasks currently undertaken by radiographers, thereby freeing their time to focus on caring for the patient. • The system should result in a more efficient working environment with a greater level of management information being made available to the radiology department. • The system will contribute to a better working environment, as the lack of film processing will result in a quieter and chemical-free workplace. Non-Radiology Clinicians The impact of PACS/RIS goes well beyond the radiology department. Non-radiology clinical staff will see major benefits for

them and their patients by the system installation. The system will contribute to the following: • Fewer wasted appointments and postponed procedures because of non-availability of patient images and reports. • Instant access to patient images and associated reports, regardless of the location in the hospital. • More rapid production of reports. • More information as to the status of the requested procedure. • Availability of images when awaiting the report.

General Practitioners While the hospital staff and the patient will undoubtedly see major benefits and improvements in the radiology service accruing from the installation of the NIMIS, the General Practitioner will also see benefits with the system. These include: • More efficient service for Radiology patients. • Ability to obtain the results of examinations electronically, with the availability to view associated images where required. • The ability to accept electronic orders from the GP IT systems. Patients The installation of the NIMIS will yield significant improvements to the service patients receive from radiology departments. The benefits of the system that specifically impact on the patient include: • No lost films. All the patient’s prior and current images will be available in the radiology department, out-patient clinic, or hospital ward. • Fewer repeat exams. • A faster turn-around in the examination report. • Rapid transfer of images between clinicians for consultation or remote referral. • Greater security of patient data with controlled and audited access to such data.

12/03/2010 15:15:57

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12/03/2010 15:16:00

HealtH Matters 47

grEEn mattErs

Developing an energY redUction prograMMe HSE is one of the largest users of energy in the country and has an obligation to be at the forefront in introducing energy reducing initiatives. Hence achieving energy reduction over current energy usage is a key objective for the HSE, writes Jim Murphy, Project manager, Estates corporate.

he government Green Paper on Sustainable Energy was released in 1999, with the White Paper setting the energy policy framework and energy efficiency as the central component: “efficient use of energy is one of the core principles of sustainable energy policies.” The National Energy Efficiency Action Plan 2009 to 2020 strengthens this further and sets a target of 33 per cent reduction in energy demand for the public sector within that period. all of this echoes the aims of the eU energy efficiency action Plan, published in October 2006.

all sectors of society, including business, industry, state and semi-state, need to continually focus on improving efficiency. One such efficiency includes environmental improvement, which can often result in cost savings. It is generally known as Eco-efficiency. Eco-efficiency involves the establishment of prudent management in environmental performance, preventing and reducing wastage by lowering resource use in terms of materials, water and energy. this can also lead to lower costs and can then be a win-win scenario.

We have seen a drop in the cost of energy from the all time high of recent years but this is now reversing and the overall trend is expected to remain upwards for the foreseeable future. therefore a return to increasing energy costs, coupled with a high growth rate in the use of energy, will result in even higher energy invoices unless a strategic programme is established to combat energy usage and cost. this must be achieved without adversely affecting our core principle of delivering a state of the art healthcare system. Many programmes have been launched throughout the health sector aimed at reducing our energy consumption, at national level, such as the Combined Heat and Power (CHP) programme and at local level as individual projects where we work closely with Sustainable Energy Ireland (SEI) for maximum benefit. Yet the demand for energy continues

hSe aVailS oF Sei SuPPort to Make energy SaVingS the Hse successfully qualified for support from sustainable Energy Ireland (SEI) in 2009 for energy efficiency projects under the Supports for Exemplar Energy Efficiency Projects (SEEEP) programme. SEI provided almost b2 million in funding for energy upgrades in 12 Hse sites consisting largely of lighting projects, which will result in average electricity/energy savings of between 30 and 50 per cent per annum in lighting energy consumption. As part of SEI’s energy cost reduction services for business and the public sector, financial support was made available for a limited number of qualifying energy efficiency projects whose implementation will achieve significant energy savings. Nine projects in HSE-funded hospitals and a further three projects in the voluntary health sector secured support of almost b2 million from SEI. The technologies employed were mainly new

HM Iss6.1 p1-70.indd 47

lighting and control systems to switch lights off when not required, lighting cost savings in excess of 30 per cent for the hospitals concerned are expected, some ventilation, insulation and heating controls upgrades were also undertaken. SEI’s new guide on Energy efficient and Cost effective Hospital lighting is now available. For more information on SEI’s Public Sector Programme and other initiatives available for businesses visit www.sei.ie/business.

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12/03/2010 15:16:04

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12/03/2010 15:16:08

Health Matters 49

Green matters

“It is the baseline use of light, heat and cooling that accounts for approximately 70 per cent of our energy use and it is here that savings must be made.” to grow, particularly in the acute hospitals sector. The introduction of additional energy intensive equipment through programmes such as the National Programme for Radiation Oncology (NPRO) will increase this demand for energy, however it is the baseline use of light, heat and cooling that accounts for approximately 70 per cent of energy use and it is here that savings must be made. In developing an energy reduction programme, the imperative was to review the HSE energy consumption patterns with a view to developing a strategic programme for reduction. This programme must give a clear corporate direction which will take account of the underlying principles of the National Energy Efficiency Action Plan 2009 – 2020 and it must be solidly based on achieving success through energy efficiency principles. The key programme objectives are to: •A chieve energy reduction over the current energy usage for each year and deliver savings back to the HSE. •D emonstrate the commitment of the HSE to EU and national energy plans through socially responsible procurement and to demonstrate its energy leadership

rates with failure to achieve these rates resulting in financial penalties to them. The HSE South Region has been chosen to pilot the project with all the sites within this region forming part of the tender. HSE Estates working with HSE Procurement will manage and deliver the contract. The infrastructure necessary to efficiently deliver

this size of programme has been established and senior management commitment is demonstrated by their representation of the project Steering Committee. A draft Contract Document has now been issued and later this year we will move to the Invitation to Tender stage followed by the contract signing.

Cavan General Hospital Energy Efficient Lighting Project An energy efficient lighting project was recently developed for Cavan General Hospital. The project was managed and delivered by HSE Estates Dublin North East, through its Kells office. The main objective of the project was to maximise the energy efficient benefits of the lighting within the hospital with minimum disturbance to healthcare services. Existing indoor corridor lights and outdoor street lights were replaced with energy efficient equivalents. The energy efficient lighting project consisted of the following works: Street Lights Lamps were replaced by Philips 55w Pl-L (CFL) lanterns. Floodlights Metal Halide Floodlights were replaced by more efficient LED Floodlights. Corridor Lighting T8 Light Fittings were replaced by more efficient T5 Light Fittings complete with daylight sensors in all appropriate areas. Main Reception Lobby Incandescent bulbs were replaced with LED Downlights. Nightlights CFL nightlights incorporated into existing light-fittings were replaced by standalone LED nightlights. The project has the potential to bring about a seven per cent reduction in the hospital’s electrical running costs and CO2 savings of 134 tonnes per year. Savings could be greater when you take into account those that will be attributed to corridor lights operating with daylight sensors. An added benefit is that the light level in the corridor areas has been vastly improved resulting in a light level of 200 lux being achieved in some corridor areas with a reduced number of light fittings operating. Overall, there have been very positive reactions and feedback from staff across all disciplines within the hospital to the improved lighting aesthetics.

A fundamental principle of increasing energy efficiency is to deploy cutting edge technology coupled with experts in the energy management field who will interpret these findings and implement actions. We have set about incorporating this principle into a contractual agreement which will commit the successful candidate to achieving pre-agreed energy reduction

HM Iss6.1 p1-70.indd 49

12/03/2010 15:16:12

50 Health Matters

Green Matters

Hospitals A number of hospitals are working with the Environmental Protection Agency (EPA)to introduce green initiatives. It is hoped that this programme will expand so that an increasing number of hospitals can reap the benefits.

Cork hospitals build up their eco-efficiency credentials

hree Cork hospitals are building up their eco-efficiency credentials by working with the Environmental Protection Agency on projects preventing and reducing waste, and cutting water and energy usage where possible. The hospitals are Cork University Hospital, the Mercy University Hospital and the Bon Secours. To date, the following activities have begun: • Food waste – surveys of amounts of food waste arising including unused food and sources within the hospitals; monitoring of current practices for patient services and menu ordering; surveys of current food waste management; implementation and impact of food waste regulations. • Risk waste – surveys of amounts and characterisation of risk waste arising and sources within the hospitals to assist implementation of the Department of Health Guidelines; Segregation, Packaging and Storage for Healthcare risk waste. • General and recyclable waste – surveys of amounts and characterisation of general and recyclable waste arising and sources within the hospitals; identifying potential for prevention and for increased segregation for recycling; • Other hazardous waste: developing best practice for management of other hazardous waste in a hospital setting, chemical waste including that arising

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from laboratories, X-rays, maintenance, hazardous electrical equipment, hazardous medical equipment; hazardous lamps, batteries, gas cylinders, aerosols, etc. • Water – Surveys are planned of fixtures to identify high usage equipment for potential replacement. • Energy – It is planned that the activities will be expanded to encompass energy improvement measures. Sustainable Energy Ireland will be involved in this process. For example, hospitals can make significant savings by simply changing to energy efficient light bulbs! (www.sei.ie).

Results to date So far the results of the green initiatives have been extremely promising. • One hospital has developed an excellent method of segregation for food waste and for cardboard. • There is already a very high level of compliance across all three hospitals in terms of risk waste segregation. • There is a very good level of co-operation and interest across all staff, with great knowledge of where improvements can be made from staff on the ground. • The hospitals have been assisted in this initiative by the Environmental Protection Agency (EPA) which has been providing

them with technical assistance to help build up prevention capacity and an improved environmental management structure. Technical assistance is being provided by the Clean Technology Centre. The team also includes Green Business Initiative staff. See http://www.greenbusiness.ie.

Planned Work It is hoped to expand this EPA programme to an increasing number of hospitals. Green healthcare guidance materials will also be developed to include booklets, leaflets, posters, PowerPoint materials and made available on the Internet. The findings from previous programmes could then be shared among many other hospitals. What can hospitals do to improve their eco-efficiency? The basic improvement cycle involves management commitment, data-gathering and assessment, implementation of improvements, and review. It is a neverending cycle of improvement. There are then a range of improvement options which can be implemented. These vary from simple low cost actions, such as changing to more energy efficient lighting, to more complicated options, such as tackling at source the reasons for food waste generation. An example of another hospital which has been active in recent years in managing its energy usage, recycling and waste disposal activities is Sligo General Hospital.

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Health Matters 51

Green Matters Cleaner Greener Healthcare at Sligo General Hospital

wo waste management teams at Sligo General Hospital helped the hospital recycle 152 tonnes of waste last year – more than a quarter of all the hospital’s waste. In 2005 Sligo General Hospital formed a multidisciplinary Green Team Steering Group to address waste management. Two waste teams were set up with very specific roles – the Environmental Team which was tasked to deal with healthcare risk waste, general waste, and energy conservation; and the Recycling Team which was recruited from local Rehabilitation Centres on a voluntary training programme. In addition, a Support Service Partnership Sub-group was set up to address how any waste management initiatives could be introduced on a cost neutral basis. The main objective of the Green Team Steering Group was to promote environmental best practice while also ensuring that any set up costs were recouped within an agreed two-year period. The set up cost of c50,000 was spent on the provision of recycling equipment such as balers, shredders and compactors. The two-year targeted pay-back period was achieved by significantly reducing the amount of waste going to landfill and redirecting it instead to recycling.

The targets set by the Green Team Steering Group were communicated to staff through educational seminars, training sessions, emails and posters. Other methods used to communicate with the wider community – patients and the general public – included the use of ‘Green Notice Boards’, newsletters, information messages displayed on plasma screens and suggestion boxes.

Examples of Waste Management in practice: • The hospital, in conjunction with the Estates Department, negotiated a Service Level Agreement with a Waste Contractor for the free collection of cardboard and plastic and landfill costs were significantly reduced. • Waste audits were carried out within the hospital and the recycling levels within the hospital were increased as a result. • Waste food collection was introduced which diverts approximately six tonnes from landfill to composting each month. • A system to collect hazardous waste was introduced for fluorescent tubes, batteries, IT equipment, toner cartridges, cooking oil, aids and appliances and WEEE waste. • In 2009, the Energy Officer obtained a grant from Sustainable Energy Ireland for

+ Some members of the Environmental and Recycling Teams with John McArthur, Catering Manager at the baler in the existing waste compound at Sligo General Hospital, (L-R): Joe Casey, Keith Stewart, John McArthur, Eithne Sheridan, and Matt Hogan.

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the installation of a new lighting system to replace luminaries throughout the multistorey building with movement detectors either switching on/off lighting within defined intervals. These efforts have resulted in increased recycling levels since 2005 with 152 tonnes of waste recycled in 2009; on average 26 per cent of all waste was recycled each month and some months as much as 36 per cent was recycled. Due to the nature of some waste produced within an acute hospital there will always be a difficulty in reaching higher levels, however, this remains the continued focus at Sligo General Hospital. In 2010, the hospital will be focusing on high energy areas such as catering, laboratory, radiology, and theatres, as well as office areas. Commenting on the achievements Domhnall McLoughlin, Deputy General Manager said, “The benefits of our waste and energy initiatives have been farreaching. This has been evident through providing for a cleaner, safer hospital together with assisting the environment through reducing, reusing and recycling. These actions have also resulted in a much reduced energy bill that has enabled the hospital to save money that would otherwise have had to have been achieved in perhaps more critical areas, had this initiative not been undertaken.” Mr Mc Loughlin also explains that “from our experience it was a relatively easy programme to initiate and implement. We found many of our staff, patients and visitors, were more than willing to cooperate and assist. Indeed we continue to get very positive suggestions on what more can be done to sustain and enhance our achievements to date. We also feel that the system of waste management and energy conservation that we introduced back in 2005 has served us well. It has been recognised as being both innovative and a model of best practice and we were very proud to win Regional and National Achievement Awards in 2007 for our Waste Management System”.

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52 Health Matters

Green Matters

Energy Efficiency – a ‘win-win’ situation for our health service Our health system has much to gain by introducing energy efficiency programmes and there are benefits to be realised for both staff and patients, writes John Gibbons.

here are few situations in life that could truly be described as ‘win-win’. Energy efficiency is one striking case in point. Ireland’s health service is among the nation’s largest energy users. HSE facilities alone spend over c1.5 million a week on energy. Electricity costs account for around half the total energy outlay in our major acute hospitals. Money spent on energy is clearly cash that is not going to be available elsewhere in our hard-pressed health service budgets. Paradoxically, energy efficiency means a more, not less, comfortable environment, both for staff and patients. In Britain, the NHS calculates that its 1.3 million workforce could experience productivity increases from 6 to16 per cent as a direct result of working in an energy efficient environment, one that doesn’t lurch from being unpleasantly hot and stuffy one day to being uncomfortably cold the next. By definition, energy-inefficient buildings require constant heating when it’s cold and cooling almost as soon as the sun appears. Under recent EU Directives, all Irish buildings

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“HSE facilities alone spend over c1.5 million a week on energy. Electricity costs account for around half the total energy outlay in our major acute hospitals.” with a floor size greater than 1,000m2 are required to produce what’s known as Display Energy Certificates (DECs). In the entire health sector, only 46 buildings currently display them, according to Sustainable Energy Ireland, which points out that the buildings sector accounts for 40 per cent of total energy consumption in Ireland. The Intergovernmental Panel on Climate Change (IPCC) points out that

cutting energy use in buildings has more potential for reducing carbon emissions worldwide than any other single sector. A typical Irish acute hospital is responsible for the production of thousands of tonnes of emissions annually. Much of this infrastructure was designed at a time of poor awareness of the true dangers of carbon emissions. The good news is that, when implemented, efficiency gains can be truly dramatic. Some 12 HSE sites have recently undergone energy upgrades, leading to cost savings of around a third in lighting, due to the introduction of newer technology and ‘smart’ lighting control systems. The incandescent lightbulb is over a century old, and is showing its age. Barely five per cent of the electricity in a typical bulb makes light. The rest is lost as heat. This author had around 20 recessed light fittings installed during a recent domestic refurbishment. The standard 50-watt halogen bulbs provided by the builder burn 1kw of energy. Changing them for identical sized LCD units producing

12/03/2010 16:00:21

Health Matters 53

Green Matters

equivalent light yielded dramatic results. Yes, the LCD bulbs were more expensive to buy, but they last far longer and each consumes just three watts, an astonishing 16-fold power saving. A good-sized room can now be evenly lit using less power than the equivalent of one dim 20-watt incandescent lightbulb. Now multiply those energy savings across an entire office, laboratory or hospital and modest initiatives can suddenly translate into dramatic energy efficiency improvements. Electronic devices, from computers and monitors to printers, are major consumers of both energy and materials. Most offices and stations are cluttered with documents only printed on one side. If the printer you use has a ‘duplex’ function, this should be set to be the default for all users. Many organisations produce documents as PDFs, but neglect to delete blank pages. Removing these before you create a PDF, and avoiding fussy backgrounds, saves everyone money, time and hassle. In many cases the most environmentally efficient, as well as thrifty, thing is simply not to print that document or email at all, unless it’s absolutely necessary. Most modern computers and monitors have energy-saving settings that put them into ‘sleep’ mode if not being used for 15 minutes for example. If your machine is humming away constantly, the settings need to be adjusted. Also, these devices come with an ‘off’ switch. Almost no computer needs to be left on overnight unless there are good business reasons for doing so. If you have a role in procuring electronic equipment, you should query the policies of prospective suppliers regarding their use of hazardous materials, including brominated flame retardants, lead, chromium, mercury and PVC. Quality suppliers will offer you greener, safer alternatives. Within a large, complex organisation like the HSE, energy efficiency can only truly succeed if it’s both a top-down and bottom-up process. Senior managers clearly have a vital role in making the right procurement decisions. ‘Smart’ equipment is generally a little more expensive initially, but this is more than offset with energy savings over its full life cycle. However, the people who are best placed

HM Iss6.1 p1-70.indd 53

“If you have a role in procuring electronic equipment, you should query the policies of prospective suppliers regarding their use of hazardous materials, including brominated flame retardants, lead, chromium, mercury and PVC. Quality suppliers will offer you greener, safer alternatives.” to ensure that energy efficiency becomes a reality within the HSE are in fact the thousands of people who work within the system, who know its ins and outs intimately. If the arguments in favour of energy efficiency and recycling weren’t themselves compelling enough, then consider carbon dioxide (CO2), a powerful heat-trapping gas that, once released, stays active in

the atmosphere for upwards of a century. The emissions of billions of tonnes of greenhouse gases, principally CO2 as a result of human activity, are steadily ratcheting up the earth’s temperature. Already, average temperatures have increased by 0.8 degrees celsius over pre-industrial levels. This doesn’t sound like much, but given the Earth’s average surface temperature is around 14.5°C, this actually represents around a six per cent warming in barely a century. By way of medical analogy, a similar increase in a person would see their body temperature rise to over 39°C – a level that would quickly necessitate urgent treatment. The equally dangerous additional heat we have injected into the earth’s system is now melting the Arctic Sea ice, shrinking glaciers all over the world and gnawing away at even the 3km thick Greenland ice pack. The rate of warming is predicted to increase by a disastrous 2-6°C in the coming decades. Scientists warn that if we do not act strongly and act now to drastically reduce emissions, the conditions for life on our small blue planet will deteriorate irreparably, within our children’s, and possibly our own lifetimes. “We” means you and me. Don’t wait for others to lead, and never believe there’s nothing you can do. In the words of Mahatma Gandhi, “Be the difference you want to see in the world.”

+ John Gibbons, a journalist and commentator on environmental issues, has established the not-for-profit website Climatechange.ie.

12/03/2010 16:00:23

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12/03/2010 15:16:38

Health Matters 55

Reform

HSE moving to new service delivery model Our organisation is moving to adopt a new model of service delivery that will support the integration of hospital and community-based services. Damien McCallion, Integrated Services Programme Director, reports on progress to date.

he HSE is continuing to develop a model of service delivery that will support the integration of hospital and community-based services. The model is designed to ensure that patients and clients are more likely to receive the type and quality of care they need, when they need it and in the most appropriate setting and from the most appropriate health professional or team of health professionals. This emphasis is reflected in the 2010 HSE Service Plan that stresses the shift of care from hospital to community and an increase in the provision of day care in hospitals. It is also reflected in the approach to some of our community based services, for example in Mental Health. Working within an integrated model, staff will be able to focus on the totality of needs of the patient and client. There will be a strong focus on effective working relationships across various services designed to ensure that our patients and clients receive the care they need supported by teams of health professionals. Implementation is already underway and recent work has simply served to ensure that the respective elements are brought together. Examples would include our primary care strategy, the Vision for Change programme in mental health, recent review of childcare structures, development of clinical directors and the various hospital reconfiguration programmes. Key is ensuring that hospital and community-based services primarily focus on populations in defined catchment areas to help ensure a more integrated service for the patients and clients in those areas.

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Care is essentially delivered at four levels: 1. Primary Care Teams (7,000 â&#x20AC;&#x201C; 10,000 population) 2. Community Health & Social Care Networks (30,000 â&#x20AC;&#x201C; 50,000) 3. Integrated Service Areas (100,000 â&#x20AC;&#x201C; 350,000) 4. Tertiary Acute Services (500,000 plus) See diagram of Service Delivery Model.

National Programmes of Care It is widely accepted that Chronic Disease management will be one of the major challenges in the coming years for our health and social care system. A programmatic approach to improving

care is being introduced. This approach is designed to enable significant improvements in patient access in the short term with sustainable and more affordable healthcare in the longer term. The objective is to bring about results that will increase quality of life, reduce demand on services and reduce bed days. Ultimately, the international evidence suggest that the most effective improvements in health and social care come by focusing on the processes that deliver patient care. This will be a primary focus of these programmes of care. Clinical Care Programmes will be headed up by Clinical Care Programme Directors

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56 Health Matters

Reform

“Ultimately, the international evidence suggests that the most effective improvements in health and social care come by focusing on the processes that deliver patient care. This will be a primary focus of these programmes of care.”

who will engage with the relevant disciplines to define the appropriate model of care for a particular illness. The first programmes in 2010 will initially concentrate on: • Stroke • Heart failure • Acute coronary syndrome • Diabetes • COPD/Asthma • Epilepsy • Obstetrics • Mental Health • Care for the Elderly The first Clinical Care Programme Directors are currently being appointed. This is being led out from the Quality and Clinical Care Directorate under Dr Barry White.

Service Delivery System To support the preferred model of care

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significant organisational changes have already taken place nationally with the introduction of the Quality and Clinical Care and the Integrated Services Directorates. In addition, the four HSE regions are now headed up by Regional Directors of Operations. Services will be managed within the regions through Integrated Service Areas, which will gradually replace the current Local Health Offices and Hospital Networks during 2010 and 2011. The first area has been established in the Mid-West. During the next two years between 14 and 20 area management units will be established across the organisation’s four regions. Further design work is required before the new areas are finalised. The following is a brief outline of the components of the new service delivery system.

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Health Matters 57

Reform

Primary Care Teams Primary Care Teams (PCTs) are designed to provide an easy single access point to local health services such as general practice, physiotherapy, public health nursing, diagnostic services, occupational therapy, speech and language services, community welfare and support for chronic illnesses such as diabetes and asthma. Primary Care Teams are continuing to be developed around the country. Community Health and Social Care Networks Community Health and Social Care Networks are designed to deliver specialist services in response to requests from primary care teams, in line with national shared care protocols and guidelines. They will deliver community care services through teams such as child care teams, community mental health teams or early intervention teams. Further work is now being undertaken to agree where these networks should be. Integrated Service Areas (ISA) ISAs will facilitate the integration of secondary care, primary care and continuing

“To support the preferred model of care significant organisational changes have already taken place nationally with the introduction of the Quality and Clinical Care and the Integrated Services Directorates.” care services for a defined catchment population. The purpose of having defined ISAs is to improve integration of acute and primary care services and support the movement of services into the community. ISAs are designed to ensure: • Clarity for primary care providers on access to secondary care. • Patients requiring a routine, straightforward level of care can be

safely provided with treatment delivered at home or as close to home as possible. • That the minority of patients who require more complex or critical care will be safely managed in a designated acute centre where the relevant clinical expertise is concentrated so that consultant-led high quality care is available. • Support for clinical governance across a group of hospitals. • A population health focus for the broad range of health needs of a community • Improved integration for personal and social services with clear responsibility for integration with other public services, such as local authorities.

Tertiary Services More complex conditions need to be managed in regional hospitals, where the clinical expertise, continuous medical supervision and the support of critical care can be provided. While each region will be broadly self sufficient in this regard some services will be provided on a multiregional or national basis. This will be based on current hospital reconfiguration programmes and programmes of care.

HSE Board and National Management Team HSE Board Members Professor Brendan Drumm Pat Farrell PJ Fitzpatrick Eugene McCague Joe Mooney Professor P. Ann Scott Professor Niamh Brennan Dr Dermot Power Sylda Langford Joe Lavelle John Fitzgerald CEO Professor Brendan Drumm

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Internal Audit Michael Flynn, National Director of Internal Audit National Cancer Control Programme Tony O’Brien, Interim Director, National Cancer Control Programme Corporate Planning and Corporate Performance Jane Carolan, National Director of Corporate Planning and Corporate Performance

Quality and Clinical Care Dr Barry White, National Director, Quality and Clinical Care Integrated Services Directorate Laverne McGuinness, National Director of Integrated Services – Performance and Financial Management Brian Gilroy, National Director of Integrated Services – Reconfiguration

Finance Liam Woods, National Director of Finance Human Resources Sean McGrath, National Director of Human Resources Communications Paul Connors, National Director of Communications Commercial and Support Services Brian Gilroy, National Director of Commercial and Support Services

12/03/2010 15:17:02

More expertise. More opportunity.

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Sports management mSc Sport & exercise management (Sport/Golf/exercise management streams) applicants may also be interested in NFQ level 7 and 8 part-time programmes in occupational Safety and Health: Higher Diploma in Safety, Health and Welfare at Work; Certificate in Safety and Health at Work (offered in centres throughout Ireland). Applications can be made online. See www.ucd.ie/apply for closing dates. For further details about the range of research and taught graduate programmes please visit us online, or contact Ann Oâ&#x20AC;&#x2122;Hanlon, Admissions Tutor, at a.ohanlon@ucd.ie or 01-716 3419. www.ucd.ie/phpps HM Iss6.1 p1-70.indd 58

12/03/2010 15:17:04

HealtH Matters 59

DuBlIn nOrtH East // News INNOVATIVE EXERCISE DVD FOR OlDER PERSONS STAFF AND ClIENTS of lusk Community Unit for Older Persons have made an exercise DVD with a difference. “le Cheile” is a sit down exercise DVD that is suitable for older people particularly those with reduced mobility. The DVD includes warm up, stretches, movement with props and cool down exercises. all of the aerobic exercises are demonstrated by Mona sweetman from the activities Department to the ten clients from the unit who participated in the making of the DVD, which was filmed in the Day Hospital. Susan Dunne, Staff Nurse and Project leader said, “the highlight of the project was definitely the day the unedited version of the DVD was sent for our analysis. everyone was so excited to see a first glimpse of how it would look and all clients enjoyed giving their editing opinions. the DVD is now already an integral part of our exercise programme both with long term residents and day care/ day hospital clients. this immediately benefits approximately 80 clients in lusk Community Unit”. Copies of the DVD may be purchased by contacting lusk Community Unit, Tel: (01) 807 1240.

Clients of lusk Community Unit for Older Persons taking part in the making of the DVD.

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NEW KITCHEN DINING AREA FOR ST JOSEPH’S STAFF AND RESIDENTS at St Joseph’s Hospital, Ardee, Co louth recently celebrated the opening of a new extension to one of the units comprising a purpose-built kitchen, sitting room and dining room. the unit received funding to implement the Household Model of Care (Teaghlach Model), an innovative programme aimed at improving the lives of older people living in residential care. St Joseph’s was chosen for this project because it had previously embarked on a two year programme of culture change, known as person-centred care. this assisted and trained staff to focus on the principles of privacy, choice, autonomy and self-determination for the residents in their care. the new kitchen/dining area is now the central focus of the household and staff make every effort to include the residents in the rituals of preparing and eating meals. For some this may include assisting in the preparation of the meals but for others it may just be about the sensory and social experience that is part of everyday family life. relatives are also encouraged to join residents in the kitchen/dining room to make tea and coffee or a snack with the residents and join them for a meal or relax in the sitting room.

Pictured (l-R): Rosie, Paula and Hugh O’Neill with ‘Cara’ the house dog at the opening of the new extension at St Joseph’s Hospital, ardee, Co. louth.

GOlDEN RETRIEVER STARS IN TV3 DOCUMENTARY THE RESIDENTS and day care visitors to Cuan ros, a Community Unit for Older Persons in north Dublin were recently filmed for a TV3 documentary about Dublin Zoo. Cuan ros is a member of Peata and as such the residents and day care clients are provided with weekly visits from “Honey” and her minder, Mary Neville. “Honey” is a golden retriever and she resides in “City Farm” in Dublin Zoo. the fly on the wall documentary shows different aspects of life in Dublin Zoo. As Honey provides a service to the wider community she was featured as she visited Cuan ros. the residents and day care clients enjoy the therapeutic benefits of the weekly visits from Honey.

12/03/2010 15:17:14

60 Health Matters

News // Dublin north east Staff manual for children’s residential centres New psychiatric unit for adolescents

(L-R): Donal McCormack, HSE Regional Manager, Residential Childcare Services; Minister for Children and Youth Affairs, Barry Andrews TD; Phil Garland, HSE Assistant National Director for Children and Families and Pat Dunne, Assistant National Director PCCC pictured at the launch.

A new Policies and Procedures Manual for use by staff members working in both statutory and non-statutory children’s residential centres and a young person’s version of the manual ‘Your Guide to Living in Residential Care’ have been introduced in the Dublin North East region. The Policy and Procedures Manual is the result of the review and amalgamation of policy documents for children's residential centres in the former North Eastern Health Board and the former Northern Area Health Board, now HSE Dublin North East. ‘Your Guide’ was developed to inform young people in care about the different policies that are in place in residential centres to help them understand when, how and why certain decisions are made about their care. The Irish Association of Young People in Care (IAYPIC) facilitated the development of this unique guide which is written by young people in care and presented in a format that uses language that they can understand. ‘Your Guide’ aims to provide young people with information to help them become more involved in the decisions that are made about their lives.

A new unit designed to treat 16-18 year old adolescents with severe and/or complex mental health difficulties was officially opened at St Vincent’s Hospital, Fairview in November. The six-bedded inpatient unit ‘St Joseph’s’ is an age-appropriate environment for inpatient psychiatric treatment for older adolescents, not previously available in the public sector. The catchment area for the unit is Dublin North East, however, some referrals have been accepted from other parts of the country where there is currently no such service. A multidisciplinary team that includes psychiatrists, nurses, a clinical psychologist, speech and language therapist, social worker with sessional input from a dietician and physiotherapist who provide 24/7 care and treatment for the young people. Doctors in Child and Adolescent Psychiatry from the Mater, Temple Street and St Vincent’s hospitals and Child and Adolescent Mental Health Services in Navan, Co. Meath provide the on-call cover for the unit in a unique model of collaboration. The HSE provided the c3.2m funding for the refurbishment and equipping of the unit and plans are currently underway to increase its capacity to 12 beds in the future.

Stress levels rise as recession bites The Community Mental Health Team in West Blanchardstown has seen an increasing number of referrals as people seek help for the emotional distress triggered by unemployment and the recession. The Community Occupational Therapist's role involves working with individuals whose lives at work, home or in their social groups have been disrupted for some reason. Interventions may include managing stress and anxiety, developing healthy routines, exploring new interests, goalsetting, linking with community resources, lifestyle balance and confidence-building. Group work can be an efficient way of offering interventions to greater numbers of people. Jackie Fox, Community Occupational Therapist recently ran a pilot group called ‘Horizons’ for five

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individuals from a variety of backgrounds, but who had all experienced anxiety, depression, lack of direction and low confidence. The group covered topics such as career interest assessment, goal setting, information on local resources, volunteering and time-management. The participants who all showed moderate improvements commented in their feedback sheets that they had learned: “not to give up on yourself”, “I’ve achieved more than I thought I did”, “I can sometimes be too hard on myself” and “there are plenty of opportunities out there for me”. ‘Horizons’ meant that individuals received Occupational Therapy intervention in a more timely manner and will be held again in the future if similar referrals continue to be received.

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HealtH Matters 63

sOutH // News

rEgIoNAl cANcEr cENTrE SouTH oPENED the regional Cancer Centre south at Cork University Hospital (CUH) was officially opened in December 2009 by Mary Harney TD, Minister for Health and Children. Under the National Cancer Control Programme (NCCP), the new Centre in Cork, one of eight designated centres for cancer care in Ireland, provides diagnostic, surgical, medical oncology and radiation oncology services for patients in the south. the new Breast Care Unit in the regional + staff nurses linda Fitzgibbon and Maria ryland. Cancer Centre south at CUH will be the largest in the country seeing more than 10,000 patients annually and diagnosing approximately 520 patients with breast cancer. The specialist multidisciplinary team involved in breast care management includes five consultant breast surgeons, four consultant radiologists, four consultant pathologists, six clinical nurse specialists, staff nurses and a clinical nurse coordinator. this team is supported by senior medical scientists, two clinical mammographers, senior radiographers, a cancer centre manager, data manager, patient appointment coordinator, medical secretarial staff, a clinical nurse specialist in psycho-oncology and portering and housekeeping services. the unit is also further supported by the CUH physiotherapy, occupational therapy and social work teams. the commissioning of the remainder of the new centre in early 2010 will involve the opening of two new rapid access lung and prostate cancer clinics.

+ tony McNamara, CEO of CUH; Mary Harney tD, Minister for Health and Children; Professor Paul redmond and Professor tom Keane.

+ Operating theatre staff at south tipperary General Hospital in Clonmel, pictured during their recent launch of the hospital’s ‘safe surgery’ campaign.

SURGICAl SAFETY CHECKlIST staFF at sOUtH tipperary General Hospital in Clonmel recently launched its ‘Safe Surgery’ policy. It includes promotion of a surgical pause ‘team time Out’ checklist. With increasing complexity in the healthcare system, there has been a growing emphasis on design and implementation of interventions that contribute to a high degree of teamwork and communication in the operating theatre. More recently the World Health Organisation (WHO) has led an international effort to develop a surgical safety checklist. this has been supported by HIQA. In the UK, the National Patient safety agency has adapted the checklist for use throughout the NHS and is making its introduction mandatory in all operating theatres across england and Wales.

“BIG AND lOUD” IN WEST CORK a group of patients with Parkinson's Disease recently participated in an intensive therapy called lee Silverman Voice Treatment (lSVT), which targets both the speech and motor symptoms of Parkinson's Disease. Patients engaged in a standardised exercise programme that emphasises larger amplitude in voice (lSVT lOUD) and movement (lSVT BIG). It requires that patients participate in one hour of lSVT loud delivered by a speech and language

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therapist and one hour of lSVT BIG delivered by an occupational therapist or physiotherapist four days a week for four weeks. Participants also had a specific home exercise programme which was integrated into their daily activities. Patients were screened and referred by Dr Oliver de Buyl, consultant physician, who runs a Parkinson clinic in Bantry General Hospital. all therapies were delivered at the new PCCC Health Centre in Bantry. Initial

+ (l-R): Rosaleen Hurley SlT, Niamh lyons SlT, Niamh McCutcheon OT and Eileen O'Keefe PT. results and feedback are very positive and encouraging. For all enquiries, contact liz O'sullivan at liz.osullivan1@hse.ie.

12/03/2010 15:17:48

64 HealtH Matters

News // sOutH NEW DUNGARVAN COMMUNITY HOSPITAl PATIENTS ARE NOW attending the new c10 million Community Hospital in Dungarvan following building works. the purpose-built 32-bedroom hospital is on the grounds of St Joseph’s and replaces St Vincent’s District Hospital. The new facility provides GP access beds, convalescent, respite and terminal care and also short-term accommodation for dependent, chronically-ill young patients. The new hospital focuses on nonacute services to complement those of Waterford regional Hospital. When fully operational, older people will be able to be assessed as day patients and in many cases avoid hospital admission. Waterford local Health Manager, Dermot Halpin said, “the development of these services has benefited from the dedication of medical, support staff from catering, housekeeping, healthcare attendants, administration, maintenance, nursing, religious and health professions.”

+ (l-R) Brigid Burke, Director of Nursing; Sarah McCloskey, Assistant Director of Nursing; Anne Fraher, Clinical Nurse Manager 2; Mary Reilly, Clinical Nurse Manager 2; Paula French, Assistant Director of Nursing; and Mary Kerr, Nurse Planner, Community Hospital Project team.

+ (l-R): Pat Healy, Regional Director of Operations, HSE South; Gretta Crowley, local Health Manager, South lee; Nicola O’Sullivan, Project Coordinator; Micheál Martin TD, Minister for Foreign Affairs; Dr Thomas Quigley, CEO of the Bessborough Centre, and Cathleen Callanan, Child Care Manager.

SPECIAlISED FAMIlY SUPPORT SERVICE DEVElOPED IN CORK A NEW OUTREACH FAMIlY SUPPORT service aimed specifically at children who are at high risk of coming into care has been launched in Cork. Called the ‘lime tree’ project, it was established in partnership between the Bessborough Centre and the Hse south’s Child Protection service in response to the unique circumstances currently faced by vulnerable or high risk families and children. a support team, which comprises social workers, a psychologist, family support workers and a community worker, deliver the necessary childcare and parenting skills, therapy and practical help, either within the home or at the Bessborough Centre. the service is also unique in delivering not only practical family support and advice but it also directly provides for therapeutic interventions and educational opportunities. therapeutic services, led by a clinical psychologist, can be directed to individuals or families who have particular issues, concerns or problems relating to their ability to care for their children or their management of family relationships. the services also support foster care access whereby access between children who are in care and their birth families can be facilitated in the most humane way. therapeutic interventions are also available to help fostered children re-unite with their families.

ST. lUKE’S ACUTE STROKE UNIT’S FIRST BIRTHDAY staff recently celebrated the first birthday of the acute stroke Unit for Carlow/ Kilkenny. They are using the chance to highlight the effectiveness of giving patients Thrombolysis – medication to break down blood clots; best given within three hours of a stroke onset and potentially lasting for up to four-and-a-half hours. the st luke’s Unit has already successfully treated nine patients using clot busting medications so far this year. One such patient is Kilkenny man John Kelly who shared his experience at a special reception to mark the first year of operation for the unit. John is one of 180 patients who have been treated by the team since the unit opened a year ago, according to Consultant Physician Dr rory McGovern who specialises in elderly Medicine at st luke’s.

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+ (l-R): Dr Rory McGovern, Consultant Physician/Specialist in Elderly Medicine; Anna Marie lanigan, HSE South Interim Assistant National Director for PCCC/local Health Manager, Carlow/Kilkenny; and Pat Healy, RDO, for HSE South.

12/03/2010 15:17:57

HealtH Matters 65

WEst // News NATIONAl BABY-FRIENDlY HOSPITAl AWARD FOR PORTIUNCUlA GENEVIEVE BECKER, National Co-ordinator of the Baby-Friendly Hospital Initiative (BFHI) in Ireland presented the Baby-Friendly National Award to Portiuncula Hospital in January 2010. Ms Becker congratulated Portiuncula Hospital on being the first Hospital in the country to achieve the re-designation of this Award. The Baby-Friendly Hospital Initiative is a global campaign by the World Health Organisation (WHO) and The United Nations Children’s Fund (UNICEF), which recognises that implementing best practice in the maternity service is crucial to the success of programmes to promote breastfeeding. Mary Mahon, Clinical Midwife specialist in Breastfeeding/ lactation at Portiuncula Hospital said, “Portiuncula provides a 24 hour phone-in midwife support to breastfeeding mums. A clinic to help mums experiencing any difficulties breastfeeding is run by appointment every Wednesday. We also provide a directory of breastfeeding support groups in the hospital’s catchment area to mothers, which advises them of times, dates and locations of support groups.” this quality initiative is associated with increasing breastfeeding rates in the hospital. In 2004, 48 per cent of mothers initiated breastfeeding and this rate has been growing steadily in the last five years with over 58 per cent of mothers initiating breastfeeding in 2009. Portiuncula staff who provide care for women and babies have adopted practices that aim to protect, promote and support exclusive breastfeeding from

Hse CeO Professor Brendan Drumm with Noreen and ayva O'Donnell at the opening of the new Primary Care Centre in letterkenny.

l-R: John Hayes, local Health Manager Donegal; HSE CEO Professor Brendan Drumm; laverne McGuinness, National Director, Integrated Services; Dr James McDaid, Scally Medical Practice and Noel McGinley at the opening of the new Primary Care Centre in letterkenny.

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Back Row (l-R): Olive Cummins, Staff Nurse; Marie Darcy, Healthcare Assistant; Ann Clarke, Administration; Mary Mahon, Clinical Midwife Specialist in Breastfeeding and lactation; lucy Kelly, Staff Nurse; Mairead Hynes, IT Project Midwife; Mairead lynch, Staff Nurse; Mary Dowling, Staff Nurse. Front Row (l-R): Sarah Mc Mickan, Director of Nursing and Midwifery; Dr Naveed A. Khawaja, Consultant Obstetrician/Gynaecologist; Dr Genevieve Becker, National Coordinator of Baby Friendly Hospital Initiative in Ireland.

birth, while at the same time ensuring women who choose not to breastfeed are supported in their decision and provided with unbiased information and advice.

NEW PRIMARY CARE CENTRE IN lETTERKENNY THE NEW PRIMARY CARE CENTRE in letterkenny was officially opened by Professor Brendan Drumm last November. In addition, Professor Drumm also launched three primary care teams for the letterkenny area – two to be based in the new primary care centre, covering the population of the Scally and Ark practices; and one to be based in the Ballyraine area covering the populations of the Ballyraine and Dr Birmingham practices. Commenting on the opening, John Hayes, local Health Manager for Donegal said, “the new Primary Care Centre will be a one stop shop for primary healthcare services in letterkenny. It will facilitate local GPs and Hse staff to work more closely together, sharing information and jointly planning care for people who live in the letterkenny area. It will dedicate resources, such as Physiotherapists, Occupational Therapists, Public Health Nurses and Home support Workers, to the people of letterkenny and its environs and it will enable members of the local community to be involved in the identification of health priorities and to contribute to the planning and delivery of services to meet those needs.” there are plans to develop a total of 20 primary care teams in Donegal. Currently there are five other primary care teams in the county, with plans for a further 12 teams by the end of 2011.

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M.Sc./P.Grad.Dip. in Clinical Supervision Closing Date: 31st May 2010 The M.Sc./P.Grad. Diploma in Clinical Supervision is a part-time course (two years for the M.Sc. and one year for the P.Grad.Dip) aimed at practitioners in the helping professions who normally hold an honours degree in psychology or a related field and relevant post-graduate experience. Telephone: +353 -1 - 896 2431 Email: camcnall@tcd.ie

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12/03/2010 15:18:16

Health Matters 67

west // News New intern paramedics for the west Six new paramedics recently began their internships having completed a ninemonth paramedic training course in the National Ambulance Training Campus in Ballinasloe. The new Ambulance Service staff will be deployed across the Western Region where the Ambulance Service responds to over 36,000 calls a year in an area of approximately 14,000 square kilometres in counties Galway, Roscommon and Mayo.

HSE officially launches two new children’s services in Sligo The Solas Children’s Respite Service on the Old Bundoran Road, Sligo and the Early Intervention Service based in Nazareth House, Sligo were launched in November 2009. The Solas Children’s Respite Service provides planned and emergency overnight and day respite to children with a learning disability and autism in the Sligo/Leitrim area. The service operates from a new purpose-built bungalow, which was developed at a cost of c1.35 million and funded under the National Development Plan. The Early Intervention Service based in Nazareth House is a community service which works with parents to assess, diagnose and provide intervention for children who have development delay which requires a multidisciplinary approach. The Early Intervention Team consists of Consultant Community Paediatrician, Occupational Therapist, Physiotherapist, Speech and Language Therapist, Autism Therapist, Counsellor for Special Needs, Dietician and Early Intervention Team Manager. Pat Dolan, Local Health Manager Sligo commented, "These new facilities will further enhance the services we provide to children with disabilities and their families. The Solas Centre provides a safe and caring environment for children which allows their families the opportunity to deal with emergencies in their lives or take care of other important priorities; the Early Intervention Service works in partnership with children and their families on their journey through assessment, diagnosis and intervention, enabling each child to reach their full potential."

Staff of the Early Intervention Service, based in Nazareth House, Sligo at the launch in November 2009.

(L-R): Pat Dooher (Galway); Seamus Hayes (Mayo); Jonathan Patton (Donegal); PJ Commins, Ambulance Officer; Joyce Coss (Galway); Leo Stewart (Galway); and Eugene Kelly (Donegal).

Westbury Primary Care Centre Opened The Westbury Primary Care Team and Primary Care Centre in Co. Clare were officially launched by John O’Brien, HSE National Director last December. The Primary Care Team (PCT) comprises of local GPs and existing HSE staff who provide services to a population of approximately 7,720 people including Westbury, Shannonbanks, Clonlara, Parteen and Ardnacrusha. The current team delivers GP services, community nursing, physiotherapy, occupational therapy, speech and language therapy services, community welfare, home help and extended services such as mental health services, podiatry and school health services. HSE staff are now based in a new purpose-built Primary Care Centre. A range of primary care services will be delivered from here including community nursing, physiotherapy, occupational therapy, speech and language therapy services, community welfare officer, while additional future services will be delivered on a sessional basis. Alice McGinley, Primary Care Development Officer said, “One of

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the major problems in the past with primary care was the fragmentation of services. Now for the first time a conscious and ongoing effort is being made to deliver + John O'Brien, National Director; Fergal Flynn, Local primary care services Health Manager; Joe Hoare, HSE Estates Manager; and Alice McGinley, Primary Care Development Officer, in a ‘joined-up’ and at the official opening of Westbury Primary Care Centre. ,integrated way. The Westbury Primary Care Team is one of 12 Teams which have commenced in Co Clare. These Teams mainly work with a defined population and work together through inter-referral and regular Team meetings to provide an integrated service for clients in the area. We are hoping that it will make a real difference in the areas of disease prevention, rehabilitation and personal social services."

12/03/2010 15:18:23

68 HealtH Matters

nEWs // DuBlIn mID-lEInstEr FIRST STROKE PATIENT ASSESSED REMOTElY THANKS TO ROBO-DOC

(l-R): Mr Pat Clarke, Dr Maura Cuffe, Joan Murphy, and Professor Hilary Hoey at the launch of the ‘Oral Health and Down syndrome’ brochure.

orAl HEAlTH AND DowN SyNDromE brocHurE lAuNcHED Hse Dental services were delighted to launch a brochure entitled ‘Oral Health and Down syndrome’ at the World Down syndrome Congress and to distribute copies to the estimated 1,000 international delegates. the Congress was held in Dublin. the brochure is aimed at parents of young children with Down syndrome and will also be helpful to the multidisciplinary team involved in Early Services. It addresses parents’ concerns about dental development and Down syndrome e.g. missing teeth, gum disease and grinding. the brochure also delivers key oral health messages. Hse dental staff from the Oral Health Promotion Committee, Hse Dental services, led this project and consulted with Down Syndrome Ireland and the Irish society for Disability and Oral Health. Dr Maura Cuffe, senior Dental surgeon, longford/Westmeath lHO and past president ISDH also developed a ‘poster presentation’ at the World Congress to highlight the collaboration involved.

THE MIDlAND REGIONAl HOSPITAl in Mullingar recently became the first in the country to use Robo-Doc, a remote presence (RP7) robot doctor. Robo-Doc is a tool to assist consultants to make a remote assessment, diagnosis and care intervention for a patient presenting with acute stroke. The first patient to benefit from the new process was an 81-year-old woman who presented at Mullingar Hospital in January. The patient had suffered a stroke. She was initially assessed by emergency medical personnel. The on-call physician in Tallaght Hospital, Professor Des O'Neill expertly guided the on-site team after he assessed the patient using the remote technology. Professor sean Murphy, Midland regional Hospital in Mullingar, welcomed the development and complimented all those involved with the Dublin Midlands Stroke Network.

how do you reCogniSe a Stroke? • Numbness, weakness or paralysis on one side of the body • Slurred speech, difficulty thinking of words • Confusion

• Sudden blurred vision or sight loss • Being unsteady on your feet • Severe headache

how to aCt F.a.S.t. a simple test can help you recognise if someone has had a stroke: Facial weakness – can the person smile? Has their mouth or eye drooped? arm weakness – can the person raise both arms? speech problems – can the person speak clearly and understand what you say? Time to call 999 for an ambulance if you spot any one of these signs.

(l-R): Anne Kelly, Director of Nursing; Dr Jim Slattery, Radiologist; Dr Richard lynch, Consultant in A&E Medicine; Yvonne Kane, Business Manager; Edel Shannon, ED, Caroline Carty, ED; and Professor Sean Murphy, stroke Physician.

CHIlD SAFETY WORKBOOK lAUNCHED IN lONGFORD A SAFETY WORKBOOK devised to promote child safety and help prevent unintentional injuries has been published in longford. the workbook provides children with a visual guide that identifies safety issues. It is designed to be informative and engaging and includes colourful pictures and activities. the workbook is accompanied by a child safety DVD and leaflet. Every year approximately 75 children die, 15,000

HM Iss6.1 p1-70.indd 68

are admitted to hospital and 150,000 are seen in emergency Departments for unintentional injuries. It was developed with assistance from Stars Academy Playgroup/Montessori, Newtownforbes and longford County Childcare Committee. Contact: Brenda shannon, Hse Child safety awareness Programme Project leader. Tel: (043) 334 4084.

12/03/2010 15:18:31

Health Matters 69

Dublin mid-leinster // News Retirement of Larry Bane Tributes were paid by friends and colleagues of Larry Bane at a function held recently to mark his retirement from the HSE after 39 years’ service. Larry, who is a native of County Mayo, was based in Tullamore but worked in a number of areas of the Health Services throughout his tenure. At the formation of the Health Service Executive in 2005, he was appointed Assistant National Director of Human Resources for Dublin Mid-Leinster. Throughout his time with the service, Larry was also involved with the European Hope Exchange Programme, as National Co-ordinator for the Health Services and was also a council member of the Health Care Managers Institute (HMI). Larry will be greatly missed by all his colleagues across all areas of the Health

Services. He will enjoy his retirement with his wife Carmel, sons Ronan, Colin and Killian, and daughters Orla and Joanne; not forgetting his grandchildren.

Larry Bane is pictured receiving his presentation by HSE National Director of Human Resources, Sean McGrath. Also in the picture is Joe Masterson, HSE Employee Relations Manager and Larry's wife, Carmel.

Dieticians complete XPERT training Fifteen dieticians recently became trainers in the XPERT Structure Diabetes Programme after completing a course run in the Dublin Mid-Leinster Region. HSE Dublin Mid-Leinster is the first region to provide in-house training on the XPERT Structure Diabetes Programme. The new educators, 15 in total, completed their training in Mullingar at the end of November. The XPERT programme is a six session group diabetes education programme. The aim is to empower patients to gain the confidence, skills and knowledge to look after their own diabetes. This programme was developed by dieticians in the UK and adapted for use in an Irish setting by community dieticians Yvonne O’Brien and Karen Harrington (HSE South). The XPERT programme is a quality and an immensely effective approach to the treatment of Type 2 Diabetes. The incidence of Type 2 Diabetes is increasing – it is important therefore to ensure that we are able to provide the best quality of intervention for people with diabetes. Training in the programme delivery up to now has been provided by XPERT UK. However, 2009 saw a welcome development when a number of dieticians, representing most areas of the country, completed a ‘train the trainer’ course. This means that they can now train XPERT educators in-house, saving significant funds, and potentially allowing for greater access to the training programme.

+ 16 New XPERT diabetes educators are pictured with two Student Dietitians and five XPERT Trainers from HSE Dublin Mid-Leinster who recently completed the XPERT diabetes training in Mullingar.

HM Iss6.1 p1-70.indd 69

Nine new Primary Care Teams launched in DML Nine new Primary Care Teams were launched recently in the Dublin Mid-Leinster region. They will serve a combined population of more than 90,000 people. Primary Care Teams are designed to provide an easy access point to local health and personal social care services. Launching four Primary Care Teams in Tallaght West, Minister for Health and Children, Mary Harney also stressed the importance of accessible services for local communities. The Primary Care Team in Tallaght will serve the communities of Jobstown-Citywest, Brookfield - Fettercairn, Killinarden Oldbawn, and Springfield-Belgard. Over the next two years teams will also be introduced to Kilnamanagh-Tymon, Milbrook-Oldbawn, and Firhouse. The Team will work to provide integrated care to people with complex health needs. This will include working in partnership with Tallaght Hospital in the management of conditions such as diabetes, arthritis and asthma. The Primary Care Team in Clonaslee/ Mountmellick will serve the population of Clonaslee, Mountmellick, Rosenalis and the surrounding areas. This development is a significant boost to health services in Laois. It is currently being progressed through PublicPrivate Partnership. The teams in Greystones and Shankill will serve the areas of Shankill, Greystones and Delgany including the townlands of Charlesland and Eden Gate. Primary Care Information leaflets are available from the following contacts: • Greystones: Elizabeth Doyle (0404) 68400 • Rialto: South Inner City Partnership/ Dublin South City, Meath Community Unit (01) 454 5385 • Tallaght: Patricia Hegarty (01) 463 2823 • Shankill: Celine Judge (087) 617 2399 • Clonsalee/Mountmellick: Carol McCann (086) 385 2772

12/03/2010 16:04:06

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Health Matters 71

Green Fingers

GARDEN PROJECT SUPPORTS CANCER PATIENTS The challenge of engaging male cancer patients in psychosocial support services has been addressed by a group in Wicklow who established a project focused on providing the services through the social setting of a garden allotment. Dr Paul D’Alton, Clinical Psychologist at St Vincent’s University Hospital, Dublin outlines how the project worked.

lear evidence in the local area suggested that a large number of local men living with cancer were not engaging in support services compared to women. The evidence also indicated that while men were not participating in formal meetings, they were participating in organised activity type fundraisers. The allotment project simply involved the men coming together in a neutral environment to plan, plant, maintain and harvest a vegetable allotment (garden). Ten men, living with lung, melanoma, adenocarcinoma and pancreatic cancer diagnosis, (aged 43-56) participated in the project, which involved meeting once a week at the allotment, donated by local charity Feinste Lente. The team and 10 participants met for an informal chat and catch-up over a cup of tea or coffee. This was followed by a brief mindfulness exercise led by one of the group facilitators before heading into the garden. The activities in the garden were carried out under the direction of horticulturalists. The men spent up to two hours engaged in various activities, from seed sewing to harvesting. This framework was flexible and organic to allow men of all degrees of ability, or with varying energy levels to participate in some way, as suited their needs. The men were free to take a break at any point during the morning, and the day typically ended with another informal group discussion. During the initial weeks, a physiotherapist attended to assess the men before they engaged in physical work.

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In order to determine the effectiveness of the project, the men participated in an evaluation process which involved interviews focusing on three main themes: • Challenges of living with cancer •G oals when deciding to attend, prior to project • Benefits of participating in the project The evaluation process found that a majority of the participants reported ‘feeling useless/impacting negatively on those around’ as the main problem associated with the illness, while a small number reported being tired/low energy and feeling isolated by the illness. Most of the participants said the

opportunity gave them the chance to divert their attention from their illness and allow them to meet people and get some exercise, get outdoors and engage with nature. The men reported that the benefits associated with participating included social support received from the group, the benefits of gardening activity, education mindfulness, relaxation and exercise. These benefits were reported as being a source of hope, and allowed the men to focus on living with cancer as opposed to dying from cancer. The project was initiated in 2008 by the Bray Cancer Support Centre, Dr Paul D’Alton, Clinical Psychologist at St Vincent’s University Hospital and Feinste Lente, in collaboration with the HSE. The project is premised on studies which suggest that social and psychological support lead to improvements in mental health, less psychological distress and even prolonged survival. For further information on this project, please contact either Dr Paul D’Alton, Senior Clinical Psychologist on email P.D'Alton@svuh.ie or contact Yvonne Durac, Senior Project Office, Cancer & Palliative Care at (01) 274 4228.

Participants in the Allotment Project enjoy a glass of Elderberry Champagne with project leaders Paul D’Alton, St Vincent’s University Hospital, Dublin; Yvonne Durac, HSE Cancer & Palliative Care, Bray; Brendan and Veronica O’Leary, Bray Cancer Support Centre and staff from Feinste Lente during an Open Day.

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Health Matters 73

Health & well-being

Dental Health

Improvements Professor Helen Whelton, Dean of Graduate School and Director of Oral Health Services Research Centre, College of Medicine and Health in University College Cork writes on the improvements over the last two decades in public health dentistry and what has brought them about.

he HSE Public Dental Services (PDS) are currently the subject of review. Whilst it is important to determine how system performance could be improved, it is also valuable to consider advances and successes in the service over the last two decades. The PDS is the main provider of dental services for children in Ireland and employs a cohort of over 350 dentists, over 400 dental nurses and almost 60 dental hygienists having responsibility for approximately one million children and adolescents and for the special needs population of all ages. In addition, the service employs 12 consultant and 39 specialist orthodontists to provide orthodontic treatment for those children and adolescents with the greatest need. The PDS is also the gate keeper of the Dental Treatment Services Scheme for adults with Medical Cards. Twenty years ago in 1990, the landscape with regard to the provision of public dental services was very different. At that time, one third of the country’s dentists were employed in the PDS and were responsible for the provision of services to two-thirds of the population, comprising children up to sixth class in primary school, those with special needs and adult medical card holders. In reality, primary school children were prioritised and only an emergency service for the relief of pain was provided to eligible adults. There was no provision for dental hygienists to work in Ireland; there was no specialised training in dental public health or oral health promotion. The publication of

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the ‘Dental Health Action Plan’ in 1994 as part of ‘Shaping a Healthier Future’ marked a turning point for the services. It redistributed the responsibility for service provision in a more equitable way amongst the profession, allowing the PDS to focus on the care of children and special needs groups. For the first time, it set out explicit goals and objectives for the service with an emphasis on health outcomes rather than activity. Some changes which have led to improvements in the PDS in the last two decades include: • The introduction of a choice of dentist scheme (the Dental Treatment Services Scheme) for medical card holders • The policy to extend eligibility for care within the PDS to all children up to their 16th birthday • Setting up of consultant-led orthodontic units and revision of guidelines for referral to prioritise cases most in need • The provision of a scheme for the education and deployment of Dental Hygienists

disabled, children in special needs schools, elderly in residential care, development of oral health policy options for services for the elderly, standards for fluoridation of water supplies; up-skilling of staff in research methods. An increased focus on evidence-based practice through the development of PDS evidence-based guidelines for the prevention of caries, use of topical fluorides, screening and use of fissure sealants. Research collaboration among the PDS, academia and agencies such as the Health Research Board, Dental Health Foundation, EU and Northern Ireland R&D Office to develop public dental services has been an important driver in this regard. The Forum on Fluoridation (2002), which reviewed the safety and effectiveness of fluoridation and established the Expert Body on Fluorides, has also been an important driver of change. • Further transition from a demand-led service for school-age children to a systematic school-linked service. • Introduction of electronic patient records in many parts of the country. • Insisting on the highest standards of cross-infection (driven by HIQA). • Introduction of audits in radiology in compliance with SI 478.

Increased targeted educational opportunities: Masters in Dental Public Health (UCC), Specialist Cert in Oral Health Promotion (NUIG), Training in Special Needs Dentistry (TCD) Specialist Training in Orthodontics (UCC and TCD). Among senior PDS staff, postgraduate training is now the norm rather than the exception. Use of research and epidemiology as the basis for service development; surveys of oral health of children, adults, intellectually

Important facilitators for these developments over the last 20 years included leadership within the service and from successive Chief Dental Officers and other key influencers in the Department of Health and Children, advocacy from the Irish Dental Association, its subsidiary groups and academics in the field as well as public and political pressure. Good interagency communication was a critical success factor over this period.

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74 HealtH Matters

HealtH & well-beinG

lAPTOP lUNCHES lunches to save you money, calories and time, writes Susan Higgins, Regional Community Dietician Manager, HSE South.

aking a healthy lunch to work is one of the simplest ways to eat well and trim your budget. For me, eating out at midday used to be the norm whereas now I brown bag it Monday to thursday and look forward to treating myself on Fridays. In addition to the cost savings, most meals prepared at home are healthier than those in restaurants. We can control our portion sizes and also use healthier ingredients. However, it can be easy to run out of ideas for interesting and appetising

lunches. I’ll admit that they do take time but with a bit of foresight and planning, you can make your lunch something to look forward to!

what is a healthy lunch? a lunch which includes some high fibre starchy carbohydrate such as a wholemeal roll along with some low fat protein (for example, lean ham) will keep your body fuelled for the afternoon and help you feel satisfied until dinner.

It can be as simple as a sandwich with a piece of fruit and a yoghurt, but why not try some new easy to prepare options? • Wholemeal pitta bread stuffed with lettuce, tomato slices and chicken strips and a little low fat Caesar dressing or salsa • Wholewheat pasta salad with feta cheese, olives and cherry tomatoes served on a bed of lettuce • Garlic tortilla wrap spread with hummus and topped with grated carrot, lettuce and sliced red onion. simply roll up. • A green salad loaded with tuna and mayonnaise and mixed with diced celery, sweetcorn and green onion. top with sliced cucumber and round off with two slices of wholemeal bread or a brown scone.

nutty Rhubarb Muffins Makes 18-20 muffins. approximately 150 calories per muffin.

With the Irish rhubarb season approaching, Nutty rhubarb Muffins make a healthy alternative to the commercial muffins widely available. the latter are usually loaded with fat and calories and can provide as much energy as a light lunch! eaten with morning coffee or to supplement a light lunch, these rhubarb muffins are delicious.

Ingredients:

150g plain flour 150g wholemeal flour 1 teaspoon sieved bread soda 1 teaspoon baking powder 1 teaspoon ground ginger 200g brown sugar 225 mls buttermilk 1 egg 75 mls vegetable oil (not olive oil) 225g rhubarb diced 25g walnuts chopped

Method:

Mix together the first five ingredients. In a second bowl, beat together the sugar, milk, egg and oil. stir in rhubarb and nuts. stir dry ingredients into wet being careful not to mix. spoon into lightly greased bun or muffin tins; alternatively, you can line tins with bun cases. Bake at 200˚C/400˚F/Gas 6 for 20 minutes.

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HealtH Matters 75

HealtH & well-beinG

Hummus

Makes approximately 450g. approximately 100 calories per serving. this tasty chickpea dip works well with raw vegetables or else as a pâté spread for wraps or crackers. Pulses, such as chickpeas, are a good source of protein and fibre but are low in fat and inexpensive

Ingredients:

1 tin chickpeas (400g) 2-3 cloves garlic crushed Juice of one lemon 2 tablespoons sesame seeds toasted ½ teaspoon ground cumin Black pepper 100 mls plain natural yoghurt

Other than sanDwiches… sandwiches are far from your only option at midday. If you have access to a microwave and sandwich toaster your choice of lunch options can be expanded considerably. Many dishes you enjoy at home can be packed up and eaten for lunch.

moistened with plain yoghurt or a little mayonnaise • Bolognaise sauce (with or without kidney beans) • Peas and diced ham with a little mayonnaise • Low fat coleslaw and chopped tomatoes • Baked beans

super spuDs On a cold wet day, leftover baked potatoes are delicious when stuffed with grated cheese, onion and tomato and microwaved. Other fillings include: • Sweetcorn and tuna moistened with plain yoghurt or a little mayonnaise • Raisins and grated carrot. Sprinkle with chopped peanuts after heating • Celery, apple and chopped walnuts

sOups anD casserOles You may already spend time on the weekends preparing food in bulk to be eaten during the week. It is a great idea. Bolognaise sauce is a favourite of mine, as is shepherds pie. Why not freeze some individual portions that can be taken to work in the coming weeks? Other ideas include soups, chilli and various casseroles.

Method:

Drain and rinse chickpeas. In food processor or blender, purée the chickpeas and all other ingredients, except the yoghurt. When smooth, stir in the yoghurt until well combined. Garnish with chopped onion, tomato and parsley if serving as a dip.

cOnvenience fOODs Convenience foods such as carton soups and prepared meals can also make quick and easy lunches. they can be inexpensive, especially if you find them marked down. Pair with a side salad and fresh fruit to ensure adequate fibre in order to keep you filled up.

Check out the following websites for more ideas on healthy lunches and eating well www.littlesteps.eu www.weigh2live.eu www.indi.ie

Get the ‘whole’ benefit of Super Milk. Avonmore Whole Super Milk contains 3.5% fat and the additional goodness of Vitamin D, extra Calcium and other key nutrients.

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Health Matters 77

health & Well-being

Physical Activity at Work The benefits of physical activity are plentiful and well researched writes Karen Clerkin CPOHE, Senior Physiotherapist, Ergonomics and Back Care at St Vincent's University Hospital.

hese include improving physical fitness and cardiovascular health, relieving muscular and mental stress, improving well-being and maintaining normal stretch of soft tissues to name but a few. The World Health Organisation (WHO) recommends that healthy adults partake in 30 minutes of physical exercise at least five days each week. During our busy lives, it may be difficult to fit in exercise but there are many simple ways we can build elements of physical activity into our daily routines at work. Do a little, do a lot, it all adds up! Before commencing a new exercise programme, or if you have signs or symptoms of musculoskeletal injury, it may be helpful to be assessed by a Chartered Physiotherapist who will be able to assist you in getting started or in treating any preexisting aches or pains.

Exercising and Work During the day… • Wear comfortable, supportive footwear if your work involves a lot of walking. • Choose to use the stairs rather than the lift where possible, even if just on the way down to begin with. • Take regular stretch breaks through your day e.g. between tasks, during meetings or during breaks.

•V ary your tasks whenever possible, to allow respite for working muscles. •M ake time for a brisk walk as part of your lunch break. •U se any equipment provided which is designed to help with strenuous tasks. •D on’t overstretch to perform tasks, move closer instead or adjust equipment to suit you. •A void adopting a stooped posture e.g. adjust trolley/bed height to bring it level with your hip height. •A ssess all manual handling tasks before carrying them out.

“During our busy lives, it may be difficult to fit in exercise but there are many simple ways we can build elements of physical activity into our daily routines at work. Do a little, do a lot, it all adds up!”

• Ask for assistance or use mechanical equipment if tasks are beyond your physical capabilities.

Office work… • If you work at a desk for most of your day, be sure to take regular short stretch breaks every 20-30 minutes and intersperse other physical activities such as filing or other office based duties between the duties spent at your desk. • Adjust your computer workstation to suit you, taking care to eliminate awkward postures. • Adjust the overall chair height to bring the forearms parallel with the floor and then align the keyboard with the monitor. • Ensure adequate support for your low back by adjusting the backrest height and angle. • Keep the mouse arm supported either on the desk, or on the armrest of the chair.

Not getting enough Vitamin D? Need more Calcium? Avonmore Super Milk has the extra Vitamin D, Calcium, and other key nutrients you need to grow healthy and strong.

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12/03/2010 15:24:36

University College Cork, College of Medicine and Health Postgraduate Opportunities

School of Clinical Therapies

School of Medicine

jointly by UCC, TCD and the RCSI. Email applications will be accepted up to an annual closing date of March 31st to: hsriadmin@rcsi.ie Research Masters: Available in Obstetrics (MAO) and Surgery (MCh). http://www.ucc.ie/calendar/postgraduate/Masters/page09.html MMedSc (Sport and Exercise Medicine): Classes are held at weekends for this part-time cyclical programme with a research project submitted at the end of year 2. For further information contact: medschool@ucc.ie MSc (Obstetrics and Gynaecology): Taught modules, clinical attachments and a thesis - the course is part-time, running for 18 months. http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page16.html MSc in Occupational Health: Part-time taught programme over 2 calendar years held 2 evenings per week (Monday and Thursday), October to May. http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page12.html Postgraduate Certificate in Health Protection: Specifically designed to meet the needs of working professionals, part-time running from January to April/May. http://www.ucc.ie/calendar/postgraduate/certificate/page01.htm

Advanced Southern Simulation Education and Training (ASSET) Centre: A full immersion, high fidelity simulation centre using the world’s

School of Nursing and Midwifery:

MSc (for Clinical Therapists) in Evidence Based Therapy Practice: Candidates must hold a primary professional degree in Occupational Therapy, Speech & Language Therapy or Physiotherapy. PhD & Doctor of Occupational Therapy D.Occ.T: Candidates must hold a primary professional qualification, a Masters Degree and for the D.Occ.T, 5 years of professional practice experience. http://www.ucc.ie/en/ot/postgrad/

School of Dentistry and Department of Epidemiology and Public Health Masters Degree in Dental Public Health – MDPH: Flexible full or part time course designed for health professionals. Applicants are required to have a BDS degree of the NUI or equivalent degree. For further information contact: m.harding@ucc.ie http://www.ucc.ie/academic/pubh/

PhD (by research) and Doctor of Nursing Practice (taught mode) Masters Programmes: (by research or taught mode) Postgraduate Diploma: 7 speciality areas. Postgraduate Certificates (subject to approval): 3 speciality areas:

most advanced human simulator, offering opportunities to all healthcare professionals to train for high risk situations in a simulated clinical environment. Contact: d.power@ucc.ie Masters in Public Health (MPH): Offered full or part time and aimed at healthcare professionals and students whose efforts contribute to the health of individuals and populations. Four pathways allow students to specialise in General Public Health, Epidemiology, Health Protection or Health Promotion. http://www.ucc.ie/academic/pubh/ Postgraduate Diploma in Palliative Care: A 2-year, part-time programme run in partnership between the Medical School and St. Patrick’s/Marymount. For further information contact: edcentre@stpatricksmarymount.ie or medschool@ucc.ie

Community Health Nursing, Gerontological Nursing and Multiple and Complex Disabilities (Intellectual Disability). Applications can be completed online at www.pac.ie/ucc, The closing date for receipt of completed applications is 30th April, 2010. Flexi-Option Modules: A range of modules are available. For more information, phone 021-4901555. http://www.ucc.ie/en/nursingmidwifery/ProgrammesonOffer/ PostgraduateProgrammes/

Postgraduate Education Centre, Cork University Maternity Hospital: Runs programmes aimed at healthcare professionals engaged in

School of Pharmacy

teaching, as well as courses in Neonatal Resuscitation. For further information contact: nrp@ucc.ie Doctoral thesis (MD/DMed): May be pursued on the basis of work completed at UCC, off-site or published work. http://www.ucc.ie/calendar/postgraduate/Doctor/page002.html PhD in Health Services Research: Cross-institutional Health Services Research programme aiming to improve health through quality healthcare management and delivery in the Irish system. Funded by the HRB and offered

MSc Clinical Pharmacy/Postgraduate Diploma/MSc Postgraduate Diploma Conversion Course: Part-time distance education programme, featuring teleconferencing and e-learning, provides pharmacists with specialist training to enhance their role in hospital environments. www.ucc.ie/acad/pharmschool/teaching/PostgradProgrammes.php PhD in Clinical Pharmacy/Pharmacy: Offers multiple research opportunities leading to the award of a PhD. See research interests of individual staff at http://www.ucc.ie/en/pharmacy/people/acad/

Application queries should be directed to: Graduate Studies Office, University College Cork • Tel: (021) 4902876 • Fax: (021) 4901897 • Email: graduatestudies@ucc.ie

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Health Matters 79

health & Well-being

• Keep business/dress shoes at work and wear comfortable walking shoes for your commute or so you can take a brisk walk at lunchtime.

Healthy commuting… • Can you build some physical activity into your daily commute – is it possible to walk, jog or cycle some or all of the way? • Ask your employer if your workplace offers the ‘Bike to Work Scheme’. • Consider getting off the bus a few stops early and walk the rest of the way to or from work. • If driving, take a moment after getting out of the car to stretch muscles which may have become tense during the commute – try some shoulder shrugs or gentle neck tilts. • Keep a pair of walking shoes in your gym bag in your car so you may choose to stop off and exercise before going home.

Chest Stretch • Put hands behind your head • Arch your upper back and bring your shoulder blades together • Do not put pressure on your neck or push your head forward • Hold for 10 seconds Hamstring Stretch • Place one leg above the floor e.g on step • Hold your desk/counter for support • Bend at your waist • Slowly lean toward your foot • Keep your back and knee straight • Hold for 10 seconds Forearm Stretch Good for frequent keyboard and mouse use • Apply gentle pressure to bend your wrist back • Hold for 10 seconds • Alternate arms

Neck Side Bend • Tilt your head to bring your ear down to your shoulder • Keep shoulders relaxed • Hold 10-20 seconds • Alternate sides Neck Rotation • Turn your head to one side while keeping your chin tucked in • Hold for 10 seconds Reach for the Sky • Reach overhead with both arms • Hold for 10 seconds Please note that these are general exercises and may not be suitable for everyone. Specific exercises may be prescribed by a Chartered Physiotherapist. Visit www.iscp.ie or www.physicaltherapy.ie for more information on how to find a private practice Chartered Physiotherapist in your area.

sample stretches Stretch to prepare muscles for activity. Stretch through the day (every 2-4 hours) to prevent or relieve muscle aches and stiffness. The stretch should: • Be a smooth, slow, gradual movement • Create a gentle pull without pain

Back Extension • Place hands on your hips • Lean back at the waist • Keep looking forward • Do not bend the knees • Hold for two seconds and perform 5-10 times

Get the ‘whole’ benefit of Super Milk. Avonmore Whole Super Milk contains 3.5% fat and the additional goodness of Vitamin D, extra Calcium and other key nutrients.

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12/03/2010 15:24:42

Get the ‘whole’ benefit of Super Milk. Avonmore Super Milk is now available in Whole Super Milk as well as original Low Fat. Whole Super Milk is a whole milk, naturally rich in protein and enriched with extra Calcium, Folic Acid and four key vitamins (A, B, D and E). It’s a simple and versatile way to contribute to a healthy, balanced diet, helping to improve nutrient intakes which are essential for good health. Containing 3.5% full-fat milk, it’s also ideal for patients that require an energy-rich diet. For more information please log on to www.avonmoresupermilk.ie

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2:09:58 7:34:27

Health Matters 81

health & Well-being

Top Ten Health Tips Put a spring in your step early in the year by making a few simple changes and following a few handy rules that will leave you feeling healthy and revived… Exercise Just by taking a five minute walk at lunch you are contributing to your recommended daily exercise (30 minutes a day). Or you can take up a new hobby of yoga, dancing, water aerobics, pitch and putt or swimming. Brown or white bread? Try to always opt for brown. Also, go for healthier options like brown rice and pasta as they are made from wholegrain. They also provide fibre to help you feel fuller for longer, therefore you are less likely to overeat fatty treats. Wait before you help yourself to seconds Hang on 15 minutes after your meal before you decide to refill your plate. At that stage, you can decide whether you are truly full or not. Be careful of sun exposure Ultraviolet rays weaken blood vessels in the skin and damage connective tissue, which both contribute to cellulite formation. Although many people believe

the sun gives you a healthy glow, the reality is it can increase your chances of getting skin cancer and make cellulite look a lot worse.

Money saving ways of exercising Cycle – using your car costs money. A relaxing exercise you can do or a way of getting to the shops, cycling is brilliant. Get outside Going to the park or beach with your kids doesn’t cost a single cent; try playing some team sports like netball or tag rugby. Local Leisure Centres Many people have given up pricey gym memberships but you can still use all of the equipment at one of the hundreds of Leisure Centres around the country. They are usually pay as you go and it is normally a modest fee compared to the gym. How to deal with cramps in your legs Some people get them while out jogging or running, they can happen when you

have been standing for a long period of time or during the night. If you get a leg cramp you should try to stretch out the muscle that’s cramped. This well help release the pressure.

Fight cellulite Focus on areas prone to cellulite such as the thighs and stomach. This will improve circulation around the skin. If you manage to lose some weight, it will minimise the skin surface area and this will help somewhat to improve the appearance of cellulite. Watch what you drink as well as eat Swap from full fat to semi-skimmed milk in your morning tea or coffee and you will reap the health benefits, also never underestimate the benefits of water. Keep hydrated! People often mistake thirst for hunger, this means they eat large portions instead of having a glass of water. Drink eight glasses of water a day to prevent dehydration and that empty stomach feeling that tends to make one reach for foods you don’t really need. Studies show that chronic dehydration can worsen the pain and prevent the body from properly handling inflammation. Although dehydration doesn’t cause arthritis, it can exacerbate the pain in the joints. It’s also vital to drink water when you are on medication for arthritis as becoming dehydrated can negatively effect how these treatments work.

Not getting enough Vitamin D? Need more Calcium? Avonmore Super Milk has the extra Vitamin D, Calcium, and other key nutrients you need to grow healthy and strong.

HM Iss6.1 p71-128.indd 81

12/03/2010 16:12:45

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Health Matters 83

Health & well-being

Dr Eddie Murphy –

– my role in RTE ’s Operation Transformation HSE Principal Clinical Psychologist Dr Eddie Murphy has been on our TV screens during the hit RTÉ show Operation Transformation. The show returned to our screens this year with five brave individuals all hoping to transform their lives and become healthier, fitter individuals. Here Dr Murphy, who is based in the Carlow/Kilkenny area, explains how he got involved and the role he has been playing in the series.

hen approached to participate in the recent series as a Clinical Psychology expert, I could immediately see how the show could help in the delivery of health promotion messages and positively influence the battle to curb obesity. With huge interest in the programme’s website pages and up to 300,000 radio listeners on the Gerry Ryan Radio Show and 550,000 TV viewers, Operation Transformation offered an excellent platform to get positive health promotion messages to a massive audience across all age groups. Part of my role was to examine the psychological factors that stop us from eating less and moving more. In addition I was able to use my professional knowledge and psychological insights to help

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participants achieve their personal goals and promote psychological well-being. As the programme expanded with many groups registering to follow the participants, there was a great opportunity to raise awareness of health services and resources and to get involved in promoting health and wellness goals including weight loss, healthy physical activity and emotional health. We also focused on the areas of childhood obesity and alcohol consumption. Operation Transformation offered viewers and listeners lots of support and information for their health goals on the web, radio and on television. The Gerry Ryan Radio Show on RTÉ carried out a nationwide search to find five people with very genuine reasons for losing weight and getting fit. A team of four experts – including myself – developed an eight-week programme for

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84 Health Matters

Health & well-being

programme from HSE Assistant National Director Anna-Marie Lanigan and the National Director for Primary Care Brian Murphy. I also received support from my colleagues in the National Communications Unit, Fiachra O’Ceilleachair and Audrey Lambourn.

the five participants. Each day of an eight week period was mapped out for each individual in terms of a detailed diet and exercise routine and all of this information was available on the dedicated website. Most people are familiar with the phrase 'Healthy Body, Healthy Mind' but I often find it beneficial to focus first on the mind. So I sometimes refer to a 'Healthy Mind, Healthy Body'. I put a lot of hard work, time and commitment into the programme this year and I was very happy to be a part of it. People see a one-hour programme and often just a few minutes of interaction between the participants (leaders) and the experts – sometimes confrontational or emotional! But on a weekly basis, we provided hours of encouragement, expertise and input into supporting the leaders and working with them to help them achieve their goals. Even though the programme takes place over eight weeks, the leaders are making changes that will continue on in their lives; it’s a continuous process. One of my colleagues pointed out that “this programme allows more people to have access to psychology resources than could be achieved on an individual basis over the whole of your career.” A humbling thought indeed.

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“You can still access all of the recipes, workouts and psychology resources at www.rte.ie/ot. The workouts are stored as video files so you can watch and follow the exercise plans for free.” You can still access all of the recipes, workouts and psychology resources at www.rte.ie/ot. The workouts are stored as video files so you can watch and follow the exercise plans for free. It was great to hear that more than 10,000 members of the public participated by following the diet and exercise plans devised for the programme. At the time of going to print, the Operation Transformation website had more than three million hits; more than 13,000 people had signed up to the programme and shared a weight loss of 1,128 tonnes. I am very grateful for the support I received for my participation in the

Eddie’s goals for Operation Transformation were: • Understanding the psychological factors to promote success – Eddie identified how our thinking, feelings, and actions can often be barriers to our success. He used psychological tools with Operation Transformation leaders and placed psychological resources on the website to help groups and individuals change unhelpful beliefs. • Promoting enduring change – Eddie placed on www.rte.ie/ot challenging resources to help people change from where they are to where they want to go using powerful psychological strategies. Here are two useful resources to help you if you want to make changes to your eating habits…

mindless eating • Do you eat your breakfast while standing? • Do you have your lunch in the car or by the computer? • Do you have your dinner in front of the TV? • Do you eat because you are upset? If you answered yes to these questions, you are guilty of Mindless Eating and it leads to over eating and ensures that you are making unhealthy choices about how much, how fast and what foods you eat. Mindless Eating means you are not in control. Mindful Eating, on the other hand, puts you in control and gives you choices so that you choose a healthier journey. When you choose to engage in Mindful Eating, you will choose food that brings you further along your healthier journey. You will choose Mindful Portions. The challenge of Mindful Eating is to slow down, look, feel, smell, chew, and concentrate on the taste of the

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Health Matters 85

Health & well-being

food and the speed you are eating. Pay attention to the here and now. Don’t do other activities such as read, TV, computer etc. Before eating your next mouthful, lay down your cutlery and pause a few seconds – become mindful, that is pay attention and eat mindfully. This is a skill and like all new skills, it takes practice and persistence.

emotional eating Know the role that emotional eating plays in your life. How you know if you are an emotional eater? Do you “comfort” eat or do you eat “junk” food as a result of your feelings instead of hunger? We learn from an early age that food brings comfort. Recently I brought my two-year-old son for his swine flu vaccine and as a psychologist I was observing the behaviours around me. What happened was very interesting; my son was crying after his injection and as I was comforting him, the practice nurse gave him a chocolate button. You see, from such a young age we are shown that our hurts can be healed by food.

Think about it… Often during times of happiness (birthdays) and sadness (bereavement) food plays such a central role. Putting food in our mouths can become a habit when we are dealing with our emotional distress of boredom, stress, anger, loneliness, depression, relationship and communication difficulties, low self-esteem etc. In effect, our eating habit stops us from learning valuable skills to solve our emotional distress.

This becomes a negative cycle where our overeating results in weight gain and more negative emotions – self-blame, criticism, anger etc. By understanding the triggers to our emotional eating and using Cognitive Behavioural Therapy (CBT) techniques we can learn new skills to deal with our emotional distress. With these skills emotional eating, stress eating, night grazing and mindless eating with subsequent weight gain are no more. The following categories from CBT help us identify triggers to overeating: •E motions: Eating in response to stress, tiredness, boredom, anger, anxiety, depression as a way to self-sooth and comfort. • Situations: Overeating because of certain activities; frequent business lunches, watching TV shows, going to the movies etc. •T houghts: Self-defeating eating as a result low self-esteem, self-dislike, guilt, punishment and self-hopelessness. •B ody cues: Overeating as a result of body cues. How many times have you skipped a meal and over-compensated, such as by eating in the supermarket while shopping, eating in the car on the way home, eating while preparing your meal, going back for seconds etc.

“By understanding the triggers to our emotional eating and using Cognitive Behavioural Therapy (CBT) techniques we can learn new skills to deal with our emotional distress. With these skills emotional eating, stress eating, night grazing and mindless eating with subsequent weight gain are no more. ”

Three Steps to Tackling Emotional Eating Step 1: Tracking The key to tracking your emotional eating is to keep a food diary that identifies your negative emotions and distinguish them from feelings of hunger. What gets measured gets done. With your food diary you will be able to identify your overeating habits. Step 2: Basic tools to breaking the habit of emotional eating Instead of eating as a result of being emotionally upset tell yourself that “this food will only comfort me temporarily”, “If I eat I will have two problems, the one that was upsetting me and feeling bad about eating”. Keep in control, remember it’s a choice: you can choose to eat or do a different activity – walk, swim, make a phone call and take a soothing bath. So try to do something else pleasurable until the urge to eat passes. Step 3: Advanced tools for breaking the habit of emotional eating Using distraction will help some people but for others, however, it’s not enough. For more effective ways to manage emotional distress that leads to overeating, try relaxation exercises, meditation or some counselling. Therapy may help you identify underlying emotional difficulties that are causing you to overeat.

HM Iss6.1 p71-128.indd 85

12/03/2010 15:25:06

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HM Iss6.1 p71-128.indd 86 211675-FC-HSE-Stamf-PG.indd 1

12/03/2010 15:25:09 10/03/2010 12:08:41

12:08:41

Health Matters 87

Health & well-being

GPs refer patients to leisure centres for exercise under new national programme Being active is one of the most important steps that people of all ages can take to improve their health. Caroline Kelleher, Health Promotion Officer, describes how the HSE Health Promotion Department has developed a National GP Exercise Referral Programme to help physically inactive adults to develop an active lifestyle.

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hirty minutes of moderate intensity activity, five days per week is the recommended amount of activity for us to achieve health benefits. The aim of the National GP Exercise Referral Programme is to enable physically inactive adults to develop an active lifestyle with the help of specialist support. The concept was initiated by a series of local pilot programmes in Cork, Kerry and Limerick. Evaluation of the pilot programme in Leisureworld, Bishopstown, Cork showed that a GP Exercise Referral Programme was an effective means of increasing activity levels in the patients who participated in it. The vast majority of those referred (78

per cent) completed the programme and had sustained the level of activity one month later. Reaction to the programme by participants, general practitioners and the manager of the leisure facility was overwhelmingly positive. There is a large amount of evidence with regard to the benefits of an active lifestyle. Meeting physical activity guidelines can reduce the risk of developing a wide range of diseases, help people reach and/or maintain a healthy weight and improve cardio-respiratory and muscular fitness. Being active also reduces the risk of falls and improves cognitive function in older adults. The results of the National Survey of Lifestyle, Attitudes and Nutrition (SLĂ N 2007) reported that 46 per cent of respondents (10,364) reported that they do not take enough physical activity for health benefits. Over half of these respondents (24 per cent) reported doing some activity while the remaining 22 per cent reported being physically inactive. Given this prevalence of physical inactivity and the high risk of cardiovascular disease in Ireland, research has recognised the need for more innovative strategies to encourage regular physical activity. The National GP Referral Programme has been developed using best practice from each of the pilot studies. All protocols and procedures, resources and training have been standardised. The programme is based on referral to physical activity as an important part of primary and secondary prevention of disease. Promoting physical activity

12/03/2010 15:25:13

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HM Iss6.1 p71-128.indd 88

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Health & well-being

through Primary Care is crucial as the GP is a powerful source of health information for up to 75 per cent of the population (SLAN 1999). Health Professionals can recommend patients ask their GP to refer them to the programme if they feel it will be of benefit to them.

How the pathway works A registered GP identifies that one of his/ her patients would benefit from exercise but may need a little more support. The GP then establishes that their patient meets the inclusion criteria (low to moderate; back pain, stress, osteoporosis, arthritis, diabetes, overweight, hypertension, depression, hyperlipidemia, asthma) for the programme. On securing the patient’s consent to attend the programme, completed referral forms are sent to the patient’s chosen leisure facility. Once the coordinator in the leisure facility receives the referral form, they will then contact the patient to arrange an initial assessment. At the initial assessment, the coordinator will carry out the necessary screening procedures and will show the client around the facility. They will then design a programme to meet the patient’s individual needs. The programme lasts for 12 weeks for

What people who have completed the programme have to say: “I would never have thought of joining a gym. I had a completely different perception of one. I took to the gym like a duck to water.” “I am amazed at the progress I am making with the cardiovascular machines. I love the stretch and tone exercises.” “I learned to swim with confidence at 50 with the help and encouragement of the dedicated staff.” each individual. Patients can become involved in other activities whilst on the programme in addition to their programme. The patient’s progress is reviewed by the coordinator at six and 12 weeks. Once the programme has been completed, a report is sent to the GP from the coordinator to

National training course The annual GP Exercise Referral National Training Course was launched in 2007 and is currently recruiting for candidates for the 2010 course. The course has been developed as a vocational training course that leads to the delivery of a structured pathway in partnership with the HSE Health Promotion department and the Irish College of General Practitioners (ICGP). The Irish course encompasses behaviour change techniques, clinical theory and managerial skills and links directly into the HSE-ILAM (Institute of Leisure and Amenity Management) national pathway. The delivery of the course is overseen by ILAM and agreed with a national steering group who has representatives from the HSE, Irish College of General Practitioners (ICGP), Exercise & Sports Science Association of Ireland (ESSAI), and Recreation Education Forum (REF). The training course provides instructors with the specialist training they need to help physically inactive adults and those with chronic disease become more active. Upon completion of the training course, the instructor is awarded a certificate in GP Exercise Referral. The National programme is being delivered in facilities across Ireland and as more instructors complete the National Training course, more and more patients are accessing the pathway.

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inform the GP of the patient’s progress on the programme. The GP referral pathway offers the choice of a variety of ways to get active so referred patients can find activities that they enjoy. Each patient is also provided with one-toone professional support along the way. This means that if they have tried to be active before but have not been successful or if they have an underlying medical condition, they have a suitable qualified instructor to advise them. In order to prove the National GP Exercise Referral Programme is both clinically effective and cost effective, an action-research approach has been adopted. The use of a web-based database enables accurate data collection across all delivering facilities. Individual patient data is collected across the 12-week exercise referral programme and is evaluated at six, 12 and 24 months. This not only provides individual progress reports for the patient and GP, but also looks at the programme as a whole in order to actively develop the programme. For further information on this programme and a list of the leisure facilities offering the programme, please visit www. gpexercisereferral.ie.

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HM Iss6.1 p71-128.indd 90

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12/03/2010 15:26:41

HealtH Matters 91

HealtH & well-beinG

SPORTING PASSIONS Health Matters talks to Karen Nugent who combines working with the Immunisation Programme in the Public Health Department in Tullamore and playing camogie for Co Offaly and her club Drumcullen. Karen was part of Offaly’s winning team when the county won its first ever junior All-Ireland camogie title in 2009. When did you start playing camogie and what was the first team you played for? I started playing camogie when I was about seven or eight years old. the first team I played for was my club Drumcullen in an Under 10 challenge game. What benefits does it bring to your life? It is a great way to unwind and relieve your stress after a day at the office. sometimes you may dread going to training especially on a cold Friday night in January, but you feel so good after it knowing you are getting fit. Would you recommend camogie as a sport to others? Yes definitely. It’s a great team sport and as you go through life you become part of different teams and meet new people, national school, secondary school, college etc. there is a great social aspect when you are part of a camogie team. Does being a sports person help you in your work? Yes it does; being fit helps me with the stresses and strains of the working week. I work as part of a team and being a member of a camogie team has taught me how to communicate and deal with those who I am in contact with. What is your best sporting memory? It is winning Offaly’s first ever junior all-Ireland title in 2009. We came within minutes of winning it in 2008 and lost out by a goal in the last few minutes, so to come back and win it a year later was very special. It just shows the character and determination that is in this Offaly team. Is there any one thing that you feel helps a team win? Motivation. this is definitely a key factor in my opinion. We were strongly motivated

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after the heartbreaking defeat in 2008 and this gave us the drive and the determination to achieve one step better in 2009. On hearing the final whistle in the All-Ireland, what was going through your mind? shock and disbelief…yet excitement! I’ve watched so many great Offaly teams down through the years trying to achieve this goal and to think that I could be part of the first team to achieve this was just unbelievable. I still have to give myself a little pinch! Is there any stand out moment from the whole All-Ireland experience, pre-and post-match, which best sums up the time for you? It has to be the Garda escort from the Spa Hotel into Croke Park. We had it in 2008 also and it was still as exciting the second time. One of our selector’s had made a CD of music for us and it was playing on the bus and I could tell by the girls

sitting around me that this team was more determined than ever. What are your sporting ambitions for this year? I’d love to win an Intermediate all-Ireland with Offaly and then get to play among the top names at senior level. I’d also like to win back-to-back club championships with my club Drumcullen. What famous sports person do you most admire? Rugby player Brian O’Driscoll. His work rate for his team, his determination and skill is unbelievable. He never gives up until the game is over and this is evident in the numerous late tries he has scored in many games. What is your favourite Irish sporting memory? The Ireland rugby team winning the RBS six Nations Championship, the triple Crown and the Grand Slam last year. What an achievement!

+ Karen Nugent, in action for Offaly against Chloe Morey of Clare in the all-Ireland Camogie Junior Championship.

12/03/2010 15:26:50

92 Health Matters

hospice care

Improving the quality of end of life care No one should have to face death or bereavement without appropriate care and support. Eugene Murray, Chief Executive of the Irish Hospice Foundation, explains how the organisation is working to make this vision a reality. + Eugene Murray, Chief Executive of the Irish Hospice Foundation

ut simply, the Irish Hospice Foundation aims to ensure that we all have a good death, one that respects our dignity. No one should die alone and in pain. As Bono has said, “how we treat dying and death is a measure of our humanity.” The actor Gabriel Byrne puts it another way, “how we live our later life and go on to die is something that we should all spend some time considering, if we are to influence what kind of death we will eventually have and what situation we leave behind”. In the medical arena, the predominant focus is on cure. We have, however, to

Cyclists to hit the saddle from Dublin to Paris for Hospice Care Cyclists, either novice or expert, are being invited take to the road in the Kingspan Irish Hospice Foundation’s (IHF) Cycle Challenges this summer. The 600km trip will start in Dublin on Sunday July 18th and end in Paris on Thursday July 22nd. The timing will give participants the opportunity to spend the weekend in Paris and watch the finale of the Tour de France on Sunday July 25th. Places are limited and people are being encouraged to register their interest in participating in either cycle by the end of March. Full details are available on www.hospice-foundation.ie.

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recognise that the majority of people die of incurable disease and advanced organ failure. We have to change the culture of how we deal with death. We want palliative care to be extended to all who need it. We want to bring hospice principles into hospitals. We want to address the needs of dying children and their loved ones. We want to address the principles and ethical issues surrounding life’s end. Nearly 30,000 people die annually in Ireland with the main places of death being acute hospitals (48 per cent), longstay facilities (20 per cent) and home (25 per cent). An [2004] IHF survey shows that only 10 per cent want to die in a hospital setting. Two-thirds want to die in their own homes, pain-free and surrounded by their families. How do we accommodate that? Overall, how do we respect the autonomy of people who are dying and the wishes of their families? How do we deal with unexpected deaths? Do we give special care at the end of life? Information on this is emerging from two sources. One is the forum on End of Life in Ireland which was launched last year by the President, Mary McAleese. The Forum, which is now going into report stage, has been a listening process. Written submissions, 160 in all, have been received from organisations and individuals. At 23 workshops there have been 103 presentations and there have also been nine public meetings around the country.

This has helped us get a flavour of what people believe are the main issues at end of life. Key themes have been emerging: knowledge/understanding of End of Life; communications; ethical and legal concerns, and the suitability of care setting for the dying among them. Some of this is reflected in the National Audit on End of Life Care, which will soon produce its third report. This audit is part of the unique Hospice Friendly Hospitals programme, which has been working with over 40 hospital settings to enhance how they deal with death and dying. Irish Hospice Foundation staff members have been co-operating with hospitals in assessing their bereavement

“How we live our later life and go on to die is something that we should all spend some time considering, if we are to influence what kind of death we will eventually have and what situation we leave behind.”

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hospice care

policies, suitability of morgues, procedures and end of life care. Already substantial changes are being made, most notably in communications. How do we tell patients they are dying? The audit itself relates to patients who died in Irish hospitals in 2008/9, based on questionnaires completed by nurses and doctors. These deaths are a representative sample of 10 per cent of annual deaths. It is encouraging that in many respects, the quality of end-of-life care in Irish hospitals compares favourably with that reported in other jurisdictions. However, despite this relatively positive picture there are some issues needing deep analysis. One issue is that doctors and nurses can disagree on pain levels and their frequency. They can also have different views on the acceptability of how patients died. Doctors and nurses agree that they are better at communicating with relatives rather than their patients. The Irish Hospice Foundation also recognises that while patients in some areas of the country can access comprehensive services, other areas suffer serious underprovision. More palliative care beds are needed, as indicated in the Government's five-year development framework. But this need not be a financial drain. It can come about within the reconfiguration process underway within the HSE. This would involve reallocating beds and staff to palliative care without adding to the total number of State funded beds. Indeed, while ethics and quality of care is our compass needle, it is relevant to stress that international evidence supports the view that palliative care is cost-effective and can help the State save money. Patients who use palliative care have fewer admissions to acute hospitals, shorter stays and quicker discharges. It is time for innovative thinking. We must have increasing co-operation between the IHF, the HSE, and the DOHC. Encouragingly this is coming about under our new five-year programme to develop a hospice home care service for children. This will oblige the IHF to fundraise more than c3 million to pay for Ireland’s first Paediatric Palliative Care Consultant as well as five of eight outreach nurses: they will provide support and co-ordinate care to children

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“Irish Hospice Foundation staff members have been co-operating with hospitals in assessing their bereavement policies, suitability of morgues, procedures and end of life care. Already substantial changes are being made.” with life-limiting conditions at home. Meanwhile we will continue to support the extension of hospice care to all patients with life-limiting conditions (we

are currently funding four pilot projects to enhance palliative care for people with advanced heart or respiratory failure, and dementia). As is clear in Palliative Care for all – Integrating Palliative Care into Disease Management Frameworks (IHF 2008) – palliative care should be provided on the basis of need, not disease. Our grants programme for innovative projects and research, the MSc/ postgraduate diploma in bereavement studies, the certificate in children and loss, and training on aspects of loss and bereavement are always integral to our work. We will also continue to support night nursing for non-cancer patients. Most importantly, we will continue to promote good hospital design and dignity standards and quality standards for end of life care. With all of this work, in cooperation with the statutory and other voluntary agencies, Ireland one day can claim that no one has to face death or bereavement without the appropriate care and support.

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10/03/2010 15:26:57 12:22:52 12/03/2010

12:22:52

Health Matters 95

Transplants

Record year for organ donations Last year was a record breaking one for both organ donations and for kidney transplants in Ireland. Mr David Hickey, Clinical Lead of the National Organ Procurement Office and Clinical Director, Nephrology, Urology and Transplantation at Beaumont Hospital, reports.

atest figures from the National Organ Procurement Service show that there were 154 donor referrals last year, an eight per cent increase on referrals in 2008. These referrals came from 24 hospitals out of a potential 40 acute hospitals which participate in the national programme. Of the 154 referrals, 90 resulted in organ donations leading to transplants. All but three involved multi-organ donations which variously included heart, lung, liver, kidney and pancreas donations. A total of 17 hearts were donated last year, compared to 10 in the preceding 12 months; four double lungs (against one in 2008); five single lungs (against seven in 2008) and 68 livers (against 59 in 2008). It should always be borne in mind that this level of life enhancing and life saving activity would simply not happen without the courage and generosity of families at times of great personal loss. The most active transplant programme in the State, the renal transplant programme at Beaumont, also enjoyed significant growth during 2009. A total of 172 kidney transplants were done last year. This was an increase of 11 per cent on the 157 undertaken in the previous highest year, 1998. Of the 2009 total, 164 transplants were kidney only, eight were combined kidney and pancreas and one was pancreas only. The growth in the number of patients treated under the living donor kidney transplant programme, led by surgeon Ms Dilly Little, was a significant factor in last year’s outturn. Despite constraints on activity due to an outbreak of norovirus in Beaumont Hospital in the early part of the

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year and the later outbreak of swine flu, a total of 18 living donor kidney transplants were completed in 2009. This was three more than originally planned and further

“There has been some discussion here in Ireland and also in the UK about whether changes in approach to obtaining organs from people recently deceased might increase the availability of transplant organs.” growth is expected in the current year. The need for renal transplantation results from renal disease, which is a common health problem in Ireland. Chronic kidney disease (CKD) afflicts up to 280,000 citizens, most of whom are unaware of that fact. More significant, kidney disease afflicts up to 180,000 of these in whom it is a significant risk factor for cardiovascular disease and premature death. The most prominent manifestation of advanced kidney dysfunction is End Stage Kidney Disease (ESKD), requiring long-term dialysis or renal transplantation. In Ireland, about 450 people each year reach the end-stage of renal failure and

need treatment to replace their nonfunctioning kidneys. The HSE National Renal Office (NRO), under the direction of Cork University Hospital Consultant Nephrologist Dr Liam Plant, has identified that the demand for dialysis therapy has risen by 60 per cent over the last five years. The NRO’s role is to provide governance, integration and leadership in developing a national framework for delivering renal services. One of its priorities is to ensure that access to transplantation is available to as many patients as possible from all parts of the country and at Beaumont we are working with the NRO to maintain and expand the current programme to meet this growing need. It is noteworthy that 52 per cent of Irish citizens with kidney failure have a functioning transplant and the latest results ensure that this proportion is maintained. There has been some discussion here in Ireland and also in the UK about whether changes in approach to obtaining organs from people recently deceased might increase the availability of transplant organs. The widely held view within Irelands transplant community is that the consistently high level of donation in Ireland with the consent of relatives indicates that the respectful voluntary “opt in” approach now employed is well suited to the national psyche. Most informed observers believe a change to an “opt out” system would be counter-productive and many also find it morally repugnant. Organ donation is an extremely sensitive and emotionally difficult situation, especially for relatives of the donor. But many speak afterwards of the consolation

12/03/2010 15:26:57

96 HealtH Matters

transplants

“it is noteworthy that transplantation is a vitally important service for a number of reasons. at the most fundamental level, it literally represents the difference between life and death for some patients.” they feel in giving permission for donation to occur and how this permission can give some sense to an otherwise meaningless death. such gratitude can only materialise if relatives also feel that their grief has been respected throughout the donation and transplant process and they have not been placed under pressure to give consent. Clearly all practical steps designed to promote increased levels of organ donation are welcome. this could include, for example, increasing the numbers of transplant coordinators working on the ground at a regional level to complement the excellent work already done by the national team of five transplant coordinators based in Beaumont and their clinical colleagues throughout the hospital system. It is noteworthy that transplantation is a vitally important service for a number of reasons. at the most fundamental level, it literally represents the difference between life and death for some patients. In very many cases it results in dramatic improvements in length and quality of life and in virtually every case it represents an extremely cost-effective approach leading to savings of millions of euro each year to the national exchequer. Mr David Hickey is Clinical Lead of the National Organ Procurement Office; and Clinical Director, Nephrology, Urology and Transplantation at Beaumont Hospital.

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A DONATED ORGAN IS A WONDERfUl GIfT fOR SOMEONE

aura Cummins, who works for Hse Procurement, was delighted when her husband sam got a phone call in 2008 asking him to go to Beaumont Hospital in Dublin for a kidney transplant operation. sam was diagnosed with kidney disease in May 2004 and had been on dialysis since November of that year. “the operation has made such a difference. sam was working as a service engineer and having dialysis three evenings a week at Waterford regional Hospital. they were very long days for him. If we wanted to go away for a weekend or go abroad we had to make arrangements for sam to have the dialysis and there was a lot of advance planning involved.” Laura, based in Kilkenny and working in Portfolio and Category Management,

remembers that she could see a huge improvement in sam’s health about 10 days after the operation. “He had the operation at the beginning of august and was back at work by the middle of October. We have been able to travel to see relatives in england for the first time in four years without organising dialysis and we can take a sun holiday too without having to make those arrangements. “the hard thing about dialysis is that you don’t know how long you will have to do it for. sam feels his life has been given back to him by the donor and the donor family. We are very appreciative and our lives are much easier now. a donated organ is a wonderful gift for someone.” laura continues to be grateful to the team of doctors who look after sam and follow his progress very closely.

hOw tO apply fOr a DOnOr carD • Freetext the word DONOR to 50050 • Lo-call 1890 543639 with your details • Collect a donor card at your local pharmacy • Tick the donor box on the back of your driver’s licence

• Apply for a card through the Irish Kidney Association’s website at www.ika.ie • Fax your name and address to (01) 620 5366 • Post your name and address to: Irish Donor Network, c/o Irish Kidney association, Donor House, Park West, Dublin 12

• Email your name and address to donor@ika.ie

It is vitally important that you carry your donor card at all times, and also ensure that your next of kin are informed of your wish to donate, as it could make a huge difference to someone in need.

12/03/2010 15:27:00

HealtH Matters 97

transplants

TIPPERARy COUPlE MADE HISTORy WITH fIRST SPOUSE TO SPOUSE KIDNEy DONATION

hen Deirdre Crowe discovered that she could help her ill husband edward by giving him one of her kidneys she was determined to do so. Deirdre, now a third-year nursing student, discovered that spouse-to-spouse donation was possible while attending a conference on kidney disease in the United states. “It was the first time I realised that spouse-to-spouse donation was possible. Up until then I thought the donor had to be a biological match”, she recalls. Deirdre and edward live in Carrick-on-suir in Co. tipperary and have three children David (16), Niall (9) and sean (8). Ned, who works in Clonmel with abbot laboratories, became ill with kidney disease in 2004. He was on dialysis for two-and-a-half years before the transplant operation in March 2008. “We became the first couple in Ireland to do spouse-to-spouse donation. It is possible now for a non-blood relative to donate because the anti-rejection drugs have become so good.” Before the operation Ned had been on the transplant list for three years and one month with no sign of a matching donor. Deirdre and Ned underwent surgery in March 2008 and the following May, Deirdre took her first year nursing exams. she is now a third-year nursing student and has been on placement at the South Tipperary General Hospital recently. They both have nothing but praise for the unit in Beaumont Hospital where they were cared for before and after the operation and the surgeons involved. Before the operation Ned spent a lot of time on dialysis in Waterford regional Hospital and in the Wellstone Centre in Kilkenny. “Our quality of life is very much improved since the operation. I have benefited because Ned is well and our sons are delighted for him.” Ned is working full time, playing badminton and jogging. He is also hoping to participate in this year’s european Dialysis and Transplant Games which are being held in Dublin. He took part in the 2006 event in Hungary when he was a medal winner. Deirdre would urge everyone to carry a donor card, “When you are dead your organs are no good to you but they can make all the difference for one or more people who really need them.”

“our quality of life is very much improved since the operation. i have benefited because ned is well and our sons are delighted for him”

+ the Crowe Family – sean, Deirdre, David, edward and Niall.

HM Iss6.1 p71-128.indd 97

12/03/2010 15:27:23

98 Health Matters

Social Media

WEB 2.0 Social Media is now an accepted term for a wide range of online resources known as Web 2.0. Bernard Barrett, Information Scientist with the HSE in Limerick, is an enthusiast and explains how Web 2.0 can be used to organise, share, collaborate and create new knowledge.

What is Social Media? SOCIAL NETWORKS Social Networks include websites such as Facebook, MySpace, Bebo and LinkedIn. A recent article in Wikipedia listed in excess of 170 such sites. The starting point for participation in these networks is the building up of a personal profile. Once this has been achieved, there are then a plethora of features/functions, which enable you to find, link to others, establish both personal and professional relationships and hold conversations. These could be a valuable resource from the perspectives of: • Ongoing communication • Continuing professional development • Building/development of research networks With both ‘Linked-In’ and ‘Facebook’, completing a personal profile is the start of the process. Once this is complete, you can search for and link/connect with professional colleagues who share your profession and/or research interests. You

HM Iss6.1 p71-128.indd 98

“With both ‘Linked-In’ and ‘Facebook’, completing a personal profile is the start of the process. Once this is complete, you can search for and link/connect with professional colleagues who share your profession and/or research interests.” can, in the case of Facebook, blog your thoughts on your ‘wall’ and invite comments from others. In the case of ‘Linked-In’, you can create groups/forums to discuss particular issues. Many more features are

available in both of these, but the important point is that both offer opportunities to meet, connect, learn and discuss in a form that is not limited by distance.

BLOGS These can be set up free of charge by anyone and any organisation. They can be topic specific or personal – either way, their function is to encourage discussion and the sharing of information. If an organisation has a blog, there will usually be a link to it from within its website. Contributions to a blog are usually published with the most recent contribution (or posting) first. Each post usually has a ‘comments’ section allowing for discussion of the post, together with the facility to add links to useful websites – all in the context of the ongoing discussion. One can begin a blog by using free publishing software such as ‘Blogger’ (now owned by Google). One normally reads blog postings through a RSS (Really Simple Syndication) Reader, which again are made available, free of charge through websites such as Google, or dedicated websites such as ‘Bloglines’.

12/03/2010 15:27:26

Health Matters 99

Social Media

Using RSS feeds through sites such as Google Reader allows one a highly structured way of keeping up to date with a whole range of web-based content. Usually, two clicks of the mouse are all that is needed to incorporate desired RSS feeds into Google Reader, which can be displayed and viewed in an easy-to-digest format. For any websites that do not have RSS feeds, you can use 'Watch that Page' to monitor any changes in specific web pages.

WIKIS These are websites that allow people to contribute or edit content on them. Again, the websites and software are freely and easily available for these. They are a great media for collaborative working, for example, creating a large document or project plan, with teams spread across a number of offices – or for a specific purpose such as an appeal. Content communities/providers such as Google, Yahoo etc., provide access to all of these free of charge – all that is needed is the effort to set them up and maintain them. PODCASTS Podcasts are audio or video files published on the World Wide Web that users can subscribe to. Subscriptions are not necessarily on the basis of payment, but are a means of building a specific community or audience around a feature. FORUMS They are possibly the earliest form of social media and like Social Networks and Blogs, exist around specific topics and interests. Sometimes, these are also known as Discussion Forums and can be utilised via the forum's web pages, or via subscription to an e-mail ‘discussion’ list. They give people the opportunity to ask questions, seek partners for research – but present more limited opportunities for interaction and connectedness than Social Networks. CONTENT COMMUNITIES These communities represent a huge area, but are focused on the web-based sharing of content. Some well-known examples are Flickr, which is based around sharing photography, as well as Social

HM Iss6.1 p71-128.indd 99

“Blogs can be set up free of charge by anyone and any organisation. They can be topic specific or personal – either way, their function is to encourage discussion and sharing of information.” Bookmarking websites such as Delicious. Lenus, the Irish Health Repository, is another example of how content can be made available and shared electronically.

MICROBLOGGING This is a tool that combines many of the elements of blogging, instant messaging (or texting) and social networking. The best known example of this is Twitter. It is a great way of ‘interacting’ with people, discovering what they think and feel (as well as what they know!) and again of being able to connect to, relate to and be part of the bigger picture out there. A quick visit to some of the sites in the panel will demonstrate that we can share content and collaborate together – the essential nature of Social Media, which has the potential to form an integral part of our working lives. The author Bernard Barrett can be contacted by email at bernard.barrett@ hse.ie where he is happy to discuss feedback to this article.

Sites to visit Social Network Websites Facebook: www.facebook.com MySpace: www.myspace.com Linked-In www.linkedin.com RSS Readers/Blogs Feed Bucket: http://www.feedbucket. com/ Bloglines: www.bloglines.com Blogger: www.blogger.com Watch That Page: www.watchthatpage. com Wikis Digital Research Tools: http:// digitalresearchtools.pbworks.com/ Google Sites: http://sites.google.com PB Works: http://pbworks.com/ Wikia: http://www.wikia.com/wiki/Wikia Forums Dental Phobia: http://www. dentalfearcentral.org/forum/ Health Message Boards: http://www. healthboards.com/ Content Communities Delicious: http://delicious.com Flickr: www.flickr.com Lenus: www.lenus.ie Google Docs: http://docs.google.com Microblogging Twitter: www.twitter.com Additional Resources http://www.educause.edu/ELI/ CollaborationTools/163150 http://www.fumsi.com/ http://www.hrb.ie/about/rss-e-mailalerts/

Note: All web access within the HSE is governed by the terms of the HSE Electronic Communications Policy which is available to HSE staff on the HSE intranet http://hsenet.hse.ie (Go to HSE Central and select Commercial and Support Services. Then go to ICT and select Policies and Procedures and click on Policies).

12/03/2010 15:27:26

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212003-HSE-FC-GiftV-PG.indd 1 HM Iss6.1 p71-128.indd Health Matters a4.indd 1100

10/03/2010 12:29:19 12/03/2010 23/02/2010 15:27:29 12:19:01

12:29:19 12:19:01

Health Matters 101

cycle to work

Get Fit, Go Green and Save Money The government's cycle to work scheme is extended to all HSE staff; find out more in this report.

ach year, 70 per cent of people make New Year’s resolutions, but how many people actually stick to them? Be realistic, set achievable goals that you can stick to all-year-round and harness your motivation by making a plan immediately. Cycling is a great way to get around while keeping fit. Not only do you improve your cardiovascular fitness and lower the risk of heart attack and stroke, but you will lower your carbon emissions and save money all at the same time. Cycling is also a practical mode of transport; you don’t have to pay for parking, fuel costs, or public transport fares. A government scheme to encourage people to cycle to work came into force on January 1st 2009. The scheme was initially piloted in Dublin North East and is now being extended to all HSE employees. The

Gift Voucher Shop, home of the An Post One4all Gift Voucher and Gift Card has developed a special One4all Bikes4work Voucher, which facilitates this scheme. Bikes4work offers support and encourages employers to avail of the government’s benefit-in-kind tax break that gives employees savings on a bike supplied through their employer. The aims of the Scheme are to encourage staff to cycle to work for both environmental and health reasons. The bicycle and safety equipment provided must be used by the employee mainly for journeys between the employee’s home and normal place of work, or between his or her normal place of work and another place of work. Under this scheme, bicycles and safety equipment can be purchased tax-free up to the value of c1,000 once every five years. It is not necessary to cycle to work every day but your bicycle must primarily be used for the purpose of cycling to work. Since the Government introduced this benefit-in-kind tax break, the Bikes4work

+ Ciaran Cuffe, Green Party TD, at the launch of the One4all Bikes4work scheme.

HM Iss6.1 p71-128.indd 101

road show has travelled up and down the country demonstrating an impressive range of bicycles and safety equipment to over 750,000 employees nationwide. Feedback to the scheme has been very positive; scheme coordinators find that the scheme provides the most seamless and cost effective package for them, while at the same time making it easier for employees to both understand their options and choose the particular type of bicycle and safety equipment that they need. As well as providing demonstrations to employees, the Bikes4work team provides a full support service to employers around how the scheme works including their legal responsibilities and will help employers and Bikes4work scheme coordinators promote the benefits of the scheme to their staff.

How does it work? The HSE purchases the bike and the employee pays the sum back through a salary deduction over a period of up to 12 months. The repayment is made before tax and PRSI are applied. There are many benefits for HSE staff members. Cycling is one of the best exercises you can undertake in terms of calories burned per minute, it is nonweight bearing, muscle strengthening and can raise the metabolic rate for up to four hours after exercise. More details of the scheme are available on the staff Intranet site HSEnet. Visit Working in the HSE and go to Cycle to Work Scheme. Or alternatively you can find out more by logging on to www.Bikes4work.ie or contact the Bikes4work helpdesk on (01) 870 8181. Once you get on your bike, always remember to obey the rules of the road and ensure your safety comes first when cycling to work.

12/03/2010 16:19:37

102 HealtH Matters

UpDates

SUPPlIER CHARTER lAUNCHED By HSE PROCUREMENT HSE Procurement recently launched a Supplier Charter that sets out how our organisation works in partnership with suppliers to ensure that all supply chain activities are managed in line with our business principles, values and requirements.

ENT HSE PROCUREM RTER SUPPLIER CHA

liers partnership with our Supp ged in line Our goal is to work in ly chain activities are mana to ensure that all supp requirements. and s value , iples with HSE business princ HSE Commits to:

Prompt Payment

Fair Competition

ce with the • Payment in accordan Act standards • Applying the highest Prompt Payment of Accounts the European of integrity, fairness, legality, interest 1997 as amended by e of in confidentiality & disclosur Communities (Late Payment transactions. related ons) ent Transacti procurem ial all to Commerc ns 2002. Regulatio procurement • Applying all relevant ion is regulations so that competit secured, Social Responsibility promoted, value for money funded • Taking account of relevant equal access to publicly factors when all tax environmental & social contracts is afforded to or works. & openness & buying products, services paying suppliers transparency assured.

HSE Expects Suppliers

to: Sales & Marketing Activity

Maintain Security of Supply

of all sales & • Give advance notice on HSE marketing activity occurring sites.

tion

• Deliver to agreed specifica on time & to agreed cost.

ent to

• Demonstrate a commitm putting patients first.

regarding • Advise HSE promptly or safety any change of delivery issues. • Take a non-adversarial to dispute resolution. • Manage deliveries in with HSE staff.

approach

agreement

Pricing Consistent & Favourable ive • Apply consistent, competit all HSE & favourable pricing to goods & services supplied.

any publicity • Do not cause or facilitate without prior regarding sales to HSE HSE consent.

ents Comply with all Legal Requirem Terms, • Adhere to HSE Standard agreed & except where otherwise from HSE treat information obtained as confidential.

tion Provide Management Informa

in a timely • Provide on request & goods & fashion full details of all HSE by services supplied across & current time, location, quantity supplied price, including any products

which under Community Schemes Care Primary are reimbursed by the Reimbursement Service. full breakdown of • Provide on request, a , price, identifying cost elements & associated cost drivers, market forces goods & services. weightings for supplied

Act Ethically

elements of their • Ethically manage all protection supply chain including s, nonof workers pay & condition ental use of child labour & environm responsibility.

• Declare any potential

conflicts of interest.

activity which • Avoid engaging in any d as an might reasonably be interpretety of attempt to affect the impartiali HSE employees.

Together we will: • Protect frontline patient

he Charter was launched at one of six nationwide engagements with Irish small to Medium size enterprise association (IsMe) held in 2009. as the largest purchaser in the state, Hse spends a total of c4.5 billon annually on products and services. Hse conducts business with in excess of 20,000 suppliers in the marketplace. this expenditure covers a diverse range of products and services from 64 slice Ct scanners to sliced bread. In general, the spend is across the following four major

portfolios: (1) Hotel services, (2) Pharma and Medical, (3) equipment/laboratory and Diagnostics and (4) Professional, Office and ICt. “the Charter sets down the methodology to be applied in how commercial activities are to be carried out across Hse so that all commitments and expectations are clearly respected,” said Julie ryan, assistant National Director Procurement with the Hse. “this approach is endorsed by Hse management and should be seen as a means for progress and to address

+ HSE’s Kevin Keegan, Assistant Head of Logistics and Inventory Management and Julie Ryan, Assistant National Director, Procurement with Mark Fielding, Chief executive of the Irish small & Medium enterprises association (IsMe) and John O’Donovan, assistant National Director of Hse Procurement at the launch of the supplier Charter.

HM Iss6.1 p71-128.indd 102

services

& services • Deliver quality goods on-time & within budget e waste • Reduce cost & eliminat ment through continuous improve

issues such as security of supply, sales and marketing activity. We recognise that continuing to deal with quality suppliers is integral to the successful provision of good customer service. the supplier Charter details the principles, values and expectations that underpin a modern and successful working relationship.” Ms ryan added, “Hse Procurement is committed to working with all our suppliers to ensure that they manage their operations in line with Hse business principles and values in delivering a quality service, achieving value for money and in ensuring optimum patient care services. “the Charter sets out Hse’s commitment to fair competition, prompt payment and socially responsibile procurement. the document should be viewed not as an end in itself but as another step along the way in creating a reputation for fairness, efficiency and building supplier relationships across Hse.” staff co-operation and support is now required to further promote the charter and its principles across Hse in terms of dealing with the marketplace. Hard copies of the supplier Charter can be obtained by forwarding your request by email to feedbackprocurement@hse.ie. soft copies are available on the Hse staff Intranet; select Hse Central and Commercial and support services. then go to Procurement and Procurement regulations.

12/03/2010 15:27:51

MarshConsumerAdA4_HSE-88x275_2010-02-26 copy.pdf 1 26/02/2010 12:13:08

Postgraduate diPloma/msc in Bereavement studies The irish Hospice Foundation in association with the royal college of surgeons in ireland This part-time programme is designed to equip participants with an understanding of bereavement and loss from theoretical and practice perspectives. Successful completion of six modules will result in the award of Postgraduate Diploma in Bereavement Studies with the option of further study for the award of MSc Bereavement Studies. Commencing in September, this programme is likely to appeal to those working in a range of health and community settings. Closing date for completed applications is Friday, april 23, 2010. Please note this is not a counselling qualification. For further information contact Maura Dunne, Education Administrator, Irish Hospice Foundation, Morrison Chambers, 32 Nassau Street, Dublin 2. C

Tel: 01 679 3188 Email: maura.dunne@hospice-foundation.ie For general information: www.hospice-foundation.ie

CMY

HM Iss6.1 p71-128.indd 103

12/03/2010 15:27:55

104 Health Matters

Pensions Special

Your Pension – what you need to know M

embership of an occupational pension scheme is a valuable feature of employment in the Health Service Executive. The pension schemes within the HSE, similar to the Public Service generally, are Defined Benefit Schemes i.e. the pension benefits payable are defined in the rules of the scheme and are not dependant on the performance of stock markets or investment returns. The main provisions of HSE pension schemes are: • Retirement Lump Sum and Pension (minimum service requirement of two years at age 60/65) • Death Gratuity (in the event of death in service – minimum of one years’ salary) • Spouse’s and Childrens’ Pensions (death in service or post retirement) • Preserved Benefits (early leavers with a minimum of two years service) • Transfer of Service (between Public Sector Organisations/Agencies) In this regard, the level of benefits payable at retirement are determined by the number of years service (expressed in whole years) which an employee has accrued, and their pensionable remuneration at retirement date. Pensionable remuneration is comprised of the whole time salary of the appropriate grade, plus averaged pensionable allowances earned in the best three consecutive years in the 10 years preceding retirement. Arising from changes to the pension scheme rules in recent years, access to the scheme is now automatic for all

HM Iss6.1 p71-128.indd 104

new employees who work on a contract of service, irrespective of working hour commitment. Minimum retirement age is 60 years for employees appointed pre 1st April 2004; provided that they did not have a break in service of 26 weeks or more since April 2004, and compulsory retirement age is 65 years. New entrant public servants

“Pensionable remuneration is comprised of the whole time salary of the appropriate grade, plus averaged pensionable allowances earned in the best three consecutive years in the ten years preceding retirement.” appointed on/after 1st April 2004 have a minimum retirement age of 65 years and no compulsory retirement age, subject to satisfactory performance and health. While minimum retirement age is 60 or 65 years, staff members who retire from their posts by reason of ill health (permanent

infirmity) receive immediate benefits based on actual service enhanced by added years, subject to having a minimum of five years service. The holders of certain professional and technical posts may have their service at retirement enhanced by virtue of the essential qualifications attaching to their appointments. Early leavers with a minimum of two years service who are not transferring to another employer within the Public Service Transfer Network will have their benefits preserved until minimum retirement age (60 or 65). Early leavers aged 50 or 55 (New Entrants) who resign with entitlement to Preserved Benefits at age 60 or 65 (New Entrants) may apply for the Cost Neutral Early Retirement Scheme in lieu of Preserved Benefits.This scheme involves payment of actuarially reduced pension and lump sum benefits at date of resignation.

Options for Enhancement of Service and Pension Benefits While minimum service requirement for the payment of retirement benefits is two years, 40 years whole time service is required, in order to derive maximum benefits from the pension scheme, i.e. lump sum of one-anda-half times the salary and pension of half the salary. Many employees will not attain this level of service by retirement date for a variety of reasons e.g. late entry to the HSE, working reduced hours (job sharing/ flexible working), availed of career breaks.

12/03/2010 16:16:01

Health Matters 105

Pensions Special

In order to ensure that any service capable of being included is reckoned for pension purposes, it is important for employees to ascertain if there is any previous service with organisations/agencies within the Public Service Transfer Network which may be reckonable. If a previous award has been received from any such body e.g. marriage gratuity or refund of superannuation contributions, it may be possible to repay such award to the HSE in order to restore the relevant service for pension purposes. The main options for enhancement of service are through: • The purchase of Notional Service Scheme and, • Additional Voluntary Contributions (AVC) Schemes. The purchase of Notional Service Scheme enables an employee to buy extra service for pension purposes at full actuarial cost, either by lump sum or by way of additional periodic contributions up to age 60 or 65 years. Certain union endorsed AVC Providers have arrangements with the HSE whereby contributions are deducted at source through payroll and remitted to the pension provider. Under AVC schemes, any additional benefits which accrue are paid separately by the pension provider following retirement. Further information on the inclusion of previous reckonable service, the purchase of Notional Service Scheme and AVC Schemes may be accessed on the HSE intranet (http://hsenet.hse.ie) in the Working in the HSE section. Go to ‘Pension Management’ and then ‘Current Employee’s/ Pension Scheme Members’.

The benefit tables are listed separately in respect of: •L ump Sum (payable at minimum retirement age) •P ension (payable to member at minimum retirement age) •D eath Gratuity (payable to legal representative if member dies in service) •S pouses’ Pension (if applicable, where member dies in service or after retirement). In addition, individuals may calculate estimates of their pension benefits by using the pension estimator, through entering details of service to date, salary (wholetime), projected retirement date and work pattern into the future. The pensions’ estimator may be accessed on the HSE Intranet (http:// hsenet.hse.ie) in the Working in the HSE section. Go to ‘Pension Management’ and ‘Pension Estimator’. Further information and contact details for your Local Pensions Management Unit may be accessed on the HSE Intranet in the Pension Management section.

“Individuals may calculate estimates of their pension benefits by using the pension estimator, through entering details of service to date, salary (wholetime), projected retirement date and work pattern into the future.”

Illustration of Benefits Payable and Using the Pension Estimator An illustration of the range of benefits payable to members on various salaries with varying years of service may also be viewed on the HSE intranet site (directions as above).

HM Iss6.1 p71-128.indd 105

12/03/2010 15:28:01

106 Health Matters

Pensions special

Ask the Advisor Eoin McGee, an independent financial advisor, looks at how to add more value to your private sector pension.

HM Iss6.1 p71-128.indd 106

12/03/2010 15:28:14

Health Matters 107

Pensions Special

he current economic climate has given everyone a taste of what it is like for your take-home pay to be effected. What a lot of people don’t realise is that when they reach retirement, even with the best of pension schemes and perfect retirement planning, you will still be looking at a minimum of a 33 per cent drop in income. Members of the HSE are entitled to one of the best pension schemes available. In the private sector, those who are lucky enough to have an employer provided pension are most likely to be entitled to what’s called a defined contribution pension. This means that the employer pays in (if they pay in!) a certain amount on a year-to-year basis, a defined contribution. These contributions are invested in markets and grow, or don’t grow as the case might be, and whatever the contributions plus the growth are at retirement determines how much money you have to go out and buy an income for the rest of your life. A defined benefit scheme, which is available to all staff of the HSE means that it is guaranteed what you will get out at retirement, a defined benefit. You are required to pay an amount in every month and in return you are guaranteed to get a percentage of your salary at retirement. The percentage you get is determined by how many years service you have at retirement. It is not dependant on market performance and your employer (the HSE) takes all of the risk; in other words, if there is not enough money in your pot when you hit retirement, the HSE guarantees to provide you with the promised income anyway. A defined benefit pension scheme is the Rolls Royce of pensions but that does not mean that you will be able to afford to buy one when you hit retirement. There are limitations to what it will provide. Revenue restricts any employee heading into retirement whether that be from the private or public sector to a maximum benefit of two-thirds of their final salary, or less than this if you want to take a tax free lump sum out first.

HM Iss6.1 p71-128.indd 107

“If you believe you are not going to retire with full service, you need to consider your options and even if you are going to retire with full service, there may still be room for further pension funding.” At retirement, most people who have full service in the HSE will be entitled to a lump sum of one and a half times their final salary, along with half of their final salary as an income. But not everyone will have full service. Some people will have joined the HSE later in life, may have spent many years in training, worked part-time or even taken a career break. If you believe you are not going to retire with full service, you need to consider your options and even if you are going to retire with full service, there may still be room for further pension funding.

What are the options available? In reality, you have two options. Buy back years or purchase notional service, or fund a defined contribution pension yourself whether that is in the form of an AVC or a PRSA. (These will be explained a little further). You could of course do both. Purchase Notional Service Buying back years or purchasing notional service is effectively buying into a defined benefit scheme and in most circumstances these options, if available to you, are very good ones. Again you pay in on a monthly basis or you put in a once-off lump sum.

Effectively what you are buying is an enhanced promise of income at retirement from the HSE. There is no investment risk to you and the promise is provided by the State. These are very costly options for the Exchequer so be careful, in the current climate they may not be around for much longer and there has already been hints that they may disappear. It is, however, difficult to see how the State could take it away from anyone who is already in the process of buying back their years or purchasing notional service. In limited circumstances, this is not the route to go but you need to be completely satisfied, ideally by getting expert advice, that it is not before considering the other options.

Additional Voluntary Contributions The other options do have an investment risk, but if you get the right advice that should not be an issue. AVCs (Additional Voluntary Contributions) are payments into a private pension scheme. There are several providers who can facilitate the payments through your payroll. These providers include Marsh, Cornmarket and Irish Pensions and Finance. Who you go to often depends on the Union you are with but these companies are generally open to deal with anyone in the HSE. Each of the three has arrangements with the country’s largest life companies. They offer a wide choice of funds and are experts in their field of facilitating the payment through your salary on a monthto-month basis. Personal Retirement Savings Account The other option you have is to fund your own PRSA (Personal Retirement Savings Account). Most good independent financial advisors including the companies already mentioned can organise a PRSA for you or you could deal directly with the life company. Due to the fact that you organise

12/03/2010 15:28:25

108 Health Matters

Pensions Special

“The options at retirement offered by PRSAs and AVCs are more flexible than the options offered by the fund you accumulate through the main scheme. You can of course use the fund built up to buy an income, provided you stay within maximum revenue limits.”

it privately, it is typically paid for through your bank account. As with AVCs, you have a wide range of fund choices to choose from and complete flexibility when it comes to increasing, decreasing, stopping and starting payments. You can also add lump sums in at any stage. The other big advantage with PRSAs is that if you move jobs – whether that be within the public sector or into the private sector or if you became self employed – you keep the same PRSA account. The introduction of PRSAs in recent years has completely opened up this market and life companies are aggressively going after your business. My advice would be to seek advice in this area as the offers change quite frequently from company to company. The funding of PRSAs and AVCs is limited to a total contribution into all pensions of a percentage of salary. This starts at 15 per cent of salary at age 20-30 and rises up to 40 per cent just before retirement. If you are on the higher end of the salary scale, your earnings are capped at c150,000 for pension purposes. It is also important to note that further restrictions have been implemented recently

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where Revenue are limiting contributions into pensions for private practice income for doctors etc where their salary is above the c150,000 salary threshold. There are some very clever and perfectly legitimate ways around this for your private practice income, but they would be beyond the scope of this article and would certainly require individual advice. The options at retirement offered by PRSAs and AVCs are more flexible than the options offered by the fund you accumulate through the main scheme. You can of course use the fund built up to buy an income, provided you stay within maximum revenue limits. What most people are attracted to is the idea of funding an ARF (Approved Retirement Fund). This is an account that you can invest your accumulated pension fund into and you can draw money out of (subject to income tax) whenever you want. Some people will even take it all out on day one, and who knows, this option may become even more popular if the sitting Government introduce the proposed changes and further restrict the amount of tax-free cash you can take out of your pension.

Everybody in the HSE is entitled to be a member of the defined benefit scheme that is offered but be warned, it may not be enough for you and you are certainly looking at a bigger drop in income at retirement than you have experienced in recent months. Take some time now, whatever stage you are at in your career, to at least review your options. Get good financial advice and don’t be afraid to pay for it. Eoin McGee is the owner of Prosperous Financial Services, an independent firm regulated by the financial regulator as a multi-agency intermediary and mortgage intermediary. He has over 10 years experience giving advice to both individuals and companies in relation to their finances, he can be contacted on eoin@prosperous. ie, Tel: (045) 841 738 or (087) 644 5533.

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Clinical Collections Limited Clinical Collections Limited 4 Railway Terrace, Dublin Road, Drogheda, Co. Louth For Collections phone PatDrogheda, on (087)Co. 237Louth 0553 4 Railway Terrace, Dublin Road, For Collections phone Pat on (087) 237 0553

We are committed to utilising the best available technology to reduce, and help to ensure minimal environmental impact ofto your waste. Werecycle are committed utilising the best available technology reduce, recycle and help ensure minimal environmental impact of your waste. Clinical Collections Limited are fully compliant and both Collections Health Service and Local Authority approved. Clinical Limited are fully compliant and

both Health Service and Local Authority approved. Goods Safety Advisor • Healthcare Risk Waste (including sharps) • Dangerous Services Available • Pharmaceutical Waste

• Amalgam Waste from Dental Care

• Site Clearance (needle search)

• Photographic Industry Waste (chemicals, fixer developer, etc.)

• Waste Audits, Annual Environmental Reports, C1 Forms

• Waste Electrical & Electronic Equipment

• All Staff Fully Hazchem Trained

(computers, fridges, fluorescent tubes, medical equipment, etc.)

FoR ADvICE AnD ASSISTAnCE on HAzARDouS WASTE DISPoSAl PlEASE CAll JASon on (087) 255 7286, FoR ACCounTS CAll MARIE on (041) 984 5253.

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Health research

How research can lead to improved patient care and technology to make life easier The Health Research Board (HRB) is the lead funder of health research in Ireland. Here, HRB Chief Executive Enda Connolly explains how research can lead to improvements in the way we deliver care, better understanding about a disease or the introduction of technology to make life easier.

very day, members of staff across the health services are faced with challenges. These can range from juggling a complicated caseload to finding a patient record, or from understanding what is causing an illness, to making a patient more comfortable while they are cared for. Often people are simply too busy just getting through their workload to think about how they could make doing the job easier. Research can play an important part here by helping identify problem areas and providing the evidence to make informed decisions about what can be done about these problems. People may think that research is what happens in labs or relates only to new treatments, products or diagnostics, but this simply isn’t true. Everyone working

“Everyone working in healthcare has the potential to come up with new concepts, ideas and practices that will help improve patient care or the way that care is delivered in our health system.”

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in healthcare has the potential to come up with new concepts, ideas and practices that will help improve patient care or the way that care is delivered in our health system. As the lead funder of health research in Ireland, every year the HRB receives applications for funding for projects from a wide range of health professionals including nurses, physiotherapists, ICT departments as well as doctors and laboratory scientists. They all have ideas. They all want to understand how to do things better – whether it is changing the way you deliver care, understanding more about a disease or introducing technology to make life easier.

A snapshot of what we mean… Perinatal Ireland is a research collaboration between eight of the principal maternity hospitals across the island of Ireland. The aim is to harness the combined experience of the medical teams in all of these centres, along with the advanced images available from the HRB funded equipment, to help improve outcomes for both mothers and babies. A group of GPs led by Prof Andrew Murphy, a GP in Galway, designed tailored care plans for patients with heart disease. Having patients follow this prevention programme has led to a reduction in hospital admissions for heart disease. A group of health professionals at the Mater Hospital in Dublin have developed a new rapid access clinic where people at high risk of stoke can be treated before a

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stroke occurs, saving lives and reducing pressure on acute hospital services. More than 700 patients have been treated at this clinic, led by Dr Peter Kelly. Zena Moore, a practising nurse and an HRB Research Fellow, discovered that a small change in patient management practices, which involves tilting bedbound patients at a 30 degree angle rather than a 90 degree rotation, resulted in a four-fold reduction in the incidence of pressure ulcers among patients. It also saved nursing staff time and cost less to do. A multi-disciplinary team at Beaumont Hospital, which included administration, ICT, nursing staff, physicists and consultants created a new electronic patient record to manage treatment and support of epilepsy patients. The system saves significant time and ensures that the most up to date information is available to the entire care team at the same time. This model is already benefiting more than 1,000 epilepsy patients treated at Beaumont Hospital in Dublin. It is a strong learning model that could be used in the treatment of other complex chronic conditions. A new internet-based system has been developed that allows patients to self-manage their warfarin dosage. It has improved the control of warfarin compared with the current anticoagulant management service, is more convenient for patients and saves valuable clinical time.

Where can you find out more about health research funding? If you or your team wants to do research, the HRB runs a range of competitive funding programmes. The details of all funding opportunities are available on our HRB website www.hrb.ie. Go to Research, Strategy & Funding then Grants and Fellowships. If people are interested in putting a proposal together, but are not quite sure how to do so, the HRB also runs a series of grant-writing workshops which are specially designed to help people develop a competitive proposal.

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These examples only give a snapshot of the research taking place across the system. It is important to emphasise that it is not all about practitioners. Health managers also have an important role. They can support their staff to do research by working with them to identify a good research project and giving them time out to do research. More importantly, they can be knowledge brokers – the people who help ensure the new research findings are actually applied in health care or health system practice. The Irish research landscape has been transformed in the last 10 years. A substantial capability has been built up and the HRB has had an active role in developing the health research component of this. The next challenge is to focus on how research can be translated or applied to deliver better care of patients, improve health service delivery and inform health policy – it is this step that provides the opportunity to make that difference.

Making sense of the latest research available A really practical tool that the HRB has made available here and people working in health care should be aware of is the Cochrane Library. With millions of scientific articles published in research journals each year, making decisions about health care can be really difficult because of the volume of information available in journals, books, magazines, newspapers and on the internet. Some of this information and advice may be helpful, but some could be inaccurate or harmful. The Cochrane Library is a clinical treasure trove that can help people with this dilemma because it provides Cochrane reviews, compiled by experts in the field, which pull together all the available research evidence about particular treatments. The HRB has taken out a subscription for Ireland, which means that everyone in the country can access the Cochrane reports. Last year, more than 60,000 documents were downloaded in Ireland alone. Find out more at www.hrb.ie. Go to Quick Links box and select Cochrane-Collaboration.

+ HRB Chief Executive Enda Connolly.

“As a result of the willingness of so many of you to change how we do things over the past few years, we are in a better position to minimise the effect of the budget pressures the country is facing.”

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Updates

National College of Ireland Invitation The National College of Ireland is inviting HSE staff who were former students there to sign up to its NCI Alumni Association. In the past the college was formerly known as the College of Industrial Relations, the National College of Industrial Relations and the Catholic Workers College. The College is trying to reconnect with its thousands of former students and has developed a new website and online community to help its alumni reconnect with their college and with their old friends and colleagues. The National College of Ireland, or NCI, is now located in the IFSC, in Dublin’s Docklands. It was established in 1951 by the Jesuit Community as the Catholic Workers College and was based in Ranelagh where it remained until 2000. Over the years it underwent several name changes becoming the College of Industrial Relations and the National College of Industrial Relations before its final name change in 1998. For nearly six decades, National College of Ireland has provided education at diploma and degree level to generations of mostly part-time students. Its early focus on industrial relations meant that countless leading trade union and HR professionals owe much of their academic learning to the college. “From its establishment in 1951 our college has provided an invaluable opportunity for people with no chance to gain a third level qualification and to access education”, says Paul Mooney, the College President who received his early professional education in the NCI. “Today, National College of Ireland has a renewed and strengthened commitment to widening participation in higher education and to supporting activities that contribute to a knowledge-based economy and an active social citizenship”. Membership of the NCI Alumni Association is free; all you have to do is sign-up on the website at http://alumni.ncirl.ie.

HSE awards scholarships to doctors to train abroad The HSE’s Medical Education and Training (MET) Unit has awarded scholarships to four Specialist Registrars to train in centres of excellence abroad. The awards represent the fourth round of the Dr Richard Steevens’ Scholarship, an innovative programme developed and established by the MET Unit in 2007. The programme awards doctors at SpR level, who have a proven track record in achievement, to train in novel areas of medicine which will enrich the Irish health service and patient care on their return and for which training is limited or unavailable here. The programme builds on the strong tradition of Irish doctors travelling overseas to gain the knowledge and expertise available in major centres of excellence abroad. This programme is an important method of ensuring that our doctors maximise the expertise available in other countries and bring their knowledge and skills back to the Irish health service.

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All awards are for a maximum of 12 months. The four doctors who will take up their scholarships from July 1st 2010 are: • Dr Frank Waldron-Lynch, Specialist Registrar in Endocrinology and Diabetes mellitus – Fellowship in Immunotherapy of Type I Diabetes at Yale University Medical School. • Dr Grainne O’Regan, Specialist Registrar in Dermatology – Fellowship in Epidermolysis Bullosa and Skin Fragility at Stanford University • Dr Kevin Foy, Senior Registrar in General Psychiatry – Fellowship in Neuropsychiatry at the National Hospital for Neurology and Neurosurgery, London. • Dr Caitriona Kirwan, Specialist Registrar in Ophthalmic Surgery – Fellowship in Paediatric Ophthalmology at the Hospital for Sick Children, Toronto. An expert panel, convened by the HSE’s MET Unit, provided advice to the

MET Unit on applications received. The members of the expert panel were Dr Eilis McGovern (Chair of the Panel and Consultant Cardiothoracic Surgeon), Prof Gerard Bury (Director of Medical Education and Training in the HSE and a General Practitioner), Prof T Joseph McKenna (outgoing Chair of the Forum of Irish Postgraduate Medical Training Bodies and a Consultant Physician) and Prof John Higgins (Professor of Obstetrics and Gynaecology and Clinical Director for Service Reconfiguration in HSE-South). This programme was developed in consultation with the Forum of Irish Postgraduate Medical Training Bodies and is one of a number of developments being implemented by the Medical Education and Training Unit of the HSE arising from targeted investment funding from Government for the implementation of the Fottrell and Buttimer Reports. For further details, contact: Ciara Mellett, Business Manager, Medical Education and Training Unit, Health Service Executive. E-mail: metr@hse.ie.

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Development

Simulator developed to assess doctors’ technical performance A Consultant Anaesthetist at Cork University Hospital (CUH) is leading the development of a novel form of assessment of doctors’ procedural skills. The new system uses simulation technology to provide detailed, personalised feedback as doctors learn the procedure spinal anaesthesia.

‘MedCAP’ (Medical Competence Assessment Procedure) is an innovative form of competence assessment for doctors, which uses haptic technology (accurately recreates the touch and feel of surgical procedures) and ‘competence based knowledge space theory’ (applies mathematical formulae to each step in a procedure) to assess the performance. The MedCAP research team is led by Professor George Shorten, Department of Anaesthesia and Intensive Care Medicine at CUH and UCC and comprises members from the University of Graz, Austria, the Interaction Design Centre, University of Limerick, University of Pecs, Hungary and Medic Vision, a UK-based company developing simulators for medicine. The project is funded through the EU Leonardo da Vinci Lifelong Learning Programme. Current training in such procedures usually entails theoretical learning, observation and practice under supervision. The work of the MedCAP research team is part of a worldwide move to competencebased training and assessment for healthcare professionals. MedCAP represents the first attempt to apply this innovative approach to the world of medical learning. Professor Shorten said, “In simple terms, the newly developed haptic simulator recreates the same tensions and sensations felt by the practitioner when they insert a needle into the patient to administer a spinal anaesthetic. Throughout the procedure, MedCAP not only gives rapid audio and visual feedback but also assesses the doctor’s performance.” “This has the potential to improve the way that medical students and doctors

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learn and are assessed in their performance of technical skills. By providing ‘intelligent’ and detailed feedback to learners as they practice a procedure in a simulated setting, a footprint of their competence is created. This will provide him/her with a detailed map to future learning. With practice over time, the learner progressively focuses on areas of weakness accelerating his/ her progress up the learning curve. This substantial experience can be acquired before a learner undertakes the procedure on a patient,” he added. The challenge in developing such a procedure lies in defining each skill while taking account of the many factors which influence doctors’ learning and performance. These include cognitive, motor, communication, and human (for example; fatigue, anxiety and fear) factors. The project is particularly relevant to Ireland, as the Medical Council engages with the Irish medical training bodies to improve the

ways in which Irish doctors monitor their performance. Spinal anaesthesia was selected as the sample procedure for study because it contains many of the elements common to other procedures. The principles employed in developing this procedure could be extrapolated to creating similar assessment tools for other medical procedural skills. It is also timely as it takes into account the fact that 2006 saw a change in the Medical Practitioners Act in Ireland, which now stipulates that doctors have a statutory obligation to undergo ongoing competence assessment throughout their career. The MedCAP team look to progress their work by further refining the system extending it to similar procedures and introducing it to medical training bodies. Already MedCAP is being used in parallel with existing assessments by trainees on the Irish Southern Regional Anaesthetic Training Scheme.

+ Professor George Shorten, Department of Anaesthesia and Intensive Care Medicine at Cork University Hospital who is leading the development of a novel form of assessment of doctors' procedural skills.

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RCSI

+ (L â&#x20AC;&#x201C; R) Pictured recently at the Royal College of Surgeons in Ireland (RCSI) were Cathy Hennebry, Assistant Director of Nursing, Childrenâ&#x20AC;&#x2122;s University Hospital Dublin, Temple Street; Vincent McDonagh, Department of Anatomy, RCSI; Emmet Campion, Department of Pharmaceutical & Medicinal Chemistry, RCSI; Sibeal Carolan, Programme Director, Institute of Leadership, RCSI; Dr Matthew Sadlier, HSE; Pauline Joyce, Director of Academic Affairs, Institute of Leadership, RCSI and Dr Emmanuel Eguare, Locum Consultant, Tallaght Hospital, Dublin.

The RCSI Institute of Leadership The RCSI explain what is involved in their Institute of Leadership programme and how it can benefit HSE staff. What is the Institute of Leadership? As health professionals, we now work in a challenging and rapidly changing environment that requires us to display, in addition to our technical/clinical skills, a broad range of leadership, supervisory and management skills. Established in 2005, the RCSI Institute of Leadership provides opportunities for health professionals to develop as leaders capable of displaying a wide range of management and supervisory skills in their

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clinical or administrative roles. With over 450 students registered for postgraduate degrees and an equal number taking our short development programmes, the Institute is fully integrated into the RCSI. Our mission is to improve human health through the development of excellent leaders and managers in the health professions. We achieve this through a combination of academic rigour, a practical focus on improving healthcare delivery and helping professionals understand and develop themselves.

Our degree programmes are part-time, inter-professional and modular and delivered using a blend of distance and classroom education. We offer a range of accredited postgraduate diploma and masters programmes in leadership, professional development, healthcare management, quality and patient safety. The Institute has bases in Ireland, Bahrain and the UAE and also provides training in Jordan, Egypt and Saudi Arabia. Short professional development programmes in leadership, management, communication, coaching and personal development are also available. Our priority research interests are in patient safety and quality, healthcare management, leadership, and postgraduate education.

How do our programmes apply to practice? Our management and leadership programmes are similar to those of the best international business schools but

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RCSI

tailored specifically for healthcare. Although grounded in up-to-date academic research, our courses are flexible and practical. Our students learn to analyse complex organisational and managerial problems and deploy a broad range of management tools to identify and assess solutions. We focus strongly on the characteristics and dynamics of multi-professional teams and the variety of disciplines represented on our programmes is a distinct asset in this regard. Our programmes are grounded on the core principles of modern interactive adult learning. In addition to lectures and tutorials, students participate actively in case studies, group projects, assignments and debates, and we provide a supportive atmosphere that fosters learning from experience, through reflection, dialogue, advocacy and enquiry.

Who takes our courses? Doctors, nurses, pharmacists, scientists, allied health professionals, researchers and administrators take our courses. They work in hospitals, community-based healthcare systems, government agencies, academic and research institutions or pharmaceutical companies. They are at early, middle or senior stages in their careers and usually have responsibility for managing others. Our typical student is proactive, open to exploring new ways of learning and thinking, is keen to learn from and share their experience with others, and is motivated to develop themselves and their organisations in order to improve the delivery of healthcare to patients. Professor Ciarán O'Boyle, Head of the Institute, speaking at a recent conferring captured the central mission of the Institute when he said, “We are focused on the formation of a new generation of healthcare leaders. Our graduates, now in nine different countries, are well placed to assist their communities and organisations to cope with the emerging challenges in providing safe, modern and effective healthcare for the greatest number of patients.” What time commitment is involved? We are aware of the time constraints on busy professionals and have developed a

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blend of classroom and electronic media in order to facilitate our students. Direct contact days are kept to a minimum. For example, a Masters programme involves 12 contact days in year one. In addition to classroom teaching, our students are supported by a sophisticated online learning portal that provides a wide range of learning materials including academic papers, weblinks, presentations, podcasts, vodcasts, and communications fora. Our Masters programmes can be completed over a five-year period and fees can be paid on a modular basis.

What continuing professional development programmes are on offer? The Institute offers a number of continuing professional development and bespoke training programmes. These include

‘Coaching and Mentoring Skills for Consultants’, ‘Communications Skills for Clinical Staff’, ‘Train the Trainer’, and ‘Introduction to Management’. In 2009, we also provided the General Professional Development Course for 184 senior house officers on behalf of the Royal College of Physicians in Ireland.

Have you additional queries? Come to one of the open evenings, which are held on the first Tuesday of each month. Alternatively, visit the RCSI website www.rcsileadership.org or contact the administration team on (01) 402 2378 or (01) 402 8655.

Testimonials from HSE staff Name: Avilene Casey MSc Leadership and Management Development Title: Director of Nursing, St Luke’s Hospital “As Director of Nursing, the MSc in Leadership and Management Development was of huge benefit to me in practical and theoretical terms. It gave me the opportunity to meet senior managers and hospital consultants from a range of disciplines in a learning forum. This allowed me to gain a variety of diverse perspectives from across the breadth of the health system encouraging me to critically analyse situations objectively. The new materials offered on the course – both theoretical and practical – provided me with tools and skills to take my approach to another level and reflect on my leadership and management style. The course content was varied and focused. Each module built on the previous material covered culminating in a holistic approach to leadership and management development. I thoroughly

enjoyed the two years and found the part-time commitment approach to the study achievable even with a demanding day job.” Name: Patricia Hackett MSc Leadership and Management Development Title: Service Manager, Wexford General Hospital “The completion of the MSc in Leadership and Management Development has been valuable for me, giving an increase in self-awareness and development of leadership skills. The knowledge of the concepts and theories of leadership and management gained through this course has been insightful, improving my understanding, appreciation and application to practice. The practical application of the learning has already been useful to me and I feel equipped with the necessary skills to cope with the current turbulent environment in the health service and indeed to help me through the next 10 years of my career.”

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Advertisement feature

One Step Forward Swiss technology speeds up rehabilitation and offers hope to spinal injury and stroke patients.

hen Joan Ryan and her children set off on the short car journey from her home to her parents’ house in 2001, little did they know it would change their lives forever as their car was involved in a severe accident. “As a result of the collision I am blind, and my daughter Edel, who was then five, suffered a spinal injury just under her shoulder, which has been termed as complete.” Edel Ryan now receives regular treatment on the Lokomat. “For circulation and for her heart, it’s of huge benefit,” says Joan. “Even psychologically; we want Edel to have a long, happy and healthy life and the Lokomat can help keep her as healthy as possible.” Due to the severity of Edel’s injury, the Lokomat will not mean that she returns to walking, however, Joan and family hope that holistic benefits will accrue from regular exercise. The Lokomat uses robotic locomotion therapy to assist walking movements of gaitimpaired patients on a treadmill, combining functional locomotion therapy with patient assessment and feedback tools. It is used in the rehabilitation of patients following stroke, spinal cord injury, traumatic brain injury, as well as patients with Multiple Sclerosis, Cerebral Palsy and other neurological disorders. The benefits of using robotic therapy are many, not least the intensity of therapy one therapist can give, as opposed to manually assisted gait training, which can be challenging, labour intensive, requires many therapists and usually results in relatively short training sessions. Joan Ryan, who founded the charity Coiséim Eile, undertook a massive fundraising effort and, with the help of another parent with a child in therapy at The First Step Therapy Centre, managed to raise the c300,000 needed to bring the Lokomat to the clinic. “First Step is always open to any innovation in the field of rehab,” said Senthil Periyasamy, Director of the centre. “We have seen the benefit of [using the] Lokomat for the patients and their

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“The Lokomat uses robotic locomotion therapy to assist walking movements of gait-impaired patients on a treadmill, combining functional locomotion therapy with patient assessment and feedback tools.”

functional improvements. Lokomat really does the work of two physiotherapists, who would otherwise have to pick up and move a patient’s legs, one at a time, in a walking motion.” First Step Rehab Centre is the only centre in the Republic to have a Lokomat system available to the public (8am-8pm) six days a week. To find out more, visit www.righttherapycare.com. Lokomat is supplied by Hocoma via its partner in Ireland – RollingBall. For more information go to www.rollingball.ie. Tel: Jane Evans + 353 (0)87 224 6287

Another Hocoma Product Armeo – Effective upper extremity rehabilitation Strong research suggests that intensive task-orientated therapy is effective for improving the arm function of individuals after stroke, traumatic brain injury or other neurological diseases and injuries. The Armeo facilitates upper extremity therapy and combines an adjustable arm support with Augmented Feedback and a large 3-D workspace that allows functional therapy exercises in a virtual reality environment.

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Advertisement feature

Here’s what patients at the First Step Centre, Patrickswell had to say: “My injury is complete; I use the Lokomat to exercise my legs, just to get some movement in my lower body. It is excellent. It takes all the spasm out of my legs and lower body. I find that I’m far more flexible after using it.” Pat Flannery, 34, Spinal Injury Patient

+ (L-R) Joan Ryan, Founder, Coiscéim Eile; Sean O’Donavan, Chairperson, Coiscéim Eile; Mary Prendergast, Director of Nursing, St Patrick's Hospital; Oludayo TJ Giwa, Senior Physiotherapist; Gothandan Ramalingam, Senior Occupational Therapist; Bríd Cronin, Physiotherapist and Rosmarie Culley, Physiotherapist Assistant.

St Patrick’s Hospital To receive Armeo donation Coiscéim Eile, the charity founded by Joan Ryan and who recently successfully raised funds to provide a Lokomat to the First Step Clinic, Limerick for use by people with spinal injury, stroke, Cerebral Palsy, Multiple Sclerosis and other neurological disorders, is making another donation! This time, the piece of equipment is the Armeo Spring and the equipment is going to be donated to the Rehabilitation Unit in St Patrick's Hospital, Cashel. Oludayo TJ Giwa, Senior Physiotherapist in St Patrick’s Hospital, explained what the donation means to the patients and staff, “We are delighted that we will be receiving the Armeo and looking forward to the benefits that it will give patients.”

“I suffer from MS; and my walking and movement is affected. Since using Lokomat, I've seen a big improvement with my walk. I'm certainly able to get up easier, and it's easier to get around. Before I could only walk about 100 metres, and now I can walk a kilometre.” Con O'Leary, 29, Multiple Sclerosis Patient “I have had MS for 20 years, which means I can’t walk without crutches or assistance. To be honest, I didn’t really want to start using the Lokomat and went half-heartedly. I have been through a lot of other treatments and I thought ‘oh no, not another one of these places!’ But since using Lokomat, my exercise tolerance and my posture is much better. Two years ago I couldn’t get to the shops, now I can, and it is fabulous to be able to do that.” Geraldine O’Donoghue, Multiple Sclerosis Patient “My son Dylan uses Lokomat as he has Cerebral Palsy. He is three years old and, I think, the youngest person to use it in Europe. The Lokomat is great for teaching Dylan the proper movement of each step and he now has the concept of walking. He used to be terrified of falling over, but it has given him the confidence of being upright.” Maria Walsh “My daughter Soirse is eight years old and developed Acute Disseminated Encephalomyelitis (ADEM) a few years ago. ADEM is a neurological disorder characterised by inflammation of the brain and spinal cord. Lokomat has helped her physically by keeping her weight at bay and it builds up muscle. It means that she walks more often and more quickly.” Lisa Murphy “My daughter Brid is seven years old and has Cerebral Palsy and is completely paralysed as a result. The Lokomat gives her the opportunity to use the muscles she wouldn’t use everyday. The exercises in turn help exercise her organs. She loves using it. I think it is very beneficial for her.” Deirdre Caurtney “My daughter Hannah uses Lokomat; she has Cerebral Palsy. Hannah uses a wheelchair and after using the Lokomat she can now regularly stand. It has given her great motivation. I would recommend the Lokomat as it has given us hope that Hannah may be able to walk with an aid (crutches or a walker) one day.” Catherine O’Sullivan

This is a medical device intended for use by qualified medical personnel only. As a medical device it must be used in strict adherence to the User Manual. It is strongly recommended that the user of this medical device regularly consults Hocoma AG’s website, www.hocoma.com/disclaimer, for any supplemental information that may be provided.

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12/03/2010 15:28:53

Evolution Drives You Forward

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You can also get a 10% discount on your motor insurance (new or renewal) and free Motor Rescue Plus.

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traVel

Malaga Budapest

A tale of THREE CITIES Make the most of springtime with an enthralling break abroad. Travel writer Karen Creed recommends three of her favourite cities for this time of year. BUdapEst

he time of year as winter yields to spring, Budapest is set alight. However, it does not matter what month you visit the Hungarian capital as spa baths and spires, hearty food and quirky shops make it an intriguing escape all year round. the city is often referred to as a big bathtub as it has sulphuric waters that bubble up from the thermal springs below the city. It is this asset alone that sets it apart as one of the best places in the world for a good soak. add to that a direct two hour flight from Ireland, reasonable prices and a stunning setting, and you can see why it takes little convincing to visit this dynamic eastern european capital. the best way to start a visit in Hungary’s capital is on a sightseeing tour along the Danube. the river bisects the capital, and cruising along its 28km stretch is an ideal way to take in the story of how modern day Budapest evolves. It’s like two cities for the price of one as you have the ancient Buda

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district complete with its charming castle and on the other side of the river the modern metropolis of Pest. Budapest offers a slice of east european charm that has not been ruined by bland communist architecture, and the city still boasts many of the most beautiful buildings. although the outskirts of Budapest can be somewhat drab, it is compensated by a city of charming squares, rattling trams and peace and quiet – punctuated only by music. andrassy street adds to Budapest’s list of World Heritage sites, and the restaurants stretch way beyond the stereotypical expectations of goulash. Franz liszt square is one of the most popular areas for dining and the csárda is the most distinctive type of Hungarian venue. two of the most enticing restaurant options include apetito in the Castle district, and Karma in Franz Lizst Square. the romans were first to develop the baths in Budapest and the city has some of the world’s finest turkish baths. Most visitors look for pure soggy, steamy, flotational

Venice

relaxation. For a typically Hungarian spectacle, Széchenyi Bath in the City Park is the largest public bath. as well as bathing in hot springs, you are encouraged to drink the sulphuric water, and enjoy the aromatheraphy saunas and mud chambers. Although Budapest is a tempting getaway for couples and groups, it is also geared towards families with an impressive zoo and the largest ice skating rink in europe. Opera and theatre is also an integral part of Hungarian culture and you can purchase a ticket for as little as c7. The Budapest Card is another worthwhile purchase which combines public transport with free admission to museums. Whether it is sightseeing, dining or pampering; Budapest is one of the most rewarding places to visit in this current climate. For flights to Budapest visit www.aerlingus.com or for package holidays to Budapest, visit www.abbeytravel.ie.

malaga

very year millions of Irish tourists swarm to southern spain, but many bypass the charming capital of the Costa del sol. authentically spanish with a pretty

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Health research makes it win-win for everyone A new cutting-edge ICT (information and communications technology) project improves both patient care and patient management. It also offers a successful template which could be extended to help manage a range of chronic diseases. An Electronic Patient Record (EPR), developed with Health Research Board funding, provides a secure web-based records system which allows one or more health care workers to view and appraise patient information at the same time and in a variety of ways, irrespective of location. This speeds up and improves the quality and safety of care patients receive compared to using traditional paper-based records. Developed by a multi-disciplinary team at Beaumont Hospital, the ERP is already benefiting over 1,000 epilepsy patients receiving treatment there.

• • • • •

Benefits include: Less time needed to review complex medical records when optimising antiepileptic drug therapy. Instant access to up-to-date records to support the epilepsy nurse telephone advice line. Easy identification of patients who meet the criteria for clinical research studies. Better and more effective communication between referring clinicians. Ability to share decision making across all sectors (community, primary care and hospital) in relation to an individual’s care.

This project is a recent success story that illustrates the benefit of health research. The Health Research Board is committed to supporting research that delivers impacts and benefits for patients, for population health and for the health system. Health professionals interested in conducting research should visit www.hrb.ie/research-strategy-funding/grants-and-fellowships/ and sign up for automatic notification of HRB funding opportunities. M35628 HRB 130x188 D.indd 1

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traVel old town, sandy beaches, and real live flamenco, Malaga is an intrinsic reflection of the real andalucia. With more than three hundred days of sun and average temperatures of 23ºC, there is never really a wrong time to visit this coastal city. somehow Malaga has remained a very traditional spanish city, untainted by the surrounding tourism boom. steeped in more than 3,000 years of history, moorish archways and rambling streets lead onto stunning piazzas that are buzzing by day and dazzling by night. Beachlife in Malaga is just as good as anywhere else along the coast and sun worshippers don’t have far to walk to the sandy shores. No discussion of Malaga would be complete without mentioning Picasso. the artist is Malaga’s most famous export (followed by actor Antonio Banderas) and consequently the city’s most famous museum is the Museo Picasso. Housed in an old 16th century palace, it boasts a fascinating collection of the artist’s work and has apparently boosted the number of tourists coming to explore Malaga. Other attractions include the cathedral, la Manquita, the national park and the Paseo del Parque, a botanical masterpiece with tropical plants and trees. Most of the main cultural attractions are gathered around the city’s historic district. Malaga also has plenty to keep the fashionista content, with contemporary malls and enviable boutiques on the swankiest shopping street, Marqués de larios. the people in Malaga, called Malagueños, are known for their hectic social lives whether they are going out for a chat, a drink or a bite to eat. the town therefore has a great variation of restaurants, bars and bodegas, which are normally busy throughout the week. la Campana is a tiny open-fronted space, with locals spilling out onto the streets while the overflow tuck into paella nearby at Plaza de Uncibay. Malaga is also renowned for its seafood and you can sample the finest fish around the old fishing villages of el Palo and Pedregalejo. alongside the high-end restaurants and glitzy hotels, its old town is a trendy mix of alleyways with pretty terrace cafes. While there are plenty of hotels and apartments to choose from, cheap youth hostels are not very common in Malaga.

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renting a car is worth your while if you are staying longer than a weekend. although the city itself is relatively small and it is easy to visit many of the cultural attractions on foot, you will miss out on a myriad of interesting sights around the rest of the Costa del sol if you don’t have access to a car. For flights to Malaga visit www.aerlingus.com or www.ryanair.com. For information on Malaga, check out www.andalucia.com.

VEnicE

ou have seen it in photos and films, but there’s no substitute for the reality – the shimmering Grand Canal, the gondolas slipping down watery alleyways, the elegant palazzos emerging straight from the sea. Venice is all about subdued elegance. that said, it is essentially a touring city, full of labyrinth streets and tons of bridges so if you don’t want sore feet, bring your most comfortable shoes for daytime. Don’t ditch the style completely – pack a few beautiful dresses and tailored suits to live up to the Venetian glamour at night. Venice has reason to call itself the world’s most romantic city with a delightful maze of fine palaces, galleries of stupendous works and a new breed of excellent restaurants. Not to mention the key attraction, the canals that confront you at every turn, and make getting lost in Venice a pleasurable adventure. the gondola ride is the ultimate

touristy thing to do and lasts anywhere from thirty to fifty minutes and costs approximately c80. Negotiate the rate before you get in or keep costs down by sharing a gondola with other tourists. to revel in pure Venetian charm the Cipriani has a secluded setting, but it might be too remote for some. For a hotel with views of the canals and gondolas check into the magnificent Danieli. the san Clemente Palace occupies a private island, 10 minutes across the water from the Piazza san Marco. their guest book is also bursting with big names, mainly film stars. Venice gets unfeasibly crowded in high season, and queues are frequent. remember though that many visitors are day-trippers and that evenings are usually less fraught. try going out of season. You will not get the warmth of summer, but what you’ll be rewarded with is bargains galore as hotels are desperate to fill their rooms. You will also get good value in restaurants. For a gastronomic dinner hunt down one of the atmospheric bars known as bacari, which serve traditional Venetian cuisine at cheap prices. the waterside terrace of the De Pisis is quite simply the most romantic place in Venice for dinner, while Il Gatto Nero in the nearby island of Burano is worth booking also for a memorable lunch or dinner. For flights to Venice visit www.aerlingus.com or www.ryanair.com. For hotels in Venice visit www.hotels.com.

Venice

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122 HealtH Matters

reaDinG

HEAlTH MATTERS

BOOK REvIEWS

There are quite a few new Irish books both out now and soon to be released. Health Matters picks the best of the bunch.

the guarDs Set in Galway, The Guards is the first of Ken Bruen’s awardwinning Jack taylor crime novels. It tells of taylor, a disgraced policeman, and his entanglement in a high-powered conspiracy following a drunken encounter with a mysterious woman. throughout, Bruen creates memorable characters infused with edgy, disturbing and occasionally comic qualities as taylor’s booze-addled, dishevelled and disruptive persona forces his way into their lives. this

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series of books has proven to be massively successful, establishing Bruen as a crime writer comparable to Ian rankin and has drawn praise from other crime writers such as George Pelecanos, novelist and cowriter of HBO’s The Wire. this breakthrough novel won the award for best novel at the 2004 shamus awards for detective fiction and has been reissued to coincide with the filming of The Guards, starring Ian Glen (Tara Road, Song for a Raggy Boy), due for release in 2010. Penance Room FINAL AW final 26mm

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the penance rOOm From Carol Coffey, the author of The Butterfly State, comes this fantastically written book. It is based around a generation of characters that lived through worldwide conflict but is seen through the eyes of 13-year-old boy Christopher who lives in Broken Hill Nursing Home. Christopher has been deaf since childhood and also lost his foot in an accident at a train track. the book takes us on an adventure with Christopher as he meets friends such as Maria, a young, beautiful melancholic girl; and a young man who arrives to document the lives of the nursing home's immigrant residents. Carol Coffey has used her extensive background in disabilities to bring the world of special needs to the wider population through her writing and this latest book is a fine example of that. this book is intensely poignant and original and it will take you on a journey of great emotional and atmospheric depth. Broken Hill Nursing Home is a house laden down with secrets, its residents now settled in Australia but living out their troubled lives trapped in the past. Thirteen-year-old Christophe r, whose parents run the home, self-appointed guardian. Deaf is its since childhood, his foot severed in a horrific accident, he notices what others miss. Isolated and ignored, he is obsessed with helping these damaged souls find the peace they crave. He befriends the beautiful young Maria whose strange sadness puzzles him, then gains an ally when a mysterious young man arrives to record extraordinary lives of the aging the immigrants. Christopher eagerly awaits the transformations he expects will result from these ‘confession s’. But will delving into the past disturb the residents’ fragile mental state and open up a Pandora's box that was best left closed? And can Christopher himself survive their terrible disclosures? 'Beautifully written, this novel should not be overlooked!' U magazine

978-1-84223- 408-2

poolbeg fiction

Designer genes Ireland’s newest author, emma Hannigan, has arrived on the scene with an impressive first book, Designer Genes. taking a look at the world through the eyes of two women, this book takes you on a journey of very real life experiences. emily, a happily married mother of two, has her world turned upside down when she discovers she is the carrier of a dangerous cancer gene. she struggles to deal with the challenges arising before her, making life and death decisions. Her friend and psychologist, susie, supports emily in her time of need, but has demons of her own to wrestle with. this book will take you on a rollercoaster of emotions as emily and susie embark on their individual voyages that are both heartbreaking and hilarious!

skippy Dies this is the second novel from Irish novelist Paul Murray. His first, An Evening of Long Goodbyes was shortlisted for the Whitbread First Novel award 2003 and nominated for the Kerry Irish Fiction Award. Seven years later, Murray is back with a bang and a tragi-comic tale of adolescence, adulthood and death. set in the fictional seabrook College, a private boys’ school in the south Dublin area and run by the Holy Paraclete Fathers, Skippy Dies introduces a cast of characters with numerous interwoven narratives from students and teachers alike. squeezing in an education on robert Graves, World War One, M-theory, string theory and the origins of the universe, Skippy Dies is ambitious to say the least. However, Murray rises to the challenge and delivers a cult read that will hold your attention to the 661st page.

I d e al fo

r your B ook Club discussion

the village The Village, the third in the series of books by alice taylor, is now available in a new edition, republished by Brandon Books. Alice taylor is renowned for her successful series of memoirs detailing the delicacies of Irish rural life, her experiences of the Irish countryside, its traditions, and many of the quirky yarns and characters that populate this past world. Following on from her other books To School Through the Fields and Quench the Lamp, The Village recounts her move to Innishannon, Co. Cork, where the newlymarried taylor and her husband represent incremental change in early sixties Ireland.

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Health Matters 123

kids' Corner

Kids' Corner It’s spring! And Health Matters has not forgotten about our section especially for kids. We have a wonderful picture to colour in below and some fun quiz questions too. As usual, the same rule applies: no parents allowed! Have fun!

QUIZ TIME! Here are five fun questions about cartoons; see how many you can answer… 1: In the movie Toy Story, what is the name of the kid Woody belongs to? 2: What two languages does Dora the Explorer speak? 3: What is the name of Jimmy Neutron’s teacher? 4: What is Drake and Josh’s little sister’s name? 5: In Ben 10, what evil character keeps trying to get the Omnitrix from Ben? 6: In the movie Up, what uniform was Russell wearing?

Answers: 1: Andy, Woody is his favourite toy…until Buzz comes along! 2: Spanish and English 3: Miss Fowl 4: Megan 5: Vilgax 6: A Wilderness Explorer uniform HM Iss6.1 p71-128.indd 123

COLOUR ME IN!

This Easter bunny is collecting some yummy chocolate eggs to give to boys and girls across the country. What kind of Easter egg are you getting this year?

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124 HealtH Matters

CoMpetitions

Win! A one-year licence

for eset smart security – the most effective computer software protection against internet and email threats

surfing the web and using email is a part of daily life and cybercriminals capitalise on this to their advantage, flooding the internet with over 100,000 new attacks every day, in an effort to steal your identity, your money, or even turn your computer against you by launching email spam and other internet crimes. Over 70 million users worldwide trust eset to defend themselves from these attacks. eset smart security is the most effective protection you can use to combat today’s huge volume of internet and email threats. It combines eset's award-winning NOD32® proactive antivirus and antispyware protection with a powerful yet easy-to-use firewall and robust anti spam technology. Using the advanced threatsense® technology, eset smart security proactively protects computer users from new attacks during the critical first hours. eset smart security detects and disables both known and unknown viruses, trojans, worms, adware, spyware, rootkits and other internet threats. It is also faster, more effective and easier to use yet simple to optimise for anyone’s specific needs. We have five three-user, one-year licences for eset smart security to giveaway in this issue of Health Matters. simply answer the question below:

Bewley’s hOtels ARE OffERING HEALTH MATTERS READERS THE CHANCE TO WIN A SHORT BREAK fOR TWO STAyING IN ANy ONE Of THE GROUP’S SIX POPUlAR HOTElS! Occupying a variety of enviable locations throughout the UK & Ireland, you and a lucky companion can choose to stay at any of four Dublin-based properties; Dublin Airport, Newlands Cross, Ballsbridge or Leopardstown or one of two Bewley’s Hotels in the UK; one at Manchester Airport and the other in Leeds. Checking in and staying for two nights, guests will begin each morning with a hearty Bewley’s Hotel breakfast, the perfect way to set you up for the day, whether you intend to visit the local sites, attend a business meeting or just relax in the comfort of your hotel. When night falls, enjoy a delicious dinner for two on an evening of your choice in the hotel’s Brasserie restaurant where you will find a menu bursting with variety and local flavour created by the hotel’s talented team of international chefs. Bewley’s Hotels offer great value accommodation in some of the UK and Ireland’s most popular destinations. their close proximity to the city centre, airport and major road networks makes them an ideal base for business and leisure visitors seeking a superb central location for even better value. A good night’s sleep is definitely on the cards at any Bewley’s Hotel and guests can expect to find sound-proofed bedrooms, fluffy hypo-allergenic pillows and ‘dive-into-bed’ duvets. Bliss!

which Of these cities in the uk has a Bewley’s hOtel lOcateD in it? a) manchester

hOw many new attacks DO cyBercriminals unleash OntO the internet Daily? email your answer, full name, address and phone number to competition1@ashville.com with ‘eset competition’ in the subject line. Closing date for entries is Friday 16th april. all entries will be entered into a draw and the five winners will be notified by eset and receive their prizes in the post.

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b) lOnDOn

c) newcastle

Please email your answer plus your full name, address and phone number to competition2@ashville.com with ‘Bewley’s competition’ in the subject line. Closing date for entries is Monday 12th april. all entries will be entered into a draw and the winner will be notified by Bewley’s Hotel. Whichever Bewley’s Hotel you choose to stay at you will always be guaranteed quality and value in warm and friendly surroundings. For more information about the group or for great rates and availability online check out www.bewleyshotels.com or loCall 1890 79 89 99 (rOI) or 0845 234 5959 (UK).

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HealtH Matters 125

CoMpetitions

Win a pair oF mBts MBT – THE PHySIOlOGICAl fOOTWEAR! You may have spent past years following fad diets or exercise crazes to get rid of excess winter weight, but this year there is an added solution to kickstart your spring fitness regime: physiological footwear. a new study by sports scientist Marcus Hien and Weight Watchers has revealed that participants in the Weight Watchers nutrition program who trained wearing MBT footwear lost on average 12 per cent more weight than Weight Watchers participants who did not take part in the MBT training. the study’s findings were confirmed by research by the University of salzburg in austria, which revealed that jogging slowly in MBTs increases energy expenditure by 13 per cent compared to jogging in normal running shoes. Further research by the University of Bern in Switzerland revealed that even just standing in MBTs increases oxygen consumption by nine per cent compared to standing in conventional shoes, and also helps train additional muscles while

relieving strain from the back and joints. the patented sole construction of MBT physiological footwear simulates walking barefoot on soft, natural grounds, thus activating the very important small muscles throughout the body. this strengthens the muscles involved in support and posture, relieves the strain on the joints, shapes the body and speeds up the metabolism. MBTs can help to relieve back and joint pain, improve the figure, increase sporting performance or keep you comfortable during a long day on your feet. The effectiveness of MBT has been proven by numerous studies at leading universities. It is a registered medical product in switzerland and in the eU. MBT was developed in Switzerland and came to market in 1998 after the inventor studied the Masai people of Kenya, who are renowned for their great posture and stamina. so he honoured them by naming the shoes Masai Barefoot Technology

(MBT). MBTs are now worn by millions of people in over 30 countries. We have three pairs of MBTs to give away! to be in with a chance to win a pair, please answer the following question:

what DOes mBt stanD fOr? email your answer, plus your name, address and phone number to competition3@ashville.com with ‘MBT competition’ in the subject line. Closing date for entries is Wednesday 14th april. all entries will be entered into a draw and winners will be notified by MBT Ireland. For more information on www.ie.mbt.com or email: info@swissmasai.ie. MBT Ireland, Glen Mervyn House, Glanmire, Cork. tel: (021) 482 1106

WIN TWO NIGHTS B&B fOR TWO AND DINNER ON ONE EVENING IN the heritage gOlf & spa resOrt The Heritage Golf & Spa Resort is one of the most exciting resorts to have opened in recent years and is the true jewel of the midlands. this comprehensive and all-embracing resort offers everything, and renders guests speechless with its range of first-class facilities. Nestled close to the foot of the Slieve Bloom Mountains, on the Laois/Kildare border and just one hour from Dublin, it has something for even the most discerning of guests. this world-class lifestyle resort features: a 98-guestroom five-star hotel, a championship golf course co-designed by Seve Ballesteros

and Jeff Howes, a magnificent club house, resort spa, the seve Ballesteros ‘Natural’ Golf School, health club with pool, children’s games room, tennis court, trim trial, a four-mile ground-lit walking track, self-catering homes, on-course two-bedroom suite apartments and a variety of restaurants and bars. the Heritage resort offers many activities for all the family to enjoy during school holidays. this easter, there are a host of free activities lined up such as family rounders, giant games, basketball and more. to be in with a chance to win, answer this question:

which cOunty is the heritage gOlf & spa resOrt lOcateD? a) kerry

B) laOis

c) Offaly

email your answer, plus your name, address and phone number to competition4@ashville.com with ‘Heritage competition’ in the subject line. Closing date for entries is thursday 15th april. terms & conditions apply and prize is subject to availability at time of booking. For more information; tel: (057) 864 5500; email info@theheritage. com, or log on to www.theheritage.ie.

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Radio & Security Products LTD. We are specialists in Radio and wireless communications systems for the Health Sector.

Wireless Nurse Call Staff Protection Lone Worker Solutions Hospital Bleep System Conventional & Digital Two-Way Radio Solutions Authorised Irish agent for STANLEY/BLICK paging and AMCOMSOFT FUSION paging. We supply new systems and offer maintenance on existing systems. Located in Dublin 12 with full 32 county service offering. Tel: (01) 429 0002 E-mail: info@rsp.ie

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“What we sell, we support” Lo-Call 1890 210 210 www.advancedmon.com • Camera Systems • Access Control • Intruder Alarms • Intercoms • Barriers/Gates • System Integration

www.peoplesafe.ie 0818 333 150 Risk Assessment Safety devices Expert advice and support

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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

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Health Matters 127

crossword

Crossword No 1

by Zoë Devlin

ACROSS 1. Cleansers and moisturisers perhaps (8) 5. No. 52 St, home of the Mater Hospital, Dublin (6) 9. Hurt or deceive – as in elder abuse (3-5) 10. Recent arrival, only here a wet week! (4,2) 12. Ophthalmologists care for these organs (4) 13. Network of tissue that fills bone cavities – bit of a maroon brew! (4,6) 15. Having these little head-lice isn’t funny! (4) 16. Remote medical presence now in use in Mullingar (7) 19. Weight-bearing rehabilitation machine (7) 21. He nods to these teachers at universities (4) 23. Place organ or 13 Across into a recipient’s body (10) 24. Symptom of physical hurt (4) 27. Untie or make less strict (6) 28. Condition associated with high levels of sugar in blood (8) 29. The digestive and urinary perhaps (6) 30. GP Exercise Programme, designed to improve health (8)

DOWN 1. The H1N1 vaccination is against flu (5) 2. Malnourished (3-3) 3. City where new cancer centre opened last December (4) 4. Even Señoras have these explanations! (7) 6. Bone linking the scapula and

9 11 12

13 14 15

17 19

18 20

21 22

26 27

sternum (6-4) 7. Not too serious in infections – inferior (3-5) 8. Lunchtime snack (8) 11. Look searchingly at this person of equal standing (4) 14. Acid-base indicator or critical indication of failure or success (6,4) 17. Minute cell, essential for clotting (8)

18. US state and musical – we’re doing OK here! (8) 20. Cost of epidemic or road deaths (4) 21. Hard material which makes up a tooth (7) 22. Head of hospital or high-ranking chess player (6) 25. Relating to the nose or high-pitched (5) 26. Having skills and being capable (4)

Scribble box

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128 HealtH Matters

Me anD MY Job

Getting to

KNOW yOU... NAME: Brendan Cuskelly JOB TITLE: Maintenance Manager laois/Offaly BASE: Midland regional Hospital tullamore

HOW lONG HAVE yOU WORKED WITH THE HSE? I am with the Hse since February 1994; I took three years leave of absence in 2002 to work on the construction of the new hospital in tullamore. I returned to my current position in October 2005. DESCRIBE yOUR JOB IN fIVE WORDS Maintaining safe comfortable healthcare facilities WHAT'S yOUR AVERAGE WORKING DAy lIKE? I am responsible for all maintenance activity in two hospitals in Portlaoise and tullamore (520 beds) and over 500 beds in elderly care units in the Midlands, with an additional 191 beds in the psychiatric services in laois/Offaly. a typical day would generally begin in tullamore Hospital at 8:30 a.m. where I respond to emails and liaise with maintenance supervisory staff on urgent issues for resolution. I would be in daily

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contact with Hospital Managers and Directors of Nursing on day to day issues relating to running of the service, such as staffing, budgets, resources, Hr and Ir issues. I also work closely with our estates department, in relation to new construction projects, refurbishments, minor capital and major capital expenditure and health and safety issues. I would be in constant contact with our accreditation department and infection control on a wide spectrum of issues such as decontamination, legionella control, hygiene audits, HIQa audits and waste management. WHAT DO yOU lOVE ABOUT yOUR JOB? the fact there are never two days the same and the challenge of managing a service which is currently under reform and ever changing. If yOU COUlD CHANGE ONE THING ABOUT yOUR JOB WHAT WOUlD IT BE? I would like if I could specialise more on particular aspects of the job in, which I have a keen interest, for example, energy conservation and utility management. WHAT'S yOUR fAVOURITE BOOK AND WHAT DID yOU lIKE ABOUT IT? Kings of September by Michael Foley â&#x20AC;&#x201C; this was an epic story of the 1982 classic all-Ireland Final that changed lives and dramatically altered the course of Gaelic football history. The day Offaly denied Kerry five in a row. WHAT'S yOUR fAVOURITE fIlM AND WHAT DID yOU lOVE ABOUT IT? Favourite film is the shawshank redemption â&#x20AC;&#x201C; this was a highly entertaining

gripping story line, brilliantly executed by the two leading actors Morgan Freeman and tim robbins. WHAT'S THE MOST MEMORABlE THING yOU HAVE EVER EXPERIENCED? the most memorable thing I have ever experienced was the birth of Dylan our son. WHAT TEAM WOUlD yOU DIE fOR? None, I am interested in all sports, and have a huge interest in Gaelic football and hurling. I would be a strong supporter of Offaly GAA and I am involved in under age training with our local GAA teams. I am also a Manchester United fan. fAVOURITE SPORTING MEMORy? I am fortunate to have many great sporting GAA memories following Offaly in the eighties and nineties but the one that stands out is being in the Hogan stand at the 1994 all Ireland final when Offaly came back from the dead to snatch an unbelievable win over limerick. WHO HAS INSPIRED yOU THE MOST? My parents and family. PET HATE? Being late for anything. TOP THING ON yOUR DREAM lIST If yOU WON THE lOTTO? I feel fortunate to have most things I could want, winning the lotto would give me the opportunity to financially support my wider family and friends and local charities. I probably would splash out on season tickets for Old trafford and spend more time getting down my golf handicap.

12/03/2010 15:30:08

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15/03/2010 12:37:04

HEALTH Vol 6 I Issue 1 I Spring 2010

INSIDE - CERTIFICATES.IE - GP EXERCISE REFERRAL PROGRAMME - KIDNEY TRANSPLANT - PENSIONS

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

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

MATTERS National Staff Magazine of the Health Service Executive

HEALTH matters ROLLING OUT Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Spring 2010

FILMLESS X-RAY SERVICES

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 27

Vol 5 I Issue 3 I Autumn 2009

HM Iss 6.1 Covers.indd 1

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