Health matters Spring 2011

HEALTH Vol 7 I Issue 1 I Spring 2011

INSIDE - KNOCKAMANN RESIDENTS SETTLE IN - NATIONAL SPINAL UNIT - FOSTERING UPDATE - CROKE PARK AGREEMENT

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

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

MATTERS

ational Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Spring 2011

DRAWING ON ART FOR THERAPY

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 9

22

90

96

Vol 5 I Issue 3 I Autumn 2009

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03/03/2011 15:45:20

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02/03/2011 16:41:11

HealtH Matters 1

welCome... …to the spring edition of Health Matters! Our first edition of 2011 is packed with updates and features from across our health system.

My colleague laura Monaghan writes about a small group of patients who are benefitting from high-tech treatment now available in Dublin’s Mater Hospital. laura also visited Knockamann, a new development of ten bungalows and a Day resource Centre in the grounds of st Ita’s Hospital, Portrane in north county Dublin, and shares the experience with us. elsewhere in this issue, read about six-year-old Conor reidy and his battle with a very aggressive form of liver cancer.

We have a selection of great stories from staff; Katie Mcelroy writes about her experiences in Dublin’s tallaght Hospital as an intern and Kapil sharma describes his time as a medical student.

I want to thank all our readers for their continued support for the magazine. Health Matters was recently shortlisted for as Customer Magazine of the Year 2010 by Magazines Ireland, the association for magazine publishers.

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 special thanks to all the contributors to the magazine.

We hope all our readers enjoy this issue!

Sites We Like...

www.timewisefostering.ie

www.cismnetworkireland.ie

stephen McGrath – editor Head of Internal Communications the magazine is produced by the hse's communications directorate. publishers: ashville Media – www.ashville.com feedbAck: send your feedback to internalcomms@hse.ie production cost: Health Matters is supported by advertising and last year there was no cost to the Hse for its print, design and distribution.

Did you know?

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• Our front cover picture shows Brent Pope with Hse art physchotherapist Catherina Brady. see page 30 for full story • From next May, doctors are subject to a statutory obligation to maintain professional competence • anne-Marie Ward, a Disability service Manager in Donegal, made history when she became the first Irish woman to swim the North Channel, which connects the Irish sea to the atlantic Ocean • Professor eilis McGovern is the first female President of the royal College of surgeons in Ireland in its 226-year history

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• More than 200 nurses are to complete a course enabling them to prescribe certain x-rays independently 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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16/03/2011 16:07:30

Biomnis Ireland A New Name For Your Partner In Pathology Claymon Biomnis has become Biomnis Ireland.

Biomnis Ireland is proud to have over 20 years experience in Ireland providing a laboratory service that uses the most sophisticated diagnostic equipment and techniques in all fields of medical pathology. Now as part of the Biomnis Group, one of Europe’s largest medical laboratory groups, Biomnis Ireland is committed to investing in skilled people, innovative tests and cutting edge technologies which will assist healthcare professionals diagnose, monitor and treat patients every day.

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The Biomnis Group was formed over 100 years ago by Marcel Mérieux, a protégé of Louis Pasteur. Since then, it has grown to become one of Europe’s leading specialist medical laboratories, with 65 pathologists and over 1,000 specialist scientists and technologists.

Be in with a chance to WIN an Apple iPad To help us celebrate our renaming to Biomnis Ireland, we want to offer you the chance to WIN a FREE Apple iPad. All you have to do is correctly answer this question: How many years experience does Biomnis Ireland (pronounced By-Om-Nis) have providing a laboratory service in Ireland?

Email your answer followed by your name and organisation name to info@biomnis.ie.

All correct replies will be entered into a draw on March 31st 2011. The winner will be contacted by email.

Biomnis Ireland, Three Rock Road, Sandyford Business Estate, Sandyford, Dublin 18, Ireland.

Tel: +353 1 295 8545

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16/03/2011 16:07:33

HealtH Matters 3

Contents

77 HaND HYGIeNe Dr Fidelma Fitzpatrick highlights the importance of preventing healthcareassociated infection 78 MOBIle MeDICatION eileen Coleman explains how ‘Home Pharmacy’ works 80 elDer aBUse this feature looks at the first prevalence study of elder abuse in Ireland 82 astellas aWarDs rewarding outstanding work 83 a FaIr WaY tO HealtH Greg Conlon tells us about the Health Fair in st Vincent’s Hospital, Dublin 85 VIDeO CONFereNCING

DeVeLopMentS 4 Dr rICHarD steeVeNs scholarship Winners 2011 9 eCMO Innovation in the Mater Hospital 15 KNOCKaMaNN residents tell us about their new homes 19 eXIt sCHeMes thank you from sean McGrath 20 CrOKe ParK aGreeMeNt Developing services nationwide 22 aMBUlaNCe UPDate Innovations are producing significant improvements in patient care 24 NatIONal sPINal INJUrIes UNIt Mr ashley Poynton gives us an update on the Mater Unit 27 NatIONal sUrGICal CeNtre FOr PaNCreatIC CaNCer taking a closer look at the new centre 30 tHe art OF tHe MIND Brent Pope on why it can be good for people with mental health issues to display their artistic work

reGIONal NeWs 44 DUBlIN MID leINster 48 DUBlIN NOrtH east 52 sOUtH 56 West FeAtUreS & UpDAteS 60 MeNtal HealtH serVICes seminar looks at progress on ‘a Vision for Change’ 62 NOrtH sOUtH CHIlD PrOteCtION HUB National specialist Caroline Cullen highlights the online resource 64 GOrDON JeYes the newly appointed Hse National Director for Children and Family social services outlines his aims and objectives 65 FOsterING this feature looks at some new initiatives to help foster families 68 DIaBetes FeDeratION Hse dietician liz Kirby on the best way to manage diabetes

87 MeDICal COUNCIl this feature looks at the Medical Council’s new system to promote patient safety and quality of care.

YoUr StorieS 89 INterNsHIP Katie Mcelroy writes about her new life as an intern at tallaght Hospital 90 aGaINst all ODDs Hse doctor Gerardine sayers on what happened after her young son was diagnosed with liver cancer 93 DIet Matters Hse staff member Denise Melia allows two Hse experts to give her feedback on her diet and exercise programme 95 MUsIC tHeraPY taking a closer work at the work of music therapist sebastian Boes who is based in Cherry Orchard Hospital 96 sPOrtING PassIONs Disability services Manager anne Marie Ward on being the first Irish woman to swim the North Channel.

70 OPD ClINICal PrOGraMMes Dr Barry White on how the programmes are aiming to cut waiting times for outpatient appointments

97 MeDICal stUDeNt’s DIarY Kapil sharma on his path to becoming a junior doctor

71 CHIlDHOOD OBesItY One in four six year olds are either overweight or obese

98 GettING tO KNOW YOU Greg Conlon on his job as a health promotion officer

37 PHYsIOtHeraPY eDUCatION Creative models of clinical education can have significant benefits for patients

72 OPeratION traNsFOrMatION Dr eddie Murphy on his role in this year’s rte show

99 a DaY IN tHe lIFe Kerry-based clinical nurse manager Mary Devane tells us about her day

39 aPPOINtMeNts New appointments in the health service

75 tO JaB Or NOt tO JaB? a special feature on how the Hse is issuing an updated immunisation guide for new parents to mark european Immunisation Week

101 PersONal FINaNCe eoin McGee on where to invest your additional Voluntary Contributions

trAininG 33 rCsI PresIDeNt Professor eilis McGovern talks to Health Matters

neWS 41 NeWs IN BrIeF

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104 COMPetItIONs

16/03/2011 16:07:40

4 HealtH Matters

developments

Dr richard Steevens sCHOlarsHIP WINNers 2011 the HSE’s Medical Education and training unit has awarded four scholarships and three bursaries to Specialist registrars (SPrs) to train in centres of excellence abroad. this update explains the importance of this programme and this year’s winners.

t

he 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. the Dr richard steevens scholarship funds doctors to train in centres of excellence abroad in novel areas of medicine, which are unavailable or limited in Ireland. the aim of the programme is to sponsor doctors to train abroad, allowing them to bring the skills gained back to the Irish health service. It also provides the Hse with the opportunity to actively target particular areas of patient care for sponsorship.

bAckground the scholarship was established in 2007 by the Medical education and training Unit of the Hse, in collaboration with the postgraduate medical training bodies.

It was developed in response to the recognition by the Government of the importance of developing medical trainees and providing them with opportunities to obtain the best training in some of the top international centres. the scholarship was named after Dr richard steevens, in whose memory Dr steevens’ Hospital in Dublin was established in 1733. Dr steevens was an original signatory on the charter for the royal College of Physicians in Ireland in 1692 and President of the College. the decision to name the scholarship after him provided a fitting way in which to link the history of medicine in Ireland with the desire to acquire the best skills and knowledge available from world leaders in medicine, for the benefit of patients in Ireland.

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to date, 20 doctors have been sponsored on the programme, 16 of these on scholarships and a further four on bursaries. these doctors have trained in hospitals and centres in australia, North america, France, sweden and the UK. Many of the doctors who have been sponsored on the scholarship in the past have since returned to Ireland to work in the Irish public health service and a number have been appointed to consultant posts.

applicants to the scholarship must be in the latter stages of their higher specialist training and must demonstrate a strong track record of achievement. scholarship winners are awarded their salary for the duration of their placement, which may be up to 12 months.

the 2011 scholArships this year, the Hse targeted the areas of transplantation medicine and paediatric immunology, but also considered applications in other sub-specialty areas.

+ Winners of the 2011 Dr richard steevens’ scholarship are (l-r): Dr Colin lenihan, Dr Mary laing and Dr William robb

16/03/2011 16:07:47

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Quest Diagnostics is committed to applying the highest possible quality of care and expertise to each and every test we undertake for Irish patients. We can offer this pledge due to the 40,000 people we employ (including 900 MDs and PhDs), our world-class laboratories and the expertise we acquire from our 150 million laboratory tests annually.

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16/03/2011 17/11/2010 16:07:48 15:02:43

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16/03/2011 16:07:50

HealtH Matters 7

developments

+ Past recipients of the Dr richard steevens scholarship symposium, pictured at the inaugural Dr richard steevens symposium on December 8th 2010 in the Worth library. l-r: Dr Fionnuala Breathnach, Consultant Obstetrician/Gynaecologist, Brian Manning, Consultant General/ Vascular surgeon, and Conor shields, Consultant Colorectal and General surgeon

the four recipients of the scholarship in 2011 have just been announced.

hse dr richArd steevens scholArship 2011 winners: • Dr Mary Laing – who will train in dermatooncology in transplant patients at the royal albert Hospital and sydney Melanoma Diagnostic Centre in University of sydney • Dr Elizabeth Smith – who will train in gastrointestinal oncology and lymphoma at the royal Marsden Hospital, london • Dr Colin Lenihan – who will train in kidney transplantation in stanford University Medical Centre • Dr William Robb – who will train in oesphago-gastric surgery at l’Hôpital Claude-Huriez, lille In addition, three bursaries were awarded under the programme to Dr Venita Broderick, Dr Crochan O’Sullivan and Dr Anne O’Neill. pAst recipients In December 2010, the inaugural Dr richard steevens symposium was held in the Worth library in Dr steevens’ Hospital. the symposium was opened by Dr Frank Dolphin, Chairman of the Board of the Hse. three of the past recipients of the Dr richard steevens scholarship presented at the symposium – Dr Fionnuala Breathnach, Dr Conor Shields and Dr Brian Manning – outlining their experiences abroad and how the knowledge and training gained while

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away has been applied to the care of patients since their return.

Dr Fionnuala Breathnach was awarded the scholarship in its inaugural year in 2007 and trained in maternal-fetal medicine at Columbia University College of Physicians and surgeons, New York. since her return, Fionnuala has been appointed as Consultant Obstetrician/Gynaecologist and senior lecturer in Maternal Fetal Medicine at the rotunda Hospital, Dublin.

Dr Conor shields also received the award in its inaugural year and trained in minimally invasive approaches to inflammatory bowel disease and colorectal cancer surgery at Hôpital Beaujon, Clichy and Hôpital saint-antoine, Paris. after completing his placement abroad, Conor was appointed as Consultant Colorectal and General surgeon at the Mater Misericordiae University Hospital, Dublin.

Dr Brian Manning was awarded the scholarship in 2008 and trained in endovascular surgical techniques at the University of Malmo. since returning to Ireland, Brian was appointed as Consultant General/Vascular surgeon at Cork University Hospital. extracts from the Dr richard steevens scholarship symposium will be available shortly on the new Medical education and training Hub on www.hseland.ie Further information is available from the Hse’s Medical education and training Unit; email: metr@hse.ie.

dr conor shields “the aim of the fellowship year in surgery has always been to secure a position within a highly-regarded clinical centre. Given the close cultural and linguistic ties that link our countries, the United Kingdom and the United states have always seemed the logical choices for an experience abroad.

However, non-english speaking europe has a lot to offer; the world’s first laparoscopic cholecystectomy was performed in France, while the Dutch and scandinavian health systems are frequently cited as models that we should attempt to emulate. armed with limited French, I set off to spend 16 months working in Paris, in Hôpital saint antoine, and Hôpital Beaujon, Clichy, under the supervision of Professeurs emmanuel tiret and Yann Parc, and Professeur Yves Panis, respectively, renowned gastrointestinal surgeons. the post required full immersion from the start, including participating in an on call rota. this highlighted one of the issues that was to dominate my time in France: language.

While there is no doubt that acquiring and working in a second language is a very rewarding experience, it certainly introduces an extra layer of complexity to the workplace, and contributes to a number of fraught nights on call. anyone considering a fellowship in France should bear in mind that they would be expected to have attained a reasonable proficiency in the French language.

Working and living in Paris was hugely enriching on a personal as well as a professional level. Weekends were spent exploring Paris, while weekdays were spent gaining an understanding of the workings of the French healthcare system, which in structure is not much dissimilar from our own. the clinical focus of my year was the management of rectal cancer, and since returning to Ireland, I have been fortunate to secure a post as a Consultant Colorectal and General surgeon in the Mater Misericordiae University Hospital, one of our national rectal cancer centres. the ‘centre of excellence’ model is employed in France, and seeing it in operation was of enormous benefit. the experience, which I gained, has been invaluable to me in contributing to the service in the Mater Hospital.”

16/03/2011 16:07:54

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15/03/2011 09:20:46

Health Matters 9

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,

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A small group of patients who cannot be maintained or supported through their acute illness with conventional therapies are benefiting from high-tech treatment now available in Dublin’s Mater Hospital, writes Laura Monaghan.

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T

he Extracorporeal Membrane Oxygenation (ECMO) machine hooked up to a very sick patient in the Mater’s Intensive Care Unit is surprisingly slick and small. The patient is battling H1N1 flu and has severe lung failure.

The ECMO technology is draining blood out of her body, removing carbon dioxide and adding oxygen before sending the blood back into her body, basically doing the work of her lungs. It’s also doing something else that you can’t see. It is giving her family hope.

An extra level of support ECMO treatment is used to help people who have severe lung or heart failure. The machine is for patients who continue to deteriorate despite the best conventional treatments such as breathing machines. The Mater team treated their first lung failure patient with ECMO in August 2009 and have treated about 14 patients to date.

International figures show how ECMO survival rates have improved from 10 per cent in the 1970s to a 60 per cent or higher survival rate today.

16/03/2011 16:07:56

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25/11/2010 16/03/2011 12:30:12 16:07:57

2:30:12

HealtH Matters 11

developments

+

Medical Director of the Mater eCls service ed Carton believes it is important to be able to offer eCls treatment to the small number of critically ill patients who won’t survive without it

world expert in eCls, Dr Palle Palmer in the Karolinska Institute. Carton had thought his patient was going to die when she failed to respond to any of the conventional treatments, but she recovered after the treatment in sweden and returned to the Mater for rehabilitation.

He explains, “Our best conventional supports are good and we’re fortunate to have very good equipment, but there is a small group of patients who just cannot be maintained or supported through their acute illness. so from 2005 onwards, having been a complete non-believer in eCls, we said this is something we absolutely need to develop in the Mater and we need to plan how to do it.”

Dr Carton began to liaise with colleagues in Our lady’s Children’s Hospital, Crumlin who were putting together an eCls programme to support their heart surgery programme. a steering committee was formed in the Mater with representatives from intensive care doctors, intensive care nurses, cardiothoracic surgeons and profusionists. the team approached Mater CeO, Brian Conlon who was ‘very supportive’ of the plan.

around the world including the Karalinska hospital in stockholm, leicester, Paris, regensburg and Melbourne. Irish nurse serena O’Brien, who was a specialist Intensive Care Nurse educational Facilitator in the alfred Hospital in Melbourne, was appointed eCls Coordinator in the Mater in February 2009. she immediately started putting together an eCls education programme for ICU nurses and physicians, which is based very closely on the recommendations of the Us-based extracorporeal life support Organisation (elsO).

“One of the big logistical problems with eCls is that you need highly-trained specialists in attendance all of the time”.

Dr Carton explains “the Mater, the eCls specialist staff are fully-qualified ICU nurses, who have undertaken advanced training in extracorporeal support”. “the Mater eCls training course includes lectures, practical demonstrations, an exam and 40 hours bedside practice under the supervision of the eCls co-ordinator. the eCls specialists are fully supported by the eCls co-ordinator, intensive care clinical nurse managers, senior ICU nursing staff, perfusion staff and ICU physician staff. there are now 17 ICU nursing staff who are fully-trained eCls specialists and additional Mater eCls training courses are planned in the near future”.

further educAtion to educate himself about eCls, Dr Carton travelled to a number of the expert centres

the key to success Dr Carton is adamant that the Mater programme is very dependent on the very

+ l-r: ann rooney, Perfusionist; rob regan, Perfusionist; Colman O'loughlin, Intensivist; and edmund Carton, Medical Director of Mater eCls Programme

extra Corporeal life support (eCls) is the term they use for the treatment available in the Mater. Consultant in Intensive Care Medicine and Medical Director of the Mater eCls service, ed Carton says, “It is important to have this level of expertise and to be able to offer this level of support in Ireland. From my point of view, we had been trying to support critically ill patients with our best conventional therapies, but a small number of patients continued to deteriorate despite all our efforts. We had nothing else to offer them, whereas now there is this extra level of support. some patients who may not have survived in the past are now going to do well.”

Increasing patient numbers suffering from H1N1 flu triggered an increase in demand for the eCls beds in the Mater’s Intensive Care Unit. In January 2011, the unit was operating at full capacity with three eCls machines being used by very sick patients. the Mater is the only hospital in the country providing this service for adult patients.

Prior to its introduction any adult who was gravely ill and needing eCls care had to be looked after outside the country.

Initially Carton was sceptical about using eCls, but says he changed his mind in 2005, when a young female patient of his with severe lung failure was flown to stockholm and successfully treated by

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“International figures show how eCmo survival rates have improved from 10 per cent in the 1970s to a 60 per cent or higher survival rate today.”

16/03/2011 16:07:59

12 Health Matters

developments

©istockphoto.com/AtnoYdur

“So from 2005 onwards, having been a complete non-believer in ECLS, we said this is something we absolutely need to develop in the Mater and we need to plan how to do it.” committed, highly-trained ICU Nursing staff saying, Far more important than the technology, is the highly-trained ECLS specialist staff at the bedside. The success of our programme here is absolutely down to the commitment of the ICU nurses.

They’re outstanding.”

In April 2010, Colman O’Loughlin, a Consultant Intensive Care doctor, joined

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the team. He specifically trained in ECLS treatment in Melbourne and has brought a lot of valuable experience to the team.

Since January 2011, the team has started to operate a ‘retrieval service’, whereby they bring the ECLS equipment to hospitals around the country when patients are too sick to be brought to the Mater using conventional ventilatory support. The team carried out two retrievals in the first fortnight in January.

Dr Carton explains how it works, “When patients are so sick that they can’t be moved, we’ll go to the referral hospital with the ECLS equipment and deploy it there. Once it’s up and running the patient is much more comprehensively supported and can be safely transferred back to the Mater in the Mobile Intensive Care Ambulance Service (MICAS).

Ideally, it is better to have the patients come to us before they are in extremis, but the ECLS retrieval service has the potential to rescue people in severe heart or lung failure.”

Support for the future Last year, the Mater organised a very successful joint educational meeting on ECLS in conjunction with Our Lady’s Children’s Hospital, Crumlin. There was great interest in the event, which had invited speakers from Leicester and Stockholm and they’re planning a similar event for May 2011.

The Mater ECLS service has strong links with the Alfred Hospital in Melbourne and the Karolinska Institute in Stockholm.

Dr Carton speaks highly of Dr Palle Palmer (Sweden), whom he describes as a mentor, adding that he gave them great encouragement to keep going when they were starting off.

Dr Carton is frank about the difficulties starting off the programme but he is personally committed to it, “With the newer ECLS equipment, we’re anxious to apply this support to a bigger cohort of critically-ill patients. We are working with our cardiologists and our heart surgeons so that in time, ECLS may be applied more often in heart failure patients than in lung failure patients.”

16/03/2011 16:08:00

Health Research Board Funding Alert Building health research capacity and leadership is central to delivering on key actions in the HRB Strategic Business Plan and the National Action Plan for Health Research. The HRB is pleased to announce new funding opportunities for post-doctoral training and development.

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HM Iss7.1 p1-70.indd 14

16/03/2011 16:08:09

HealtH Matters 15

developments

a new development, a NeW HOMe the opening of the new knockamann development at Portrane in north County Dublin is welcomed by residents and staff and brings new warmth, energy and excitement for everyone involved, writes Laura Monaghan.

I

nside the modern building of the Day resource Centre in the grounds of st Ita’s Hospital, there is a buzzing atmosphere as staff and residents are taking part in various activities; a smell of fresh baking is coming from the kitchen, where some of the clients of st Joseph’s Intellectual Disability service are learning how to make scones and other residents are using the exercise bikes in the purpose-built gym down the hall. the development at Knockamann comprises of 10 houses and a Day resource Centre. the total cost of the

build and fit out was €16.53 million. the resource Centre offers a range of services and facilities to cater for the residents. there is a lot of vibrant artwork on display and the artists are all clients of st Joseph’s Intellectual Disability service.

A hoMe thAt is theirs speaking at the official opening last October former Minister for Disability and Mental Health, John Moloney said, “this development forms a crucial part in progressing national policy in effecting the transfer of clients with intellectual disabilities + a sitting room in one of the houses

+ teresa Price with staff member, Orla Brennan in the resource Centre

HM Iss7.1 p1-70.indd 15

currently in psychiatric hospitals to more appropriate accommodation.” the service also opened a new community home, Barden lodge in nearby Julianstown, Co. Meath in December.

Nine clients from st Joseph’s Intellectual Disability service live in Barden lodge, which is a large detached house located on three-quarters of an acre.

Knockamann gives residents the opportunity to live with a small group of people and to have their own space within a home that is theirs alone. each home has a living area that looks out on a large

+ Catherine Quinn making buns in the kitchen in the resource Centre

+ l-r: Neil Mcloughlin, Zac Byrne and Kieran leanne in the gym

16/03/2011 16:08:19

HealtH Matters 17

developments enclosed garden and a smaller sitting room overlooking a second enclosed garden.

Manager Caroline Coakley and Director of Nursing eileen Kelly are justifiably proud of what has been achieved by the clients and staff at Knockamann. Paying tribute to the tremendous work of the staff they explain how a lot of planning went into the move from the old red-brick dormitory accommodation to the new homes.

Caroline Coakley explains, “It has been a very successful move for all of us and hugely positive. all of the clients have responded really well to the brightness, the access to the grounds and the environment. People are happy and there is a real buzz around the place. It was a real privilege to be involved with it.”

client hAppiness One of the clients, teresa Price, moved into one of the bungalows in Knockamann late last year. she is delighted with her new home, has decorated her own room with her own things and happily describes how she works to keep her room tidy. teresa goes to the Day resource Centre

every morning where she says, “the staff are lovely.” another client, Catherine Quinn, says one of the best things about her new home is having her own room. I have a tV, video and a DVD player. I love watching Home and away and every day I come over to the resource centre where I attend different classes.

On Mondays, I’m in art class from 9.30am to 10.30am, then I go to the workshop, and in the afternoon, I’m in Montessori. On tuesday afternoons, I go to tuas Nua. I really like doing the art class, it is great.”

Director of Nursing eileen Kelly said, “this development offers clients of st Joseph’s Intellectual Disability service an opportunity to maximise their independence and to participate in the community within which they live, an opportunity that is welcomed by the clients themselves, their families, friends and service providers alike. the development has worked really well, even for some of our most profoundly disabled clients.”

Accessing cAre the st Joseph’s Intellectual Disability service supports 350 clients in total. about 100 of those clients are in supported-community living accommodation, about 150 are living in houses on the st Ita’s complex, while staff also offer support services to another 100 clients who live at home. the Day resource Centre provides an access point to a range of allied health professionals including a senior physiotherapist, senior dietician, senior social worker, senior speech and language therapist and senior occupational therapist and a parttime psychologist.

Paying tribute to all of those involved in the Knockamann development project, Cate Hartigan, Hse assistant National Director for Disability services, said the development marked a major milestone in the move away from large institutionalised accommodation and care, and enables the provision of accommodation and services which any client as a citizen, staff member or family can be proud of.

+ Caroline Coakley, Manager and eileen Kelly, Director of Nursing are very proud of what has been achieved at Knockamann + stephen Flynn shows off some artwork, which can be seen on the walls of the new resource Centre

+ a sitting room in one of the houses

HM Iss7.1 p1-70.indd 17

+ the dining room in one of the houses in Knockamann

16/03/2011 16:09:15

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HM Iss7.1 p1-70.indd 18

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16/03/2011 16:09:24

HealtH Matters 19

THANK YOU...

More than 2,000 healthcare staff from the HSE and the voluntary healthcare sector accepted offers made under the recent Early retirement and voluntary redundancy Schemes and left the service.

SĂŠan McGrath, national Director of Human resources in the HSE, outlines how the process was managed.

D

etails of the Voluntary early retirement scheme and the Voluntary redundancy scheme were announced by the Government last October and applications were sought from employees by the following December 3rd, following the granting of an extension of time. a total of 3,775 applications were received and of this number just over 2,000 (including staff from the Voluntary Hospitals) accepted the scheme. the overall cost of the schemes is approximately â‚Ź103 million. the processing of so many applications over a short period of time was a big challenge. It was the first time that the Hse was asked to process these types of schemes. there was significant expertise available in the superannuation and pension calculation area, but our staff had to adapt quickly to manage all of the requirements involved in the Voluntary redundancy scheme.

Not alone did they need to process high volumes of applications, a very manual process, but they also had to master all the details involved in the new scheme.

I want to convey my thanks, and that of the Hse Management team, for the exceptional commitment shown by staff to meet the December 30th deadline to facilitate interested staff to avail of the schemes. I appreciate that this was achieved in many cases only because people adapted to the circumstances, for example, working additional hours on late evenings and weekends during November and December. I know also that those whose work involved driving distances coped with very considerable challenges in the very difficult road conditions that prevailed

HM Iss7.1 p1-70.indd 19

due to the severe weather conditions at that time. the staff of the Hse once again demonstrated their capabilities, dedication and commitment.

Overall, I believe that the uptake of the scheme was reasonable, bearing in mind that it was announced and closed within an eightweek period, which included Christmas. this was a significant achievement in the current economic environment of reduced budget allocation and continuous pressure for a reduction of numbers in the Public sector. the exit of these staff is a challenge and our services continue to be dependent on

our people to continue to make the extra effort for our patients and clients that can make all the difference.

I want to particularly thank the staff who availed of the schemes and left our service on December 30th.

I would like to thank them for their contribution to the health service over the years and wish them every success in the future. their dedication and commitment during their time in the public health service is very much appreciated. I join with my colleagues of the Hse Management team in wishing all of them well in the years ahead.

the nuMbers who AvAiled of the scheMe Are broken down As follows: hse (non voluntaries)

hse (voluntaries and others)

Grand total

Area

number

Dublin/Mid-leinster

265

Dublin/North-east

279

south

450

West

420

total

1,414

Dublin/Mid-leinster

345

Dublin/North-east

167

south

58

West

22

total

592 2,006

16/03/2011 16:09:27

20 Health Matters

Developments

HSE delivering on the Croke Park Agreement In accordance with provisions of the Croke Park Agreement, the HSE has made great strides in implementing changes to work practices and developing services throughout the country.

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©istockphoto.com/rrocio

Significant changes to hospital laboratory work practices The HSE, with the relevant stakeholders, has greatly advanced the laboratory modernisation process. The process was established following an external review, which highlighted a number of limitations in relation to existing services and made a number of recommendations regarding how services should be developed.

The Public Service Agreement acknowledged this advanced level of engagement of the relevant stakeholders: “…to deliver major change to the medical laboratory services and associated work practices.”

More recently, there has been a period of intensive engagement between employers and unions under the auspices of the Labour Relations Commission and the Labour Court in relation to the introduction of more service appropriate and cost effective work practices within laboratories.

As a result of this process, all laboratories are to introduce rosters to reflect the extended working provisions set out in 2.9.12 of the Public Service Agreement.

Initially, rosters are to be based on 8am to 8pm, working on a Monday to Friday basis. This arrangement was introduced with effect from February 1st 2011. It has been agreed that there will be a requirement to introduce further extended working arrangements over an extended period, up to and including 24/7 emergency services in some service locations. This will be implemented on a site by site basis, thereafter subject to service requirements

and following appropriate local consultation (paragraph 2.9.13 and 2.9.14 of the Public Service Agreement refers).

These changes apply to medical scientific staff – scientists and biochemists. Local discussion is to take place in relation to the requirements in respect of laboratory aides and clerical staff assigned to laboratories.

A revised payment system for the provision of out-of-hours and emergency medical laboratory services is also to be introduced. This new system payment will replace the 1981 collective agreement, which is not considered appropriate in the context of the level and type of services now provided on an out-of-hours basis. Changes to this system are expected to make significant savings for the health service.

These changes are a very welcome development and represent a significant step forward in the development and delivery of appropriate, fit-for-purpose health services in Ireland.

Modernisation in Kerry General Hospital At Kerry General Hospital (KGH), laboratory

medicine services are critical to supporting the delivery of high-quality patient care. The modernisation of the medical laboratory at the hospital (in line with national initiative), with a view to enhancing processes for critical areas, is underway at present.

Changes to laboratory staff rosters in the context of an extended working day are being implemented through the framework of the Croke Park Agreement. The extended working day will be implemented on a phased basis initially from 8am to 6pm pending ballot by the Medical Laboratory Scientists Association (MLSA). The extended working day will enable improved work scheduling that allows prioritisation of work process. It will reduce overall cost in terms of out-of-hours cover to the HSE. These changes demonstrate the hospital’s capacity to achieve optimal match between staff and service activity levels across the working day. Additionally, it is proposed to enhance the laboratory skill mix through the introduction of laboratory aides to the workforce. Further efficiency gains are expected through the phased introduction of central specimen reception

16/03/2011 16:09:29

HealtH Matters 21

developments the pro-active co-operation of all staff involved who are focused on maximising the therapeutic potential of all the experiences throughout the child’s day and maintaining a homely, caring culture in the new CaMHs unit. the change of work practice was concluded within the framework of the Croke Park agreement.”

+ the New emergency Department at Our lady of lourdes Hospital, Drogheda which will allow blood samples to be processed more efficiently. the laboratory also aims to broaden the scope of its accreditation to the internationally recognised IsO 15189 standard in 2011.

iMproved MentAl heAlth services in gAlwAy In January, the Child and adolescent Mental Health services (CaMHs) unit, which was previously located at st anne’s on taylor’s Hill in Galway, re-located to a new purpose-built unit on the grounds of Merlin Park University Hospital. the new unit includes a children’s inpatient unit, an adolescent inpatient unit and overnight accommodation for parents along with therapy space and a sports/indoor activity hall set in landscaped gardens with carefully designed therapeutic areas. the project to build the new unit involved all staff and incorporated views of the service users with everyone working together with the architects and engineers from the preliminary design stages through the selection of colours, fittings and equipment.

Following discussions with staff and their representatives, seven staff members who previously worked in the catering department of st anne’s have become multitask attendants based in the new CaMHs unit. these staff members have experience of working with children in a service which is recovery oriented and their understanding of the requirements of the service meant they were ideally placed to make this transition. adrian ahern, Manager of Galway Mental Health services said: “this change of work practice was enabled by

HM Iss7.1 p1-70.indd 21

louth/MeAth hospitAl group stAff redeploy to new roles More than 100 staff from a variety of disciplines (including Nursing, Health Care assistant, social Work, Catering, laboratory, Physiotherapy and administration) have redeployed from their positions within the louth/Meath Hospital Group to facilitate the reconfiguration of services in the north east. Over 34 of these staff have redeployed from the louth County Hospital in Dundalk to Our lady of lourdes Hospital in Drogheda. the change of work practice was concluded within the framework of the Croke Park agreement. the transformation Programme underway involves widespread and fundamental change. the objective of the transformation Programme is to reconfigure acute and complex care onto the Cavan and Drogheda Hospital sites and to expand day and outpatient services and procedures on the Navan, Monaghan and Dundalk Hospital sites.

For example within the louth/Meath Hospital Group a number of services have been reconfigured to date. a new emergency Department opened at Our lady of lourdes Hospital in June 2010 and the emergency Department at the louth County Hospital converted to a Minor Injuries Unit. a new Medical assessment Unit, CCU facility and two new general wards also opened at Our lady of lourdes Hospital between July and september 2010. Other service

developments within Our lady of lourdes Hospital associated with the reconfiguration programme included development of a mixed specialty short stay Ward and a Cohort Isolation Facility to streamline patient flow and enhance the efficiency of the care pathway and discharge process for patients. a number of services have transferred from Our lady of lourdes Hospital to the louth County Hospital including the elective medical Venesection service and the elderly Day assessment service. the Colposcopy service for the north east was centralised at louth County Hospital in august 2010. an inpatient palliative care facility will be established in louth County Hospital in March 2011 and rehabilitation services will also be further developed in 2011. louth County Hospital has also recently been selected as one of the 15 candidate colonoscopy centres that will support the national colorectal cancer screening programme. stephen Mulvany, regional Director of Operations, Hse Dublin North east said, “the reconfiguration programme underway in the north east is a major and very complex change process that we have no option but to complete if we are to address the many issues that have existed particularly within hospital care in the north east for many years. It will have significant benefits in terms of the safety and quality of the services that we provide for patients. the processes of reconfiguration and transformation have challenged staff to work differently. By working together in new and more effective ways staff have raised the standard of healthcare and services in the region. I would like to acknowledge the staff who have changed their roles and/or work locations and also management, staff associations, unions and all others involved in facilitating and enabling the reconfiguration of these services”.

+ l-r: Maria Conlon, ann Cronin and Nora ann Nolan multi-task attendants in the new CaMHs Inpatient Unit in Galway

16/03/2011 16:09:36

22 Health Matters

Developments

A new era for the National Ambulance Service The National Ambulance Service (NAS) is continually working to further improve the care provided to HSE patients and provide much faster access to care.

I

nnovations in ambulance service provision, such as the introduction of the Advanced Paramedic Training Programme and a system of up-skilling for the 1,200 paramedics, have produced significant improvements in patient care.

The future direction of the NAS will focus on responding to developments taking place across the healthcare system, which include the reconfiguration of acute hospital services, the roll-out of the Croke Park Agreement, clinical care programmes, and the recent publication by HIQA of Response Times and Quality Standards for PreHospital Emergency Care.

The plans to develop the NAS will also take into consideration the government task force report on sudden cardiac death and the C&AG report on the Dublin Ambulance Services. A clear vision for the future of the NAS will ensure that it continues to provide high quality call handling, clinical advice and safe and effective mobile healthcare.

Effective leadership One of the first priorities of the NAS reconfiguration programme has been to ensure that effective leadership is in place to drive the changes necessary. As part of this process, the HSE has announced two senior appointments to the NAS: Robert Morton has been appointed as the new Director of the NAS, Morton was formerly a Chief Ambulance Officer with the HSE with responsibility for the Midlands area; and Dr Cathal O’Donnell, Consultant in Emergency Medicine at

HM Iss7.1 p1-70.indd 22

Limerick Regional Hospital has been appointed on secondment basis, as Medical Director. Further part-time support will be provided by Dr Mark Doyle, Consultant in Emergency Medicine, Waterford Regional Hospital as Deputy Medical Director. Both O’ Donnell and Doyle have significant experience and involvement in developing pre-hospital emergency care services in Ireland.

Upholding standards and meeting targets The NAS is committed to delivering prehospital emergency care services in line with best practice and in accordance with the recent standards outlined by the Health Information and Quality Authority which, amongst other targets, requires a response rate of 75 per cent of immediately life threatening calls within eight minutes.

The new HIQA Standards are a welcome development requiring the NAS to collect response times in a different format since January 1st 2011. These response times will be reviewed after a six month period to establish a baseline from which performance improvement can be measured.

The NAS is working with its staff and stakeholders on the development of a Performance Improvement Action Plan to meet these targets. It will pose significant challenges for staff and stakeholders to achieve these response times given the rural and urban geography of our country.

Meeting the patient’s needs The reconfiguration of ambulance command and control centres is being progressed under the Croke Park Agreement. Moving from eight regional centres to two national centres, one live and one back-up centre, is fundamental in ensuring that a nationally configured service can be provided which is not restricted by

“The NAS is very clear on the continued requirement to involve other ‘blue light’ services in the delivery of prehospital emergency care services.” county or regional boundaries. This means that the nearest available resource with the most appropriately skilled paramedic or advanced paramedic will be dispatched based on the patient’s clinical need. This will help achieve the best possible outcome for the patient.

Improved communications infrastructure Over the next number of years, the NAS will provide a top-class system of call handling and telephone based clinical advice, by modernising all of its communications infrastructure and technology in line with international best practice. The Advanced Medical Priority Dispatch System (AMPDS) will allow for the systematic categorisation and prioritisation of emergency ambulance calls by identifying the appropriate skill level required to meet patients needs and facilitate sending the nearest appropriate resource available to them.

The Comptroller and Auditor General has commented on the existing control arrangements in Dublin identifying that the lack of a single point of contact

16/03/2011 16:09:36

HealtH Matters 23

developments groups of patients, for example stroke, acute coronary syndrome and trauma. additionally, the work underway by both the acute medicine and emergency medicine programmes will require significant prehospital and inter-hospital support from the Nas to deliver on their specific objectives.

+ robert Morton newly appointed Director of the Hse National ambulance service

+ ambulance personnel involved in a recent training exercise for all ambulance calls for Dublin city and county was not a satisfactory arrangement for supporting the needs of patients or clinicians. the new National ambulance Control Centre will ensure that there is a single point of contact for answering and directing all 112/999 calls. this will further reduce the potential for duplicate responses and ensure that the nearest available ambulance is dispatched to an incident or patient at all times.

HM Iss7.1 p1-70.indd 23

pre-hospitAl reconfigurAtion Core to delivering on the acute Hospital reconfiguration Programme with be the need to enhance and improve pre-hospital emergency care services in the community and implement an intermediate care transport system to support the needs of centres of excellence to both receive and repatriate critical or time dependent patients. the Nas has an important role to play in providing the pre-hospital elements of improved clinical care pathways for specific

governMent tAsk force report the Nas is very clear on the continued requirement to involve other ‘blue light’ services in the delivery of pre-hospital emergency care services. the government task force report on sudden cardiac death recognises this point in recommendation 5.19 of their report, which sets out: a tiered response system should prioritise the training and equipping of rapidly deployable ‘uniformed responders’ such as: • Full time fire services in urban communities • retained fire services in rural communities aligned to this, the Nas is of the view that the ongoing investment in new purpose built fire stations, many of which are geographically well placed around the country and vacant for much of the time, could provide an ideal network of facilities from which to dynamically deploy Nas resources with a view to further improving response times. consultAtion In order to meet the demands ahead, the Nas has embarked on a process of consultation with existing managers and staff with a view to identifying ways to improve and streamline leadership arrangements within the context of the government’s moratorium on recruitment and promotion. Consultation in relation to how the Nas will be developed to meet the future demands and challenges, as outlined above, will also be carried out with managers and staff. the dedication and skills of all grades of Nas staff have made possible the quality of service that patients expect today. the new vision for the Nas will build on these achievements to provide a more pro-active, efficient and dynamic service delivering high quality care that meets patient needs and provides a fulfilling career for our staff.

Further information about the National ambulance service can be found on: www.hse.ie/go/ambulanceservice

16/03/2011 16:09:46

HealtH Matters 25

developments the same day as the injury or within 24 hours for definitive management.”

A coMplex orgAn there are certain patients that respond very well to surgery and it is very important that they are transferred rapidly and operated on quickly. surgery has advanced a lot in terms of techniques and safety. the worst spinal cord injury is a complete cord injury. Despite all of the talk about stem cell research, the tough reality is that there is still no way to regenerate a spinal cord and make a completely severed spinal cord work again. Mr Poynton can’t see this changing in the near future saying, “We see a lot of research into stem cells. It is all very positive, but there is nothing yet that will regenerate a spinal cord and make a completely severed or traumatised spinal cord work again. You hear reports about people going off to get stem cell therapy.

It doesn’t work. the spinal cord is such a highly complex organ. It’s so difficult to get a traumatised spinal cord to work again in a meaningful way. I think it will be a long time until we see that. But hopefully I’m wrong.”

Five consultant orthopaedic spinal surgeons and a team of junior doctors provide the on-call service in the unit and work alongside the other multi-disciplinary team members including the nursing team and physiotherapists. there are 10 spinal beds in the unit, which includes a six-bed acute unit and a four-bed step down unit. Patients go to the step down unit when they’re stable and after they’ve had their surgery. If patients need to be ventilated they may end up in intensive care for some time. some patients can spend months in hospital before they’re ready to be transferred to the National rehabilitation Hospital in Dun laoghaire.

A nAtionAl AppeAl the Mater takes patients from every hospital nationwide. Calls come from all over the country seeking help for patients with spinal trauma and other spinal conditions. Mr Poynton said, “Many hospitals, including some of the larger ones, don’t have out-of-hours MrI, so if you have a spinal cord problem out-ofhours you need to be transferred here. It is

HM Iss7.1 p1-70.indd 25

appropriate to centralise the care of these patients at one National Unit. Patients with spinal cord injury require complex multi-disciplinary care. surgery is often just a small part of it. the multi-disciplinary care of that patient is essential. It is very important that they are dealt with by a team experienced in this area of care. the example would be the patient with a complete spinal cord trauma meaning there is no function left. everything is paralysed below the level of injury. Most of those patients don’t get better, but it is important that they don’t get worse or develop secondary complications.” the team now treats as many nontrauma spinal cases as trauma cases.

Increasingly, they are also getting more and more calls about spinal tumours such as secondary metastatic tumours.

Mr Poynton said they are also seeing an increasing number of older people with degenerative conditions, where the spine actually wears out.

In these cases, he is adamant that surgery can make a real difference to

people’s lives. “they can be very difficult cases but techniques have advanced dramatically in the last ten years. the surgery can be very invasive and challenging, it can be very expensive surgery but you can make a huge difference to people’s quality of life.

Paralysis in many of these tumour and degenerative cases is preventable.” the team has access to just one theatre to run their spinal service and orthopaedic trauma service and the limited space can be a problem.

Mr Poynton added, “If an urgent spinal case comes in, it has to be dealt with and then the patient with the hip fracture gets delayed. that does have implications. like everywhere else, the hospital access to beds is an issue, not too much for the urgent cases but for the semi urgent cases. they still need surgery. that will be addressed in the new hospital where we will have two theatres.

We expect it to be up and running in a year to 18 month’s time, so that problem hopefully will be solved.”

+ Members of staff greeting President Mary Mcaleese during her visit to the National spinal Injuries Centre in Dublin’s Mater Hospital

+ l-r: John Morgan, Chairman of the Hospital Board; Mary Cleary, CNM 2 st agnes Ward; Dearbhala Cassidy, CNM3 spinal/Orthopaedic Department; Mary raftery, surgical Divisional Nurse Manager; President Mary Mcaleese; Geraldine Jordan, CNM 2 spinal Unit; ashley Poynton, spinal/Orthopaedic Consultant and Brian Conlon, CeO

16/03/2011 16:09:51

Research Laboratory at RCSI

Professor Arnold Hill at BNY Mellon Lecture Series

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Our goal is to help support the collaborative initiative we have established with each of the breast cancer centres in Waterford, Cork, Limerick and Dublin, thereby enabling us to create the country’s first national Breast Cancer tissue biobank, which will in turn speed up discovery and ultimately translate our research into more effective and efficient treatment for patients diagnosed with this disease.

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Breast cancer is the most common type of cancer among women in the developed world. It affects women of all ages, races and social classes. In Ireland, it is very common with about one in ten over the course of their lifetime developing the disease.

In light of this, the Royal College of Surgeons in Ireland has committed to developing a Breast Cancer Research Programme, funded by its charity, Breast Cancer Ireland.

At the RCSI, through passion and commitment, our diverse team of scientists and clinicians collaborate to transform laboratory findings into smarter, integrated and coherent approaches to diagnosing, treating and ensuring more personalised treatment plans are devised for breast cancer patients.

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COMMUNICATE

CONQUER

ancer we’re here to listen

Concerned about cancer?

Diagnosed with cancer?

Caring for someone with cancer?

We are here to help, to listen, to answer your questions.

The Irish Cancer Society’s Cancer Information Service includes: National Cancer Helpline, staffed by specialist cancer nurses:

Freefone 1800 200 700 Email service: helpline@irishcancer.ie Interactive help online: www.cancer.ie (Cancer Chat & Cancer Forum) 33078 ICS 'Listen' 188x130.indd 2

HM Iss7.1 p1-70.indd 26

43-45 Northumberland Rd, Dublin 4, www.cancer.ie 11/26/10 11:19 AM

16/03/2011 16:10:01

Health Matters 27

developments

Centralising cancer care

©istockphoto.com/LionHector

A look at the new National Surgical Centre for Pancreatic Cancer at St Vincent’s University Hospital, Dublin.

T

he new HSE/NCCP National Surgical Centre for Pancreatic Cancer at St Vincent’s University Hospital, Dublin was officially opened recently by the former Minister for Health and Children, Mary Harney.

Incorporating a networked satellite unit at Mercy Hospital, Cork, with surgery to be transferred into the designated cancer centre in Cork University Hospital early this year, the national centre has successfully transferred all pancreatic cancer surgery from the multiplicity of hospitals that had been providing the service over 12 months ago.

Pancreatic cancer in Ireland Over 400 patients are diagnosed with pancreatic cancer in Ireland every year.

Most of these are aged over 65 and while the incidence of the disease has remained relatively static over the past decade, it is widely anticipated that

HM Iss7.1 p1-70.indd 27

with the ageing population the incidence will increase significantly over the coming decades.

Although the disease carries a challenging prognosis, early intervention and access to expert diagnostic, imaging, surgical and post operative care are viewed as a vital in managing the patient’s care. On a European basis, access to surgery is on average available for up to 16 per cent of cases. Access to surgery in Ireland, while low in the 1990s (at around seven per cent), has improved in recent years. Considered to be in excess of 12 per cent at present, it is anticipated that this increase will continue over the coming decade following the opening of the new National Surgical Centre for Pancreatic Cancer.

Pancreatic cancer surgery Pancreatic cancer surgery is highly complex requiring a sophisticated surgical team

and support services to achieve the best outcomes. International evidence clearly shows that the best survival and best outcome opportunities are achieved when surgery is concentrated in institutions performing significant volumes of surgery, performed by experienced personnel.

It is also recognised that the wider care experience of nursing and other healthcare staff looking after the patient in the immediate post operative phase is also of vital importance.

National Surgical Centre for Pancreatic Cancer St Vincent’s University Hospital has the biggest concentration of hepatopancreatico-biliary (HPB) surgery in the country, including the National Liver Transplant Unit. As a result, the hospital already had a significant concentration of the necessary infrastructure and medical

16/03/2011 16:10:03

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Completion of a further three modules, scheduled in year two, will result in 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, May 6 2011.

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.

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Applications must be submitted online through PAC at: www.pac.ie Closing date: 30th June 2011 Fees: This course currently attracts a reduced fee for EUstudents under the National Development Plan.

This funding is reviewed annually.

Email: postgraduate@scss.tcd.ie Website: www.scss.tcd.ie/courses/mschi Tel: 00 353 1 896 1765

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27/01/2010 15:35:23

16/03/2011 16:10:04

HealtH Matters 29

developments

expertise to facilitate this development. there is a comprehensive cancer service including Medical and radiation Oncology and a highly-specialised team of interventional and diagnostic radiologists, interventional endoscopists and specialist pathologists. the hospital has a strong team of specialist cancer nurses and allied health professionals including a fully developed Palliative Care service.

While some investment was involved in the designation and development of the centre, the NCCP has confirmed that the successful transfer of resources and their concentration in the national centre reduced the necessity for significant new funding. the establishment of the new centre involved the major re-organisation of surgical services and the creation of dedicated intensive care beds, post anaesthetic care beds and in patient beds, including a single en suite isolation facility. It also included a dedicated four-bedded surgical observation unit and the establishment of dedicated theatre sessions.

referrAl process the new national centre formally began accepting referrals in late 2009 and by the end of 2010 had received over 270 referrals from across the country, with over 115 pancreatic cancer surgeries having taken place. the significant planning that has underpinned the designation of st Vincent’s University Hospital led to the development of one of the most comprehensive referral processes for patients nationally in any clinical programme.

Consultants in hospitals across the country all follow the same pathway in referring their patients to the centre. all new patient cases are referred to the National surgical Centre for Pancreatic Cancer on a weekly basis. this referral process is completed by Friday. every Wednesday, the national centre’s multidisciplinary team meets to discuss each case and decide on the best approach for that patient. the gathering consists of up to 20 experts – including consultant radiologists, consultant surgeons, consultant pathologists, specialist nurses

HM Iss7.1 p1-70.indd 29

and data analysts. the Cork satellite service forms part of this MDt.

treAtMent plAn these experts review each case individually, accessing the range of agreed diagnostic tests provided through the initial referral process. Once their assessment is complete, a treatment plan is drawn up for the patient. Many patients will be seen later that day and will be invited to attend at the national centre on an outpatient basis where their treatment plan will be discussed and a date for admission agreed. through

their outpatient appointment, the patient will receive support in areas including dietetics and physiotherapy.

Once their surgery and treatment in the national centre is complete, and with the complexity of treatment involved this can take up to five or six weeks, the patient will be advised of their post operative care plan by the team. they will be discharged home and follow up treatment will be provided in an agreed networked hospital.

However, the national centre will at all times oversee the treatment plan, with any technical issues that may be encountered referred back in immediately as necessary.

Justin Geoghegan has been appointed as lead Consultant surgeon at the National Centre for Pancreatic Cancer surgery. Mr Geoghegan was originally appointed as Consultant surgeon with a special interest in hepatobilary surgery and liver transplantation in 1999 at st Vincent’s University Hospital, after having previously worked at Frederich schiller University, Jena, Germany and at Kings College london. according to Justin Geoghegan, the development of the new national centre has been a key development in the treatment of pancreatic cancer. surgery in Cork is led by Criostoir O’suilleabhan, Consultant surgeon. the Corkbased team provide the full range of diagnostic, surgical and follow-up care. this team is well-established and will be participating in the national MDt meetings with patients assessed and cases reviewed as per national protocols.

16/03/2011 16:10:10

30 Health Matters

developments

The art of the mind HSE art psychotherapist, Catherina Brady, has linked up with rugby commentator Brent Pope to highlight artistic work created by clients with mental health issues, writes Sarah Murphy.

B

rent Pope opened an art gallery in Dublin’s docklands last November to encourage people with mental health issues to display their work. The gallery is currently showing art that was created by clients attending the acute unit in Tallaght Hospital. The unit provides an in-patient and out-patient service for people with mental health issues.

“I heard he was opening the gallery to facilitate people with mental health issues to show their work, so I gate-crashed the launch event and asked for his help!

I wanted to try to raise the profile of what the unit was doing and exhibit what the patients were doing in the group this year titled, Creative Beginnings. He was only too delighted to help out,” says Catherina.

A lot of the patients’ work is now on sale at Brent’s art gallery. “It is a victim of its own success,” he described it when speaking about how well the public have received the concept and the amount of artists who have been encouraged to show their art pieces. The pieces are many and varied using a cornucopia of oils, watercolours and mixed media.

Therapy through the medium of art “Painting takes me away from dark corners and dark places. It helps me to express myself in ways that I can’t say properly in words.” These are the words and insight of one of the clients dealing with mental health issues. The patient has been given the chance to express his feelings through art thanks to the work of full-time art psychotherapist Catherina Brady at Tallaght Hospital, under the remit of the Dublin Mid-Leinster region.

It is estimated that one-in-four Irish people will experience some mental health problem during their lifetime. Between 2008 and 2009, the HSE spent approximately

HM Iss7.1 p1-70.indd 30

b300 million on drugs for treating behavioural disorders and mental health.

“It is not a subject that can or should be brushed under the carpet,” believes Brent Pope, who has a huge interest in mental health issues.

It was through using different art mediums to help deal with mental health issues that Catherina first approached Brent to highlight the work created by the patients she works with at the hospital.

Many of the patients are dealing with issues around anorexia, self-harm, depression, schizophrenia and old age psychiatry.

“Painting takes me away from dark corners and dark places. It helps me to express myself in ways that I can’t say properly in words.”

Public awareness is critical Brent opened his own art gallery, Inside Out, on Dublin’s Spencer Dock, last November, to allow and encourage people dealing with mental health issues to show their art and find would-be buyers.

Brent, who was selected in the original 1987 New Zealand Rugby World Cup training squad, and is a former player and coach for two Irish rugby clubs teams, has made his home in Ireland for the past 21 years. He knows at first-hand what it is like to deal with the issue. Rugby is not a sport that conjures up thoughts of getting onside with one’s inner thoughts and feelings.

But the philanthropy-orientated powerhouse is not slow to vocalise his thoughts on the issue. An older brother, 18 months his senior, living in Wellington, New Zealand has suffered from depression but now practices as a psychiatrist. “There is a lot of misunderstanding and flippant attitudes out there about mental health. If more people explore different avenues about dealing with it, then more can be achieved,” believes Brent.

Those who have spoken in the public domain about mental health in the past are author Marian Keyes and another rugby pundit and Newstalk radio presenter George Hook. “I’m not an expert on mental health but too often it is swept under the counter and it is hoped it will go away. High achievers and creative personalities often seem to have trouble.

“Art is an amazing thing. It tells a story behind what is happening to a person.

It is all about doing something positive.

For too long, suicide, which is the apex of mental health problems, has been deemed as a dirty word. The more people explore this issue the more that can be done about it,” states Brent.

Brent points out, “New Zealand is similar in culture to Ireland, where there is a high rate of youth suicide, depression and too much stereotyping of men who are meant to be strong and don’t open up because they feel weak or vulnerable.

Instead, for too long it has been, ‘let’s go down to the pub and have a pint.’ But I think, finally, this is changing.

“But more needs to be done to address mental health. The tip of the iceberg has begun to be chipped away here. It should no longer be seen as abnormal or a taboo.

You can’t take anyone’s mental health for granted. Everyone is different. You can meet a guy who has broken his neck after

16/03/2011 16:10:10

Health Matters 31

developments

+ Rugby commentator Brent Pope and HSE art psychotherapist Catherina Brady look at some of the art work which is on display

“For too long, suicide, which is the apex of mental health problems, has been deemed as a dirty word. The more people explore this issue the more that can be done about it.” an accident who is getting on with his life and dealing with it or you can meet a man who has a great job, lovely wife and family but can’t come to terms with the power of what is going on in his mind.

“More money needs to be spent on educating young people through the school system so that they will not feel alone when dealing with issues like this.

HM Iss7.1 p1-70.indd 31

Teenagers don’t realise why they may be feeling a different way,” he added.

The challenge is early intervention Longford native Catherina Brady spent six years qualifying as an art psychotherapist. She completed a postgraduate diploma in Art Therapy/ Art Psycotherapy in Queen Margaret University College Edinburgh. Her work is a labour of love. She is adamant about the benefits and says, “I see the benefits (from art therapy), it helps people, and I can see a release sometimes in people being able to express what is going on in their heads, in connecting and sharing their stories with others in a therapeutic space and getting a new view on something.

“I did a pilot study a number of years ago and it showed very positive responses as to why people found art therapy useful. I see how art reaches into the hard to reach areas.”

Catherina’s patients this year have entered the Lundbeck Art against Stigma

Awards and the International Mental Health Day Art Therapy Award titled, Mental Health My Story.

She adds, “The challenge is early intervention. The sooner we can support people the better as it helps to reduce the stigma and the labelling. These are myths that I think need to be challenged. Everyone struggles to cope with different aspects of their lives at different times.”

For Catherina, there can be drawbacks to working in the field as there can be a feeling of professional isolation and a lack of understanding or lack of clarity to what she does. But she feels she is well supported by St Loman’s Mental Health Service, based at Tallaght Hospital.

A new home The Outside In gallery space was given to Brent free of charge for several months on a trial basis, but now time is now running out and he is looking for a new house to home the burgeoning art work on show.

Sarah Murphy is a Communications Executive for Dublin Mid Leinster.

16/03/2011 16:10:11

School of Nursing Postgraduate Opportunities Nursing and Healthcare Practice Postgraduate Framework DCU School of Nursing promotes a person-centred, multidisciplinary care model, in line with international best practice in healthcare. Applications are invited from health care professionals with relevant qualifications, to the following part-time postgraduate programmes. Participants who have successfully completed 60 credits will have the option to exit at the end of year two with a Graduate Diploma.

• MSc in Child and Adolescent Nursing Practice (PAC code: DC701) • MSc in Child and Adolescent Health Care Practice (PAC code: DC707) • MSc in General Nursing Practice (PAC code: DC708) • MSc in General Health Care Practice (PAC code: DC709) • MSc in Mental Health Nursing Practice (PAC code: DC711) • MSc in Mental Health Care Practice (PAC code: DC710) • MSc in Intellectual Disability Health Care Practice (PAC code: DC713) • MSc in Intellectual Disability Nursing Practice (PAC code: DC712)

Entry Requirements Candidates must hold a related primary degree, with a minimum of second class honours or, alternatively candidates can be considered for admission on the basis of AP(E)L (accreditation of prior learning) and/or the completion of Access modules. Candidates are expected to work in the area of practice that relates to their particular chosen specialism.

Closing date for receipt of completed applications: Friday, 27th May 2011.

For further information contact: Gerard Clinton, tel: +353 (0)1 700 8523 or e-mail: gerard.clinton@dcu.ie

Masters in Psychotherapy (PAC Code DC715) Candidates must hold a relevant primary degree, have relevant practical experience and demonstrate personal suitability or, alternatively candidates can be considered for admission on the basis of AP(E)L (accreditation of prior learning) and/or the completion of Access modules.

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Please note that applicants who already hold a Graduate Diploma in Psychotherapy or equivalent may be eligible to apply for entry to year 3 to complete the MSc in Psychotherapy.

Closing date for receipt of completed applications: Friday, 29th April 2011.

How to Apply for These Programmes To apply, visit the Postgraduate Applications Centre (PAC) at www.pac.ie.

Postgraduate Research Degrees (MSc/PhD) There is an evolving and vibrant multidisciplinary research portfolio at DCU School of Nursing. For further information on undertaking a postgraduate research degree (MSc/PhD) contact Pamela Gallagher, tel: +353 (0)1 700 8958; e-mail: pamela.gallagher@dcu.ie

Professional Development Modules In addition to our existing wide-ranging suite of professional development modules, a selection of modules at Degree and Masters levels on the Psychotherapy, Nursing Practice and Health Care Practice programmes, are available on a stand alone basis for the ongoing development of therapists and other health and social care professionals. For further details, visit www.dcu.ie/nursing/professional.shtml or contact Tracey Harrington, tel:+353 (0)1 700 7153; e-mail: tracey.harrington@dcu.ie A sample list of our current available modules include: NS487: Cooperative Learning: Service Improvement Leadership for Mental Health NS499: Case-Management and Collaborative Working with People who have Complex Problems NS463: Personal Growth; Community Building/ Leadership NS568: Advancing Person-Centred Management in Dementia Care NS466: Person-Centred Dementia Care NS464: Mental Health in Primary Care Setting NS447: Blood Donation and Transfusion NS448: Haemovigilance Practice NS449: Professional Development for Specialist Practitioners NS488: Telephone Nursing in Healthcare For further information on all programmes visit: www.dcu.ie/postgraduate, tel: +353 (0) 1 700 5947 or email: nursingenquiries@dcu.ie

15/02/2011 16:09:55

16/03/2011 16:10:12

Health Matters 33

education & training

The future for our trainee doctors RCSI President Professor Eilis McGovern is very aware of the importance of making every training post attractive to young doctors, writes Sally Downing.

W

hen asked what the future holds for Non-Consultant Hospital Doctors (NCHDs), Professor McGovern is adamant that the training bodies have tried hard to improve the quality and structure of training programmes. She adds, “I think that we do need to ensure that every training post is attractive for the trainee and that means that there has to be a good balance between the service aspect of the post and the training aspect of the post that would keep trainees in the system.”

Professor McGovern would like to see manpower planning, which is transparent and visible. She believes graduates need to have a reasonable expectation of a job at

HM Iss7.1 p1-70.indd 33

the end of their training saying, “Manpower planning needs to be transparent, so that graduates can make informed career planning for the future.”

Appointed as President of the Royal College of Surgeons in Ireland in June 2010, Prof McGovern is a graduate of UCD and a Fellow of RCSI. She has also been a Consultant Cardiothoracic Surgeon in St James’s Hospital since 1987. She has served on the Council of RCSI since 1995, chairing the Faculty of Medicine and Health Sciences Committee – the governing body of the schools of medicine, pharmacy, physiotherapy and nursing from 2001-2006. Prof McGovern has also

chaired the college committee, making recommendations to the council on issues relating to surgical training and practice.

“I am adamant that a number of factors led to the current lack of NCHDs in particular fields in Irish hospitals,” she states. “There is no doubt that there are trainees who are working long hours and not getting sufficient training time for their role. There is no doubt as well that their net pay is less because they have had a salary cut and their over time hours have been cut. And I think they worry about career prospects because our manpower planning is opaque.”

16/03/2011 16:10:13

The Faculty of Nursing & Midwifery and School of Nursing Leading in Education and Research for Nurses and Midwives since 1974

The following RCSI/NUI accredited education programmes are offered commencing in September 2011: • PhD • MSc (Research) • MSc Nursing / Midwifery • MSc Nursing / Midwifery (Advanced Leadership) • M Sc Nursing / Midwifery (Advanced Practice) incorporating Nurse Prescribing and Ionising Radiation (X-Rays) (optional module) • Post Graduate Certificate in Nursing/Midwifery (Advanced Practice) incorporating Nurse Prescribing and Ionising Radiation (X-Rays) (optional module) • Post Graduate Diploma/MSc in Nursing (Wound Management and Tissue Viability) • Post Graduate Diploma/MSc in Nursing (Pain Management in Nursing) • Post Graduate Diploma/ MSc in Nursing (Infection Prevention/Control Nursing) • Post Graduate Diploma/MSc in Nursing (Respiratory Care in Nursing Practice) • Post Graduate Diploma/MSc in Nursing (Practice Nursing) • Post Graduate Certificate in Nursing (Clinical Research) • B Sc Nursing

• B Sc Nursing Management • Certificate in Nursing (Nurse / Midwife Prescribing) • Pathway to Post Graduate Diploma (for non-graduate students) 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.

The Fellowship of the Faculty of Nursing & Midwifery RCSI (FFNMRCSI) is exclusively offered by the RCSI and is one of the most prestigious professional qualifications awarded to nurses in Ireland.

Stand Alone modules in: • Infection Control Nursing (Microbiology) • Principles of Infection Control • Managerial Issues in Infection Control • Critical Issues in the Assessment and Management of Individuals with Pressure Ulceration • Critical Issues in the Assessment and Management of Individuals with Diabetic Foot

Ulceration • Critical Issues in the Assessment and Management of Individuals with Leg Ulceration • Critical Issues in the Assessment and Management of Individuals with Lymphoedema • Advanced Leadership (Professional & Clinical) • Clinical Supervision and Mentorship • Quality Assurance in Healthcare Delivery in a Multicultural Environment • Cervical Check (The National Cervical Screening Programme) • Reflection Clinical Judgment and Decision Making • Advanced Management and Strategy 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 Connolly Hospital Blanchardstown: Post Graduate Diploma/MSc in Nursing: (Gerontological Nursing)

In Association with the Royal Victoria Eye & Ear Hospital: • Post Graduate Diplomas/MSc in Nursing: (Ear Nose and Throat Nursing) • (Ophthalmic 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 Our Lady’s Children’s Hospital, Crumlin: Post Graduate Diploma/MSc in Nursing: (Peri-operative Children’s Nursing)

Introductory Single Study Days in Wound Management 12th April 2011 General Wound Management 9th June 2011 Leg Ulcer - Assessment & Management

11th May 2011 Pressure Ulcer Prevention & Management 7th July 2011 Assessment & Management of the Diabetic Foot

Further details & Application Forms are available from our 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, Fax: (01) 402 2465, Email: facnurs3@rcsi.ie Website: www.rcsi.ie/nursing Closing Date for receipt of applications is Friday 14th May 2011.

All programmes are delivered using a blended learning approach

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. D ip your toe in the water with a single module, such as: • Effective clinical teaching • Minor surgery & related dermatology in general practice •C linical update modules in primary care: Cardiovascular Disease, Diabetes, Infectious Diseases, Respiratory Disease, Women’s Health 2. A ccumulate modules toward a certificate, diploma or masters in: • Primary Care • Clinical Primary Care • Clinical Education ICGP accredited for CME An Bord Altranais approval expected May 2011 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.”

HM Iss7.1 p1-70.indd 34

“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.”

16/03/2011 16:10:14

HealtH Matters 35

eduCAtIon & trAInIng

she adds that trainees know from colleagues abroad that other countries have got the balance right between service and training, quality of life and career prospects saying, “I actually think these things are cyclical; that every so often things happen all at once, which makes doctors look abroad. I think that here everything came together, the european Working time Directive, the downturn in the economy, etc and there was a bit of low morale amongst the NCHDs. these are our future consultants and GPs and it is very important that we address this.”

flexible trAining Highlighting that a lot of young female doctors drop out before completing their training, Prof McGovern points out that few doctors opt for the flexible training, part-time or job sharing work arrangements that are available to them in Ireland. she says, “In the UK, seven to eight per cent of the total trainee workforce in medicine is training flexibly at any one time. In Ireland, it is 20 places out of 4,500 NCHDs.

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“there is no reason, even in surgery, that people can’t work flexibly or do parttime work. It is all about good handovers, even in those surgeries that require good continuity of care. It is probably something we should be pushing and perhaps the Hse’s Consultant applications advisory Committee could look into this in the future.”

Young female trainee hospital doctors juggle training, studying, working and family life today. this is a lot of pressure but it is important that women are represented in all specialities. “I did my surgical training in the male-dominated world of cardio-vascular surgery in the 1980s and when I started training in surgery, which would have been in 197980, there was only one other female trainee ahead of me at that time. that was probably the hardest part because it really was very unusual. It is a lot easier today because the proportion of females going into the surgical training schemes is considerable and the culture is different.

“I have to say, I only had one negative experience from a trainer,” she comments. “Which if you think about it is not bad. I got great support from the other trainers and trainees on the team, which without I might have quit!

“Perhaps because I was a novelty when I was training, people were paradoxically more interested in me, and in the end, I actually found people were very positive.”

Professor McGovern believes surgery is a good choice for women nowadays saying, “there are specialities in surgery where there would be a significant on-call commitment, which perhaps makes it harder to balance family life, but there is enough choice for people who want to have a family-friendly career that is also a surgical career.”

dr richArd steevens’ scholArship progrAMMe Professor McGovern speaks enthusiastically about this programme that awards doctors 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.

Professor McGovern is currently chairman

of the scholarship assessment panel.

“It is a wonderful initiative,” she explained. “It is funded by the Hse every year and is open to trainees in any speciality, but especially for trainees in Hst, who have been identified as high fliers.” some 20 scholarships have been awarded to date. “the benefit of the scholarship is that it is not just about learning more in a particular clinical area, but their experience of how that country’s health system works and how care is delivered. a similar initiative should be rolled out for managers in the Hse, who could go abroad and bring back innovative ideas for delivering care to patients in Ireland. then you would have an ideal combination – clinicians who have trained abroad, working with managers who have worked abroad and you would have a real meeting of minds. at the moment there can be a difficulty that the clinician has a great idea and they find it hard to get it delivered because there isn’t the same meeting of minds.”

estAblishMent of cArdio thorAcic unit in st jAMes’s When asked about her proudest moment in her career, Professor McGovern cites her work establishing the second cardio thoracic unit in Dublin at st James’s Hospital.

“It was a huge achievement in the health services. Within two years, the waiting list for cardiothoracic surgery in Ireland had come under control with the opening of the second unit. We brought in a lot of innovation in the unit such as pre-admission clinics, advanced nurse practitioners, taking over some of the role of junior doctors including working as assistants in surgery, which was a first.” some the innovations at the unit in st James’s have had a ripple effect, including the introduction of integrated care pathways in the Hse. “In a personal capacity, it has to be the epitome of anyone’s career to become the President of the rCsI. It is the peak of my career. I can’t think of a higher honour. It is bestowed on you by your own peers and colleagues to be President, which makes it more precious.”

16/03/2011 16:10:16

University College Cork, College of Medicine and Health Postgraduate Opportunities

School Therapies SchoolofofClinical Clinical Therapies

MSc Therapists) in Evidence Based Therapy Practice: Practice: MSc(for (forClinical Clinical Therapists) in Evidence Based Therapy

Candidates must hold a primary professional degree in Occupational Therapy, Speech Candidates must hold a primary professional degree in Occupational Therapy, & Language Therapy or Physiotherapy. Other applicants with a healthcare professional Speech & Language Therapy or Physiotherapy. qualification on an active register with their professional body may be accepted at the PhD & Doctor of Occupational Therapy D.Occ.T: Candidates must hold discretion of the Head of the programme. a primary professional qualification, a Masters and must for the PhD & Doctor of Occupational Therapy D.Occ.T:Degree Candidates holdD.Occ.T, a primary 5 years of qualification, professionala Masters practiceDegree experience. http://www.ucc.ie/en/ot/postgrad/ professional 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

School of Dentistry Department Epidemiology andand Public Healthof Epidemiology and Public Health Masters Degree in Dental Public Health – MDPH: Flexible full or part

Masters Degree in Dental Publicprofessionals.

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

SchoolofofMedicine Medicine School Advanced Southern Simulation Education and Training (ASSET) Advanced Southern Simulation Education and Training (ASSET) Centre: A full Centre: Ahigh fullfidelity immersion, high fidelity using the world’s immersion, simulation centre usingsimulation the world’s centre most advanced human simulator, offering opportunities to all healthcare to train for high situations in a most advanced human simulator,professionals offering opportunities to risk all healthcare simulated clinicaltoenvironment.

Contact: professionals train for high risk d.power@ucc.ie situations in a simulated clinical Masters in Public Health (MPH): Offered full or part time and aimed at healthcare environment.

Contact: d.power@ucc.ie professionals and students whose efforts contribute to the health of individuals and Masters in Public Health (MPH): Offered full or part time and aimed at populations. Three pathways allow students to specialise in Epidemiology, Health Protection healthcare professionals and students whose efforts contribute to the health and Health Promotion http:/www.ucc.ie/academic/pubh of individuals and populations. Four pathways allow students to specialise in Postgraduate Diploma in Palliative Care: A 2-year, part-time programme run in General Public Health, Epidemiology, Protection or Health Promotion. partnership between the Medical School andHealth St. Patrick’s/Marymount.

For further information http://www.ucc.ie/academic/pubh/ contact: edcentre@stpatricksmarymount.ie or medschool@ucc.ie. Palliative Care modules also Postgraduate available as CPD. Diploma in Palliative Care: A 2-year, part-time programme run in partnership between the Medical School and St. Patrick’s/Marymount.

Postgraduate Education Centre, Cork University Maternity Hospital: Runs programmes at healthcare professionals engaged in teaching, as well as or courses in For further aimed information contact: edcentre@stpatricksmarymount.ie Neonatal Resuscitation. For further information contact: nrp@ucc.ie medschool@ucc.ie Doctoral thesis (MD/DMed): be pursued the basis of work completed at UCC, offPostgraduate Education May Centre, CorkonUniversity Maternity site or published work. http://www.ucc.ie/calendar/postgraduate/Doctor/page002.html Hospital: Runs programmes aimed at healthcare professionals engaged in PhD in Health Services Research: Cross-institutional Health Services Research teaching, as well as courses in Neonatal Resuscitation. programme aiming to improve health through quality healthcare management and delivery For further information contact: nrp@ucc.ie in the Irish system. Funded by the HRB and offered jointly by UCC, TCD and the RCSI. Email Doctoral will thesis (MD/DMed): May closing be pursued the basis work applications be accepted up to an annual date ofon March 31st to:ofhsriadmin@rcsi.ie completed at UCC, off-site or published work.

Research Masters: Available in Obstetrics (MAO) and Surgery (MCh). http://www.ucc.ie/calendar/postgraduate/Doctor/page002.html http://www.ucc.ie/calendar/postgraduate/Masters/page09.html MMedSc (Sport and Exercise Medicine):Cross-institutional Classes are held at weekends for this partPhD in Health Services Research: Health Services time cyclicalprogramme programme with a research project health submitted at the end of year 2.

Research aiming to improve through quality healthcare For further information contact: medschool@ucc.ie management and delivery in the Irish system. Funded by the HRB and offered

MSc (Obstetrics Taught modules, clinical a thesis jointly

by UCC, TCDand andGynaecology): the RCSI. Email applications will beattachments accepted and up to an the course is part-time, running for 18 months. annual closing date of March 31st to: hsriadmin@rcsi.ie http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page16.html Research Masters: Available in Obstetrics (MAO) and Surgery (MCh).

MSc in Occupational Health: Part-time taught programme over 2 calendar years held 2 http://www.ucc.ie/calendar/postgraduate/Masters/page09.html evenings per week (Monday and Thursday), October to May. MMedSc (Sport and Exercise Medicine): Classes are held at weekends http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page12.html for this part-time cyclical programme with a research project submitted atthe the Postgraduate Certificate in Health Protection: Specifically designed to meet end of ofyear 2. For further information contact: medschool@ucc.ie needs working professionals, part-time running from January to April/May. http://www.ucc. ie/calendar/postgraduate/certificate/page01.htm MSc (Obstetrics and Gynaecology): Taught modules, clinical attachments MSca in Older Person Rehabilitation: A new, interdisciplinary MSc and Postgraduate and thesis - the course is part-time, running for 18 months.

Diploma in Older Person Rehabilitation; scheduled to commence in September 2011, subject http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page16.html to final approval.

These can be taken either part-time or full-time, and will be aimed at MSc in Occupational Health: Part-time taught programme over 2 calendar healthcare workers/managers who work with older people. Individual modules can also years held 2 evenings per week (Monday and Thursday), October to May. be taken for CPD. Further information is available from the Centre for Gerontology and http://www.ucc.ie/calendar/postgraduate/Masters/medicine/page12.html Rehabilitation, 021 4205976; k.sheehan@ucc.ie Postgraduate Certificate in Health Protection: Specifically designed toSchool meet theof needs of working Nursing andprofessionals, Midwifery:part-time running from January to April/May. http://www.ucc.ie/calendar/postgraduate/certificate/page01.htm PhD (by research) and Doctor of Nursing Practice (taught mode)Masters Programmes: (by research or taught mode) Postgraduateof Diploma: 7 speciality areas.Midwifery: School Nursing and

Postgraduate Certificates (subjectof to Nursing approval):Practice 3 speciality(taught areas: Community PhD (by research) and Doctor mode) Health Nursing, Gerontological (by Nursing and Multiple and Complex Masters Programmes: research or taught mode) Disabilities (Intellectual Disability). Applications can be completed online at www.pac.ie/ucc, The closing date for Postgraduate Diploma: 7 speciality areas. receipt of completed applications is 30th April, 2010.

Postgraduate Certificates (subject to approval): 3 speciality areas:

Higher Diploma in Midwifery: an 18 month full time programme for registered general Community Health Nursing, Gerontological Nursing and Multiple and Complex nurses which leads to registration with An Bord Altranais (Nursing Board) as a Registered Disabilities (Intellectual Disability). Applications can be completed online at Midwife (RM) and the award of a Higher Diploma in Midwifery from University College Cork in www.pac.ie/ucc, date for receipt of completed applications is 30th partnership with theThe Corkclosing University Maternity Hospital.

April, 2010.

Flexi-Option Modules: A range of modules are available. For more information, Flexi-Option Modules: A range of modules are available. For more phone 021-4901555. http://www.ucc.ie/en/nursingmidwifery/ProgrammesonOffer/ PostgraduateProgrammes/ information, phone 021-4901555. http://www.ucc.ie/en/nursingmidwifery/ProgrammesonOffer/ School of Pharmacy PostgraduateProgrammes/ MSc Clinical Pharmacy/Postgraduate Diploma/MSc Postgraduate Diploma Conversion Course: Part-time distance education programme, featuring teleconferencing

School of Pharmacy

and e-learning, provides pharmacists with specialist training to enhance their role in hospital

MSc Clinical Pharmacy/Postgraduate Diploma/MSc Postgraduate environments. www.ucc.ie/acad/pharmschool/teaching/PostgradProgrammes.php Diploma Conversion Course: Part-time education programme, PhD in Clinical Pharmacy/Pharmacy: Offersdistance multiple research opportunities leading

featuring teleconferencing and e-learning, providesstaff pharmacists with specialist to the award of a PhD. See research interests of individual at http://www.ucc.ie/en/ training to enhance their role in hospital environments. pharmacy/people/acad/ www.ucc.ie/acad/pharmschool/teaching/PostgradProgrammes.php CPD: Flexi Option Modules in Asthma, Coagulation Management, Diabetes, and Herbal Medicine.http://www.ucc.ie/en/pharmacy/ContinuedProfessionalDevelopmentCPD/ PhD in Clinical Pharmacy/Pharmacy: Offers multiple research Or Tel 021.4901661 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

HM Iss7.1 p1-70.indd 36

16/03/2011 16:10:17

Health Matters 37

education & training

Enhancing physiotherapy education Challenging traditional clinical education models and harnessing new HSE practice education initiatives can have significant benefits for service provision in physiotherapy, according to Aileen Barrett (RCSI) and Sarah Slattery (CUH).

Senior physiotherapist, Liz O’Sullivan said that while the placement demanded a new perspective as a teacher as well as clinician, this was a welcome learning experience and she also commented on the high standard of the service provided to patients.

Since the pilot was carried out, this model has successfully been incorporated into the placement provision schedule and has been repeated in the gym and the geriatric rehabilitation unit settings.

Guidelines for this model are currently being developed based on the CUH experience. Details of this model were presented at the Association for Medical Education in Europe (AMEE) and the Irish Society of Chartered Physiotherapists (ISCP) Conferences in 2010.

L-R: Sarah Slattery, Practice Tutor CUH and Aileen Barrett, RCSI with students Aideen Henry, Sarah Jane Bennett, Jane Dickson and Sarah McShane Back row: Sinead Glennon, Physiotherapy manager and Liz O’Sullivan, Senior Physiotherapist

C

linical education is a key feature of undergraduate physiotherapy degree programmes across the world. In Ireland, students must complete 1000 hours in supervised clinical practice to be eligible for membership of the professional body, the Irish Society of Chartered Physiotherapists. The establishment of practice tutor posts by the HSE over the last five years has contributed significantly to the quality of clinical teaching provided to these students and to the development of clinical placement capacity in HSE hospitals.

Placement Models Traditional undergraduate placement models see one student supervised by one clinician, a 1:1 model of education. In October 2009 the School of Physiotherapy at the Royal College of Surgeons in Ireland and the Physiotherapy Department at Cork University Hospital collaborated on a new 4:1 placement model, the brainchild of Sarah Slattery, practice tutor in physiotherapy at CUH. Four final-year

HM Iss7.1 p1-70.indd 37

students were placed in the rehabilitation gym for six weeks, under the supervision of Sarah and senior physiotherapist, Liz O’Sullivan.

Together with the four students, Liz and Sarah managed the entire rehab gym caseload allowing two junior physiotherapists to be redeployed to the wards. According to Sinead Glennon, physiotherapy manager, this facilitated increased activity of the inpatient ward physiotherapy service, improving the quality of service by allowing increased frequency and length of treatments.

The pilot resulted in 1.62 WTE posts being redeployed, the equivalent of 340.2 hours of clinical time and a 50 per cent reduction in gym waiting times.

Feedback After the placement, the students were unanimous in their views that this model provided a unique and high-quality education experience, incorporating facets of supported and peer learning, team-working abilities and graded independence.

Take-home message New and creative models of clinical education can have significant benefits for undergraduate students, patients and clinical staff, fostering relationships between the Higher Education Institutions and the HSE, creating professional development opportunities for staff as well having huge efficiency implications for services in these challenging times.

For further information Aileen Barrett Practice Education Co-ordinator at the School of Physiotherapy Royal College of Surgeons in Ireland / Chartered Physiotherapist Email: abarrett@rcsi.ie; Tel: (01) 402 8666 Sarah Slattery Practice Tutor at the Department of Physiotherapy in Cork University Hospital / Chartered Physiotherapist.

Email: sarah.slattery@hse.ie

16/03/2011 16:10:20

HealtH Matters 81

HealtH & Well-being Ireland’s leading School of Nursing & Midwifery delivers a comprehensive range of nursing & midwifery courses for students entering the profession whilst also offering lifelong learning opportunities for qualified health care professionals. courses: association aimed at influencing the(in consumer towith be National Children’s Hospital, AMNCH, Tallaght) it is Postgraduate lower in salt and increased public • M.Sc./PG Dip in Professional Nursing Studies • Higher Diploma salt aware. In being more salt aware, we in Midwifery (R.M.) awareness of the need to omit added Optional strands available in: (intable association increasingly omit salt at the and inwith The Rotunda Hospital and The Coombe salt and choose low-salt products Nursing Women’s and Infant’s University Hospital) cooking. also, we become more educated whenbuying food.

- Clinical Health Sciences Education Research Degrees as consumers to actively select low-salt - Advanced Nursedone?

Practitioner in Emergency Nursing M.Sc. by on research • Ph.D. foods, which significantly• impacts What has been Introducing 2 NEW strands (subject to CollegeCouncil approval): Funding opportunities for Ph.D. students may be available. achieving change in the food industry.

Many agencies have undertaken to Child Health For information, please contact the School. the Hse is also playing a part in influence the levels of salt in our food, - Specialist information on all our courses is available at dietary salt reduction byFurther contracting such as the FoodNursing safety authority of (in association with St. James’s Hospital and AMNCH) www.nursing-midwifery.tcd.ie for low-salt bread as a first step, and Ireland (FsaI), who have worked with specialities availablereformulation – see website for moredetails) School of Nursing in 2010 new contracts for a number of & Midwifery University of Dublin, the food(7sector to promote • M.Sc. in Midwifery/ PG Dip in Professional Midwifery Studies Trinity College other foods will be agreed. In 2009, the24 D’Olier Street, Dublin 2 of bread, soups, sauces, sausages and (Option in Clinical Health Sciences Education) 896 2692 Hse commissioned the +353 Public(0)1 analyst rashers among others. also, academic • M.Sc./PG Dip in Gerontological Nursing nursing.midwifery@tcd.ie laboratory to survey the salt levels in bread institutions have targeted the research (in to association with St. James’s www.nursing-midwifery.tcd.ie purchased for patients and staff. Hse needed overcome technical andHospital) • M.Sc./PG Dip in Cancer Care For of closing date for receipt of applications please see contracted bread was one the lowest other barriers. (in association with St. Luke’s Hospital, Rathgar) www.nursing-midwifery.tcd.ie salted breads on the market, being seven Other initiatives such as safe Food’s • Higher Diploma Children’s Nursing (R.C.N) Allthe postgraduate applications must submitted online at www.pac.ie to 13 per cent lower than agreed salt campaign, ‘shake the in Habit’ and Irish reductions with FsaI. Heart Foundation promotions are

“almost 80 per cent of salt is ‘hidden’ in the increasingly processed food that we eat. bread and processed meats make up about 50 per cent of the hidden salt in our diet.”

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 Health Services Management (NFQ level 6) This 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. Attendance is required one-day every three weeks from September to April.

Diploma in Health Services Management (NFQ level 7) This 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.

Attendance is required one day every two weeks at the University of Limerick from September to May. BA in Health Services Management (NFQ level 8) This two year programme is aimed at developing the managerial competencies required by health service professionals 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. Attendance is required one-day every three weeks from September to May at the University of Limerick.

For further details and an application form contact: Breda Ahern or Brid Henley, Management Development Unit, Kemmy Business School, University of Limerick.

Tel: 061-202915 or 061-202665. Email: Breda.Ahern@ul.ie or Brid.Henley@ul.ie.

It is advisable to book as soon as possible to secure a place on these programmes.

Courses commence in early September.

HMHM Iss6.2 p71-128pg2.indd Iss7.1 p1-70.indd 38 81

16/06/2010 16/03/201112:43:36 16:10:22

HealtH Matters 39

AppoIntments

+ Dr Siobhan O’Halloran has been appointed as National lead for acute Hospital services. she was formerly Nursing and Midwifery services Director

+ Gordon Jeyes has been appointed as the new National Director for Children and Family services in the Hse. He was formerly Deputy Chief executive in charge of the Office of Children and Young People’s services with Cambridgeshire County Council

+

Frank Murphy has been appointed as area Manager for Mayo. He is local Heath Manager for roscommon on an interim basis

+

+

Dr Cathal O’Donnell, Consultant in emergency Medicine, MWrH, limerick, has been appointed on a secondment basis, as Medical Director to the National ambulance service

+

John swords has been appointed Head of Portfolio and Category Management. He was formerly Head of logistics and Inventory Management

+

+ Robert Morton has been appointed Director of the National ambulance service. He was formerly Chief ambulance Officer for the Midlands area

+

+ Bernard Gloster has been appointed as area Manager for the Hse Mid West. He was formerly local Health Manager for North tipperary/east limerick

+

+ Leo Kinsella has been appointed as area Manager for Hse Cavan/Monaghan. He was formerly local Health Manager for Cavan/Monaghan

Philip Crowley has been appointed as National Director of risk, Quality and Clinical Care in the Hse. He was Deputy Chief Medical Officer, Department of Health and Children and has been seconded to the Hse

HM Iss7.1 p1-70.indd 39

Dr Cate Hartigan has been appointed asst National Director of Disabilities. she was formerly asst National Director of Older Persons

Pat Dolan has been appointed as area Manager for Hse sligo/leitrim.

He was formerly local Health Manager for sligo/leitrim

John Hayes has been appointed as area Manager for Hse Donegal. He was formerly local Health Manager for Donegal

16/03/2011 16:10:43

Faculty of Health Sciences Ireland’s leading University delivers a comprehensive range of multidisciplinary courses and lifelong learning opportunities for students and qualified Health Sciences professionals.

Multi-disciplinary postgraduate courses: •

M.Sc./PG Dip in Mental Health (in association with the National Forensic Mental Health Service) (Option available in Child, Adolescent and Family Mental Health)

•

M.Sc./PG Dip in Palliative Care (in association with St Francis Hospice, Raheny)

•

PG Dip in Clinical Health Sciences Education

•

M.Sc./PG Dip in Dementia

Research Degrees •

M.Sc. by research

•

Ph.D.

Counselling and support for anyone affected by

All options discussed

Funding opportunities for Ph.D. students may be available.

For information, please contact the School.

Further information on all our courses is available at www.nursing-midwifery.tcd.ie School of Nursing & Midwifery University of Dublin, Trinity College 24 D’Olier Street, Dublin 2 +353 (0)1 896 2692 nursing.midwifery@tcd.ie www.nursing-midwifery.tcd.ie For closing date for receipt of applications please see www.nursing-midwifery.tcd.ie All postgraduate applications must be submitted online at www.pac.ie

Physicians, Nurses, Allied Health Professionals and Biomedical Scientists!

Are you looking for Career Advancement, Continuing Professional Development Postgraduate Study Options?

Then come to NUI, Galway The College of Medicine, Nursing and Health Sciences at NUI Galway is amongst the largest providers of healthcare education in Ireland. We enjoy close research and academic links with a range of affiliate hospitals, community-based and other healthcare providers in addition to strong relationships and affiliations across the international healthcare arena.

Our programmes are unique, innovative and we constantly re-focus them towards the changing demands of health professionals, managers and scientists, who need specialist education and professional development opportunities.

Programmes are delivered online in many cases and material is blended with on-site sessions to enable students to avail of education at their convenience.

To find out more about our existing programmes as well as new programmes on offer in 2011 click on www.nuigalway.ie/colleges/mnhs/courses.html or email: graduatehealth@nuigalway.ie

HM Iss7.1 p1-70.indd 40

16/03/2011 16:10:48

HealtH Matters 41

In BrIeF // News

boDY talk!

BUsY BODIes aDOlesCeNt Development Programme provides information on the physical and emotional changes that children may experience during puberty. the main aim of the resource is to reassure children that puberty is a normal part of growing up. Busy Bodies is a useful tool to help support both teachers and parents in providing information on puberty to children aged between 10 and 14.

Busy Bodies was developed to support the teaching of the 5th and 6th class component of relationships and sexuality education within the context of social, Personal and Health education. It was produced by Hse Health Promotion working in partnership with the rse support service, the National Parents Council (Primary) and the Hse Crisis Pregnancy Programme. the programme includes an animated child-friendly DVD and booklet. Copies of the booklet are available in both english and Irish. how to order: Parents – to order a free copy, text BUsY, plus your name and address to 50444. teachers – to order a free copy of the DVD and student copies of the booklet, log on to www. healthpromotion.ie. Go into the ‘search Publications’ under the topic ‘sexual Health’. to order class-size quantities, you will need to create an account as a professional.

Busy Bodies DVD and booklet are also available to download from www.healthpromotion.ie

nuI awarDS

+

Pictured at the December 2010 IPa conferring of NUI awards in Dublin Castle were: Dr Maurice Manning, Chancellor National University of Ireland; tim O’sullivan, IPa; Dr Brian Cawley, Director General, IPa; angela tierney-O’reilly, first place Ba (Hons) Healthcare Management and Dr attracta Halpin, registrar, National University of Ireland

HElP, SuPPort anD oPtIonS

tHe Hse CrIsIs Pregnancy Programme recently launched a new public health campaign, Positive Options, to raise awareness of the free, trustworthy, state-funded services, which offer help and support to those experiencing a crisis pregnancy. Non-judgemental crisis pregnancy counselling services, promoted

HM Iss7.1 p1-70.indd 41

through the campaign, are available at over 50 locations around the country. the Positive Options campaign was first developed by the Crisis Pregnancy agency in 2003 and the new campaign messaging aims to highlight the fact that there is always a supportive listener available to help during a crisis pregnancy, in the form of highly-trained crisis pregnancy counsellors. Counselling offers an opportunity for people to explore their feelings about a pregnancy with someone who is not personally involved, while counsellors can also provide practical information on rights and entitlements and referral to specialist services if required. Crisis pregnancy is a common experience in Ireland.

Of women who have been pregnant, 28 per cent have experienced a crisis pregnancy; 23 per cent of men whose partners have been pregnant have experienced a crisis pregnancy (Irish Contraception and Crisis Pregnancy study, 2004). the new tV, radio and poster advertising campaign was launched in January to highlight the availability of services at the time of year when crisis pregnancy counsellors traditionally experience a peak in demand. to order posters, leaflets and wallet cards, visit: www.healthpromotion.ie.

For more information on state-funded crisis pregnancy counselling services, visit: www.positiveoptions.ie

16/03/2011 16:10:55

42 HealtH Matters

In BrIeF // News

Do You work wItH brEaStfEEDIng MotHErS? WHY NOt atteND the spring study Day of the association of lactation Consultants in Ireland on saturday March 26th? the event will take place at the Coombe Women and Infants University Hospital, Dublin 8. the theme is Breastfeeding and Mothering and the keynote speaker is Naomi stadlen, author of What Mothers Do especially When It looks like Nothing, who will present twice over the course of the day. Naomi is a psychotherapist and lecturer, who works with mothers in weekly discussion groups, through tai Chi with mothers and babies, and through being a la leche league leader.

Other topics covered will be breast milk in neonatal units, breastfeeding and bereavement, private practice and code compliance. It is hoped that this combination of topics and speakers will provide stimulation and interest for all attending. a study day pack, refreshments and a light lunch are included in the delegate fee, which is b50 for members and b60 for non members. there will be a student / Unwaged rate of b25. Booking forms and more information are available from www.alcireland.ie or from alCI@ireland.com or text (089) 441 6497.

+ l-r: Brian Howard, CeO, Mental Health Ireland; Martin Mcaleese; President Mary Mcaleese; tony Bates, Headstrong; and Priya Prendergast, Hse local Health Manager, Galway.

PresIDeNt MarY MCaleese visited Jigsaw Galway in January. Jigsaw Galway is part of a national initiative being developed by Headstrong – the National Centre for Youth Mental Health.

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InCrEaSE In StrokErElatED aDMISSIonS DuE to f.a.S.t.

CaMPaIgn strOKe-relateD HOsPItal admissions increased by 87 per cent following the launch of the Irish Heart Foundation’s act F.a.s.t. campaign to raise awareness of Ireland’s third biggest killer disease. research carried out by the royal College of surgeons in Ireland (rCsI) also showed that 59% more stroke victims got to hospital in time to receive potentially life-saving thrombolysis treatment during the first phase of the campaign in 2010. the results of the study, which was conducted in Beaumont Hospital and Connolly Hospital, were announced at the launch of the second phase of the campaign in Dublin, attended by patients who survived their stroke because of the swift treatment they received after seeing act F.a.s.t. advertisements. the F.a.s.t. acronym was developed to inform the public about the key symptoms of a stroke: •Face – has their face fallen on one side? Can they smile?

•arms – can they raise both arms and keep them there?

•speech – is their speech slurred?

•time – time to call 999 if you see any one of these signs.

16/03/2011 16:11:07

HealtH Matters 43

In BrIeF // News PrestIGIOUs GlOBal reCOGNItION GaINeD BY IrIsH HOsPItals

+ Back row l-r: Dr Nazih eldin, Irene Gilroy, Dr Kirsten Doherty, ann O’riordan, Director IHPH Network, rosemary Orr and Miriam Gunning. Front row l-r: Prof Cecily Keleher, Dr tony Holohan Chief Medical Officer DOHC, Mary smyth and Mary Walshe tWO IrIsH HOsPItals have received global recognition for tobacco management in a growing global trend for health services to be tobacco-free. Connolly Hospital and st Vincent’s University Hospital (sUVH) were acknowledged internationally by the eNsH–Global Network for tobacco Free Healthcare services (eNsH) for their implementation of comprehensive tobacco management policies.

Both hospitals received the coveted Glass Globes (2009/2010) in addition to an eNsH Gold level Nomination Certificate. the awards were attained in recognition of the high-quality implementation of the

eNsH standards that included tobacco cessation services, as well as being tobacco-free campuses. to gain this prestigious recognition, both hospitals had to demonstrate that international criteria had been attained and presented at a global forum where their efforts to develop as a ‘tobacco-free hospital campus’ were validated. their efforts were peer-rated as being in a superior category, which will be instrumental in supporting tobacco control in health services both nationally and internationally. the Hse has set out a strategic plan within the Hse tobacco Control Framework to address tobacco control at all levels. this includes a commitment to develop all healthcare settings to ‘totally tobacco-free’ over the next five years. this development will see tobacco-use addressed as a care issue in all interactions. the challenge for the Hse in implementing the tobacco Control Framework will create an opportunity for Ireland to maintain its leadership role in tobacco management and through active participation in the eNsH process, Irish health services will have an opportunity to develop and showcase smoke-free campuses throughout their services.

ProtECtIng babIES bonE DEvEloPMEnt PareNts OF all BaBIes, from birth to 12 months, both breastfed or formula-fed, are being advised to give their infants a daily vitamin D supplement of 5 micrograms (5µg) to protect their growing bones. this advice comes to parents and guardians from the Hse, the Food safety authority of Ireland (FsaI) and the Department of Health and Children. the introduction of the policy will see Hse staff and healthcare workers like paediatricians, midwives, public health nurses, GPs, pharmacists and dieticians routinely advising pregnant women and parents and carers of infants of this.

Multivitamin products are not recommended for babies, and a number of Vitamin D only products that are suitable for infants are available for purchase in pharmacies and other locations across Ireland. a prescription is not required. the Hse has set up a dedicated web page, www.hse.ie/go/vitaminD, which will answer the questions of parents and health professionals, and also outlines the suitable vitamin D products for infants that are available in Ireland. an information leaflet for parents and factsheet for health professionals is also available.

HM Iss7.1 p1-70.indd 43

QualItY aSSuranCE aCCrEDItatIon awarD for nowDoC

+ Dr Diarmuid Hegarty, NoWDOC Medical Director with angela tysall, Hse service Manager for the NoWDOC service IN JaNUarY, the NoWDOC GP out-ofhours service in the North West secured a quality assurance accreditation award from the royal College of General Practitioners (rCGP) in Northern Ireland.

NoWDOC, through its involvement in cross-border out-of-hours GP services, became aware of the rCGP Quality Programme to accredit out-of-hours service providers in Northern Ireland and started the accreditation process in 2008. the rCGP Quality Programme enables out-of-hours GP service providers to ensure that they are moving in the right direction in their development and that they have the proper procedures in place to deliver a quality service to their patients. the process involves written submissions and an assessment team visit to ensure that all the components are in place. the ethos is very definitely formative, educative and supportive. angela tysall, Hse service Manager for the NoWDOC service said, “It is a source of tremendous professional satisfaction for all involved in NoWDOC that the quality assurance accreditation demonstrates to others that a high-quality service is being provided to patients in this region. the accreditation will also enable us to further develop cross-border services as mutual recognition of quality of service is paramount.”

16/03/2011 16:11:12

44 HealtH Matters

news // duBlIn mId-leInster

ratHDruM PrIMarY CarE tEaM a NeW PrIMarY Care teaM (PCt) serving more than 5,000 people has been set up in Co. Wicklow. a comprehensive range of health and social services, with the support of local GPs, for rathdrum and the surrounding areas of aughrim, Ballinacash, Ballinacor, Ballinderry, Knockrath and tropperstown is now in place. the range of integrated services that is + l-r: Marion Meany lHM; Fionnuala O’Mahoney available includes; Community Nursing, Primary Care; Dr Phillip sheeran-Purcell GP; eliz Physiotherapy, Occupational therapy, Doyle tDO/MsOP and Dr rick aboud, GP Unit Home Help, social Work for all age groups, Doctor for the area Dietetics, speech and language therapy, Psychology services and adult Mental Health and Dental. the PCt will be enhanced when a new primary care centre is built – the planning of which is ongoing. Marion Meaney, local Health Manager for Wicklow said, “the teams will demonstrate that the localised delivery of services is the most effective and logical way of ensuring that our communities get top quality prompt and appropriate medical and social care services.”

nurSES InDEPEnDEntlY PrESCrIbIng X-raYS sOMe 66 reGIstereD NUrses from 20 hospital sites have now completed a course for Nurse Prescribing X-ray (medical ionising radiation). the course enables nurses to prescribe x-rays independently within an agreed list. this results in the nurse being able to provide a more responsive, accessible, effective, timely and efficient service that improves and speeds up the patient’s journey within the health care system. It also leads to better patient satisfaction. In addition, it provides an exciting opportunity for registered nurses, in all fields, to expand their roles. the nurse Prescribing X-ray education Programme was introduced two years ago following the completion of a Hse national + at stewarts Hospital, Palmerstown is audrey Daly, framework by the national advisory Orthopaedic Dept, Mid-Western regional Hospital, limerick committee led by Dr siobhan and Frank Philpott lloyd, Mercy Hospital, Cork.

O’Halloran. Dr O'Halloran is now National lead for acute Hospital services. the role expansion for nurses occurs in the context of the Hse transformation Programme 2007-2010, and the Hse Integrated services Programme, where the focus is to improve the provision of safe, effective and timely patient care. an evaluation and audit of the nurse prescribing of medical ionising radiation will take place at each hospital site. the programme has been validated by HetaC. the accredited centres are based at Connolly Hospital, Dublin and the Midland regional Hospital in tullamore, Co. Offaly. Up to 220 nurses are expected to have completed the course by next year.

HM Iss7.1 p1-70.indd 44

DEMEntIa EDuCatIon PrograMME launCHED In bIrr

+

l-r: Dr siobhan O’Halloran, former Director of the Office for Nursing and Midwifery services Directorate; Josephine McDonald, service User; former Minister for Health and Children, Mary Harney; Professor Diarmuid O’shea, Clinical lead for the elderly Care Programme Consultant Geriatrician, st Vincent’s Hospital and Mary Manning, Project Manager National Dementia Programme

DeMeNtIa Is seeN as one of the ‘most significant health issues’ facing older people in this country. a programme designed to develop and identify gaps in dementia education and training is now up and running. the national dementia education programme is a generic education programme geared towards nurses and nonnursing staff working across all care services. the programme is supported by a National Dementia education Needs analysis report and evaluation pilot programme. these findings framed the Dementia education Programme Manual: an Introduction to Dementia Care, which was also launched in conjunction with the programme.

Dr siobhan O’Halloran explained at the launch that, “Dementia is a condition that affects at least one family in every street around the country and there are growing numbers of people under 65 who are being diagnosed with it.”

In 2009, the figure for people who have younger onset dementia stood at 4,000 and the number is expected to increase.

16/03/2011 16:11:19

HealtH Matters 45

duBlIn mId-leInster // news

butterfly Moments –

CHangE tHE MoMEnt a

n initiative called “Butterfly Moments” is helping staff enrich the lives of residents through personal interactions and spontaneous activities at st.

Vincent’s Care Centre, athlone, Co. Westmeath. the introduction of ‘Butterfly Moments’ is one of a number of projects that have been undertaken by staff at st. Vincent’s Care Centre to identify ways to provide care and services based around the needs and preferences of individual residents.

Based on the results of research conducted by staff with residents and family members, new and meaningful activities are being explored and developed for each resident. the Butterfly approach was developed

by David sheard in the UK. the metaphor of the Butterfly is used to enable nurses and care staff to improve the lives of

“the Butterfly Approach was developed by david sheard in the uK. the metaphor of the butterfly is used to enable nurses and care staff to improve the lives of residents with dementia in residential care.”

HM Iss7.1 p1-70.indd 45

residents with Dementia in residential care. the approach involves training coaching and encouraging staff to increase their level of positive interactions with residents. the initiative was launched recently at st Vincent’s Care Centre and residents, staff and pupils from two local schools participated. the pupils were joined by staff and family members of residents when they created a series of colourful butterflies prior to the launch. the pupils who participated were from the local Our lady of the Bower secondary school and st Patrick’s National school.

‘Butterfly Moments – Change the moment’ is the slogan for the initiative and colourful butterfly posters and paintings were erected throughout the centre. even before the implementation of the approach, the sight of butterflies around the centre has generated a great level of excitement for everyone. residents have greatly enjoyed all the activity associated with the preparation and the amount of social interaction involved. this in itself acts as a sign of things to come, once the initiative is up and running. as the project has been managed using a continuous quality approach, staff intend to carry out an impact evaluation of Butterfly Moments over the coming months in an effort to improve further person centred services for residents. the project is sponsored by Nurse Midwifery Planning Development Unit, tullamore. st Vincent`s athlone wish to acknowledge and thank their sponsors and all who contributed in any way to make this a very successful venture.

+ l-r: Corina Finn, Michelle Conlon, both members of staff at st Vincent’s Care Centre

+ Members of staff and clients who worked on the project – Back row (l-r): Geraldine Mcmanus, ann-Marie Healy, Mary Fagan, Noeleen McGovern, Julie Molloy, Mary Donoghue, andrea O’reilly, rosie adamson. Front row (l-r): Gráinne ní Domhnaill, Pauline Quast, Frank Montgomery, Mary Browne

Back row (l-r): eilish Croake, Hse National Midwifery Planning Development Unit; Pauline Quast, st Vincent’s Care Centre; eithne Hanevy, st Vincent’s Care Centre, Mary Mannning, Hse National Midwifery Planning Development Unit; Gráinne NicGabhann, Community services Manager, longford/Westmeath Front row (l-r): Frank Montgomery, Mary Browne, st Vincent’s Care Centre

16/03/2011 16:11:24

46 HealtH Matters

news // duBlIn mId-leInster

StrokE Can HaPPEn to anYonE Senior occupational therapist, ann Murphy, received the adult Courage award at the inaugural Irish Heart foundation Stroke awards last november.

l

ast september, nine months after her retirement from the Dublin south-east community care area, ann Murphy suffered a haemorrhagic stroke while shopping in Dublin city centre. ann was lying on a wet and busy street, just metres from where her car was parked, passers-by who saw her and thought she was drunk, did nothing. eventually, ann was helped to her car where she managed to send a text to her daughter saying, ‘I think I’m having a stroke’. she was quickly brought by ambulance to st James’s Hospital, Dublin, where she was admitted. ann’s initial presentation included loss of power in her right arm and leg, dysphasia, and balance and co-ordination deficits. she also developed stroke-induced epilepsy. When she was stable enough, ann was transferred to the rehabilitation Unit at Hospital 2 in st James’s. as a result of the stroke, ann was forced to miss her daughter’s wedding just two weeks later. this came as a huge psychological blow on top of the adjustment to her sudden stroke. “Once the wedding was over was when I decided okay, this has happened and now I’m here to work hard on my rehabilitation,” ann explained.

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+ ann was deligthed with the treatment she received from the rehabilitation team in Hosptial 2 in st James's

ann was delighted with the treatment she received from the rehabilitation team in Hospital 2. she received input from a comprehensive multi-disciplinary team (MDt), including dietician, occupational therapist, speech therapist, physiotherapist, nursing staff and the medical team. through the combined hard work of ann and the rehabilitation MDt, she made rapid progress with her speech, mobility and function.

Unfortunately, there was one more setback to come. On the morning she was due to collect her Irish Heart Foundation stroke award she suffered a stroke-induced seizure and had to be readmitted to hospital, missing the award ceremony. Her rehabilitation continued after this and she was pleased to be discharged from st James’s in time to spend Christmas with her family. she is now continuing her rehabilitation at Baggot street stroke Unit. ann’s advice to anyone going through something similar is to keep looking to the future, to set small goals, and to seek support and encouragement to achieve these goals. Without the backup of an effective rehabilitation team, it would have been difficult to progress.

asked for her observations on the health service from the perspective of a patient who is a health professional, ann said, “Patients generally do not have medical knowledge. If a patient doesn’t have a health professional in the family it can be difficult to advocate for themselves and understand the medical processes going on around them.” this could be an important insight for health professionals in terms of their communication. she also remarked how much of a difference it made to her when she was greeted with a ‘hello’, a smile, and particularly a friendly introduction. she was also impressed at the dedication of the nursing staff, but disappointed at the constant staffing shortages on the wards.

Dignity and respect was also a concern for her. a particular concern was the lack of shower facilities on the wards. she also feels that female patients, particularly those who are elderly or have communication deficits, should be given a choice as to whether they are assigned male attendants for personal hygiene care.

Having come through her own stroke journey, ann is determined to highlight the need for dedicated stroke rehabilitation units at both tertiary and primary levels.

16/03/2011 16:11:29

HealtH Matters 47

duBlIn mId-leInster // news

ParEntIng tHE trIPlE P waY PareNts IN tHe counties of longford and Westmeath now have free access to one of the world’s most respected parenting programmes triple P, thanks to the longford/ Westmeath Parenting Partnership (lWPP). “triple P – Positve Parenting Programme – is not a one size fits all parenting programme.

It is a multi-level preventative parenting and family support strategy which addresses parenting as a public health issue,” says Conor Owens, Project Director. access to a range of five different intervention levels help to ensure that parents identify the correct level of intervention for them. If successful, it is hoped that this interagency model for the delivery of an evidence-based parenting course may be repeated in other areas of the country. the triple P’s selection of courses, seminars and one-to-one consultations are now available free to all parents of children aged seven years of age and younger.

Joseph ruane, local Health Manager (Hse) says, “the partnership is committed to working together to enhance parenting skills for a better community. triple P is flexible and it has the strength of the evidence base.”

Group triple P sessions are already being held in community venues. Over 350 parents have booked and completed the group programme since October.

investment in our future the triple P trained practitioners include; public

+ Dorrie Mangan, Conor Owens, triple P Project Director; liz Canavagh, Office of the Minister for Children and Youth affairs; Joe ruane, local Health Manager; ambassador Bruce Davis; Professor Matt sanders; eamon Farrell, triple P Chairman; Jane Foreman, atlantic Philanthropies and Maria larkin Child Care Manager health nurses, health visitors, family support workers, youth and community workers.

Dr Phil Jennings, Director Public Health in the Midlands is confident triple P’s impact will be noticeable. “Most people have no training for the role of parent, so this parenting programme can really help all parents to build their confidence in meeting the challenges that present,” she said. “We hope this programme will bring a reduction in child behaviour problems, an increase in children’s pro-social skills and an increase in parental confidence and a decrease in parental depression worry and stress related to bringing up children.”

any parent of a child aged seven years and under living in longford/Westmeath can get more information about the different triple P levels and how to book a place at www.triplep-staypositive.net (restricted to longford/Westmeath area) or by phoning (090) 6434 070. this population approach to parenting is being evaluated by the Child and Family research Unit NUIG. the lWPP triple P Project is funded by lWPP members, Hse, the Office of the Minister for Children and Youth affairs, the atlantic Philanthropies and aontacht Phobail teoranta (aPt).

HEaltH workErS SEE ParEntS tHrIvE wItH trIPlE P HealtH PrOMOtION WOrKer, Karen Heavey, has seen first-hand how the stress of family meal times can wear a parent down. “Parents who are trying to deal with a child who won’t eat often end up at the end of their tether,” said Karen, who is one of the many practitioners sharing triple P with parents in longford/Westmeath. according to Karen, parents can experience a lot of stress but there are simple solutions. “We often find that parents expect their children to behave well at meal times but haven’t spoken to their children about what is and what isn’t acceptable behaviour. Consistency is important and ground rules need to be established,” she said.

Karen and her colleague Kate egan, who is a Public Health Nurse, facilitate triple P in both group courses and shorter one-to-one Primary Care sessions. they say both methods give parents the confidence to adapt triple P’s strategies to suit their own family life. Both Karen and Kate enjoy seeing how triple P changes parents, watching them to become more assured and empowered to develop their own strategies for positive parenting.

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16/03/2011 16:11:33

48 HealtH Matters

News // duBlIn nortH eAst nEw aCutE PSYCHIatrIC warD oPEnS at ConnollY HoSPItal

+ l-r: Mary Walshe, Hospital Manager; Margo Wrigley, executive Clinical Director; Deirdre Murphy, area Manager; ann McManus, CNM2, Pine Ward; Jackie Benbow, Clinical Director; anne O’Connor, lHM; former Minister for Disability and Mental Health, John Moloney; stephen Mulvany, regional Director of Operations; and sean tone, Director of Nursing, North West Dublin Mental Health services at the official opening of the Pine Ward, Connolly Hospital tHe ‘PINe WarD’ in the Department of Psychiatry, at Connolly Hospital, Blanchardstown was officially opened in November and completes the new acute admission facility for the North West Dublin Mental service, which serves the areas; Cabra, Finglas and Blanchardstown. the Department of Psychiatry at Connolly Hospital now has two 22 bed acute units and a five-bed High Dependency Unit. the opening of the new unit facilitated the transfer of 12 acute patients from st Brendan’s Hospital, which marked a key milestone in the modernisation of Mental Health services in the Dublin North east area. the occupancy of the Pine Ward is the penultimate stage in a long process which when complete, will lead to the de-commissioning of the old institutional facilities at st Brendan’s. this development has been facilitated by the Croke Park Agreement. last september, it was announced at the launch of the Grangegorman Development Project that the modernisation of the Mental Health services will continue with the construction of replacement mental health facilities on the grounds of st Brendan’s Hospital. the Government has allocated b19 million for a purpose-built 54-bed facility that will replace the remaining units of st Brendan’s.

SuPPortIng PoSItIvE attEnDanCE DurIng anD aftEr PrEgnanCY a PrOJeCt Is UNDerWaY in Dublin North east to support pregnant employees in the workplace. as a predominantly female workforce, the health sector has significant numbers of pregnant employees at any given time.

While the majority will continue to work throughout their pregnancy with no difficulties, the absenteeism rate among pregnant employees is higher than the average. the focus of the project is on the promotion of heath and wellness, and to provide a supportive health, safety and welfare approach to pregnant employees. an information pack has been devised to assist managers with pregnant employees and a separate pack has been devised to assist and inform staff who apply for maternity leave.

Initial feedback from staff in the four pilot sites; a community area in north Dublin, Our lady of lourdes Hospital, Drogheda, st Ita’s Hospital, Portrane and Cavan General Hospital has been positive and the learning from this will be rolled out on a national basis. For further information contact: Mary McCarthy tel: (041) 987 5210 email: maryf.mccarthy@hse.ie

PrEMaturE babY EXHIbItIon In DrogHEDa town CEntrE

+ staff from Our lady of lourdes Hospital and members of the public at the recent Premature Baby awareness Day balloon launch

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staFF FrOM tHe Maternity Unit of Our lady of lourdes Hospital hosted an event to mark International Premature Baby awareness Day. the event included an exhibition of photographs, posters and biographies of several of the babies born in the hospital, and cared for in the Neonatal/special Care Baby Unit. equipment such as incubators and monitors were on display and staff were on hand to explain how the equipment is used to nurse premature babies. some of the babies who have passed through the unit and who are now teenagers and adults came along to the exhibition to help celebrate the day.

Balloons were also launched from the town centre to celebrate all of the premature babies born at the hospital, and to commemorate those who sadly died.

Colette McCann, Manager of Women and Children’s services said, “the posters displayed at the exhibition provided a great source of information and hope for parents who attended. By holding the event in the town centre it gave an opportunity for members of the public to see how premature babies are cared for in hospital.”

16/03/2011 16:11:40

HealtH Matters 49

duBlIn nortH eAst // News a vItal SErvICE to tHE woMEn of tHE nortH EaSt

EXCItIng DEvEloPMEnt for SErvICES In MonagHan HoSPItal + staff from the Colposcopy Unit. l-r: Karen Clinton, CNM2; Marina O’reilly, CNM2; and Dr Yahya Kamal, Consultant Obstetrician and Gynaecologist (lead Consultant)

tHe NOrtH east regional Colposcopy service in the louth County Hospital, Dundalk was officially opened in December. the unit is staffed by a highly-trained team; two Consultant Obstetrician/Gynaecologists who are accredited Colposcopists, two CNM2 Colposcopy Nurses, three clerical staff and one healthcare assistant, who will provide a quality-assured service to women requiring further investigation following a smear test. the unit was refurbished at a cost of b500,000, with b100,000 being spent on equipment and includes a reception and waiting area, meet, greet and history taking room, examination room, treatment room, with recovery area and supporting administration offices. the finance was provided by the National Cancer screening service, through the Cervical Check Programme.

Dr seosamh O’Coigligh, lead Clinician, Obstetrics and Gynaecology said, “the unit will provide a vital service to the women of the north east, which will help, both in the short and long term, to manage pre-malignant cervical disease and reduce the occurrence of cervical cancer.” the development of this regional service has been facilitated by the Croke Park Agreement.

a NeW Ct sCaNNING serVICe commenced in Monaghan Hospital in November. Patients requiring specific Ct scans may now be referred directly

by GPs in Cavan and Monaghan. the new service will also facilitate patients who are referred by outpatient clinics at Cavan and Monaghan Hospital sites.

Dermot Monaghan, former General Manager, Cavan/Monaghan Hospital Group stated, “this is an exciting development for the services in Monaghan Hospital and ensures that we are delivering on commitments given when acute medical services were centralised to Cavan General in 2009. this development, which cost in the region of b500,000, demonstrates our commitment to the expansion of services in Monaghan Hospital.”

volunteers enhance lives of residents at St Mary’s Hospital st MarY’s HOsPItal in the Phoenix Park is experiencing the benefits of increased numbers of volunteers offering their time and skills to enhance the quality of life of residents.

In 2009, st Mary’s put in place formal policies and procedures to support and develop best practice in the area of recruiting and working with volunteers. this led to the establishment of a Volunteer Committee, which focused on identifying what aspects of residents’ lives would be enriched by the introduction of volunteers.

Individual volunteers provide support by bringing residents to their place of choice, for example; the gardens, daily Mass, going for a walk, or to one of the many activities provided on campus, for example; music, bingo, art, woodwork, baking, reading and gardening. the volunteers support the activity and occupational therapy teams by staying with a resident during a group activity to offer one to one support and to help in developing residents’ individual interests.

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Corporate groups who have donated their time, energy and funding include; Bank of New York, Deloitte and touche, accenture, Barclays Bank, United Biscuits and Ulster Bank have created beautiful sustainable gardens for the residents to enjoy. eithne Kenny, Occupational therapy Manager said, “During our Celtic tiger years, we had great difficulty in attracting people to volunteer, but within the last year we have seen a noticeable shift and are benefitting from the generosity of people who are giving of their time for others.” the european Union has designated this year as the european Year of Volunteering.

For further information or if you would like to join the volunteer team contact: siobhan Yeates Volunteer Co-ordinator tel: (01) 625 0321 email: siobhan.yeates@hse.ie

+

Before and after photos of the garden area that has been developed by volunteers at st Mary’s Hospital

16/03/2011 16:11:45

50 HealtH Matters

News // duBlIn nortH eAst SuCCESS of CroSS-borDEr Ent MoDEl a UNIQUe MODel for planning and managing a cross-border hospital service has been established between the Hse Dublin North east (DNe) and the southern Health and social Care trust in Northern Ireland. this cross-border collaboration has seen ear, Nose and throat (eNt) waiting lists in the DNe area significantly reduced by facilitating eNt consultants from Northern Ireland’s southern trust to work in Monaghan Hospital. It is also + eNt patient, Noel Marron from Carrickmacross, enabling eNt patients from DNe to access Co. Monaghan who received treatment recently under inpatient care in Northern Ireland’s Daisy Hill the initiative with (l-r) Joan Breen, senior Nurse, theatre/Day services, Monaghan Hospital, linda and Craigavon Hospitals. saunderson, Programme Manager, CaWt Cross Border to date, 2,270 people living in the acute Hospitals Project; Daniel Pretorius, Consultant DNe area have received eNt outpatient anesthetist and Mary Galligan, senior Nurse, theatre Day services, Monaghan Hospital; turlough Farnan, appointments in Monaghan Hospital, eNt Consultant, sHsCt and Bernadette Murphy, senior with day case treatment also available if Nurse, theatre/Day services, Monaghan Hospital required. additionally, 859 southern trust patients have been seen in eNt clinics in either Craigavon or Daisy Hill Hospitals. eNt patients from DNe requiring inpatient treatment can now receive this in either Craigavon or Daisy Hill Hospitals.

Funding for the ‘start up’ period was provided by the european Union’s INterreG IVa programme secured by Co-operation and Working together (CaWt), the cross-border health and social care partnership. Due to the success of the initiative the service will continue as a permanent collaborative between the Hse DNe and the southern trust.

Happy Heart Catering awards seVeNtY-ONe CaterING premises in the North east were presented with a ‘Happy Heart Catering award’. the successful establishments included; restaurants, hotels, pubs and service stations. the Happy Heart Catering award shows the great dedication and commitment of each individual catering premises in terms of offering wholesome and healthy food in a clean environment. Healthy eating plays an important role in heart health and in preventing heart attack and stroke. Heart disease remains the number one cause of death in Ireland and rates of overweight obesity and type 2 diabetes are on the increase. the Happy Heart Catering award meets the growing demand by the public for food that is both healthy and delicious. as well as promoting better health in the population, the award can provide companies with resources and opportunities to promote their business, build customer goodwill, produce satisfied customers and show customers that they care. this year marked the 11th anniversary of the Happy Heart Catering award. Of the 71 premises who received the award, 20 have got the award previously on seven or more occasions.

+ Happy Heart Catering award Committee pictured with stephen Mulvany, regional Director of Operations; Nazih eldin, Head of Health Promotion; Martin Higgins, CeO, safefood and Michael O’shea, CeO, Irish Heart Foundation

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Person-Centred Dementia Care Programme NUrses aND OtHer staff at Claremont residential and Day Care services in Glasnevin recently completed a programme on person-centred care of older people with dementia. the main emphasis of the programme is to improve communication with residents, for example, through the use of picture signs on doors and communicating with the resident in a more meaningful way by getting to know their biography and designing activities to suit each resident’s level of ability. environmental changes in dining areas, such as using colour contrast and reducing noise levels at mealtimes, have contributed to the residents’ meal time experience. Other outcomes of the programme have included the formation of a working group, the production of a booklet, Caring for a Person with Dementia, for use by staff in Claremont and available to other areas on request and the provision of further education sessions on dementia care for staff.

Using a practice development approach and experiential learning activities, the programme has given the participants the necessary skills and knowledge to make practical changes in their care settings and to improve the quality of life of older people with dementia in their care. the programme was facilitated by Dr Jan Dewing, an internationally renowned expert in dementia care nursing, and lorraine McNamee, Practice Development Co-Ordinator, Claremont services.

For further information contact: lorraine McNamee, tel: (01) 704 4468, email: lorraine.mcnamee@hse.ie.

16/03/2011 16:11:52

HealtH Matters 51

duBlIn nortH eAst // GALLeRY

+

President Mary Mcaleese and Dr Martin Mcaleese pictured on a recent visit to st Clare's Home, Griffith avenue, Dublin with Mary Flanagan, Director of Nursing and Blaithin stuart-Kelly, staff member Day Care Centre. st Clare's provides residential, respite and day care services to older people in Dublin North Central. the visit was a memorable occasion for the residents, clients, their families and the staff of st Clare's Home

+ Members of the talented cast of Christmas Funtime, performing their show in the Garage theatre, Monaghan, last December. the performers attend Monaghan training Workshop (MtW). the Christmas production consisted of song, dance, recitation and drama and provided an opportunity for clients to showcase their abilities and talents. the workshop is part of Cavan/Monaghan PCCC Disability services, which provides day services for adults with a learning disability

+ sinéad Cronin, from Dublin, with the MacClancy Medal, for coming top of her class in the neonatal medicine specialty examinations. sinéad, who is a final year medical student at the royal College of surgeons in Ireland (rCsI), completed the neonatology component of her undergraduate medical training at Our lady of lourdes Hospital, Drogheda under the tuition of Dr Ireti Farombi and her team in the Department of Paediatrics

+ l-r: Back row: Gráinne Walsh, Olive Howe, Margaret Kelly, Juliette Kiernan, Beatrice shorten and Michelle Bolger. Front row: Philomena Nicholas, sinéad Boyd, Caroline Moran and Mary McDonagh. staff who recently completed a three-day Primary Care team administration support training Programme and who are now using their new skills in their work as key members of Primary Care teams in north west Dublin

+ l-r: ann Nolan, Irish Pharmaceutical Healthcare association; anne McNeely, Beaumont Hospital and Patricia Kelly, General Manager, astellas Pharma at the astellas Changing tomorrow awards. this winning initiative entitled Developing leadership Potential at Beaumont Hospital was chosen from over 100 entries. the awards recognise and reward individuals or teams who are leading positive change within their clinic, ward, community or any health setting

+ President Mary Mcaleese is pictured accepting a gift of a basket of herbs from project worker liam Breraton with eileen Kavanagh, Project leader (left) and anne O'Connor, local Health Manager at the official opening of Daisy roots Garden Project, st Helena's Family resource Centre, Finglas, Dublin. the garden is being developed by a number of local men and women who volunteered to develop a community garden at the centre

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16/03/2011 16:12:11

52 HealtH Matters

News // soutH

WINNer OF MOst IMPrOVeD serVICe 2010 aWarD fallS PrEvEntIon ClaSSES In tralEE tHe tralee PrIMarY Care team in conjunction with staff from Kerry General Hospital completed a successful Falls Prevention Course in autumn 2010. the Falls Prevention Programme aimed to improve participants' balance, mobility, confidence and prevent future falls. the planning and design of the falls prevention classes was assisted by advice and the sharing of information from colleagues in other areas including Cork, limerick and Dublin. this eight-week course was offered to clients in the tralee area, who had a history of falls, or were at risk of falling. the team providing the course included; physiotherapists, occupational therapists, a nurse and a dietician. the unique element of this Falls Prevention Group was that it was an integrated project between acute and community sectors with staff from both areas involved in the running of the group. this has enhanced teamwork across the sectors.

+ James Kirby and ron O Meara participate in balance exercises at the Falls Prevention Classes

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West COrK’s MeNtal Health service was voted the ‘most improved service’ over the past three years in a survey carried out by National service User executive (NsUe). this was one of only three awards made by the NsUe. the second Opinion survey was completed at the end of 2010. Individuals and families who had been in contact with mental health services across the + West Cork Mental Health service (l-r): Dick Page, service User; country were asked about their Dr Iseult twamley, senior Clinical Psychologist; teresa O’Mahony, experiences. Feedback on service Carer; former Minister for Mental Health and Disabilities, John developments in west Cork was Moloney; Dr Pat Bracken, Clinical Director; Michael Bambrick, the most positive in the country.

Director of Nursing and Priscilla lynch, section Officer Dr Pat Bracken, Clinical Director said, ‘We are very honoured to be recipients of this award from NsUe. everyone knows that it is hard to get everything right in the field of mental health.

But this represents very positive feedback from those who use our service and their families. In west Cork, we have genuinely tried to make Vision for Change a reality.”

Gretta Crowley, local Health Manager said, “the fact that service users and their families voted for the service is really important to us as it is a reflection of the commitment our staff and the local partner agencies have undertaken to provide and sustain a high-quality mental health services. Involving service users in service design and delivery in a meaningful way is a key element of our transformation programme.”

nEw PrograMME aIMS to HElP PrIMarY CarE nurSES tHe NatIONal CaNCer Control Programme (NCCP), in partnership with the Office of the Director of Nursing and Midwifery services, launched a new Community Nurse education Programme for primary care nurses at Cork University Hospital.

Primary care nurses play a key role not only in caring for patients who have been + Kathleen Wallace, Monica sheehan and Noreen diagnosed with cancer, but also in helping Cremin all from Hse Kerry at the new Community Nurse to prevent cancer among the patients they education Programme for Primary Care Nurses at CUH see and treat. Forty-eight nurses including practice nurses, public health nurses and registered general nurses participated in the four-week course. Focusing primarily on the most common cancers, the course featured modules on breast disease, lung cancer, skin cancer and prostate cancer. this education programme aims to provide the nurses with enhanced knowledge and skills to carry out their role in promoting health, reducing cancer incidence, integrating cancer care and improving cancer survival among the people they see and treat.

NCCP is also offering the course through the designated cancer centres in Galway and Dublin, with further plans to roll it out nationally.

16/03/2011 16:12:21

HealtH Matters 53

soutH // News

rOaDMaP FOr COrK aND KerrY HOsPItals tHe reCONFIGUratION rOaDMaP, a plan that sets out how acute hospital services in Cork and Kerry are to be re-organised, has been published. the plan has been agreed by all six acute hospitals in this region. the roadmap recommends that Bantry General Hospital (BGH), Cork University Hospital (CUH), Kerry General Hospital (KGH), Mallow General Hospital (MGH), Mercy University Hospital (MUH) and south Infirmary + l-r: Prof Josephine Hegarty, school of Nursing and Victoria University Hospital (sIVUH) operate as Midwifery UCC; Ger reaney, area Manager, Hse Cork; Pat Madden, CeO, Mercy University Hospital; Pat Healy, an integrated university hospital network.

Director of Operations, Hse south; Prof John Higgins, In order to create this integrated network, Director of reconfiguration; Nora Geary, executive lead each hospital will fundamentally change reconfiguration and Ger O’Callaghan, CeO south Infirmary Victoria University Hospital the services they deliver and how they are delivered. Complex and cancer care will be concentrated at Cork University Hospital. Mercy University Hospital will be the regional centre for several surgical and medical specialist areas. south Infirmary Victoria University Hospital will become a specialist elective hospital in areas such as orthopaedics and eye surgery.

Bantry General Hospital and Mallow General Hospital will continue to provide acute care to their populations in addition to new outreach specialist services from the larger hospitals. Kerry General Hospital will continue to provide the full range of acute services to the people of Kerry.

Pre-hospital and emergency care features strongly in the roadmap’s recommendations. a team of advanced Paramedics (aPs) has already been established in west Cork since November 2009 and are due to come on stream in north Cork in 2011. an assessment of the north and west Cork aP services will determine whether they will be rolled out in other areas. also, in order to free up the acute ambulance service, Intermediate Care Vehicles (ICVs) will be introduced and used to transfer up to six patients at a time between the hospitals for routine diagnostic tests and non-emergency work.

Copies of the report and supporting publications are available on Hse’s internet and intranet or contact laura.cullinane@hse.ie for electronic copies.

nEw raDIologY SuItE CoMPlEtED a raPID aCCess Prostate Clinic has been officially opened at Waterford regional Hospital by Dr Frank Dolphin, Chairman of the Hse. establishing a rapid access Prostate Clinic means that there will no longer be a need to admit such patients to a dayward bed at WrH, as they will access this service directly. as a result, bed capacity will be available to support other clinical services + l-r: radiographers Mary Kinsella, sarah McDonald, – so ensuring optimum utilisation of day beds at WrH. Maíre Ní aonghusa, Joan Maloney and elaine Carroll with Dr Frank Dolphin, Chairman, Hse the radiology suite was completed with National Cancer Control Programme funding of b174,000. the full clinic service commences this year, following the initiation of a joint appointment of a Consultant Urologist with Cork University Hospital Cancer Centre and the appointment of a Consultant Urologist at WrH. In addition, an NCCP-funded Consultant radiologist and a Consultant Histopathologist will also come on stream to complete a multidisciplinary team.

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nEw unIt EnSurES PatIEntS arE SEEn QuICklY

+ Dr Frank Dolphin, Chairman of the Hse with staff at the new acute Medical Unit in Cork University Hospital Hse CHaIrMaN, Dr Frank Dolphin officially opened the new acute Medical Unit (aMU) at Cork University Hospital (CUH) in January. the b1.4 million 23bed unit, which is being implemented as part of the Hse’s National acute Medicine Programme, is open 24-hours a day, seven days a week. the unit provides for the acute treatment and/or observation and investigation of patients where the estimated length of stay is less than 48 hours. acutely ill medical patients referred to the unit are seen by a consultant within one hour of arrival and have ready access to diagnostics such as x-rays, blood tests and scans.

With 30-40 per cent of patients presenting at the eD affected by acute medical problems such as chest infections/pneumonia, clots, chest pain, stroke and heart failure, the new unit ensures that patients are seen quickly and treated appropriately outside of the eD. the aMU will receive patient referrals directly from their GPs who will make contact with the unit’s case manager, where patients will either be referred for prompt admission to the unit or for assessment as an outpatient to the aMU’s dedicated Outpatient Clinic.

16/03/2011 16:12:27

54 HealtH Matters

News // soutH

truE CoMPaSSIon SuICIDE PrEvEntIon awarEnESS for kErrY + l-r: Dr stephen smith, lead Nurse, leadership in Compassionate Care Project, the NHs/Napier University, edinburgh, scotland; antoinette Doocey, Programme Director, Integrated Care, National transformation Programme 1, Hse; Mary Prendergast, Director of Nursing, st Patrick’s Hospital, Cashel; Prof Claire Hale, Professor of Clinical Nursing, University of leeds, Yorkshire, UK; Brian Crowley MeP for Ireland south; Michael Brophy, Consultant in Personal excellence, Barrister at law, formerly senior Investigator with Office of the Ombudsman and Ben totterdell, school of Healthcare studies, University of leeds, Yorkshire, UK. tHe Hse aND the european Pathways association joined forces recently to jointly host a conference entitled true Compassion. the conference was supported by patient advocates and healthcare professionals. the european Pathways association is an international ‘not for profit’ organisation of clinical/care pathway networks, user groups, academic institutions, supporting organisations and individuals who want to develop, implement and evaluate clinical and care pathways.

Brian Crowley MeP officially launched Compassion Footprint for Healthcare – a document based on research, in co-operation with the Practice Development team at st Patrick’s Hospital. ten principles of compassion are highlighted in it.

Mary Prendergast, Director of Nursing, st Patrick’s Hospital, Cashel, said everyone interprets the quality of healthcare in different ways but fundamentally, the human connection between staff and patient becomes the defining moment for the whole experience of excellence in healthcare.

HEaltHY lIvIng CEntrE offICIallY oPEnED

+ seán Connick, former Minister of state at the Department of agriculture, Fisheries and Food, with Hse management and users of the Healthy living Centre in New ross at its official opening seÁN CONNICK, former Minister of state at the Department of agriculture, recently officiated at the opening of the new Healthy living Centre in New ross, Co. Wexford. the purpose-built Healthy living Centre replaces the old Day Care Centre and provides care and support for the elderly population

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of the surrounding areas to help maintain the independence of elderly people in their home environment for as long as possible.

In addition to social activities, the centre provides services such as meals, social activities, chiropody, personal care and hairdressing for its elderly clients. there is also provision at the centre for the Hse to provide local access to physiotherapy, speech and language therapy and occupational therapy on an appointment basis. Other sessional services provided include; the tissue Viability Nurse and a psychiatrist of later life. admission to the unit is by GP or Public Health Nurse referral. the Brandon Unit, which is coming into operation on a phased basis at the centre, is currently used once a month by the alzheimer society of Ireland to provide a day service for up to eight clients from the local area.

KerrY MeNtal HealtH services and Jigsaw Kerry joined forces to launch the county’s newest suicide prevention training – safetalK. the training aims to increase awareness of self-harm and suicide and is open to anyone, over the age of 18, with an interest in suicide prevention. the safetalK course is available to all Hse staff in Kerry starting with some frontline staff including nurses, doctors, social workers, secretaries, community workers and psychologists. the safetalK programme is a training package that prepares participants to identify persons with thoughts of suicide and connect them to suicide first aid resources. Most people with thoughts of suicide invite help to stay safe. alert helpers are trained to know how to use these opportunities to support that desire for safety. sixteen of Kerry’s frontline staff qualified as safetalK-trained suicide alert helpers.

Cathy O'sullivan, Nurse Practice Development Co-ordinator, Hse Kerry Mental Health service said, “safetalK provides participants with the skills and tools to potentially save lives.

Further training programmes will be run with other Hse staff in Kerry over the coming year, as there is a high level of interest in the programme. there must be raised public awareness too of the reality of suicide and that means talking about it more often and more openly.” the safetalK training package involves powerful video clips, illustrating both nonalert and alert responses to suicide.

For more information on safetalK or our asIst (applied suicide Intervention skills training) programme visit: www.livingworks.net

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soutH // GALLeRY

+ Former Minister of state at the Department of agriculture, Fisheries and Food, seán Connick, at the Camphile Health Centre with members of the Ballycullane area Primary Care team at the recent launch of the service

+

+ Cork University Hospital (CUH) Group Jubilee award winners 2010: team award Winner – radiology Department for the improvements by the department in the quality of patient care. l-r: Dr Max ryan, Carol O’sullivan, Catherine O’Neill, Catherine O’Donnell, Bridget Quirke, elaine Hickey and Martin Payton

+ CUH Group Jubilee award winners 2010: special achievement award Winner for the reconfiguration of the Mercy University Hospital, south Infirmary Victoria University Hospital and Kerry General Hospital Breast services to CUH. l-r: Marie Cremin, elizabeth O’Keeffe, Catherine O’Neill, Dr Max ryan, Mary Murphy, Dr Fionnuala O’Connell, Professor Paul redmond, louise Kelly and Ber Baker

+ sr laurentia roche, Mercy University Hospital was conferred with an Honorary Degree of Master of science in Nursing from UCC in recognition of her remarkable achievements and unparalleled dedication to nursing. she has been a member of the Mercy Congregation for over 50 years. sr laurentia is pictured here with Dr Michael B Murphy, President, UCC and Professor Geraldine McCarthy, acting Head of Medicine, Catherine Mcauley school of Nursing and Midwifery, UCC

+ at the recent launch of the National Childminding Initiative on the Quality of Childminding in Waterford City and County report were (l-r): Fiona McDonnell, National specialist, early Years services, Hse; Monica ryan, Pre-school services, Hse Waterford; Noirin Healy Magwa, Co-ordinator, Waterford City Childcare Committee; John Martin, Childcare Manager, Hse Waterford; rose Murphy, Coordinator, Waterford County Childcare Committee and Dr Mary Daly, early Years researcher and report author

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at the official opening of the refurbishment at New Haughton Hospital, New ross were (seated l-r): Michael Crosbie, founder member of Friends of New Haughton Hospital; Mary Kate Doyle, resident; seán Connick, former Minister of state at the Department of agriculture, Fisheries and Food; (standing l-r): stephanie lynch, Hse Wexford area elderly Care and Mental Health services Manager; Jeanne Hendrick, General Manager, Hse Wexford Community services; Margaret Nowlan-O’Neill, Director of Nursing at New Haughton Hospital; angela looby, secretary at Friends of New Haughton Hospital; Paul Kehoe tD; Michael Darcy former tD and Pauline Bryan, Hse local Health Manager for the Wexford area

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News // west nEw unIt wIll EnHanCE CoMfort anD PrIvaCY of PatIEntS

+ Breege O’Donnell, Multi task assistant; elaine Bruton-Byrne, Ward secretary; Charlie Meehan, General Manager; Bernie Kelly, Haematology/Oncology Nurse; Mary Hannigan, Oncology/Haematology Unit Manager; Mags Nimmo, Oncology Nurse; Mary t Gibbons, a/ Director of Nursing; Bernie Byrne, Oncology liaison Nurse; Mary McHugh, Chief Pharmacist; Madeline Gallagher, Clinical Nurse specialist, Oncology; sharon lyons, Ward secretary; and Paula Conway, staff Nurse tHe eXteNDeD ONCOlOGY UNIt at Mayo General Hospital was officially opened in December. the Oncology service is now operating from an area with double the space of the old unit, which will enhance the comfort and privacy of patients and ensure that the support services which are holistic to patient care will be delivered in a more appropriate setting. the newly extended unit is also the base for the Haematology day service.

Charlie Meehan, General Manager, Mayo General Hospital commented, “the newly expanded and refurbished Oncology Unit was developed as an interim solution to address the inadequate space and related issues while we await the provision of a purpose built Oncology Unit. this refurbishment and the provision of the permanent MrI unit will enhance the service provided to cancer patients in County Mayo.” the new unit was extensively refurbished by the hospital’s own maintenance team and is equipped to a high standard. the support of local fundraising groups was significant and the additional funding paid for high specification treatment chairs and a new television system for patients in the unit.

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nEw onE-of-a-kInD ClInIC oPEnED

+ sharon Whealan, NUI Galway Podiatry school second year student with lynda Donnellan, senior Podiatrist at the Hse Podiatry Clinic a NeW ClINIC to provide podiatry care for people in Galway has recently opened on the grounds of Merlin Park University Hospital. the new Podiatry Clinic is the only one of its kind in Ireland and will offer podiatry services as well as providing clinical placements for students studying the Bsc Programme in Podiatry at NUI Galway, the only Podiatry Degree course in the country. the clinic will provide specialised services to clients throughout Ireland.

David Watterson, Podiatry Clinic Manager said, “the main aim of the clinic is to provide a high standard of evidence-based podiatric care to the whole population of Ireland and to develop a national resource for healthcare providers by becoming an internationally recognised centre for podiatry care, education and research”. the Podiatry clinic will maintain 7,000 clients at any one time with up to 25,000 appointments in a calendar year with the majority of the clients being people with chronic and long-term illnesses. International research has shown that podiatry care can improve and maintain the mobility of clients and prevent the requirement for more extensive health care.

MEDICal aCaDEMY HaIlED aS an HIStorIC DEvEloPMEnt letterKeNNY GeNeral HOsPItal is now a step-out clinical site for the education of medical students from NUI Galway. In January, 20 third-year medical students started one full year of their training at the hospital studying the same curriculum as their classmates based on the campus of Galway University Hospitals. Both hospitals will use internet and video-conferencing facilities to facilitate linkages between the centres including multidisciplinary meetings, joint lectures, tutorials and discussion groups. the official opening of the Medical academy was carried out by Professor Fidelma Dunne, Head of school of Medicine, NUI Galway. Hospital Manager, sean Murphy paid tribute to all involved in establishing this new Medical academy in letterkenny.

He said, “this is a historic development

+ l-r: Dr Brian Callaghan, Director of Medical education, lGH; sean Murphy, General Manager, lGH; Dr liam Bannan, academy tutor; Prof Fidelma Dunne, Head of school of Medicine, NUI Galway; Dr Joanne Kearney, Director of Medical education, lGH; Dr sarah Brennan, academy tutor; and Dr Charles McManus, academy tutor for Donegal and builds upon the excellent educational and clinical role of letterkenny General Hospital already established in the areas of Post Graduate Medical; Nursing and Midwifery; and allied Health Professional education. this year we will start planning for a new Clinical education and research Facility as part of the hospital’s continuing evolution as a University Hospital in the North West.”

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west // News

+ Some members of the Bariatric Medical and Surgical Team, University Hospital Galway (UHG) and Primary Community Continuing Care (PCCC) L-R: Prof Tim O’Brien, Endocrinologist, UHG; Katriona Dullea, Dietitian, PCCC and UHG; Marguerite O’Donnell, Dietitian Manager, PCCC; Dr Francis Finnucane, Endocrinologist, UHG; Helena Griffin, Obesity Nurse Specialist, UHG and Mr Oliver McAnena, Consultant Surgeon, UHG

New service marks milestone in treatment of obesity A

dedicated bariatric medicine service for people from the west of Ireland with severe overweight and obesity issues has been officially launched at Galway University Hospital.

Over the last number of years, the hospital has developed a programme for the management of patients with severe obesity requiring medical and surgical intervention. This care is delivered by a dedicated multidisciplinary team with nursing, dietetic, psychological, medical and surgical expertise.

Galway University Hospital and HSE West have recently recruited Dr Francis Finucane, an endocrinologist with a special interest in the management of these patients, to lead the medical aspects of the programme. This appointment will enhance our ability to deliver timely, quality care to the

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increasing number of patients with severe obesity and related disorders, like type 2 diabetes, within the HSE West region.

Professor Donal O’Shea from St Vincent’s Hospital in Dublin, who attended the launch, said, “I am delighted that the Galway service is now formally up and running. It takes us towards the halfway mark in our overall target of having a treatment unit for severe obesity in each of the four HSE regions. While we all agree that prevention is the core goal, access to treatment for people with severe obesity is a basic entitlement. As there will only be four treatment units in the country, it is crucial that each will have the full multidisciplinary team with nursing, psychology, physiotherapy and nutritional expertise.”

Dr Nazih Eldin, HSE Lead for obesity, remarked, “In our quest to halt and reduce the current levels of obesity, we must help the public to recognise overweight and

obesity, when present, in themselves and their families. Due to its growing prevalence in our society we tend to normalise it and not see it for what it is. Those that have put on a few pounds gradually over time are often shocked to discover that they are not just overweight, but obese. The important thing for us to remember is that “obesity” is a clinical term with real and avoidable health implications, rather than a term to describe how we look.”

Dr Finucane noted, “This service is primarily for patients with very severe obesity who have found it difficult to lose weight through lifestyle changes such as increased physical activity and dietary modification. Our work will compliment that of dieticians, GPs and other health professionals in the community caring for these individuals. We will also work with our surgical colleagues in GUH to identify patients who would benefit from bariatric surgery to reduce their excess body weight.”

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News // west B10.5 MIllIon DEvEloPMEnt of SPECIalISt HEaltH SErvICES a NeW CONstrUCtION development at the Mid-Western regional Hospital is aimed at filling significant gaps in the provision of specialist services. these include; cystic fibrosis, neurology, stroke, dermatology and symptomatic breast disease. the development was announced in limerick in January. the development of a purpose-built sixstorey building on the hospital’s Dooradoyle campus represents a united effort by the Mid-Western Hospitals Development trust, the Parkinson’s association and the Cystic Fibrosis association of Ireland. Planning permission for the development was received in December 2010. Construction is due to begin in June 2011 and the various + l-r: Una anderson ryan, Chair, Parkinson’s association of Ireland; standing: Philip Watt, CeO, Cystic components of the project are expected to Fibrosis association of Ireland; louis Creaven, Chairman, Mid-Western Hospitals Development trust and be operational by January 2013. Construction John Harty, Chairman, JP McManus Charity Committee 2010 costs are estimated to be b10.5 million and additional funding is available for equipment. the facilities to be provided in the development include: • Cystic Fibrosis Outpatients Unit with five treatment rooms and an inpatient unit with nine ensuite rooms • Neurological Unit to cater for eleven neurological conditions. From the very young with epilepsy, all ages with Parkinson’s, Multiple sclerosis, Motor Neuron Disease • Dermatology Outpatient Centre to bring all dermatology services together at one location • symptomatic Breast specialist Unit to consolidate services which are at present fragmented in different areas of the hospital

launch of CaMHS report in galway tHe seCOND aNNUal rePOrt on progress of the delivery of Child and adolescent Mental Health services (CaMHs) was launched by Dr Frank Dolphin, Chairman of the Hse in the new CaMHs unit in Galway in November. the report provides a comprehensive update of the current stage of development of CaMHs services, as outlined in the Vision for Change policy, and provides vital data on: the number of new cases seen; waiting time to be seen; mental health problems presented by age + Front row: eleanor Kelly, Principal social Worker; Dr Delia McGuinness, Clinical Director, CaMHs; Dr Frank and gender; and data on the admission of Dolphin, Chairman of the Hse; Mary lally, Director of Nursing, CaMHs; Martin rogan, Hse assistant National Director, Mental Health services. second row: Una russell, senior staff Nurse; Geraldine Donnelly, Principal, young people under the age of 18 years st anne’s school; Dr amanda Burke, Consultant Child Psychiatrist; Mary Keenan, social Care; lucy Kellehan, for inpatient treatment. staff Officer, CaMHs; antoinette Feeney, CNM2; Verona Warde, social Care; Genevieve Joyce, CNM2 the launch of the annual report was Back row: Orla Darcy, Occupational therapist; Niamh McDonnell, CNM2; Michael Kavanagh, senior social followed by a tour of the new CaMHs Worker; adrian ahern, Manager, Galway Mental Health services; David Dawson, Clerical Officer; ruth inpatient unit in Merlin Park, Galway. the new Kilcawley, senior Dietician unit replaces st anne’s Children’s Centre on taylor’s Hill in Galway and provides an extended range of services for inpatient needs of children up to the age of 18, along with a wide range of therapeutic interventions. the 20-bed unit includes a children’s inpatient unit, an adolescent inpatient unit and overnight accommodation for parents set in landscaped gardens with carefully designed therapeutic areas.

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west // GALLeRY

+ Galway teen Parents support Programme staff, past and present attending the teen Parent support Programme Conference in Galway last December. l-r: sheila lawlor, Principal social Worker, Galway University Hospitals; rosemary Grant, Principal social Worker, Coombe Women’s Hospital and Chair of National advisory Committee for tPsP; Professor Pat Dolan, UNesCO, Chair in Children, Youth and Civic engagement and Director of the Child and Family research Centre at NUI Galway; Dr aisling Gillen, Nationalist specialist Family support Hse; Margaret Morris, National Co-ordinator teen Parent support Programme

+ Hse West Health Promotion staff with their Green Heroes award for their work on the Healthy Gardening and Green exercise Programme – a ten-week educational and skill development programme initiated by the Health Promotion Department, Hse West in partnership with Donegal VeC with Donegal County Council. l-r: Graham seymour, Director of Natural Heritage, Northern Ireland environment agency; lynda Mc Guinness, Green exercise Co-ordinator and ann Marie Crosse, eco-health Officer

+ Participants of the FÁs Community employment scheme based at st Joseph’s Hospital limerick receving their certificates. the scheme provides up to 400 temporary part-time jobs on the grounds of the hospital, community houses and other facilities associated with the hospital. Front row: evelyn O’Keeffe sheehan, FÁs Community Development Officer; Joe stackpoole; tom O’sullivan; leonard Moore; Ken Mulcahy; Jonathan Flanagan; James Begley and annette Fitzgibbon, Hse staff member. Back row: eugene O’Gorman, Hse; tony toomey; Gary McNamara; John Joe Walsh; Joe Condon; Dermot McMahon; Gerry McCormack and Joe Harrington, FÁs supervisor

+ the radiology Department at sligo General Hospital has recently installed two Discovery Xr650 Digital Detector X-ray systems as part of the move from analogue x-ray technology to digital technology. l-r: Domhnall Mcloughlin, assistant General Manager; terry Mc shane, Business Development Manager of Ge (supplier of equipment); eileen Kelly, senior radiographer; Mary Gannon, senior radiographer; Dr ann Mc Namara, Consultant radiologist; Fiona Malone, X-ray and Vascular sales specialist, Ge; and Dr andreas Mohr, speciality Coordinator, radiology Department

+ two diabetes nurses from Jabir abulez Diabetes Centre (JaDC) in Khartoum, sudan recently participated in a four-week observational training attachment at University Hospital Galway. l-r: lorna Hurley, Diabetes Day Centre, UHG; Khadiga Gibreel, Diabetes Nurse, sudan; Dr sean Dinneen, Consultant endocrinologist, UHG; Helen Burke, Diabetes Day Centre, UHG; Maysa Osman, Diabetes Nurse, sudan and Dr abobakr shadad, Department of Medicine lecturer, NUI Galway

+ the John Paul Corcoran (rIP) annual sponsored walk this year raised €11,240 in support of the sacred Heart Hospital, roscommon. the money has been used to purchase a gait trainer, which is rehabilitation equipment used to help clients learn to stand again following significant injury such as a stroke. Photographed at the sacred Heart Hospital with the gait trainer (l-r): Bernie Crehan, Clinical Nurse Manager 2; ann Corcoran, Fundraiser; Isaac Bontha, Physiotherapist; larry Barrett, resident; Dolores Conneally, Health Care assistant; anthony Costello, Health Care assistant; Marie Duffy, Clerical Officer; Julie silke-Daly, Director of Nursing; and Priya Ganesh, Physiotherapist

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+ l-r: Kay Beggan, Mental Health services Dublin south east; and sean tone, Director of Nursing, North West Dublin Mental Health services

+ l-r: Dr Justin Brophy, executive Clinical Director for Dublin south and Wicklow; and Kevin Plunkett, Director of Nursing, Wexford Mental Health services

IMProvIng IrElanD’S MEntal HEaltH SErvICES over 130 people attended a half-day information seminar in Dublin Castle, hosted by the HSE in partnership with the Department of Health and Children and the national Service users Executive (nSuE), to report on progress towards realising a vision for Change, Ireland’s mental health policy.

a

Vision for Change was launched at the start of 2006 and is an ambitious ten-year programme, which fundamentally revisits the focus and function of mental health care in Ireland. the recent seminar in Dublin Castle involved a review of how much progress has been made in its implementation after five years.

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In attendance were Cathal Magee, CeO of the Hse and Minister for Mental Health and Disabilities, John Moloney tD. a highlight at the seminar was an introduction to the first Vision Online survey by Martin rogan, assistant National Director for Mental Health. the Vision Online survey provides a quantitative update on every Hserelated recommendation in a Vision for Change at a local and national level. this online reporting tool provides baseline information to assess the advancements to be made in the second five years and to identify gaps in service provision. the survey was completed in December 2010 by the thirteen executive Clinical Directors and the National Forensic service (centred at the Central Mental Hospital in Dundrum). “this inaugural Vision Online survey gives us a unique insight into progress

achieved to date and allows us to refocus our efforts on particular areas that may have found it difficult to keep pace with policy. the findings from the Vision Online survey indicated that at this mid-point of a ten-year implementation plan, many of the objectives have been fully delivered and significant progress has been made in the remainder. It is heartening to note that a key finding of the survey, which is endorsed by the National service User executive, is that service delivery is improving for users. Mental health service users are no longer passive recipients of care but are actively involved in their own care plan, service development and national projects,” said Martin rogan, assistant National Director, Mental Health. the survey has been developed in two phases; Phase I has been developed allowing for the collection and analysis of quantitative data. Phase II will allow

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for the development of more qualitative approaches and provide a basis for transfer of learning from service to service.

Findings from the inaugural survey indicate that the majority of service users are actively involved in their own care plan. some of the findings of the inaugural survey include: • 100 per cent of in-patient settings have an accredited peer advocacy service • 77 per cent of services actively include service users in service planning • 84 per cent of services report that they offer access to information and advice to colleagues at primary care level, 50 per cent have formal shared protocols • In mental health services for older persons, while 70 per cent provide homebased care, 21 per cent of services report some gaps in their specialist mental health programmes for older persons the Vision Online survey results are available at www.hse.ie/go/visionforchange. a range of presentations on mental health topics were presented by

“the Chronic disease programmes do not operate in isolation, they are working together to develop solutions that will provide the best care for patients. this is particularly necessary in the area of chronic diseases.” representatives including; adrian ahern, Hse; Paddy McGowan and liam MacGabhann, Dublin City University; Jennifer Kelly, NsUe; and John Fitzmaurice, JIGsaW. Dr Ian Daly, Hse National Clinical Programme Director for Mental Health also outlined the future

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+ Winner of the Most Improved service 2010 was West Cork Mental Health service. l-r: Dick Page, service User; Dr Iseult twamley, senior Clinical Psychologist; teresa O’Mahony, Care assistant; former Minister for Mental Health and Disabilities, John Moloney; Dr Pat Bracken, Clinical Director; Michael Bambrick, Director of Nursing; and Priscilla lynch, administrator direction of mental health services provided by the Hse. this year marks a new endeavour for the NsUe in the form of the awards to Mental Health services under three categories; Most Improved service, Best Community Mental Health team, Best Day Hospital/Day Centre. Minister Moloney tD presented the award to the Hse south Mental Health service in West Cork, which was voted the Most Improved service over the past three years in a survey carried out by NsUe. the second Opinion survey was completed at the end of 2010. Individuals and families who had been in contact with mental health services across the country were asked about their experiences.

Feedback about developments in the service in West Cork was the most positive in the country. awards were also presented to loughrea Mental Health service for Best Community Mental Health team 2010; while the tara suite Mental Health Day Centre in Dunshaughlin won Best Day Hospital/Day Care Centre 2010.

nAtionAl service users executive 2010 WINNERS lists best coMMunity MentAl heAlth teAM 2010 winner: loughrea Mental Health service special mention to: tallaght and Carlow Mental Health services best dAy hospitAl/dAy cAre centre 2010 tara suite Mental Health Day Centre, Dunshaughlin special mention to: Clifden, Cavan and Castlebar

Most iMproved service 2010 winner: West Cork Mental Health service special mention: Kerry, Cavan, Central Mental Hospital Mental Health services

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feature

Online child protection service

+ Northern Ireland Assembly Health Minister Michael McGimpsey and former Minister for Children and Youth Affairs, Barry Andrews

The North South Child Protection Hub (NSCPH) is an online resource aimed at better informing childcare professionals, and is a stepping stone towards better protection of children north and south of the border, writes Caroline Cullen, National Specialist, Children, Families and Social Services.

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Sharing child protection knowledge Through the provision of daily updates to its online content, the NSCPH aims to enhance and share child protection knowledge within the professional communities throughout the island of Ireland. The content available to users on the NSCPH includes: • Summaries of findings and information about local, national and international research in the field of child protection • RoI, NI and UK national policy documents and guidance • Reports of child protection inspections,

“The NSCPH is a unique, online resource that will be of particular interest to professionals who have child protection and welfare within the scope of their responsibilities.”

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inquiries and executive summaries of serious case reviews • Written media coverage of child protection news and issues • Conference and seminar calendar events in the area of child protection • A forum for professionals to ask questions, share views and link with other colleagues in child protection

Benefits of the Hub This single repository of current and relevant materials will be of benefit to professionals, saving time that might otherwise be spent in searching different sites and checking various sources.

Users of the NSCPH will find it easy to navigate and there are some useful tools to personalise the resource, for example, you can create a list of bookmarks of materials you find useful on the NSCPH and view them at any time. Users can also set up automated email alerts for all content matching the areas of child protection they are interested in.

According to Áine Shanahan, Social Care Leader, Child Protection Team, Galway, “The new resource is excellent, userfriendly and timely.”

The NSCPH was developed under the auspices of the North/South Ministerial Council by the Child Protection CrossBorder Sub Group on Research and Knowledge Transfer. The NSCPH is one of a number of projects aimed at enhancing cross-border co-operation on key social and economic issues. The website is managed by Childlink, a company that already provide the successful www. childlink.co.uk site. The National Children and Families Office has entered into a contract with Childlink to fund access for HSE staff and HSE-funded agencies to the NSCPH. Since it was launched in November, the NSCPH has been available through the HSE intranet on a pilot basis. The project team now plans to standardise and improve access to the hub for HSE staff.

Staff groups making use of the NSCPH are likely to be working as social workers, medical personnel, public health nurses, social care staff, psychologists, allied health professionals

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and service managers. However, given that most HSE staff have specific responsibilities for reporting child abuse concerns as Designated Officers, it is likely that many other staff groups will find it of benefit.

“...the project team will be seeking feedback from users on how to maximise the relevance of and availability of content on the hub.”

Accessing the Hub Staff members wishing to register as users of the NSCPH under the HSE contract should initially access the site through one of the HSE portals (doorways!) Two routes are available: Through the www.hseland.ie site. This is the HSE learning and development website and is freely accessible to HSE and partner-agency staff through the intranet and internet i.e. you can access it from work and home. If not currently registered with www.hseland.ie, you will need to complete a simple registration process, but will then have access to a variety of learning and development resources. You can find the NSCPH link on the homepage – just click on the logo!

Through HSE intranet – HSEnet. From the homepage of HSE intranet, follow the links on the left-hand side navigation bar to ‘Find a Health Service’ and ‘Children and Family Services.’ The link for the NSCPH will take you to the NSCPH homepage.

Once logged on to the NSCPH as a HSE user, you can then register as a personal user (see the links for ‘demonstration video’ or ‘personal user account’). This provides you with a username and password for direct access to the hub in the future. Registered users can simply logon to www.nspch.com.

According to Child Care Training Manager and NSCPH Project Manager, Paul Fitzgibbon, “Staff will use this resource to support their work and supplement other professional development, if it is seen as relevant.”

With this in mind, the project team will be seeking feedback from users on how to maximise the relevance of and availability of content on the hub. It is planned to evaluate the staff experience of using the NSCPH through focus groups, online evaluations and targeted questionnaires. The project team is exploring means of providing specific updates to staff in particular service areas and professions, as well as utilising the Hub’s potential for discussion and sharing of information.

Comments and queries may be directed to Paul Fitzgibbon; Email: paul.fitzgibbon@hse.ie.

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working together to Put tHE IntErEStS of CHIlDrEn fIrSt Gordon Jeyes, who has recently taken up his role as HSE national Director for Children and family Social Services, writes about his aims and objectives in the role.

F

rom the outset, it is important to recognise that our role is about children who may be vulnerable and in need of care.

I will be listening carefully to colleagues about how each aspect of the Children and Families services structure is organised to ensure we work together in the best interests of the child. as part of my consultation with the team, it has become apparent that there is a need for a clear structure so that people’s efforts in their daily work can make maximum impact for children who may be vulnerable. therefore, the starting point for my work is to provide clarity of accountability. there is a need to have a straight line of accountability from social work practice, to case conferences through to the National Director, the Chief executive Officer and the Board of the Hse. since joining the Hse in January, I have been extremely impressed by the commitment, dedication and professionalism of all of the staff that I have met. I believe that with a more defined structure all can benefit greatly from the professionalism and collective wisdom that is available within Children and Families services and the wider Hse. One of the first tasks is to strengthen the effectiveness of the national office and to make sure it operates in a dependable and reliable manner. there is a need to strengthen our partnerships and how we work. It takes a whole community to keep a child safe. reliability and trust are the hallmarks of effective partnerships and we will need to work hard to build confidence in the services we provide.

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I have been struck by the need to bring about change in the culture of Children and Families social services within the Hse. I would like to work collaboratively with all of those involved to build a culture that is more inclusive, outward-looking and confident about the work that we do. We need to be explicit about our values, and above all, that all of our actions are based on the best interests of the child. I will be organising a change programme at a strategic level that will review the distribution of resources, consider the relationship of childrens’ services to the rest of society and set out the management arrangements that provide accountability and specific responsibility at each and every level.

In developing projects, I will be listening to the experience and expertise of those who work in Children and Families services and I will work to: • establish agreed and consistent policy, practices and procedures to ensure there is high quality and consistent care, right across the country • Develop a well informed quality assurance strategy • Introduce workforce development strategy, for example, with clear links between the final year of graduate training and the first year in work • establish a single national training strategy with a commitment to continuing professional development for all staff • support the development of quality relationships at the most local practical levels through children service committees • establishing the national office and deciding on immediate priorities for Children and Families social services and meeting with groups of staff at all levels

of the organisation will be key to my work.

If you have any questions, queries or comments, please feel free to contact me: Email: Gordon.jeyes@hse.ie Address: National Director’s Office, Children and Family services, 2nd Floor, Block D, Parkgate Business Centre, Parkgate street, Dublin 8. tel: (01) 635 2897 / Fax: (01) 635 2513

gordon jeyes’ cAreer • Hse First National Director of Children and Families social services 2011 • Director of Children’s services and Deputy Chief executive, Cambridgeshire • Britain’s First Director of Children’s services • General secretary of association of Directors of education scotland • led the response to Dunblane tragedy to safeguard children and young people • Director of education services for stirling Council in scotland in 1995 • trained as secondary school teacher and was assistant head teacher in Glasgow • Membership of several key policy groups

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Fostering This update on the importance of foster care services includes examples of HSE staff working in Children and Family Services, who are promoting best practice and developing new initiatives.

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he HSE has a statutory responsibility to provide alternative care services under the provisions of the Childcare Act 1991, the Children Act 2001 and the Childcare (Amendment) Act 2007.

Children who require admission to care are accommodated through placement in foster care, residential care, placement with relatives or adoption. Alternative care services are provided for children who are homeless, separated, or seeking asylum.

There were over 5,700 children in the care of the HSE at the end of December 2010,

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with 92 per cent of these children placed in foster homes. Nearly half of these children are placed in foster care with relatives. There are over 3,000 foster families providing foster care for children.

Aidan Waterstone, National Specialist for Alternative Care Services said, “The development of fostering in Ireland over the last 25 years has been a great success story, whereby the Irish public has consistently responded to appeals to provide a family experience for children who cannot, for a whole range of reasons, live with their own

family. Fostering has a historically strong cultural resonance for Irish people because it fits easily into our culture. Fostering is an overt expression of how a society can care for some of its most vulnerable members.

It enables ordinary families to make a difference to the lives of children, very often a life changing difference.�

The services featured on these pages are excellent examples of the motivation of HSE staff in Children and Family Services in promoting best practice and developing new initiatives in fostering.

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Fostering success with new initiative S

ocial workers working on care planning in the mid-western area embarked on research after becoming concerned about the educational progress of children in care.

The research revealed that while foster carers were viewed as very supportive with regard to education, a large number of children in care had learning difficulties (frequently undiagnosed) and considerable educational needs.

The research included direct feedback from young people in care who had sat the Junior and Leaving Certificate. This indicated that, for many, Irish and Maths posed particular problems and had been an ongoing struggle at school. It became evident that a radical new approach was needed.

The Fostering Success initiative arose from cross-border collaboration between the Fostering Network, Northern Ireland, social workers and foster carers in HSE Mid-West and the Irish Foster Carers Association.

Foster carers undertook to work with children in fostercare at home on numeracy and literacy skills using a fun resource pack of games and reading materials.

The key component of the initiative was the introduction of the Study Buddies Resource pack, which comprises of a series of age and stage-related activities, games and tools, as well as a DVD and educational software. The DVD provides practical guidance to foster carers on how to use the materials contained in the education pack and explains how carers can support children’s learning in a fun and interactive way at home. In addition, the CD-ROM uses the Study Buddies characters in an animated birthday party scenario to apply learning. The Pack was further complimented by a Guide to speaking in Irish to Young Children, added to reflect the needs of foster children here.

Linked to this, a range of, what might seem unusual, training programmes were provided on topics such as; card playing as a tool for mental maths, Irish language classes, learning styles, tips for handwriting and less stressful, more successful

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+ Majella Harnett, Foster carer using the pack with April, aged 8 and Ryan aged 6 homework. Some foster carers even went on to complete the Teastas Eorpach na Gaeilge (TEG) level one course, run by the Irish language officer so that they would be better able to help children in care with Irish.

Majella Hartnett, one of the foster carers who used the resource pack and participated in the training said, “It is a wonderful scheme; it helps you spot a problem and gives you a chance to work on a one-to-one basis with the child and help them to open up and speak up. The games were fun and all the family could be involved. A positive approach is important and the games avoid you getting stuck on a weakness and instead focus on the positives. For the children, it didn’t seem like homework, just like playing and they loved the games!”

It became clear during the research stage that while many young people in care struggled academically, they also had a wealth of talents in other areas. The programme is designed not only to assist children with academic pursuits, but also to support individual creative talents. To this end, an exhibition of art and design work was commissioned from children in care that went on display at the IFCA National Conference and in other centres in the

Dublin area, culminating in some of the work being included in the IFCA’s fostering calendar. In future, it is hoped to organise an annual national exhibition of works by children in care.

Currently, there are three phases of the Fostering Success initiative in operation, with foster carers increasingly self-referring to the programme. The first phase has been evaluated, with foster carers giving an overwhelming ‘thumbs up’ to the scheme.

Mary Halpin, General Manager for Clare, and responsible for the team that developed the initiative said, “Fostering Success is an excellent example of a cross-border initiative, where colleagues working both north and south of the border can come together to share expertise and learning for the benefit of children across the whole island of Ireland.”

By the end of the programme, it is hoped that a series of guidance materials, recommended reading materials and games will be made available on the HSE and IFCA websites. Information regarding the research undertaken in relation to the educational needs of children in care and the Fostering Success initiative is available from Agnes Feely and Caroline Roe at CAPS@hse.ie.

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TimeWise: multi-dimensional treatment foster care T

imeWise Fostering is a unique and specialised treatment fostercare programme, committed to achieving positive outcomes for children aged between 11-18 years.

This Multi-Dimensional Treatment Foster Care Programme (MTFC) was established in 2008 as a partnership between the HSE Local Health Office in North Dublin and the Daughters of Charity Child and Family Service.

The programme was originally developed in 1983 by the Oregon Social Learning Centre as an alternative to institutional placements. It is a treatment model of fostercare that focuses on making positive changes in young people’s lives. The first young person began the programme in August 2009 and ten young people have been placed in MTFC fostercare homes to date.

The programme aims to improve outcomes for young people so that they can return home, or where this is not possible, to long-term foster placements.

The goal of the programme is to systematically change the child’s social environment, to control antisocial behaviour and encourage appropriate social behaviour and the development of educational skills through the support and guidance of a multi-disciplinary team and foster carers.

Of the young people who began the programme to date, four returned home to their birth family, two did not complete the programme and four young people are currently engaged in the programme. A robust referral process is implemented by the TimeWise and HSE staff.

The programme enables young people to live in specialist fostercare placements within the community for a limited time

+ TimeWise staff members (L-R): Gráinne O Sullivan, Programme Supervisor; Erin McHugh; Kerry Gordon, Skills Worker; Lisa Crowe, Skills Worker; Bernadette Neville, Fostering Social Worker; Anne Guinan, Individual Therapist and Bridget Mc Donagh, Programme Manager

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period and only one youth can be placed in an MTFC foster home at any one time.

MTFC is a team approach, which offers wrap around care to young people to help them develop better relationship and life skills. There are nine members on the TimeWise Team; a programme manager, programme supervisor, fostering social worker, birth family therapist, individual therapist, two part-time skills workers, education worker and an administrator/ PDR staff.

The treatment programme is individualised for each young person, adopts a behaviourist approach and is underpinned by social learning theory. The intervention occurs across the various settings in which the young person interacts in such as home, school and their local community.

Foster Carers recruited to become MTFC foster carers are offered specialised and ongoing continuous training. Their approval and ‘match’ with the young person is by the Local Fostering and Adoption Committee in HSE local health area, North Dublin.

Foster carers have daily contact with the Parent Daily Report (PDR) staff member to outline the young person’s behaviours for the previous 24 hours. They also attend weekly meetings with the programme supervisor. The weekly behavioural targets, as identified by the programme supervisor, are set at the meeting and foster carers work to the plan.

Evidence shows that the young people who have engaged positively with the MTFC Programme have demonstrated decreased anti-social and criminal behaviours, decreased self-harm behaviours, development of pro-social behaviours, and re-engagement with education or training.

For further information go to: www.timewisefostering.ie

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A healthy diet = healthy diabetes If you are one of those people who has forgotten your New Year’s resolutions already, then spring is the time for you. Remember, giving some attention to your lifestyle now, is a long-term investment in your health writes Liz Kirby, HSE Senior Dietician.

Spring is the time when we de-junk, redecorate and look forward to the brighter days and better weather. This is also the ideal time to spring clean your lifestyle. The key to managing your diabetes is managing diet, activity levels and medication. Long-term lifestyle change takes careful planning and consideration to other things going on in your life. Demanding and unrealistic goals will be quickly abandoned. So, if you have diabetes, then a healthy diet and active lifestyle will help to control, not just your blood sugar levels but also the other important cardiovascular risk factors such as weight, high blood pressure and raised cholesterol.

Prioritise Don’t try to make all the changes at once.

Start by making a list of the changes you want to make in order of importance.

Don’t move onto the next new thing until you have achieved the first thing on the list. By the end of the first month you could have made a number of significant changes that make you feel better.

Personalise It is important that your goals and plans are based on what you want to do and not on what others want.

“Don’t try to make all the changes at once.

Start by making a list of the changes you want to make in order of importance.”

The following steps are keys to successful long-term lifestyle changes:

Plan ahead This means giving careful consideration to what you are going to do and when you are going to do it. For example, it is not enough to simply say, ‘I am going to do more exercise,’ you need to say, ‘I will go for a 30-minute walk on Monday, Wednesday and Friday and I will do one hour of gardening on Saturday.’

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Preparation This means organising the things you need to help you achieve your new goal. This might mean buying a new pair of walking shoes or signing up for swimming classes.

If the changes you want to make are diet related, then you will need to sit down and carefully plan your meals for the week and your shopping list.

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clever shopping Have a look at your usual shopping list and see if there is room for improvement.

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suggestions: • Buy fresh fruit, vegetables and salads • Buy frozen vegetables as a back up • Cut down on the amount of packet or tinned vegetables, soups, sauces as they tend to be high in salt • Buy more wholemeal and wholegrain cereals and breads • Buy less biscuits, cakes and pastries • Buy healthy items for snacks, for example, wholegrain crackers • Buy fresh meat, chicken or fish rather than processed meats or items in batter or breadcrumbs • Buy low-fat dairy products such as milk, cheese and yogurt cooking up A storM Have a look at your usual cooking habits and see if you can make some changes. If you seldom cook and rely on ready meals or takeaways, remember these foods can to be high in fat and salt, and low in fibre and other nutrients. suggestions: • try to find recipes for quick and easy meals in minutes • add plenty of vegetables to stir-fry, stews and casseroles • Prepare a salad to have with pasta, pizza, fish or chicken dishes • avoid the frying pan or deep-fat fryer and use a steamer or grill instead • Use very little oil, butter or cream in cooking • Don’t add butter to potatoes, vegetables or sauces • Drain off any excess fat from stock before making soups or gravy • try to make homemade soup and keep portions in the freezer • try juices or smoothies to encourage you to eat more fruit reMoving the skeletons froM your cupboArd Having your cupboards and fridge filled with the right food choices can help you stick to a healthy diet and avoid snacks.

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suggestions: • Give away or remove any unhealthy foods that might be still lying around, for example, cakes, biscuits, chocolate, crisps • stock up on herbs, spices and pepper to flavour foods, they are a good replacement for salt • Make sure you have either 100 percent sunflower, corn or olive oil for cooking • Fill the fruit bowl with your favourite fruits • Fill up the water jug and try to drink more water during the day • Keep a water bottle in the car too; it can prevent you from snacking while you drive out And About spring is an ideal time to make the most of the lengthening days by going for a brisk walk, tidy up the garden (weeding, raking leaves). remember household jobs such as window cleaning, vacuuming, ironing, dusting and polishing use up calories and keep you active and mobile.

• lDl cholesterol 2.5mmol/l or less • triglycerides 1.8mmol/l or less • a1c 6.5 per cent • Weight – a BMI of 20-25 is a healthy weight, if you are overweight aim for 10 per cent weight loss as this has significant benefits to health • Your blood pressure should be 135/85mmHg or less If you don’t know what your readings are or if you are uncertain about your medications or anything else to do with your diabetes care, make a list of questions for your doctor and bring it with you on your next visit. this feature was supplied by the Diabetes Federation of Ireland

keeping fit And heAlthy By tidying your medical records, you can obtain or monitor your weight, cholesterol, blood pressure and a1C (long-term glucose levels). whAt should your levels be?

For someone who has diabetes: • total cholesterol 4.5mmol/l or less • HDl cholesterol 1mmol/l or more

+ liz Kirby

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OPD clinical programmes established to improve patient care

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OPD Clinical Programmes aim to reduce waiting times for outpatient appointments so that patients will not wait longer than three months for an appointment with a consultant, writes Dr Barry White, National Director of Clinical Strategy and Programmes Directorate.

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s part of the range of Clinical Programmes within the Directorate, programmes will improve access to outpatient services. The programmes will target dermatology, rheumatology, epilepsy and OPAT.

Dermatology Skin conditions are the most frequent reason for people to consult their general practitioner. The conditions most commonly seen in dermatology outpatients are skin lesions (up to 40 per cent of all referrals), eczema, psoriasis and acne. The majority of specialist dermatology care for patients is provided in an outpatient setting though there is a growing need for skin surgery.

The waiting time for a new patient assessment is unacceptably long and this programme is seeking to address this problem. The measures in this programme will lead to patients being seen and treated quicker by a consultant dermatologist.

The dermatology programme will target reductions in waiting times by appointing 11 new consultant dermatologists which will increase capacity in hospitals. The programme is also seeking to improve patient self-management in consultation with community-based services, while establishing standard referral pathways for GPs and their patients.

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Rheumatology Rheumatology is the specialty that largely deals with disorders of joint (arthritis), bone and associated connective tissue, for example, ligaments, muscle, etc. While arthritis can occur at any age, including during childhood, it is the leading cause of disability in people aged over 55 years and hence is the greatest cause of health service usage – one in six people in Ireland have chronic musculoskeletal pain.

This programme is developing a plan to reduce waiting times by appointing seven additional consultant posts and specialist musculoskeletal physiotherapists and developing community based services.

Research shows that many patients can be seen, treated and discharged without having to see a consultant.

Epilepsy Epilepsy is a paradigmatic chronic disease requiring ongoing management at community level, but with occasional acute exacerbations, which means patients sometimes require acute hospitalbased care. The epilepsy programme is targeting improvement in the community management of this chronic disease to increase the number of patients that are

seizure free. It is anticipated that this will save up to 50 lives each year.

The range of measures to deliver on this will include the establishment of epilepsy expert nurses to work with patients in the community. The epilepsy programme will take five years to fully realise but initial improvements will be experienced in 2011.

Outpatient Parental Antimicrobial Therapy (OPAT) The administration of intravenous antimicrobials in Ireland has traditionally occurred in inpatient settings/acute hospitals. However, there is a growing trend internationally to deliver intravenous antimicrobials in a non-inpatient setting.

The OPAT programme aims to administer intravenous antimicrobials to patients in their home or community, instead of in a hospital setting, where patients currently receive this treatment.

This marks a considerable improvement for patients, who would prefer to be treated at home, and will reduce the risk of hospital acquired infections.

The plan currently being developed is for four regional centres initially with implementation to commence in late 2011.

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Keeping Childhood Obesity on the Agenda Dr David Evans, Senior Research Officer at the Department of Public Health, Merlin Park, Galway, discusses childhood obesity, the extent of the problem in the west, and calls for urgent action to tackle this national and worldwide epidemic.

Childhood obesity is rapidly increasing worldwide. Doing less exercise and eating more high energy foods are key factors contributing to a ten-fold increase in obesity levels in Ireland since the 1970s. The health care and personal costs are enormous with both immediate and long term health risks.

Monitoring childhood obesity Preventing childhood obesity is a significant challenge. To make sure we adopt effective measures, we need an accurate assessment of the extent of the problem and to monitor trends over time.

As no routine monitoring systems existed in Ireland, we sought to establish the feasibility of monitoring in schools, and to determine the extent of the problem in the west. The School Public Health Nursing Service in Co. Mayo agreed to work with the Public Health Department to gather data as part of their school health check. A team of five Public Health Nurses (Margaret Collins, Bridie Grogan, Rita Hyland, Mary O Malley and Nuala O Hora) recorded the height and weight of senior infant school children between 2004 and 2007 (5,953 children in 189 schools).

This is the largest study of this age group undertaken in Ireland.

From the data, a team at the Public Health Department (myself, Dr Marita Glacken, and Deirdre Goggin) determined obesity levels in six-year-old children and changes over time.

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+

Dr David Evans, Senior Research Officer; Marita Glacken, Specialist in Public Health Medicine (recently retired); and Deirdre Goggin, Health Informatics and GIS

What we found One in four (27 per cent) of six-year-olds were either overweight or obese. There have been no significant changes in obesity levels between 2004 and 2007.

This represents a significant challenge to policy makers and if left unchecked will lead to an increased risk of longterm health consequences. Interestingly, even at the age of six, we found gender differences, with a significantly greater proportion of girls overweight or obese than boys. This highlights the need to develop both generic and gender specific initiatives to tackle obesity.

The way forward There is an urgent need to prioritise the effective management of obesity. The National Taskforce on Obesity launched a policy on obesity in 2005. In addition, the HSE introduced a Framework for Action on Obesity in 2009. This aims to address the broader determinants of obesity and health inequalities. We need to review and monitor outcomes from these policies to

ensure more rapid progress. A welcome development is that Ireland is now part of the WHO Childhood Obesity Surveillance Initiative. This means that obesity levels will be monitored in Ireland on an ongoing basis. Obesity is a complex issue, and we need to continue to strive to determine the best way foreword for Ireland. Policies are of no value unless sufficient resources are allocated to their implementation. We hope our study will help to keep the issue of childhood obesity high on the agendas of those allocating resources. We need to think of the long-term health of the nations children.

After all, it makes much more sense to prevent problems than trying to fix them when they arrive.

For more information The study has recently been published in the international peer review journal entitled: Child: Care, Health, and Development. A copy can be obtained on request, please email: david.evans@hse.ie

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Helping to change lives Dr Eddie Murphy is a Principal Clinical Psychologist working with the HSE, with over 20 years experience in healthcare. He is based in the Carlow/Kilkenny area. This is his second year as a member of the Operation Transformation expert team. Here, he explains why he thinks Operation Transformation works so well.

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his is the fourth season of the show. My role this year was similar to previous years in that I helped the participants to examine the psychological factors that stop them from eating less and moving more. I also used my professional knowledge and psychological insights to help the five leaders to achieve their personal goals and promote psychological well-being.

There was a huge interest in the programme’s website pages, we had up to 300,000 radio listeners on the John Murray Show on RTÉ Radio 1 and 550,000 TV viewers.

Social media played a much bigger part this year as well.

We had over 13,000 people following us on facebook. It’s hard to argue with the numbers!

Part of the reason why I do the show is that you can reach tens of thousands of people with positive health promotion messages. It’s really a great opportunity to raise awareness of the health services and resources and to get involved

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in promoting health and wellness goals including weight loss, healthy physical activity and emotional health.

“I work hard with each individual leader to help them to identify how their thinking, feelings and actions are of primary importance and maybe key to their success.”

A change of focus This year, we had a slightly different focus in that we were helping more families to try and change their eating habits.

We’ve seen a huge rise nationwide in the number of overweight families where both the adults and the children need to change their habits, become healthier and lose weight.

As part of this new focus, the Falconer family, from Co. Kilkenny, appeared on Operation Transformation this year. Aidan and Angeline Falconer and their children, Kate, Luke and Emily, were a group to

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watch as they take on the challenge to lose weight and get fitter.

We also organised a campaign on this year’s Operation transformation to encourage food outlets to display the calorie count of their products. We really believe that customers could benefit if restaurants/cafés/takeaways provided clear calorie information like they do in the Usa. Food outlets in america are obliged by law to display the calorie count of their products but there’s no such law in Ireland. We think it would really help people if this did exist.

challenging participants like last year, a team of experts, including myself, developed an eight-week programme for the five participants. each participant was given a detailed diet and exercise routine for each day. they were also given a huge amount of emotional support and back-up. as the senior psychologist on the team, a lot of my role is about helping the leaders to understand the psychological factors that promote success. the programme took place over eight weeks but these five leaders were making changes that will continue all through their lives. they faced many difficult challenges in their bid to make sustainable, lifestyle changes. I worked hard with each individual leader to help them to identify

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how their thinking, feelings and actions were of primary importance and maybe key to their success.

Using psychological tools, I tried to help the leaders to change unhelpful beliefs that might be stopping them from reaching their goals. You’ve heard of the phrase; ‘Healthy Body, Healthy Mind’, but I really believe in focusing on the mind first, so for me, the phrase is; ‘Healthy Mind, Healthy Body’.

You can access all of the recipes, workouts and psychology resources at www.rte.ie/ot. I am very grateful for the support I received for my participation in the programme from the Hse assistant National Director, anna-Marie lanigan.

“We’ve seen a huge rise nationwide in the number of overweight families where both the adults and the children need to change their habits, become healthier and lose weight.”

The PSYchoLogY oF Food – are We being fooled or are We fooling ourselves?

Millions of euros are spent every year to entice us to overeat. In our society people overeat not because of hunger but because of hidden but powerful influences. Most people think they are too clever to be fooled by packaging, portion sizes, mood lighting, smells etc, yet time and time again psychological research shows that we are easily fooled. the challenge for us is to change our surroundings to work with our healthier futures instead of working against our healthier futures. We need to remove the influences that cause us to overeat.

In america scientists have studied a particular group called the National Weight Control registry NWCr. looking at this group of 700 people there were significant achievements namely • they lost almost five stone in weight and kept it off for more than five years.

• they reported more positive moods, self-confidence, mobility and energy. these significant results were far better than the achievements of those in the best weight-loss programs. the NWCr group acknowledged that they needed to change for health or emotional reasons. Now what insights to successful weight-loss did the NWCr group provide for researchers?

• there was a change in both eating and exercise habits • regular eating – on average five times a day • Had breakfast • Changed certain types or classes of food • Changed portion sizes • Focused on reducing fat • Increased levels of exercise (GauntlettGilbert & Grace, 2009)

16/03/2011 16:19:52

Protecting today.

Growing tomorrow.

Pfizer Vaccines – helping to protect children right from the start.

Pfizer Healthcare Ireland, 9 Riverwalk, National Digital Park, Citywest Business Campus, Dublin 24, Ireland.

PRE/2010/002

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tO JAB OR nOt tO JAB? launched to highlight the importance of the recommended childhood immunisation schedule.

Ireland’s increasing birth rate of recently means that over 70,000 babies annually are now entitled to receive the primary childhood vaccination schedule.

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“Children who have not had all the recommended vaccines are not fully protected against most forms of meningitis so it is important they complete their vaccinations.”

that is the question that european immunisation Week hopes to raise awareness of this April, and the hSe is issuing an updated immunisation booklet to mark this week.

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he Hse National Immunisation Office is issuing an updated immunisation guide for new parents nationwide to mark european Immunisation Week at the end of april 2011. european Immunisation Week is organised by the World Health Organisation to increase public awareness about immunisation in member states. Ireland was one of the first countries to participate in this initiative and has taken part every year since the Week was launched in 2004. the new immunisation guide contains the most up-to-date information for parents on childhood vaccines, including information

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about the new pneumococcal conjugate vaccine (PCV) – Prevenar 13, which was introduced into the childhood vaccination programme in October 2010. the new easy-to-read guide also answers common queries parents have about the diseases and the vaccines to prevent them as well as the vaccine schedule and vaccine safety. the guide is usually given to parents at their first visit from the public health nurse and contains a record card so parents know which vaccines their babies have received.

In addition to the revised guide, a leaflet and poster are also being

the most recent vaccine uptake rates (Q3 2010) from the Health Protection surveillance Centre have shown a 94 per cent uptake for most of the vaccines and a 90 per cent uptake for the MMr (measles mumps and rubella) vaccine at 24 months. However, there is concern that there has been a drop in some of the uptakes for the vaccines recommended at 12 and 13 months, which may be related to parents choosing to have some but not all of the vaccines recommended at these visits. Uptake rates of over 95 per cent are required to prevent outbreaks of these diseases.

Hse Consultant in Public Health Medicine at the National Immunisation Office, Dr Brenda Corcoran, said, “the new booklet is a really useful guide for parents. We’ve tried to make the information as reader-friendly as possible.

Our main message is that immunisation is the safest, simplest and most effective way to protect children against certain

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diseases. We must make sure that parents know their child needs five GP visits to receive the full immunisation schedule so they are fully protected against these serious diseases. Children who have not had all the recommended vaccines are not fully protected against most forms of meningitis so it is important they complete their vaccinations.” the Hse’s vaccination website, www.immunisation.ie provides up-to-date information on the state’s vaccination programmes.

European It is the only Immunisation website in Week Ireland that has been 23rd - 30th April accredited 2011 as an official vaccine Prevent, Protect, website of the Immunise World Health Organisation.

case study: laura Monaghan speaks candidly about iMMunising her son oscar.

“Probably like a lot of mothers, I treat my baby getting his vaccinations with a certain amount of trepidation.

Initially I was very conscientious, and took the job of him getting his jabs very seriously, so for his first year Oscar got all of his vaccinations right on time. then around the time he was due to get his 12-month MMr and PCV vaccines, he seemed to have a lot of colds and high temperatures. this seemed to coincide with me relaxing a bit about the whole business, so we made and cancelled a few appointments to get these jabs.

Ultimately, Oscar was three months late getting the jab he should have received when he was a year old. subsequently he was also late getting his Men C and Hib vaccines which he should have received at 13 months. When I talked with the nurse, I realised that he was still not fully protected against many causes of meninigitis, which I hadn’t fully appreciated before. I did feel a bit guilty about this and know I would have blamed myself had he contracted any of the serious childhood diseases like measles, mumps or meningitis.

I always felt a bit mean bringing him for his jabs because he was usually smiling and chatting away as we walked to the GP’s rooms and I knew what was coming and he didn’t. But although he cried a little after getting the jab I know having a seriously sick baby would be so much worse. It is definitely better to get the vaccination than the disease.”

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16/03/2011 16:20:02

Health Matters 77

feature

Hand Hygiene Dr Fidelma Fitzpatrick, Consultant Microbiologist Beaumont Hospital and the Health Protection Surveillance Centre, was recently appointed the Royal College of Physicians in Ireland (RCPI) and HSE Clinical Lead in the prevention of healthcare-associated infection and antibiotic resistance.

In the first of a series of articles, she outlines the background to her programme and its overall aims.

What is a healthcareassociated infection?

A healthcare-associated infection (HCAI) is an infection that someone acquires as a result of coming into contact with the healthcare system.

Antibiotics, for example, penicillin are drugs that kill or interfere with the growth of microorganisms, especially bacteria and are therefore used to treat and sometimes to prevent infection. Not all microorganisms are susceptible to all antibiotics, which means, the antibiotic does not kill or prevent the growth of those bacteria. Microorganisms which are not killed or inhibited by an antibiotic are called ‘antibiotic resistant’. They continue to grow in the presence of that antibiotic, which means, the infection continues. ©istockphoto.com/robynmac HM Iss7.1 p71-104.indd 77

When an antibiotic is given, it kills the sensitive bacteria, but any resistant ones can survive and multiply. The more antibiotics are used, the greater the ‘selective pressure’, favouring resistant organisms (the survival of the fittest).

Organisms which are resistant to several antibiotics are called ‘multi-resistant organisms’. Examples of multi-resistant organisms include meticillin-resistant Staphylococcus aureus (MRSA) and carbapenem resistant enterobacteriacae (CRE) Antibiotic resistance (AMR) is more likely to emerge when more antibiotics are used and where many vulnerable people are gathered together, for example, patients in hospital often need antibiotics, and intensive use means resistant organisms are more likely to emerge. However antibiotic resistant organisms are also found outside hospitals and can cause infection in these settings. HCAI caused by multiresistant organisms such as meticillinresistant Staphylococcus aureus (MRSA) are therefore potentially more difficult to treat because of limited antibiotic choices.

Why bother?

HCAI impacts on our patients and on our healthcare system. It causes increased mortality and morbidity costs money and results in increased length of stay. In 2008 the European Centre for Disease Control estimated that approx four million HCAIs occur every

year in Europe. These result in 16 million extra days of hospital stay, 37,000 deaths and an estimated cost of approximately seven billion Euros annually in direct costs. While not all HCAI is preventable, it is now accepted that between 30-50 per cent are depending on the type of infection.

What information do we have in Ireland?

On a national level we have a variety of sources of information on HCAI and antibiotic resistance in Ireland. Some information provides us with an overall snapshot, for example, hospital and nursing home prevalence studies, and others give us information on an ongoing basis so that we can track trends and measure the impact of our preventative programmes, for example, quarterly S. aureus bloodstream rates, alcohol hand rub consumption data and annual antibiotic consumption data for acute hospitals.

Further information can be found at www.hspc.ie.

What are the aims of the HCAI and AMR programme?

In 2007, the HSE launched a Say No to Infection strategy to reduce the spread of infection in all our Health Facilities and Hospitals. Our focus for 2011 is on getting the basics right all the time every time we interact with our patients so that we; • Prevent a significant proportion of HCAI in our patients/residents • Improve hand hygiene by healthcare staff • Use antibiotics appropriately (antibiotic stewardship) • Prevent medical device-related infections, which means, IV lines (drips) and urinary catheters (care bundles/insertion checklists/ measuring infection associated with devices) In the next issue, the focus will be on hand hygiene and the World Health Organisation (WHO) hand hygiene day, which takes place during May 2011.

16/03/2011 16:20:06

78 Health Matters

feature

Mobile Medication

+

Mary Connell, Community Registered General Nurse; Eileen Coleman, Public Health Nurse and Frank McAnena, Pharmacist at the Shantalla Health Centre in Galway City

Eileen Coleman, Public Health Nurse in Shantalla, Galway explains how a new initiative called Home Pharmacy works and how it is helping to benefit local patients on medication.

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F

or the past 18 months, patients of Public Health Nurses (PHNs) in Galway City have had their medication dispensed weekly by pharmacist Frank McAnena, who travels to clients delivering a Home Pharmacy service.

This initiative came about in response to a serious issue concerning the hoarding of medication, with the associated risks that this poses to the health of the patient, the safety risks attached to members of the household, or visiting relatives particularly children, and finally the cost to the HSE in wastage.

Eileen Coleman, PHN in Shantalla, Galway describes how Home Pharmacy came about, “About two years ago, we realised that there was a growing problem with patients hoarding large amounts of

medications and putting their health at risk by not taking their prescribed drugs correctly. Many of these patients were elderly, living alone and were particularly vulnerable.

“A colleague, Teresa Broderick, PHN in Mervue, Galway had a chance meeting with Frank McAnena, a local pharmacist who was also interested in addressing the issue of hoarding of medication and non-compliance. This led to a PHN group meeting with Frank, where he proposed weekly dispensing and delivery of prescribed medications. This was discussed and agreed with the patients and from there the initiative took off!”

The change to weekly dispensing involved the PHNs, the participating patients’ GPs and the Pharmacist working

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Health Matters 79

feature

Once the new weekly delivery system was up and running with a small number of patients, Eileen decided to undertake an observational study to determine the extent of the problem of hoarding and non-compliance and to monitor the effectiveness of weekly dispensing of medication.

©istockphoto.com/ArtisticCaptures

together. The medication pattern for each participating patient was reviewed and with the patients’ consent, all medications not on their current prescription were removed and disposed of correctly.

Once the new weekly delivery system was up and running with a small number of patients, Eileen decided to undertake an observational study to determine the extent of the problem of hoarding and noncompliance and to monitor the effectiveness of weekly dispensing of medication.

Eileen explains, “The reasons for noncompliance with medication are many and, in ways, are as much down to a systems problem as anything else. For example, a full monthly prescription is often filled when a patient requires one additional new item, despite already having two to three week’s supply at home. Similarly, a new prescription following hospitalisation, or a consultant review, may be filled in full and results in doubling up along with the added confusion when branded and generic versions of the medication are prescribed. I also found that the communication between the Health Care Provider and the patient is not always ideal.”

HM Iss7.1 p71-104.indd 79

“When asked, the patients gave a variety of reasons for not taking their medication. It may have been forgetfulness, or not liking the taste or side effect of the medication. Patients were at times unsure of the purpose of a particular medication, and were either under-dosing or overconsuming. Some were worried about becoming dependant on medications or were just tired of taking ‘meds’ and some patients were in denial of their medical condition,” Eileen continues.

While the failure to adhere to medication instructions can be either willful or inadvertent, the outcome of noncompliance is either a dose omission, over-consumption or taking the wrong medications, with the resultant loss of treatment efficacy or overdose-related side effects. This in turn can lead to the administration of further medication and the involvement of the patient in unnecessary diagnostic procedures or hospitalisation.

There are other costs as Eileen explains, “In addition to the effect of non-compliance on the health of patients, there is a cost to the HSE in terms of unused and misused medication. As part of the review of medications, the pharmacist found dozens of out-of-date unused inhalers and nebules and presses full of unused medications which were ‘just there’. One patient had 14 boxes of unused insulin in his fridge (cost €700) and another had 10 partially used boxes of Zyprexa (cost €900).”

Many patients are benefitting from the Home Pharmacy and currently 12 PHNs in Galway are liaising with the pharmacist to provide weekly dispensing and monitoring of medication to 37 patients, who previously had difficulties with compliance and/or hoarding.

Eileen Coleman says, “The response has been very positive and, without exception, all patients who have their weekly medication delivered and personal contact with their Pharmacist are very satisfied with the service. We have noticed a marked decrease in the frequency of hospital admissions, GP appointments and PHN or Community Registered General Nurses callouts from patients receiving weekly prescriptions and who are now taking their medications as prescribed.

“The new service is also helping elderly patients who previously struggled to continue living alone and who may have become a little forgetful or confused. We have found that the weekly monitored medication has led to a general overall improvement in the quality of their life and these patients are able to enjoy their own homes for longer,” Eileen adds.

If you would like further information on the Home Pharmacy initiative and the observational study of non-compliance and hoarding carried out in Galway, contact Eileen Coleman, PHN: Tel: (091) 546 241; Email: www.homepharmacy.ie

16/03/2011 16:20:09

80 Health Matters

feature

Study highlights elder abuse Over 6,500 cases of alleged abuse have been referred to HSE Senior Case Workers since the dedicated Elder Abuse Service was set up in 2007, writes Dr Corina Naughton and Paschal Moynihan.

Šistockphoto.com/Yuri_Arcurs

S

ix thousand five hundred cases is a significant number, but international research suggested that the actual number of older people suffering abuse may be much greater than this. Now this research has been supported by the first prevalence study of elder abuse in Ireland.

Mindful of the under-reporting of elder abuse, the HSE embarked on a significant public awareness campaign in 2010 to

HM Iss7.1 p71-104.indd 80

highlight the issue of elder abuse, help people to recognise when it might be happening and inform them where they can go for advice and support.

The awareness campaign was launched on June 15th, World Elder Abuse Awareness Day, in UCD. It included radio ads, which ran in June and September. Information leaflets and legacy cards were produced and we

also produced a public awareness DVD entitled Open Your Eyes to Elder Abuse in the Community.

The public awareness campaign culminated in a short film competition, inviting people to submit short films on the subject. Just fewer than 100 entries were received and the winning entries were announced in January 2011.

(See www.hse.ie)

16/03/2011 16:20:11

Health Matters 81

feature

In October 2010, the National Centre for the Protection of Older People (NCPOP), which is funded by the HSE and based in the School of Nursing, Midwifery and Health Systems, UCD, launched its report on the prevalence of elder abuse.

Elder abuse is defined as – “A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” WHO 2002 Prevalence of abuse In conducting the survey, 2,021 people aged 65 or older were interviewed. The study found that 2.2 per cent of the study population experienced abuse within the previous 12 months. If this is extrapolated to the general population then 10,201 older people experienced elder abuse in the past year.

The most frequent type of abuse was financial abuse, followed by psychological abuse, physical abuse, neglect and sexual abuse (figure 1).

Figure 1 Types of abuse experienced by older people in Ireland Sexual Neglect 0.05% 0.3% Pysical 0.5%

Financial 1.3%

Psychological 1.3%

Risk profile of people who experienced mistreatment Overall, older women (2.4 per cent) were significantly more likely to experience abuse than older men (1.9 per cent), mainly interpersonal abuse (physical, psychological, sexual abuse) and financial abuse while men were more likely to

HM Iss7.1 p71-104.indd 81

experience financial abuse. The risk of abuse also rose with increased age with men in their eighties experiencing the highest level of mistreatment and this was mainly related to financial abuse.

Older people who lived in intergenerational or extended family households were more likely to experience mistreatment compared to those living alone or as a couple. People on lower incomes, with lower levels of education and belonging to manual type social classification experienced higher levels of mistreatment compared to those on higher income, or higher levels of education and belonging to a non-manual or professional group. This pattern was particularly evident for women.

“People in poorer physical heath were three times more likely to experience mistreatment while those with poorer mental health were nearly six times more likely to experience mistreatment.”

People in poorer physical heath were three times more likely to experience mistreatment while those with poorer mental health were nearly six times more likely to experience mistreatment. Social support was also a factor, people with poor family or community support experienced higher levels of mistreatment compared to people who felt well supported.

Perpetrators of mistreatment The study found that adult children were the most likely to be implicated in the mistreatment (50 per cent), followed by other relatives (24 per cent), spouse or partners (20 per cent), close friends

(4 per cent) and care workers (2 per cent).

Nearly 50 per cent of perpetrators were identified as unemployed at the time of the mistreatment, and in 19 per cent of cases, addition (mainly alcohol) was reported.

Impact of mistreatment When asked how they felt about these experiences, 84 per cent of older people felt the abuse had had a serious impact on their welfare. However, 37 per cent of older people did not report the abuse to anyone and in 25 per cent of cases the abuse was ongoing at the time of the survey. The older person was most likely to turn to other family members for help.

Implications of study The prevalence of elder abuse identified in the Irish study (2.2 per cent) was similar to that identified in other countries. The survey provides a valuable insight into the experiences of older people living in Irish society. The majority of older people were well supported and cared for by people they trust, but for a significant number of people this was not the case.

This study highlights the complexity and the multiplicity of factors that can result in an older person experiencing abusive behaviour by people close to them. As the Irish population of older people continues to increase and age risk factors for elder abuse such as poor health and dependency are likely to increase. To prevent an escalation in the prevalence of elder abuse and reduce the current rate of abuse will require engagement and action from all sectors of society including government, state agencies, public and private organisations, the media but especially older people themselves, and their families.

The full report including contributors to the study can be obtained on the NCPOP website – www.ncpop.ie Dr Corina Naughton is based in the UCD School of Nursing, Midwifery and Health Systems and led the research into the prevalence of elder abuse.

Paschal Moynihan is a Specialist in Services for Older Person with HSE West.

He chaired the HSE’s Public Awareness Campaign Group.

16/03/2011 16:20:11

82 Health Matters

update

Changing Tomorrow Award Winners Cork University Maternity Hospital (CUMH) and St James’s Hospital, Dublin have won awards for outstanding work in healthcare at the Astellas Changing Tomorrow Awards 2010.

T

he ‘Cois Tí’ scheme was the winning entry from Cork University Maternity Hospital (CUMH) for the ‘environmental / social responsibility’ category in the Astellas Changing Tomorrow Awards. The outreach service brings antenatal, postnatal and gynaecology services to Cork’s urban and rural communities. Low risk patients are seen by a team from CUMH and their care is planned and provided in a location close to the patient’s home, reducing the need for patients to travel and reducing the numbers attending CUMH. The ‘environmental/social responsibility’ category rewards individuals or teams who have introduced an initiative that have had significant impact on the

+

Ann Nolan, CEO, IPHA; Anne McNeely, Beaumont; and Patricia Kelly, Astellas.

health and well being of local communities, or have delivered patient care in an environmental sustainable way.

St James’s Hospital was the winner in the leadership category, which rewards individuals or teams who are leading positive change, for an initiative that improves patient safety. A system was introduced to reduce the interruption/ distraction rate experienced by nursing staff during the administration of medication.

A set of interventions previously proven successful in reducing disruption were developed. The project resulted in a significant decrease in the interruption/ distraction rate during medication

+ Anne Roche and Caroline Donnelly, runners up for their education and exercise programme for patient’s with Parkinson’s disease in HSE South + Astellas Award Winners Cork University Maternity Hospital (L-R): Mindy Dooa, Astellas Pharma; Helen Coe, A/Clinical Midwifery Manager; Geraldine Keoghane, Director of Midwifery; Edel Nagle, Clinical Midwifery Manager; and Patricia Kelly, Astellas, Pharma

+ Astellas Award winners Eileen Relihan and Valerie O’Brien, St James’s Hospital

+ Astellas Award Runners Up (L-R): Dolores O’Brien, Dr Brian Carey, Joan Browne from Bantry General Hospital

+ Runner up; members of the HSE South West Cork Continence Promotion Initiative (L-R): Cathy Sheehan, Ber Power, Catherine O’Sullivan and Norma O’Sullivan.

+ Nicola Maddock and Martina Corcoran from St Vincent’s Hospital, who were runners up for their project aimed at reducing failure to attend (DNA) rates

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administration from 27 interruptions per hour to 12 interruptions per hour. This lower rate reduced the risk of medication errors and improved safety for patients.

Runner up prizes were also presented to the Stroke Unit at Bantry General Hospital, Cork; the Leadership Development Programme at Beaumont Hospital, Dublin; the Continence Promotion Initiative in HSE South; an initiative to reduce failure to attend (DNA) rates at St Vincent’s University Hospital, Dublin; an education and exercise programme for patients with Parkinson’s disease in HSE South; and the ‘living with aphasia chat group’ at Peamount, Co. Dublin.

+ Bridget Daly, Jim Daly and Sarah McDonagh from Peamount, runners up for the ‘Living with Aphasia Chat Group’

16/03/2011 16:20:20

HealtH Matters 83

uPdate

A fAiR WAy tO heAlth An estimated 900 people attended the first health fair held in the new Ambulatory day Centre at St vincent’s university hospital, dublin following six months of planning and preparation, says Greg Conlon, health fair Co-ordinator and health Promotion Officer at St vincent’s university hospital.

t

he free event hosted more than 25 stands including representatives from ten national organisations such as the Irish Heart Foundation, Irish Cancer society, UCD’s sports Department and Mental Health Ireland.

Health professionals from 16 departments at st Vincent’s such as cardiology, diabetes, preventive medicine and rheumatology also attended. the aims of the Fair were to raise awareness of health services and promote healthy living. a range of health professionals were on hand to answer questions and give advice to attendees, and a wide variety of leaflets and posters were available too.

Demonstrations were also held on how to check breasts for lumps, calculate calcium amounts in food and how to communicate to people with hearing difficulties. the busiest stands were the breast care and dietetics/catering stands. staff from Citizen’s Information commented that through networking at the Fair, a link had been established with an older persons’ group regarding the provision of important information in relation to entitlements.

the Health Fair was a cost effective, innovative health promotion initiative. there was a tremendous atmosphere created and the Fair proved to be a great opportunity for networking. I would thank all those who participated, particularly the national organisations who gave up their time to attend.

Following the launch day, the stands with displays were available for viewing.

If you are interested in taking part in a future Health Fair at st Vincent’s, please contact Greg Conlon, Health Fair Coordinator at g.conlon@svuh.ie or phone (01) 221 4958. (Please note: the Health Fair is a non-commercial event).

innovative initiative the event stands, leaflets, layout and overall Fair were rated ‘excellent’ by 70 per cent and ‘good’ by 30 per cent of respondents surveyed at the Fair.

Participating staff were also highly commended for their work. When attendees were asked: ‘What was the best thing about the Health Fair in your opinion? the top three responses were: information, variety of stands and the staff. When attendees were asked Can you give an example of something new that you learned?, Comments included: preventing osteoporosis’, healthy eating, patient safety, examining moles and sleeping tips.

HM Iss7.1 p71-104.indd 83

16/03/2011 16:20:25

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Until there are vaccines for all types of meningitis, knowing the signs and symptoms of the disease can save lives.

Our free professional support services include: • A freephone 24-hour nurse-staffed helpline • Professional counselling and bereavement support.

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HM Iss7.1 p71-104.indd 84

16/03/2011 16:20:34

HealtH Matters 85

feature

COMing tO An OffiCe neAR yOu Graham O’Neill on how videoconferencing technology is bringing people closer.

video conferencing in the court service

©istockphoto.com/leluconcepts

Many expert witnesses will have experienced the inconvenience of travelling to court venues around the country to give evidence, only to find that cases have been delayed significantly or adjourned, writes Kevin O’Neill, Principal Registrar with the high Court.

F

or a long time, videoconferencing was the stuff of science fiction, but in recent years, it has very much become reality for a lot of businesses.

When you take into account the worldwide economic slump, videoconferencing is back to the forefront for many companies looking to cut back on unnecessary travel expenses and time-wasting journeys. apart from obviously saving money, firms can also increase their Corporate social responsibility (Csr) by cutting down on their carbon footprint in the fight against climate change. If employees do not have to travel, particularly fly, then their carbon emissions can be greatly reduced.

By bringing people together over long distances through the medium of video, it allows participants to pick up on non-verbal communication. Body language, which consists of body posture, gestures, facial expressions, and eye movements, can make up to 70 per cent of conversations.

Humans send and interpret such signals subconsciously and many are lost when a conversation is conducted over the phone.

One area that has benefitted from the advancements in technology is telemedicine, according to sean Holohan, Managing Director of Videnda Distribution – a leading provider in Ireland. “scalable, cost-effective,

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telemedicine solutions that leverage the public internet and existing general purpose IP networks at medical facilities to enable secure, encrypted remote doctor-patient and doctor-doctor interactions that are as close as possible to face-to-face meetings, are coming on stream. “the solutions allow healthcare providers to deploy high definition (HD), low latency video conferencing anywhere an examination, operation, or consultation needs to take place, from within medical facilities and at patient homes, clinics, other hospitals or physician home offices. “a variety of endpoint options are available including: HD room systems for conferences or auditorium events, desktop endpoints for doctor’s offices, single-click, touch screen options for patients at home, and customised endpoints for medical cart use in hospital emergency rooms, operating rooms or clinics. the solutions support end-to-end encryption and easily integrate into existing healthcare environments with support for a variety of medical devices and interoperability with existing conferencing infrastructure.

For more information on telemedicine solutions over IP networks, please contact Videnda Distribution on (01) 461 1970; Web: www.videnda.ie; or email: info@vivenda.ie.

In recent years, the Courts service has invested in courtroom technology, including the installation of video conferencing equipment with a view to improving the service provided to and experiences of those citizens who come in contact with the court system, while also reducing costs in litigation. this facility enables witnesses give their evidence from locations convenient to them rather than having to appear in a courtroom.

In practical terms, either a solicitor will organise for a video conferencing facility privately or the witness may have access to such a venue in, for example, a hospital or university. a live link is then created with the relevant courtroom. evidence can be given by this means into courtrooms in Dublin (the Four Courts and the Criminal Courts of Justice) and in Cavan, Cork, letterkenny, Dundalk, Monaghan, Castlebar, Galway, limerick and Kilkenny.

While it is appreciated that medical witnesses do not come into direct contact with the courts in advance of a trial, I am of the view that it is worthwhile publicising the availability of video conferencing in case witnesses are unaware of its existence and would consider it to be of benefit.

16/03/2011 16:20:36

T:+44 (0)28 2563 2615 F:+44 (0)28 2563 9572 www.methealthcare.net e: info@methealthcare.net

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MET Healthcare’s superior product range and experienced staff ensure that we deliver the optimum solution to any specialist construction project.

HM Iss7.1 p71-104.indd 86

16/03/2011 16:20:38

Health Matters 87

Update

Maintaining competence, MAINTAINING TRUST Medical Council’s new system to promote patient safety and quality of care

I

n May 2011, the Medical Council launches a new system to support doctors in maintaining their professional competence throughout their professional lives.

Dr Paul Kavanagh, Head of Professional Competence at the Medical Council, and Dr David O’Keeffe, Chair of the Medical Council’s Professional Competence Committee, explain how maintaining competence will help maintain trust between the public and doctors.

Trust is central to the relationship between the public and doctors. When trust is placed, the patient assumes that the doctor has the knowledge and skills to provide safe and effective care in their best interest. But this trust is not placed blindly, and it is the role of the Medical Council to ensure the highest professional standards amongst doctors. This helps to protect the public and to strengthen the relationship between patients and doctors.

In May, the Medical Council will launch new professional competence schemes.

Registered medical practitioners are legally obliged to maintain their professional competence by enrolling in these schemes and following requirements set by the Medical Council. A survey of 500 registered medical practitioners conducted by the Medical Council in 2010 found that over 99 per cent believed that lifelong learning is a professional responsibility. This highlights that the new professional competence system will formalise doctors’ existing commitment to continually updating their knowledge and skills. It will also provide a transparent process which will make it clear to the public that doctors are committed to furthering their knowledge and improving quality of care.

The Medical Council consulted with doctors and the public on the new professional competence schemes during development in 2010. It listened carefully to their views, and based on feedback

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received the schemes have been designed to be straightforward, practice-based and outcome-focussed.

The schemes will be operated by Postgraduate Training Bodies and build on their existing continuing professional development structures. Postgraduate Training Bodies must fulfil standards set by the Medical Council and their performance will be subject to review to provide doctors with confidence in the system.

The Medical Council has worked with the HSE to ensure that these new schemes coordinate with a number of its key quality and safety developments.

This new professional competence system responds to changes in healthcare.

Patients can now be confident that, with Medical Council oversight, doctors are demonstrating their commitment to maintaining and continually developing their knowledge and skills. This is an important step forward which will help to drive good professional practice and will help maintain trust between the public and doctors.

“When trust is placed, the patient assumes that the doctor has the knowledge and skills to provide safe and effective care in their best interest.”

Doctors – What you need to know: • From May 2011, you are legally obliged to maintain your professional competence.

• You will be required to enrol in a professional competence scheme (unless

you are not in a recognised training post).

• A range of schemes will be established by the Medical Council and detailed guidance will issue closer to May 2011.

There will be schemes accessible for doctors who are not currently a member or fellow of a Postgraduate Training Body.

• Doctors should follow the Medical Council’s Standards for Maintenance of Professional Competence, which define the process to be followed as well as providing a framework for the broad types and quantities of activities to be pursued annually.

• On average, each doctor will complete 50 hours of continuing professional development activity per year spread across internal (maintenance of knowledge and skills), external (practice evaluation and development), personal learning and research/teaching categories. In addition, each doctor is expected to complete one clinical audit per year.

• Doctors will declare to the Medical Council that they are fulfilling requirements from 2012, and a sample will be asked to provide additional evidence for assurance.

Health service managers – What you need to know From May 2011, doctors working in your healthcare organisation are subject to a statutory obligation to maintain professional competence.

Employers are legally obliged to facilitate doctors’ pursuit of professional competence requirements.

Health service managers should consider how this new system can best integrate with local clinical governance systems and clinical directorate arrangements. For example, an employer may request that a doctor provide evidence that they are pursuing a professional competence scheme as part of a clinical appraisal process.

16/03/2011 16:20:39

80% 5% IN AFRICA WOMEN DO

WITH ONLY

SCAN ME WITH

OF THE FARM WORK

YOUR SMART PHONE

OF THE HELP & SUPPORT

In Africa, the hand that rocks the cradle also tills the field. In addition to raising children, preparing food, carrying water and collecting firewood, African women do up to 80% of the farm work. But they get as little as 5% of the support - in training, seeds, land and credit. You can change this. Add your name to the petition to demand increased support for African women farmers. Find out more at www.changeherlife.org

ADD YOUR NAME

Text ‘PETITION’ followed by your name to 57856 Texts will be charged at your standard network rate

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HER LIFE .ORG 16/03/2011 16:20:39

Health Matters 89

your stories

Dr Jekyll and Ms Hyde: The paradox of internship Katie McElroy writes about her new life as an intern at Tallaght Hospital.

I

t begins with fear. A knot of anxiety unravelling and retying itself in the pit of your stomach. A sleepless night. An uneaten breakfast. Walking through the front doors of the hospital that first morning I was terrified; how would I ever cope? How was this real?

But somehow it was. My new team greeted me with a smile and a casual, “So, will we go around?”. And that was it. That simple.

The cogs of the hospital kept turning. And we cautiously fell into place; even if things sometimes ran less than smoothly.

The first few weeks teach you how little you really know. A whirl of computer logins, scans, consults, and drug doses. Even the small things seem complicated. You learn to ask for help. You depend on each other.

By day you are the mild-mannered intern standing at the back of the ward round shuffling a sheaf of papers and looking confused. And by night you are a crimefighter battling non-stop against the tide of poor IV access, shortness of breath and falls.

You find yourself looking at the world differently. You admire people’s veins on the Luas. You dislike household appliances that bleep. Your world contracts, shrinking to fit the confines of the tiled corridors – from the wards to A&E, from Radiology to the Res Room. And slowly you find yourself feeling comfortable: you’ve settled into your routine. You have a pattern. You know what to expect.

Starting over And just then it’s pulled from under your feet and you start all over again. New job. New rules. The new medics can’t understand why ward rounds take so long. The new surgeons think that theatre is a Vortex from which their team will never return. You learn to adapt to life at the other end of the spectrum. You start trusting yourself.

And every once in a while you have one of those dazzling moments. A connection

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“Internship is a contradiction. Finally finished with being a student and yet with so much to learn.” with a patient you’ll never forget. A situation well-handled. A knowing smile from a consultant remembering days gone by.

Internship is a contradiction. Finally finished with being a student and yet with so much to learn. The year is a process, a baptism of fire followed by a steep learning curve. Medicine reflects life in that you can’t afford to stand still. From this perspective the internship prepares us for all that is to

come, a rapidly changing world that shifts beneath you at times, but that always keeps you challenged and opens your eyes to things you never thought possible.

And best of all, the intern year allows us to fulfil our ultimate goal, that of repaying our greatest teachers – the patients.

Active involvement in patient care is the most satisfying aspect of being an intern.

This sense of purpose is what motivates us. The intern year may be exhausting and trying at times, but the honour of serving those in need acts as a beacon of light at the end of the long corridor of hospital medicine.

Dr McElroy is a graduate of Trinity College Dublin and is currently completing internship in AMNCH (Tallaght) Hospital. Dr McElroy is one of over 500 intern doctors who are currently training in hospitals and GP practices around Ireland, the first step in the postgraduate career of all doctors.

16/03/2011 16:20:40

90 Health Matters

your stories

Against all odds HSE doctor Gerardine Sayers and her husband Michael Reidy describe their experiences after their son Conor was diagnosed with a very aggressive form of liver cancer.

O

n the day he was born in January 2004, Conor was just on the third percentile for both weight and height. By his fifth birthday in 2009, he had made it up to the 10th percentile, which means only one-in-ten children of his age was smaller and lighter than him. While he had a healthy diet, he was always very reluctant to feed himself.

Nevertheless, Conor generally had good health apart from an eye infection when he was two years old.

By April 2009, Conor had just completed his second term of junior infants in St Mary’s National Boys’ School, Booterstown. For about two weeks before the Easter holidays, he had complained about relatively mild tummy aches and he had begun to sweat very heavily through his head in bed at night.

However, on the morning of Good Friday, Conor complained of a very severe pain in his stomach and this resulted in a midmorning trip to the family GP. From there he was referred to Our Lady’s Children's Hospital, Crumlin for further investigation.

A long wait...

By mid-afternoon, a series of tests (blood, x-ray and ultrasound) indicated the seriousness of the situation. Conor had a major growth in his liver. Within a few days, a biopsy and a CAT scan confirmed everybody’s worst fears. Conor was diagnosed with a very aggressive form of liver cancer known as a Hepatoblastoma.

This is the most common malignant liver tumour of early childhood with an incidence of about one per million of population.

Crumlin Hospital has dealt with about 25 cases since the early 1990s.

Luckily, this type of cancer has its own

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+

Conor Reidy with Captain Anne Brogan, a member of the Air Corp crew, who flew Conor to London

unique bio-marker, Alpha fetoprotein (AFP).

Under normal circumstances, this biomarker should be less than ten. Conor’s value was almost 800,000. Hepatoblastoma cancer cells can spread to other areas of the body including the lungs. Thankfully there was no immediate evidence of this. It did, however, take quite a while and several tests to confirm that for sure.

A key concern was whether or not Conor’s was an anaplastic cancer. This is a cancer that does not appear to resemble the tissue of origin. This is a rather aggressive tumour in its behaviour and is very difficult to treat. The four samples taken in the biopsy showed no evidence of this and indicated that the tumour would probably react well to chemotherapy.

However, only time would tell for sure.

The right treatment The large size of the tumour, which was in both lobes, was of great concern, as was the presence of tumour in the hepatic portal vein. The portal vein is very important because it delivers about half of the oxygen and about three-quarters of the blood supply needed by the liver.

Conor’s oncologist, Dr Jane Pears, and Prof Martin Corbally, Consultant Paediatric Surgeon, said the treatment would be high-risk chemotherapy, followed by a liver transplant and a further course of chemotherapy.

Chemotherapy started just six days after the initial hospital referral. This was administered through a permanent chest Hickman line. All going well and according to plan, the full course would take nine weeks and there would be an assessment of surgical options at that stage.

As it happened, after just seven rounds of chemotherapy it was clear that Conor’s body wasn’t able to cope with the protocol.

He had picked up a number of nasty infections/viruses, he developed a clot in the right atrium of his heart, he suffered a permanent partial loss of hearing at the high-tone level, there was some evidence of renal damage and the anti-sickness drugs couldn’t prevent a rather dramatic loss of weight. A decision was taken to revert back to a less severe protocol.

Notwithstanding all the adverse side effects, there were glimmers of hope along the way. A number of very dramatic falls in

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Health Matters 91

your stories the bio-marker were recorded early on, indicating that the tumour was reacting very well to the treatment.

As there is no paediatric liver transplant programme in Ireland, Conor travelled to King’s College Hospital (KCH) in London for an assessment at the end of July.

Prof Nigel Heaton (KCH) confirmed the likely need for a transplant while stressing that every effort would be made on the day to limit the operation to a resection. Within a matter of days, Conor was placed on the transplant list with the highest order of priority. We were not given the option of enrolling on the living donor programme as it was felt that a suitable liver, from a non-living donor, would more than likely become available within two weeks.

The big day arrives On August 11th, just five days after being placed on the transplant list, a phone call came through confirming the possible availability of a liver. We were immediately transported, with Conor, to London by the Air Corps air ambulance service. That evening the suitability was confirmed, surgery started at about 5.30pm and Conor was transferred back to the paediatric

“Under normal circumstances, this biomarker should be less than 10. Conor’s value was almost 800,000.” intensive care unit just before midnight.

Conor made a very good post-op recovery and was moved from intensive care to the paediatric liver ward within two days.

Initially, the blood test results were very encouraging and it appeared that Conor could return to Crumlin within three weeks.

On the 10th day post-op however, Conor showed signs of acute liver rejection and he had to be given high doses of steroids for three days. This didn’t go quite according to plan and a second anti-rejection drug had to be introduced to supplement the main anti-rejection medication. Thankfully, that worked and the likelihood now is that he will

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be on a combination of both of these drugs for the rest of his life.

As the liver function test enzyme results dropped steadily towards the normal range over the next few days, a decision was made to discharge Conor back to Crumlin to finish his chemotherapy treatment. Conor was back in Dublin almost one month after his transplant and his treatment recommenced within a few days. A few weeks later, chemotherapy treatment finished and his AFP bio-marker reading was at long last under 10. By this time, he was under the care of Dr Annemarie Broderick, Consultant Gastroenterologist.

Very frustratingly for everybody concerned, Conor’s liver function test results failed to decrease to within the normal range and there was an almost constant fear of organ rejection for us. Matters were also complicated by the fact that Conor inherited the Cytomegalovirus (CMV) with his new liver. CMV is by far the most common infection in solid organ transplant recipients and requires a prolonged dose of treatment.

By Christmas Eve, a further biopsy confirmed that Conor was going through a second round of acute liver rejection. This required another three days of high doses of steroids over the Christmas period. As before, progress with lowering the liver function test results throughout the spring was painfully slow, with many worrying fluctuations. During all this time however, Conor’s overall health continued to improve and he was well enough to return to school in senior infants for short days at the beginning of the new term after Christmas.

By the end of April 2010, a further biopsy showed there was no evidence of rejection, acute or chronic. The conclusion was that Conor would probably continue to have higher than normal liver function test results without doing any apparent damage to his new liver.

Thankfully, as it happened, that marked the beginning of the long- awaited and sustained gradual downward trend in the results.

Some of the side effects of Conor’s treatment were also quite evident at this time. He was very lame and his left leg was particularly weak. Physiotherapy sessions at the hospital were gradually improving this.

However, there were a number of setbacks.

Conor fractured two bones in his left ankle due to a fall in mid-February, and two months later, he fractured a bone in his right

wrist. These breaks were as a result of the osteoporosis that he had developed.

A decision was taken to stop the steroids, which were originally intended to be long term and to start Conor on bisphosphonate treatment.

Conor acquired new digital hearing aids in March 2010 to compensate for his loss of hearing at the high pitch tones. These will be a regular feature for the rest of his life along with the soundfield system which will move with him from classroom to classroom.

Keeping positive There have been very positive milestones through the year. By the end of March, there was no further sign of the clot in his right atrium, the CMV virus was not detected and tests showed that there was only relatively minor renal function damage as a result of the chemotherapy. Conor finally got rid of the feeding tube in March. This coincided with steady improvement to his fitness, along with sustained weight gain. He is now up to the 25th percentile for weight and height.

The Hickman line was finally removed by the end of June, marking a return to more normal living, and Conor was well enough to join his first class peers in school on a full-time basis from September.

Before Christmas, the liver function test results were the lowest since this journey began. The most important achievement of all, however, is the bio-marker evidence that Conor has been cancer-free for well over a year. Long may that last!

See www.originalwriting.ie This article featured in the Irish Times HEALTHplus supplement and is reproduced with the permission of the Irish Times.

Michael and Gerardine have written a book based on their experiences, A Lot Can Happen in a Year and a Half.

All proceeds will help fund cancer research and treatment at Our Lady’s Children’s Hospital, Crumlin.

Another objective of the book is the promotion of organ donation. They believe Conor’s story is yet further evidence of the benefits of organ donation and would strongly urge people to become organ donors.

16/03/2011 16:20:41

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16/03/2011 16:20:42

HealtH Matters 93

yOur stOrIes

undeR the SPOtlight – diet We all know that diet matters. it can affect our weight, health, even our mood. But what we don’t often realise is, what we think are the right foods, can in fact be the wrong ones. to learn more, we asked two hSe experts – a physical activity co-ordinator and a senior community dietician to examine the diet and exercise routine of denise Melia, Senior executive Officer, Operational Services dept, health and Safety Management, Our lady of lourdes hospital, drogheda, Co. louth, to see if this is a reality.

denise’s diet any particular concerns or worries?

I would like to get my cholesterol checked as I have a weakness for chips and crisps. I try to be good during the week, but I would have either homemade chips or a takeaway on a saturday night.

In general, if I feel like a treat, I wouldn’t deny myself! When I’m out socialising, I tend to have two to three glasses of red wine.

What did you have yesterday? breakfast: Consisted of a glass of water, a glass of orange juice, a bowl of organic porridge with all Bran and low fat milk.

I had a quick cup of tea when I arrived at work. at 11am, I had a banana, fruit scone with butter and jam and cup of tea.

I would also have a bottle of water on my desk for during the day. lunch: I had a bagel with ham, cheese, lettuce and tomato; a bowl of homemade vegetable soup, a prune activia yogurt, kiwi and an orange. late afternoon: I had another cup of tea at about 4pm and one chocolate from the roses tin in the office! at 5pm, I had an apple in the car on the way home. I then went for a nine kilometres run followed by some weight exercises and 200 sit ups.

For dinner, I had scrambled egg and beans with wholemeal toast, followed by a cup of tea with a fun-size Crunchie. other snacks: the nights I run I find I am very hungry so at about 9.30pm on these nights, I would have a bowl of rice Krispies.

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What kind of exercise do you do, if any?

I do a nine kilometres run two evenings a week, and a six kilometres run at the weekend. I have a German shepherd that I take for a two kilometres walk most evenings in the winter. In the summer, it would be a longer walk and at weekends I would take her for a six kilometres walk. I also try to fit a swim in every other weekend. In 2011, I would hope to compete in a number of ten kilometres runs. I would also aspire to compete in a sprint triathlon (750m swim, 20 kilometres cycle, five kilometers run) in May.

any bad habits?

Well I used to smoke. I’ve quit smoking as a New Year’s resolution and so far so good. Before I stopped, I would have smoked about 12 cigarettes a day and I am currently using Nicotine replace therapy (patches) to help with the cravings and have received great support and encouragement from the health promotion corner in the hospital. I really notice the difference when I go out for a run now and overall I feel much better now that I’ve stopped.

16/03/2011 16:20:46

94 Health Matters

your stories Shirley O’Shea, Physical Activity Co-ordinator, DNE – Evaluation of Denise’s exercise: Denise is certainly reaching the National Physical Activity recommendations of 30 minutes of moderate intensity activity most days of the week. Running, walking and swimming are all aerobic type activities, which just means they are ‘with oxygen’. They are ideal exercises for the cardiovascular system.

Denise would also benefit from incorporating some light weights and resistance exercises into her routine. These exercises are particularly good for improving your strength which would help with her running and swimming.

Denise has set herself some exercise goals for 2011 and part of staying motivated and keeping active regularly is setting yourself a long-term goal. Denise may want to consider completing some shorter races first at five kilometres or five miles before moving to ten kilometres. Athletics Ireland, in conjunction with Local Sports Partnerships, run meet and

train groups all over the country called Fit 4 Life.

While Denise seems to be running regularly, increasing her swimming at least one day a week would improve this discipline in order to achieve her goal of completing a triathlon.

Denise does not mention in her profile that she is doing any cycle training at present. It is still not too late to start for a May triathlon.

The bike to work scheme has encouraged many people to actively commute to work.

Visit: www.biketowork.ie.

Ideally Denise would divide her weekly exercise routine between running, cycling, and swimming, however, a good rule of thumb is to only increase time and intensity of exercise by 5 per cent a week. Some stretching exercises after her workout helps to cool down and keep muscles flexible.

Best of luck to Denise with achieving her goals for 2011!

Irene Cunningham, Senior Community Dietitian, DNE – Evaluation of Denise’s diet: Firstly, congratulations Denise on being a healthy weight – your BMI (Body Mass Index) is within the normal range of 20-25kg/m2.

Your breakfast and mid-morning snacks are good sources of fibre. Having a supply of water at your desk throughout the day is an excellent way of ensuring you meet the recommended eight to 10 cups of fluid daily.

Butter would be best replaced by a low-fat mono/polyunsaturated spread.

Try to have chicken and fish, including oily fish, as alternative filling choices for sandwiches. When making homemade oven chips or wedges, slice your potatoes, parboil for five minutes, drain and brush the chipped potatoes with a little mono/polyunsaturated oil/spray oils, before baking in a hot oven.

Your evening meal is very healthy. However, try and have a dinner with potatoes, pasta, rice, vegetables or salad and meat, fish or chicken most evenings to enhance the nutritional complement. Given the high energy demands of your exercise routine, the calories

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from the fun-size bar are not a problem for you, but it would be best to keep them for either before or after exercise, as you don’t want to develop the bad habit of having to finish off a meal with something sweet.

Undoubtedly, the takeaway on a Saturday night gives you a welcome break from the kitchen. However, remember that the portions tend to be large. Crisps, which are high in salt and fat, should also be kept as occasional foods. Your alcohol intake of two to three glasses on occasion is fine.

But remember when drinking at home, use standard wine glasses.

To achieve your fullest potential, I suggest these adjustments to your diet.

Before exercising, increase your intake of carbohydrate foods and drink 300-600mls fluids in the 30 minutes prior to exercise.

After finishing your exercise/training session, eat a high glycaemic index snack within 30 minutes such as cereal bars, smoothies, jelly sweets, soft drinks, etc.

Also try to have a carbohydrate and protein containing snack within the next two to three hours such as ham sandwich, beans on toast, chicken, pasta, etc.

Keep up the good work with your daily diet and exercise and the best of luck with the triathlon Denise!

16/03/2011 16:20:49

Health Matters 95

your stories

The Sound of Music +

Instruments used in Music Therapy can be played easily and do not require any form of musical training. They include many different drums, xylophones, shakers, cymbals and a range of other small percussion instruments

Music therapy allows people to explore new possibilities, helping transform and enhance their individual well-being. Music therapist, Sebastian Boes, is adamant that you don’t have to be musical to benefit from music therapy, writes Laura Monaghan.

Sebastian is based in Cherry Orchard Hospital in Dublin’s Ballyfermot and has worked as a music therapist for the HSE for a number of years. Initially he started out as a musician and gradually developed an interest in the therapeutic powers of music.

“Music therapy relies on the innate responses of almost everyone to the sounds and silences in music, irrespective of their physical, mental or emotional status. Thus, anyone can engage,” claims Sebastian.

“I decided to become a music therapist as I felt this was the perfect mix between the musical and therapeutic aspects of music. Music therapy works on

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the innate human impulse to engage with, react to, and identify with musicsound. This allows people to explore new possibilities, helping transform and enhance their individual well-being. The therapeutic relationship between client and therapist is crucial in building and sustaining a trusting, non-judgemental shared space of creative engagement.

Sebastian uses drums, xylophones, shakers, cymbals and a range of other small percussion instruments during his sessions with clients and patients.

He explains, “Instruments used in music therapy are chosen carefully in order to fulfil their therapeutic purpose. They can be played easily and do not require any form of musical training. The voice can also be used as a very effective instrument in music therapy and therapists will frequently use the guitar or the piano as an accompaniment instrument.”

A music therapy session can last from 15 minutes up to two hours depending on the setting and the attention level of the clients. For example, a one-to-one session with a person with severe Alzheimer’s and low concentration span will be shorter than a group session with adolescents who are

able to participate to a much higher degree.

Sebastian adds, “Sessions vary widely, and will depend on the inclinations, preferences and dispositions of the individual client. All ages and all situations are catered for. A music therapist will offer different options in instrumental sounds, music patterns, vocalisations or improvisations while playing, listening and exploring many possibilities. The sessions are usually client-led, interactive and dynamic operating in a free creative zone of personal expression. The sessions may be mostly non-verbal, using the music-sound exchange as a framework of communication.”

Music therapy has become an integral part of many health systems throughout the world. It is an evidencebased profession, where therapists use music in a planned and intentional way to meet an individual’s social, emotional, psychological, cognitive and physical needs. In Ireland, students who want to qualify as music therapists can undertake an MA postgraduate training programme at the University of Limerick.

To contact Sebastian for more information; Email: sebastian.boes@hse.ie

16/03/2011 16:20:53

96 Health Matters

your stories

Sporting Passions Anne Marie Ward, a Disability Service Manager in Donegal, talks to Health Matters about being crowned the 2010 World Open Water Swimming Woman of the Year having made history to become the first Irish woman to swim the North Channel connecting the Irish Sea to the Atlantic Ocean.

Congratulations on becoming the 11th member of the elite North (Irish) Channel Club. Tell us about your epic 35km swim?

At 8.30am on September 1st 2010, I pushed off from the rocks at the Gobbins, north of Belfast Lough. The water temperature was 12 degrees and I settled into a steady stroke rate of 62 per minute.

Four weeks previously, my joints seized up after swimming through beds of jellyfish for five hours. The toxins poisoned my system and I had to be taken from the water. With the mounting hours, still haunted by the memories of my four previous attempts, I battled with all my might. All I had to hold on to was my mantra: ‘The boys will bring me home, the boys will bring me home.’

After 18hrs, 59minutes and 26 seconds I touched Scotland.

What was the toughest part of the crossing?

About eight hours into the swim, I knew that I was about to face the dreaded north flowing tide and that I would have to fight for the following six hours to maintain my position. I knew that the tide was going to bring me a few miles north and if I stopped I would be pulled backwards. This was a huge mental and physical challenge. The last couple of hours were also extremely tough, there was very little left in the tank at this stage and we were not getting the tidal flow that we expected. Every hundred meters had to be fought for.

What went through your mind when you finally touched land at Portpatrick, Scotland?

It was all a bit surreal; it was 3.30am in the morning. The only light was from the spotlight that was shining from my support boat. The official observer shouted to confirm that he was happy that I had cleared the water and that the swim was

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completed. My brother, who had entered the water to accompany me to shore, gave me a big hug and I just cried with pure relief. All I could say is ‘thank God it’s over, it’s over.’

What other marathon swims have you completed?

I swam from a lot of the islands off Donegal to the mainland, including Tory Island in 2003. In 2006, I was part of a six-person relay team that swam around the entire coastline of Ireland. It was the first time ever that a country was circumnavigated by swimming. In 2007, I swam the English Channel.

When and why did you start long distance swimming?

As part of a NWHB Management Development assignment in 2002, I had to identify and achieve a personal goal, preferably something that I always wanted to do but never got around too. A few former North Western Health Board colleagues and I discovered that we all liked

swimming as children and decided to do a charity swim. We completed a two-mile swim and this was the start of it for me.

Are you going to hang up your goggles now or do you have more long distance swimming dreams to be fulfilled?

I have no immediate plans, but there are other stretches of water that I would love to have a go at in the future!

Does your sporting life have an impact on your job as a Disability Services Manager in Donegal?

I think most people who exercise would agree that they are fresher and have much more energy. I feel my sporting life enables me to bring that energy and vitality to my job. Also, because I have a rigorous training regime, I have had to perfect time management and discipline. My swimming is a great way of de-stressing and normally I have all my problems sorted after a long sea session!

16/03/2011 16:20:55

Health Matters 97

your stories

The end of the beginning Final year medical student Kapil Sharma has been an undergraduate medical student at NUI Galway for the best part of six years. In the first of a four-part series, Kapil shares his experiences on his path to becoming a junior doctor.

A

fter years of college I’m accustomed to lengthy study and arduous exams, however the final medical year has a different atmosphere than any of the years that have gone before.

I’m currently rotating through modules that cover a wide array of topics – from neurology to plastic surgery – every three weeks I switch from one speciality to another. The day ordinarily commences with ward rounds at eight in the morning.

This is a great opportunity to familiarise myself with patients as well as learn from the consultant that I am assigned to.

Afterwards, hours are spent interviewing patients, practicing clinical examination skills and presenting findings to doctors who graciously give me a lot of their very valuable time. This apprentice-style of learning is essential to refine one’s ‘book knowledge’. In addition, the days are punctuated with lectures and tutorials, which usually serve to highlight how deficient my understanding of a topic really is. On top of this, countless late evenings are spent studying in order to keep up with the information acquired from clinical experiences.

Over time my skin has thickened to early starts, study, rounds and lectures.

However, the real change in final year is the realisation that in a shockingly short space of time the decisions I make are going to have consequences. A day rarely passes without someone rightfully reminding me that in six months “you will be an intern”. Even if this position is the most impotent form of a doctor, it immediately promotes the things I learn from matters of interest to items that will soon be life affecting. This naturally leads me to worry about letting some vital piece of information go unstudied or slip my mind and what awful consequences that may have.

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Metamorphosis So, presently, I am glad about the six months that remain before I am (hopefully) adorned with the title ‘doctor’ because I feel some kind of metamorphosis has to occur between now and then. However, a part of me, which is growing by the day, relishes the opportunity that internship will give me. The chance to finally put the study I have done over the past years to use by caring for patients and to prove to others that I am worthy of this great responsibility. For now I’ll just have to focus on becoming as competent as possible and passing my final year exams.

“The real change in final year is the realisation that in a shockingly short space of time the decisions I make are going to have consequences.”

16/03/2011 16:20:58

98 Health Matters

your stories

Getting to

know you...

Name: Greg Conlon Job title: Health Promotion Officer Base: St Vincent's University Hospital, Elm Park, Dublin 4 What do you love about your job?

Facilitating lifestyle change with patients and staff.

How long have you worked with the HSE? Two years.

Describe your job in five words Diverse, challenging, engaging, interesting, different.

What's your average working day like?

The working day varies depending on the time of year. When events like the health fair or promotional days are coming up, I am busy organising and promoting the events.

I also cover our smoking advice service on Wednesday and also Friday afternoon.

I meet with hospital inpatients and staff who want to quit smoking and also phone outpatients offering support and advice.

We have developed a new health promotion clinic that helps patients address lifestyle risk factors for chronic diseases. I see patients on Friday mornings. We publish a quarterly newsletter which I contribute to and edit in between things.

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If you could change one thing about your job what would it be?

It’s not so much my job, but the way health services are delivered. I would like to see major investment in large scale preventative health measures. How else are we going to tackle issues such as childhood obesity?

Strategies need to be put in place also to develop healthier older people. We know from the last census that over the next 30 years, 33 per cent of the population will be aged between 55-74 years old.

What's your favourite book and what did you like about it?

Michael Jordan – Driven from Within was the last memorable book I read. It’s about setting your own standards and being successful.

What's your favourite film and what did you love about it?

Too many to mention, but the Lord of the Rings Trilogy was a proper cinematic experience.

What's the most memorable thing you have ever experienced?

Travelling has always been very rewarding.

The world is so accessible now. Also, I think friendships developed over the years provide lots of memorable moments.

What's the best advice you've ever received There’s no such thing as luck.

Who has inspired you the most A collection of people actually; anyone who has a tough life but is happy regardless, self-made people and the enthusiasm older people have for life.

Pet hate?

Cigarette smoke.

Top thing on your dream list if you won the lotto?

I would buy a villa in the Caribbean. If I was super rich, I’d love to take on the tobacco industry and put them out of business!

16/03/2011 16:20:59

Health Matters 99

your stories

A Day in the Life

Mary Devane is a Clinical Nurse Manager at the Acute Medical Unit (AMU) in Kerry General Hospital (KGH), and this is her day...

I

have been working at KGH since 1997 and in the AMU since it opened in August 2010. Over the years, I have worked in a number of areas, mainly in the Emergency Department and in Quality and Risk management. My day in AMU is a very busy one, seeing many different types of patients and no two days are the same. This makes for a varied and interesting occupation.

My working hours are 8.45am - 6.00pm and to begin the day, the team and I carry out quality assurance and equipment testing for the day ahead.

Early in the morning, Haemochromatosis patients are treated. Later, I receive calls from the bed manager about medical patients in the community who require consultant review and are due into AMU throughout the day. Medical patients are also treated as required from the Emergency Department. The consultant is present all day in AMU and therefore, the senior clinician can support both AMU and the Emergency Department, ensuring that medical patients are seen by the consultant on arrival at Kerry General Hospital.

Typical patients seen include those with complaints involving chest pain, respiratory complications, diabetes, headaches, collapse or stroke. Referrals are taken from the GP, emergency department, community hospitals and other disciplines as required.

Any medically compromised patient is seen by the consultant and the AMU team ensuring they receive the right care in a timely manner and in the right place.

The staff members in the AMU also include; the registered nurse, the multi-task attendant, the clerical officer, the consultant and the on-call senior house officer. The registrar for the medical team covers both the Emergency Department and AMU ensuring that he/she monitors all the medical patients presenting to the hospital at any one time. He/she links closely with me throughout the day ensuring the pathway for all medical patients is streamlined.

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The team and I work very closely with various diagnostic departments including; radiology, cardiology, laboratory, endoscopy, the discharge co-ordinator and the primary care teams (PCTs), as a means of fast-tracking patients through the service and back out to the community as required.

The average length of stay for a patient in AMU is three to four hours, during which time the patient and their GP will receive a preliminary diagnosis, a set treatment plan and investigation results. After this time, the patient will be either discharged home or transferred to the ward.

On average 50 per cent of patients presenting to AMU go home and with supports as required. Integral to the whole AMU process is close

communication between the hospital and community services, namely the PCTs and the GPs. The GPs have been fundamental to the establishment and maintenance of the AMU in Kerry. They were part of the steering group (which set up the AMU) and now engage with the bed manager and I on a daily basis.

Feedback from the GPs to date has been very positive with a number of GPs commending the speed and level of quality service that the medical patients are now receiving.

I also take part in the maintenance team meetings on a fortnightly basis. The aim of the group is to commit to quality improvement targets and ensure that the AMU continues to provide an accessible, streamlined and worthwhile service.

16/03/2011 16:21:02

You said you wanted a more helpful bank. We hear you.

Here are just some of the 15 commitments we’re making to our customers • We’ll open our branches in the main towns and cities on Saturdays.

• We can send you free text messages which will help you take action to reduce avoidable current account charges.

• We’ll resolve your complaint fairly, consistently and promptly, with 75% of cases resolved within two days.

• We won’t close any of our 236 branches, and where we’re the only branch in your town we will maintain our opening hours.

• We’ll launch a community fund, and offer all of our employees a day off for local volunteering.

We intend to deliver on these commitments; however, we don’t expect to achieve all of them immediately. We know we have work to do in some areas.

Our progress will be measured by independent auditors Deloitte and a report will be published every six months on ulsterbank.ie/helpful Help for what matters Source: Research completed with personal customers on behalf of Ulster Bank by Amárach Research in July 2010 and August 2010. Our progress against the Customer Commitments will be independently assured by Deloitte LLP. Ulster Bank Ireland Limited. A private company limited by shares, trading as Ulster Bank, Ulster Bank Group and Banc Uladh.

Registered in Republic of Ireland. Registered No 25766. Registered Office: Ulster Bank Group Centre, George’s Quay, Dublin 2. Member of The Royal Bank of Scotland Group.

Ulster Bank Ireland Limited is regulated by the Central Bank of Ireland. Calls may be recorded.

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25/02/2011 09:52:05

Confused about the best Health Insurance cover for your family?

The Health Insurance advice service free from Lyons Financial Services is here to answer your questions.

Whether you’re interested in VHI, Quinn or Aviva health insurance plans, Lyons Financial Services are an independent advisor and will help you to choose the most suitable cover for you and your family.

Contact our Health Insurance Team today on

Lo-Call 1890 304 304 or email us health@lyonsfinancial.ie

www.lfs.ie Roisin Lyons t/a Lyons Financial Services is regulated by the Central Bank of Ireland.

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16/03/2011 16:21:04

Health Matters 101

for you

Investing in your future Answering all of your investment questions, Eoin McGee, owner of Prosperous Financial Services, looks at the lessons learned from the recent turbulent markets and if and where to invest your Additional Voluntary Contribution.

M

arch 9th 2011 was the second anniversary of what is now believed to be the end of one of the world’s greatest declines in stock markets. Since then, we have seen some very attractive returns on markets. For example, the US benchmark market the S&P500 is up 84.66 per cent in that two-year period. This means if you timed it exactly right, you were not far off doubling your money in a two-year period.

In fact, if you had been bold enough to invest in Asia in those two years, you would be up almost 120 per cent, so you would have more than doubled your money.

In the last four to five years, we have been witness to some of the best of the times and some of the worst of times. This article will try and address, what can be learned from the recent events? How can these lessons be applied to the way you invest your AVC (Additional Voluntary Contribution).

Lesson One – Markets are cyclical Contrary to what was said in the newspapers two years ago about the demise of the world’s financial system, we now know that financial markets are not actually broken. You could be forgiven in believing the many commentators who suggested that the world would never be the same again. Markets did rebound with gusto and some long-term spectators of markets recognised this and benefited dramatically from it.

How does this affect my AVC investment?

If normal markets are cyclical then you should be able to take advantage of this.

When you invest on a month-to-month basis you are buying into markets at different levels. If you have confidence in your investment strategy and have learnt that markets, despite some commentators’ opinions, do have the ability to rebound, then you should see declines in markets as

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a real buying opportunity, which should lock in real value for you in the future.

Lesson Two – Diversification Unfortunately for Ireland, we have been exposed on many fronts; the turbulent markets, the property bubble, the banking crisis and the construction collapse, have left us all feeling very negative about investing. We are also still in the middle of a difficult recession.

Don’t let this impact on your world view.

The rest of the world is actually doing okay at the moment. Inflation is creeping up in both Europe and the UK leading to the very real prospect that interest rates will rise soon. The US unemployment figures are improving with each month and China is still going strong.

How does this affect my AVC investment?

If your AVC was invested only in Ireland, you would have been hit very badly during recent years; however, all AVC providers will offer you a broad range of investment

options. For example, Cornmarket have access to in excess of 15 funds for their AVC customers. One of these funds is the Consensus fund. At present, this fund has less than 6 per cent exposure to Ireland; it then diversifies the remainder of the fund across government bonds and gilts, cash, property and international shares.

The shares element is then further divided into sectors such as pharmaceutical companies, telecoms, consumer products etc. By picking a fund like this, along with some other funds, you can broaden your exposure and reduce your overall risk to peaks and troughs.

It is as simple as the old saying – ‘Don’t keep all your eggs in one basket.’

Lesson Three – Time not Timing Let us assume you invested money into your AVC in 2007, over the next two years you watch it go down as markets took one of the worst falls in history. Some people may get tempted to pull out and

16/03/2011 16:21:04

Are you confident your dependents would be financially secure if you were to die, get serious ill or were unable to work due to illness?

Are you confident you are getting best value for money for your current cover?

Could you benefit from meeting with a professional to check the answers to the above question.

Eoin McGee QFA

Call

087 644 5533

Prosperous Financial Services, 1st Floor, Weavers Court, Main Street, Prosperous, Co. Kildare

Tel: 045 841738 n Mob: 087 6445533 n eMail: eoin@prosperous.ie Eoin McGee trading as Prosperous Financial Services and Bluesky Mortgages is regulated by the Central Bank of Ireland.

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16/03/2011 16:21:05 23/10/2009 12:14:31

Health Matters 103

for you

switch their money into safer options. If you are very close to retirement, this may be a necessity, but if you are not, however difficult it may be, you are most likely better off riding out the storm.

“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.”

A market recovery is typically a mirror image of its fall, so therefore, if you switch investment choices halfway through, your recovery may not reflect your decline and therefore could fall short of your investment expectations.

How does this affect my AVC investment?

It is important to design your investment strategy at the outset and stick with it, this strategy should change only if your investment objectives have changed and not because of market movement.

Lots of people spend more time deciding how much to invest in AVCs and less time actually deciding where the money is invested. Get good advice and make an informed decision and then stick to your plan.

Lesson Four – Plan your exit Although in lesson three we looked at the fact you need to stick with your decision at the outset, one of the best strategies you can take is to plan your exit at the outset.

For example, some people will decide to have a set return that they want to achieve on their investment, and when they reach

HM Iss7.1 p71-104.indd 103 10/2009 12:14:31

this point, they will alter their strategy to something safer. This can have its downfalls, in that you could potentially miss some good returns on what was a perfect viable investment strategy.

One of the most successful exit strategies is one that reduces your risk over a set period of time. For example, it will move 10 per cent of your fund into safer options every year for the last 10 years, resulting in less exposure to ups and downs immediately prior to retirement. There is some discussion over whether the optimum time to reduce your exposure is five years, 10 years or more.

How does this affect my AVC investment?

I recall attending a presentation where Zurich Life’s Director of Pensions, Brendan Johnston had done some analysis on this and found that five years prior to retirement switching 20 per cent per annum was in fact the optimum route to take. Zurich (formerly Eagle Star) along with many other companies now has an option where this can be done automatically for you and you can decide to do this at the outset. You should check if your provider has this option and if not work with your advisor prior to retirement to ensure that you do it manually.

Lesson 5 – Get Advice Our hospital corridors are full of people who are experts at what they do; people from all over the country rely on this expertise on a day-to-day basis. A doctor would be horrified at the idea that somebody might self medicate and this should be the same for financial advice.

Unless your day-to-day role is providing expert financial advice in the area of financial planning and portfolio construction, it is likely that you are not an expert in providing financial advice and portfolio construction.

In the same way, it could lead to disastrous results for me if I were to try and diagnose and cure my own ailments this should work in reverse.

How does this affect my AVC investment?

Get an expert opinion, make sure you trust the advisor and you are comfortable in their knowledge and ability to manage your finances. Everybody needs a plan tailored to their own risk tolerance levels and each plan should take into consideration all of your existing investments outside of the AVC. It should also consider other factors such as length of time to retirement.

About the Author Eoin McGee is the owner of Prosperous Financial Services, an independent firm regulated by the financial regulator as a multi agency intermediary and mortgage intermediary. He has over 10 years experience giving advice to both individuals and companies in relation to their finances, he can be contacted on eoin@prosperous.ie, (045) 841 738 or (087) 644 5533.

Two year performance figures 9/3/2009-09/03/2011 Stock Market

Region

Return

MSCI Asia ex Japan

Asia

117.15%

FTSE 100

UK

94.45%

Hang Seng

Hong Kong

89.76%

MSCI world Index

Global

85.91%

S&P 500

America

84.66%

DJ Euro Stoxx 50

Europe

74.63%

16/03/2011 16:21:06

104 Health Matters

competitions

Win a night in the

BROOKLODGE AND WELLS SPA G

eorgina Campbell’s Hotel of the Year 2010 and AA Hotel of the Year 2008/2009, the Brooklodge is a four-star country house hotel situated in beautiful Macreddin Village and surrounded by spectacular Wicklow countryside, yet only an hour from South Dublin.

The luxury spa, The Wells, is a joint operation with Ireland’s leading experts in beauty and health treatments and its extravagant experiences and water features are sourced around the globe.

All the water used in the centre is from their own pure water wells and a unique indoor-to-outdoor swimming pool and gym complete the experience.

The Waterside Lounge is also a perfect spot for unwinding and on fine summer days you can sit out by Ballycreen Brook.

In the Strawberry Tree Restaurant, Ireland’s only certified organic restaurant, they use only

Win a

T

Pampered Weekend

he Ice House Hotel Mayo is a surprising retreat, perched on the edge of the River Moy in Co. Mayo.

Independently owned, this Mayo fourstar hotel is a refreshing distance from the generic trappings of chain hotels, where nothing is defined and anything you need will be catered for in a laidback, warm and friendly fashion.

Lovingly restored from its historic status as a 19th century “Ice Store”,

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organic and wild foods, prepared expertly and served in possibly Ireland’s most dramatic dining rooms. While in La Taverna Armento, a full Southern Italian menu based around the foods available from the towns of Armento and Basilicata is offered.

The championship standard, par 72 Macreddin Golf Club is designed by Irish Ryder Cup hero Paul McGinley and incorporates 160 acres of woodland and meandering brooks. To be in with a chance to win this amazing prize of one

midweek nights stay and a meal for two in La Taverna Armento, please answer the following question: Q: In which county is the Brooklodge and Wells Spa situated?

(A) Wicklow (B) Wexford (C) Waterford For further information contact info@brooklodge.com, call (0402) 36444 or visit www.brooklodge.com Email your answer plus your name, address and phone number to competition1@ashville.com with 'Brooklodge' in the subject line.

Closing date for entries is April 30th.

the Ice House enjoys the sort of unfussed, modern panache expected of a contemporary rustic retreat, two centuries later. Thirty two luxurious bedrooms, waterside hot tubs, an intimate spa, chic design and a standard of food celebrated by the country’s leading critics.

To win two nights of luxury at the Ice House, be pampered with Yonka Goodies in your room on arrival and unlimited time in the Thermal Suite in Chill Spa. Dine in style in the 2AA Rosette Pier Restaurant with dinner on one evening from our a la carte menu and breakfast each morning, answer the following question: Q: The Ice House is located on the edge of which river? a) River Moy b) River Lee c) River Liffey Email your answer plus your name, address and phone number to competition1@ashville.com with 'Ice House' in the subject line. Closing date for entries is April 30th.

16/03/2011 16:21:13

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Healthcare Programmes at the IPA Your Career Just What the Doctor Ordered

The Whitaker School of Government and Management at the Institute of Public Administration (IPA) offers several part-time programmes in healthcare management. These nationally accredited programmes appeal to those who want to understand the key issues in modern healthcare delivery and bolster their career opportunities.

IPA Healthcare Management Programmes Certificate in Health Services

Diploma in Healthcare Management

Diploma in Health Services Policy

BA (Hons) - Healthcare Management

Diploma in Health Economics

MA - Healthcare Management

These programmes are... � part-time � delivered in flexible, student friendly ways � keenly priced

� between levels 6 and 9 on the National Framework of Qualifications (NFQ) � designed to allow students progress from Certificates to MA qualifications

So, wherever you work and whatever your responsibilities, make 2011 the year you return to education, obtain new qualifications, and re-charge your health services career.

IPA Healthcare Management programmes commencing September 2011.

(01) 240 3600

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information@ipa.ie

www.ipa.ie

02/03/2011 16:41:11

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02/03/2011 16:41:13