Health Matters Spring 2013 by HSE Communications

H E A LT H Vol 9 I Issue 1 I Spring 2013

INSIDE - Lean Healthcare - Step Challenge -T riple P - Patient Feedback

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

The Story of Our Lives

Eileen Gibbons: Preserving Stories Through the Generations

H E A LT H Vol 9 I Issue 1 I Spring 2013

MATTERS National Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Spring 2013

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 11

Vol 5 I Issue 3 I Autumn 2009

32 Front Cover9.1.indd 1

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The Minimum Effective Dose of Oral Nutritional Supplements = 400kcals

• ONS should supply an additional

food intake of at least 400kcal/day1

• 400kcals/day results in improvements in patients ‘total energy intake’ and is linked with clinical benefits2

• 1 x Fresubin 2kcal Drink provides 400kcals & 20g Protein

• 1 Patient, 1 Bottle, 1 Day • GMS Approved www.fresenius-kabi.com Date of Preparation: Feb 2013. EN/2kcal/002.13 References: 1. Raynaud-Simon A: Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr 2011, 30:321-319. 2. Hubbard GP. A systematic review of compliance to oral nutritional supplements. Clin Nutr 2012,31:293-312.

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Health Matters 1

Contents 58 EMERGENCY DEPARTMENT FEEDBACK Collecting and acting on patient input. 60 TALLAGHT HOSPITAL ARTS The National Centre for Arts and Health. 62 NURSing AND MIDWIfery 63 MENTAL HEALTH TRAINING 65 News Briefs 66 REGIONAL NEWS 5 GRANGEGORMAN The new Phoenix Health Centre opens. 8 WORD OF MOUTH Eileen Gibbons talks about her Per Cent for Art project recording nursing home residents' stories. 11 PROSTATE CANCER TREATMENT A new National Cancer Control Centre service is launched.

29 N EWS BRIEFS 82 AUDIOLOGY 32 P UMP SCHOOL DIABETES New service rolls out in Cork and Kerry.

85 B REASTFEEDING

34 C ROKE PARK AGREEMENT

86 HUMOUR

37 S INGLE ASSESSMENT TOOL Improving services for older people.

87 D ISABILITY 88 G ARDENING

40 N EWS BRIEFS 91 D IARY OF AN INTERN

15 UNIVERSAL HEALTH INSURANCE Important new documents published.

41 R OLE OF THE AUTHORISED OFFICER Duties under the Mental Health Act.

16 RAPID RECOVERY KNEE AND HIP Midlands patients benefit from a new programme.

42 P RODUCTIVE WARD PROJECT HSE initiative wins the Lean Healthcare Award.

18 BREASTCHECK Over 125,000 women receive a mammogram.

44 TREAT MENT ABROAD SCHEME The case of toddler Laura Oâ&#x20AC;&#x2122;Gorman, who received a liver transplant in Britain last year.

19 RESEARCHING PRIMARY CARE Health Matters talks to Professor Anne MacFarlane at the Graduate Entry Medical School, University of Limerick. 22 LIBRARY Open access for health research authors. 24 MENTAL HEALTH GUIDELINES Promoting positive health in schools.

47 W ORLD CANCER DAY 48 I RISH-SUDANESE PARTNERSHIP HSE staff improving maternal outcomes in Sudan.

100 NURSE OF THE YEAR 102 V OLUNTEERING IN HAITI HSE staff Geraldine Murphy and Caroline Keyes help post-earthquake rebuilding efforts in Haiti. 105 H EALTHY LIVING Tobacco cessation staff training, Bikram yoga and Step Challenge. 111 I RISH CANCER SOCIETY The organisation's 50th anniversary. 121 SPORTING PASSIONS 122 BOOKS AND FILMs Update

50 C LINICAL PROGRAMMES New HSE National Director of Clinical Strategy and Programmes Dr Aine Carroll on governance.

124 A DAY IN THE LIFE 125 NEWS BRIEFS

26 TRIPLE-P The Positive Parenting Program: helping parents to cope with family life.

53 C RISIS PREGNANCY

126 MEET THE TEAM

55 P RIMARY CARE UPDATES

127 GETTING TO KNOW YOU

28 HEALTH RESEARCH BOARD

57 C HILDREN FIRST

128 COMPETITIONS

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2 HealtH Matters

WelCoMe …to the spring edition of Health Matters, the national staff magazine of the Hse. In this issue we talk to Dr. aine Carroll, the new National Director of Clinical strategies and Programmes. she tells us about her focus for the Hse’s 30 plus clinical programmes in 2013. We feature the story of toddler laura O’Gorman, who received a liver transplant in Britain under the treatment abroad scheme. elsewhere in the magazine, we find out how a ten year partnership between the Irish and sudanese health service staff has successfully managed to reduce the maternal mortality rate by 86 per cent at the Omdurman Maternity Hospital in sudan. Finally, we profile the work of talented actress and writer eileen Gibbons, whose current project with the Per Cent for art scheme gives a voice to community nursing unit residents in County Galway. We hope you find this issue’s mix of features, interviews, news and updates of interest. For more regular updates, check out our staff intranet site http://hsenet.hse.ie or the Hse website – www.hse.ie

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stephen McGrath – editor Head of Internal Communications

the magazine is produced by the hse communications Directorate Publishers: ashville Media – www.ashville.com FeeDback: send your feedback to internalcomms@hse.ie

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• since 2008, CervicalCheck has taken almost 1.3 million smear tests from women aged 25-60. • smoking is the single highest cause of death in Ireland, killing over 5,200 people a year. • Ireland has the highest incidence of prostate cancer in europe, with over 3,000 men diagnosed annually. Johnny’s Got You Covered

• there are eight hospitals designated as Baby Friendly Hospitals in Ireland.

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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Our Sevices • Care of Older Persons • Care of Adults and Children with Physical Disablities • Care of Adults and Children with Intellectual Disabilities • Care of Adults and Children with Sensory Impairments • Child Care/ Nanny Services • Dementia Care • Palliative Care • Acquired Brain Injury • Spinal Injuries • Pre and Post Operative Care • Live-in Care • Specialist Personal Assistants

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EDUCATION OPPORTUNITIES FOR NURSES, HEALTH AND SOCIAL CARE PROFESSIONALS DCU School of Nursing and Human Sciences is currently offering the following programmes:

Nursing and Health Care Practice Postgraduate Framework (NFQ Level 9)

Applications are invited from nursing and health care professionals to the following part-time programmes: Masters in General Nursing Practice (PAC Code DC708)/ Masters in General Health Care Practice (PAC Code DC709); Masters in Mental Health Nursing Practice (PAC Code DC711)/ Masters in Mental Health Care Practice (PAC Code DC710); Masters in Intellectual Disability Nursing Practice (PAC Code DC713)/Masters in Intellectual Disability Health Care Practice (PAC Code DC712); Masters in Child and Adolescent Nursing Practice (PAC Code DC701)/Masters in Child and Adolescent Healthcare Practice (PAC Code DC707).

Entry Routes and Requirements

Applicants normally hold a relevant undergraduate degree (NFQ level 8), with a minimum of second class honours and are expected to work in the area of practice that relates to their particular chosen specialism. Applicants can be considered for admission based on RPL (Recognition of Prior Learning) and/or the completion of Access modules. Closing date for receipt of completed applications: Friday, 24th May 2013.

Masters in Psychotherapy (NFQ Level 9) (PAC Code DC715)

This four year, part-time programme is integrative in nature and provides comprehensive academic and practical grounding in humanistic, cognitive-behavioural, systemic and psychodynamic approaches to psychotherapeutic practice with individuals and couples.

Entry Routes and Requirements

Applicants normally hold a relevant undergraduate degree (NFQ level 8), have relevant practical experience and are able to demonstrate personal suitability. Applicants can be considered for admission based on RPL (Recognition of Prior Learning). Applicants who already hold a Graduate Diploma in Psychotherapy or equivalent may be eligible to apply for entry to year three. Closing date for receipt of completed applications: Friday, 22nd March 2013.

Masters in Sexuality Studies (NFQ Level 9) (PAC Code DC643 Full-time/DC644 Part-time)

This one year, full-time or two year, part-time programme equips candidates with the knowledge and skills to become competent professionals in all issues related to sexuality.

Entry Routes and Requirements

Applicants normally hold an undergraduate degree (NFQ level 8), with a minimum of first division second class honours. In exceptional circumstances, applicants can be considered for admission based on RPL (Recognition of Prior Learning). Closing date for receipt of completed applications: Friday, 19th July 2013. For further details, contact: Dr Mel Duffy, tel: +353 (0) 1 700 5833; email: mel.duffy@dcu.ie

How to Apply

To apply for these programmes, visit the Postgraduate Applications Centre (PAC) at www.pac.ie

Certificate in Homeless Prevention and Intervention (NFQ Level 8) This 18-month programme enables practitioners in homeless related services to further develop knowledge and skills in the prevention of homelessness and in the use of effective, supportive interventions with people encountering homelessness. Closing date for receipt of completed applications: Friday, 21st June 2013. For further details, contact: Dr Briege Casey, tel: +353 (0) 1 700 8521; email: briege.casey@dcu.ie

Bachelor of Nursing Studies (NFQ Level 8) (Online)

This online programme, delivered over one or two years, will enable you to build on your professional knowledge and experience and obtain an honours degree in a flexible and accessible manner. Closing date for receipt of completed applications: Friday, 21st June 2013. For further details, contact: Dr Pamela Hussey, tel: +353 (0) 1 700 5698; email: pamela.hussey@dcu.ie

For further information on all programmes, postgraduate research opportunities and professional development modules, including: Dementia Care, Psychotherapy, Mental Health and Diabetes Care, contact: DCU School of Nursing and Human Sciences, Dublin City University, tel: +353 (0) 1 700 5947; email: snhsenquiries@dcu.ie or visit www.dcu.ie/snhs

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Health Matters 5

Mental Health

Phoenix Care Centre Opens at Grangegorman The opening of the Phoenix Care Centre marks the end of an era at St. Brendan’s Hospital and heralds the first phase of the Grangegorman redevelopment programme in Dublin.

+ Minister for Health, Dr James Reilly TD; Minister of State, Department of Health Kathleen Lynch TD; and Anne O’Connor, HSE Area Manager, Dublin North City looking at the new building in Grangegorman.

he new Phoenix Care Centre mental health facility in Grangegorman, Dublin was officially opened on February 28th. Built at a cost of e21m, it is the state-of-the-art replacement acute mental health facility for St. Brendan’s Hospital – Ireland’s oldest public psychiatric hospital, which operated on the 75-acre Grangegorman site for 199 years. Minister for Health James Reilly TD and Minister of State Kathleen Lynch TD presided over the launch on an auspicious day for mental health services in North Dublin: one that marked the initiation of St. Brendan’s closure, exactly 199 years to the day that its first patient was admitted on February 28, 1814. As history’s curtain drew over St. Brendan’s, a new chapter began just over the road at the aptly-named Phoenix facility, which was purpose-built to cater for mentally ill patients’ needs in accordance with best practice. The centre aims to contribute to the recovery of all patients in a safe and secure environment.

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Dr Margo Wrigley, Executive Clinical Director said: “It is a great joy that at long last there is a new hospital on the Grangegorman site that will both provide an excellent setting for patients and complement the skills of staff caring for patients, thereby enhancing recovery.” The contemporary 54-bed Phoenix Care Centre has light-filled spaces, landscaped courtyards, south-facing rooftop terraces with views of the Dublin Mountains, single en-suite bedrooms and built-in furniture are all part of the centre’s non-institutional and patient-focused design.

Design Features Some of the design features include under-floor heating throughout (except in bedrooms), a bio-fuel heating system, solar panels, bedrooms fitted with interactive intercom systems to allow communication with each bedroom from the nurse’s station, and radiant panels in the bedrooms to allow the room environment to be adjusted

quickly to suit the needs of the occupants. For the last 30 years, the move from asylum care to a targeted rehabilitation and recovery programme has led to the reduction in the number of patients in St. Brendan’s and facilitated the development of highly-specialised psychiatric intensive care services for the wider region. The Phoenix Care Centre will continue to advance this ethos in its new purpose-built accommodation.

Psychiatric Intensive Care Service The psychiatric intensive care service transferring to the Phoenix Care Centre from St. Brendan’s provides a tertiary-level acute psychiatric intensive care service for units in Dublin, Wicklow and the HSE North East region. This service cares for and treats people with acute episodes of major mental illnesses who cannot have their needs adequately met in local acute units because of associated difficulties in managing these

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6 Health Matters

Mental Health behaviours. The aim is to provide proactive, specialist multidisciplinary treatment within a setting of low therapeutic security such that people may return to their acute units to complete their treatment, and thereafter their homes. This is a highly-regarded service accepting referrals from this broad area. The plan is both to continue it and to refine the therapeutic services it provides. To accommodate this service, two 12-bed psychiatric intensive care wards are located on the ground floor of the Phoenix Care Centre: the men’s ‘Oak’ and women’s ‘Alder’ wards. Designed around a landscaped courtyard, these wards contain three day areas; two separate dining rooms, an activities room and a quiet sitting room are key features of this space. Here, patients’ acute mental health needs will be met in this bright and airy setting.

Rehabilitation Programme The previous government’s national policy for the mental health services, Planning for the Future (1984), started the process of rehabilitation of people who had spent many decades in asylums. This presented a major challenge to staff in St. Brendan’s, who responded magnificently. St. Brendan’s had almost 1,000 patients on its wards 30 years ago – that figure is now fewer than 30. This is in large part due to the ethos of rehabilitation. Following a careful assessment of their needs, suitable patients moved to appropriate settings, with followup provided by the Rehabilitation Service. In addition, there continues to be an active focus on rehabilitation of the patients who remain in the hospital, with a view to them also enjoying the benefit of moving to the most independent setting that can meet their needs. This commitment to mental health rehabilitation, which is a key tenet of the 2006 mental health policy document A Vision for Change, is central to the services the Phoenix Care Centre will provide into the future. The centre houses two rehabilitation wards: the 20-bed Birch Ward on the first floor and the ten-bedded Hazel Ward on the second floor. These areas have been designed to promote independent living and training. Shared dining and sitting rooms in each ward open onto two rooftop terraces and both have assisted daily living kitchens. The Birch Ward is also home to an art and pottery and therapy room.

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Indeed, flexibility in the planning of the accommodation has been included to meet future changes or expansion of the services provided. All the bedrooms have been designed to the same specification, allowing maximum flexibility in use. In addition, internal walls are lightweight metal stud walls which will accommodate changes to suit the changing needs of the building. This adaptability will allow the building to accommodate the change in the service or the services provided in the future, and extend the building’s duration of use.

Staff The needs of staff and family members were also central to the Phoenix Care Centre’s design process. The main entrance area includes a suite for mental health tribunals. The first floor includes the on-call doctor’s overnight accommodation, medical records and patients’ property store. The second floor houses an open-plan office area for 20 staff. Visitors and families (including children) can meet residents in the visitors’ room on the first floor without entering the wards. It is expected that the move of both the staff and patients of St. Brendan’s to the new facility will commence towards the end of the first quarter 2013. Once complete, it will enable the full transfer of the St. Brendan’s site to the Grangegorman Development Agency. The Next Chapter Societal values continue to shape the care of the those in need, and the next chapter of the history of the Grangegorman site will

be written in the knowledge that the best of modern design and resources were made available to provide the highest quality of care for a group of patients who over many centuries have suffered more often than not because of the lack of priority society placed on their needs. The Phoenix Care Centre strongly reflects the more central role that society places on the provision of the highest quality of care and reflects in real terms the implementation of health policy as laid down in A Vision for Change.

Grangegorman Redevelopment Project The Phoenix Care Centre is the first new building to be constructed as part of the redevelopment of the original St Brendan’s Hospital site. The campus aims to provide a new urban quarter and a campus for healthcare and education. Grangegorman is an initiative aimed at rejuvenating the north inner city through healthcare, educational and transport initiatives. The HSE is currently working with the Grangegorman Development Agency (GDA) to finalise plans to build a new primary care centre on the Grangegorman site, which will provide state of the art primary care facilities to the local population. The project was delivered by the GDA, the statutory body responsible for the development of all facilities on the Grangegorman site. It also acted as the contracting body. See facing page for a picture gallery of current and retired staff who attended special events to mark the opening of the Phoenix Care Centre.

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Health Matters 7

Mental Health

+ Paddy and Kathleen Coleman (husband and wife retired nursing staff) and Tom Walsh (retired nursing staff).

+ L-R: Martin Farrell, retired/former Director of Nursing, John Joe Fitzgerald and Peter Byrne, retired nursing staff.

+ L-R: May Staines, Nora Burke, Martin Farrell, Jimmy Reilly, Joan Hynes, Kathleen Corby, Kathleen O'Leary, Pauline Casement, Margaret Harris and Angela O'Callaghan â&#x20AC;&#x201C; all retired nursing staff except for Kathleen O'Leary, Mental Health Nurse (Community Services) and Angela O'Callaghan, Mental Health Nurse (currently based in mental health services, Connolly Hospital.

+ L-R: Cormac Walsh, Assistant Director of Nursing and Clinical Planner for Project; Carmel Kitching, Mental Health Manager; Sean Tone, Director of Nursing; Dr. Margo Wrigley, Executive Clinical Director; Larry Currid, Hospital Administrator and Derek Dockrell, Project Manager (HSE).

+ Sean Tone, Director of Nursing.

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+ L-R: Aideen McDonnell, Mental Health Social Worker (who will be based in Phoenix Care Centre) and Aoife Farrelly, Mental Health Social Worker (who works with the Rehab Mental Health Services and will be providing a service to clients of the Phoenix Care Centre).

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8 Health Matters

per cent for arts

The Story of Our Lives In this issue of Health Matters we profile the work of talented actress and writer Eileen Gibbons, whose current project with the Per Cent for Art Scheme gives a voice to nursing unit residents in Loughrea, County Galway – and they have fascinating stories to tell. Melissa Byrne reports.

ileen Gibbons can trace her love of storytelling back to childhood, when her mother would enchant her with tales. As an actress and writer with a strong background in theatre, she has experience writing and performing her own plays. Based in County Galway and a graduate of NUIG, her subject matter concerns how people relate to one another, life and people – and ranges from the secrets that people attempt to conceal to the life of a woman sitting alone on a park bench. Now Eileen is working on a project called Word of Mouth Across the Generations for the Per Cent for Art Scheme. The stories she collects from local nursing home residents, and the pictures local schoolchildren draw based on these tales, will be put in a keepsake and kept in the nursing home for all to enjoy.

Collecting Memories Eileen was invited to submit a proposal under Per Cent for Arts for St. Brendan’s Community Nursing Unit in Loughrea, Co. Galway. While the idea was certainly intriguing, it was also slightly daunting. Shortly after receiving the invitation, she was asked to attend an information morning in the nursing home with the other artistic people who had also been asked to pitch proposals for St. Brendan’s. “A lot of people were visual artists, and I was kind of thinking: what can I possibly bring here to the nursing home with my experience? I asked one of the people working there what is the one thing you can’t give them that you would like to give them more of – and the answer was they would like to give them more time. So I kind of devised my project around that.” Her thoughts turned to a unique anthology of stories she had come across recently: the Schools’ Manuscript Collection, 1937-38, which is archived in the National Folklore Collection. The collection consists of stories that children heard from older people in their

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community about how they used to live and what they remembered from the past. The information was gathered together and is now housed in UCD’s Belfield campus. “So I based the idea on the fact that for the people in St. Brendan’s, their whole lives are their story. I just really wanted to mine them for information and to find out about the past. I decided to share these stories with two of the local national schools, St. Brendan's and St. Ita's in Loughrea, who have been great. I’ve spent a lot of time up in the nursing home talking with people and listening to people and really having the craic with them. They’re brilliant!”

Creative Connection With a gifted, storytelling mother and a national school that took an interest in theatre and performance, it is no wonder that once she reached college Eileen immediately became a member of the Drama Society. When it comes to pinpointing the beginning of her career,

“I’ve spent a lot of time up in the nursing home talking with people and listening to people and really having the craic with them. They’re brilliant!”

she’s thrown: “I just kind of rolled into it accidentally,” she says. “But I’ve been writing all my life; that’s the sort of thing I’ve been doing from when I was really young. How did I really get involved? I have no idea. Here I am is all I know.” Previous work has influenced Eileen’s approach to the project. “There would be a crossover in my work prior to this. I love

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10 Health Matters

per cent for arts

+ Eileen with Larry Lee, a 79 year-old resident in St. Brendan’s, Loughrea who started writing after a stroke around ten years ago. A former engineer, he regards honing his craft as a writer as his second apprenticeship.

listening to people who don’t get listened to, and one of the plays I’ve written is about an old woman who sits alone on a bench. Another is about two old women living in a house. In a way, I’m fascinated by that. Meeting the people, listening to them and just spending time with them – it’s just been such a benefit for me and such a privilege. I can’t believe how great it has been and I feel a bit guilty sometimes, thinking: am I enjoying this too much?” Eileen’s passion for her work is evident. She speaks about it with an unrelenting enthusiasm. One of her great joys working in St. Brendan’s is in connecting and interacting with people, and giving something back

“He has an amazing memory and talking to him has just been wonderful. Then there are people who are just so full of life. I love it.”

Positive Feedback There is a timetable in place for Word of Mouth Across the Generations. “I started in September and it’s going to finish up around May, during Bealtaine, the festival for older people, and I’m hoping to do a presentation day. At the moment I’m making a DVD and tomorrow I’m going to be photographing the people [involved]; taking video portraits of them. In fact, the National Folklore Commission came down and recorded one of the people, William Concannon, because he was just so extraordinary. I told them they had to come down and meet this man. He had beautiful Irish and they really wanted to record him. The connections go all over the place really,” she explains. Eileen spoke to between 25 and 30 people, some more than others, with the

task continually evolving and changing depending on those she met. She understands that the people shape the project – and sometimes lead her to a path she then chooses to pursue. “I have had positive feedback, you know. A couple of people have said to me they’ve seen good improvements in people who might have been a little bit isolated. For me, it is a great honour to get to talk to people about their lives, and to have that in my life is such a great privilege. I’m meeting people who are natural-born storytellers as well. In fact, William Concannon has written a book there and he has just been incredible. He has an amazing memory and talking to him has just been wonderful. Then there are people who are just so full of life. I love it.”

Hidden Message “One of the things I keep saying to the kids in the school is that stories have a way of living all on their own, and they’re passed down through generations – they’re great time travellers. I just love the notion that a story I’m telling to the schoolchildren today that I've heard in the nursing home is one that they might tell when they’re old. Some of them say ‘this is what I did as a child’, and kids ask things like what was it like before television? Listening to the people talk and bring their past to life is the main message.” Their stories will live on. Eileen's show Waiting for Elvis will run in Axis, Ballymun from April 3rd to 13th.

to them in the process. “It was interesting meeting new people and trying to fit in and find my place there at St. Brendan’s. It’s important to me not to add work to anyone’s life, not to be in the way, and to bring benefit rather than anything else. The staff there are absolutely incredible. They really care and they are totally involved with the people they look after.”

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Health Matters 11

cancer

Prostate Cancer treatment to be enhanced by new NCCP Service The National Cancer Control Programme (NCCP) recently launched a new national service for the treatment of prostate cancer. The NCCP National Prostate Brachytherapy Service will provide patients with a once-off treatment option that involves the implantation of radiotherapy seeds directly into the prostate as an alternative to conventional radiotherapy treatments. The brachytherapy treatment has been available to patients in the west on a local basis for the past five years as a result of the innovation of Professor Frank Sullivan, Consultant Radiation Oncologist, who has been successfully treating patients in Galway University Hospital since 2007. The launch marked the expansion of the service and its establishment nationally, with the appointment of new consultants and investment in new equipment in St Luke’s Hospital in Rathgar, Dublin and Cork University Hospital. Ireland has the highest incidence of prostate cancer in Europe, with over 3,000 men diagnosed annually. This number is expected to increase over the

coming decades as the population ages. Considerable advances have been made in both the surgical and radiotherapy options in recent years. Brachytherapy has gained international acceptance as a standard of care in the management of the disease.

Prostate (Seed Implant) Brachytherapy Prostate (seed implant) brachytherapy is a technique to treat early stage, low risk prostate cancer by strategically placing radioactive seeds inside the prostate gland (using specialised equipment) where they remain to irradiate the malignant tissue within the prostate. For men who have been

diagnosed with prostate cancer, the option of brachytherapy means just one visit to the cancer centre, which is more convenient for patients who may otherwise require seven to eight weeks of daily external radiotherapy sessions or surgery. “This is a very exciting development for prostate cancer services in Ireland and is particularly positive for our patients,” according to Professor Sullivan. “Patients who are suitable for prostate brachytherapy benefit from high-dose highly targeted radiation, shorter treatment times, and studies are showing disease control rates equivalent to the other curative options as well as improved quality of life for patients. “In GUH we provide the full range of cancer treatments for patients with prostate cancer. Our rapid access prostate clinic has been hugely successful since its opening in 2009 and in 2010 the Prostate Cancer Clinic at NUI Galway was established

“Ireland has the highest incidence of prostate cancer in Europe, with over 3,000 men diagnosed annually. This number is expected to increase over the coming decades as the population ages.” + Pictured at the launch of the NCCP National Prostate Brachytherapy Service at Galway University Hospital were (L-R): Mr Gerard McVeigh, Consultant Radiation Oncologist, St Luke’s Hospital Rathgar; Mr Brian O’Neill, Consultant Radiation Oncologist, Cork University Hospital; Dr Susan O’Reilly, National Director National Cancer Control Programme; Mr Jerome Coffey, National Clinical Lead, Radiation Oncology, National Cancer Control Programme; and Prof Frank Sullivan, Consultant Radiation Oncologist, University Hospital Galway.

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12 Health Matters

cancer

“The National Cancer Control programme has had a strategic and operational focus on improving access to diagnosis and optimal therapies for men with prostate cancer nationwide.” + Pictured at the launch were (L-R): Mr Noel Daly, Chairman, Galway and Roscommon University Hospital Group; Mr Paul Kelly, Consultant Radiation Oncologist, CUH; Mr Bill Maher, CEO, Galway and Roscommon University Hospital Group; Mr Gerard McVey, Consultant Radiation Oncologist, St Luke’s Hospital Rathgar; Prof Frank Sullivan, Consultant Radiation Oncologist, Galway and Roscommon University Hospital Group; Mr Jerome Coffey, Clinical Director, St Luke’s Radiation Oncology Network; Dr Susan O’Reilly, Director, National Cancer Control Programme; Mr Kilian McGrane, Deputy Director, NCCP; Dr Jamsari Khalid, Clinical and Research Fellow, National Prostate Brachytherapy Programme.

to develop new therapies and better treatments. We are well placed to deliver the latest treatment in a region that has the highest incidence of the disease nationally.”

Appointments With the development by the National Cancer Control Programme of radiotherapy services nationally a number of key consultant appointments were made, including Consultant Radiation Oncologists Gerard McVey in St Luke’s Hospital Rathgar and Paul Kelly in Cork University Hospital. The decision to develop a national brachytherapy service allowed for the harnessing of the expertise of these two consultants in their respective centres. A specialist training programme devised by the NCCP and led by Professor Frank Sullivan provided the necessary skills to allow Mr Kelly and Mr McVey to deliver the new service in Cork and Dublin. Bringing his own experience to this training process, Professor Sullivan played a pivotal role and the service now available in all three centres is delivered on a quality assured standardised basis, with patients guaranteed to receive the same high standard of care and treatment regardless of their location.

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The patients who are referred for this new national service will have already been seen in the NCCP rapid access prostate cancer clinics established in all eight designated cancer centres over the past three years. These clinics are now successfully diagnosing patients in a targeted manner, allowing for access to the concentration of expertise available in the designated centres.

Prostate Cancer Rapid Access Clinics A total of 2,768 patients were seen in all eight rapid access clinics in 2012, with 1,031 prostate cancers detected. As a result of this latest initiative, those patients who have had a prostate cancer diagnosis and are deemed suitable will have access to prostate seed implant brachytherapy as part of an overall treatment plan. Over 100 men received the brachytherapy treatment in Galway University Hospital last year, and as the service is rolled out nationally it is anticipated that over 300 will be availing of prostate brachytherapy annually. According to Dr Susan O’Reilly, National Director of the National Cancer Control Programme, “the National Cancer Control programme has had a strategic and operational focus on improving access to

diagnosis and optimal therapies for men with prostate cancer nationwide. “We have collaborated with the eight designated cancer centres to implement prostate cancer rapid access clinics in 2010 and 2011. A total of 2,466 patients were referred to these clinics according to NCCP guidelines in 2011, with 2,768 referred last year. From these referrals a total of 925 cancers were detected in 2011, with that figure increasing to 1,031 last year as the clinics were becoming fully operational. “Now, men seen in these centres who have curable prostate cancer benefit from having a multidisciplinary team input into their treatment plan and have options which span active surveillance, radical prostatectomy, external beam therapy and prostate brachytherapy. We are also pleased that the HSE has supported funding for new prostate cancer drugs which were recommended by the NCCP Technology Review Committee. “Professor Sullivan and Galway University Hospital have led the way in the development and delivery of prostate brachytherapy for the curative treatment of this cancer,” said Dr O’Reilly. “I am delighted that we now have these services available in Dublin and Cork, so that men have options wherever they live. Professor Sullivan and his team have provided the national leadership and training to implement these national services and they are to be congratulated and thanked for their significant innovation and contribution.”

13/3/13 16:19:44

We take cancer personally

Patients are at the heart of everything we do at Roche. They motivate and inspire us to produce innovative medicines and therapeutic solutions that will continue to transform the lives of people with cancer around the globe. Weâ&#x20AC;&#x2122;ve come a long way, but thereâ&#x20AC;&#x2122;s still a long way to go. Fortunately, no one takes cancer more personally than we do.

P10/11/12

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13/3/13 16:19:44

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where you come first

PROFESSIONAL PHARMACY SERVICES • Simplifies and aids medication management using the Abbey Pouch dosage compliance system.

• Free systems training, and continuous education by the Pharmacist Clinical to support the nursing team.

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• Free same day delivery and immediate turnaround for medication changes 7 days a week. EMERGENCY

• Dedicated Pharmaceutical Technician to assist in provide placing orders, manage stock levels and the best customer service.

• Free pharmacy support 7 days a week from our highly have been experienced team of professionals who servicing Irish nursing homes since 1996.

• Regular patient medication reviews and systems by the Clinical audits undertaken Pharmacist to comply with the HIQA standards for Medication Management.

• Free safe hygienic and easy to use dosage aid. compliance

• Improves dosage compliance.

• Reduces error in drug administration. • Quality control checks in situ before medicine is administered to patient.

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• Free Medication Administration Record (MAR) sheets provided for each patient to ensure accurate recording of medication administration. • Unwanted for and expired medicines may be returned safe disposal in accordance with the provisions of the Pharmacy Act 2007.

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Tel: 01-2023336 Mobile: 087-6300984 Email: geraldine.diamond@abbeyhealthcare.ie Website: www.abbeyhealthcare.ie

HM Iss9.1 p1-53.indd 14

13/3/13 16:19:44

Health Matters 15

reform

Key Health Reform Policy Papers Published by Minister for Health The introduction of universal health insurance (UHI) has been brought a step closer with the publication of two new documents mapping out how the new funding model is to be achieved.

he Minister for Health, James Reilly TD, recently launched two key health reform documents entitled Money Follows the Patient: A Policy Paper on Hospital Financing and The Path to Universal Healthcare: A Preliminary Paper on Universal Health Insurance. The two documents fulfil important commitments in Future Health, the strategic framework for health service reform which was launched in November 2012. To read the documents, visit www.dohc.ie/publications. Speaking at the publication of the papers, the Minister said: “I am delighted to publish the Money Follows the Patient policy paper. This is a key building block for universal health insurance (UHI) which will also deliver significant benefits in its own right and in advance of the introduction of UHI. The system will provide a fairer and more transparent basis for funding hospital services. “It will drive greater efficiency in the delivery of services and will ultimately support the provision of quality care in the most appropriate setting. It represents a vital early step on the journey of health reform. The policy paper will form the basis for consultation with stakeholders and for commencing implementation of the first step, known as shadow funding.”

Payment System According to the policy paper, draft proposals have been prepared on the introduction of a prospective case-based payment system (Diagnosis Related Group system) which will replace the current block grant allocation mechanism for public hospitals. “These proposals represent a first step in the process to transform the healthcare funding system so that it is truly patient-centred, value-focused and, thus, supportive of wider health sector objectives.

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“While health insurance will be mandatory, a system of financial support will ensure affordability by paying or subsidising the cost of insurance premia for all those who qualify.”

The proposals focus on public treatment in public hospitals,“ he said. The Minister noted that Money Follows the Patient is one of a number of building blocks which he is working on to achieve UHI. “Work is advancing across all areas of the reform agenda. The Preliminary Paper on Universal Health Insurance provides a progress report on the work we have done so far. It also maps out the critical actions and initiatives to be delivered in the year ahead.”

Equal Access The Preliminary Paper on Universal Health Insurance says that the Government is committed to a single-tier health service, supported by UHI, which provides equal access based on need, not ability to pay, and which delivers the best health outcomes for Irish citizens. “Under universal health insurance, everyone will be insured for a standard package of primary and hospital care services, including mental health services. Insurance will be provided under a multipayer insurer model with no distinction between ‘public’ and ‘private’ patients. The system will be founded on principles

of social solidarity, encompassing the fundamental tenets of financial protection, open enrolment, lifetime cover and community rating. “While health insurance will be mandatory, a system of financial support will ensure affordability by paying or subsidising the cost of insurance premia for all those who qualify.” The Minister thanked the UHI Implementation Group and the Hospital Financing Subgroup for their advice and guidance in relation to Money Follows the Patient – an initiative which is key to creating a more equitable and efficient health system. In Future Health: A Strategic Framework for Reform of the Health Service 2012- 2015, the Minister promised to publish two key papers relating to UHI. The Money Follows the Patient paper is a major step in mapping out how a new, transparent and fairer system of funding will work. The Preliminary Paper on UHI describes the progress made last year in preparing for UHI, and it signals the main areas of work for 2013.

13/3/13 16:19:45

16 Health Matters

Orthopaedics

Rapid recovery programme for hip and knee replacement patients Hundreds of patients in the Midlands are benefiting from a rapid/enhanced recovery programme for hip and knee replacements. The programme has been introduced by the Midland Regional Hospital in Tullamore, the regional centre for orthopaedics in the Midlands. Arlene Crean reports.

he Rapid Recovery Programme is designed to optimise all aspect of a patient’s journey from pre-operative assessment through to and beyond discharge. Success of the programme is dependant on holistic care planning, coupled with the team work ethos which empowers the patient to take an active role pre and post surgery; the patients are guided, educated and encouraged to take ownership of their recovery. The core elements of the approach include: a clear protocol agreed by the team, in some cases using minimally invasive surgical techniques for hip replacements and advanced healing concepts to aid patient recovery, team based performance and monitoring to continually improve practice and educating patients prior to their operation and throughout their stay so they have realistic expectations and understand their role in their recovery. Commenting on the introduction of the programme, Hospital Manager Orlagh Claffey said: “Reducing length of stay is a huge factor in combating waste within the acute hospital setting. Not only does this initiative save the hospital bed days, the structure of the joint school and pre-assessment process reduces the time spent by individual staff with individual patients hence allowing for a more efficient use of staff time. Twenty per cent of all joint replacement done in 2012 had an average length of stay of two days with three patients discharged within 24 hours. This fast track protocol is the future for orthopaedic surgery and we are delighted to be leading providers of the service in Ireland.”

Joint School Educating and setting expectations is a key feature of the rapid recovery

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+ L-R: Mr Eoin Sheehan, Consultant Orthopaedic Surgeon, Orlagh Claffey, Hospital Manager, Louella Cummins, Occupational Therapist, Mr PJ Murphy, Consultant Physician, Dr Cara Egan, Consultant Anaesthetist, Dearbhaill Foy, Joint Replacement Nurse, Mr Dave Cogley, Consultant in Trauma and Orthopaedics and Pat Conway, Senior Physiotherapist.

programme. Patients attend an education session called a ‘joint school’ as part of a group in advance of their hospital stay. A presentation is given by a professional from each department on the specific stages of their care. For instance, the surgeon gives a step-by-step talk on the surgical procedure, which includes an opportunity for the patients to see and feel the implant. The joint school is an opportunity for patients to ask questions in a relaxed setting. Being with others going through the same procedure also builds up a supportive environment and greatly reduces the patient’s anxiety. In adopting this approach team members understand that the patient is not just the centre of the process but a pivotal player and partner. Eoin Sheehan, Consultant Orthopaedic Surgeon said: “Surgery can be a very daunting event for any patient. With our programme we get the opportunity to meet with the patient pre-operatively to ensure their concerns are addressed and fears are eased.”

Mr Dave Cogley, Consultant in Trauma and Orthopaedics said: “While the minimally invasive hip replacement surgery is used elsewhere, the full benefit has been greatly enhanced by the multidisciplinary team approach which we are adopting in

“This fast track protocol is the future for orthopaedic surgery and we are delighted to be leading providers of the service in Ireland.” Tullamore. The whole concept is that we involve the patient in their care from day one, they are fully informed, engaged and

13/3/13 16:19:45

Health Matters 17

Orthopaedics “Our patients engage with the same hospital team in the lead up to their surgery right through final discharge so the patients are more confident and relaxed when they encounter the various interfaces and staff when in hospital.” + Matthew Farrelly, who was diagnosed with osteoarthritis in both hips in 2009, with Dearbhaill Foy, the Joint Replacement Nurse.

committed to their rehabilitation programme which leads to an earlier discharge for the patient and reduced levels of re-admissions.”

Team The implementation team includes a Consultant Surgeon Trauma and Orthopaedics, Joint Replacement Nurse, Consultant Anaesthetist, Consultant Physician, Physiotherapist and Occupational Therapist and has a wider nursing and support staff network which greatly strengthens the delivery of the approach. Dearbhaill Foy, Joint Replacement Nurse, summarises why the share care approach is working for the team at Tullamore Hospital. “This approach ensures patients are comprehensively educated before coming into hospital, are aware what the surgery entails and prepared for the intense rehabilitation process immediately following surgery as well as for their discharge home. This empowers and involves patients in their care pathway. We are spending more time with patients in a group format basis and are finding that our patients are much more motivated throughout their recovery. Our patients engage with the same hospital team in the lead up to their surgery right through final discharge so the patients are more confident and relaxed when they encounter the various interfaces and staff when in hospital.” Dr PJ Murphy, Consultant Physician, said: “The advantage of being in this team is that we are not looking at the patient in isolation. We are considering in unison all

HM Iss9.1 p1-53.indd 17

aspects of their care plan. It is hoped by collectively treating the patient in this manner that we can reduce the likelihood of patients requiring to be admitted to hospital again.” According to Pat Conway, Senior Physiotherapist, “Pre-admission 'joint school' allows patients to familiarise themselves with their exercises and informs them of the expected early mobilisation, intensive physiotherapy and early discharge. This helps motivate them to be active participants in the rehab process which, coupled with changes to anaesthesia and pain relief, has allowed for earlier mobilisation and multiple treatment sessions per day resulting in earlier discharge from hospital without compromising patients’ outcomes.” Louella Cummins, Occupational Therapist said: “Patients and their families are more involved in their rehabilitation process. Education on hip precautions and aids for activities of daily living are given during the joint school. Patients are given equipment during the joint school to practise at home prior to their surgery, gaining confidence before admission.” According to Dr. Cara Egan, Consultant Anaesthetist, “The changes introduced in post operative pain relief mean patients have fewer side effects from their medication which means they can rehabilitate at a much earlier stage.”

Features � The Rapid Recovery Programme involves: �P re-operative joint school and patient partnership

� Anaesthetic involvement both peri and post operative � Pre-operative medical assessment � Day of surgery admission (DOSA) � Minimally invasive surgery approach to hip replacements � Multimodal analgesia in all patients � Earlier, more intensive physiotherapy, occupational therapy and coordinated nursing support � Community support.

Patient Experience Matthew Farrelly from Geashill, Co Offaly (33) was diagnosed with osteoarthritis in both hips in 2009. With the pain worsening and increasingly impacting on his day to day life, his only option was to have his two hips replaced earlier this year. “The most beneficial aspect of the programme for me was the joint school. Everything was explained in a very basic, understandable and logical way and it really eased my fears. My rehabilitation has been successful and post op wounds and pain have all been very well managed.” Conclusion Last year 376 patients underwent joint replacement and rapid/enhanced recovery compared to 232 in 2010 and 234 in 2011. The hospital is aiming for a sustained 75 per cent day of surgery admission rate and plans to improve on this by year end. It is constantly undergoing audit and using prospective analysis tools to provide objective and evidence-based confirmation of the beneficial effects of new processes.

13/3/13 16:19:47

18 Health Matters

breastcheck

Over 125,000 women receive a BreastCheck mammogram Free mammograms were provided to 125,329 women aged 50-64 and 832 breast cancers were detected during 2011 according to the recently published BreastCheck – The National Breast Screening Programme 2011-2012 programme report.

reastCheck invites women aged 50 to 64 years for free breast screening and is part of the National Cancer Screening Service (NCSS), which is part of the HSE National Cancer Control Programme. The overall acceptance of invitation to screening was 72.2 per cent, in excess of the programme target of 70 per cent. Of the 125,329 women screened, 5,242 were re-called for assessment. Some 832 women were diagnosed with breast cancer, representing 6.6 cancers per 1,000 women screened. For 37,429 women it was their first BreastCheck mammogram and 87,900 women had previously had at least one BreastCheck mammogram. This reflects the availability of BreastCheck nationally. Welcoming the publication of the report, Dr Susan O’Reilly, Director of the National Cancer Control Programme (NCCP), said: “We were delighted that during 2011, a challenging year, we screened over 4,500 more women than the previous year and again surpassed our target uptake of 70 per cent.” “The programme performed strongly against most commitments in the BreastCheck Women’s Charter during this time of sustained resource shortages, thanks to staff dedication and innovation. While BreastCheck aims to offer a woman her first mammogram within two years of becoming known to the programme and her subsequent mammograms every two years, this does not always happen, however we are pleased that 94 per cent of women were re-invited for their next mammogram within 28 months.”

Uptake Majella Byrne, Acting Director of the National Cancer Screening Service said:

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“We thank each of the 125,329 women who availed of their free mammogram this year for their participation. When a woman attends one appointment they tend to return for their next round of screening, with over 86 per cent being screened in the subsequent rounds. Uptake remains highest in younger women invited for the first time, but we are concerned with the continued fall in uptake among women invited for the first time in all age groups compared to previous years.” In Ireland, over 2,700 women are diagnosed with breast cancer each year and the cumulative risk increases with age, as is reflected in the government’s reiterated commitment to the age range extension of the BreastCheck programme. Screening aims to detect breast cancer at the earliest stage when treatment is likely to be more successful and less extensive and we would like women to consider this when deciding whether to participate in screening,” concluded Ms Byrne. Where women were diagnosed with a breast cancer following a BreastCheck mammogram, Dr Ann O’Doherty, Lead Clinical Director, BreastCheck said: “A significant improvement has been made in terms of the percentage of women with cancer offered hospital admission within three weeks of diagnosis, which is just outside of the standard of 90 per cent, a significant improvement on last year, and we are grateful for the ongoing collaboration with host hospitals to develop a service response to this issue.” Since BreastCheck began screening in February 2000 to the end of 2011, the programme has provided 835,598 mammograms to 371,208 women and detected 5,484 breast cancers.

Brief overview of performance in 2011: � During 2011, BreastCheck invited 172,076 women for screening. � 125,329 women attended their screening appointment. � 832 breast cancers were detected. � For 37,429 women it was their first BreastCheck mammogram. � 87,900 women had previously had at least one BreastCheck mammogram. � 74.5 per cent of eligible women invited for screening accepted their invitation, in excess of the programme target of 70%.

13/3/13 16:19:47

Health Matters 19

Primary Care

Researching Primary Care Health Matters talks to Professor Anne MacFarlane about her new role at the Graduate Entry Medical School (GEMS) in the University of Limerick and her work with primary health care. How significant is primary healthcare research in Ireland? We need a high-quality evidence base about primary care. This needs to be generated in Irish primary care settings so that services meet the needs of service users and their families. My focus is on ensuring that service users have a ‘voice’ in generating that evidence base. Participatory research and qualitative research methods provide important opportunities for ensuring that service users and their families have such a voice. Tell us a little bit about yourself? I have over 20 years’ experience of health services research, and have recently moved to the University of Limerick where I am now Professor of Primary Healthcare Research at the Graduate Entry Medical School. I am the first social scientist to hold a chair in academic primary care in Ireland, which presents very exciting opportunities. I work closely with the GEMS Professor of General Practice, Walter Cullen and enjoy the collaboration between our clinical and social science backgrounds.

I am currently leading a s2.9 million EU participatory research project on communication between migrants and health care providers called RESTORE. It began in April 2011 and is funded for four years and the project group consists of seven participating European institutions, including UL and NUI Galway researchers Mary O’Reilly-de Brún and Tomas de Brún. The project aims to explore how cultural and language barriers experienced by migrants can be overcome by general practitioners and primary care staff and how available resources can be used more efficiently. Primary care service users and their GPs face significant challenges on a daily basis in their consultations because they do not have a shared language or cultural background, which results in frequent misunderstanding and communication breakdowns which is distressing and frustrating. The research focuses on the implementation of evidence-based health information (e.g. guidelines to enhance communication in cross-cultural consultations) and interventions (e.g. training initiatives on interculturalism and the use of paid interpreters) designed to address language and cultural barriers in

primary care settings. The project group will explore how these are translated into everyday practice in primary care settings. I am also working on a project with Edel Tierney about involving people from disadvantaged communities in Primary Care Teams in Ireland, called FUSION. This study focuses on projects around the country that were funded under the HSE and Combat Poverty Joint Community Participation in Primary Care Funding initiative in 2008. We are interested in the experiences of service user involvement from case study sites in Mayo, Donegal, Dublin and Offaly. Specifically, we are interested in exploring: �W hat definitions of user involvement or community participation are being used in these projects and what do they mean for the people involved? �W hat motivates people to become involved in user involvement projects? �W hat methods of ‘doing’ user involvement are being used? �W hat are the reported outcomes of user involvement projects (i.e. what changed, was it better? How do we know?). The HRB FUSION project is complemented by an analysis with Rachel McEvoy of the implementation of the National Strategy for Service User Involvement in the HSE.

What is the focus of your research? I focus on the involvement of people from marginalised or disadvantaged communities in primary care research. This is a common thread in my ongoing research and has recently led to a new and exciting collaboration with Dr Austin O’Carroll from the North Dublin City GP Training Programme and HSE colleagues in Social Inclusion and Primary Care in Dublin and Limerick (Diane Nurse, Tony Quilty, Maurice Hoare and Alice McGinley). Researcher Fiona O’Reilly is in post and we will be hiring a clinical fellow in social inclusion in the near future. What projects are you currently involved in?

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+ Members of the Primary Care Research Group pictured here are: Madeleine O’Sullivan, Tomas de Brún, Edel Tierney, Prof. Anne MacFarlane, Mary O'Reilly-de Brún, Ruth McMenamen, Fiona O Reilly, Jane Howlett, Rachel McEvoy.

13/3/13 16:19:50

20 Health Matters

Commercial Feature

Sudocrem® celebrates Another year as Ireland’s Family Favourite with tips from Expert nurses Must-have product for baby bags and bathroom cabinets.

udocrem®, one of Ireland’s best loved products celebrates the end of another year as Ireland’s family favourite, with fans using the lavender scented formula for everything from treating nappy rash on babies’ bottoms to applying to the hands and face as part of a girl’s beauty routine. The trusted family formula, which recently celebrated its 80th anniversary, is still the number one choice for Irish mums – from first time mums to grandmothers, it’s widely regarded as the must-have product in every baby bag and bathroom cabinet. Developed as an antiseptic healing cream to treat nappy rash, it has been the first choice for generations of mums and healthcare professionals in its native Ireland and internationally since its formulation in 1931. The soft textured white cream has a water-repellent base which forms a protective barrier. Hypoallergenic lanolin provides its emollient effect and Peru Balsam its healing properties, making it a leading choice in over 30 countries worldwide.

Top tips The Sudocrem® team give their top tips for making the most of Sudocrem for you and your family. • Whenever possible remove the nappy and leave the baby’s bottom exposed to air. This can be especially helpful during cold months when exposure to central heating can affect the skin. • Change your baby’s nappy as soon as it’s wet or soiled • Carefully wash the nappy area with warm water and cotton wool, gently patting dry especially in the creases • Gently massage Sudocrem® into the skin

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using light; circular movements (don’t rub, especially if the skin looks sore) • When you’re finished, there should be a thin translucent film left on the skin. • Try to change your baby’s nappy before putting him or her down to sleep • Beware of potential triggers: Teething Antibiotics Weaning Change of milk type Diarrhoea For over eighty years, Dublin pharmacist Thomas Smith’s original formulation has remained unchanged and continues to soothe generations’ skin found in every baby bag and first aid kit at home and abroad. A recent addition to the range, the 30g tube has also become a firm fixture in handbags, as a versatile cream to carry anywhere. Sudocrem® is available from independent pharmacies, major pharmacy chains, supermarkets and selected

children’s department stores nationwide. Visit www.sudocrem.com for further information or like us on facebook at https://www.facebook.com/#!/ SudocremIreland Sudocrem is the market leader in over 30 countries all over the world and is served from its IMB approved plant in Baldoyle, Dublin where over 100 people are employed.

13/3/13 16:19:57

Not everyone has a licence to heal. Unlike some nappy rash creams, Sudocrem Antiseptic Healing Cream is a licensed medicine, which actually treats nappy rash and doesnâ&#x20AC;&#x2122;t just soothe the symptoms.

maternity &

ROTE . P

HES .

HEALS

S . SO

Always read the label

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For the science bit go to:

www.sudocrem.com Available from supermarkets & pharmacies nationwide

13/3/13 16:19:58

22 Health Matters

research

HSE supports open access for health research authors The HSE is encouraging authors of work published in peer-reviewed journals to have their research also made available in Lenus, the organisation’s Irish Health Open Access Repository. Aoife Lawton, Systems Librarian at Dr. Steevens’ Hospital, Dublin explains.

he HSE recently endorsed a new position statement on Open Access publication which applies to all staff and others involved in Irish healthcare who have published peer-reviewed journal articles since January 1st 2009. The statement is in line with national policy on open access publication, which sees the results of publicly funded research made freely and openly available online.

Broadened Horizons Lenus (www.lenus.ie) is the home for Irish health research and authors are encouraged to submit their research for publication on by emailing their documents to regionallibrary@hse.ie. Lenus welcomes submissions from those working in health facilities as well as those involved in other areas such as healthcare charities, voluntary organisations and in local communities. The benefits of this development include greater and easier access to Irish health research, increased dissemination and impact, preservation of intellectual output, raising the profile of Irish health research and making evidence more easily available for practice, service delivery and patient care. The HSE is committed to sharing

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the findings of its research as widely as possible to enhance its use and impact on the population it serves. In support of this goal, the HSE’s senior management team recently has endorsed the following position statement on Open Access Publication. "Where copyright permits, all research output published in peer-reviewed journals since 1st January 2009 can be made freely available in Lenus (www.lenus.ie), the HSE’s Irish Health Repository. This should be the final peerreviewed, pre-publication version of the paper where copyright restricts the use of the published version. "Authors are gratefully encouraged to deposit other types of research outputs (including book chapters, theses, reports, conference presentations, posters and grey literature) in Lenus where copyright permits. "With regard to journal articles, authors are encouraged to keep the final peerreviewed version of the article which may then be deposited to Lenus where publisher’s copyright allows. For further

information on publishers’ copyright, fees, and embargo periods please consult www.sherpa.ac.uk/romeo.php"

Submitting a paper to Lenus If you have had an article accepted for publication or published in a peerreviewed journal on or after January 1, 2009 take the following steps: (1) Check to see if the copyright transfer agreement allows a version of the article to be posted to a repository or research archive (i.e. Lenus). If you are unsure, the copyright position of most publishers and journals may be checked online at this address http:// www.sherpa.ac.uk/romeo.php. (2) The HSE encourages authors to register on Lenus. Contact the Lenus service via the email address regionallibrary@hse.ie for authorisation to submit. If successful the paper is submitted to Lenus and a creative commons licence is assigned. For further information, please contact the Dr Steevens’ Regional Library on 01-6352558.

13/3/13 16:19:59

Health Matters 23

Research Feature

Your beating heart Cardiac arrest: new ‘App’-roach could save hundreds of lives.

Health Research Board (HRB) funded research shows that hundreds of lives could be saved in Ireland each year if GPs were equipped with defibrillators and trained to use them to intervene rapidly when someone has a sudden cardiac arrest. Timely treatment In Ireland, an estimated three to five thousand people die each year from sudden cardiac events that may not be fatal if they were treated in time. New research shows patients would be three or four times more likely to survive sudden cardiac arrest outside hospital. The study built upon a five-year project called MERIT (Medical Emergency Responders: Integration and Training), which equipped 500 GPs with defibrillators and provided appropriate training to use the device when dealing with a sudden heart attack. According to Gerard Bury, Professor of General Practice at University College Dublin, who led the investigation: “Nationally, survival rates for a sudden cardiac arrest, if it happens out of hospital, are one in 20. However this research shows that the availability and proper use of defibrillators by GPs increases these survival rates three or four fold. Additionally, the majority of the cardiac events that we have recorded have been in small towns and rural Ireland, where traditionally outcomes have been worse.” Just such a tragic event inspired the winner of this year’s HRB Special Prize for Health at the BT Young Scientist Exhibition. Sinead Lawless’s grandfather died of a cardiac arrest in his car on the street in Thurles. Sinead and two fellow fifth year friends at Presentation Convent, Jane Anne McKevitt and Rachel McCormack decided to do something positive about it. New ‘App’-roach They designed a three stage smartphone ‘app’ which not only tells you what to do if someone has a heart attack, but it also can show you where the nearest

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defibrillator is and how to use it. According to Sinead: “We plan to copyright the app and contact the Pre-Hospital Emergency Care Council to see if we can incorporate their master defibrillator location data into it, so that it could be used countrywide to let you know where is the nearest defibrillator to you. So many people came up to us at the exhibition telling us that it is a super idea, that we’re really delighted to have made something which could make a real difference and help to save lives.” “These students have a great idea which could only be improved if every GP in the country had a defibrilator,” says Professor Bury. “It would cost approximately €4,000 per GP for equipment and training, but

as these girls have demonstrated from personal experience, this sort of structured intervention allied with the strength of GP practice could make a huge difference and save hundreds of lives.”

 Prof Gerard Bury’s work was featured in the HRB’s Picture of Health 2012. (L-R) Dr Claire O’Connell, Science Writer, Prof Gerard Bury, UCD, and Mr Enda Connolly, Chief Executive, HRB.

 Sinead Lawless, Jane-Anne McKevitt, Rachel McCormack from Presentation Secondary School, Thurles with Dr Teresa Maguire, HRB.

13/3/13 17:17:04

24 Health Matters

mental health

Guidelines Promote Positive Mental Health in Schools ‘Well-being in Post-Primary Schools’ – new guidelines are an important tool in assisting schools to support teenagers.

he Minister for Education and Skills Ruairi Quinn TD, the Minister of State for Disability, Older People, Equality & Mental Health, Kathleen Lynch TD and the Director of the National Office of Suicide Prevention, Gerry Raleigh launched new guidelines for mental health and suicide prevention for post-primary schools at the end of January. The guidelines provide a clear framework, with information for schools and agencies supporting schools, on how to address issues of mental health promotion and suicide prevention. The guidelines are for all members of the school community, boards of management and school management teams. They will also be useful for the statutory and non-statutory partners, parents, parents’ associations, students, student councils, health and other personnel who are seeking an understanding of how to best work in and with schools.

“The guidelines provide a clear framework, with information for schools and agencies supporting schools, on how to address issues of mental health promotion and suicide prevention.”

School Support It is estimated that one in ten children

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+ Pictured at the launch of the Well Being in Post Primary Schools new national guidelines are: Minister for Education and Skills, Ruairí Quinn TD; Gerry Raleigh, Director of the HSE’s National Office for Suicide Prevention and the Minister of State for Disability, Older People, Equality and Mental Health, Kathleen Lynch TD; and pupils from O'Connell's Secondary School and Mount Carmel Secondary School.

and teenagers experience mental health disorders which impact on their relationships and day-to-day coping skills. Many mental health problems emerge in childhood and early adolescence. At the launch Minister Ruairí Quinn TD said: “Young people learn more effectively if they are happy and feel supported in school. Building resilience and emotional well-being is crucial to their school progress and their success in life. The promotion of well-being and the prevention of suicidal behaviour among young people in Ireland is a major public health concern for the Government and these guidelines will be an important tool is assisting schools to support our teenagers.” Minister of State Kathleen Lynch TD commented: “Youth suicides and youth mental health are serious issues that need to be addressed

urgently. It is vital that we support our young people in their social, emotional and mental health needs in order to ensure that they reach their potential and develop into happy well adjusted adults.”

New Model The ‘Well-Being in Post-Primary Schools: Guidelines for Mental Health Promotion and Suicide Prevention’ outline a wholeschool model which was informed by the completion of an extensive literature review and consultation process. Welcoming the publication of the guidelines Gerry Raleigh, the Director of the HSE’s National Office for Suicide Prevention, who co-funded the development of the guidelines, said: “I welcome the publication of the guidelines. The documents provide advice and information for all external agencies

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mental health including the HSE, on how we can all work with schools in a safe and evidencebased way to support and develop the mental health and well-being of all young people. He added: “The fact that the guidelines were developed in partnership between the DES, the HSE and the DOH shows how no single agency alone can promote mental health and prevent suicide. We need to develop effective inter-agency relationships if we are to make a difference to suicide rates among young people in Ireland.”

Community Approach A whole-school approach refers to an approach which goes beyond the learning and teaching in the classroom to pervade all aspects of school life. This includes involvement by students, teachers, principals, all other school staff, health personnel, school managers, school visitors and the wider school community who interact with the school. ‘‘Post-primary schools play a unique role in supporting the positive mental health and well-being of young people,” said Gerry Raleigh. “They do this by creating a caring environment, by educating young people about their mental health and by providing support for those facing difficulties.’’ He paid tribute to the great

work being carried out by many teachers across the country in terms of supporting their students with their academic skills, their physical development and also their mental well-being and added that he hopes the National Office for Suicide Prevention can assist with the implementation of the guidelines by directing resources towards second-level schools. He added that he believed the well-accredited, international training programmes including ASSIST, SafeTalk and Mind Out are of particular relevance to schools.

“They do this by creating a caring environment, by educating young people about their mental health and by providing support for those facing difficulties.”

+ Gerry Raleigh, Director of the HSE’s National Office for Suicide Prevention, with (L-R): Mihai Cadere (18), Nadine Connors (16), Julieanne Murphy (16) and David Shaughnessy (17), students from O'Connell's School, North Richmond Street, Dublin 1 and Mount Carmel Secondary School, Kings Inn Street, Dublin 1. Pic: Robbie Reynolds/CPR.

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The Guidelines The initial consultation process around the new guidelines involved stakeholders from the voluntary and statutory sectors including teachers, principals, parents’ councils, school support services, young people and health professionals. The guidelines are divided into three main sections: � School Support for All provides a whole-school approach to mental health and suicide prevention � School Support for Some specifically focuses on the early identification of a small number of young people or groups who are at risk of developing unhealthy patterns of behaviour or who are already showing early signs of mental health difficulties � School Support for A Few outlines how schools can support young people with more complex or enduring needs relating to their mental and emotional well-being. Schools are in a unique position to identify and support those who are experiencing distress and to provide an environment which encourages young people to bring to attention any incidents or issues of concern. It is important to recognise that mental health and wellbeing are not the sole responsibility of schools. Parents and the wider school community also have complementary roles, each supporting the other. It is also important for schools to be aware of available services and supports in their communities. Young people with good school connectedness are less likely to experience subsequent mental health problems and are more likely to have good educational outcomes. School connectedness includes relationships with peers, adults and learning. The guidelines present in an integrated way the existing elements of good practice, which schools should have in place. These include whole-school implementation of SPHE and a wholeschool guidance plan, which includes planning to deal with critical incidents. The HSE’s Health Promoting School Process (HSP) is also outlined and the guidelines show how the HSP can be introduced to schools to complement existing good practice.

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26 Health Matters

family

Triple P: the positive approach for families in the Midlands You have a child and you’re expected to be an instant expert. It’s straight into the toughest job of them all – parenting. Fortunately, the Triple P – Positive Parenting Program helps parents manage the big and small problems that are a normal part of family life, writes Arlene Crean.

he Triple P – Positive Parenting Program is one of the most carefully-researched parenting programmes in the world. Kids who grow up with positive parenting are more co-operative, do better at school and make friends easily. Parents reap the rewards too: they’re more confident, less stressed and get on better with their partners. The Longford Westmeath Parenting Partnership, an interagency group which includes HSE Midlands, introduced the programme to all parents of children aged seven and under in Longford and Westmeath in 2010. Almost 3,000 families to date have chosen some element of the programme. This February they are now extending it to Laois and Offaly. Conor Owens, Director Triple P for the Midlands said: “We know that parenting is crucial to how a child develops and can have an impact that extends far beyond the family home. Good parenting sets children up for life and will have a positive influence that can affect everyone in the community. We see Triple P as an investment in our children’s future, and by extension in the future of our society.”

in Australia the Every Family project was the largest public health trial of a parenting intervention ever conducted in that country, involving in excess of 8,500 families across three states. In the communities offering Triple P, children had fewer behavioural and emotional problems. Similarly, parents using Triple P said they were less stressed, less depressed and weren’t using harsh discipline (such as yelling or smacking) with their children.

How does Triple P work? Parents are offered support tailored to their specific parenting needs, ensuring they get as much or as little assistance as required. This is achieved by using the Triple P programme, which is a multi-level system of parenting and family support which was specifically developed as a population level strategy. Triple P incorporates five levels of intervention on a tiered continuum of increasing strength for parents of children and adolescents, from birth to age 16. This allows for families seeking parenting advice for mild

to moderate behavioural issues, but who do not require an intensive parenting intervention, to have their needs met in a cost and timeeffective way. This frees up resources to support families with more intensive needs. In HSE Midlands, all five levels of the Triple P Programme will be available FREE for parents of children aged seven years and younger. � Level 1 – Widespread parenting information campaign, e.g. newspaper columns, radio commentaries aimed at providing parenting tips to a broad audience and normalising parents seeking advice and skills. � Level 2 – Brief parenting advice: a series of seminars covering common parenting concerns in more detail, such as ‘Raising Confident, Competent Children’ and ‘Building Resilient Children’. � Level 3 – Brief discussion groups. These are a two-hour group session. There are four different topics available: good night time routines, hassle free shopping,

+ L-R: Conor Owens, Project Co-ordinator; Prof. Matt Sanders, Triple P Founder; and Eamonn Farrell, Chairperson.

Evidence-based Programme Triple P Professor Matt Sanders is the clinical psychologist whose doctoral thesis more than 30 years ago was the starting point for what is now the Triple P programme. The programme has been the focus of ongoing clinical trials and studies. Each year, dozens of new research projects are carried out internationally, with researchers trialling new variations of Triple P or assessing the impact of Triple P in different cultures or social groups. The evidence base is always growing and shows that positive parenting helps children and parents function better and feel better about themselves. For example,

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faMIly dealing with disobedience and fighting and aggression. � level 4 – Broad focus parent skills training (an intensive eight-week group intervention targeted at families who have children – for parents who want to further develop their parenting skills and also for parents whose children have social emotional or behavioural problems. � level 5 – Behaviour family interventions: designed to provide support for families with additional needs such as parental mood disturbance and marital distress. all levels of triple P are designed to empower parents to become independent problem solvers and are based on five principles of positive parenting: � Providing a safe and engaging environment � Promoting a positive learning environment � Having an assertive discipline strategy � Having realistic expectations � Parental self care.

Future Plans Professor sanders says triple P will always be a work in progress so it responds to parents’ needs. “Over the past year, many studies were conducted that can help to tailor triple P in the future,” he said. “there was a promising study looking at whether parenting style influences whether a child is bullied at school and whether triple P strategies can prevent that bullying. there were also encouraging results from a new triple P programme, lifestyle triple P, which aims to help parents of overweight and obese children manage their weight and physical activity. there was more evidence showing how specific triple P discussion groups, on hassle-free shopping with children and dealing with disobedience, were effective in reducing disruptive behaviour in pre-school aged children.” the Midlands Parent Partnership intends to introduce this lifestyle triple P for the families in the Midlands.

26% of parents say that they are too stressed to enjoy playing with their children. (Ikea Play Report 2010) Three in four children prefer playing board games with their parents to playing computer games with them. (State of Play, Back to Basics Report, 2010) 32 – the average hours kids aged 2-5 years spend watching TV each week. (Nielsen Media Research)

the concannon Family When it comes to hectic schedules, working mother Michelle Concannon’s timetable is about as crowded as one can get. Mother to Oisin (7), Peadar (5), Caimin (4), ruairi (2), and nine month-old Fionnuala, Michelle also runs her own business, Concannon’s Pharmacy in athlone. Of course, with such a busy household there is never a dull moment, but Michelle has had a little help to make sure things run smoothly. she took part in the triple P – Positive Parenting Program. “I trained for years to be a pharmacist, I spent money on lessons to learn how to drive but for the most important job in the world – parenting – I had no training,” she says. One of the first principles Michelle encountered in the triple P programme was to make sure her children lived in a safe, interesting environment. so how does Michelle do that for five children under eight? “When we moved into this house a couple of years ago the first thing we did was to make sure all the fittings were raised up. there are no shelves within stretching distance for little fingers. We don’t have any ornaments to knock over and the furnishings are nearly all soft. the house is actually quite bare so it’s very safe,” she laughs.

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Michelle also likes to keep the children out of harm’s way when she is preparing meals. “If I don’t give them something to do, they are around my feet in the kitchen and that’s when something could happen, like a saucepan turning over. so I sit them up at the counter and give them jigsaws to play with or books to read,” she says. Four boys are a handful but Michelle is lucky in that she has a large garden for them to run and play in. “We don’t let them outside unless the front gate

is closed. I still need eyes in the back of my head though.” If you’d like to stay up to date with positive parenting in longford, Westmeath, laois and Offaly visit the triple P “stay Positive” website, www.triplep-staypositive.net, for the latest news, stories and information. this site is dedicated to helping local parents find the support they need all day, every day. You can also contact (090) 643 4070 or email info@triplep.ie.

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28 Health Matters

antibiotics

Resistance needed for antibiotic misuse HRB-funded research reveals why an antibiotic prescription is not always the best medicine. Dr Akke Vellinga is a senior lecturer in the School of Medicine at NUI Galway; her research has confirmed two issues relating to antibiotic prescribing and use.

irstly, antibiotics are being prescribed too often and secondly they are often not prescribed according to guidelines on their appropriate use. There is no doubt that antibiotics revolutionised healthcare following their introduction in the 1940s. However, our research findings show that if you take an antibiotic for a current infection, a future infection is more likely to be resistant, because bacterial communities continually adapt and develop new strains that are resistant to those antibiotics.

research has clearly shown that individual prescriptions have a wider community or population effect as well. In one of our studies we looked at prescribing practices in 22 general practice surgeries in the west of Ireland for patients with urinary tract infection (UTI). This is the second most common bacterial infection in general practice, so it is a good candidate to explore what the wider effects might be. We also performed laboratory tests on urine samples from patients with a UTI.

Limiting Usage Since the first antibiotics were discovered, very few new antibiotics have been found and, combined with increasing resistance of bacteria, we are therefore running out of treatment options. So you can help yourself and others by limiting the use of antibiotics. While the doctor and patient are obviously focussed on the most effective and immediate cure for an individual patient, our

Increasing Risk From our analysis of this information it was clear that the more antibiotics a patient takes, the higher the chance that a subsequent infection with an E. Coli will be resistant. Depending on the antibiotic, the risk of resistance was two to six times higher if a patient had received two or more courses of this antibiotic. We found that the risk increased irrespective whether the

antibiotic was taken for a UTI or for another infection entirely. We also found evidence of the wider effects of one patient taking antibiotics. It has a ripple effect on bacteria in the wider community. It increases the likelihood that other bacteria in the environment develop resistance, which in turn means that when someone else develops an infection, antibiotics are less likely to be effective against it for them also. But this is not all; our studies also showed that just 22 per cent of the urine samples had an organism identified, which confirms an infection, yet 56 per cent of them had an antibiotic prescribed. And of that 56 per cent, just 37 per cent were prescribed with the recommended treatment. So to help minimise the spread of antibiotic resistance, it is vital that antibiotics are only prescribed when necessary, that the correct antibiotic is prescribed by the doctor, and that the patient completes the course as directed.

Further Research There are three research papers which discuss the findings in detail; two of these are available at the Journal of Antimicrobial Chemotherapy (doi:10.1093/jac/dks222) and (doi:10.1093/jac/dks237). The third paper is BMC Family Practice, 2011, 12-108; www.biomedcentral.com/14712296/12/108.

â&#x20AC;&#x153;If you take an antibiotic for a current infection, a future infection is more likely to be resistantâ&#x20AC;? + L-R: Dr Claire Oâ&#x20AC;&#x2122;Connell, science writer; Dr Akke Vellinga, NUI Galway; and Mr Enda Connolly, Chief Executive, HRB.

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in brief // News

Teddy Bear Hospital

+ Second year NUI Galway medical student Joe Conway with Ava (6) and Jared Brady (7).

Medical and science students diagnosed and treated over 1,500 sick teddy bears admitted to the hospital. They were accompanied by their minders, 1,500 primary school children, at the eighth annual Teddy Bear Hospital at NUI Galway. In the process they helped children ranging in age from three to eight years to feel more comfortable around doctors and hospitals.

SeeMySelf launched

National Early Warning Score launched The National Clinical Guideline, the National Early Warning Score, clearly sets out how to recognise and respond to patients whose condition is deteriorating. This guideline has been designed for adults in acute hospitals and is based on international evidence of what is known to work best. The guideline was developed through the collaborative work of frontline clinical staff, patient groups and key patient safety experts led by the Acute Medicine Programme of the HSE. Launching the National Early Warning Score as the first National Clinical Guideline for Ireland the Minister for Health, Dr James Reilly TD, commended the Acute Medicine Programme of the HSE in being to the forefront internationally in this patient safety initiative and on Ireland being the first known country to agree a National Early Warning Score. You can see the HSE complete guide to the National Early Warning Score and Compass education programme on www.hse.ie.

New App for Credit Union Members

+ At the launch of the SeeMySelf online program were members of the Sheevawn musical theatre group in Bray. L-R: Aoife Common, Jessica Lennon, Adam O'Gorman, Lorna Fanthon, Cian Gallagher and Zara Boxall.

SeeMySelf is a new online programme launched by Bodywhys, the Eating Disorders Association of Ireland, to support teenagers with self-esteem issues and to help prevent these developing into eating disorders or other related psychological problems. The launch of SeeMySelf marks the first time here that this type of ‘e-therapy’ has been introduced for young people with eating disorders. SeeMySelf is underpinned by technologies developed by SilverCloud Health which emerged from a joint project undertaken by the NDRC (National Digital Research Centre), Trinity College Dublin and Parents Plus, Mater Misericordiae University Hospital. SilverCloud Health is now based at the NDRC (National Digital Research Centre).

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The cuAnywhere mobile app for iPhone and Android smartphone users incorporates online mobile banking facilities plus a wealth of social media integration, ensuring that members can stay in touch with their finances and their credit union 24/7. The ‘CU’ range of products also available to members includes cuOnline, an online banking service which allows you to check balances, view and print statements, apply for loans, make payments and lodgements and communicate directly with your local credit union from any PC or laptop anywhere in the world. Additional services include automated SMS alerts and same day clearance on electronic payments through the European Clearing Area.

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30 Health Matters

Commercial Feature

THE FIRST 1000 DAYS How nutrition can shape the rest of your life Nature or nurture? What makes us the way we are? Why are some people more predisposed to heart disease or high blood pressure? There are lots of conventional explanations to answer these problems and lots of room for lively debate too. But there is now another powerful source of influence that many people may not have previously considered – the environment we are exposed to during the First 1000 Days. By Louise Reynolds, MSc MINDI Consultant Nutritionist health, predicting a child’s risk of developing coronary heart disease, hypertension, type 2 diabetes, certain cancers and even obesity. Similar to the detailed records kept by public health nurses in clinics all over Ireland today, detailed records of birth weights, baby illnesses and developmental milestones from the UK from 1911 to 1948 provided a wealth of data for researchers who discovered them in 1986 and have been working with them ever since. The researchers followed up with the individuals who were then in their 60s/70s and older, linking their health outcomes in later life with their early life nutrition. The results have since been replicated many times over throughout the world. Much of this influence on future generations is down to foetal programming – the ability of the environment in the womb to up-and down-regulate genes, with long term health consequences. ‘Epigenetics’, this exciting area of research, is of enormous importance in human nutrition and the aetiology of chronic disease.

he First 1000 Days of life refers to the time from conception through to a child’s second birthday. It has been highlighted as a critical time for the development of both cognitive and motor function in infants and toddlers, and an opportunity too important to miss in terms of ‘programming’ a child’s future health, growth and development – right through to adulthood.

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This is the basis for Professor David Barker’s ‘Foetal Origins Hypothesis’, which proposes that the origins of many of the common diseases affecting our society today can be traced back to the responses of the foetus or infant to under or overnutrition during the First 1000 Days. In fact, right up until the child’s second birthday, nutrition can have a long term impact on

PREGNANCY Good diet during pregnancy is critical to ensure the baby, and the mother, meet all of their nutritional needs. We now know that it is also crucial to the long term health of the baby, and can exert an influence right throughout their lives. The placenta captures nutrients from the mother’s blood and transports them to the baby. The growth of the placenta and the food it supplies are the key to health for a lifetime. An undernourished baby may try to

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commercial Feature compensate by increasing the size of its placenta to extract more nutrients from the mother. This is not desirable because the baby and the placenta have to share the available food between them. A larger placenta will require a larger share of the nutrition. The shape and size of the placental surface predict heart disease, high blood pressure and certain cancers in later life, with a larger placenta and a smaller baby being a negative risk factor. A follow up study of adults’ blood pressures at age 46-54 years concluded that the highest blood pressure had occurred in those who had been small babies with large placentas. To ensure that the baby wins out over the placenta, a good, regular supply of nutrients from the mother is essential. Key nutrients to include in a healthy pregnancy diet include calcium (for healthy bones and teeth), vitamin D (to aid calcium absorption), omega-3 fats (for baby’s brain and sight development) and folic acid (for the formation and growth of healthy cells and to prevent certain birth defects in the very early stages of pregnancy).

“Right up until the child’s second birthday, nutrition can have a long term impact on health, predicting a child’s risk of developing coronary heart disease, hypertension, type 2 diabetes, certain cancers and even obesity.” BREASTFEEDING The important nutrition effect does not stop when the baby is born but continues with breastfeeding. The WHO recommends exclusive breastfeeding during the first six months of life with the introduction of solid foods thereafter, and continued breastfeeding until two years of age or above. Breastfeeding rates in Ireland are among the lowest worldwide, with rates

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for breastfeeding at hospital discharge of 54% cited by the ESRI (2010). This is concerning, as the evidence for the short and long-term health benefits of breastfeeding (for both mother and baby) is robust and globally recognised. A WHO review of studies into the benefits of breastfeeding has looked at a wide range of possible benefits. Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests in school, and had a lower risk of overweight/ obesity and type 2 diabetes. To optimise the benefits for all involved, any increase in breastfeeding rates during the First 1000 Days will improve the health outcomes for both mothers and babies in Ireland.

“Iron and vitamin D intakes were seen to be problem nutrients for this age group – almost one quarter of one year olds were estimated to have low intakes of iron and and the vast majority do not achieve the recommendations for vitamin D.” WEANING Weaning practices in Ireland are not always in line with best practice guidelines. Over 20 per cent of Irish mothers wean their babies onto solid foods prior to 12 weeks of age, rather than waiting until the 17 weeks or beyond currently advised (six months in the case of exclusively breastfed infants). It has also been reported that unsuitable additions to infant foods such as ordinary gravy, sugar, honey and sauces are being given to infants aged less than six months. Such findings indicate that a significant proportion of six month olds eat foods high in saturated fats, salt and refined sugars – all practices which may result in bad feeding

habits and have adverse consequences for health in later life. A poor weaning diet at this critical stage may expose the infant to risk of iron deficiency anaemia – this can have long term health consequences, being linked to poor school performance and behavioural problems at the age of ten years.

TODDLER NUTRITION From the age of one to two years, it can be difficult for parents to know exactly what their toddler needs in terms of good nutrition. Results from the Irish National Pre-School Nutrition Survey 2012 highlighted that over 60 per cent of all parents of one to two year olds find it difficult at times to provide a healthy diet for their toddler. While toddlers may now sit with the family for mealtimes, not all family foods are suitable – salt intakes were too high in all groups of toddlers studied. Similarly, iron and vitamin D intakes were seen to be problem nutrients for this age group – almost one quarter of one year olds were estimated to have low intakes of iron and the vast majority do not achieve the recommendations for vitamin D. Such inadequacies may have long term consequences for these children in terms of cognitive development and behaviour (iron) and bone health (vitamin D). It can be difficult to achieve adequate intakes of these key nutrients. This data reinforces the importance of considering a tailored diet for toddlers – specific foods and drinks designed with the needs of toddlers in mind can go a long way to help parents address these dietary deficiencies. CONCLUSION The science behind the First 1000 Days presents an exciting window of opportunity for health care professionals to promote and positively influence the nutrition and long term health of mothers and babies in Ireland. *References available on request. Supported by:

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32 Health Matters

diabetes

‘Pump School’ for Diabetic Children in Cork and Kerry Children in Cork and Kerry with type 1 diabetes can now be treated with insulin pumps – a service previously only available in Dublin.

new service to help children with type 1 diabetes, their parents and their carers to better manage the condition has commenced in Cork. Children with type 1 diabetes who normally receive insulin injections up to five times daily may be suitable for a new insulin pump treatment and attend a dedicated ‘pump school’ to learn how to use the device. An insulin pump is a mini computerised device which continually infuses insulin under the skin and optimises the blood glucose control. This new service, which is being rolled out under the HSE’s National Diabetes Clinical Programme, is being made available to children with type 1 diabetes in Cork and Kerry who are clinically suitable. Children under five years of age are being prioritised.

Pump School The children, their parents, teachers, special needs assistants and other carers are trained to use and manage the insulin pump at an education programme delivered by a consultant-led team from Cork University Hospital (CUH) at a dedicated

pump school. This is the first dedicated pump school for children with type 1 diabetes in Ireland, and the first time insulin pump therapy can be offered outside Dublin. The pump school takes a day and a half to complete.

Insulin Pump The pump, which is device about the size of a small mobile phone, is attached to the child via a plastic tubing just under the skin. The pump delivers a continuous amount of insulin, 24 hours a day based on the requirements of the child, and the amount of insulin delivered can be changed by the user (or their parent). The child initially wears the pump for a week using only salt water in order to get accustomed to using it and to identify any issues before starting on insulin. There is intensive support provided to the families by health professionals during the first week and by the third week they are usually well established in using the insulin pump. Evelyn McCarthy (6) from Millstreet in Co. Cork switched from having daily

+ Pump school attendee Emily McCloskey with Norma O'Toole, Paediatric Diabetes Nurse; Irene O'Mahony, Clinical Nutritionist; Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist; Anne Bradfield, Paediatric Diabetes Nurse; Shirley Beattie, Senior Paediatric Diabetes Dietitian; Dr. Susan O'Connell, Consultant Paediatrician; and Evelyn McCarthy, pump school attendee at the launch of the new insulin pump treatment service in Cork.

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“Attending pump school was invaluable and we got great back-up support from the specialist diabetes staff at Cork University Hospital when Evelyn first started on the pump.”

injections to the insulin pump ten months ago and her mum Christine McCarthy, who is a GP, is full of praise for the device. According to Dr McCarthy, “Evelyn is a new child since commencing the pump – she hated the injections and her dad Gerard and I had to cajole her daily around the kitchen table to take them. With the pump, she can input her own data and more or less manage it herself. She has better control and it is less regimented as she can eat when she wants, which she could not do when she was on the injections as we were trying to match her food intake and her insulin. And the added bonus is: the pump is purple! “Attending pump school was invaluable and we got great back-up support from the specialist diabetes staff at Cork University Hospital when Evelyn first started on the pump. It took us about six months to get used to it and we haven’t looked back since. Evelyn has been able to go to swimming classes from school. Her teacher detached the pump before each lesson and re-attached it afterwards.

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diabetes

+ Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist at CUH with Charlee Jade Scotton and Megan Linehan.

Had Evelyn still been on the injections, we would possibly have had to accompany her to the classes.”

“Pump therapy improves blood glucose control and quality of life and reduces the long-term complications associated with diabetes such as blindness, coronary heart disease and kidney failure.”

Diabetes in Children Diabetes is a serious metabolic condition in which the body fails to produce enough insulin to regulate blood glucose (sugar). There are two types of diabetes (types 1 and 2) and if the condition is not well controlled it can cause serious health complications. The vast majority of diabetes in childhood is type 1 diabetes, which is very inconvenient and generates a significant family burden for children and their carers on a daily basis. The incidence

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of type 1 diabetes in children is increasing yearly and the incidence is at epidemic proportions in the under five age group.

National Diabetes Clinical Programme The provision of insulin pump therapy to children under five years of age is part of the HSE’s National Diabetes Clinical Programme. Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist at CUH has been appointed the national lead for this programme. A second Consultant Paediatric Endocrinologist, Dr Susan O’Connell was appointed in CUH during 2012. These two consultant appointments have allowed for the commencement and maintenance of the pump school service in Cork. The team is comprised of these two consultants, supported by medical staff, diabetes nurse specialists and a dietician specialising in type 1 diabetes. In modern day diabetes care, these specialised staff are the core of the diabetes team who assist each family who commence on insulin pump therapy. According to Dr. Stephen O’Riordan, Consultant Paediatric Endocrinologist at CUH and national clinical lead for the insulin pump programme in the under fives, “insulin pump therapy has evolved considerably in recent years and is now considered the gold standard for children with type 1 diabetes. Pump therapy improves blood glucose control

and quality of life and reduces the longterm complications associated with diabetes such as blindness, coronary heart disease and kidney failure. There is a significant practical benefit of pumps over injections for children and their families – for example, a reduction from five insulin injections per day to one infusion set change every two to three days. The reduced incidence of noctural hypoglycaemia (low blood sugar at night) is also of considerable benefit to children and reduces parental anxiety once established on pump therapy. Pump therapy is not for all, and careful patient selection is at the core of successful insulin pump service.” The pump school service is provided by the CUH team in Blackrock Hall Primary Care Centre in Mahon, and this link with community services allows for a more flexible and child/family friendly approach in a non-hospital environment. There are more than 400 insulin-dependent diabetic children attending CUH, which is developing as a regional centre for many aspects of children’s health services and is the regional centre for paediatric and adolescent diabetes and endocrinology. To date, 20 children have already commenced on pump therapy in Cork and it is envisaged that a further 20 will commence therapy during 2013. Gabrielle O’Keeffe, A/Operations Manager, HSE Community Services in Cork said: “In the past, children from this area had to travel to Dublin hospitals to access insulin pump therapy. These children are now returning for care here locally, which is hugely beneficial. The service is at an early stage of development but it is a significant advance for our services in Cork”. “Research has shown that insulin pump therapy is one of the most effective ways to manage type 1 diabetes,” said Kieran O'Leary, CEO of the Diabetes Federation of Ireland (DFI). “Until now, local families of children with diabetes who wanted access to insulin pump therapy had to make the conscious effort to switch their diabetes care to a Dublin hospital. So we very much welcome availability of this new service in Cork, which I am sure will open the door for many other children to access this therapy".

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34 Health Matters

croke park agreement

THIRD CROKE PARK AGREEMENT ANNUAL REVIEW U

nder the terms of the Public Service (Croke Park) Agreement 2010-2014, each sector must compile and publish an annual review and progress report. The health sector’s third annual review and progress report, covering the period 1st April to 31 st December 2012, has been recently completed and submitted to the Health Sector Implementation Body (HSIB). The HSIB is a group consisting of senior health sector managers and trade union representatives, set up under the Public Service Agreement (PSA). Ultimately the finalised PSA third annual review and progress report will be published by the Department of Public Expenditure and Reform. Publication is expected to take place in the near future. The health sector PSA report is a compilation of reports of achievements, savings, efficiencies and reconfigurations of service submitted by health services and agencies, which have been achieved and implemented under the auspices of the agreement. The report reflects the successful efforts of health service managers and staff to maintain levels of service delivery over the past year in the context of reduced budgets and reduced staff complements. Some of the key achievements outlined in the report include:

Consultants’ Agreement Agreement reached with the hospital consultant representative bodies in November 2012 will enable the delivery of significant flexibilities and efficiencies. Clinical Programmes Ongoing implementation of clinical programmes with resultant efficiencies and increased quality of care.

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Ambulance Service Significant progress has been made during 2012 on the PSA change programme in the National Ambulance Service: � Efficiencies have been achieved which will deliver up to s2m in savings in a full year; � The right skill mix is now being focused on each patient – improving patient safety; � The Intermediate Care Service has been agreed and rollout has commenced – delivering improved capacity for less cost. Procurement Total savings of over s50 million have been achieved by HSE Procurement for the period Jan-Dec 2012. Radiography Service Savings estimated at s2.25 million per annum will be made as a result of an agreement made with all radiography staff grades, under the PSA.

Redeployments Over 2,400 instances of redeployment and reassignment were reported for the period April-Dec 2012. Across the health service, staff have been redeployed and reassigned in order to enable the continued delivery of services in the context of the very significant reductions in staff levels in 2012. Roster changes Roster changes and revised skill mixes are being implemented across all services, as necessary, in order to maximise efficiencies and to enable the continued delivery of service at the required level. Once published by the Minister for Public Expenditure and Reform, the Health Sector PSA Third Annual Review and Progress Report, along with a Health Sector PSA Savings Report and a Bulleted Summary of Key Achievements, will be made available on the HSIB web pages at www.hse.ie/go/crokepark.

Heart Failure Service The Heart Failure Service in Galway is an example of an innovative change programme underway supporting the reorganisation and development of service in line with the aims and objectives of the Croke Park Agreement. University Hospital Galway, Portiuncula Hospital, Ballinasloe and Galway PCCC are developing an integrated Heart Failure Service. Two Nurse Specialists and a Cardiac Technician, employed through CROI (West of Ireland Cardiology Foundation), are supporting patients and GPs in the management of patients with heart failure in the community in conjunction with consultants and nurses in both hospitals. The aim of the Heart Failure Service is to reduce admissions and length of stay resulting in reduced costs for the organisation. Liz Killeen, Clinical Nurse Specialist in heart failure is pictured here with Petros Boulos, Oranmore at one of the community based nurse-led heart failure clinics in the Galway City East Primary Care Centre in Doughiska.

13/3/13 16:20:26

Ireland’s only third level Institution dedicated exclusively to developing the leadership, management and educational capacity of health professionals

Postgraduate Leadership & Management Programmes MSc/Postgraduate Diploma in: ·Leadership ·Healthcare Management ·Leadership in Health Professions Education Professional Certificate in: ·Quality & Safety in Healthcare In addition we offer a range of Professional Development Courses. These can be tailored to meet your organisations needs. All programmes are flexible and can be taken in modular format.

Contact Us For any details on our programmes or any queries you may have, please call us on 01 402 8655 or visit our website

www.rcsileadership.org

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13/3/13 16:20:28

Educating for Career Success Home to 6,000 students drawn from around the world, Athlone Institute of Technology offers students an education that equips them for career and life success.

PgD/MSc in Intellectual Disability Nursing

This part-time Master’s degree/postgraduate diploma will facilitate the upskilling of qualified nurses working in this critical area. The philosophy which underpins this programme is grounded in values and beliefs relating to the nature of four fundamental philosophical nursing concepts, namely; nursing, environment, person and health.

HDip in Behaviours that Challenge

This part-time programme is designed for nurses to enable them to reflect systematically on their practice and to contribute to the development of nursing knowledge, theory and practice in the area of challenging behaviour.

CONTACT admissions@ait.ie www.ait.ie/postgraduate

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

What’s more, employees on the Easipay scheme can get 10% off a new home insurance policy or €30 off your home renewal. AXA customers can also save money on new and used cars, holidays and lots more. Just visit www.axaplus.ie.

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

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

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redefining

standards

redefining

standards

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HealtH Matters 37

older persons sinGLe assessment tOOL tO imPrOve serviCes fOr OLDer PeOPLe the single assessment tool is currently in the development process. its purpose is to help identify older people's health and social needs and ensure greater access to information across health care services.

he Hse is developing a single assessment tool (sat) to help ensure that older people living in the community will receive a standardised needs assessment, leading to better care. Determining the needs of older people is a very important part of delivering health and social services. the new sat will also ensure there is access to better information which will improve the planning and delivery of these services to older people. assessment information will be stored in a central database, reducing the need for multiple assessments. Careful assessment will enable alternatives to residential care to be identified, and there will be greater capacity to measure client outcomes and ultimately measure service outcomes. the tool will be developed and implemented in phases over a five-year period and it is envisaged that it will be used to assess applications for schemes such as the Nursing Home support scheme (a Fair Deal) and the Home Care Package scheme.

standards for residential Care settings for Older People in Ireland [HIQa, 2009] and the Government’s Future Health strategy [DoH, 2012], identified the requirement for a national single assessment tool.

aims By introducing a standardised single assessment tool, older people's health and social care needs are thoroughly assessed, and information can be shared appropriately between health and social care services without duplication. a single assessment tool is needed for the following reasons: � to have the needs of older persons met in the most appropriate setting � to provide care that is properly coordinated to support quality and efficiency � to maximise value to older persons within the available budget resource � to provide demonstrable fairness of access to resources for health and social care, e.g. for long-term residential care or a home-care package � to support current national policy on enabling older people to remain at home in independence for as long as possible. a number of government strategies, policies and reports such as the leas Cross report [O’Neill, 2006], the National Quality

methoDs Following an extensive stakeholder consultation and review, the interraI suite of instruments was chosen. this system was found to have a positive clinical impact in identifying previously unrecognised health and social care needs. a pilot study examined the system’s usability, practicality and acceptability and clients, carers and health professionals showed a high level of acceptability of this system. ten sites (five urban and five rural) were selected comprising of six long-term care facilities (three private, two public and one voluntary); two community care areas (ten community health units) and two acute hospitals. Clients and their representatives particularly liked the direct client interview items and valued that their opinions were sought and respected. the assessment system covers a range of services such as: community, residential, acute, rehabilitation, disability and mental health. It also offers additional supports with embedded alerts that trigger the assessor to conduct further in-depth assessments.

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Positive views Overall, the system was found to be a robust and potentially powerful system for assessing the health and social care needs of older people. Participants expressed overwhelmingly positive views regarding the acceptability and value of using the interraI system. Funding for implementation is principally to come from two sources: � a funding commitment from the atlantic Philanthropies, a limited life foundation; � CMOD (Department of Public expenditure and reform) who have recently approved the Hse to begin procurement of a suitable information system. the project scope is to implement specific parts of the interraI suite for use in relation principally to the care needs assessment part of the Nursing Home support scheme, Home Care Package scheme and home-help provision. a key purpose is to replace the Common assessment summary record (Csar) which is currently in place.

staFF training the implementation will include training some 2,000 health and social care staff over a four year period (2013 to 2016).

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38 Health Matters

Commercial feature

That’s A Wrap! National Learning Network’s successful implementation of WRAP (Wellness Recovery Action Plan) is being used as a guide by other large organisations around the world to support people with mental health difficulties. National Learning Network is the training and employment division of the Rehab Group.

 Pictured at the annual WRAP Around the World Conference held in Oakland California from January 25-27th 2013 are Ed Anthes, Head of Copeland Publishing; Paula Hurley, Outreach Support Worker, National Learning Network; Margaret Wallace, Programme Development Officer; and Mary Ellen Copeland, Founder of the WRAP Programme and the Copeland Center. The conference brought together people with mental health difficulties, peer specialists, professionals, and supporters from all over the world with the aim of sharing information about wellness and recovery skills and strategies.

ational Learning Network staff members Margaret Wallace and Paula Hurley were recently invited to a prestigious international conference in the United States to present the organisation’s experience of using the WRAP mental health programme to support people in National Learning Network training centres across Ireland. They are two of only 130 Advanced WRAP Facilitators worldwide. Although there are thousands of success stories around the world from people who

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attribute their wellness to WRAP, there are few organisations who have successfully integrated the programme to the extent that National Learning Network has. The WRAP Around the World conference which was held in Oakland, California, in January, was organised by the Copeland Centre for Wellness and Recovery. It brought together people with mental health difficulties, peer specialists, professionals, and supporters from across the globe with the aim of sharing information about wellness and

recovery skills and strategies. Every year, more than 13,000 people all over Ireland are supported by National Learning Network – the Irish training and education division of Rehab Group – to achieve their goals in education and training. The number of people with mental health difficulties undertaking training with the organisation has been increasing in recent years and so, five years ago, National Learning Network introduced WRAP as part of its

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Health Matters 39

commercial feature response to the Government’s mental health strategy A Vision for Change. Each student is placed at the heart of service delivery, supporting them in tapping into the resources of people in their own immediate social networks and in participating fully in community life.

Wellness Recovery Action Plan WRAP, or Wellness Recovery Action Plan, is a self-management and recovery system developed by a group of people who had mental health difficulties and who were struggling to incorporate wellness tools and strategies into their lives. It aims to decrease and prevent intrusive or troubling feelings and behaviours, increase personal empowerment, improve quality of life and assist people in achieving their own life goals and dreams. WRAP also provides a structured system for monitoring uncomfortable and distressing feelings and behaviours and, through planned responses, reduces, modifies, or eliminates them. It also includes plans for responses from others when people cannot make decisions, take care of themselves, or keep themselves safe. The person experiencing difficult symptoms develops their own personal WRAP, which can be with the help of supporters and health care professionals if they choose. “We are delighted to be able to share with our international colleagues how best to make WRAP operational and, more importantly, sustainable, in large organisations like our own, where people have diverse and complex needs and where it’s important to deliver value for money services,” says Margaret Wallace, National Learning Network Programme Development Officer and Advanced WRAP facilitator. “In fact, such has been its success; National Learning Network hopes to be able to extend the availability of WRAP outside the organisation and into the community in the coming months. In particular, we believe WRAP would be hugely beneficial in schools, as well as to young adults and to those out of work. ‘Youth WRAP’ and ‘WRAP for the Unemployed’ which are in use in other countries could be of significant benefit in Ireland, particularly in light of the great difficulties being experienced by many at this time.”

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“ The number of people with mental health difficulties undertaking training with the organisation has been increasing in recent years and so, five years ago, National Learning Network introduced WRAP as part of its response to the Government’s mental health strategy A Vision for Change.” International Awards To date, almost 100 National Learning Network staff have been trained as WRAP facilitators to deliver the programme to its students and 2012 saw the first students also become facilitators. National Learning Network has a proud track record of excellence in its service provision, most recently evidenced by its awarding of the coveted European Quality in Social Services Award for all of its services, the first organisation in Europe to gain this recognition. The organisation has also been invited by the Copeland Centre in the USA to go forward for the WRAP Centre of Excellence Award, an award which one other organisation in the world holds. In simple terms, WRAP is a wellness programme for people who are interested in being well and in staying well. Although its origins are in the mental health area, WRAP is for everyone. While many people place much emphasis on looking after their physical health, the same importance is often lacking in the safeguarding of one’s mental health. The WRAP philosophy is that by looking after our mental health, we can better manage the onset of mental health challenges or difficulties when they present and, in particular, can prevent their deterioration and avoid crisis. Margaret Wallace explains: “WRAP

benefits everyone not just people who have experienced mental health issues. The reality is that everyone’s mental health is challenged at some point in their lives through bereavement, financial or relationship strains, stress, decisionmaking or life choices. This programme gives you the tools and strategies to deal with these issues. “WRAP runs alongside the regular HSE or FÁS-funded programmes that National Learning Network provides. It is delivered over a period of weeks in a group setting with two facilitators. Participation is voluntary and it usually takes 18 hours. The group setting is very effective as, in my experience, this is fundamental to peer learning. There are six elements to the programme which the group works through in practical exercises, group discussions and small group exercises. The elements include identifying the tools that promote wellness, establishing a daily maintenance plan, identifying triggers, recognising early warning signs as well as signs of when things are breaking down, managing a crisis and post-crisis planning. For each of these elements, an individual and personal action plan is drawn up. The idea is that the participant is the expert on themselves and their own situation and that by working through the steps of WRAP, they can find the right tools and strategies to be well and stay well. Some of the discussions can be challenging or uncomfortable but the outcomes for each person are really positive. It’s all about taking action and having a preventive approach. You don’t just finish with WRAP and move on, it becomes a way of life, a mindset.”

“To date, almost 100 National Learning Network staff have been trained as WRAP facilitators to deliver the programme to its students and 2012 saw the first students also become facilitators.”

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40 Health Matters

News // in brief Medical Council and HSE Enhance Education Co-Operation

The Medical Council and the HSE Medical Education and Training Unit have signed a memorandum of understanding (MOU) which focuses on enhancing co-operation between the two bodies in the area of medical education and training. Recognising the positive impact of excellence in medical education and training on clinical practice and patient safety, the MOU puts in place a framework for co-operation which seeks to ensure that the medical education and training system in Ireland continues to produce doctors with a strong commitment to safe patient-centred care, interdisciplinary teamwork, high ethical principles, lifelong learning and professional competency. At the signing were (back, L-R): Prof. Kieran Murphy, President of the Medical Council and Barry O’Brien, National Director of HR; and (front L-R): Caroline Spillane, CEO, Medical Council and Professor Eilis McGovern, National Programme Director for Medical Training.

Cry Out for Support

Key Challenges for Nurses in the 21st Century Dr Michael Shannon, Assistant National Director, HSE Nursing and Midwifery Services, recently launched Yvonne O’Shea’s third book, The Professional Development of Nursing and Midwifery in Ireland – Key Challenges for the Twenty First Century. In her current book, Yvonne reflects on how the professions of nursing and midwifery have developed since the Report of the Commission on Nursing (1998) and on the challenges they face in a radically changed world, emerging from the greatest economic crisis in the history of the State – and after the introduction of the Nurses and Midwives Act 2011, the changes in regulation and the increased emphasis on patient safety and protection of the public. Having spent 11 years as Chief Executive of the National Council for the Professional Development of Nursing and Midwifery, Yvonne also reflects on what has to happen now in order to ensure that the professions continue to develop in line with the needs of the services and in a manner that builds on the achievements of the past. The book is firmly set in the context of the current political and economic climate and contains a detailed analysis of the Programme for Government and the reform agenda that is underway.

RTE sports presenter Jacqui Hurley, alongside model and TV presenter Daniella Moyles, joined the Lord Mayor of Dublin Naoise Ó Muirí to encourage women to sign up to take part in this year’s Flora Women’s Mini Marathon in aid of CRY (Cardiac Risk in the Young).The charity supports families who have lost a relative to sudden cardiac death (SCD), raises awareness of the conditions that cause SCD and funds the activities of the Centre for Cardiac Risk in Younger Persons (CRYP) in Tallaght Hospital, which provides free cardiac evaluations of those who may be at risk from SCD. Register your support at www.cry.ie.

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Health Matters 41

mental health

The Role of the Authorised Officer The Mental Health Act 2001 (MHA) provides a clear process to permit interference with a person’s liberty and a set of safeguards to their rights when that happens. The HSE has an obligation under the Mental Health Act 2001 to make Authorised Officers available to perform this function. The role of the Authorised Officer is outlined here.

Thinkstock/Stockbyte/GeorgeDoyle

f someone becomes unwell mentally they are usually in a position to take the initiative and go to the doctor, or seek other appropriate help to address their illness. Occasionally people who become mentally unwell do not see themselves as unwell or in need of assistance to relieve their distress or minimise the risk of harm to themselves or others from their condition; they lack insight into what is happening to them. In these circumstances it is sometimes necessary to admit people to hospital for assessment and possibly care and treatment. An application can be made to a GP who then needs to assess the person and, if they are satisfied that the person may be suffering from a mental disorder, they are obliged to apply to the local inpatient mental health service for the person to be seen and assessed with a view to being admitted for treatment. All of these steps have to be completed in writing on specified forms because the process in effect deprives the person of their liberty for the purpose of assessment, care and treatment. The forms are the legal basis for possible detention which in turn is subject to independent review. The application to the GP can be made by a number of people including spouses or other family members, a member of the Gardaí, an Authorised Officer or others. The HSE has an obligation under the Mental Health Act 2001 to make Authorised Officers available to perform this function.

Expertise An Authorised Officer brings professional mental health expertise to a difficult situation and may be able to propose alternative care options, or offer advice and support to the person or their family. The key difference between the Authorised Officer and other applicants is that (s)he will offer a professional assessment in considering whether a person meets the criteria for involuntary admission. The role seeks to balance individual civil

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liberties and the rights of the individual, with ensuring that treatment (if indicated) is provided, as well as taking into account the safety of individual members of the community. The role of the Authorised Officer is about seeking the best outcome within the least restrictive environment for the person, giving consideration to alternatives available to involuntary admission. This will be in partnership with the person and/or their carers/ families. Where possible, the person who is the subject of the assessment and application must be kept informed and made aware of what is going on and of their rights in this situation.

Liberty Because of the seriousness of depriving a person of their liberty, the correct filling of the forms associated with the process and the time lines that apply to the process overall have to be strictly adhered to. The Authorised Officer is aware of these requirements and his/her knowledge of the entire process is of invaluable assistance to others involved in a situation which is often characterised by distress for the person, family members and others who may be involved. In developing the Authorised Officer role, the HSE relied heavily on the report

of the Mental Health Commission to the Department of Health and Children (MHC, 2006) on the regulations for Authorised Officers. This report recommended mental health professionals with specific experience and training in mental health law and the treatment of mental disorders as the preferred option for the role of Authorised Officer. It recognised that such mental health professionals would be well placed to have an awareness of what services are available in seeking to determine the best option of care for the person at the centre of the process in line with the principle of least restrictive alternative depending on the presenting condition of the person.

Independent Tim Srahan is an Assistant Director of Nursing in Longford/Westmeath Community Mental Health Services and a trained and experienced Authorised Officer. Tim said of the role: “The Authorised Officer assessment provides an independent, objective and impartial assessment that ensures adequate protections are in place to protect the person’s human rights whilst also ensuring that the person has access to all appropriate services to support their health and wellbeing.”

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42 Health Matters

Productive Ward Project

Improving Patient Care HSE’s Productive Ward Initiative wins the Lean Healthcare Academy International Award. The Productive Ward: Releasing Time to Care is a quality improvement initiative designed by the NHS Institute for Innovation and Improvement (NHSI) and licensed by them to non-NHS services. Since its launch in the UK in 2007 it has been introduced in Australia, New Zealand, the US, Canada and Europe. The Productive Ward aims to empower frontline staff to drive forward improvements in health services through redesigning and streamlining the way staff and services deliver care with an emphasis on patient safety. Sites involved in the project claim that implementation of the Productive Ward has resulted in up to a 40 per cent increase in the amount of time nurses/midwifes spend on direct patient care, improvements in the organisation of the ward and patient safety. The HSE’s Productive Ward Initiative has won this year’s prestigious Lean Healthcare Academy International Award, hosted in the UK, for its project structure and implementation to date. Also among the three finalists was the Coombe Women and Infants University Hospital, one of the national implementation sites who were commended by the judging panel of Lean experts for their innovative improvements and progress with the project.

Introduction of the Productive Ward in the HSE The HSE joined this global initiative in December 2010 through the Director of the HSE’s Office of Nursing and Midwifery Services Directorate (ONMSD) and the Director of the National Clinical Strategy and Programmes Directorate. Consequently, a National Advisory Group to oversee the roll-out of the Productive Ward across the four HSE regional areas was established. Mark White was appointed National Lead to oversee the implementation of the initiative and a National Implementation Group was established and supported by the regional Nursing and Midwifery Planning and Development units. Two hospitals, Cavan General and Roscommon County Hospitals,

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+ From left: Bob Gomersall, Chairman at the Virtual College, Mark White, HSE National Lead for Productive Ward, Michelle Waldron DNE and Raphael McMullin DML, HSE Area Co-coordinators for the national project.

had previously engaged with the Productive Ward in 2010 and had commenced module implementation. A total of 23 wards in 17 pilot sites throughout Ireland were identified by November 2011. Following module implementation training they commenced implementation in January 2012. A further seven sites (15 wards) joined the initiative at the end of 2012 and are currently in the process of commencing the improvement work.

� I ntroducing appropriate stock itemisation and levels have reduced monthly stock expenditure. All wards have highlighted key patient safety issues that they intend to improve, collecting monthly data tracking their progress. The most common patient safety issues which have seen marked improvements include: unplanned absenteeism, patient falls, hospital acquired infection and patient ID band compliance.

Results to date Early results show that direct patient care times have improved through the completion of the foundation modules by: � Reducing interruptions � I ntroducing patient status at a glance boards with real-time patient information � Re-designing their ward environment to reduce waste and unnecessary walking

Evaluation A large, robust multi-site evaluation, led by Dr Randal Parlour and the NMPD in the HSE-NW, has commenced. The evaluation will examine the impact on quality and safety, return on investment, patient and family experience, the development of a person-centred culture and the efficacy of implementation and facilitation.

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Health Matters 43

productive ward project CASE STUDY: Midlands Regional Hospital, Tullamore

s part of the Releasing Time to Care project in the Midlands Regional Hospital, Tullamore, a Patient Status at a Glance (PSAG) Board was introduced in 2012. Its purpose is to facilitate the timely retrieval of patient information. This promotes a seamless episode of care by improving multi-disciplinary team (MDT) communication and reducing the number of interruptions to nursing staff, thereby increasing time to provide direct patient care. The board also identifies what tests the patient has undergone or are outstanding while also addressing data protection considerations by using the three second visualisation rule.

Feedback In identifying improvements, qualitative and quantitative approaches are used. A survey was carried out to determine if the board is useful or if it gives the MDT the necessary information. Feedback has indicated that the board works very well, particularly in communication; can track progress and handover while lessening the need to seek

+ Members of the staff in the Midlands Regional Hospital, Tullamore. The ‘Patient Status at a Glance’ Board was introduced in 2012.

information with far less need to interrupt the nurse. MDT members interviewed included physiotherapy, bed management, medical, nursing and catering staff.

Results Quantitative measures include compliance with the accuracy of completion of the board. To date, compliance measures of

60 per cent on one episode initially, to an average of 100 per cent on subsequent measures have been achieved. Future quantitative measures include a repeat measure of the number of interruptions to the nurse within a 12-hour period. The team anticipate a significant reduction on previous results, which indicated that over 50 per cent of interruptions related to patient status.

CASE STUDY: Coombe Women and Infants University Hospital

+ Members of the team from the Coombe at the Lean Healthcare awards in the UK in February – the hospital was commended by the judging panel of ‘Lean’ experts for their innovative improvements and progress with the project.

The Coombe Women and Infants University Hospital is a tertiary referral centre for maternity neonatal and gynaecology patients, with approx 9,000 births per annum. Implementation of the Productive Ward began on a 36 bed post natal ward in 2012 where occupancy is 88 per cent; the average length of stay is 36-48 hours and the average number of discharges per day is 15 mothers and babies.

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The Well Organised Ward Many improvements have been introduced, including re-arranging stocks, clinical diagnostic equipment and medication management. MDT opinions were accommodated using process mapping. A total of 39 hours per week has been reassigned for direct care as a result. Knowing How We Are Doing Staff organise patient/staff satisfaction

surveys, monitor patient compliments and complaints, and clinical risk reports. Regular audits are carried out by the multidisciplinary team. A quiet time initiative was introduced in November 2012, in response to our patient satisfaction survey. This quality initiative provides protected rest periods for mothers and babies and allows for more skin-to-skin contact with mother and baby, patient satisfaction and reduced risks. There has been an instigation of a discharge KPI (15 per cent of mothers and babies discharged by 10.00am) leading to identification of inefficient processes which were streamlined. As a result, seven beds per month were saved. An audit showed that recording of infant oxygen saturation levels (pre-discharge) took between five to 22 minutes. Monitors and probes were changed, leading to a saving of 21 minutes.

Achievements The productive ward achievements resulted in more time released to care, more patient and staff satisfaction, and financial savings.

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44 Health Matters

Treatment abroad scheme

Life Saving Operation for Toddler Laura The Treatment Abroad Scheme provides access to public hospitals in Europe for patients who cannot access the treatment they need at home. Health Matters looks at the case of toddler Laura O’Gorman, who received a liver transplant in Britain last year, and explains how the Treatment Abroad Scheme works.

aura O’Gorman from Dublin underwent a life-saving liver transplant operation in London last August when she was just 19-months-old. Her parents Aoife and Greg, both from Dublin, were told by a team at Our Lady’s Hospital, Crumlin in February 2012 that their daughter would need the vital operation. Laura, now two years old, was diagnosed as having bilary atresia soon after her birth: a blockage in the ducts (tubes) that carry a liquid called bile from the liver to the gallbladder. Surgery to rectify the problem was not successful and Laura’s health declined rapidly. Before her life-saving surgery, Laura attended Our Lady’s Hospital, Crumlin twice weekly. “We were told we would have to bring Laura for a two day long assessment in London in March 2012, just six weeks after being referred by Crumlin Hospital,” said mum Aoife.

Suitable Donor Laura’s father Greg has the same blood type as his daughter and it was hoped that he would be a suitable donor, but this was not to be. An adult’s liver regenerates, which means it can be used in the context of a live donor. It was Aoife’s sister Deirdre, a GP, who was the suitable donor and on August 12 all four travelled to King’s Hospital, London for Laura’s and Deirdre’s surgery. “We weren’t superstitious about Laura having the surgery on Friday the 13th. Laura was in hospital for four weeks and was seen by the medical team in Crumlin Hospital within 24 hours of returning home. The King’s Hospital Outreach team followed up with Laura several times after her surgery. Emotional Rollercoaster “We were going through an emotional rollercoaster as we watched our child’s chances of survival getting slimmer the longer she was on the transplant list. Emotionally it was the most difficult thing I’ve ever done.”

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+ Laura O’Gorman in London, two weeks post-transplant.

Laura continues to attend Our Lady’s Children’s Hospital regularly. As a result of her transplant, Aoife and Greg have set up the support group Children’s Liver Disease Ireland. For information, log on to www.cldi.ie Aoife O’Gorman says the Treatment Abroad Scheme (TAS) was extremely helpful to the family while they were in London. “TAS made sure the system was in place, making our path through the medical system so much easier. “They looked after arranging so much for us. We didn’t really have to worry about financing the treatment in King’s Hospital as all that was taken care of by the TAS.”

Treatment Abroad Scheme The scheme is administered by the HSE in Kilkenny and provides access to public hospitals in Europe (EU/EEA member states) for patients where the treatment is not available in Ireland. The HSE funds acute hospital inpatient care for patients here, but there are occasions when the treatment a patient needs is very specialised and is not available in Ireland. Such referrals are made via the TAS (E112) form and are subject to an application

process and prior approval by the HSE. For over the past three decades and more, E112 forms have been issued to patients travelling within Europe to receive treatment that couldn’t be provided to them in Ireland. The TAS has a simple application process: the application is mainly completed by the Irish referring consultant and submitted along with a clinical letter to the TAS office for processing. The decision process takes a maximum of 20 working days, but cases are often decided upon well in advance of this timeframe. TAS can issue E112 forms for patients requiring multiple visits where their referring consultant outlines the need for specific episodes of care outside the State. When a patient has received his/her treatment, care reverts to the Irish referring consultant for ongoing management. In 2012, the TAS office processed in excess of 800 applications. TAS acknowledges the invaluable support of the Irish Air Corps and the Irish Coast Guard Service. More information on the scheme is available on the HSE website or by phoning 056 778 4551.

13/3/13 16:20:41

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Footnote: Plant sterols have been shown to lower LDL cholesterol. High Cholesterol is a risk factor for developing coronary heart disease.

The benefits of plant sterols are achieved by consuming 1.6 - 2.4g daily; consuming more than 3g per day should be avoided. A reduction of 7-10% can be achieved in 2-3 weeks. Consume as part of a balanced diet rich in fruits and vegetables to maintain carotenoid levels. References: 1. Nutrition Guidelines for Heart Health - Irish Heart Foundation (2007). 2. Plant Sterols and Blood Cholesterol. Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies. The EFSA Journal (2008) 781, 1-12 3. Katan MB et al (2003) Efficacy and Safety of Plant Stanols and Sterols in the Management of Blood Cholesterol Levels. Mayo Clin Proc; 78: 965-978

Postgraduate Diploma/MSc in Bereavement Studies The Irish Hospice Foundation in association with the Royal College of Surgeons in Ireland This part-time programme is designed to equip participants with an understanding of bereavement and loss from theoretical and practice perspectives. Successful completion of six modules will result in the award of Postgraduate Diploma in Bereavement Studies. 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. Please note this is not a counselling qualification. Closing date for application: May 3, 2013 For further information contact Maura Dunne, Education Administrator, Irish Hospice Foundation, Morrison Chambers, 32 Nassau Street, Dublin 2. Tel: 01 6793188 Email: maura.dunne@hospicefoundation.ie. Website: www.hospicefoundation.ie; www.bereaved.ie or www.rcsi.ie

www.zerochol.ie

Professional Certificate in Children and Loss (Level 9) (September 2013 â&#x20AC;&#x201C; March 2014) This training course is recommended for professionals who work with children or adolescents experiencing loss such as; teachers, social workers, social care workers, psychologists and counsellors. It aims to equip practitioners with an informed understanding of loss and how best to support grieving children and adolescents. The training combines both didactic and experiential learning and covers topics such as; working with traumatic loss, loss in families, group work, and using the creative arts. This part-time course meets monthly over a seven-month period. Closing date for receipt of completed applications is Friday, 3rd May 2013. Applicants must hold an honours primary degree. Consideration will be given to applicants without a primary degree who can demonstrate equivalent educational or work experience in a relevant area. For further information or if you would like to be added to the mailing list for this course please contact: Iris Murray Irish Hospice Foundation Morrison Chambers, 4th Floor, 32 Nassau Street, Dublin 2. Tel: 01 679 3188 Fax: 01 673 0040 Email: iris.murray@hospicefoundation.ie Website: www.hospicefoundation.ie and www.bereaved.ie or www.rcsi.ie

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46 Health Matters

Commercial FEATURE

Leading the Care Revolution in Ireland Bluebird Care has revolutionised the way care is delivered in Ireland by concentrating on high quality customer service, whilst at the same time upholding the very best in professional care service both in the home and in the community. With 18 offices nationwide they offer a unique service of tailored care visits from 15 minutes to full live-in support. High quality, advanced enablement packages are provided in the community for people of all ages and with very diverse needs. professional development Bluebird Care social care workers lead out in terms of their expertise and abilities. All social care workers at Bluebird Care are FETAC qualified and this year Bluebird Care developed a partnership with Irish Times Training to deliver accredited training on an ongoing basis. Bluebird Care also works with eTraining ensuring continuous professional development for all staff.

Total Flexibility According to Laura Liney, National General Manager of Bluebird Care, “everybody has different needs and abilities, and that is something we are very conscious of. We pride ourselves on offering an individual, personalised service which also offers value for money. Re-enablement plans are personcentred. There is total involvement from the individual and/or family members. Many of our social care staff have third level degrees or have/are currently undertaking a suitable FETAC accredited training course which is relevant to their working experience and all staff must complete monthly continuous professional development in appropriate learning and up-skilling.

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“Our ethos is simple – we help you or a loved one remain at home and we have the expertise to facilitate this.” Quality and Accreditation “We are delighted with our recent Q Mark of Quality from Ireland’s leading certification body,” says Eddie O’Toole, Operations Director. Focusing on quality standards coupled with continuing

Staying at Home Remaining in your own home as you get older or as you cope with disability, or simply returning to your community after illness, is what most people prefer to do. With the right help and qualified support this is possible for the majority of people. Bluebird Care delivers services that allow people to do just that, for customers of all ages and abilities and on a nationwide basis. “For those who require live-in care or those with greater needs we work with individuals and families to design an enablement package to suit,” says Lorna Liney. “We pride ourselves on offering an individual, personalised service, which also offers value for money.” With a nationwide network and a fully qualified team Bluebird Care will visit you in your own home to assess your individual needs. Bluebird Care is a HSE-approved provider for enhanced homecare packages 2012 (services for older persons). To find your local Bluebird Care office, log onto www.bluebirdcare.ie, call us on 0818 227 052, or email: info@bluebirdcare. ie. You can also find Bluebird Care on Facebook and Twitter.

13/3/13 16:20:44

HealtH Matters 47

CanCer

sCreeninG anD PreventiOn aDviCe fOr wOrLD CanCer Day world Cancer Day, held this year on february 4th, aimed to increase awareness and education about cancer worldwide.

he National Cancer Control Programme (NCCP) advises that your risk of getting cancer is greatly reduced if you have a healthy lifestyle. the NCCP advises people not to smoke, to avoid other people’s smoke, keep active, reduce alcohol intake and eat at least five portions of fruit and vegetables a day.

be Fully inFormeD about breast screening BreastCheck aims to find breast cancer in women aged 50-64 at the earliest possible stage. these women are invited for a free mammogram every two years. In recent years, the numbers of women attending has been slowly dropping. BreastCheck encourages all women aged 50-64 to attend for their mammogram when invited. there has been much debate recently about the potential over-diagnosis of non-invasive breast cancer, known as ductal carcinoma in situ (DCIs) through screening. as digital mammography improves, so does the detection rate. However, it is impossible to tell which DCIs will develop into an invasive cancer and which will not. as a result, every woman who has a DCIs diagnosed is offered treatment. BreastCheck would encourage any woman who has a concern about possible over-diagnosis to contact them on freephone 1800 45 45 55 for more information, or view an information sheet at www.breastcheck.ie. women ageD 45+ at risk by not having a smear test CervicalCheck became available to women aged 25 to 60 in september 2008. since then almost 1.3 million smear tests have been taken and more than 805,000 women have had at least one test. Worryingly, CervicalCheck’s screening statistics have shown that too few women

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being cancer aware – know the abcs the NCCP has four warning signs that you should look out for. these are: � abnormal lump or swelling � Bleeding that is not normal � Changes in your body functions such as losing weight without trying, a change in your bowel movements or a persistent cough or hoarseness � skin changes including moles that are changing or sores that won’t heal. If you have any of these warning signs you should contact your family doctor. the good news is that in most cases, these signs are not cancer. You know your own body best. so if there is anything that is not normal for you, go to your GP without delay.

aged 45 and over are having their smear test. Women aged 25 to 44 should have a smear test every three years and women aged 45 to 60 should have one every five years. there are over 4,600 GPs and practice nurses nationwide who can take a smear test as part of the CervicalCheck programme. Details of all smeartakers are available on www.cervicalcheck.ie or by calling freephone 1800 45 45 55. bowel cancer is the seconD most common Form oF cancer Bowelscreen – the National Bowel screening Programme is for men and

are you uP to Date with your Free smear test? european Cervical Cancer Prevention Week (January 20 to 26) saw women aged 25 to 60, and in particular those aged 50 and over, encouraged to ensure they are up to date with their free smear test. a lower proportion of women in this age range attend for cervical screening. Women aged 25 to 60 should have a smear test every three to five years, depending on their age. For details of all registered smeartakers you can visit www.cervicalcheck.ie or call CervicalCheck on freephone 1800 45 45 55.

women aged 60 to 69. Bowel screening is a simple test that is done in the home every two years. the test looks for tiny amounts of blood in a bowel motion (also called a stool) that is not visible to the eye. Blood in the stool can be due to a number of causes. But it can also be a sign that something might be wrong. Bowel screening may also find other changes in the bowel such as polyps. these are small growths that are not cancer, but if not removed they might turn into cancer. In time, the programme will be extended to men and women aged 55 to 74.

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48 Health Matters

Global Health

Irish-Sudanese partnership brings major improvement in maternal outcomes The Omdurman Maternity Hospital in Sudan, where just over 100 babies are born every day, has successfully managed to reduce its maternal mortality rate by 86 per cent and has seen a 50 per cent drop in stillbirths and early neonatal deaths.

+ Dr Lisa Clarke, Neonatal Nurse Practitioner, demonstrating the fall in maternal mortality at OMH over the last decade.

ten-year partnership between Irish and Sudanese health service staff has contributed to the remarkable achievement. In Sudan, some 80 per cent of babies are born at home, yet over 36,000 babies are born each year in Omdurman Maternity Hospital which is the largest maternity hospital in Africa. This is equivalent to the combined annual births in Cork University Maternity Hospital and the three Dublin maternity hospitals, or over half the number of babies born in Ireland each year. Omdurman Maternity Hospital is located in the old city of Omdurman in Khartoum. Families sit in the shade under trees outside the busy hospital waiting for new babies to be born. Many women arrive at the hospital with serious complications. Medications and local anaesthetics are limited. Very few of the women have an epidural during delivery and new mothers are discharged quickly, some as early as two hours after giving birth. Women start breastfeeding very quickly after birth and

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+ Hana Awad, Library Manager, Omdurman Maternity Hospital. Technology enhanced learning has great potential in further developing professinal education links between Ireland and Sudan.

many of the newborns are immunised before they leave the hospital.

Improving Care Consultant Neonatologist at Cork University Maternity Hospital Professor Tony Ryan, who has been involved with the partnership since the beginning, is adamant that the dramatic improvement in patient outcomes in the hospital is down to the changes made by the staff at the hospital who set their own goals and objectives. Dr Murwan Omer, Clinical Director at Omdurman Maternity Hospital and his medical team took on the challenge of improving care and reducing deaths. They introduced 24-hour specialist coverage on site to ensure that all women received immediate emergency interventions, they introduced new protocols to ensure that every woman with a complication like postpartum haemorrhage is treated according to international best practice, and daily audit meetings were introduced.

â&#x20AC;&#x153;Very few of the women have an epidural during delivery and new mothers are discharged quickly, some as early as two hours after giving birth.â&#x20AC;? Contribution of HSE staff Multidisciplinary educational visits to Sudan began in 2002 with the establishment of a National Neonatal Resuscitation Programme in Khartoum University by Dr Sami Ahmed, Consultant Paediatrician at the Bon Secours Hospital in Cork, Professor I Salah and Professor Tony Ryan.

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Health Matters 49

Global Health HSE doctors and staff have helped in a number of ways since that time. Notnew but functioning beds, warmers, incubators and other equipment were sent to Omdurman Maternity Hospital after the amalgamation of three maternity hospitals in Cork in 2007. Over 20 staff members from CUMH took part in ten multi-disciplinary educational team visits to the hospital, where they facilitated workshops on newborn resuscitation, obstetrical emergencies and other educational sessions. Midwives, midwives' tutors, neonatal nurses, consultants, EMTs and biomedical technicians travelled to Sudan to share their expertise. Good working relationships between the Irish staff and their Sudanese partners developed over time. The institutions involved in the collaboration included the Departments of Obstetrics, Gynaecology and Paediatrics at the University of Khartoum; the Departments of Obstetrics and Gynaecology, Neonatology and Midwifery and Nursing at Cork University Maternity Hospital, and the HSE South ambulance service. Cork Fire Brigade was also involved in fitting out an ambulance for Omdurman Maternity Hospital.

Irish Aid Grant In 2005 the project benefited from a s165,000 grant from Irish Aid, which was matched by the Sudanese Ministry of Health for structural investment in the hospital. A new special care baby unit, a new maternity wing and a new general laboratory were built. Other measures were put in place aimed at improving areas such as waste management, infection control and information technology. Evidence-based changes in practices Quality improvement is the combined and unceasing efforts of everyone – healthcare professionals, patients and their families, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better systems performance (care), and better professional development (learning). The data-driven system changes put in place by the Omdurman Maternity Hospital project team focused on implementing a number of evidence-based practices in the

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management of pre-eclampsia, maternal haemorrhage, multi-disciplinary teamwork and better communication. Rapid access to supplies of safe blood is critical and blood transfusion services were improved at the hospital when the laboratory was built. Although maternal mortality in OMH is now one tenth that of national Sudanese rates, it is still ten times higher than in Ireland. The same basic principles of systems improvement, quality control and governance as outlined in the HSE Patient Safety First Initiative apply to both countries if lives are to be saved and morbidity reduced.

able to make a difference that really matters in terms of human lives saved. The support and connections between Cork and OMH has helped to keep Sudanese doctors in Sudan, and the international links and friendships have had a deep impact on the Irish healthcare staff involved in the joint project. Improving quality and saving lives is our theme for the future as we continue to build upon our previous commitments to respectful collaboration, partnership, and excellent, safe and affordable healthcare for women and children in Sudan.”

North-South hospital partnerships Ireland has a long tradition of developmental assistance to sub-Saharan Africa. This project shows that important health benefits can accrue when the HSE and Irish Aid work together in supporting North-South hospital partnerships. Professor Tony Ryan added: “This project shows how a small group of committed individuals from Sudan and Ireland were

“Quality improvement is the unceasing efforts of everyone to make changes leading to better outcomes.”

Helping Babies Breathe Helping Babies Breathe is an educational programme designed to teach neonatal resuscitation techniques in developing countries. The first minute after birth is vital. Most babies who do not breathe within the first 60 seconds will die but babies who breathe or are helped to breathe have an excellent chance of surviving. When a baby is born in the Sudan, often the midwife cuts the umbilical cord and begins delivering the placenta. By the time the midwife notices that a baby is not breathing, it may be too late to save his or her life. The Helping Babies Breathe initiative is teaching the Sudanese midwives to turn their attention to the baby’s breathing in the first critical 60 seconds of life – the so-called 'golden minute.' The midwives learn how to use a bag/mask to help babies breathe on their own. In January 2013, Professor Tony Ryan and Dr Sami Ahmed spent a week delivering the Helping Babies Breathe training programme to 80 paediatricians and senior health midwives from across Northern Sudan. They in turn will train hundreds of village midwives on neonatal resuscitation. Overall there are 14,000 midwives in Sudan and of these, some 1,000 midwives are trained to date. At the conclusion of the training, 1,000 bagmask devices from Irish Aid were distributed to healthcare teams from each of the 17 states in Northern Sudan. This national Train the Trainer programme is sponsored by Irish Aid and is supported by the health ministries in northern Sudan. Professor Ryan describes the project as having huge potential to help babies survive in rural areas. He says: “These midwives are amazing women. They came to these courses wide open to new knowledge and new practices. They know that things like this can make a difference. I think we’re going to see significant improvements in the country as a whole and not just in specific hospitals or specific regions. It’s about getting to a place where every baby who is born has a chance to be helped to breathe in the first minute of life.”

13/3/13 16:20:48

50 Health Matters

clinical programmes

IMPROVING QUALITY, ACCESS AND VALUE The new HSE National Director of Clinical Strategy and Programmes, Dr Aine Carroll, says her focus for her tenure is the consolidation of the achievements of the programmes to date and building on the successes to date by implementation of the programmes, in partnership with local teams, to spread effective changes and take a consistent national approach to improvement – being cognisant of the diversity of Ireland.

he programmes will take a cross programme collaborative approach to local implementation of best practice using a systematic, collaborative and informationbased approach. The aim is to improve services and provide better value for money and value for patients and families. The Clinical Strategy and Programmes Directorate was established to improve and standardise patient care in the health system by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to patients.

encompassing a wide spectrum of healthcare ranging from disease prevention to intensive care, were established in the three years up to 2012. The first phase of the programmes – joint initiatives between the HSE and the professional bodies – involved frontline clinicians redesigning clinical services with the objectives of improving access to services, improving quality and improving value for money. While the principle of optimum patient flow and pathway integration needs to be embedded in all programme solutions, it is clear that the programmes have

developed to such an extent that it is now necessary to group programmes to enable and foster collaborative work practices across closely related programmes and to allow for appropriate and effective programme management. She explains: “There are in excess of 30 programmes and they are a very diverse group,” she explains. “There are some diagnostic specific programmes like the stroke, asthma or epilepsy programmes and then there are some programmes that are much more overarching, like the acute medical, rehabilitation and surgical

“It is now necessary to group programmes to enable and foster collaborative work practices across closely related programmes”.

Dr Aine Carroll, who took up her position in November 2012, is a Consultant in Rehabilitation Medicine, immediate past Chair of the Medical Board of the National Rehabilitation Hospital and Senior Clinical Lecturer at University College Dublin. Prior to her appointment, Dr Carroll was the Clinical Lead of the Rehabilitation Medicine Programme.

Good Governance More than 30 clinical programmes,

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52 Health Matters

clinical programmes programmes. Then you also have some initiatives like the Outpatient Parenteral Antimicrobial Therapy (OPAT). They are diverse in what they are and what they do. All of the programmes have the same overarching themes of quality, access and value, yet how they go about that is quite different,” she says. “So for the next couple of years and especially for the first part of my tenure, the emphasis is on re-structuring the programmes. We need to bring them under an organisational structure that allows them to develop their guidelines, pathways and care bundles but in a much more integrated way.”

Multiple conditions Dr Carroll says that there will also be an emphasis this year on chronic disease management. Treating patients with multiple health conditions involves different care bundles for different conditions. Dr Carroll explains: “One of our priorities for this year is to look at individuals with multiple morbidities and come up with more integrated ways to manage them. A cross-programme collaboration is looking at developing a framework for the management of long-term conditions. “Our priorities are to facilitate the development and implementation of those programmes that are currently in place. Chronic disease management is going to be extremely important and we’re also continuing the good work of the programmes in terms of ensuring that clinical leadership defines how healthcare should be provided in this country.” Implementation Dr Carroll acknowledges that some of the programmes are at a later stage of development than others, but is adamant that they have all delivered a huge amount in a short period of time. She recently attended the national launch of the early warning score system which was developed through the collaborative work of frontline clinical staff, patient groups and key patient safety experts led by the HSE’s Acute Medicine Programme. “There’s no other country in the world that has a national early warning score system,” she says. “We are the first. Other countries are trying to develop such an initiative but Ireland is the first country to launch. The health service here tends to attract negative

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publicity at times but this is a real cause for celebration. It is something to be very excited by and very proud of. It will have a direct impact on patient outcomes.”

“Our priorities are to facilitate the development and implementation of those programmes that are currently in place.” Challenges On the challenges that lie ahead, Dr Carroll says one of the biggest challenges has been the amount of change within the health system. She points out that the temptation could be to wait and see how things pan out – but says this is not an option: “We don’t have the luxury of time. Our patients don’t have the luxury of time. We need to crack on and implement good quality patient care. We know we’ve got the why and the what and now it's time for the how – how will the system respond to those recommendations. The ISD and CSP and QPS Directorates are working closely to develop implementation plans to make the recommendations a reality whilst at the same time being cognisant of the current financial situation. It’s very challenging and it’s not going to be easy – but there’s always a way and it’s a matter of finding a way. It’s a work in progress but I think once people get used to doing things in a slightly different manner it will have a snowball effect.” Journey of Improvement Dr Carroll feels strongly that we need to have a culture where people are learning from mistakes and constantly seeking to improve things all of the time. “There’s no healthcare system in the world that’s immune to things going wrong and mistakes, but if we’re monitoring and collecting the right information. It will alert us that something hasn’t gone right and we can look back and find out: why did that not go right? We need to acknowledge

and learn from our mistakes so we’re doing everything in our power to make sure it doesn’t happen again.”

Mindful organisation She also feels strongly that we shouldn’t have a ‘blame’ culture, but we need a ‘mindful’ organisation where people will be much more ready to be forthcoming with learning from near-misses, or even situations that might not have had an adverse outcome – but perhaps could have been done differently. “We need to have the structures in place so people feel they are working in a blameless or ‘mindful’ culture – in the US they don’t even like to use the word blameless – a ‘mindful’ culture is one that is constantly alert to the potential of risk, and mindful of the tiny things that can happen. “We know why serious incidents happen. We need to have the structures in place so that people feel they have a blameless or mindful culture. Everybody has to feel comfortable about raising things. I’m used to working with people in multi-disciplinary teams and everybody is encouraged to be an active participant in that. “We’re all much more likely to be comfortable raising things knowing we’re not going to have someone shouting at us. That’s a ‘mindful’ organisation – even the term whistle-blowing is not what we want. We don’t want someone with an image of someone blowing a whistle and pointing a finger. That’s not what it’s about. It just makes people much less likely to report adverse incidents and that makes it much less likely for an organisation to change for the better. We want an organisation to pick up early on things that can be changed so there are fewer adverse outcomes.” Invested in programmes Dr Carroll is adamant that people really are invested in the programmes, and not just paying lip service: “I haven’t heard any resistance to the programmes at all. I’ve only heard positive things, which is extraordinary. It is asking a lot of people. We are asking people to change and change is very difficult, very difficult. I really admire the determination and drive of the people involved. That’s from the national clinical leads right down to people in local hospitals and local services who just want to do their job and do their job better. Everyone wants to make things better.”

13/3/13 18:20:03

Health Matters 53

update

Crisis Pregnancy Programme 1

1 + Roisin Guiry, HSE Crisis Pregnancy Programme and the Think Contraception team at the launch of Sexual Health Advice and Guidance (SHAG) fortnight in UCD. 2 + Winner of the Think Contraception ‘Get Protected’ game competition at the NUI Maynooth Christmas party in December. The Think Contraception team were out and about distributing protection packs on the streets of Cork, Dublin, Galway and Kilkenny and at a number of college parties as part of the Think Contraception ‘The 12 Safer Sex Days of Christmas’ campaign. 3 + Students of the Crisis Pregnancy Counselling Skills certificate course pictured at the graduation ceremony in NUI Maynooth, December 2012. Five students graduated in abstentia. The course is funded by the HSE Crisis Pregnancy Programme. 4 + ‘Sex in Ireland: Recent Research and Policy Implications’ seminar funded by the Irish Research Council and HSE Crisis Pregnancy Programme. Pictured at the seminar, L-R: Prof. Richard Layte, ESRI; Prof. Kaye Wellings, London School of Hygiene and Tropical Medicine; Dr. Ashling Bourke, Irish Research Council for the Humanities and Social Sciences (IRCHSS) research team; Dr. Caroline Kelleher, IRCHSS research team; Dr. Karen Morgan (Principal Investigator), RCSI; Maeve O’Brien, HSE Crisis Pregnancy Programme; Gemma Smith, IRCHSS project team; Dr. Derval Igoe, HSE Health Protection Surveillance Centre; and Prof. Roger Ingham, University of Southampton and Director of the Centre for Sexual Health Research.

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54 HealtH Matters

commercial feature

50 years In IrelanD Colin Edwards, head of national medicine and general manager on Boehringer ingelheim’s irish operation, its 50th anniversary and plans for the future.

 Colin edwards

oehringer Ingelheim is a familiar name in healthcare. With over 44,000 employed worldwide, the family-owned business has a 45-strong Irish operation, based in south Dublin. “In Ireland, we are a sales, marketing and clinical research organisation,” explains Colin edwards, Head of National Medicine and General Manager. “We have sales representatives who visit doctors and other healthcare professionals to explain our products; they’re working in both primary care and secondary care. We have a clinical research team which is conducting research in a range of therapeutic areas including oncology, virology, diabetes and respiratory medicine, and we have marketing executives.” among their range are products for chronic obstructive pulmonary disease, an angiotensin receptor blocker (along with several combination products) for hypertension and cardiovascular protection. another significant product is an anticoagulant for the prevention of embolism after hip and knee surgery, and for stroke prevention in atrial fibrillation. they also have a range of other cardiovascular products such as a thrombolytic agent. Boehringer Ingelheim and eli lilly have entered a global

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alliance on diabetes products and the first product has been launched by this alliance and was developed by Boehringer Ingelheim. “We’re supplying quite a range of products, most commonly in cardiovascular, metabolic and respiratory medicine. We’re developing some new products in diabetes, respiratory medicine, oncology and hepatitis C and these are at the research and development stage now. We’re optimistic,” he says. edwards is a biochemist by training, and started his career as a professional research scientist working in an academic life sciences environment. He moved to the pharmaceutical industry in the mid-1980s to learn about business and to work in a science and research-based enterprise. “about 25 years ago I started working for Boehringer Ingelheim in Ireland. I first started working in the development of our clinical research programme in Ireland, which hadn’t existed up to then. so for a lot of my career I’ve worked in clinical research for Boehringer Ingelheim in Ireland, but I’ve also managed projects across europe, particularly for our antihypertensive drugs. about three years ago I was offered the opportunity to also take on the role of general manager in Ireland and responsibility for national medical affairs and have been in this position since autumn 2009.”

50th annIversary last year the company marked its 50th anniversary in Ireland by launching their ‘Making More Health’ project in partnership with ashoka, a global organisation supporting social entrepreneurs. In Ireland, Boehringer Ingelheim provides practical support to MyMind, a community-based mental health organisation. What are the company’s plans for the future? “If you asked people what we were known for in terms of products, most people would say Boehringer Ingelheim is

a respiratory and cardiovascular product company. Now we have launched our first diabetes product in late 2011. We will be launching other diabetes products over the medium term. We’re working on an alliance partnership with eli lilly worldwide – they have a long history working with diabetes.” “the other thing that’s also exciting is that we have three molecules in an advanced state of development in oncology. We hope to launch the first in late 2013 or early 2014, depending on licencing, with others to follow – we’re getting into a therapeutic area that we’ve not been in before, and we’re also developing two products in hepatitis C. We are continuing to develop our respiratory portfolio. another product looks like it may have potential for treating interstitial lung fibrosis, a very difficult condition to treat. We’re moving into new areas,” he says.

“we’re supplying quite a range of products, most commonly in cardiovascular, metabolic and respiratory medicine. we’re developing some new products in diabetes, respiratory medicine, oncology and hepatitis c and these are at the research and development stage now. we’re optimistic.”

13/3/13 16:25:09

Health Matters 55

primary care Kerry Traveller Women’s Health Fair A Success

+ The Christmas fair at Castleisland.

The Kerry Travellers’ Health and Community Development Project Team,

in partnership with the HSE primary care teams, organised a Traveller women’s health and beauty Christmas fair in Castleisland in December. Over 50 Traveller women from Kerry attended the event. The focus was on women’s health and the dangers of tanning injections and the sharing of needles. The team of Traveller Community Health Workers (Bridget McCarthy, Helen O’Driscoll, Breda Quilligan, Doll McCarthy, Anita Quilligan and Mikey McCarthy), supported by

Mary Kiernan, Health Team Co-ordinator and various HSE health professionals on the primary care teams, were actively involved in planning the event. The fair consisted of health information and beauty stands. The stands covered topics such as breast checks, healthy eating, diabetes, BMI, physiotherapy, menopause, sexual health including contraception and sexually transmitted disease awareness, damage caused by smoking and how to deal with stress in ten easy steps.

Primary Care Centres in Cavan Officially Opened

+ Alex White TD, Minister of State with responsibility for Primary Care meets Louise Clarke, Senior Physiotherapist in Bailieborough Primary Care Centre with (left) Jane Waugh, Senior Occupational Therapist and (right) Mary Tully, Primary Care Team Coordinator.

Primary care centres at Bailieborough and Drumalee, the Community Services Centre at Cootehill and the primary care team at Darley Primary Care Centre were recently officially opened and launched. Primary care teams which operate from the recently refurbished Bailieborough and

Darley PCC, and the purpose-built Drumalee PCC include public health nursing, speech and language therapy, physiotherapy and occupational therapy. The staff work alongside social workers and psychologists to provide services to local people. A mental health day care centre is also located in Bailieborough PCC, which receives referrals from the Community Rehabilitation Service, Cavan Community Mental Health Team and Psychiatry of Old Age. The centre is part of the Assertive Outreach Team, which provides a home-based service to people living in Cavan. A clinical co-ordinator, consultant psychiatrist, senior registrar,

nursing staff, occupational and behaviour therapists provide mental health day care services from this centre. Drumalee PCC also accommodates mental health community services and a new state-of-the-art dental department. The dental department caters for children in 30 primary schools and four secondary schools in Cavan, extending to the borders with Leitrim, Longford and Westmeath. The Community Services Centre in Cootehill is a facility that provides day services for older people. A purposebuilt audiology suite is also located in this centre, which provides a service to children and adults in the Cavan/Monaghan region. All babies referred by the newly-established newborn hearing screening programme operating at Cavan General Hospital and Our Lady of Lourdes Hospital are followed up at this facility for further treatment.

Ballyfermot and Palmerstown One-Stop Shop Ballyfermot and Palmerstown Primary Care Centre opened in 2012 to serve the local communities of Ballyfermot, Palmerstown and Cherry Orchard. Designed by A&D Wejchert Architects, the building acts as a ‘one-stop shop’ in facilitating the development of an integrated approach to care delivery involving the community, GPs, HSE professionals and other service providers. The complex consists of a three-storey

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primary care and mental health centre and there is also a single storey creche on the site, which is run by the Daughters of Charity. Services operating from the new building include public health nursing and home care attendants, GPs, social work, physiotherapy, occupational therapy, speech and language therapy, dental, dietician, community welfare officers, smoking cessation, footwear clinic and mental health.

Additional services will be provided on a sessional basis from bookable rooms. The centre is unique in that it offers a primary, secondary and tertiary service all from one campus. There is a mental health day hospital and day centre along with extensive psychiatric services delivered from this building. This facilitates the primary care teams and encourages working more effectively in a multidisciplinary way.

13/3/13 16:25:11

56 Health Matters

primary care WellBeing Campaign Launched Dr John Connolly, Secretary of the Irish Association of Suicidology, officially launched a wellbeing campaign in the Mayo County Council Offices in January. The project aims to encourage all of us to look after our mental health. It highlights the importance of listening to others and also talking to others who can support us in our community. The campaign is led by the Mayo Suicide Prevention Alliance, which comprises of organisations and groups working in the area of mental health and suicide prevention. Speaking on behalf of the Mayo Suicide Prevention Alliance, Mary O’Sullivan, HSE West, said: “This project would not have been possible without the very generous funding received from Mayo County Council. We are also very grateful for a further donation from the Living Links Mayo Tri Fundraising Group. It shows the huge good will, community spirit and value placed on promoting positive mental health and wellbeing within the county. By

+ Mayo Suicide Prevention Alliance members: Front Row, L-R: Liz McHale, HSE and Choose Life Reach Out; Rose Conway-Walsh, Erris Community Development Project; Mary O’Sullivan, HSE (Chair); Marina Tuffy, Psychotherapist representing LGBT Community; Jacinta Lavelle, HSE and Choose Life Reach Out; Therese Ruane, Mayo Intercultural Action and Mayo Community Platform. Middle Row, L-R: Breda Ruane, VEC; Kate Donnelly, Aware; Maire Ni Dhomhnaill, Family Centre Castlebar; Bina Munnelly, VEC. Back Row, L-R: PJ Rainey, HSE; Laurence Gaughan, HSE; Dolores O’Boyle, Employability Service Mayo and Choose Life Reach Out; James Ryan, representing families bereaved by suicide.

us all working together, we can make a difference.” As part of the project, a flyer called ‘Tips for Keeping Positive – Mayo Be Well’ is being distributed. It lists practical tips to help people stay well in these challenging times. Some are to do with

looking after physical health such as eating well, getting a good night’s sleep and getting some fresh air every day. Others suggest ways in which to deal with challenges in our lives, such as worries. It encourages people to listen to others and talk about problems.

Newborn Hearing Screening Programme Rolled Out in West During 2013, the national Newborn Hearing Screening Programme, which offers all babies born a routine hearing screening test, will be rolled out in HSE West. The test will be available to babies born in Letterkenny General, Sligo Regional, Mayo General, University Hospital Galway, Portiuncula and the Midwest Regional Maternity Hospitals.

It’s a quick and simple check of the baby’s hearing. The test is undertaken by trained screeners employed by Northgate Information Services, who have been contracted by the HSE to provide this service. Any necessary follow-up will be undertaken by the HSE audiology (hearing) services. Family supports will

be available, as appropriate, from the Department of Education and Skills Visiting Teacher Service and DeafHear, a voluntary organisation that provides a range of services to deaf and hard of hearing people and their families. The commencement of the programme in HSE West in 2013 will complete the national roll-out of the service.

MAYO MEN ON THE MOVE TO A HEALTHIER LIFESTYLE Many men are feeling fitter, looking better and enjoying being more physically active as a result of the Men on the Move activity programme. The programme has helped participants to become more physically active, increase fitness levels, lose weight, have more energy and improve their overall health and wellbeing. Last year over 100 men took part in the Men on the Move physical activity programme in Ballina, Claremorris and Westport. Over 16 weeks, the men met twice a week in the three towns to take

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part in the programme. A leader in each town led the group and encouraged men to take part in a range of activities including walking, running, cycling and other activities. The men were aged between 35 and 75. A recent evaluation of the programme undertaken by Health Promotion Researcher Lucia Canavan, which was launched in Claremorris at the end of January, showed that these men have increased their physical activity levels, lost weight, reduced their BMI (body mass index), improved their fitness levels and overall lifestyle.

Men who have participated in the programme really enjoyed it. One participant said “I have far more energy and my health is better… my quality of life is great!” Another commented on his improved self confidence: “Once you get a bit fitter… the self-confidence... you feel a whole lot better in yourself.” Anyone interested in more information, contact Mayo Sports Partnership on 0949047025 or log on to www.mayosports.ie/news.

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HealtH Matters 57

children first

Progressing imPlementation of ‘children first’ hse disability services set up a children first steering group in march 2012 to provide guidance and a standardised approach to the implementation of the ‘Children First’ guidance in disability services across the hse and non-statutory agencies, writes Ann Bourke, hse national disability unit.

epresentatives from the Hse, the National Federation of Voluntary Bodies, Disability Federation Ireland, Not for Profit Business association and Inclusion Ireland are on the steering group. It is important to have a collaborative approach to the implementation of Children First in Disability services, as over 80 per cent of services and supports in the disability area are provided by non-statutory agencies.

baCkgrounD to ‘ChIlDren fIrst’ the revised Children First: National Guidance for the Protection and Welfare of Children (2011) promotes the welfare of children and their protection from abuse. It states what organisations and individuals must do to keep children safe. the guidance sets out specific protocols for Hse social workers, other frontline staff and Gardaí in dealing with suspected abuse and neglect. It emphasises the importance of multi-disciplinary, inter-agency working, training and sharing of information in the best interests of protecting children, and highlights procedures and practices essential in organisations working with children in order to safeguard children from abuse. the Children First Heads of Bill (april 2012) defines the responsibilities and enforcement role of the Hse and is currently under review by the Department of Children and youth affairs. legislation is expected to be enacted by end of 2013.

progress of steerIng group the Children First steering Group has developed Children First in Disability services – a Guide to Policy Formation and Implementation, detailing clearly what must be included in each service provider’s child protection policy, a child protection policy compliance checklist and a monitoring

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compliance template for internal quality assurance and reporting compliance on a quarterly basis to the Hse.

mInImum traInIng reQuIrements Children and Family services are currently reviewing their Children First training programmes with the aim of developing a six-hour Children First module for staff who may come in contact with children during their work, a refresher module, and an advanced module for designated liaison persons and those responsible for an organisation’s compliance with Children First. they are also developing a ‘train the trainers’ programme to help care groups to develop their own Children First training capacity. In the interim, Children and Family services advise all organisations to continue accessing certified training programmes, e.g. Keeping safe for non statutory agencies. the Children First Bill clearly states which types of children’s organisations come under the Bill, but training for all adult service staff is also critical. For example, adult service users may have access to or observe children at risk in the community. adult service staff may observe children at risk on home visits and also need to be trained to support and respond to adult service users communicating their concerns. monItorIng ComplIanCe wIth ChIlDren fIrst We have developed and incorporated into Disability service arrangements 2013 a set of key performance indicators (KPIs) to drive compliance with Children First. they will be reported on each quarter. Hse Disability services will also be requested to return these KPIs quarterly. Organisations and services will remain accountable

to the local disability governance group for Children First compliance, whilst the national steering group will monitor trends and obstacles to compliance with Children First to inform the National Disability Governance Group.

CommunICatIon the group presented on its role and work to date, as well as the implications of the three heads of bills – Children First, Criminal Justice (Withholding of Information on Offences against Children and Vulnerable adults), and National Vetting Bureau – for disability organisations to the National Federation of Voluntary Bodies, Disability Federation Ireland and Not for Profit Business association’s Disability Umbrella Groups. a dedicated site on www.hseland.ie is being planned to host relevant information such as Children First in Disability services – a Guide to Policy Formation and Implementation and Monitoring template mentioned above.

13/3/13 16:25:14

58 Health Matters

patient feedback

Emergency Departments Responding to Feedback from Patients Patient feedback is integral to the design, delivery and evaluation of our hospitals’ emergency departments. The improvement of emergency departments across Ireland depends on patients giving regular and honest feedback about what worked well, what could be improved upon and what should always happen every time when they or others use these services.

recent report, Emergency Departments: Taking Patient Feedback Seriously, looks at the feedback received from 81 people who provided comment on their experience of emergency department services to the HSE corporate email address, yoursay@hse.ie. The feedback was also provided to the hospitals concerned. The report was developed as a collaboration between the HSE’s National Advocacy Unit, Patient Safety and Quality Directorate, and the National Emergency Medicine (EMP) Programme, led by Dr Una Geary, to provide patient feedback to emergency department teams to assist them in improving the safety, quality and patient experience of care in these departments. The information in the report will be used to inform the prioritisation of work for emergency services across Ireland. Staff working in emergency departments across the country will discuss this feedback, along with patient feedback provided directly by their patients, at team meetings and agree and implement quality improvement plans based on what is important to patients who use their services. It is important to note that people who have negative experiences of health services are more likely than those who have had a positive experience to write to or inform the HSE. The most predominant issue commented upon was in relation to communication skills, followed by issues relating to treatment and care and then admission delays.

Improving Care Pathways While the report does not reflect the experiences of a representative sample of people who used emergency departments

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in Ireland in 2011, it has been married with the expertise of the Emergency Medicine Programme to develop a plan for improving care pathways, communication and service delivery. According to June Boulger, National Lead Service User Involvement, National Advocacy Unit, “Patient and service user feedback is a cost-effective way of identifying what we are doing well and areas for improvement. Who better to give us that information than those who use our services? By involving staff in the analysis of that information, we can ensure that the processes and initiatives developed using the feedback are practical and relevant. “Through the generosity of those who shared their experiences with us, the work and commitment of the Emergency Medicine Programme working group, the staff of the National Advocacy Unit and

others, we have a very clear example of the power of feedback.” The data from each of the online complaints/compliments received through yoursay@hse.ie was entered into a computer software programme for qualitative data analysis. The report provides an insight into people’s experiences of emergency department services but it cannot be considered to be representative, as the data emerges from a self-selecting sample with feedback solely received online. It does not capture all the valuable feedback submitted to services locally. The report highlights some obvious areas for improvement.

Access • Improve emergency department throughput to achieve the six-hour standard for all patients

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Health Matters 59

patient feedback “Combined with the expertise and knowledge of our staff, this information is fundamental to improving the quality and safety of healthcare in Ireland.”

• Fast-track clinical investigation such as blood tests.

Dignity and respect • Ensure patients are treated in private, not on corridors • Improve and monitor the waiting room environment. Safe and effective care • Better pain management • Responding to the needs of patients with Alzheimer’s disease. Communications and Information • All emergency department team members must ensure appropriate communication as outlined in the National Healthcare Charter and Guidelines for Implementation • Provide information regarding waiting times, test results, pain management, self-care and discharge follow up.

Accountability • Be aware of patient dissatisfaction with the statutory charge and use feedback to improve processes and patient communication. Listen to patients, take patient feedback seriously and use it to improve services. Challenging Environment Greg Price, Director of Advocacy recently said: “In the provision of health and social care, there is an unlimited demand for services with limited resources – we as staff try to balance the scales. We have to be creative in our thinking, re-evaluate and reassess plans continually and as part of that day-to-day work, think strategically so we not only continue to deliver services but improve them in a challenging environment. “Service user feedback is an essential part of this process. It is increasingly being acknowledged as a vital source of intelligence on the performance of health services. Combined with the expertise and knowledge of our staff, this information is fundamental to improving the quality and safety of healthcare in Ireland.” Improvements Improvements underway to enhance customer service in emergency departments include the development of a system of gathering patient feedback systematically and using it to inform quality improvement and to evaluate progress. Overcrowding needs to be eliminated so that patients do not experience avoidable waiting in emergency departments

Frontline staff are developing solutions to improve patient care and safety in emergency departments via the Emergency Medicine Programme. A national visiting policy for these departments is being developed by a team of nurses and patient representatives to ensure the needs of patients and their families and carers are addressed while allowing staff to manage the number of people in an emergency department at any one time. The system is also looking at providing quicker pathways of care for patients who need less complex care (e.g. wound closure) to reduce delays for these patients. Advanced Nurse Practitioner services available in many departments will be expanded so that more patients with limb injuries receive efficient, high-quality care in our emergency departments. Fast-tracking of blood tests is being implemented along with new recommendations for the most appropriate blood tests to be done. Additional communications training is needed for staff and this is being implemented with the support of the National Advocacy Unit.

National Healthcare Charter You and Your Health Service, the National Healthcare Charter, outlines what people can expect and what their responsibilities are when using health services in Ireland. The charter applies to emergency departments across Ireland and invites patients to actively get involved in the decisionmaking about their health and to give feedback about their experience – and about what actually happened during the course of their patient journey or encounter with health services. The National Advocacy Unit is working in partnership with the Emergency Medicine Programme to implement the National Healthcare Charter in all emergency departments across Ireland.

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60 HealtH Matters

art therapy

healing arts in duBlin’s tallaght hosPital the national centre for arts and health at tallaght hospital, founded ten years ago, aims to improve the hospital experience, writes Sarah Murphy. “I’m not a cracked jug made of porcelain,” declares a determined Pacelli O’rourke, an outpatient at Dublin’s tallaght Hospital. Pacelli is an example of how the clinical recovery and psychological aftermath of a sudden illness can be coped with, in some way, through the arts. “It’s all about thinking outside the box [of illness],” explains Pacelli, who suffered a heart attack six years ago. to this day he remembers the events of that morning which, in a way, rekindled his love of life and the arts when he least expected it. “I never want to feel as bad as I did on that morning of March 26, 2007. It made me really feel and say to myself during my recuperation in hospital that ‘that’s it. I’m never going to be able to play ball with my grandchild again.’” But it was a hospital arts programme leaflet that was dropped through his front door several months later that he now believes made him realise that “I no longer had one leg in the grave and the other on a bar of soap.” Now a retired post-primary teacher, Pacelli spent 36 years working as an english teacher – so he always had an appreciation for the english language. “But I can honestly say that I never felt better than when I was with a group of outpatients at the hospital [expressing their emotions around health issues] at the creative writing courses,” he explains. He has now taken part in two courses at the hospital.

ImprovIng patIent Care the National Centre for arts and Health exists to improve patient care and to promote the benefits of the arts in health. the current arts programme includes exhibitions, live performances, creative writing classes, arts therapies, design projects and participatory art sessions on wards and in waiting rooms. there is currently a team of 30 professional artists, musicians and writers visiting the hospital

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+ Pacelli O’rourke, outpatient, tallaght Hospital.

and 25 arts sessions for patients every week. “It would be great if arts therapies could be recognised as a profession and really build on the arts and health centre ethos in hospitals nationwide, while maintaining and promoting high-quality arts programmes,” says Hilary Moss, the hospital’s art Officer, For Joan Molloy, a young mother of three children, a debilitating fall six years ago has left her learning to cope with pain management. By agreeing to take part in creative writing and visual arts courses, she realised they were “opening up a pandora’s box” of emotions. “regret, anger, frustration and a type of Jekyll and Hyde-type character of emotions came to the surface. I became aware that I was closing the door on part of my life. I was an active person who loved hiking and

dressing up in high-heeled shoes and dresses. I can no longer do those things and I felt a part of my appearance was being taken away,” explains Joan. “the arts programmes brought me out of a place that I didn’t know I was in. they helped me to be positive as you don’t realise, perhaps at the time [of clinical diagnosis] that you are in a cloudy spot. the classes, for me, were uplifting.” Joan was guided to some of the programmes by hospital clinicians as a means of coping with what was happening to her life. “through the arts programmes I realised I wasn’t dead as a person. For me, they helped to take the edge off my illness. they help you to deal with the stark reality of your [medical] condition. My illness was dealt with in a more holistic way. you need your mental health to overcome the physical illness.”

13/3/13 16:25:27

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Everything’s online these days including payslips Books? Yes. Movies? Definitely. Travel reviews? Sure. Music? Absolutely. The list of what’s available online these days is virtually endless. And this has freed people in countless different ways. Whether you want to pay a bill while you’re on a rollercoaster or book a flight from the top deck of a bus, it’s all possible.

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That’s why Core HR’s new initiative for the HSE makes so much sense. When fully deployed, it will replace the traditional paper payslip with an online version. So wherever you are and whatever device you use – a computer, tablet or smartphone – you can check your payslip as easily as watching a YouTube video. Want to know more? Check out the details (online, naturally) at www.corehr.com

13/3/13 16:25:35

62 Health Matters

leadership

Leading in Uncertain Times Programme A pilot initiative was successfully facilitated by the National Leadership and Innovation Centre for Nursing and Midwifery, with the introduction of a two day Leading in Uncertain Times Programme in ten services in 2012, writes Annette Connolly.

n evaluation of the initiative undertaken by DCU’s School of Nursing and Human Sciences highlighted that Directors of Nursing and Midwifery, facilitators and participants found the programme to be particularly practical and relevant. This two-day programme is designed to support nurses and midwives to strengthen their leadership contribution to improving care delivery for patients and clients. Programme participants were asked to implement a small change in their service area. Feedback has been extremely positive.

Margaret Carroll, Phlebotomy Co-ordinator at the MidWestern Regional Hospital, Limerick describes her experiences on the programme: ‘’I was given the unique opportunity to examine my area of responsibility

to determine where practice could be improved. Following the two day programme I was equipped with the skills and knowledge necessary with the added bonus of a support network consisting of the programme facilitators and participants. I am the Phlebotomy Co-ordinator at the Mid-Western Regional Hospital Limerick and also co-ordinate sweat testing to determine if a baby has Cystic Fibrosis. Since August 2011, the Mid-Western Regional Hospital (MWRH) is one of six centres nationally performing Newborn Screening Testing. It had been noted that in the MWRH, Limerick, 75 per cent of the sweat induced or retrieved was deemed sufficient in the amount to be analysed. Nationally the sufficient rate is 90 per cent; the reason was not clear while we knew that the test process was being followed correctly. Following a team meeting with colleagues involved in this

test, our practice was reviewed. I audited our practice in the MWRH Limerick and compared this with the practice at the other five national centres. I organised a meeting with the company representative; it also became apparent that changing the anatomical placement of the electrodes used to induce sweat on neonates yielded greater amounts of sweat. This information determined best practice and this was implemented. The local policy for sweat testing has been revised; preliminary data indicates the MWRH Limerick now has a rate of 90 per cent sufficient sweat tests in line with national guidelines. I personally gained invaluable experience conducting and analysing research and utilising this information to lead change.” For further information contact Annette Connolly, Leadership and Innovation Advisor/National Lead by email at annette.connolly@hse.ie

Nursing and Midwifery Leadership Programme Some 21 Directors of Nursing and Midwifery are currently enrolled on a pilot leadership programme for Directors of Nursing and Midwifery, writes Mary MacMahon. Feedback from Directors of Nursing and Midwifery undertaking the programme is extremely positive. Good leadership makes a significant difference to the lives of patients and service users, communities and organisations and the staff who work in them. Therefore, supporting corporate leadership development is crucial. The National Leadership and Innovation Centre, Office for the Nursing and Midwifery Service Director commissioned Choice Dynamic International, an international company specialising in healthcare leadership, to facilitate the pilot leadership programme.

Programme participant, Sheila McGuinness, Director of

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Nursing, Beaumont Hospital, Dublin shares her experiences of the course: “I want to highlight the importance of such a programme being commissioned; it really recognises the important role that Directors of Nursing and Midwifery have in reforming and developing future health services in Ireland. As participants, we had the opportunity to co-design the programme, being able to influence and shape the programme content was extremely valuable in meeting our needs. Having the opportunity to share and network with colleagues is excellent, which has enabled support structures to develop which has already

proven most valuable in my working life. We have interacted with a diversity of speakers, including experts from across the health sector and beyond, which has been a once in a lifetime experience. The opportunity to hear first hand their vision and aspirations for the future direction of healthcare has been inspiring for me. We have had informative and critical discussions around their future leadership role, and how that relates to us. This programme has only served to enhance and strengthen my future leadership role as Director of Nursing and Midwifery at Beaumont Hospital, Dublin.” You can contact Mary MacMahon, Leadership and Innovation Advisor by email at mary.macmahon@hse.ie

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Health Matters 63

MEntal health

Strong Interest in New Mental Health Programme Mental health professionals from across the country recently completed a new training programme in relation to the application of mental health legislation to practice.

rogramme participants came from a number of disciplines within mental health services and brought with them a wide range of knowledge and expertise that enriched the programme. Interest in this programme was such that it was oversubscribed at a ratio of 3:1. Those who didn’t receive a place on the first programme were offered places on future programmes. The programme, the first of its kind in the country, was designed to assist participants to further their knowledge and understanding of mental health legislation and its application to practice. It was delivered between October 2012 and February 2013. The training was devised as a stand alone module which leads to a ten-credit Special Purpose Award at Level 8 on the National Framework of Qualifications. Validation is with the Higher Education and Training Awards Council (HETAC), the qualifications awarding body for third-level education and training institutions outside the university sector. Members of the HSE Mental Health Act Training Group in collaboration with colleagues from the Regional Centre for Nursing and Midwifery Education, Tullamore, County Offaly developed the professional development programme. This was a broad and intensely-focused programme relating to the application of mental health legislation to practice, including consideration of international conventions and contemporary policy. Participants reported very positively to both the acquisition of knowledge during the programme and in relation to their overall experience. The course, in addition to providing expertise from the HSE’s Mental Health Act Training Group, also benefitted from the participation of subject experts from a service user perspective, child and

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+ Anthony Fitzpatrick, Amelia Cox, Dr. Malachy Feely and Tony Leahy, members of the Mental Health Act Training Group.

adolescent psychiatry, forensic psychiatry, and law. These included John Redican, CEO, National Service Users Executive; Dr Brendan Doody, National Lead for the Child and Adolescent Mental Health Service; Linn Dara Services, Orla Keane and Gavin Woods, Arthur Cox Solicitors; and Professor Harry Kennedy, Clinical Director, Central Mental Hospital. A second programme commenced in

February 2013 in the Regional Centre for Nursing and Midwifery Education, Tullamore. Plans are in place to roll out the programme in the Regional Centre for Nursing and Midwifery Education, Connolly Hospital, Blanchardstown, Dublin in April 2013. Details are available from the Regional Centres for Nursing and Midwifery Education in Tullamore and Blanchardstown.

Here’s what some participants had to say about the course: "It provided clarity on many of the grey areas in the Act that relate to my clinical practice. More importantly, the course helped me to develop a deeper and broader knowledge of current mental health legislation and how it directly impacts upon my practice as a community mental health nurse." David Nolan, Community Mental Health Nurse, Cork. “This is the best course I have done in the HSE and I would highly recommend it. It has also made me keenly aware that I have an obligation to keep up to date with developments in this area”. Sarah Hennessy, Social Worker, Central Mental Hospital, Dublin. ‘‘I learned something from every teaching session and it has helped me to develop my reflective practice. I have also been able to disseminate the information learned amongst my colleagues." Lisa Kiernan, Acting Assistant Director of Nursing, St Patrick's University Hospital, Dublin.

13/3/13 16:25:37

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13/3/13 16:25:39

Health Matters 65

payslips

New feature added to Online Payslips Service A new feature has been added to HSE online payslips for the convenience of HSE staff. Staff who register to view their payslips online will now also be able to view their P60 for 2012.

he P60 provides a summary of the tax, PRSI and USC deducted by the employer in the tax year and is an important document. The Revenue Commissioners have confirmed acceptance of online P60s. More than 17,000 HSE staff and retirees have so far opted to register for the HSE’s new online payslips service in the areas where this service is currently available: Dublin, Wicklow, Kildare, Galway, Mayo, Roscommon, Cork, Kerry, Cavan, Monaghan, Louth and Meath. Have you registered yet? Remember, the service allows you to conveniently access your pay details online

in a safe and secure place. The HSE is encouraging as many staff as possible to sign up. In addition to gaining access to a very

useful online service, you will be helping the environment by reducing the HSE’s paper requirements and helping the organisation to achieve cost savings.

Here’s how to register: � Take a note of your user ID and PIN number from your paper payslip. � Log on to www.hse.ie/onlinepayslips to register. You will receive an email confirmation of your registration and later, a second email containing your temporary password. (Check your inbox for the second email – it should arrive shortly before the next pay date following your registration). � Log on again to www.hse.ie/onlinepayslips to view your payslip. You will need your user ID and password.

European Award for RehabCare RehabCare, the health and social care division of Rehab, was recently awarded a European Quality in Social Services (EQUASS) award for its quality assurance and quality control in 19 of its resource centre services countrywide. EQUASS is a quality award for organisations providing social services, which aims to enhance the personal services sector by engaging service providers on quality matters and by guaranteeing the quality of services throughout Europe. The award, which is overseen by an international awarding committee, is only given after a process of external verification. As part of the process, people using RehabCare’s services, staff and other stakeholders were interviewed. Over 100 criteria were reviewed, including participation by service users and families in the development of services, staff training and development, external partnerships, linkages developed with stakeholders and corporate governance. Laura Keane, Rehab Group’s Director of Health and Social Care Services, said: “We are delighted to have received EQUASS assurance, an independent European stamp of approval, verifying RehabCare’s commitment to best practice. The award is a tribute to our committed and flexible staff who each day work to enable the people who attend our services to achieve their goals, whatever they may be – moving into their own home, finding a job, learning how to drive, or even writing a book. “It demonstrates that RehabCare is committed to people and to supporting them in living their lives to the full. Models of social care provision are changing and it is essential that people have real choice in the type of service that they access. In RehabCare, we pride ourselves on the fact that our services are centred around each person. We sit down with them to discuss what they want to achieve and help them to develop an individual plan, and then tailor the service provided to their own wishes,“ she said.

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66 Health Matters

News // Dublin north east Infant Mental Health Workshop

+ L-R: Dr Deborah Weatherston, Executive Director of the Michigan Association for Infant Mental Health; Marie French and Ger O’Riordan, Principal Clinical Psychologists in Louth and Catherine Maguire, Senior Clinical Psychologist and Infant Mental Health Specialist, North Cork.

Psychologists in Louth organised an infant mental health skills training workshop which was delivered by Dr Deborah Weatherston, Executive Director of the Michigan Association for Infant Mental Health, and attended by staff from both primary and hospital care. Senior clinical psychologists from HSE North Cork, Catherine Maguire and Mairéad Carolan, co-facilitated the workshop. Infant mental health looks at promoting social emotional development in babies and young children in the context of a nurturing and loving relationship. The workshops’ themes were: promoting early mental health, understanding how early experiences shape and form later social and emotional development, and the impact of first relationships on infant mental health. Dr Weatherston also delivered a free information talk for parents and interested members of the public, which focused on the importance of a baby’s first relationship; this is the template on which all other relationships are built. She discussed why a mother or father’s (or carer’s) nurturing is so important and what a parent can do to develop a nurturing relationship with their baby. One outcome of the workshop is the setting up of a North East network of professionals with an interest in infant mental health. For further information contact Ger O’Riordan or Marie French, Principal Clinical Psychologists, tel 041 987 5700 or email ger.oriordan@hse.ie or marie.french@hse.ie.

Physiotherapists in Cavan/Monaghan introduce new ways of providing continence service to women Urinary incontinence is quite a common condition, affecting one in three women at some stage in their lives. Research shows that 70 per cent will improve with physiotherapy. In Cavan/Monaghan, the service – which is delivered by physiotherapists across the acute hospital and primary care services – has introduced a number of new initiatives in order to improve services and reduce waiting lists. One such initiative has been the introduction of a women’s health education class in Cavan General Hospital and Monaghan Primary Care Centre. To date, 23 classes have been held, with 117 women attending from across the two counties. Issues covered include types of incontinence, pelvic floor exercises, bladder re-training and general advice. Women attending stated that they found the information very useful and would recommend others to attend. None felt that it was inappropriate to discuss these sensitive issues in a group setting, stating that it was good to hear other women’s point of view. The initiative has improved efficiency, with the information being delivered in a group setting. In addition, these classes have been delivered in the community to local ICA and Dochas women’s groups and they hope to complete further community education classes in the coming year. Other developments include the completion of audits and provision of training for staff grade physiotherapists in the treatment of this condition. For further information, contact Senior Physiotherapists Jenny Dunne on (049) 4376208 or Fiona Gilliland, (047) 39017.

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+ Transition year students from St. Joseph's Secondary School in Navan, Co. Meath are pictured with the Tooth Led Teens training manual and one of the models they use to demonstrate effective toothbrushing skills to first year students.

‘Tooth Led Teens’ – Promoting Oral Health ‘Tooth Led Teens’ (TLT) is a unique peer-led oral health promotion programme developed by the HSE Dublin North East Oral Health Promotion Team for post primary schools in Cavan, Monaghan, Meath and Louth. It aims to increase an awareness of oral health within the school environment. Transition year students are invited to take part in a course delivered by the HSE Oral Health Education Officers. The students learn about the programme and receive training in basic skills such as communication and facilitation. They also learn and practise effective tooth-brushing skills. The students then cascade this information to first year students over two SPHE (social, personal and health education) classes using a training manual with supporting CD, hygiene models, hygiene aids and displays showing the amount of sugar in some food and drink products. To date, over 1,000 first year students have received the programme. The TLT programme has won a bursary award from the Oral Health Promotion Research Group in Ireland and was also successful in the HSE Health Promotion Initiative Scheme. For further information contact Liz O’Reilly, Health Education Officer (Oral Health): tel (041) 6860710 or email liz.oreilly@hse.ie.

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Dublin north east // News New Units and Extensions at Cavan General Hospital Opened

+ L-R: Paul Hayden, Estates Manager, Dublin North East; Bridget Clarke, General Manager and Evelyn Hall, Clinical Business Manager, Cavan Monaghan Hospital; Kathleen Lynch TD, Minister of State with Responsibility for Disability, Equality, Mental Health and Older People and Cathal Hand, Service Development Manager, at the official opening of units in Cavan General Hospital.

Kathleen Lynch TD, Minister of State officially opened the Paediatric Assessment Unit, Psychiatric Unit and extension of the Renal Unit at Cavan General Hospital in December. The Paediatric Assessment Unit is a three-bed high-spec fully equipped and specifically designed facility adjacent to the Paediatric Ward with its own waiting area. Located on the hospital’s first floor, the unit treats on average 18 children per day for acute illnesses such as high temperatures, chest conditions and abdominal pain. The Psychiatric Unit, which has 25 beds and a pre-admission assessment area, has centralised admissions for patients from Cavan and Monaghan who require acute psychiatric care. Previously, their care would have been provided in either the admissions unit in Cavan General or St. Davnet’s Hospital. The development of this unit is in line with Vision for Change, which recommends providing acute mental health services within a general hospital setting. The extended Renal Dialysis Unit, which accommodates 18 stations, has alleviated the increasing waiting list of patients who were previously travelling three times weekly to Dublin hospitals for treatment. The unit is currently providing dialysis for 65 patients weekly and a pre-renal clinic for 300 patients.

Tara Suite Mental Health Day Centre, Dunshaughlin Wins NSUE Award The Tara Suite Mental Health Day Centre, Dunshaughlin was awarded 'The Service Providing the Most Effective Supports', as decided by service users at the recent National Service Users Executive (NSUE) awards ceremony. This is the fourth consecutive year the NSUE has conducted a national (service) user satisfaction survey. It aims to provide users of mental health services with a platform to share their experiences, highlight concerns, and propose suggestions. 1,488 respondents completed the questionnaire. Eugene Turbitt, Clinical Nurse Manager of Tara Suite said: “On behalf of the Louth Meath Mental Health Services, I would like to thank the service users of the south Meath sector for graciously giving of their time in completing the NSUE Questionnaire 2012. Their valued and informed opinions are a key driver to the never-ending challenge of quality mental health care provision. I would like to take this opportunity to acknowledge the NSUE for their commitment in providing a platform for service user opinion and wish them well in their future work.”

Safety Committee for Home Support Workers in Louth The first Safety Committee for Home Support Workers (HSW) in the North East has been established in Co. Louth. The committee, which meets every two months, includes the assistant director of public health nursing, home support co-ordinator, home support manager, health and safety advisor and two HSWs who were elected by their colleagues as their safety representatives. Other disciplines such as occupational therapists and occupational health nurses are invited to the meetings to address some of the issues raised. The HSW representative can make representations on behalf of colleagues to management, inspect the workplace, accompany a Health and Safety Authority inspector if requested, make representations to an inspector and investigate colleagues' complaints. Irene Ryan, Health and Safety Advisor said: “In accordance with the Safety, Health and Welfare at Work Act 2005, consultative structures should be in place between management and employees. The committee provides this forum, which is of benefit to both HSWs and management, and has proved a valuable tool with implementing our safety management programme within Louth Primary Care Services.” For further information, contact Irene Ryan on (042) 9381379.

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+ Back row, L-R: Ann Duffy, Assistant Director Public Health Nursing; Marcella Harrisson, Home Support Co-ordinator; Joan Carolan and Sharon Farrell, HSW Safety Representatives. Front row: Irene Ryan, Health and Safety Advisor and Paula Loughran, Home Support Service Manager for the Elderly.

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News // Dublin north east HSE Workplaces Recognised in IHF Award

+ Barry Dempsey, CEO, Irish Heart Foundation; Margaret Kenny, Connolly Hospital; Liz Timoney and Mary Cullivane, Navan Hospital and Dr Nazih Eldin, Head of Health Promotion, HSE Dublin North East pictured at the award ceremony.

Our Lady's Hospital in Navan, Connolly Hospital and Beaumont Hospital in Dublin were among over 60 Irish workplaces to be recognised at the Irish Heart Foundation (IHF) Happy Heart Healthy Eating Awards for their role in creating a healthier workplace for their employees. The awards accredit workplaces that provide and promote healthy eating options in their staff restaurants. According to the IHF, Irish businesses are becoming increasingly aware of the benefits of a healthier workforce in terms of reducing absenteeism, increased productivity and improved employee morale. Dr. Nazih Eldin, Head of Health Promotion, HSE Dublin North East said: “Eating healthily is essential for good health. In the last ten years there has been a significant increase in the number of people who are overweight or obese in Ireland, which damages our hearts and our joints and is mainly the result of too many calories in our diet and too little activity. As the health authority it is only right that we provide healthy eating options in our staff restaurants. We will continue to promote this initiative and work towards obtaining the award for all of our facilities.”

Dementia Care Enhanced at Claremont Claremont Residential and Community Services comprise of Seanchara Community Unit, St. Clare’s and Clarehaven Nursing Homes in Glasnevin, Dublin 11. They provide long term care, respite and day care services for older people. In 2009 the three units undertook a project to bring a better understanding of dementia care into their services. As a result, a number of education programmes have been delivered, including the HSE National Dementia Programme facilitated onsite by the Practice Development Co-ordinator and Senior Occupational Therapist. Due to these programmes, many changes and developments have occurred – for example improving signage, which helps people with dementia find their bedrooms and bathrooms. In addition, nurses’ stations were removed and made into a homely seating area for residents and families, and posters dedicated to enhancing dementia care are displayed on the units providing vital information to residents, families and staff. A baking group was formed, which allows people with dementia to use natural ingredients and eat the end product. The complementary therapy service has also been enhanced due to new knowledge gained on the education programmes. Claremont was shortlisted for the Irish Healthcare Nursing Home of the Year Award for their achievements and innovation in dementia care.

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Our Lady of Lourdes staff fund-raise for Afghanistan Staff in the Maternity Unit at Our Lady of Lourdes Hospital, Drogheda recently raised s2,300 for Motherkind, a maternal health campaign run by UKbased registered charity Muslim Hands (www.muslimhands.org.uk). Motherkind aims to respond to the causes of maternal death in some of the most high-risk countries around the world, with a variety of simple life-saving interventions. The money raised will be used to set up a training centre for labour ward attendants in Kabul, Afghanistan. The decision to raise the money was prompted by the Royal College of Obstetricians and Gynaecologists 2013 plan to address the stark differences in maternal death rates between the developed and developing world as a key initiative. Nowhere is the disparity more apparent than in rural Afghanistan, where one in 11 women die during pregnancy and childbirth, leaving close to one million children orphaned each year. Organiser Dr Natasha Abdul Aziz, Obstetric Consultant said: "The most wonderful thing about obstetrics is how simple interventions can have a huge impact on women and their pregnancy. Having worked with Muslim Hands on projects before, I was delighted to link their Motherkind initiative with our maternity unit. Every member of staff from consultants to support staff and technicians were supportive and excited to contribute.”

+ L-R: Dr Maire Milner, Consultant Obstetrician; Dr Natasha Abdul Aziz, Registrar; Leone Baillie, Clinical Midwife Manager and Dr. Madhukar Jagannath Shinde, Registrar.

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Dublin north east // gallery

+ Student nurses from Our Lady’s Hospital, Navan pictured at a recent alcohol awareness event at the hospital. The students set up an information stand and invited staff and members of the public to pour a measure of what they considered to be a standard drink, complete questionnaires and handed out copies of the HSE publication A Quick Question, which includes details on standard drinks, drinking risk levels, the benefits of cutting down, etc.

+ Pictured are staff from Cavan General Hospital, who are participating in this year’s ‘Operation Transformation – Get Fit Staff Challenge’. Forty staff members from across all disciplines, including medics, nurses, admin/clerical, care attendants, porters and cleaning staff, began their own challenge to get fit and beat the bulge by taking part in a six-week get fit challenge.

+ Pictured are some of the young people who participated in a recent Community Health Question Time event organised by the CAWT Social Inclusion project. Travellers, members of the LGBT (lesbian, gay, bi-sexual and transgender) community, local women, as well as those living with visual and hearing impairment all raised issues in relation to accessing public services and questioned representatives from public sector organisations, including representatives from the HSE North East, on how services can be more effectively delivered to meet their needs.

+ Transition year students from the local school in Lusk came to visit the residents at Lusk Community Nursing Unit in Dublin on February 1st, 2013. The students helped the residents and staff in making the St. Brigid's Cross. Making a St. Brigid's cross is one of the traditional rituals in Ireland to celebrate the beginning of spring. Pictured are resident Peter Davis and nurse Yancy Peurto, who both learned how to make the cross for the first time.

+ Up to 300 members of the public from the North East attended a free six week course on managing stress. The Stress Control Programme is aimed at anyone who is stressed or anyone who knows someone who is stressed and was delivered by HSE Clinical Psychologists Dr Mark Harrold and Dr Alison Rooney, who together have already presented it to almost 1,000 people around the country. The practical course assists participants to identify the symptoms of stress and to manage its effects. Pictured are Dr Mark Harrold and Dr Alison Rooney at the course.

+ The HSE Health Promoting Schools Yellow Flag was presented to a further three national schools in the North East: St. Paul’s in Navan, Co. Meath; Scoil Naomh Pádraig in Oram, Co. Monaghan; and St. Patrick’s in Corlough, Co. Cavan. The schools receive the flag as an acknowledgement of their ongoing involvement in the Health Promoting Schools Programme, which is now embedded in their school's policy and culture. Pictured at the presentation of the flag to St. Paul’s National School (L-R): Principal Patricia Fahy; Health Education Officer (Oral Health) Mary Carr; Fiona Daly Perez, Parents' Association; Head of Health Promotion Dr. Nazih Eldin and Senior Health Promotion Officer Anne Walsh with children from the school.

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70 Health Matters

News // Dublin mid-leinster

Integrated Nursing

+ Back row (L-R): Leah Fearon, RGN; Caroline O’Reilly, RGN; Finola Gill, PHN; Nollaig Ryan, RGN; Mary Mimnagh, ADPHN; Virginia Pye, DPHN; and John Lafferty, RGN. Front row (L-R): Sinead Cahill, RGN; Marie Shields, HCA; Paula McGovern, PHN; and Karen Walsh, RGN.

An integrated public health nursing team was introduced into an urban area in the midlands at the start of last year. The team encompasses the principles of corporate working, which means team management of a client population where a collective caseload emerges from the pooling of individual caseloads. Traditionally, public health nurses (PHNs) work in small geographical areas, individually

EVE at the CAS Film Festival A film-making group was recently awarded a community-based award for detailing mental health issues. The Digital Hub Project is a multimedia initiative promoting social inclusion for EVE learners (adults with mental health issues and/or learning difficulties) through communitybased media courses and engagement with digital arts. The project promotes recovery through enabling learners to advance from a traditional centre-based model to a community based model. HSE’s EVE network offers a range of community-based recovery-orientated training and work programmes for people with mental health difficulties and physical and sensory disabilities in Dublin, Wicklow and Kildare. EVE works via a network of vocational and rehabilitative services in 21 locations. EVE's community film-making group

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managing caseloads of approximately 2,500 people. The move to integrated team-working using a corporate caseload approach was seen as a possible solution. The incorporation of skill mix into nursing teams is considered a key reform issue within the reconfiguration of the health services. Frontline and management PHN staff in Longford/Westmeath sought a change to the existing model of working to

from the Digital Hub received an award recently for their participation in the Community Action against Suicide Film Festival. The group made a film entitled A Garden of Hope, which focused on ways in which they protect their own mental health and maintain wellness. The film was a collaborative effort, filmed in the War Memorial Gardens in Islandbridge, which illuminates one of the integral concepts of the short film: that getting out in the community is very important for promoting good mental health. The Film Festival night was organised by students from Collinstown Park Community College, and sponsored by O2 Think Big. The evening was attended by more than 500 guests and by several

address ongoing staffing and caseload management pressures. A similar modified pilot of integrated working was introduced in the same counties in 2011. Following consultation with nursing staff by management, it was agreed that two distinct nursing teams would replace the existing six area-based PHN/RGN teams. These six teams provided nursing services in a large urban setting with a population of 20,000. Each of these six teams held a mixed caseload of adults and children/families. Preliminary qualitative feedback from staff outside the team (allied health professionals/liaison nurses/support staff) was extremely positive. These staff reported that the model provided one point of contact, reduced duplication, enabled quicker responses to requests and improved team working. This initiative has shown that frontline staff can and must have an influence on service delivery, strategic planning and shaping how community nursing services are delivered. This has implications for saving of nurse time and nurse travel costs. The model is particularly suitable for urban settings with a critical mass of staff and population. However, continuing staff pressures may require that a similar model is adapted to rural areas.

well-known faces including Junior Minister Kathleen Lynch. Noel Brady, a learner and film-maker from the Hub Project, said: “Basically, we were talking about things that help keep us well and we called the film A Garden of Hope, which refers to a garden along the road of our recovery. I believe that no matter how bad things are, or how insurmountable they seem, there is always hope.” Noel Kelly, a Collinstown Park staff member who organised the event, plans to make the festival annual, and will encourage film submissions on a range of social issues.

+ A still from Yasmin Joonas and Jonathan Johnston’s A Garden of Hope.

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Dublin mid-leinster // News

EOLAS Project

+ The EOLAS Steering Group are pictured with Minister Kathleen Lynch TD.

A mental health information and learning programme for people with severe mental health difficulties was launched recently by Junior Health Minister Kathleen Lynch who has special responsibility for Disability, Equality, Mental Health and Older People, The EOLAS project is a localised venture between the HSE Kildare/West Wicklow Mental Health Service, service users and family members, Shine, the Irish Advocacy Network, Kildare Youth Services and Trinity College Dublin. The content of the EOLAS programme was decided in collaboration with service

users and family members and consists of two parallel programmes, each lasting eight weeks (one for service users and the other for families/close friends). Each programme is delivered by two cofacilitators, one of whom is a peer facilitator (ie a service user or family member) and the other a clinician and each facilitator underwent training in facilitation skills and in the content of the EOLAS Programme. The project was funded by the Genio Trust and evaluated by a research team at the School of Nursing and Midwifery of Trinity College Dublin, led by Professor Agnes Higgins. Deputy Lynch said: “This is a unique

and innovative project that is another positive step forward in achieving the targets set out in Vision for Change policy and promoting a partnership approach between service users, families and practitioners within an ethos of recovery.” Dr Pat Gibbons, Consultant Psychiatrist and chairperson of the EOLAS project group, added that the programme was an attempt to respond to service users and family needs for information relating to rights, diagnosis, treatment options, recovery strategies and knowledge of the mental health system – the result of a unique collaboration.

Diabetes Debate As we know, diabetes is on the increase globally. In Ireland there are approximately 191,380 people with diabetes. By 2012 this figure will have risen to approximately 194,000 and is expected to rise to an estimated 278,850 by 2030. Pre-diabetes is a condition where blood glucose levels have risen above normal but have not yet reached levels consistent with diabetes. There are approximately 344 million people throughout the world with pre-diabetes and approximately five per cent of them will develop diabetes within one year. There is a lot of evidence

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to indicate that a healthy lifestyle can prevent or at least postpone the development of diabetes in those at risk. To mark World Diabetes Day 2012, members of the Diabetes Team – East Coast Area Diabetes Share Care Programme (ECAD) – provided diabetesrelated information and advice along with diabetes screening to Bray HSE staff. It is vital for people to improve and maintain a healthy lifestyle for their overall health and wellbeing. These annual health awareness days allow us to impart information and ultimately raise

awareness around the need to remain healthy and well. On the day, Health Promotion Service staff in Bray asked those participating to take part in a health and lifestyle habits questionnaire. This was to assess the current health needs of staff with HSE headquarters in Bray. In response, the Health Promotion Service is putting in place a workplace health programme due to commence January 2013. For additional information on Health Promotion Services contact your local Health Promotion Service.

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News // Dublin mid-leinster

Portlaoise Launch Smoke-free Campus

+ Amy Byrne, Sacred Heart Portlaoise helps to launch the smoke-free campus at the Midland Regional Hospital at Portlaoise with Finola Shiel, Clinical Nurse Specialist, Cardiac Rehab; Aisling Mernin, Staff Nurse, Smoking Cessation; Gerry Carroll, Maintenance Foreman at the Midland Regional Hospital Portlaoise.

A child’s creative flair supported the launch of Portlaoise Hospital becoming a smoke-free campus. Amy Byrne, a thirdclass student in Portlaoise Sacred Heart School, had her poster selected as part of a design competition for the official launch by Clinical Director John Connaughton. The hospital became smoke-free last November and is receiving support from patients and staff. Smoking is now not

permitted anywhere on the hospital grounds. Connaughton said: “The smoke-free campus policy provides an environment that promotes health and supports those who want to stop smoking. The facts are undisputable when it comes to the health gains: giving up smoking greatly improves the chances of patients' recovery, which is the aim of being in hospital.”

Tullamore Hospital Pioneers New Bioactive Glass Treatment Tullamore Hospital is one of four international centres trialling an innovative material to treat osteomyelitis in the bone. Eoin Sheehan, Consultant Orthopaedic Surgeon at the Midland Regional Hospital Tullamore, outlined the positive results of a recent trial at a recent European Bone and Joint Infection Society annual meeting in Switzerland. "The use of bioactive glass to treat resistant osteomyelitis at first sounds ludicrous. However, having studied the science and Scandinavian research behind its success we were encouraged to begin using the glass in our osteomyelitic patients,” explained Mr Sheehan. Tullamore Hospital is the first hospital in the Ireland to take part in this trial. The glass works by creating an alkaline environment that discourages bacterial biofilms and the glass is also biocompatible and will integrate into the bone over time. This could have a huge effect on the lives of people who are scourged with chronic bone infections. The cost savings are also enormous in the present economy as the usage of this technology could reduce the number of procedures patients require by as much as 80 per cent. The procedure has been used in Scandinavian countries for the last ten years, but Tullamore Hospital, which is the regional orthopaedic centre for the Midlands, is the first Irish hospital to trial the procedure.

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The policy is designed to ensure a healthier, safer and cleaner environment for all and better health outcomes for patients. Maureen Nolan, Director of Nursing, outlined how the hospital is taking its responsibility around health promotion and illness prevention very seriously: “Hospitals and health systems, both nationally and internationally, are working to encourage patients to adopt healthier tobacco-free lifestyles in order to decrease the incidence of smoking related disease. We are sending a clear message that this hospital is committed to protecting and promoting the health of our patients, staff and all who visit the hospital.”

HSE Midlands Introduces Child Safety Website The HSE Midlands has recently introduced a dedicated child safety section on www.hse.ie. The webpage was developed as part of the Child Safety Awareness Programme by the Department of Public Health in the midlands. Its aim is to reduce and prevent 'unintentional injury' to children within the home and to empower and support parents and carers to make the necessary changes to promote child safety. Brenda Shannon, Department of Public Health, HSE Midlands, said: “While children are surrounded by injury risks, the good news is that nine out of ten unintentional injuries can be prevented by ‘thinking safety’ and ‘acting safely’ in everything we do. It is our responsibility, as parents, guardians and carers, to make sure our children's world is as safe as possible. Knowledge is power and action is key. If we know the dangers, we can do something about them." Visit www.hse.ie/childsafety and share the link with your family and friends. For more information, please contact Brenda Shannon, CSAP Project Leader at brenda.shannon@hse.ie.

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Dublin mid-leinster // gallery

+ MRH Portlaoise has been accreditated as a Baby-Friendly Hospital and has received the global WHO/UNICEF Award. Pictured with the accreditation are Fiona Moore, Berna Keating, Dolores Booth, Jacqueline McNulty, Dr Genevieve Becker, Maureen Nolan, Terry Cotter, Dr Miriam Doyle and Dr Ibraham, Consultant Paediatrician.

+ The Newborn Hearing Screening Programme recently set up at the National Maternity Hospital Holles Street. Picture includes Carmel Cullen, Katy O’Brien, Lynn Rubbathan, Paula Haverty, Lisa Linehan, Louise Grant, Kathleen Fitzgerald, Linda Hancox, Jaclyn Cooper, Selena Kinsella, Nicola Ryan (Local Manager Rotunda) and Dave Kinsella (Training Manager). All infants born in the hospital are offered a hearing test.

+ Richard Delaney, Gerry Moran and Jonathan Johnston pictured at the Community Action on Suicide Film Festival awards night.

+ Tallaght Hospital has introduced arts and health programmes for patients. Programmes such as the Arthritis Art Group are under way – patient Jo Killalee has proudly completed her painting, titled 'The Claw'.

+ Winner of the Nurse of the Year Award: Nurse Elaine O'Brien Doyle from the Midlands Regional Hospital, Portlaoise.

+ Disability Manager Geraldine Murphy (third from left) pictured in Haiti with singers Garth Brooks and Trisha Yearwood.

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74 Health Matters

NEWS // SOUTH

Arts Ability

Arts Ability is an inclusive, participatory arts programme led by Wexford County Council Arts Department which celebrates the artistic and creative imagination of people who experience mental health problems and/ or intellectual, physical or sensory disabilities. Initiated in 2003, the programme has included music, drama, literature, dance and visual art in a variety of caring environments

throughout County Wexford. Arts Ability recently launched Climbing Mountains in our Minds, a collection of poetry, prose and photographs about life in St. Senan’s Hospital, Enniscorthy. Members of the KTAC Writers’ Group penned their own recollections of hospital life in collaboration with writer-facilitator Sylvia Cullen.

HSE Kerry Quality and Patient Safety Awards 2012 The winning entry in the first Kerry Area Quality and Patient Safety Awards, based on the theme of ‘working together for risk prevention in the Kerry area’, was ‘GP referrals to Colposcopy – appropriate or inappropriate?’. It was submitted by Dr John Crowley, GP trainee, on behalf of his project team. The keynote speakers and judges for the event were Marie Kehoe-O’Sullivan, HIQA Director for Quality and Safety and Denise McArdle of the HSE Quality and Patient Safety Directorate. Their address outlined the new supportive function within HIQA for implementation of Safer Better Healthcare Standards 2012 – one core function is quality and safety improvement training in ten pilot

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sites in 2013. The HSE QPS Directorate presentation spoke of the development of selfassessment methodology for the HIQA standards, and this will be issued for consultation shortly. Twelve entries of a very high standard were received, including ‘Back to Fitness: exercise programme for patients with chronic back pain’, ‘Functioning of the Drugs and Therapeutics Committee, KGH’ and ‘Effective Communication between ED and the GP: an audit of current practices’.

The idea for the book came from photographer Rory Nolan and nurse Miriam Lambert, who were both keen that people who use the mental health services would have an opportunity to tell their side of the hospital’s story. The anthology was commissioned to coincide with the closure of St. Senan’s Hospital after more than 150 years in operation. The Arts Ability programme has recently been the subject of a case study on artsandhealth.ie, the national independent website for the arts and health sector in Ireland. Current partners of the core programme are County Wexford Community Workshop (New Ross) Ltd; the Recreational Therapy Unit at St. Senan’s Hospital, Enniscorthy; Killagoley Training and Activation Centre, Enniscorthy; and Wexford Residential Intellectual Disability Services, Enniscorthy. Arts Ability is currently funded by the Arts Council, Wexford County Council, the HSE and CWCW (New Ross) Ltd.

+ Dr John Crowley, GP trainee with Marie Kehoe-O’Sullivan, HIQA Director for Quality and Safety.

For further information or to receive copies of the entries, please contact Majella Daly, Quality Manager at email: majella.daly@hse.ie.

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South // News Breast Specialists Attend Forum in Waterford The third annual National Cancer Control Programme Symptomatic Breast Disease, Audit Quality and Risk Forum was hosted at Waterford Regional Hospital (WRH) recently. For the first time, the event was attended by breast cancer clinicians and practitioners from all eight designated cancer centres. Speaking at the Forum, Dr Carmel Ann Daly, Consultant Radiologist and Lead Clinician Breast Services, Waterford Regional Hospital, said: “Throughout the country, we’re ensuring we deliver high quality care to patients who have a diagnosis of breast cancer. Our aim is for all service user needs to be met in a timely, sensitive and appropriate way and for all channels of communication be open between patients and staff. This forum was an opportunity for us to highlight and reflect on the comprehensive range of excellent services we have developed at WRH since our inception in 1996 and during our expansion as a South East regional service in recent years.”

Re-organisation of Services at Mallow and Bantry Significant progress is underway on re-organising the profile of services delivered at Mallow and Bantry General Hospitals. Both hospitals will continue to treat the vast majority of the current patients attending the hospital. More complex care will transfer to the large acute Cork city hospitals with an extended range and volume of less complex treatment provided locally. The hospitals’ emergency departments are being replaced with urgent care centres (medical assessment unit and local injury unit). Emergency surgery will transfer to Cork University Hospital. Inpatient surgery which can’t be done at Mallow as day cases will transfer to the Mercy and South Infirmary Victoria University Hospitals. The volume of day surgery will increase in both hospitals to offset the emergency and inpatient surgery moving out. A new medical assessment unit and replacement endoscopy suite are being built in Mallow.

North Cork Team Helps Early Discharged Patients Recently the Community Rehabilitation and Support Team won first prize for their poster presentation describing the development of the service at the Irish Gerontological Society Conference in Cork and the National Primary Care Conference in Mallow. The CRST facilitates the early discharge of clients from acute hospitals and provides rehabilitation in the community to promote recovery. The team also + Pictured are the North Cork Community provides education and support to help Rehabilitation and Support team. patients adapt to new deficits that might be experienced after a stroke or accident. CRST sees clients with acute neurological conditions, or who have had falls or need rehabilitation following a prolonged stay in hospital. CRST hope to develop links with the new Medical Assessment Unit at Mallow General Hospital and the Stroke Units in Cork University Hospital and the Mercy University Hospital. The team can be contacted at (076) 108 4050.

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New Group in Cork to Support People Who Hear Voices A new support service called Hearing Voices Group has commenced for outpatients of the HSE South Lee Mental Health Services in Cork. The group aims to facilitate people with shared experiences in hearing voices to come together to support one another within a confidential setting. It offers a safe haven where people who hear, see or sense things that other people don’t, can feel accepted, valued and understood. It offers an opportunity for people to accept and live with their experiences in a way that helps them regain hope and some control over their lives, which is outlined in the HSE’s policy document for Mental Health Services, A Vision for Change. The group encourages voice hearers to explore their feelings, thoughts and coping skills. Group members work together towards recovery, towards a life one wants to live, not one dictated by the voices. For a lot of people this means integrating the voices in a meaningful way into their lives. In the late 1980s, Prof. Marius Romme and Sandra Escher, both from the Netherlands, researched what helped people cope with their voices. Their study showed that the problem is often not the actual hearing of voices, but the person’s difficulty or inability to cope with them. Following Romme and Escher’s groundbreaking research, the Hearing Voices Movement was founded and the first Hearing Voices Groups were established in the UK and are now beginning to take off in Ireland. For further information contact Angela Carrazza, Hearing Voices Group facilitator and art therapist, Mental Health Services Cork. Email: angela.carrazza@hse.ie.

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NEWS // SOUTH

Involving Communities in Mental Health

+ L-R: Orla Barry, Director of Mental Health Reform; Minister Kathleen Lynch TD; Siobhan O’Dowd, Manager, Ballyphehane/Togher Community Development Project; and Dr Paddy Ryan, GP in Ballyphehane and UCC GP Training Programme.

The primary Care strategy and A Vision for Change both commit to actively involving service users and communities in primary and community mental health; a seminar, Directions for Community Health, in Cork in January explored how this might happen. Seventy participants including health professionals and community projects explored how primary care, community mental health and communities themselves can collaborate for better health. The seminar was organised by Get Vocal About Primary Care – a community health initiative between Ballyphehane/Togher Community Development Project, O’Connell Court Supported Housing and primary care HSE staff and funded by Age and Opportunity as an advocacy project with disadvantaged older people. Presentations were given on a primary care approach to integrated health services for the homeless and Travellers while representatives from the mental health services discussed their experience of bringing their services to communities. Orla Barry of Mental Health Reform outlined the links between the primary care strategy and A Vision for Change.

CUH Consultant Wins Award for Developing Solution to Epidural Problems Dr Peter Lee, a consultant anaesthetist with the Cork University Hospital, has won the annual Clinical Innovation Award in association with Cleveland Clinic and Enterprise Ireland for developing a system for enabling improved epidural delivery. Dr Lee collaborated with UCC to develop a simple, cost-effective and globally applicable solution to the problems associated with epidural administration. This procedure is technically difficult, and requires a clinician to blindly pass the needle into the epidural space for delivery of a local anaesthetic. Complications include neurologic injury and post-dural puncture headache. For trainee anaesthetists, there is a one in five failure rate for the first 50 epidurals performed. The consultant will also receive a grant of e15,000 and the opportunity to work with Cleveland Clinic to develop the commercial feasibility of his innovative idea.

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CUH Anticoagulant Clinic Receives Technology Award The Anticoagulant Clinic at Cork University Hospital was the 2012 winner of the Best Use of Technology category at the Irish Healthcare Awards for the establishment of an online-based ‘virtual anticoagulant clinic’ for the management of patients on oral anticoagulant therapy. What makes this system unique is it has both a patient and clinic portal which allows patients to access their anticoagulant records and communicate with their service providers from anywhere in the world. The internet-based system allows patients to test their international normalised ratio (INR), which is a measurement of blood coagulation, based on prothrombin time by using a point of care device from home or anywhere in the world. The patient no longer needs to attend the hospital for venous sampling and dosing at the anticoagulant clinic. The system includes a series of questions that assess all the factors that affect warfarin.

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South // GALLERY

+ Pictured in the Children’s Ward of Waterford Regional Hospital at Christmas for a donation by Folens Publishers of 200 annuals were (front row L-R): Sophia Colclough and Michal Perlak and their mums. Back row (L to R): Breda Whittle, Chidren’s Ward CNM, Smitha John, Nurse; Lizzie Gibbons, Folens Rep; and Juliet Mooney, Nurse.

+ Over 1,000 adults and children turned up for the Operation Transformation walk that was held by the HSE Health Promotion Department in conjunction with the Cork Sports Partnership in Blarney in January. The walkers were joined by one of the five Operation Transformation leaders, Deirdre Hosford. L-R: Claire Hurley, Cork Sports Partnership; Deirdre Hosford, Operation Transformation Leader; and Caroline Kelleher, Health Promotion Officer.

+ The Mercy Urgent Care Centre at St Mary’s Health Campus Cork was officially opened in February by the Minister for Health, Dr James Reilly. The Centre has treated over 8,500 patients since it opened on March 20, 2012. The average turnaround time from registration desk to discharge is currently 65 minutes and the most common injuries seen are hand and ankle. Just over half were self-referrals, with the remainder being referred by other services such as GPs.

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+ Consultant Obstetricians/Gynaecologist Dr Barry O’Reilly pictured with proud mum Anne O’Mahony Donoughmore and baby Zoey. Anne underwent a robotic surgical procedure in 2010 at Cork University Maternity Hospital, which assisted her to have two successful pregnancies. She is the first woman in Ireland to have had two births following this procedure.

+ Pictured at the recent graduation ceremony held in Dublin were Dunmanway home helps Mary Quinn and Olive Murray, who successfully completed the FETAC Level 5 Health Services Skills Award.

+ Minister for Health James Reilly TD visited Waterford Regional Hospital in November where he briefed staff from the South East on reforms and future plans for the health service. The Minister also spoke to media during his visit, accompanied by Area Manager Anna Marie Lanigan, RDO Pat Healy and CEO Tony O’Brien of the HSE.

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News // west HSE West Clinical Workshop at Sligo Regional Hospital

+ Pictured at the recent HSE Clinical Workshop 2012 hosted in Sligo General Hospital were GPs from Sligo and staff from Sligo General Hospital and Community Services.

The seventh annual HSE West Clinical Workshop took place at Sligo Regional Hospital in December. The workshop brought together general practitioners from Sligo, Leitrim, west Cavan, south Donegal, Mayo and Roscommon, consultants from Sligo Regional Hospital and management representatives from both hospital and

community services to discuss a range of commonly encountered conditions and their management. The aim of the workshop was strengthening the partnership between the acute hospital and primary care services in managing patient care and providing an innovative forum for debate on the patient

journey from community to hospital and vice versa. Grainne McCann, A/General Manager, Sligo Regional Hospital, opened the workshop organised by the Acute/Primary Care Interface Group, a group comprising of consultants, GPs and management. “The workshop provided the opportunity to come together for shared learning and ultimately to help us work better together for the improvement of patient care.” Nash Patil, Consultant ENT Surgeon, in his introduction said: “Considering the fact that this event has been running for several years, it is opportune to set it in its philosophical context. It is often said that we work with ever-reducing resources, and that this often causes a lack of morale and even a sense of frustration. These may be valid views. What is palpably more true, however, that the patients we serve have to deal with these limitations, as well as with the pain, the suffering and the anxiety that their illnesses bring with them. I know that all of us here share this objective; indeed, I was impressed (and inspired) to note that every clinician that I approached agreed instantly, without exception, to participate in this meeting.”

Official Opening of Renovated Paediatric Unit at Portiuncula Hospital, Ballinasloe The official opening of the newly renovated and refurbished Paediatric Unit (St Therese Ward) at Portiuncula Hospital, Ballinasloe recently took place recently. It was opened by members of the Friends of the Special Care Baby Unit and Children’s Ward committee who, in conjunction with local communities, schools and families, were responsible for raising funds. Chris Kane, A/General Manager, Portiuncula Hospital, Ballinasloe, said: “On behalf of the hospital and staff I would like to acknowledge and pay tribute to the commitment and generosity of time of those who over the last number of years have raised funds which facilitated the renovations of the Paediatric Unit here in Portiuncula Hospital. “The newly renovated Paediatric Unit provides optimal facilities from the initial reception, assessment and treatment of children attending the unit. The renovations

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+ Back row (L-R): Collette Cowan, Group Director of Nursing, Galway and Roscommon University Hospital Group; Marita Fogarty, Asst. Director of Nursing; Fr John Kileen; Mary Kenny; Alison Kinlan; Karen Leonard, Clinical Nurse Manager; Brid Duggan; Phil Lyons; Siobhan Horkan; and Sarah Mc Mickan, Director of Nursing. Front row (L-R): Bernie Tully; Bernie Healy Kennedy; Mary Kenny; Geraldine Quinn; Brid Barrett; Ann Flanagan; and Breda Coughlan.

included the development of two additional two-bedded adolescent wards with en-suite facilities. The refurbishment also included the dedicated day care area, enhanced

isolation facilities, improved ward areas and the bathroom facilities throughout. The unit has 23 beds which are used for inpatient, day treatments and day cases.”

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west // News

New ACAD opens at Roscommon Hospital A new Ambulatory Care and Diagnostic Centre (ACAD) has opened at Roscommon Hospital. The new centre will provide diagnostic services and day surgery carried out under local anaesthetic. Elaine Prendergast, General Manager, Roscommon Hospital, says: “The new ACAD is located near the Urgent Care Centre and was where we previously provided the Medical Assessment Unit service. Since the Medical Assessment Unit moved to its current location, the space was left unused. We have modified the layout of the area and we now have two procedure rooms and a consultation room. We have the capacity to treat nine patients at any one time and this will greatly enhance our ability to see and treat more day case patients and to provide easier access to diagnostic procedures. “To begin with, Ms Deirdre Jones, Consultant Plastic Surgeon from Galway University Hospitals who spends two days per week in Roscommon Hospital,

+ L-R: Colette Cowan, Group Director of Nursing and Midwifery; Elaine Prendergast, General Manager; Sean O’Brien, A/Asst. Director of Nursing; Amanda O’Halloran, Staff Nurse; Edel Cox, Staff Nurse; Deirdre Jones, Consultant Plastic Surgeon; Yolande Fallon, Healthcare Assistant; Mary Connell, Domestic Supervisor; Aideen Banet, Clinical Nurse Manager; Michael Kilcline, Carpenter; Margaret Casey, A/Director of Nursing; Sandra Kiernan, Staff Nurse; Michael Conboy, Supplies Officer; Sandra Bracken, Staff Nurse; Bernadette McTague, Staff Nurse; Katherine Gilleran, Clerical Officer; Marie Doorly, Staff Officer; Tom Timothy, Carpenter; Mary Crowley, Clerical Officer; Bill Maher, CEO, Galway and Roscommon University Hospital Group; and Padraig Brennan, Maintenance Manager.

will be moving her service to the ACAD. We intend to add further services at a later stage. Our intention at Roscommon Hospital is to become a centre for local excellence and this is yet another step towards enhancing the patient experience

at the hospital. We are now treating more and more patients from Roscommon and Galway as part of the key role that this hospital is playing in the Galway and Roscommon University Hospital Group,” concludes Prendergast.

GUH Symptomatic Breast Care Services Report Launched The 2011 Annual Report for Symptomatic Breast Care Services at Galway University Hospitals (GUH) was launched in February. Since the establishment of the National Cancer Control Programme in 2007, the breast care service at GUH has expanded rapidly with additional consultant and staff appointments, infrastructure developments and the opening of a + At the launch of the 2011 Annual Report for the Symptomatic purpose-built facility as part of a complex which includes BreastCheck, the Breast Unit at Galway University Hospitals, from left: Bill Maher, National Breast Cancer Screening Programme. The Symptomatic Breast Unit CEO, Galway and Roscommon University Hospitals Group; Mr Kevin at GUH also includes a satellite centre at Letterkenny General Hospital. Barry, Consultant Breast Surgeon, Mayo General Hospital; Pauline Bill Maher, CEO of the Galway and Roscommon University Hospital Group Mc Gough, Clinical Nurse Manager II, Symptomatic Breast Unit; Mr said: “The Symptomatic Breast Unit has seen enormous developments Ray Mc Laughlin, Lead Clinician, Symptomatic Breast Service; and Geraldine Cooley, A/Business Manager, Symptomatic Breast Unit. over the last six years and there has been a profound change in the way we provide the service which has been completely rejuvenated. The radiotherapy development and oncology services at GUH now provide every component of state-of-the-art breast cancer treatments for women with breast symptoms. The service has a very proactive quality assurance programme which gives us confidence that we are providing a service on a par with anywhere in the world both here in Galway and at the satellite centre in Letterkenny.” According to Mr Ray McLaughlin, Consultant Surgeon and Lead Clinician at the Symptomatic Breast Unit, “The report provides an overview of 2011 and the most striking aspect in terms of activity at the breast service that year was the significant increase in the number of new cancers diagnosed, while at the same time the number of new patient referrals decreased. In 2010 we saw 7,778 new patients and made 333 diagnoses; in 2011 we saw 6,932 new patients and made 372 cancer diagnoses. “The diagnostic tests (triple assessment), treatment options and the access to clinical trials available in Galway compare favourably with any international centre and the team here work extremely hard to ensure that we provide a world-class service for breast cancer patients across the region.”

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News // west New series of ‘Way to Go Kids’ programme in Limerick A new series of the Way to Go Kids initiative, a health and physical activity programme for families who are concerned about their child’s weight, got underway at Castletroy College, Limerick in February. Way to go Kids is delivered by the HSE, Get Back Challenge and the Sports Partnership, in conjunction + Launch of Way to Go Kids!, L-R: Anne Geary, Community Dietitian, HSE; with the Limerick City and County Sports Partnership. Sinéad Glover, Community Dietitian, HSE; Rosemary Ryan, Limerick City The new programme involves eight fun sessions for children Sports Partnership; Ger Burke, Ireland and UK Biggest Loser contestant; aged eight to 12 and their parents, and is delivered by experts Mark O’Connell, Get Back Challenge; Elaine Barry, Limerick City Sports Partnership; Phelim Macken, County Limerick Sports Partnership. in the area of nutrition and exercise. The one-hour exercise classes are facilitated by professional fitness instructors. The nutrition classes are delivered by HSE community dietitians, and areas covered include food portion sizes, drinking water, reducing fat and reading labels. The programme encourages a joint family approach throughout. Sinéad Glover, Senior Community Dietitian, Limerick Health Promotion, HSE, says: “The results from previous Way to Go programmes were very positive, with 50 per cent of children losing weight and 25 per cent maintaining weight by the end of the programme. Between 10 and 15 participants are required for this new programme, so if you are concerned about your child’s weight, this programme could be the answer. Not only is the programme informative and educational, it is also fun and a great way of bringing the family together towards a healthier lifestyle.”

Primary Care Health Centres in Limerick Become Tobacco-Free

+ Back row (L-R): Zvezdana Vukosavljevic, Ballynanty Health Centre; Maria Escutea, Occupational Therapist; Jeanne Quilty; Anthony Coleman, Ballynanty Health Centre; Stephen O’Shaughnessy; and Maura Cahill, Public Health Nurse. Front row (L-R): Bedelia Collins, Health Promotion Officer; and Jothikumar Ramakrishnan, Ballynanty Health Centre.

In February, a number of primary care health centres in Limerick city and county became tobacco-free as part of the HSE’s commitment to make all its workplaces and campuses smoke-free by 2015 under the National Tobacco Control Framework. The policy applies to all staff, clients, contractors and anyone who enters the grounds of health centres, such as Ballylanders, Bruff, Bruree, Galbally, Kilmallock, Kilfinane, Ballynanty, Moyross, King’s Island and Westbury, ensuring a healthier, safer and cleaner environment for all. Bedelia Collins, Health Promotion Officer, HSE, said: “Introducing the smoke-free campus policy provides an environment that promotes health and supports those who want to stop smoking. The facts are undisputable when it comes to the health gains; giving up smoking greatly improves the chances of patients' recovery, which is the aim of being in hospital. Research shows that non-smokers or those who quit smoking prior to surgery have a much better recovery.”

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Launch of Leitrim Age Friendly County Initiative The Leitrim Age Friendly County Initiative was launched in January as part of the national Irish Age Friendly Counties programme. It aims to improve the health and wellbeing of older people in the county and show how services and supports can be made more responsive, caring, professional and accessible. In Leitrim, this initiative is being led by an Alliance Board including the HSE, local authorities, development and enterprise boards, An Garda Siochána, County Leitrim VEC, NUIG, the Irish Farmers Association and an older person’s representative. The launch was attended by over 150 people from Active Age groups and support organisations. The HSE was represented by Damien McCallion and Geraldine Mularkey.

+ Alliance board members at the launch of the Leitrim Age Friendly County Initiative.

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west // gallery

+ Pictured are staff working in the new clinic for patients with inflammatory bowel disease (IBD) at Galway University Hospitals. L-R: Dr Valerie Byrnes; Dr Ramona McLoughlin; Aine Keogh, Staff Nurse; and Prof. Larry Egan. The clinic provides consultations, diagnosis, access to investigations, dietary advice and ongoing management of IBD including access to new drugs in clinical trials. The clinic is staffed by consultant and trainee gastroenterologists, nurses and dieticians.

+ To mark Eating Disorders Awareness Week, the HSE’s Sligo/Leitrim and Donegal Mental Health Services raised awareness of eating disorders with an information event. Entitled ‘Nobody is Perfect’, the information event was open to health professionals and members of the public and was addressed by Dr Ed O’Mahony, Consultant Psychiatrist in Sligo and Jacinta Hastings, Chief Executive Officer of BodyWhys (the national voluntary organisation supporting people affected by eating disorders).

+ At the presentation of certificates to Community Nurses from Galway and Mayo on completion of the Community Oncology Nursing Programme at University Hospital Galway in January were (front row L-R): Helen Armstrong, Palliative Care, Castlebar; Fidelma Mullarkey, Achill; Dr Susan O’Reilly, Director, National Cancer Control Programme; and Anita Fannon, Ballinasloe. Back row (L-R): Mary Prendergast, Balla, Mayo; Breda McLoughlin, Kilkelly/Kilmovee, Mayo; Barbara Folan, Rosmuc, Galway; Helen Rutledge, Ballina; Helen Martin, Portumna, Galway; and Cheryl McDonagh, Galway City East Primary Care Centre in Doughiska.

+ In November, the first theatre admission lounge in the country was officially opened at Galway University Hospitals (GUH). L-R: Karl Sweeney, Clinical Director for Surgery, GUH; Dr Bairbre Golden, Anaesthesia Lead, Anaesthesia and Surgical Clinical Programme; Prof. Frank Keane, National Clinical Lead, Anaesthesia and Surgical Clinical Programme; and Dr Jennifer McElwain, Consultant Anaesthetist, GUH. The photo was taken in the corridor outside the theatre admission lounge in the theatre block at UHG.

+ Staff of the Civil Registration Service in St Camillus Hospital, Limerick pictured at the launch of a new national online booking appointment system. This system allows couples to book notification appointments of their intention to marry or intention to register a civil partnership online. In the Mid Western area, there are nine locations providing a Civil Registration Service and all locations have been configured to facilitate online appointments.

+ NCHD poster presentation gold medal winner from Letterkenny General Hospital Annual Research Symposium, Dr A. Mutwalia, Consultant Nephrology, pictured accepting the prize on behalf of the Renal Unit, Letterkenny General Hospital with Dr Ken Mulpeters, Consultant Geriatrician, and Charles McManus, Chairperson for the Research Day, Medical Education Director at LGH.

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82 Health Matters

audiology The HSE National Bone Anchored Hearing Aid Service The HSE Audiology Clinical Care Programme (ACCP) established a National Bone Anchored Hearing Aid Programme in 2012, writes Aisling Heffernan. What is a Bone Anchored Hearing Aid? A bone anchored hearing aid (BAHA) is a surgically implantable system for the treatment of hearing loss that works through direct bone conduction. It has been used since 1977 as a treatment for conductive and mixed hearing losses. BAHA is used to help people with chronic ear infections, congenital external auditory canal atresia and single sided deafness that cannot benefit from conventional hearing aids. The system is surgically implanted and allows sound to be conducted through the bone rather than via the middle ear; direct bone conduction. The BAHA system consists of three parts: The Sound Processor – this is the hearing aid part of the system. It has a snap-fit attachment at the back of the aid, which attaches on to the abutment. The sound processor is detachable. The Abutment – this is a socket that is on the outside of the scalp which is attached to the internal fixture (implant). The abutment goes through the scalp and is shaped to hold the snap-fit attachment on the sound processor. The Implant - this is a small titanium screw/fixture that is implanted into the bone behind the ear. The metal becomes firmly anchored to the skull bone and integrates or (fuses) with the bone over a period of weeks. Benefits for the patient include � Improved hearing skills � Increased ventilation to the ear � Improved quality of life e.g. educational and social benefits � Reduced need for review hospital appointments. The programme is rolled out in six sites and these are: � Galway University Hospital (Mr John Lang, ENT) – adult and paediatric � South Infirmary Victoria University Hospital, Cork (Mr Peter O’Sullivan, ENT)– adult and paediatric � Mater Misericordiae University Hospital (Mr

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+ Ian O’Neill, Clinical Engineer Manager, Aisling Heffernan, Programme Manager for Audiology and Perry Palenfeldt.

Stephen Kieran, ENT) – adult � Midland Regional Hospital at Tullamore (Mr Howard Savage Jones, ENT) – adult and paediatric � Our Lady's Children's Hospital, Crumlin (Mr Stephen Hone, ENT) – paediatric � Temple Street Children’s Hospital (Mr Michael Colreavy, ENT) – paediatric.

Setup and Funding The programme has provided each site with training and setup audiological and surgical equipment. A tender process was coordinated by the ACCP in 2012 to select a preferred provider for BAHA equipment and to achieve cost efficiencies. Each site has an integrated MDT including an ENT Consultant, Nursing Staff and Audiology Staff. The ENT Consultant will provide team leadership and clinical governance. They will be responsible for the implementation and the quality assurance of the programme

within their regional centres. A working group has been established with representatives from each site to agree polices, oversee clinical audits and to remain abreast of evidence based practice. Funding is available to provide 100 implants and relevant surgical items per annum. The programme will be reviewed carefully over a three year period to develop an evidence base for future funding required. Two of the clinical engineering staff at North Great George’s Street in Dublin have been trained up and equipped to repair certain Cochlear models of these devices. Cochlear is one of the companies selected to provide BAHA equipment to the HSE and this is the first time that Cochlear has trained non Cochlear staff to repair their BAHA devices. Aisling Heffernan is the HSE’s Audiology Programme Manager and can be contacted at aisling.heffernan@hse.ie

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Health Matters 83

Commerical Feature

Providing activity based costing solutions for Irish hospitals

‘Money Follows the Patient’ will make Irish hospitals more financially accountable.

ith changes to healthcare insurance structures and hospital funding in motion, hospitals will become increasingly accountable for their own financial health. Performation hosted two Activity Based Costing seminars to discuss how “Money Follows the Patient” (MFTP) initiatives will influence the future funding of Irish hospitals. Activity Based Costing will form the basis of future reimbursements. MFTP is a funding system which will run in shadow for 2013, and will become fully operational by 2014. MFTP replaces traditional allocations of block grants and will be based on “per patient” treatment costs. The abolishment of block grants means that hospitals will have to earn back their funding based on the amount of treatments delivered. In this changing environment, hospitals will need to prove

their patient cost prices and volumes. In order to do so, accurate and timely management information is vital. These policies formed the basis of discussion at the seminars. It was highlighted by both guests and speakers that hospitals are currently attempting to bring about cost reductions and efficiency programmes independent of new funding systems. This is a positive reinforcement that a change is welcome.

Extracting data from data recording systems is one of the major challenges hospitals are facing. Performation experts have performed cost containment exercises

and analysed data for Irish public and private hospitals. It was concluded that although information is not always centrally gathered, it is still available in hospital data recording systems. This opens the door for Activity Based Costing analysis. Enabling insight into information and data is the key to effective change in Irish hospitals. Key points at both seminars stressed that establishing cost price per activity and treatment will allow hospitals to access existing data in a fluid and transparent manner. Transparent costs will contribute to better hospital processes, outputs and profitability. Performation would like to thank all attendees for their support and contribution to the Activity Based Costing Seminars. To learn more about their products and services, call Performation at 01 662 2820 or E: info@ performation.com

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14/3/13 11:12:49

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. .. .

Health Matters 85

breastfeeding

Breastfeeding benefits mums and babies The importance of breastfeeding to infants, mothers and the wider community is widely documented and undisputed, writes Mary Mahon, Clinical Midwife Lactation Specialist, Portiuncula Hospital, Ballinasloe.

reastfeeding is considered to be a natural process – however, it doesn’t always come naturally. Exhaustion, sore nipples, sleepy babies, unsettled and crying babies, engorgement, plugged ducts and other breastfeeding problems or concerns can make the most dedicated mother want to give up. Discontinuation of breastfeeding is often followed by the realisation that breastfeeding wasn’t necessarily any more problematic than infant formula feeding, with the onset of colic, constipation, allergy and intolerance to cow’s milk protein. To avoid this, breastfeeding mothers need a safe place to go when problems or questions arise. Breastfeeding support groups offer that safe place, where new and experienced breastfeeding mothers exchange stories and help one another through the toughest breastfeeding challenges. I really believe breastfeeding mothers should leave the hospital with knowledge about and the ability to link to support groups in the community. At Portiuncula Hospital, Ballinasloe we maintain the Baby Friendly Hospital Initiative, facilitate the Ballinasloe Breastfeeding Support Group and liaise with community service providers.

+Breastfeeding mums: The existence of the Baby Friendly Hospitals initiative has made a noticeable difference to the increase in breastfeeding rates.

Comments from some of the breastfeeding mothers who attend the Ballinasloe Breastfeeding Support Group show how important such groups are.

Support and Guidance First-time mother Gretta Collins said: “As a first time mom trying to breastfeed, I really struggled with a low milk supply from the very beginning and without the help, guidance and continuous support from my lactation consultation and other mothers I was ready to quit after six weeks. They encouraged and supported me right

through the whole process so that now six months on I'm still breastfeeding. This is clear evidence to how effective and necessary the breastfeeding groups are.” Mother-of-two EJ Garvey said: “I’m very proud of the fact that I breastfed my two children for six months each. I know for a fact that the only reason I succeeded was because of the support and guidance I received by attending the Ballinasloe Breast Feeding Support Group. The friendships that I made have lived on." For further information, visit www.breastfeeding.ie.

Baby Friendly Hospital Initiative in Ireland makes a difference Dr Genevieve Becker, IBCLC National Coordinator of the Baby Friendly Hospital Initiative in Ireland explains the initiative. The BFHI began in Ireland in 1998 when the prevalence of any breastfeeding on discharge was 31 per cent; in 2011 it was 53 per cent. Evidence from the BFHI data and from data of the Growing Up in Ireland study indicates that Baby Friendly Hospitals made a noticeable difference to the increase in breastfeeding rates.The Midland Regional Hospital Mullingar and the Midland Regional Hospital Portlaoise were designated as meeting the criteria as Baby Friendly Hospitals and were thus awarded, bringing

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the number of currently designated hospitals to eight. In 2011, 41.76 per cent of births occurred in a Baby Friendly designated hospital. Breastfeeding Supportive Workplace awards were presented to four hospitals. Participating hospitals carry out a planned action during the year to improve and sustain practices. In 2012, actions included increasing the use of mother’s milk in the neonatal unit, improving early contact between mother and baby after c-section,

discussing supportive labour and birth practices during antenatal visits, clarifying the provision of informed discussion with women considering using infant formula and more. The BFHI Link newsletter is published regularly with reports of activities, research and resources with a parent handout in each issue. The BFHI Link newsletter is available on the website and accessed from all over the world. For more information visit www.ihph.ie/babyfriendlyinitiative or bfhi@iol.ie

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humour

The Table is Important Finian Murray on cliché, corporate speak, jargon and all things ‘going forward’.

love how more and more of us are using language as part of everyday speech that is sprinkled with jargon, acronyms and smothered in clichés. Jargon makes simple things sound much more complicated and impressive than they really are, giving off the impression that we are intelligent. Who needs plain talk? Acronyms are my favourite. Acronyms are not just any set of initials. The term should only apply to those that are pronounced as words. Not many people know that. I particularly like to see individuals using them as part of their speech assuming everyone knows what they mean. HIQA, KPI…BDSM. Public commentators are the real experts. For them, the table seems important. If a person is highly qualified, they say he/she brings a lot ‘to the table’. But often that’s not enough because he/she also has to ‘step up to the plate’, which I presume is ‘on the table’. However, those who bring a lot ‘to the table’ often have too much ‘on their plates’. Still they’re guaranteed a seat ‘at the table’, because they think ‘outside the box’, which puts them ‘ahead of the curve’. Unfortunately the best plates are seldom ‘on the table’- they remain in the cabinet.

Death by Cliche Journalists like to make their own contribution. If I wasn’t with the HSE, I would love to be the crime correspondent for a television station. I figure you only need a few phrases that you can copy and paste for every new case. “The victim was known to the police; the Gardaí are following a definite line of enquiry; a man has been arrested and granted free legal aid; a file has been sent to the DPP.” Animals feature strongly in the new lingo. Once upon a time, ‘the camel’s nose is under the tent’ in search of ‘low hanging fruit’. This startles the ‘elephant in the room’ who runs outside into a ‘level playing field’ and ‘cascades’ with a ‘best-of breed’ ‘cash cow’ thus ‘moving the goalposts’ which in turn ‘raises the bar’ and causes

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a ‘paradigm shift’. Some ‘ducks in a row’ are flying overhead, engaging in ‘blue-sky thinking’ and taking in the ‘big picture’. The disturbance puts one duck ‘out of the loop’ after a ‘parting agreement’ A gun club member happens to be in the next field. He shoots the duck using a ‘sliver bullet’ causing a ‘race to the bottom’ followed by a ‘soft landing’. (The man was arrested and granted free legal aid). The moral of the story? Beware of the ‘butterfly effect’. No animals were hurt in the making of this tale.

At Work and at Home It’s a shame that we ditch corporate-speak when we go home in the evening. Imagine saying to your partner: “We need to look at dinner ‘solutions’. I will do an ‘audit of available components’ and if necessary the ‘procurement’ of additional ‘evidencedbased’ materials in the local shop. On second thoughts, we could just ‘outsource’ and get a takeaway”. Or when you’re on the weekly shopping trip at the supermarket and the shop assistant asks “Can I help you?”, what if you replied: “Going forward into the future, I’m formulating a strategic plan of key deliverables for comestible replenishment over a sevenday time horizon”. It puzzles me that using jargon does not make life easy for everyone. For example, I came across a cartoon in a book called Sociology Made Simple by Jane Thompson. It shows an old man sitting on a chair in miserable surroundings. In the speech bubble he says: “I used to think I was poor. Then they told me I wasn’t poor, I was ‘needy’. Then they told me it was self-defeating to think of

myself as ‘needy’, I was ‘deprived’. Then they told me ‘deprived’ was a bad image, I was ‘underprivileged’. Then they told me ‘underprivileged’ was overused, I was ‘disadvantaged’. I still don’t have a cent but I have a great vocabulary”. To paraphrase a recent hit song, what’s great about jargon is that you can say so much and yet say nothing at all. I wonder can vegetarians become ‘key stakeholders’… Finian Murray is Men’s Health Development Officer with the HSE’s Health Promotion Department, Dublin North East. He is author of a number of peer-review and other publications in men’s health, the most recent being The Role of Humour in Men’s Health, Modern Medicine Vol. 42, No 3. His hobbies include reading, walking and performing stand-up comedy.

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disability

Support for people with disabilities Significant changes are taking place in the disability sector. Bill Ebbitt, General Manager in the HSEâ&#x20AC;&#x2122;s National Disability Unit, reports.

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ay services for adults with disabilities provide a vital network of support for more than 25,000 people across the country. New Directions, a review of HSE funded adult day services published last year, challenges us to modernise services so that they can better meet the needs of this population. The people who use these services have a widely diverse set of interests, aspirations and personal circumstances. They are people with physical and sensory disabilities, with learning disabilities and with mental health difficulties. They include young people, people who have been in day services for many years and older people of retirement age. The approach outlined in New Directions is strongly linked to the implementation of the policy of mainstreaming that is a core part of the National Disability Strategy. This places a real challenge before the HSE, service providers, people with disabilities and their families to work collaboratively to develop a modern adult day service.

New Directions The New Directions approach is based on the core values of person-centeredness, community inclusion, active citizenship and high-quality service provision. It is underpinned by good governance, monitoring and guidance for providers. In the new approach, each adult will have access to flexible and outcome-driven supports to enable them to live a life of their choosing that meets their own wishes, aspirations and needs. The core purpose of the supports will be to enable people to participate as equal citizens in their community and to contribute to that community. The range of supports to which the individual has access should equip them to make choices and plans to support personal goals and have influence over the decisions which affect their lives. They should also have the support required to achieve personal goals and aspirations and be active, independent members of their community and society.

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Personal Supports Twelve personal supports should be available for an adult with a disability. These include support for making choices and plans, making transitions and progression, inclusion in oneâ&#x20AC;&#x2122;s local community, accessing education and formal learning and maximising independence. They also include support for personal and social development, health and wellbeing, accessing bridging programmes to vocational training, vocational training and work opportunities, personal expression and creativity, having meaningful social roles and for influencing service policy and practice. Service Culture The New Directions approach will also mean a significant change in service culture, work practices, programme content, staff roles and service user roles. This change is already under way in many services. The extent of the change in any service will depend on the gap between current practice and what is needed to deliver a modern, person-centered service. Central to the implementation of the New Directions approach is the design and implementation of a national funding framework for the

allocation and management of resources. The National Implementation Group (NIG) was established last year to drive the implementation of the changes recommended in the New Directions report. The Group has representation from the Disability Federation of Ireland, the National Federation of Voluntary Bodies and the Not for Profit Business Association. Also represented are Inclusion Ireland, the National Parent and Sibling Alliance, the National Disability Authority, HSE and the Department of Health. Among the areas being examined are day service hours, day service activities, resource requirements, good practice, costs and transition arrangements for providers.

Quality Assurance A priority is the development and roll out of a national quality assurance system for day services. In this regard the National Disability Authority is supporting the drafting of guidelines which will go to consultation with the sector in the second quarter of this year. Once sign off is agreed they will be implemented by the sector as guidelines until the Health Information and Quality Authority is in a position to implement them as standards with a supporting regulation and inspection process.

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88 Health Matters

gardening

Why gardening is good for all of us Gardening impacts on all of us in some way and as such, like most things in life, you can only get back what you have put in, writes John Sweeney, Manager at Plantmarket.

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real life, the rewards for one’s efforts often pay off sometime in the future.

Nature For many of us, the garden is our piece of nature. Most of us may never get the opportunity to visit the tropical rain forests of Central America or the open plains of Africa, but we can have our own piece of nature in the garden. Public park facilities such as Dublin Zoo provide us with the

opportunity to experience the plains of Africa while the Botanic Gardens can do likewise for the tropical rain forests. Gardening is increasingly used for its rehabilitation and therapeutic value. EVE ‘Plantmarket,’ a specialist vocational training centre in Lusk North County Dublin, uses gardening activities to create and instil a positive work ethic and learning environment, whilst providing internationally recognised FETAC qualifications for people with special needs in employment skills, amenity horticulture and retail sales. Community and family bonds are strengthened as people work together in the garden environment. Gardening is a universal language and brings the community together while children learn work and team skills through gardening projects. Gardening conversations and activities bring neighbours together as can be seen in the recent surge in allotment gardens, community projects and neighbourhood landscape improvements. A testament to this is well demonstrated by the Tidy Towns competitions organised by the Department of the Environment, Community and Local Government.

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Outlet Not only do plants contribute monetarily to the value of property, they also contribute to a higher quality of life and benefit society. For the individual, gardening provides exercise, stress reduction, and relaxation. For many of us it provides a creative outlet, a sense of accomplishment, and the gardener’s personal link to nature. The garden can be a great place to learn the joy that comes from work in contrast to video games or television. The garden teaches us that life does not always give instantaneous rewards. However, it gives improved quality of life and provides a sense of achievement and helps us nurture a good work ethic. In contrast, modern society today provides us with instant gratification in so many different ways, often instilling in us an expectation that everything should and must be instant e.g. telecommunications, processed readymade meals, information technology and so on. With gardening, as in

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n Ireland today we face a lot of stress factors, including constant bombardment with information about economic concerns, health worries, community strife and environmental issues. Gardening is a tool to abate life’s stress, enhance the environment, develop individuals/families and build communities.

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gardening

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Nutrition and Health Families with home vegetable gardens eat more fruit and vegetables for improved nutrition. For families on limited incomes, fresh fruit and vegetables may be a luxury they can’t afford. The home garden can supply fresh fruit and vegetables and, at the same time, give a twenty fold increase in value of produce grown compared to the original material cost. Gardening is a key tool for improved health by providing exercise, stress reduction and relaxation. From a medical perspective researchers have documented that people who interact with plants recover more quickly from everyday stress and mental fatigue. For many the garden is their escape from the pressures of the job and familiy responsibilities. The relaxation technique reduces stress levels and related issues like heart disease. Environmental Quality Urban and community woodlands, hedge rows and plantscaping can strongly influence the physical/biological environment and mitigate many impacts of urban development by moderating climate, conserving energy, using carbon dioxide, improving air quality, controlling rainfall runoff and flooding, lowering noise levels, harbouring wildlife and enhancing the attractiveness of our local communities. Urban forests play a key role in abating the emerging energy crisis. Trees contribute to energy conservation because they help reduce the cost of heating and cooling buildings. Summer time air temperatures in cities can be as much as 10°C warmer than in surrounding rural areas due to the replacement of soil and vegetation with concrete, asphalt and metal. Computer simulations suggest that a single 7.5 metre tree can reduce the heating and cooling costs of a typical residence by eight to ten per cent. Carbon sequestration, the process of removing carbon from the atmosphere and depositing it in a reservoir, is another measurable benefit of lawns and trees, important because increased greenhouse gases in the atmosphere have been linked with global change. A fast growing tree absorbs up to approximately 22kg of carbon dioxide per year; that adds up to ten tonnes per 0.4 hectares of trees – enough to offset the carbon dioxide produced by driving a car 33,000 kilometres.

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Gardening Practices Gardening activities have a direct impact on the neighbourhood and community environment. Landscape design and maintenance sets a community standard of prosperity, tranquillity and serenity. This may be found in charming inner city gardens or tasteful rural sites such as those created by the Tidy Towns committees. Many of us are unaware how our gardening practices actually enhance or negatively impact on the environment.

Plantmarket Plantmarket is one of 22 services provided by the HSE’s EVE network which offers a range of community–based training and work services for people with mental health difficulties in Dublin, Wicklow and Kildare. Plantmarket Garden and Training Centre is located at Blake’s Cross near Lusk in north Dublin and is open to the public on weekdays from 9.00am-4.30pm (MondayThursday) and from 9.00am-3.30pm (Friday).

As a point of interest let’s look at your typical home lawn: � The home lawn provides clean space for children and adults to enjoy the outdoors. � An actively growing lawn provides significant cooling to the local surroundings. �G rass traps dust and pollen in the air that contribute to allergic reactions. �G rass helps abate noise and reflected light, common irritants in the urban setting. �G rass is a very effective element of the urban ecosystem in beaking down pollutants. �2 .3 square metres of actively growing grass converts enough carbon dioxide into oxygen for one person per day. � Soils micro-organisms associated with grass breakdown various pollutants including air contaminants washed out of the air, pollen and pesticides. � A thick turfgrass allows 15 times less runoff than a lower quality lawn. A healthy stand of turfgrass can reduce surface runoff to almost zero. � I n the landscape setting, grassy areas provide the primary process to reduce pollution caused by surface runoff. On the other hand, gardening practices can negatively impact the environment. For example: � Lawn cuttings, leaves and other organic debris entering the road drains can account for 60-80 per cent of the phosphate loading of surface water in the urban landscape. � Excessive use of fertilisers, promoting rapid growth, adds to the volume of grass cuttings. � Excessive or careless fertiliser or pesticide use contributes to water quality problems. The natural environment is intrinsically linked to our wellbeing and continued existence; each of us in our own way can help protect and enhance it by small endeavours in our own garden and at the same time, use these endeavours to develop ourselves, our families and our community.

13/3/13 16:27:01

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your stories

DIARY OF AN INTERN Laura Lenihan speaks to Health Matters about her internship at Portiuncula Hospital in Ballinasloe, County Galway.

o here I am, six months into my internship with my days of surgery behind me. And how do I feel? Delighted. Move over long hours, the endless wait for registrars to come out of surgery for ward rounds – and welcome a team full of Senior House Officers who actually do ward jobs, a starting time deemed humane by most of the working world (8.30 to 9am for those of you who must know) and finishing before 6pm. With the stretch in the evening, some might even say I have got my life back. At the minute, the news stories are rife with tales of 36hour shifts and no sleep, but thankfully in GUH we don’t suffer that same burden. Now don’t get me wrong, I loved my surgical jobs and had great teams in both urology in GUH and surgery in Portiuncula (yes, you guys know who you are) – but I wasn’t made to be a surgeon and I’m okay with that. At the minute, my whole life revolves around applications for training schemes. Today in the hospital everyone is suited and booted for the medical interviews. I sadly have to wait another week for my fate to be determined. I have been lucky enough to get interviews for my top two GP schemes – Galway and Ballinasloe. In a matter of 20 minutes, my fate will be chosen by a panel of four people who have to decide if they think I have what it takes to be on their GP scheme for the next four years. It’s ironic to think that everything I have done over the last four years of medical school has been leading to this very point, these 20 minutes in which the next four years of my life will be decided. All I can do now is try my best. I have spent the last few months working hard, gathering information for audits and case reports and spending days shadowing the GPs I so wish to emulate. In the meantime I’m finding concentrating on my current workload difficult. It doesn’t help that medical

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“It’s ironic to think that everything I have done over the last four years of medical school has been leading to this very point, these 20 minutes in which the next four years of my life will be decided.” oncology is a different world to that of my previous surgical jobs. Every day I am dealing with fighters and survivors, those who have been dealt a difficult life. From the 17 year-old boy with testicular cancer

to the 67-year-old gentleman dying of prostate cancer, each day brings a new challenge. This early on in our career, it’s difficult to deal with death, something I now see each week. I still find myself questioning it and wondering could we, or even I have done more? Those are difficult answers to find, and something that I think takes years to deal with. Instead I put my work and thoughts into other matters – I’m helping out with a charity for cancer survivors and looking at ways to help them through this difficult time. As I look forward to the next six months – and my future career in medicine – I’m not sure what the future holds. Each day I learn something new and each day I meet a new patient or family member, someone that I get to help through this difficult time in their life. At the end of the day, no matter what I end up doing, there isn’t anything more inspiring than that.

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To you, it’s about getting the help you need. To us, it’s personal.

• Companionship & Medication Reminders

• Light Housekeeping & Laundry

• Dementia & Alzheimer’s Care

• Meal Preparation

• Respite Care

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18 Offices in Ireland

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| homeintsead.ie 13/3/13 16:57:41

Home Instead senIor care sPecIaL rePort

Home instead senioR caRe wins best HealtHcaRe specialist awaRd Home Instead senior Care has been awarded the accolade of being Ireland’s Best Healthcare specialist. this award honours Home Instead’s outstanding achievement to Irish healthcare, attributable to what judges deemed their professional profile as a premium provider of home care services, their broad and specialist range of quality services and their high levels of excellence in customer care.

+ Pictured l-r: Ian talbot, CeO of Chambers Ireland and ruairi Kavanagh, Managing editor of InBusiness presenting the award for Best Healthcare specialist to ed Murphy, CeO of Home Instead senior Care.

a gReat place to woRK? Home instead senior care has embarked on a journey to be recognised as a great place to work. this scheme is used to identify what the best organisations do well and how they can continue to improve. it focuses on building trust with employees, clients and other stakeholders.

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90% a Great Place to Work

employees’ respect

83%

88%

89%

93%

� employees feeling they are respected 83% � Overall employees feel it is a great place to work 90% If you would like more information on Great Place to Work, please check out

Credible Management

employees’ Camaraderie

employees’ Pride

resUlts FrOM FIrst sUrVeY: We are delighted with the extremely positive responses from our employees at Home Instead senior Care and look forward to achieving the status as being a Great Place to Work. � Clients’ level of trust in Home Instead senior Care 97% � employees feeling pride in their work 93% � employees have a feeling of camaraderie 89% � employees feeling that management are credible 88%

100

97%

AT HOME INSTEAD SENIOR CARE: � We are committed to building our team by creating a positive culture that inspires employees � We want the voices and involvement of our employees to help implement positive change � We want to hear the opinions of our employees and their experiences, so that we can use this valuable information to ensure we continue to improve our offering and be an employer of choice.

Clients trust Home Instead

HealtH Matters 93

www.greatplacetowork.ie. Meanwhile, log on to www.homeinstead.ie to keep updated on our progress.

14/3/13 11:55:16

94 Health Matters

Home Instead senior care news & Views Home Instead Improving Quality of Care – Certification Announcement of ISO 9001:2008

ome Instead Senior Care is proud to announce another step in its commitment to quality care, customer service and continual improvement with the certification of our quality management system to ISO 9001:2008 – Quality Management System UKAS Certification (Healthmark). ISO 9001, which is administered by the International Organisation for Standardisation, is recognised globally as the guideline for establishing and maintaining an effective quality management system for business in any

sector. Companies seeking certification must be able to demonstrate to the satisfaction of an independent third party auditor an ability to consistently provide services that meet the customers’ and regulatory requirements. Home Instead Senior Care underwent a stringent evaluation process where we demonstrated that we adhere to quality standards in the areas of customer satisfaction, service delivery, CAREGiver hiring and development, and continuous improvement in how we care for our clients. CEO of Home Instead Senior Care

Ed Murphy says: “This supports Home Instead’s focus on understanding and exceeding the expectations of our clients by continually improving the quality of our services and support systems. “Accreditation formally reinforces the quality of care and values we have always provided to our clients, to build a reputation based on relationships of trust. “We believe that our decision to become an ISO 9001: 2008 certified home care provider is a proactive one that demonstrates our commitment to provide superior quality care to our clients and community”.

Rugby legend lines out for new cause G ood news for older people and their families, as Home Instead Senior Care has opened its second operation in the Cork area. Not only will the new office mean better home care provision for older people in the greater north Cork area, but by enabling more older people to live happier, healthier, more independent lives at home, their quality of life and that of their loved ones will improve. Munster and Ireland rugby legend Mick O’Driscoll is lining out for a new cause, having just opened the additional office based in Blackpool, Cork. With a successful rugby career spanning 14 years under his belt Mick, as owner of the Cork North office, has decided his future direction must be one he believes in 100 per cent. As a director of Suicide Aware he became mindful of the devastating effects isolation and loneliness have to quality of life, and the lives of older people. “The Home Instead motto is ‘To us, it’s personal’ and to me it is. I want to be able to enhance the lives of the older community in north Cork by ensuring our caregivers are the best, most reliable and professional around. This may be a complete change in direction for me career-wise, but it’s one I believe in and one I intend to give my all to, for all my clients.” He is passionate about the values of

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+ Mick O Driscoll, owner, Home Instead Senior Care, Cork North with Paddy O’Brien, organiser of the Over 60s Show.

Home Instead Senior Care and believes that its business model has proved time and time again across Ireland that by enabling older people to live at home for longer than otherwise possible, they are happier, healthier and more independent. Mick will work closely with owner of the existing Cork office Noeleen Cronin, who has run Home Instead Senior Care Cork, based at the Mahon Industrial Estate, for the past seven years. Together they will provide a wide range of home care services to seniors with trained and supervised CAREGivers providing services tailored to individual needs, from Alzheimer’s and dementia care

to respite care and companionship. Both Cork offices have come on board as sponsors of this year’s Over 60s Show. Organiser Paddy O’Brien founded this wonderful event 35 years ago after noticing how isolated people can become as they get older. Mick said: “Paddy’s focus and commitment to showcasing not only the very real talent of our seniors, but his drive to encourage and celebrate the positive spirit and social contribution Cork’s older people make to the entire community is incredible. He certainly helps to make Cork a great place to grow old”.

14/3/13 11:55:19

Health Matters 95

Home Instead senior care news & Views

The Caregiving Relationship: “To us, it’s personal” H

ome Instead Senior Care is the premium provider of quality home care services to older people and their families throughout Ireland. We achieve this through building extraordinary relationships between our CAREGivers and clients. It is through the provision of high level quality care that we enhance the lives of seniors and their family members. We believe the support home care provides to families is only as strong as the mutual connection between CAREGivers and clients. Whatever each day may bring, our relationship-first approach enables us to help bring families together by anticipating our clients’ changing needs in their homes and community. Home Instead Senior Care lives out “to us, it’s personal” by empowering each and every one of our CAREGivers to build trust, take the lead and be compassionate. We put relationship first in all we do; this is the heart and soul of Home Instead Senior Care.

"When I see how happy mam is, I know the right decision was made" The following case study demonstrates the valuable role Home Instead’s professional CAREGivers play to improving the quality of life of Kathleen O’Brien and her family in Co. Wexford. Before employing the services of Home Instead Senior Care, Kathleen O’Brien was finding it increasingly difficult to remain living in her own home and needed her daughters to take turns to stay with her at night. Her children over the last number of years had children of their own and were finding having to leave their own young families to go and stay with their mother – who also needed their love and support – a very difficult situation, experiencing both stress and guilt. Kathleen wanted to have the option to

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remain living in her own home every night so both she and her daughters made the decision to contact Home Instead Senior Care to find out about their services. For this to work, Kathleen needed extra support getting in and out of bed, some help preparing meals and importantly a like-minded person to keep her company as she lives alone. After a free and thorough care consultation with Home Instead’s Care Manager, Kathleen and her family decided they would employ a Home Instead CAREGiver allowing Kathleen to live where she feels happiest, in her own home. Kathleen’s daughter Rose remarked: “It was a difficult decision for us all to make but we have no regrets – on the contrary. When I see how happy my mam is, I know the right decision was made. My sister is able to claim 41 per cent tax relief on the cost of the care, which is certainly an added benefit as we both have young families to look after. It is because of the wonderful support of Home Instead’s CAREGivers that Mam can stay in her own home; she doesn’t want to be anywhere else. Her two

CAREGivers Teresa and Angela just ‘click’ with her. It’s as if they’ve known each other for years! Teresa is very musical and when Mammy became aware of this she invited some of her neighbours over to meet her, hoping for a music session for her and her friends. It’s brilliant – she has a new lease of life! My sister and I also feel so much more content knowing she is being cared for by true professionals. Not only do we trust both ladies to do a great job, but they are just the best companions for her.” Kathleen O’Brien commented: “I feel independent again. It’s just great. Home Instead’s CAREGivers have made a very positive difference to my quality of life. We go shopping together, bake together – they are wonderful. Now when my family comes to visit me, we really enjoy this special time because I know my daughters aren’t worrying about me! I can’t speak more highly of my CAREGivers.” If you would like to find out more about Home Instead Senior Care, please contact 1890 930 013 or log on to www.homeinstead.ie

14/3/13 11:55:20

96 HealtH Matters

Home Instead senIor care news & VIews

‘Senior Citizen: tHe eSSentIaL gUIDeBOOK’ LaUnCHeD “ireland should take the lead and make our country the best place for people to grow old” – ed murphy, ceo, Home instead senior care

+ l-r robin Webster, CeO, age action, Michael Kearney, Director of Home Instead senior Care and Ireland rugby team Manager, ed Murphy, CeO, Home Instead senior Care and Mícheál Ó Muircheartaigh, broadcaster.

ome Instead senior Care’s mission is to enhance the lives of older people, enabling them to live happy, healthy and independent lives in their home for longer than otherwise possible. While traditionally old age has been associated with retirement, illness and dependency, today most people remain independent well into their 80s. the average life expectancy for both men and women 50 years ago was 58 years of age; today it is 80 for a man and 84 for a woman. In Ireland the number of citizens aged over 75 is set to double from 207,000 at present to 414,000 in the next 12 years. Clearly this age wave means we need to be planning for our future now. From providing home care to 2,500 people throughout Ireland, Home Instead senior Care became cognisant of the fact that older people and their families were faced with a very real unmet need for quality information, encapsulating everything from allowances and entitlements, fitness and wellbeing, legal and financial information,

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bereavement, nutrition and diet to medical care and home care. Having published a number of advice booklets focusing on health and wellness for older people, Home Instead senior Care is delighted to now make available senior Citizen: the essential Guidebook 2013. With contributions from the Hse, age action and many other older people’s organisations, this quality guidebook is certainly their positive contribution to change the face of ageing in Ireland. 45,000 copies of the guide are available completely free to health centres, libraries, citizens information centres, GP surgeries, hospitals, and to senior citizens who request a copy.

EAMON TIMMINS, AGE ACTION “this year began with issues such as rural crime, the challenges posed by winter weather, and the threat to funding for the seniors alert scheme. to a greater or lesser degree, those most affected by these issues were people who were not at the heart of their community – people living alone,

in remote areas, or who had no family – isolated perhaps due to poor health, lack of transport or a declining social network,” says eamon timmins of age action. Mr. timmins was speaking at the launch

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Home Instead senior care news & Views am delighted to see Home Instead Senior Care, with the endorsement of Age Action Ireland, have again produced a well proven and valuable resource for senior citizens, their families, carers and health care professionals. I understand that 45,000 copies of this resource will be distributed nationally to GPs, community nurses and others involved in the well being of older people. This guidebook offers reliable, informative and engaging information on a diverse range of issues which specifically impact on older people, and includes a directory of useful contacts. I would like to congratulate everyone associated with this publication for their hard work. I know that it will prove a helpful resource for many.” Minister Lynch confirmed that the National Positive Ageing Strategy will be published this year. + L-R: Mícheál Ó Muircheartaigh, GAA commentator, Mildred Sargent, Templeogue Active Retirement.

of Senior Citizen: The Essential Guidebook, a roadmap to successful ageing which was launched by Mícheál Ó Muircheartaigh. MICHEAL Ó MUIRCHEARTAIGH Mícheál Ó Muircheartaigh commented: “Guidebooks on various topics and subjects have been in use in many countries for a long time. They catered for different interests by containing information deemed to be of use to members of the public at particular times. Such books were generally well received and it is in that very light that I view Senior Citizen: The Essential Guidebook. Thankfully, senior citizens in Ireland have come more to the fore in recent times and will certainly appreciate the quality of this product once they have glanced through it initially. It will lead to greater contacts between the different age groups and this can be very beneficial to all concerned. This guidebook might even become a prototype for other countries. Bail ó Dhia ar an Saothar.”

ED MURPHY, HOME INSTEAD SENIOR CARE Ed Murphy of Home Instead Senior Care says: “The challenges facing governments across the world regarding the age wave are similar; Ireland should take the lead and make our country the best place for people to grow old by helping our senior citizens to live happy, healthy and independent lives in their homes for longer than otherwise possible. We at Home Instead Senior Care would like to see the Government become

HM Iss9.1 p92-128pg.indd 97

a thought leader in how our senior citizens are viewed and valued. I am looking forward to the implementation of the impending

“Senior Citizen: The Essential Guidebook supports our goal to actively change the face of ageing by providing older people and their families with quality information on a range of topics.” – Ed Murphy, CEO, Home Instead Senior Care

National Positive Ageing Strategy and hope to see very constructive and positive impacts for older people and their families. Senior Citizen: The Essential Guidebook supports our goal to actively change the face of ageing by providing older people and their families with quality information.”

MINISTER KATHLEEN LYNCH In her foreword, Kathleen Lynch TD, Minister of State with responsibility for Disability, Older People, Equality and Mental Health, says: “I

NOEL MULVIHILL, HSE Noel Mulvihill, Assistant National Director, Services for Older Persons, HSE, in his foreword, comments: “The strategic aim of the HSE’s Services for Older People is to support older people to remain at home in independence for as long as possible or, where this is not possible, in an alternative appropriate high quality residential care setting... The Senior Citizen Guidebook is a convenient user friendly reference guide that provides useful links to other information sources which may also be of interest to the wider population.”

'Senior Citizen' features information on: • Allowances and Entitlements for older people and carers • Minding your Health • Home Care • Keeping Safe at Home • Nursing Homes • Alzheimer’s and other Dementia Care • Tips on Health and Fitness, Nutrition and Diet, Holidays and Travel • Financial and Legal Information • How to deal with Bereavement It also has a directory of older people's organisations and other useful contacts. To order a FREE copy of Senior Citizen: The Essential Guidebook, call 1890 989 755 or log on to www.homeinstead.ie to download a PDF of the guidebook.

14/3/13 11:55:24

98 Health Matters

Home Instead senior care news & Views

National Positive Ageing Strategy Imminent Home Instead Senior Care welcomes the forthcoming National Positive Ageing Strategy, due this year.

ith Ireland’s older population set to increase exponentially over the coming years, there is no doubt that our social and economic landscape is facing dramatic changes. Home Instead Senior Care welcomes the imminent publication of the National Positive Ageing Strategy and hopes to see very constructive and positive impacts for older people and their families. Home Instead Senior Care would like to see Ireland take the lead and make our country the best place to grow old by helping older people and their families to take a proactive and creative approach to ageing, so that their quality of life now and in the future means they lead happy, healthy and independent lives in their own homes for as long as possible.

What is the National Positive Ageing Strategy? The National Positive Ageing Strategy is the long-term plan for making Ireland a better place to grow older. The strategy will involve all levels of Government as well as city and county councils. It will also influence the activities of organisations in the community, voluntary and private sectors. Why is the National Positive Ageing Strategy Important? We all age. We don’t know what our lives will be like as we age. Some of us will remain healthy and active; others will experience illness and disability. We all want to live life until the end. Whatever our circumstances, the drive to manage ourselves and our own lives will remain powerful. The National Positive Ageing Strategy determines the baseline for a blend of values, policies, laws and services that will maximise our independence as we age. If this happens, Ireland will become a better place for people of all ages to live, age and die.

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Key Commitments The National Positive Ageing Strategy needs to make ten commitments if Ireland is to be a better place to grow older: 1. Equality for older people 2. Respect and dignity for people of all ages 3. Fairer health care 4. Effective home and community care, including the right to care 5. Clarity about rights and entitlements 6. Secure pension 7. Effective transport 8. Meaningful involvement of older people 9. J oined up planning and delivery of services and supports 10. A road map for implementation. Ireland has a long way to go when it comes to promoting the right for older people to age well at home. Older people should be given choice in relation to their care as they age, and assistance to stay at home as part

of an integrated health care system. Home Instead Senior Care believes older people need to be encouraged and supported to take personal responsibility to prepare for their retirement and their future care needs. Tax relief of up to 41 per cent is available towards the cost of home care, and the Government should actively promote this as their contribution to an older person’s care needs. By doing so they will encourage older people and their families to also take responsibility for their care needs. The ten commitments listed here are the key to shaping a better system that will maximise independence as we age. Home Instead Senior Care believes that effective social supports should be in place to keep older people vibrant in the community. There should be clear access to community care and information on the availability of that care to benefit the older people of today – and tomorrow.

14/3/13 11:55:26

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13/3/13 16:57:56

100 HealtH Matters

nurse of tHe year

elaine wins nuRse of tHe yeaR Hse nurse elaine o'brien doyle from the midlands Regional Hospital, portlaoise, who was named 'nurse of the year' sponsored by safeHands at the 2012 maternity and infant awards, talks to Health Matters.

HOW LONG HAVE YOU bEEN A NURSE? I have been a qualified nurse for 25 years and started my training in Jervis st Hospital. after a short period in australia and a very intense time in st luke’s Hospital, rathgar, Dublin, I started my paediatric training in temple street Hospital. DID YOU SPECIALISE IN PAEDIATRICS? From my early days I had wanted to do my paediatric nurse training. as there was no opening at the time I travelled to australia and worked as a nursing sister in the Prince of Wales Children’s Hospital sydney to gain the experience required to achieve entry to the post-graduate course in paediatrics. as a child I spent a bit of time in hospital and always wanted to be a children’s nurse when I grew up. WHERE ELSE HAVE YOU WORKED AS A NURSE? Most of my working life has been in Portlaoise regional Hospital. I worked abroad and in other tertiary centres for short periods between training. I worked for a short time as a nurse screening for heart disease and breast and cervical cancer. that was back in the early 90s during the last recession and cut-backs when there was very little employment in the public sector. I did my Higher Diploma in Paediatric Oncology between 1999 to 2001 in UCD and was supported by the Midland regional Hospital for this. all along I was driven by the notion that children should not be in hospital for any longer than necessary. I always had an interest in oncology and more specifically, paediatric oncology. HOW LONG HAVE YOU WORKED AS A NURSE? I have been nursing now since March 1983. In 1982 I started a computer course in Carlow It while waiting for my place in Jervis street after doing the leaving Certificate. then computers were a whole new concept that definitely did not tie in with nursing. However like everything else

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it was knowledge never wasted and has made many situations a lot easier.

WHERE ARE YOU fROM? I grew up within 200 yards of the hospital I now work in. I also worked in this hospital while in school as a member of the household staff. WHAT DOES YOUR DAILY WORK ROUTINE INVOLVE? First thing in the morning I find out if any of my cohort of children have been in the hospital overnight. sometimes the parents will send me a text or the paediatric unit staff may inform me. I can quickly establish if there is need for my involvement at this stage. there can be requests or information that requires urgent attention or may impact on decision making by the team in the acute services around a specific child. + elaine O'Brien Doyle with her award. throughout the day there may be elective appointments to see children of non-medical people who become very in association with another member(s) of skilled at providing specialised care to the multi-disciplinary team. Medical notes their loved one. I have a very good team may need updating or reports followed up. around me in the acute services and in at any time throughout the day I receive the unit itself which is imperative to good calls from parents, tertiary centres staff in communication and better outcomes for special schools or other multi-disciplinary families. the kind of support I offer to team members with queries or concerns. I families might be as little as a referral to a communicate regularly with the Jack-andservice or a contact number. Jill staff. Calls I receive in general, whether from a parent or a professional, can range WHAT DID IT MEAN TO WIN THE from medication q ueries to feeding devices AWARD? not working to more serious matters such I never considered that anything like this as a child deteriorating. would ever happen to me. I am grateful for the nomination and am delighted it has given attention to the role I play. I have WHAT ARE THE PROS AND CONS Of worried that in the present environment YOUR WORK? some specific posts are not recognised I have never ever been bored at my work. for the service they provide and can be My brain is always being challenged which I considered a luxury to the system. I hope enjoy. I am very fortunate to be in constant my post will continue into the future. contact with families. I am regularly in awe

13/3/13 16:57:59

School of Computer Science and Statistics

MSc in Health Informatics

School of Nursing and Midwifery, National University of Ireland, Galway. Building and Promoting Excellence in Practice th

International 44th International Nursingand andMidwifery MidwiferyConference Conference Nursing 15ththand and16 16ththApril April2013 2013 15

Part-time programme The MSc in Health Informatics, run in conjunction with the School of Medicine, aims to produce people who will play a leadership role in the effective use of information and communications technology in the delivery of healthcare. The programme runs part-time, over two years, on Friday afternoons and Saturday mornings. Closing date: 30th June 2013 Fees: This course currently attracts a reduced fee for EU students 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

The conference will cover topics relevant to the ﬁelds of chronic illness, mental health, older people, maternity care and women’s health, and teaching and learning in practice. Keynote speaker is Dr. Julie Barroso, Professor at the Duke University School of Nursing. Her research is in the areas of qualitative research methodology and chronic illness. She will speak on ‘Synthesising qualitative research’ and will host a special qualitative workshop the afternoon of the 16th April 2013. Other exciting speakers include Dr. David Tovey, Editor in Chief of The Cochrane Library and Capt. John Flanagan, an Airline Pilot and member of the International Society of Air Safety Investigators.

For registration details and other information please visit www.nursingmidwifery.ie or email: info@nursingmidwifery.ie

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102 Health Matters

volunteering

HSE Staff Return From Haiti HSE staff members Geraldine Murphy and Caroline Keyes recently travelled to Haiti to help with rebuilding efforts, still much-needed in the wake of 2010’s devastating earthquake. Health Matters hears their stories.

+ Former US President Jimmy Carter and country star Garth Brooks with volunteers during the 2012 Habitat for Humanity Jimmy and Rosalynn Carter Work Project. © Habitat for Humanity International/GLHipple.

+ Disability Manager Geraldine Murphy (third from left) pictured in Haiti with singers Garth Brooks and Trisha Yearwood.

Geraldine Murphy HSE Disability Manager in North Dublin Geraldine Murphy travelled to Haiti last November where she joined other volunteers, including former US President Jimmy Carter, for a week-long building programme. "The volunteers were from Habitat for Humanity Ireland and the non-profit organisation Haven. Up to 90 Irish volunteers donned hard hats and building boots in Haiti in an effort to build homes for thousands affected by Hurricane Sandy and the 2010 earthquake. "Former American President Jimmy Carter said: “Without the help of volunteers from around the world, homes such as these built in Haiti would not happen.” US singers Garth Brooks and his wife Trisha Yearwood also joined the Irish volunteers along with another 600 volunteers from around the world. "Explaining how she got involved with

and mortar. Part of the agreement with the families is that they provide an agreed amount of ‘sweat equity’, which means that they work side by side with us in building their house/houses. Habitat for Humanity provide a project manager and foreman who guide us and set out our daily work.” In 2010 Geraldine went to India and Ethiopia, while in 2011 she went to El Salvador. Her first trip was to Kyrgyzstan in 2009. She uses some of her annual leave to take part in the charity trips. Funds having to be raised vary from s2,500 to s4,500. President Michael D Higgins, who became patron of the charity this year, is backing Habitat housing projects in Dublin. “The trip to Haiti was very different from my other trips,” Geraldine says. “The trips I have been on prior to Haiti were small groups of seven to ten volunteers. I was amazed at the scale of the Haiti project. There were around 700 volunteers

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the charity, Geraldine says: “I found I had some time on my hands and wanted to do something worthwhile. As I have a full-time job I needed to find something I could do in planned periods of time. I also love to travel, so while shopping I got talking to a girl who was bag packing in our local supermarket for her trip to El Salvador with Habitat for Humanity. I realised I had found what I was looking for. “I think taking part in charity/voluntary work, and in particular volunteering abroad, is something that puts things into perspective. When I travel abroad with Habitat for Humanity and meet the people who benefit from the houses we help to build and hear their stories, it makes me very thankful for the charmed life I have. “When we arrive, the houses are in various stages of being built so we may start on digging foundations, making bricks or mixing cement mix from sand

13/3/13 16:58:13

Health Matters 103

volunteering organised with typical American precision. Although I knew the history of the devastation caused by the earthquake in 2010, I was not prepared for the sights I saw on the way from the airport – the makeshift houses, people living in squalor, children barefoot playing on rubbish dumps; the dirt and the filth that these people were living in was quite upsetting. However, the volunteers who had been in Haiti the previous year said things were a lot better so I suppose progress is being made.”

“The minute we stepped off the plane we experienced the intense heat and humidity which the Haitian climate had to offer. We were staying in Christaniville, a campsite approx 28km from the Haitian capital.” Caroline Keyes Caroline Keyes, a Clinical Nurse Manager in the OPD/Radiology Department at the Midland Regional Hospital at Tullamore, also recently returned from Haiti where she volunteered with the Irish charity Haven. “On November 23rd 2012 I gained a new perspective on life and the inequalities in our world. On a cold November morning, I joined 66 other Irish volunteers with the Irish charity Haven. We left Dublin Airport and our destination was Port au Prince, Haiti. "Haven’s aim for the trip was to build 100 houses in collaboration with the Habitat for Humanity charity. Each volunteer had to fundraise s4,500. "Haiti is a small country approximately the size of Munster. It is also the poorest country in the western hemisphere. The earthquake in 2010 had a devastating effect on an all ready impoverished country, leaving up to 316,000 people dead and 1.6 million homeless.

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+ Volunteer Geraldine Murphy, from Castleknock, helps to build the walls of a new Habitat home at the 2012 Habitat for Humanity Jimmy and Rosalynn Carter Work Project in Haiti. © Habitat for Humanity International/Ezra Millstein.

"These conditions, as witnessed by Haven founder Leslie Buckley while visiting Haiti for business purposes nearly ten years ago, shocked and appalled him so much so that he founded Haven. Leslie and his wife Carmel now support programmes that are helping to build sustainable communities. "The minute we stepped off the plane we experienced the intense heat and humidity which the Haitian climate had to offer. We were staying in Christaniville, a campsite approx 28km from the Haitian capital. With the 66 other Irish volunteers and 600 Habitat for Humanity volunteers, we eagerly boarded the 11 yellow buses which were to be our mode of transport to and from the build site for the week. Security is a major issue in Haiti. For this reason the 11 buses travelled in convoy each day and we were protected by armed security 24 hours a day. Travelling for the first time through the streets of Port Au Prince is an experience I will never forget. Quickly the mood on the bus changed from excitement to shock and disbelief. No one could have prepared us for those first sights. An awestruck silence enveloped the bus. The poverty, primitive conditions and squalor which the people of Haiti are living in is astounding. The streets were littered with rubbish; tents and shacks were visible from every direction and surrounded by muck, goats, hens and pigs. There was an endless stream of people standing on the side of the streets. Little scantily-clad children looked

on in amazement at the 11 yellow buses travelling through their city. As a mother of two children, I found these scenes heartwrenching. "On our first morning we had a wake up call for 6am. On site, the volunteers were divided into groups of ten to 12. Each team had two houses to complete. Galway man Micheal Davie and I were the only two Irish volunteers in our group. We spent the first two days assembling the wooden frames and nailing hurricane clips onto the rafters, two days roofing and two days painting. The work was full-on and made all the more intense due to the blistering heat and humidity. "Each day we travelled in convoy to and from the building site. Every evening we arrived back to the campsite and queued for a badly needed shower and dinner. "During the week, I had the privilege of meeting amazing, kind, funny and witty people. Niamh McDonnell, Emer O’Sullivan and Declan O’Sullivan, all from Cork, were first-time volunteers. Their enthusiasm, excitement and daily sense of achievement at the work they had completed each day was infectious. "None of the work would have been possible if it were not for the generosity of all the people who supported the Haven volunteers as we fundraised for the trip. I would like to thank all of the people who supported my fundraising efforts. "As a result of their kindness, 100 families in Leogane in Haiti now have a proper house which they can call home."

13/3/13 16:58:16

NICORETTE® QuickMist mouthspray

NEW

nicotine

Instant release spray. So fast, it’s breathtaking. · NICORETTE® QuickMist is clinically proven to relieve cravings in just 60 seconds with 2x1mg/sprays1

· NICORETTE® QuickMist is 46% more effective at helping smokers quit compared with placebo at 4 weeks2

Product Name:Nicorette QuickMist 1 mg/spray, Oromucosal Spray. Composition: 0,07 ml contains 1 mg nicotine, corresponding to 1 mg nicotine/spray dose. Form: Oromucosal spray. A clear to weakly opalescent, colourless to light yellow solution. Therapeutic indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms, thereby facilitating smoking cessation in smokers motivated to quit. Advice and support normally improve the success rate. Dosage: After priming, point the spray nozzle as close to the open mouth as possible. Press the top of the dispenser and release one spray into the mouth, avoiding the lips. Subjects should not inhale while spraying to avoid getting spray into the respiratory tract. For best results, do not swallow for a few seconds after spraying. Subjects should not eat or drink when administering the oromucosal spray. Subjects should stop smoking completely during the course of treatment with Nicorette QuickMist. Step I: Weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge. If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required, future doses may be delivered as 2 consecutive sprays. Most smokers will require 1-2 sprays every 30 minutes to 1 hour. Step II: Weeks 7-9: Start reducing the number of sprays per day. By the end of week 9 subjects should be using half the average number of sprays per day that was used in Step I. Step III: Weeks 10-12: Continue reducing the number of sprays per day so that subjects are not using more than 4 sprays per day during week 12. When subjects have reduced to 2-4 sprays per day, the oromucosal spray use should be discontinued. To help stay smoke free after Step III, subjects may continue to use the oromucosal spray in situations when they are strongly tempted to smoke. One spray may be used in situations where there is an urge to smoke, with a second spray if one spray does not help within a few minutes. No more than four sprays per day should be used during this period. Regular use of the oromucosal spray beyond 6 months is generally not recommended. Some ex-smokers may need treatment with the oromucosal spray longer to avoid returning to

smoking. Any remaining oromucosal spray should be retained to be used in the event of sudden cravings. Do not administer Nicorette QuickMist to persons under 18 years of age without recommendation from a physician. There is no experience of treating adolescents under the age of 18 with Nicorette QuickMist. Contraindications: Hypersensitivity to nicotine or to any of the excipients of the oromucosal spray. Special warnings and precautions: Nicorette QuickMist should not be used by non-smokers. Dependent smokers with a recent myocardial infarction, unstable or worsening angina including Prinzmetal’s angina, severe cardiac arrhythmias, uncontrolled hypertensions or recent cerebrovascular accident should be encouraged to stop smoking with non-pharmacological interventions (such as counselling). If this fails, the oromucosal spray may be considered but as data on safety in this patient group are limited, initiation should only be under close medical supervision. Diabetes Mellitus. Patients with diabetes mellitus should be advised to monitor their blood sugar levels more closely than usual when smoking is stopped and NRT is initiated as reduction in nicotine induced catecholamine release can affect carbohydrate metabolism. Allergic reactions: Susceptibility to angioedema and urticaria. A risk-benefit assessment should be made by an appropriate healthcare professional for patients with the following conditions: Renal and hepatic impairment: Use with caution in patients with moderate to severe hepatic impairment and/or severe renal impairment as the clearance of nicotine or its metabolites may be decreased with the potential for increased adverse effects. Phaeochromocytoma and uncontrolled hyperthyroidism: Use with caution in patients with uncontrolled hyperthyroidism or phaeochromocytoma as nicotine causes release of catecholamines. Gastrointestinal Disease: Swallowed nicotine may exacerbate symptoms in patients suffering from oesophagitis, gastric or peptic ulcers and oral NRT preparations should be used with caution in these conditions. Danger in small children: Doses of nicotine tolerated by adult and adolescent smokers can produce severe toxicity in small children that may be fatal. Products containing nicotine

should not be left where they may be misused, handled or ingested by children. Transferred dependence: Transferred dependence can occur but is both less harmful and easier to break than smoking dependence. Stopping smoking: Polycyclic aromatic hydrocarbons in tobacco smoke induce the metabolism of drugs metabolised by CYP 1A2 (and possibly by CYP 1A1). When a smoker stops smoking, this may result in slower metabolism and a consequent rise in blood levels of such drugs. This is of potential clinical importance for products with a narrow therapeutic window, e.g. theophylline, tacrine, clozapine and ropinirole. Excipients: The oromucosal spray contains small amounts of ethanol (alcohol), less than 100 mg per spray. Care should be taken not to spray the eyes whilst administering the oromucosal spray. Undesirable effects: Subjects quitting habitual tobacco use by any means could expect to suffer from an associated nicotine withdrawal syndrome that includes four or more of the following: dysphoria or depressed mood; insomnia; irritability, frustration or anger; anxiety; difficulty concentrating, restlessness or impatience; decreased heart rate; and increased appetite or weight gain. These have been observed in those using the oromucosal spray. Nicotine craving with urge to smoke is also recognised as a clinically relevant symptom, and an important additional element in nicotine withdrawal after smoking cessation. In addition to this, other cessation-associated symptoms were seen in those using the oromucosal spray: dizziness, presyncopal symptoms, cough, constipation, mouth ulceration, gingival bleeding and nasopharyngitis. Nicorette QuickMist may cause adverse reactions similar to those associated with nicotine given by other means and these are mainly dose-dependent. Allergic reactions such as angioedema, urticaria or anaphylaxis may occur in susceptible individuals. Local adverse effects of administration are similar to those seen with other orally delivered forms. During the first few days of treatment irritation in the mouth and throat may be experienced, and hiccups are particularly common. Tolerance is normal with continued use. Daily collection of data from trial subjects demonstrated that very commonly occurring adverse events

were reported with onset in the first 2-3 weeks of use of the oromucosal spray, and declined thereafter. Adverse reactions reported in clinical trials of the oromucosal spray include: Nervous system disorders: Very common: Headache, dysgeusia Uncommon: Paraesthesia Eye disorders: Uncommon: Lacrimation increase Not known: Vision blurred Cardiac disorders: Uncommon: Palpitations Not known: Atrial fibrillation Vascular disorders: Uncommon: Flushing Respiratory, thoracic and mediastinal disorders: Very common: Hiccups Uncommon: Dyspnoea, rhinorrhoea, bronchospasm, sneezing, nasal congestion Gastrointestinal disorders: Very common: Nausea, dyspepsia Common: Vomiting, flatulence, abdominal pain, diarrhoea Uncommon: Gingivitis, glossitis Skin and subcutaneous tissue disorders: Uncommon: Hyperhydrosis, pruritus, rash, urticaria Immune system disorders: Uncommon: Hypersensitivity. General disorders and administration site conditions Very common: Oral soft tissue pain and paraesthesia, stomatitis, salivary hypersecretion, burning lips, dry mouth and/or throat Common: Throat tightness, fatigue, chest pain and discomfort Uncommon: Oral mucosal exfoliation, dysphonia Not known:Allergic reactions including angioedema and anaphylaxis. MA Holder: McNeil Healthcare (Ireland) Limited, Airton Road, Tallaght, Dublin 24 Ireland. MA Number: PA 823/49/29. Revision of text: August 2012. Legal Category: Not subject to medical prescription. Further information available upon request from Johnson & Johnson (Ireland) Ltd. References: 1. Hansson A et al. Craving Relief With A Novel Nicotine Mouth Spray Form Of Nicotine Replacement Therapy. Poster POS3-45 Presented at SRNT, Feb 16–19th, 2011, Toronto, Canada. 2. Tønnesen P, et al. Efficacy And Safety Of A Novel Nicotine Mouth Spray In Smoking Cessation. A Randomized, Placebo-Controlled, Double-Blind, Multi-Center Study With A 52-Week Follow-Up. Poster POS238 Presented at SRNT, Feb 16-19th, 2011, Toronto, Canada. IRE/NI/12-0230

For every cigarette, there’s a nicorette

www.nicorette.ie HM Iss9.1 p92-128pg.indd 104

13/3/13 16:58:26

the ons de: he, ers: red rial ing ery ea, nal on: on: ers: une eral on: ary oat and nia and nd) MA 12. on. om

h A ent 9th, And ing nd, S2da.

HealtH Matters 105

HealtHy lIvInG

Health promotion training foR tobacco cessation Half of all smokers die from tobacco related disease and this accounts for 5,500 deaths in ireland every year. the estimated costs of treating tobacco related illness are 6 to 15 per cent of annual irish healthcare budgets.

o address the needs of the one million Irish people who smoke, a national training programme in Brief Interventions for tobacco Cessation will ensure that as many healthcare providers as possible will be trained to deliver a standardised and evidence-based model for effectively intervening with patients who smoke. In support of the National tobacco Control Framework, this is a one-day training programme for clinical staff to develop skills to support patients who choose to stop smoking. “Health professionals are ideally placed to raise the issue of smoking with service users. With the right mix of knowledge and skills, health professionals can make every contact count by encouraging and supporting smokers to quit,” says Biddy O’Neill, assistant National Director for Health Promotion. this training is for those who are in a position to raise the issue of tobacco use within their professional role and to support positive behaviour change in smoking cessation. this includes health professionals, nurses, midwives, allied health professionals and pharmacists as well as community workers. this skill-based training aims to develop skills in the use of brief interventions with patients/clients by raising the issue of health promoting choices with particular emphasis on tobacco use. “the course was excellent in providing the skills and competence to undertake brief interventions in smoking cessation which I have instituted on many occasions since attending the course on December 18th,” says Des ryan, area Medical Officer

Dublin North East Paula Campbell tel : 041 685 0671 email: paula. campbell@hse.ie

HM Iss9.1 p92-128pg.indd 105

Debbie Grealish tel: 01 897 6151 email: debbie. grealish@hse.ie

in North Cork. “every patient contact is an opportunity for prevention, and smoking cessation is ‘top priority’ for prevention of childhood illness through passive smoking. I have had many opportunities already to incorporate these health promotion changes for parents and carers in the course of my daily work routine.” “the staff in Occupational therapy found the training to be excellent,” said Megan Goodale, a/Occupational therapy Manager in Cork University Hospital. “the interactive learning style and the ability to practise basic skills enabled them to come away with a feeling of confidence. they also reported they would now be more likely to address the issue of smoking with patients and to give them information on smoking cessation.” the training provides participants with an understanding of the complexity of smoking and examples of simple language to intervene whilst maintaining a positive working relationship with the smoker.

TOPICS COVERED ON THE COURSE INCLUDE: � Understanding tobacco use � the health effects of smoking and the benefits of quitting � Client-centred skills for raising the issue of smoking with patients � Coping with withdrawal symptoms and

Dublin Mid West Gail McNeil tel: 043 44089 email: gail.mcneill@ mhb.ie

South sandra Coughlan, tel: 021 492 1641 email: sandra. coughlan@hse.ie

nicotine replacement therapy. the course is facilitated by Health Promotion and smoking Cessation specialists in every Hse region and is six hours in duration. this course is recognised for Category 1 approval 6 CeUs for registered nurses and midwives by an Bord altranais and 5.5 external CPD credits for registered doctors/consultants by the ICGP. to register for a course in your locality, go to Hsenet, search for ‘brief interventions training’ in the search box and you will be directed to the link for the online application system. alternatively, you can book a place on this course by contacting your local Health Promotion Department for an application form – see below.

Kate Cassidy tel: 051 846712/051 842911 email: kate.cassidy@hse.ie

West Mary McMahon tel: 065 686 5814 email: maryb. mcmahon@hse.ie

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New graphic health warnings to help people quit smoking Cigarette packages placed on the Irish market now have to display graphic photographs with a strong health warning. These images depict the negative health impacts associated with smoking.

esearch and experience in other countries has shown that health warnings combined with coloured photographs can be an effective means of discouraging smoking and informing people about the health risks related to smoking. According to the World Health Organisation, in Canada the introduction of photo images on cigarette packs resulted in a fourfold increase in smoker’s intentions to

+ Dr Tony Holohan, Chief Medical Officer in the Department of Health and Minister for Health Dr James Reilly TD launch graphic new health warnings to help people quit smoking.

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quit. The organisation also found that in Brazil, 56 per cent of people changed their opinion about the health consequences of smoking after the introduction of the new packaging. Attending a press launch publicising the new images Dr James Reilly, the Minister for Health, said he hoped the introduction of the graphic photo images will give people a clearer understanding of the great dangers of smoking. “Half, or one in two, of all long-

term smokers will die from smoking-related diseases. This is a stark statistic. There is no doubt that if tobacco were discovered today, knowing what we know about its lethal effects, it would not be a legal product.”

Preventable Illness “I am committed to reducing the number of young people starting to smoke and those current smokers,” the Minister said. “If, by introducing these graphic images on cigarette packs, some people are shocked into considering how smoking impacts on them and their families then the warnings will have achieved their objective.” Dr Tony Holohan, Chief Medical Officer in the Department of Health, added: “We should never lose sight of the detrimental impact that smoking has on our society. It remains the greatest single cause of preventable illness and premature death in Ireland, killing over 5,200 people a year.” The introduction of these warnings builds on other legislative measures taken to date in relation to tobacco, including the ban in 2009 of the display and advertising of tobacco products in retail units. It is anticipated that these particular measures will have a positive impact on reducing the numbers of young people starting to smoke. There are 14 images which Ireland selected from the library of images developed by the European Commission. All tobacco products placed on the market on or after February 1st 2013 must comply with the new regulations. Any tobacco products placed on the market prior to February 1st 2013 can continue to be sold or offered for sale until February 1st 2014. This facilitates the sale of more 'slow moving' tobacco products. A copy of the statutory instruments which include the images that will be used are available on the website of the Department of Health: www.doh.ie.

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Healthy Living

Bikram Yoga The morning after my first Bikram class I couldn't bend to pick up the soap when it fell in the shower, my stomach muscles were so sore and stretched from the 90-minute class the previous evening, writes Anne Leonard. A Bikram studio had opened up directly across from my apartment in Colorado Springs in the US where I was living at the time, and the steady stream of sweaty, happy, radiant people emerging from the studio intrigued me. They also unnerved me – so I dragged two of my friends along to the first class. Everyone remembers their first class, and I remember clearly the teacher cajoling me to bend my spine back in a posture. Of course, I thought she was crazy asking me to backward bend and resolved that even if I did return to class, I would never backward bend like the person on the mat next to me. It doesn't take many classes to work out that it is the backward bends that help release endorphins and leave you with that euphoric feeling as you finish class. They also help create space in the spine: more room for the synapses to disperse to the body, making everything work more efficiently. And they also help you get addicted to Bikram yoga. Several years later, via an intensive training with Bikram and Rajashree Choudhury, when I opened Ireland's first Bikram studio I couldn't help smiling at those who also came armed with their friends and gave that frightened glance at the person on the mat next to them. Bikram Yoga celebrates ten years in Ireland this year and of the several thousand people who come to any of the 12 centres across Ireland, testimonies abound. With regular practice, the body self regulates. For example, someone with an underactive thyroid will regulate thyroxine levels as the endocrine system balances. The blood travels through the thyroid gland every 17 minutes. A sluggish thyroid depletes energy: in the 90-minute class you stretch and compress the thyroid gland, regulating, irrigating the gland. One of our students shed four-and-a-half stone in the first summer of his attendance. When someone loses exponential weight, it is because the whole body is rebooted and works the way it is meant to.

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The yoga also strengthens the mind. Students find it easier to eat better, to give up smoking, and you take the patterns you establish in your class to your life outside. It could be something as simple as engaging the stomach muscles when you bend down to pick up the post, or more esoteric enhancing of your mind body connection. Yoga helps to limit the effects of ageing, by keeping the muscles supple, the joints loose and the mind clear. You are just as likely to have a person in their seventies on the mat next to you as a 20 year old pro boxer. Yoga is for everyone and everybody: eight to 80 is the general guideline. Yoga helps prevent injury so much of what

you do in class is preventative as well as restorative. Most studios offer first timers a special rate of s49 for their first month. It gives students the opportunity to see the benefit over a period of time, and also to attribute these benefits to the yoga. Yoga reduces stress, increases circulation, improves strength and flexibility. It is excellent for back pain, sports injuries, bad posture and it promotes relaxation and correct breathing. For more information see www.bikramyoga.ie. Anne Leonard owns and runs a Bikram yoga studio in Unit 9, Greenmount Industrial Estate, Harold's Cross, Dublin 12. Tel: 087 127 3069.

Comments from regular Bikram yoga practitioners “After undergoing keyhole surgery to remove fluid from my knee due to an arthritic condition, a friend recommended Bikram yoga to me. Although removing the fluid and sporadic use of anti-inflammatories did help my condition, I still had a constant numbness in my knee and felt that it was very fragile. As I could not participate in high-impact sports I thought that I would try it. Within a month, I no longer had any problems with my knee.” -Emily Alexander “Two years ago I got osteoporosis and Osteopenia in my lower back lumbar vertebrae and I was terrified. I kept going with Bikram on average four times per week, plus I took a calcium supplement. Yesterday I got my DEXA scan and my bones are normal.” -Cathy DeMare

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Healthy Living

Staff step up for 11,000km walk As part of a recent Step Challenge the staff in St Patrick’s Centre in Kilkenny walked over 11,000km during a four week period, the equivalent of walking around the coast of Ireland three times.

ith the aim of living healthier lifestyles, the staff at the centre took on this four-week challenge. The challenge is a simple initiative aimed at encouraging people to build more physical activity into their daily routines. Groups of colleagues organise themselves into teams, and use step counters to count every step they take. A step counter is a simple device worn on your waistband. It has a motion sensor which is activated when you take a step. The teams compete against each other over a four week period to see which team takes the most steps. Meabh McGuinness, Health Promotion Officer, said: “With physical activity we promote the message that ‘small changes make a difference’, and that’s what this challenge is about, you don’t have to join a gym or get involved in sport to be active.” Some 17 teams took part with a team from Our Lady’s Unit clinching first prize. Together this team walked over 1000 kilometres during the four-week period. Eddie Maloney the team captain said: ‘‘It was great to do it in teams because we encouraged each other along the way and it wasn’t about individual results, it was about a team effort.”

+ L-R: Kate Cleere, Edel O’Hara, Geraldine Ruessmann, Eddie Maloney.

Small Steps to Big Changes Everyone in the challenge aims to take at least 10,000 steps every day. The ‘Get Ireland Active’ website is useful to get more support and information about how to reach this target. People find that wearing a step counter all day makes them more aware of their activity patterns – for example they might be quite active on a day they work or vice versa depending on their job. Even small changes are picked up by the step counter, such as parking at the far end of the car park. Seeing

small changes giving you extra steps on the counter is very motivating for people. Geraldine Ruessmann from St Patrick’s Centre said: ‘‘It made me really aware of the days when I am not very active at all, if I saw a low number of steps on the step counter it spurred me on to get out for a walk.” The competitive element adds a bit of fun to the challenge, there is a lot of good-natured rivalry during the challenge and many people comment that one of the best bits of the challenge was the fun it generated.

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Getting Active Walking is a great choice for someone wanting to be more active, it’s free, it’s safe and it’s easy. Using a step counter is a cheap and simple way of motivating yourself to walk more. Research shows that people who use step counters can increase their activity levels by about 25 per cent. Step counters typically cost between e10-20 and you can get them in most sports shops and some supermarkets. To download a step challenge card to log on to www.getirelandactive.ie

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four peaks cHallenGe

peaK peRfoRmance the 13th annual focus ireland four peaks challenge and the my peak challenge offer participants a chance to stretch their legs – and it’s all for a good cause.

his year’s Focus Ireland Four Peaks Challenge – the 13th instalment – is Focus Ireland’s flagship event, an action-packed weekend of hiking and climbing some of Ireland’s most iconic mountains. the charity is also running its My Peak Challenge on the same weekend – a one-day event that’s less strenuous but no less fun.

IMPORTANT INfORMATION this year’s challenge will take place between Friday 7th and sunday 9th June 2013. THE fOUR PEAKS: WHAT DOES IT INVOLVE? the challenge is the ultimate team event and involves teams climbing the highest mountain in each of Ireland’s four provinces over one exhilarating weekend. � Carrauntoohil (Kerry – 3,414 ft) � Mweelrea (Mayo – 2,688 ft) � slieve Donard (Down – 2,796 ft) � lugnaquilla (Wicklow – 3,039 ft) Check out the video on the Focus Ireland website to see how much fun our teams have in some of Ireland’s most remote and beautiful locations.

HOW MUCH DO TEAMS HAVE TO RAISE? We ask each team to raise s3,800 in sponsorship – that’s only s634 per team of six! Don’t forget, we have a fundraising team on standby for any advice or hints and tips on how to raise the funds. HOW MANY ARE ON A TEAM? the challenge is a team event, with each team consisting of a minimum of three and maximum of five climbers as well as two drivers. WHAT’S NEW fOR 2013? We have listened to our past participants’ feedback and this year we are delighted

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to launch our new driver-free bus option for teams! If teams wish to avail of this bus transport option, teams should consist of a minimum of three and a maximum of five climbers. this new service is offered on a limited first come, first served basis so we do recommend that teams wishing to avail of this option register their interest early to avoid disappointment.

THE MY PEAK CHALLENGE 2013 the My Peak Challenge will take place in June over the same weekend as the Four Peaks Challenge, so if people don’t feel they’ve got four peaks in them, we have the answer! People can reach their own personal peak (or even two) whilst

enjoying the atmosphere of the Four Peaks Challenge. We are delighted to offer participants a choice of two mountains to climb: Carrauntoohil in Kerry on Friday June 7th or lugnaquilla in Wicklow on sunday June 9th.

HOW MUCH DO INDIVIDUALS NEED TO RAISE? the minimum fundraising target for the My Peak Challenge is s250 per mountain or s480 for the two. Focus Ireland will provide you with sponsorship forms, a secure online sponsorship page and advice on how to fundraise. For more information on the My Peak Challenge, see www.focusireland.ie.

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PROGRESS In 1920s Ireland, a child’s nappy was a length of cloth sealed with a pin And if that child had severe brain damage, their parents were faced with the choice to either abandon the child in hospital or take them home without any entitlement to support or care for them

In 2013 there’s a better choice of nappies

4 3 T 0 7 o 5 Donate €5 N o T ’ e r a C e W ‘ ow Text

he Jack and Jill Children’s Foundation is a registered Irish children’s charity which provides home nursing care to children up to the age of 4 throughout Ireland who are born with or develop brain damage. The Foundation was set up in 1997 by Jonathan Irwin and his wife, Senator Mary Ann O’Brien based on their own experience caring for their son Jack at home until he passed away in December 1997, aged 22 months. Over the past 16 years, Jack & Jill has supported 1,600 children who have brain damage and

who suffer severe intellectual and physical trauma. This nationwide service includes home visits and care, advice, information, lobbying and bereavement support. The ‘Gift of Time’ is how parents describe it. Time to do normal things other families take for granted like sleeping, shopping, meeting friends, or taking their other children to the park – with the peace of mind that their sick child is being well cared for at home. Jack & Jill requires d2.7 million per annum to operate this service and, with less than 20% coming from the State, the Foundation relies on mobile phone recycling, fundraisers

and public donations. CONTACT Phone: Fax: Email: Web:

045 894538 045 894558 info@jackandjill.ie www.jackandjill.ie

The Jack and Jill Children’s Foundation gets a minimum of d3.62 of each d5 donation. 1 text for each transaction. Helpline Zamano: 0818 300 048

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irish cancer society

Working Towards a Future without Cancer Donal Buggy, Head of Services at the Irish Cancer Society on fighting cancer and the organisation’s 50th anniversary.

or the last 50 years, the Irish Cancer Society has worked for and on behalf of everyone in Ireland who is affected by cancer. Since we began our work in 1963, we have grown into the national cancer charity with a set of goals which we have shaped from our mission to prevent cancer, detect it early and fight it at every level. We are celebrating our 50th birthday in 2013 and to mark the occasion we have launched our ambitious new strategy statement for 2013 to 2017: ‘Towards a future without cancer’.

“Cancer is a disease that knows no boundaries, does not distinguish between sex, race or class, and has or will affect us all either directly or indirectly during our lifetime.” Each year during the lifetime of this strategy, approximately 30,000 people in Ireland will be told they have cancer. Cancer is a disease that knows no boundaries, does not distinguish between sex, race or class, and has or will affect us all either directly or indirectly during our lifetime. The good news is that more people are surviving cancer and this is thanks to increased awareness of signs and symptoms, early detection of the disease and better treatments.

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The Irish Cancer Society’s new strategy will focus on four main goals: Goal One: Reduce the risk of cancer Goal Two: Improve lives Goal Three: Lead excellent collaborative research Goal Four: Inform and influence public policy

Our long-term vision is a future without cancer. This may not be achieved in the lifetime of this strategy statement, but we are ambitious to succeed, and each year brings new developments, new services and renewed hope. Each year we learn more about what causes cancer and how to prevent it. Each year there are new advances in treatments, and we learn more

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“We have funded over 200 research projects and this has led to significant improvements in our understanding of the mechanisms of the development of cancer and to better therapeutic strategies and outcomes.” Risks Cancer affects all parts of Irish society, but some people are more at risk than others. The Irish Cancer Society is aware that people in marginalised communities have a far greater risk of getting cancer and of dying young. We want to work to change this and ensure that people in these communities have a greater awareness of how they can reduce their risk of cancer – and if they get cancer, that it is diagnosed early and they have access to the best advice, information and treatments to improve their lives during and after their cancer. We have made this a core part of our strategy and it will mean developing different and more targeted ways of working, communicating new messages and delivering innovative services. It will also mean ensuring that the issue of health inequalities and cancer is tackled at all levels as the urgent public health issue which it is. The longer-term needs of the increasing number of cancer survivors will challenge the health services over the coming years. Many survivors will still need regular medical care, and some will have continuing financial or rehabilitation needs or mental health challenges. For some, a cancer diagnosis creates a fundamental shift in the way in which they live their lives. Research shows that one in four people diagnosed with cancer experiences significant distress, and needs more support than

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istockphoto/Sage78

about how to improve the quality of life of people who have cancer, their families and friends.

just information alone. Psycho-oncology services in Ireland are very underdeveloped at present. Over the next five years the society will work to identify the gaps in post-treatment care and support, and will advocate for them to be filled. We will introduce new pilot services to provide evidence based programmes that will be evaluated and their outcomes published.

New Services In recent years we have developed new impactful services such as specialist nurseled Daffodil Centres which will be in place in at least 12 hospitals nationally by the end of 2013 and Care to Drive, our volunteer driver programme which is a door-to-door transport service for patients attending chemotherapy treatment. This service will be available to 14 hospitals nationally by the end of 2013. These new services complement existing ones such as Night Nursing, which delivered 8,800 nights of care to 2,159 patients in 2012. We intend to continue to deliver vital services such as these into the future. The Irish Cancer Society is the leading voluntary funder of cancer research in Ireland. Since 1963, the society has invested more than€30 million in cancer. We have funded over 200 research projects and this has led to significant improvements in our understanding of the mechanisms of the development of cancer and to better therapeutic strategies and outcomes. We wish to initiate a real and sustained change in the cancer research landscape in Ireland for the benefit of the public and of cancer patients. We believe that this change will

be brought about by the development of collaborative rather than co-operative research. This collaboration will be between disciplines and between institutions. We will establish up to five Collaborative Cancer Research Centres by 2017, leading to a greater understanding of cancer patterns in Ireland and the development of markers and therapies which can be tested clinically. Our leadership in this area will enable Collaborative Cancer Research Centres to establish international leadership in many areas of cancer research, making Ireland one of the most attractive countries in which to conduct research.

Making a Difference We are acutely aware that the resilience of our health system is being tested by the economic downturn and the need to make wide-ranging, significant and ongoing cuts in health spending. We need to closely monitor how all this impacts on cancer care and outcomes. We need to engage with frontline healthcare professionals to understand the pressure points in the system and how these might effect outcomes and patient care. We are engaged to understand what we can achieve, where our advocacy is best directed. We are delivering two posts to deliver prostate cancer post-treatment care in 2013. We believe we are making a difference. Our supporters volunteer their time and money to support the work we do. We are committed to ensuring that by 2017 we are much closer to achieving our vision of a future without cancer.

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irish cancer society

Daffodil Day and Dell

+ Little flowers Lilly Hanrahan McGrath and Lauren Byrne, with the help of Dell employees Angela Burke and Brid Malone, launched the Irish Cancer Society’s fundraising campaign Our Company Cares, appealing to companies to show they care and support the society’s annual Daffodil Day campaign.

affodil Day is the biggest and longest running fundraising day for the Irish Cancer Society, Ireland’s national cancer charity. On Daffodil Day thousands of volunteers around Ireland sell daffodil pins and flowers (on streets, in businesses, in homes and shopping centres) to raise money for the society’s free nationwide services for those with, and affected by, cancer in Ireland. In 2010 Dell Ireland became the Irish Cancer Society’s lead partner for Daffodil Day for a three year period until 2013. In addition to providing financial support Dell’s 2,500 employees in Dublin, Limerick and Cork are supporting the campaign by volunteering time and expertise to the Irish Cancer Society in the lead up to Daffodil Day and on the day itself. Speaking of the partnership Caroline Grant, HR Director, Dell Ireland said: “As the official partners of Daffodil Day we really

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embrace the every part of the campaign. Last year, the company went daffodil crazy for three months in the build-up to the big day. We helped to make daffodils, we baked daffodil cakes, we sold daffodils and we wore yellow! It is a great initiative and I hope companies around the country will support this year’s Daffodil Day campaign as much as they can.” The Irish Cancer Society’s 26th Daffodil Day, supported by Dell, will take place across the country on Friday 22nd March. Here is how you can support Daffodil Day 2013:  Volunteer on Daffodil Day  Organise a Daffodil Day event in your community or workplace  Buy a daffodil or Daffodil Day merchandise on Daffodil Day or in our online shop For more information on how you can get involved, Callsave 1850 60 60 60 or visit www.cancer.ie/daffodilday

“We helped to make daffodils, we baked daffodil cakes, we sold daffodils and we wore yellow!”

If you would like further details on how you can become involved in the Our Company Cares campaign, please contact Emma Barrett on tel: (01) 231 6621 or email: corporate@irishcancer.ie. Daffodil Day is kindly supported by Dell.

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Taoiseach Unveils ‘Full Health’ Initiative Galway-based Full Health has developed a new way of distilling medical information into reports – a system adopted by Biomnis Ireland and launched by Taoiseach Enda Kenny.

aoiseach Enda Kenny has launched the Full Health system of generating reports from medical information. The Galwaybased start-up company’s system has now been introduced into the workplace of laboratory firm Biomnis Ireland, at whose Sandyford premises the launch took place. “As Ireland moves towards economic recovery, we need to secure the health and wellbeing of our workforce. Companies are increasingly aware that employee health can have a significant impact on the bottom line,” he said. The system was developed by Full Health Medical’s doctors, and distils medical test results into personalised and easily understandable reports, along with recommendations and preventative advice. Full Health now joins Biomnis Ireland’s HealthWatch workplace programme for employees, claimed by the company to be “Ireland's largest independent provider of workplace health and lifestyle screening programmes.” “This is a wonderful example of an innovative start-up company, Full Health, responding to a market opportunity and then commercialising its offering in conjunction with Biomnis Ireland. It is especially gratifying to see this level of collaboration happening in an Irish business setting and I wish the venture every success,” Kenny said. Dr. Ann Shortt of Full Health Medical said that it would help to detect and offset chronic illnesses and disease. “The cost of just one chronic illness can be huge to a national economy, for example, type 2 diabetes which affects 5 per cent of the Irish population. Extrapolating from UK figures, type 2 diabetes leads to approximately 515,000 absentee days per year in Ireland, costing e72.5 million while diabetes presenteeism (productivity loss among people still in work but suffering from this

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+ John O’Sullivan, CEO Biomnis Ireland; An Taoiseach Enda Kenny; and Dr. Ann Shortt, Medical Director Full Health Medical.

+ John O’Sullivan, CEO Biomnis Ireland; An Taoiseach Enda Kenny; Deputy Peter Mathews TD; Mark McKeever, Director of Sales and Marketing at Biomnis Ireland.

disease) costs a further €247 million. When the largest cost to business is wages and salaries, it makes sound business sense to invest in understanding employee health. Full Health can really help employers in a practical and meaningful way to anticipate and mitigate against future financial loss.” According to John O’Sullivan, CEO of Biomnis Ireland, “We are delighted to collaborate with Full Health on this partnership which we see as a unique medical reporting solution, which will form

a key part of our growing HealthWatch brand. The HealthWatch screening service delivers health checks to approximately 10,000 employees every year. The Full Health initiative will provide employees with the important information in an easy-to-understand format as well as recommendations on how to stay healthy. We also see it as having a wider application across the Biomnis group for our laboratory testing service as a premium content offering for clinicians and their patients.”

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Special Report

Siemens Ireland and Cardiogenics begin distribution partnership The Acuson P300 ultrasound system will be jointly distributed as a result of a new arrangement.

iemens Ireland and Cardiogenics have entered into a partnership to exclusively distribute the Acuson P300 ultrasound system in the fields of cardiology, point of care diagnostics and anaesthesia in Ireland. The system is a compact portable device for a wide variety of clinical settings. It encompasses advanced ultrasound technology and imaging performance in one portable package, thus enabling comprehensive patient care everywhere and any time. It is aimed principally at cardiology, anaesthesia, urology, obstetrics and gynaecology and point of care.

“ Together we will expand our coverage in the cardiac sector and make the latest technology accessible to patients across the country. This deal compliments our recent distribution agreement with Promed to serve the primary care market.”

The three-year deal will be the first collaboration between the two firms. Cardiogenics, a Dublin-based healthcare company, will provide support and product training to medical personnel across Ireland. Their products and services encompass cardiology, critical care, anaesthesia, emergency medicine, obstetrics and gynaecology, sports medicine, mobile cardiac screening for sudden cardiac death,

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and they also provide cardiac technicians to hospitals and clinics. Siemens Healthcare, meanwhile, needs no introduction as a household name, employing 51,000 worldwide and specialising in medical imagery, lab diagnostics and medical IT. “In 2011 almost one-in-five deaths in Ireland were caused by cardiovascular disease,” said Head of Siemens Healthcare Ireland, Kevin Dand. “Cardiogenics have a tremendous knowledge and experience in cardiology and the Irish healthcare market. Together we will expand our coverage in the cardiac sector and make the latest technology accessible to patients across the country. This deal compliments our recent distribution agreement with Promed to serve the primary care market.”

According to Cardiogenics General Manager, Lisa Wall, “Cardiogenics are delighted to have entered into this exciting partnership with Siemens, who remain pioneers in ultrasound technology. This natural relationship will allow our experienced teams to expand our businesses further into the area of medical imaging and greatly enhance our service. Our shared vision of innovative solutions and gold standard products and services will deliver the very best options to the Irish healthcare market. We are fully committed to strengthening and growing our partnership as Siemens release their new and pioneering ultrasound technologies.” See www.siemens.ie and www.cardiogenicsltd.com

+ Kevin Dand, Siemens Healthcare Manager (Ireland) and Lisa Wall, Cardiogenics General Manager. Photo: Sasko Lazarov/Photocall Ireland.

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ISS - Ireland’s No 1 Health Care Facility Services Company ISS is the market leader in providing Facility Services in Ireland offering: · Single service excellence arcoss Cleaning, Security, Catering, Pest Control and Property Services · Bundled or multi service options · A fully intergrated self delivered facility service solution Nationwide coverage is provided through offices in Dublin, Cork, Limerick, Galway, Drogheda, Letterkenny. 3,500 staff deployed in a range of high profile public and private sector clients. Dublin Tel: 01 4682900

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Cork Tel: 021-4556600

Limerick Tel: 061 500300

ISS is a leading global facilities provider with 500,000 employees operating in more than 50 countries around the world. ISS Ireland Ltd 3007 Lake Drive, City West Business Campus, Dublin 24 Tel (01) 468 2900 - Fax (01) 468 2901 Contact Brian Kelly Head of Business Development at brian.kelly@iss.ie for further information

Galway Tel: 091-385500

Louth Tel: 041-9806100

Donegal Tel: 074-9106900

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commercial feature

Contract Cleaning in Healthcare A clean, safe, healthy healthcare environment is an essential element of 21st century medical care. Contract cleaners fulfil much of this duty. The work of the Irish Contract Cleaning Association and its members are key: driving standards and best practice across the sector, the industry organisation is at the forefront of maintaining safety in this most sensitive of workplace environments.

The Irish Contract Cleaning Association Representing the industry is the Irish Contract Cleaning Association, which has been at the forefront of transforming the sector into a highly professional and wellorganised partner across a wide variety of Irish industries, healthcare included. Established in 2001, the ICCA has grown ever since and represents a large proportion of the industry’s players. The core aim of the association is to represent its members, but the ICCA also assists companies working in commercial cleaning with the essential work of professional training and a code of practice, helping to raise the industry’s status and standards within the industry itself. ISS Facility Services ISS Facility Services delivers cleaning, janitorial, project functions, pest control and other services across the Irish healthcare sector and is proud of its success, utilising specialised monitoring and prevention measures, innovations in technology and equipment and transferring international best practice. ISS Facility Services is a leader in the

“We were the first company in Ireland to receive ISO 9001 quality accreditation, and that’s something we’re very proud of. We also have the environmental accreditation, ISO 14,001. We are one of the market leaders in facilities services in the world. ISS are people serving people.”

facilities services sector, employing 3,500 people nationwide with offices in Dublin, Cork, Limerick, Galway, Drogheda and Letterkenny. The company delivers a large range of services to the healthcare sector – acute/non-acute and private hospitals. ISS are one of the most experienced specialist providers of single services, whilst also providing an integrated service delivery platform to clients where required. The company has a wealth of experience in the Irish market, together with a strong local management team led by Eric Doyle as Managing Director. This, together with direct access to the segmental expertise and resources available from ISS global network, ensures the company is well positioned to capture, lead and develop our strong foothold in the healthcare sector nationally. ISS recently established a national division to support, standardise and drive innovation across the sector headed by Rachel Hynes, Healthcare – Operations Director. “Rachel brings a wealth of experience to this role having worked previously as contracts manager for a large Dublin-based acute hospital prior to managing our key accounts business. I am confident that Rachel will further develop the healthcare division working closely with our clients and supporting our multi-disciplinary teams carrying out various different functions throughout the country,” says Eric Doyle. The most important thing is monitoring and the prevention of HAI. ISS play an integral part in infection control, using a proactive approach to hygiene rather than a reactive one. ISS believe: ‘What gets measured gets managed’. Our clients have invited ISS onsite management to join their hygiene multidisciplinary teams, enabling ISS to be at the forefront of the decision making within each specific hospital. ISS has introduced its own auditing platform. “We score the outcome of our cleaning so

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commercial feature

“I started with ISS nine years ago as the contracts manager for a large Dublin-based acute hospital – I started on the ground, so I know what it’s like to run a cleaning contract on a hospital site.” we can offer real-time reporting that gives our clients and infection control teams the comfort that we are providing the service required. We have implemented a tailormade training module delivered by our national trainers.” Hynes says that the information and experience gained year-onyear has served as a very positive learning tool and the improvements, notwithstanding the challenges, experienced by both parties have led to an improved output and a more streamlined and effective service delivery model.

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Recently ISS won a number of awards, including ‘Site of the Year Non-acute Hospital’ for our services at St Francis’s Hospice as part of the ICCA bi-annual awards, which was tremendous recognition for our hardworking and dedicated staff. “Looking to the future, my strategy is to implement a consistent approach to our delivery platform in terms of the key elements of services including: auditing, specification/compliance, training, chemical and safety awareness. I want to implement innovative ideas and techniques and equipment that will lead the market and secure the healthcare business in Ireland,” says Hynes.

Derrycourt Cleaning Specialists Derrycourt Cleaning Specialists was established in 1992 by Ann and Martin O’Hanlon and is a family owned and managed company. Derrycourt Cleaning Specialists takes great pride in total commitment to client satisfaction, always aiming to exceed customers’ expectations and to provide a personal and professional cleaning service through the experience and commitment of their workforce of 800 trained staff. Based in Dublin but with regional offices in Cork, Derrycourt Cleaning Specialists believe that their service excellence – as viewed with

the company recently winning ten accolades at the Irish Contract Cleaning Association Awards in October 2012 – is achieved via a hands-on management style and by supporting their employees by providing enhanced industry training in their state-ofthe-art training centre. As Managing Director Ann O’Hanlon says, “We believe that our greatest asset is our employees. They represent our brand and live our values and vision. To support them, we continue to heavily invest in training and development, ensuring that the right operatives are placed with our clients. Over the years we have grown to host a formidable workforce and we continue to expand and enhance our service offering.” Derrycourt Cleaning Specialists’ client base spans across the industrial, commercial, educational, manufacturing, retail, healthcare and hospitality industries. With expertise drawn from people with years of experience in the contract cleaning business, and specialised customised cleaning service offerings, the Derrycourt team can provide for your every need.

Diversey and ‘Sealed Air’ Diversey, a global manufacturer of cleaning services and products, has been a patron of the ICCA since its inception, making an annual substantial contribution to the ICCA, who use these funds to set high standards for the contract cleaning industry, and ensure its members adhere to them. When Diversey became part of Sealed Air during 2011, two of the biggest businesses in their respective fields joined to create the new global leader in food safety and security, facility hygiene, and product protection. With global sales of over $8 billion, and serving customers in 175 locations, the company provides a unique combination of products, equipment and services - an end-to-end solution from a single supplier that offers superior performance to protect business, manage risk and enhance reputation. Contract cleaning is Diversey’s largest sector in Europe, commanding nearly a third of all sales. Diversey’s partnership with contract cleaners is second-to-none; a long-standing relationship based on quality products, expert knowledge, on-site assistance and training. Deborah Bland, Diversey’s Contractor Marketing Manager for UK and Ireland, has a clear view on why this

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Services:

Contact Details:

路 Bathroom refurbishments 路 Boiler servicing 路 Boiler installation 路 Heating controls upgrade

Emmet McNamee M +353 86 824 1825 T +353 1 289 3951 E info@emplumbingandgas.com emplumbingandgas.com

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120 Health Matters

commercial feature is. “Diversey’s key differentiator in the market is its ability to provide a unique bundle of chemicals, machines, tools, service and support to cleaning contractors; a package that assists contractors to clean different sizes and types of site in all different sectors throughout the country, to the best of their ability” she states. “Using our vast knowledge and expertise from across the globe allows our local partnerships to flourish, and to help produce the necessary results for our contractors to delight their clients” Their ‘Smart Savings’ programme allows Diversey and its contractors to completely review cleaning methods and hygiene needs within a healthcare site, and to put into practice a range of measures to improve hygiene, reduce costs (especially in the area of improved productivity), and reduce environmental issues. “Diversey is the expert in healthcare cleaning”, adds Deborah. “For many years we have been working closely with contractors to review the products, machines and systems they use, and how they use them, and working out ways in

which we can save them time, effort and money to not only make savings for all, but also to improve hygiene standards. Moving to scrubber driers from rotary machines, or to microfibre flat mopping from Kentucky mops, or even putting polish onto kick

plates to make them easier to clean – all these method changes add up to a whole heap of improvements to benefit everyone” For information, contact Eugene Grogan: 01 808 1808/Diversey (www.diversey.com)

Why choose Derrycourt Cleaning Specialists? We are a 100% Irish owned and family run business established in 1992, employing over 800 staff nationwide

Derrycourt offer innovative contract cleaning solutions to the commercial, industrial, retail, educational, manufacturing and hospital sectors, specialising in the healthcare industry. We Supply Services to... • Healthcare Sector • Educational Buildings • Commercial Sites • Retail Sector • Public Sector Buildings and Sites • Office & Residential Complexes • Hospitality Sector

Specialising In... • Clean Room Solutions • Infection Prevention and Control • Food Handling/Catering Service • Construction/Maintenance Clean Ups

Award Winning Supplier Offering…. • Daily/regular contract cleaning services • Deep Cleans • Janitorial/Porter Service • Window Cleaning • Carpet Cleaning • Kitchen/Canopy Cleaning

Derrycourt are a multi–award winning company with recent accolades including: • IASI Supreme Winners in Healthcare Sectors all years between 2008–2013 • Golden Service Awards Winners 2009–2012 for UK and Ireland • Irish Contract Cleaning Association (ICCA) Award Winners between years 2006 and 2012

Dublin Head Office: Unit 4 B Century Business Park

Cork Office: Acorn Business Campus

St Margaret’s Road

Mahon Industrial Estate

Finglas, Dublin 11

Blackrock, Cork.

Telephone: 01 8643000 Fax: 01 8643419

Telephone: 021 4614281 Fax: 021 4350666

www.derrycourt.ie

info@derrycourt.ie

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♦

1992–2012 Market Leaders for 20 Years

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your stories

Sporting Passions Fergal Moore, senior physiotherapist with Galway University Hospitals and captain of the Galway senior hurling team talks to Health Matters. How long have you played hurling and do you or have you played other sports? I'm the youngest in the family, so as soon as I was able to stand and hold a hurl I was out in the back garden with the others! I played Gaelic football in secondary school, mostly to miss classes, and I played one season of soccer a few years ago to keep fit in the off-season. How long have you worked in GUH? Almost eight years. What is your current training routine? During the season, a typical week consists of weights, three to four hurling sessions, flexibility and recovery sessions. Why did you decide to become a physiotherapist? I liked biology and human physiology in school and so all my choices for the CAO were based on the courses and careers that involved those two subjects. So my first choice was physiotherapy, followed by sports science and then applied physiology and anatomy. Luckily, I got physiotherapy and I'm very happy with my decision. Aoibheann Daly who plays with the Galway ladies' senior football team works in the same department as you. Do physiotherapists tend to be more sporty or is this a coincidence? I know plenty of physiotherapists who are sporty but also plenty who are not. Obviously, there are huge employment opportunities for chartered physiotherapists in sport so it helps to have an interest in that area as you will enjoy the work. However, there are many other career avenues for physiotherapists to go down away from sport and thatâ&#x20AC;&#x2122;s why all types of people are attracted to it.

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What is your sporting highlight? I like my horse racing, so it has to be watching Sea the Stars win the Irish Champion Stakes in Leopardstown in 2009. He's regarded as one of the best racehorses of all time and it was brilliant to see him racing in the flesh before he retired. What is your personal sporting highlight? Lifting the Bob O'Keeffe cup (Leinster Senior Hurling Championship) last year for the first time ever. What advice could you give to

someone who knows that they need to get fit and active but doesnâ&#x20AC;&#x2122;t know where to start? The most important thing is to find an activity that you enjoy doing. Start small and gradually build up the intensity of it. Having a training partner or exercising in a group setting will make it more enjoyable and setting little goals along the way is important to measure your progress and improve motivation. How many times were you asked if you had any spare tickets for the All-Ireland? Far too many. Hopefully I'll have the same complaint this year!

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books

Novel Ideas Peter Murphy – Shall We Gather At The River Hot Press music scribe, musician and regular guest on RTÉ's The View, Peter Murphy's first full-length novel John the Revelator slouched out of its lair four years ago – mysterious, messed up, gothic and perfectly Enniscorthy, it was an instant hit. Shall We Gather At The River takes its cue from tragic events and a more difficult theme: it was inspired by the deaths by suicide of a number of people in the River Slaney ten years ago. When he mentioned the event while interviewing the Manic Street Preachers, they suggested he write a novel about it. The result – let's put it in musical terms – is more Nick Cave than Manic Street Preachers: the evangelical Enoch O'Reilly ponders his flooded town and the deaths that accompany it. Rachel Allen – Cake Surely one of the most infamous four-letter words in the English language, the subject of Rachel Allen's latest cookbook is sure to pester one's sweet tooth. No matter the cake, no matter the occasion there's a simple and easy-to follow recipe at hand. Allen is a familiar face on TV shows such as Rachel's Favourite Food and Rachel Allen: Bake, as well as numerous newspaper appearances. A graduate of

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the renowned Ballymaloe Cookery School, celebrity chef Darina Allen is her mother in law – meaning sponges, brownies, wedding cakes and all manner of treats are in seriously expert hands.

Staring at Lakes – Michael Harding “A memoir of love, melancholoy and magical thinking,” is what playwright and Irish Times columnist Michael Harding has produced from the experience of overwhelming depression. At the age of 58, Harding became ill and has set down his thoughts on leaving the priesthood, getting married, settling in Leitrim, illness and depression and finally recovery “by accepting the fragility of love and the importance of now.” On Harding's journey, “I realised... why I had clung to religion for so many years. It was fear. And it is fear.” As for depression, it is “A dark brooding shadow within watches me with indifference, or wants to wander in the past along laneways of regret and remorse. That is depression.” Seven Deadly Sins: My Pursuit of Lance Armstrong – David Walsh Lance Armstrong broke many records in his time, but perhaps he even got one over

Tiger Woods in the velocity of his downfall. Over a very short space of time late last year, Armstrong went from hero to less than zero after he was outed as one of the most flagrant cheats in the history of cycling. Pursuing him for years were Irish journalists David Walsh and Paul Kimmage (check out the infamous YouTube video of Kimmage confronting the lying champion at a press conference). From Armstrong's first Tour de France win in 1999, Sunday Times writer Walsh doubted his achievement. Armstrong nicknamed him the 'Little Troll'. It has taken this long to set the record straight.

Patricia Scanlan – With All My Love Patricia Scanlan’s trademark warmth has catapulted her to the top of the bestseller lists with this new release. The story of a family across three generations and their internal conflicts, a photo album is the cause of drama. Inside it, Briony McAllister finds a letter revealing the truth about the complicated relationship between grandmother, mother and daughter – decades of secrets are revealed. Having moved to southern Spain with her own young daughter to escape her past in the first place, she now faces even more turmoil.

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Film Side Effects hits the big screen Many people go to the movies to escape from the pressures of everyday life, be they work-related or otherwise – and so a film about the side effects of medication might not sound like the most exciting night out on the town after a busy day caring for patients in a bustling healthcare environment. Think again. Renowned director Stephen Soderbergh (of Ocean’s Eleven, Solaris remake and Erin Brockovich fame) has crafted an intelligent film with an all-star cast and an important message that might have a certain resonance for staff – and still deliver an entertaining hour and three-quarters. After her husband (Channing Tatum) is released from prison, Emily (Rooney Mara) slumps into clinical depression. Enter psychiatrist Dr Jonathan Banks (Jude Law), who prescribes her the latest in antidepressants – and as the eponymous side effects kick in, so too does the film’s psychological edge. Scott Z Burns, who penned the screenplay, had spent weeks researching in Bellevue Hospital, New York and enlisted the help of the hospital’s Dr Sasha Bardey. “It looks at the idea of where reality ends and mental illness

begins,” explained Bardey. “You don’t know if things are what they appear to be. In that sense, it’s got a Hitchcockian feel to it. And the ending is fantastic, a great lesson and a lot of fun.” Burns himself recalled his stint at Bellevue as “one of the most extraordinary experiences of my life. “There were people there who were truly terrifying criminals. There were also people who were so ill they were unable to understand the rules of society and couldn’t

possibly be expected to play by them. I wanted to write a noir-style thriller that took the audience in and spun it around, like Double Indemnity or Body Heat, set in the world of psychopharmacology. I was inspired by films that involve crafty, clever scams, set against the society the audience is really living in. People seem to have stopped making those, but I have always loved the genre.” Side Effects is in cinemas now.

thinkstock.com/Hemera

Plenty of Irish Interest as Day-Lewis Triumphs Wicklow’s finest – Anglo-Irish actor Daniel Day-Lewis – has confirmed a reputation as perhaps his generation’s greatest actor by romping home to a record-breaking Academy Awards victory for his portrayal of Abraham Lincoln. The Annamoe farmhouse resident (he was given the freedom of Wicklow in a ceremony at Rathnew four years ago) became the first man to win Best Actor three times, adding to his plaudits for playing Christy Brown (My Left Foot) and Daniel Plainview (There Will Be Blood). “I really don’t know how any of this happened,” he told Meryl Streep when accepting the award, and proceeded to thank all involved. Yet the key to DayLewis’s acting style is no secret: he obsessively immerses himself into the role well in advance of production, believing that he is the character he is playing to the extent that he learned how to build canoes

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for The Last of the Mohicans and became wheelchair-bound for My Left Foot. There was plenty of other Irish interest at this year’s Los Angeles ceremony. Kerry’s Fodhla Cronin O’Reilly (26) picked up a nomination for best short animation. Head Over Heels, co-directed with Timothy Reckart, portrayed an old married couple who have grown distant throughout the years. The only student film in contention for an Oscar lost to the might of Disney, whose Paperman took the prize. “When it was time to announce us, we were sitting across the way from George Clooney and Quentin Tarantino and it just felt very surreal,” she told RTE. Meanwhile, Seamus McGarvey, Anna Karenina cinematographer, claimed his second Oscar nomination after his work on Atonement in 2007. Life of Pi scooped the cinematography award en route to the biggest haul of this year.

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your stories

A DAY IN THE LIFE Daragh Rodger is an Advanced Nurse Practitioner (ANP) working in the area of care of the older adult community, based in St Mary’s Campus, Phoenix Park, Dublin. Daragh took the time to tell Health Matters a bit about herself and her work.

registered with An Bord Altranais in October 2012 as an Advanced Nurse Practitioner and my specialist area is assessment of the older adult living in the community and the promotion of healthy ageing. I have worked in St Mary’s Hospital in the area of care of the older adult since 2000. During that time I have gained a vast amount of experience caring for clients in outpatients, inpatients and extended care areas. I was instrumental in setting up St Mary’s Rapid Access Clinic and a nurse led Healthy Ageing clinic.

Healthy Ageing As an ANP my aim is to support the provision of a timely, quality service to the older person and their family, promoting healthy ageing and optimum levels of independence. I focus on preventive care interventions such as health screening, disease/disability prevention, case finding, evidence based diagnostic practice and health education and health promotion. I facilitate the appropriate treatment of older adults in their own home setting with early interventions and utilisation of the skills and resources available in St Mary’s. We aim to reduce admissions to the acute care setting. Through comprehensive nursing assessment, planning, implementing, evaluating and reassessing, care is carried out and interventions put in place quicker. A lot of my job is about listening to the older people in my care. Research and Education I participate in educating nursing staff and other healthcare professionals through role-modelling, mentoring, sharing and facilitating the exchange of knowledge in the classroom, the clinical area and the wider community. From a research perspective, to date I have been involved in local and national research groups on key areas of

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bone health, falls prevention and assessment of the older adult. In 2011 in collaboration with Anne Spencer, an educational technologist, we launched Bone Health in the Park: I am not falling for you! This was phase one of an e-learning education programme. In 2012 a falls prevention programme, Forever Autumn – Phase Two of Bone Health in the Park was developed and implemented in St Mary’s. The material is available on www.bonehealth.co. A key requisite of the role of ANP is continual professional development and the application of evidence-based practice for all nurses. Therefore being a member of the All Ireland Gerontological Nurses Association (AIGNA) is essential for me and in fact any nurse working with older adults.

through networking, information sharing and other knowledge translation activities. We’ll be hosting our fifth annual conference this year at the end of May. AIGNA also organises annual master classes and regular newsletters. For further information check out www.aigna.ie. Recently the Specialist Geriatric Services Report (2012) advocated the role of the ANP in effective community care of the older adult and as my role develops I look forward to working iwith other healthcare professionals to ensure continuity of care resulting in better health outcomes for older people.

AIGNA The purpose of AIGNA is to promote healthy ageing and the well being of older people through the advancement of excellence in gerontological nursing, and is the only organisation for nurses working in this specialty in Ireland. It provides a platform for the dissemination of, and engagement in, research. This enhances the gerontological nurses’ knowledge, skills and expertise

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in brief // News Emergency Ambulances Double as Mobile Billboards to Boost F.A.S.T. Stroke Campaign Emergency ambulances around the country are doubling up as mobile billboards in a new departure to help reduce stroke deaths through an advertisement campaign using emergency vehicles. They have been wrapped to promote the Irish Heart Foundation’s Act F.A.S.T. campaign on stroke warning signs, in addition to their normal lifesaving work, following a unique collaboration between the National Ambulance Service and the national charity fighting heart disease and stroke. So far, the emergency ambulances are operating in 11 locations countrywide: Cork, Donegal, Dublin, Galway, Kerry, Limerick, Longford, Meath, Roscommon, Waterford, Wexford.

The FAST signs are: Face – h as the face fallen on one side? Can they smile? Arms – c an they raise both arms and keep them there? Speech – i s their speech slurred?

+ Jim Bartley, stroke survivor and Fair City star along with James Goldrick, Paramedic Supervisor, at the launch of the Emergency Ambulances as F.A.S.T. Billboards initiative.

Time –

t ime to call 999/112 if you see any one of these signs.

The initiative was launched at St Mary’s Hospital in Dublin’s Phoenix Park by stroke survivor and Fair City star Jim Bartley and Kildare's Aisling Macken, who attributes the FAST advertisements to surviving her stroke.

It has been launched to help re-ignite the charity-funded Act F.A.S.T. campaign, which has contributed to an increase of over 400 per cent in the numbers of stroke patients receiving potentially life-saving clotbusting thrombolysis since its launch just over two years ago.

Operation Transformation Changes Lives for Fatima Residents A unique partnership between the HSE Health Promotion Department, a community family resource centre, Fatima Groups United, Dolphin Health Project and Dublin City Council has greatly impacted on the physical, emotional and mental health of a large number of residents from Fatima and Dolphin. This particular programme captured at local level the enthusiasm and participation of approximately 60 residents (20 men and 40 women). The combination of a health assessment, nutrition workshops, a healthy food made easy course, a range of exercise classes and walking/jogging training has created a sense of overall health and wellbeing for the participants. “I haven’t been in bad humour since I started the programme, the atmosphere in my house

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has changed and we are all eating better!” said one participant. During a pilot programme in November and December, resting heart rate, body fat percentages and weight + (L-R) RTE’s Kathryn Thomas, HSE’s Marion Regan, Fergal Fox, HSE Health loss dropped Promotion; Roisin Ryder, Fatima Health Project Co-Ordinator; Edel Reilly, Rialto significantly for Community Health Co-ordinator and David Phelan, Physical Activity Co-ordinator the overall group at Dublin Sports Network; with baby Jude Phelan. while for some individuals there was a substantial drop in week operation transformation programme blood pressure. Energy and mental wellbeing in January. It is expected that similar health increased for everyone. All of the participants results will be produced when the overall on the pilot scheme signed up for the eightevaluation is carried out.

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meet the team

A Step Ahead Meet staff at the physiotherapy clinic for the Dun Laoghaire and Sallynoggin primary care teams in Dublin who have recently been implementing changes to improve their service for patients.

e provide a physiotherapy clinic for the local catchment populations of Dun Laoghaire and Sallynoggin primary care teams. Our team members are: Achmat Isaacs, Physiotherapy Manager; Vicky McKenna, PCCC Administration Support; Nuala Kelly, Domiciliary and Musculoskeletal Physiotherapist; and Donna McCarthy, Senior Musculoskeletal Physiotherapist. Over the last year or so, we have been keen to improve the efficiency of our service by looking at what equipment and communication methods we had available and how we could use these to help us.

Overcoming Co-Location Issues Co-location is posing its own challenges. For example, how could we organise our appointment system more efficiently across the two sites? To overcome this challenge, we set up a shared calendar facility on our email system, Outlook Express, which we can access from different sites. Changes to appointments, such as cancellations, are easily and instantaneously done. Also, as it is managed within the email system it is fully secure and there is no cost for this service. Improving Our Referral Pathway Referrals were being delayed as they were being faxed to one building to be registered before being forwarded to the physiotherapy clinic. This led to a long delay in the pathway from the GP to our clinic. In our new system, upon registration referrals are now scanned and emailed to the physiotherapy clinic immediately. Vicky, administration support, is also now managing all referrals directly and liaises with patients about the scheduling appointments. Incorrect referrals are also re-directed by Vicky. This has created more time for the physiotherapists to treat patients.

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+ L-R: Achmat Isaacs, Physiotherapy Manager; Vicky McKenna, PCCC Administration Support; Nuala Kelly, Domiciliary and Musculoskeletal Physiotherapist; and Donna McCarthy, Senior Musculoskeletal Physiotherapist.

Easy Access While our clinic was readily accessible by foot or public transport, patients were reporting that it was difficult to find. This led to many patients getting lost and being late for their appointments. To overcome this we decided to attach directions to each patient’s appointment letter. However, the majority of patients did not bring their appointment letter and therefore had no directions to the clinic. Therefore, we have developed a new brochure containing directions the clinic, the patient’s appointment time, details about our physiotherapy service, clinic contact details, space for future appointments and our nonattendance policy. Improving Non-Attendance We were aware that our ‘did not attend’ (DNA) rates were relatively high. We also knew that if we could reduce the non-attendance rate we would enhance the efficiency of our service. To improve attendance rates we now send a text reminder to patients a couple of days ahead of their scheduled appointment. Each patient is also sent the brochure containing

their appointment details and directions. In addition, patients are provided with the contact details of our secretary, Vicky, if they wish to phone or email to cancel or reschedule appointments. The use of the appointment brochure, combined with text reminders and liaison between our secretary and patients has led to a decrease in DNA rates from eleven per cent in 2011 to seven per cent in 2012. Our waiting list has decreased from eight weeks in 2010 to two weeks in 2012.

Patient Feedback Overall, feedback from patients is excellent. They especially like the text reminders and they feel they know more about what physiotherapy involves from the information provided in the brochure. For us, there is a great sense of satisfaction in providing a good service. Previously the constant build up of administration was a great source of stress for the physiotherapists. Now we are on top of every referral and can feel proud of the service we are providing. Patients comment daily on how efficient the service is.

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your storIes

getting to Know you...

Joanne Balfe has been working as a consultant paediatrician at the national children’s Hospital, tallaght since 2009. she was appointed consultant paediatrician to the lauralynn ireland’s children’s Hospice in 2008. HOW LONG HAVE YOU WORKED AS A CONSULTANT PAEDIATRICIAN? I started my first consultant post in Northwick Park Hospital in london in 2006 but left in 2007 to return back home to Dublin with my young family. I was delighted to be appointed as consultant paediatrician to the Children’s sunshine Home, now lauralynn Ireland’s Children’s Hospice, in 2008. I have also been working as a consultant paediatrician at the National Children’s Hospital, tallaght, since 2009. CAN YOU DESCRIbE THE WORK YOU DO? I have a very busy and varied job. I have been trained as a paediatrician with a special interest in community child health. Community paediatricians assess and manage the needs of children with neurodevelopmental difficulties, for example autism, cerebral palsy and developmental delay. I also participate in the general paediatric on-call rota in tallaght Hospital and care for children with acute intercurrent illness. I care for a number of children with severe disability and associated complex

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medical needs; these children are often technology dependent. For example they may be fed via gastrostomy or require continuous positive airway pressure (CPaP) at night to support their breathing. Children with exceptional healthcare needs have reduced life expectancy. through this work I have developed an interest in paediatric palliative care, and have pursued a wide range of continuous development in this area over the past five years. at lauralynn, I participate in the multi-disciplinary team assessment of the needs of the children who attend for respite or end-of-life care. We use a holistic familycentred approach to attempt to manage the symptoms of the child while ensuring ongoing best possible quality of life. WHAT DO YOU LOVE AbOUT YOUR WORK? I enjoy meeting and working with a wide range of people, my colleagues and of course the children and families. I’ve always wanted to be a doctor and have a clear memory of stating that I wanted to look after children with disabilities when I was about ten years old, so you might say that this job is a dream come true for me. Working as a member of a multi-disciplinary team is fantastic, as we often have different perspectives on issues which arise and can

work together to find solutions. I get great support from my work colleagues. I also love that medicine is a career in which you are always learning and that ongoing study is deemed a necessity rather than a luxury. WHAT’S THE bEST THING AbOUT YOUR JOb? the best part of being a paediatrician with an interest in disability and palliative care is that you have the opportunity to meet and establish relationships with children and families over many years. Caring for children at end-of-life can be difficult but it is also rewarding to be given the opportunity to travel some part of a very difficult journey with a child and their family. WHAT’S THE HARDEST THING AbOUT YOUR JOb? I think one of the most difficult parts of doing my job is the ongoing challenge between low resources and high needs. It is so hard to continue to meet families day in and day out who have to wait many months and years to receive the appropriate therapeutic intervention. I am hopeful that the ongoing work of progressing disability services will help to reduce inequity in access to services across the country and establish clearer pathways for access to early intervention.

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competitions

Radisson Blu, Athlone L

ocated in the heart of Athlone, which is in turn at the heart of Ireland, guests will have no shortage of sights to see and visit in this maritime town. Take a scenic boat trip on the Shannon or visit the newly reopened Athlone Castle and Luan Art Gallery, which are located just across the river from Radisson Blu Athlone. Fashionfollowers will be thrilled with the selection of individual boutiques and high street stores on the doorstep of the hotel. History buffs may be more interested in a visit to Derryglad Folk Museum, just outside Athlone or in Clonmacnoise, just a 20 minute drive from the hotel. After a morning spent sightseeing or shopping, Radisson Blu Athlone is the perfect place to relax and unwind – take a swim, enjoy a drink on the terrace overlooking the river, or sit with a coffee and

the paper in the Quayside Bar and Lounge. We are giving one lucky winner the chance to win a two-night break at Radisson Blu Hotel in the heart of the maritime town of Athlone. One lucky reader will win two nights’ accommodation for two adults in this stylish hotel that overlooks Athlone Marina, including dinner on one evening in Elements Bistro, a super buffet breakfast each morning and complimentary access to Synergy Health and Leisure Club, which includes an indoor swimming pool, a fully-equipped gym with views over the river, a sauna and steam room, and fitness advisors on hand. Tel: (0)90 644 2600 Web: www.radissonblu.ie/hotel-athlone Facebook: w ww.facebook.com/ radissonathlone

To win this prize, answer the following question: What river does the Radisson Blu Athlone overlook? A) Liffey B) Corrib C)Shannon Send your answer to competition2@ashville.com with ‘Radisson Blu’ as the subject title. Closing date: April 30st.

The Malton, Killarney F

or families looking for an eggs-tra special Easter break, The Malton has eggs-actly what they need! Located in the heart of Killarney, The Malton has created the perfect packages for your family Easter holiday, and is now offering one lucky reader a fantastic two-night mid-week family break this Easter. With so many Easter activities like arts and crafts, the egg and spoon race and the annual egg hunt with the Easter Bunny, kids will be spoiled for choice. All activities are fully supervised, so mums and dads can relax in the plush surroundings of The Malton’s lobby or enjoy a drink by the fire in

the Punchbowl Bar. With six acres of beautiful gardens, and conveniently located, The Malton is an oasis of luxury in the centre of the bustling town of Killarney, and has been a favourite among visitors for over 150 years. For further information on Easter breaks at The Malton, visit www.themalton.com, email res@themalton.com or call (064) 663 8000. The Malton have kindly offered two nights’ B&B for two adults and two children, including one evening meal in The Malton and fun family activities throughout the stay. Tel: (064) 663 8000 Web: www.themalton.com

To win this prize, answer the following question: On what date does Easter Sunday fall this year? A) March 30th B) March 31st C) April 1st Send your answer to competition2@ashville.com with ‘Malton’ as the subject title. Terms & Conditions: Prize is redeemable on two consecutive nights from Monday 1st – Thursday 4th April, 2013. All activities and accommodation are subject to availability. Prize is for 2 adults and 2 children under 18. No cash alternative. Please note that the supervised playroom is for children aged four years and over. Children under four must be accompanied by an adult. Competition closing date: Monday March 25th.

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