Health Matters Summer 2011 by HSE Communications

HEALTH Vol 7 I Issue 2 I Summer 2011

INSIDE

- CROKE PARK AGREEMENT - PROTECTING CHILDREN - MEET THE TEAMS IN TULLAMORE

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

IMMunisation: 5 GP VISITS WILL PROTECT BABY

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

MATTERS

ational Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Summer 2011

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 39

101

Vol 5 I Issue 3 I Autumn 2009

Front Cover7.2.indd 1

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HEALTH MATTERS 1

CONTENTS 71

REGIONAL NEWS

CHILDHOOD IMMUNISATION Updated guide launched

DISABILITY SERVICES

CLINICAL PROGRAMMES

CLINICAL DETERIORATION Early warning scoring system agreed

SERIOUS INCIDENT MANAGEMENT Training event update

100

MALLOW PRIMARY HEALTHCARE CENTRE OPENS Minister opens new development

WELCOME

GOOD COMMUNICATORS Staff win health literacy awards

AUDIOLOGY UPDATE Newborns benefit from free hearing tests

RADIATION ONCOLOGY CENTRES First patients complete treatment

103

HOME CARE Noel Mulvihill on raising standards

104

CLINICAL INNOVATION Diabetes foot round initiative

107

DUAL DIAGNOSIS Clinicians collaborate to develop new care pathways

108

NOWDOC The accreditation process

MEN’S HEALTH WEEK Finian Murray on coping in these challenging times

STAYING SAFE IN THE SUN Dr Clodagh Loftus on understanding melanoma

TOP TIPS FOR KIDS Booklets offer great advice for parents

CROKE PARK AGREEMENT Update on recent developments

49 23

STROKE PATIENTS Benefit from exercise programme

s200M TARGETED IN NON-PAY EXPENDITURE SAVINGS Julie Ryan reports

DRINKING SAFE WITH DIABETES Anne Mullan on why binge drinking and diabetes don’t go together

GOING FOR GOLD Special Olympian Fionnuala Treacy on her dreams for Athens

112

MEET THE TEAMS Working behind the scenes in the Midland Regional Hospital

UPDATE

114

QUIT CAMPAIGN New initiative kicks off this summer

MUSIC LIFTS THE SPIRITS Jo O’Rourke describes a music programme for older people

TRY A TRI Tim Downing on why you should try a triathlon

PROTECTING CHILDREN Gordon Jeyes on the need for collective responsibility

117

TRAINING THE TRAINER Dr Diarmuid O’Shea on the role of physicians as trainers

PHD FELLOWSHIPS AWARDED

118

IRONMAN Fitness fanatic Gareth Presch on competing at a top level

MEDICAL STUDENT’S DIARY Kapil Sharma on his path to becoming a junior doctor

119

A DAY IN THE LIFE Psychiatrist Dr Mary Cosgrove tells us about her day

124

SPORTING PASSIONS Dr Brendan Murphy on the clash of the ash

LEADERSHIP AND INNOVATION CENTRE Loretto Grogan tells us about the new centre for Nursing and Midwifery ENDEAVOUR PROGRAMME Tackling severe self-harm RECORDS MANAGEMENT Updated Code of Practice

LOOKING AFTER YOUR TEETH

BREAST PAIN Guidance for GPs

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BLOOM FESTIVAL Health garden wins Bronze HSE GLOBAL HEALTH SUPPORT PROGRAMME Catherine Tunney on working in Nepal

07/06/2011 16:46:38

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

07/06/2011 15:42:07

HealtH Matters 3

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WelCome... tO tHe summer edition of Health Matters, the national staff magazine of the Hse. It’s been a very busy year so far and the content of this edition reflects some of the many changes and developments taking place within our health system. In this issue, you can read about hearing screening for newborns in Cork, and we also highlight Men’s Health Week and the new QUIt campaign aimed at smokers, which kicks off this summer. elsewhere, we feature new radiation oncology centres, update you on developments concerning the Croke Park agreement and promote a new guide to immunisation for children. Finally, take time out to meet some of the staff who play a crucial role behind the scenes at the Midland regional Hospital in tullamore. We hope you find this issue’s mix of features, interviews, news and updates interesting and informative. For more regular updates, check out our staff Intranet site http://hsenet.hse.ie or the Hse website www.hse.ie. special thanks to all the contributors to the magazine. enjoy the read!

Sites We Like... www.specialolympics.ie

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stephen McGrath – editor Head of Internal Communications the magazine is produced by the national communications unit publiSherS: ashville Media – www.ashville.com feedback: send your feedback to internalcomms@hse.ie production coSt: Our goal is to print, design and distribute Health Matters at no cost to the Hse. We achieved this goal in 2010 and we are on track to achieve it in 2011 with the support of our advertisers.

Did you know? www.cancer.ie

• One to two babies in every 1,000 are born with a hearing loss in one or both ears • stroke causes one in every three deaths • an estimated 5.5m people worldwide die every year from tobacco-related diseases • this year the Hse will spend s211m on home help services and s138m on home care packages Our cover picture shows baby leonore • Health service staffing reduced Brichard rooney by 4,179 Wtes (Whole time at the launch of the equivalents) between March 2010 Hse's information and March 2011 booklet 'Your Child's Immunisation - a • Babies should be seen by a GP for Guide for Parents'. immunisation purposes five times in see full story on the first 13 months of life page 91.

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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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07/06/2011 12:22:29

4 Health Matters

feature

New Hearing Screening Programme for Newborns All new-born babies at Cork University Maternity Hospital (CUMH) are now being offered a free hearing screening test prior to being discharged from the hospital. The development actions one of a series of recommendations made by a National Audiology Review Group chaired by Professor John Bamford, Honorary Professor of Audiology, University of Manchester.

UMH became the first hospital in the country to implement a new national Newborn Hearing Screening Programme in April. The detection of early hearing is very important to a child’s development and it also means that support and information can be provided to parents at an early age. Peter O’Sullivan, Consultant Ear, Nose and Throat Surgeon and Chairperson of the Cork Newborn Hearing Screening Implementation Group, said that the earlier a hearing loss can be picked up in a baby, the better the outcome that baby will have. “It is therefore very important to screen all babies at an early stage. In Ireland, one to two babies in every 1,000 are born with a hearing loss in one or both ears. Most babies born with a hearing loss are born into families with no history of hearing loss.” Dr Brendan Murphy, Consultant Neonatologist at CUMH said, “The screening programme aims to identify hearing impairment as soon as possible after birth to give babies a better chance of developing speech and language skills and making the most of social and emotional interaction from an early age”. “We now have a programme in place to deliver this to all our newborns. Babies who spend time in a special care baby unit have a higher incidence of hearing loss, these babies will be tested during their time in the unit.” Any baby who does not have a clear response in one or both ears from the test will be seen for a full audiological (hearing) assessment at an Audiology Clinic in Cork University Hospital (CUH) shortly after discharge.

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“It is therefore very important to screen all babies at an early stage. In Ireland, one to two babies in every 1,000 are born with a hearing loss in one or both ears.”

It is planned to roll out the Newborn Hearing Screening Programme to all HSE South maternity hospitals by the end of 2011, with further national roll out planned thereafter.

Work of Review Group to inform future planning The work carried out by the National Audiology Review Group was the most extensive examination of the state of audiology services in Ireland. Brian Murphy, National Primary Care Services Manager provided the HSE executive lead for the group.

+ Newborn baby Rebekah Gubbins being tested by Hearing Screener Emma Hogan at Cork University Maternity Hospital with her parents Sarah and Noel Gubbins from Carrigtwohill, Cork. Looking on are Dr Brendan Paul Murphy, Consultant Neonatologist, Peter O’Sullivan, ENT Surgeon and Maria O’Donovan CMM3 who were part of the Local Implementation Group.

07/06/2011 12:22:30

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07/06/2011 12:22:31

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HealtH Matters 7

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the group examined audiology services currently provided to children and adults nationwide, undertook an extensive public consultation and assessed the needs of the population. It found that better use of existing resources, coupled with additional funding, improved education and training, and integration of services across hospital and community settings will deliver better value for money and represent a long term investment in providing the best possible care, with improved health and social outcomes for clients. Brian Murphy, Hse National Primary Care services Manager, said: “this valuable report will inform future planning, development and delivery of consistent audiology services throughout Ireland. It will lead to significant improvements for both patients and staff as we work towards

“By providing rationalised care pathways, integrated teams, good leadership and better education and training of audiologists nationwide, we can work towards providing best practice audiology services for everyone, no matter where you live.” delivering fully integrated high-quality audiology services nationwide.” Prof John Bamford, Chair of the review Group, said: “It is clear from the review that there are many dedicated and committed professionals working to deliver good quality audiology services under challenging circumstances. We found good examples of multidisciplinary teams working together

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Hearing screener emma Hogan screens two-day-old rebekah Gubbins as part of the national Newborn Hearing screening Programme for Newborns. Mum sarah looks on

for the benefit of patients, but we also found evidence of services that are not meeting patient needs and which represent poor value for money. “By providing rationalised care pathways, integrated teams, good leadership and better education and training of audiologists nationwide, we can work towards providing best practice audiology services for everyone, no matter where you live.” the key recommendations made by the National audiology review Group (NarG) include: • the implementation of a National Newborn Hearing screening Programme • Improvements in hearing aid and ear mould services • a restructuring of services and staffing to provide better integrated teams, with enhanced communication between professionals and patients • the appointment of a national clinical lead for audiology and four regional clinical leads to deliver the modernisation programme, and to implement new care pathways and improved clinical governance

• a workforce review to confirm the extent of the required uplift of numbers of audiology professionals • establishment of within-country training for audiology professionals, with professional registration. arising from the recommendations of the review group, work is now underway to improve access and deliver high quality, consistent audiology services around the country. In addition to the estimated s11 million funding available for audiology services annually (excluding funding for voluntary organisations), in 2011 the Hse is investing an additional s3.7 million to begin the implementation of the recommendations of the review group. the recruitment of five clinical lead audiology positions is currently underway in order to appoint a National Clinical lead for audiology and a regional Clinical lead in each of the four Hse regions. the recruitment of a National Project Manager to co-ordinate the development of audiology services is also currently underway.

07/06/2011 12:22:34

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07/06/2011 12:22:37

HealtH Matters 9

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These are challenging times.

It’s NO JOKe – let’s talK men in ireland are often accused of being forgetful, especially when it comes to remembering significant dates such as birthdays and anniversaries. However, while this might sometimes be true, there’s a date that all men need to know about – as it could help to save their life, writes Finian Murray, men’s Health Development officer.

his year Men’s Health Week (coordinated by the Men’s Health Forum in Ireland) runs from Monday, June 13th until sunday, June 19th 2011. to highlight this week, local comedians Joe rooney (Fr Damo in Fr ted; tim in Killinaskully) and Paul tylak (savage eye; stew; Messrs tylak and rooney) are starring in an Ireland-wide poster campaign to raise awareness of the week. the message for men is simple: “these are challenging times. It’s no joke. let’s talk”.

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the health of men in ireland iS nothinG to joke about: • Men die, on average, about five years younger than women do • Men have higher death rates than women for all of the leading causes of death • Poor lifestyles are responsible for a high proportion of chronic diseases • late presentation to health services leads to a large number of problems becoming untreatable this year’s theme centres upon: “Promoting and supporting the Health and Well-Being of Men and Boys during Challenging times”. the world of men, and the roles that they play in it, have certainly changed dramatically in a very short period of time. all of these changes bring new challenges (both positive and negative). therefore, the key message for MHW 2011 is: “let’s talk”. but What iS there to talk about? the current economic recession has made a huge impact upon men’s jobs, status, income, spending, lifestyle, debt, and sense of security. It has also made a major difference to their mental, physical and emotional health. • On average, men are now living longer than at any time in history, but they are not necessarily healthier.

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• Men face a range of acute and chronic illnesses, but many of these are preventable • Obesity and sedentary lifestyles are on the increase, while healthy eating and physical activity are decreasing • Depression in men is becoming more prevalent (or at least acknowledged) and the male suicide rate is extremely high • Males are often not aware of where and how to find help and support • there is increasing recognition that males can be victims of domestic abuse and violence.

So, What can you do to mark thiS Week? Well, in the first instance, visit the Men’s Health Forum in Ireland website (www. mhfi.org/mens-health-week-2011.html) or the Men’s Health Week Facebook page (www.facebook.com/MensHealthWeek) Both of these will give you more information on MHW, what is happening around the country, and ideas for how to join in. You could promote the week by displaying a MHW poster, or inserting the MHW logo onto the bottom of your outgoing emails, or sending the website links to all your contacts. Perhaps you could use this opportunity to ‘do something extra’ for men and boy’s during MHW, like organise a men’s health awareness day at your service. But most importantly, you could take a few minutes to look at the state of your own health, and make MHW 2011 the start date for a new beginning. Now that’s a date worth remembering! For more information on MHW 2011, contact Finian Murray, Men’s Health Development Officer, Hse DNe at finianmurray@hse.ie or Colin Fowler, the Men’s Health Forum in Ireland, at: colin@mhfi.org.

to highlight Men’s Mental Health week, local comedians Joe rooney (Fr Damo in Fr ted; tim in Kilinaskully) and Paul tylak (savage eye; stew; Messers tylak and rooney) are starring in an Irelandwide poster campaign to raise awareness of the week

“the current economic recession has made a huge impact upon men’s jobs, status, income, spending, lifestyle, debt, and sense of security.”

07/06/2011 12:22:43

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07/06/2011 12:22:44

HealtH Matters 11

CommerCIal feature

Save oN HoUSeHoLD biLLS when times are tight, take a close look at your household bills and you may find that savings are there for the taking. Here, the experts tell us how to examine your personal finances and make a few small changes that will go a long way.

retty much everyone knows how difficult it can be to get by these days, whether it’s from thinking of one’s own personal finances or from listening to the anecdotes of others. Unemployment, mortgage arrears, negative equity and fear of being cut off from basic utilities are all in the headlines. these don’t look like going away any time soon, given the state of the economy. But that doesn’t mean it’s hopeless out there: examine your personal finances and you could find that a few small changes can go a very long way towards balancing the household budget – here’s what the experts have to say.

conSult the eXpertS there’s a lot the householder can do to chop down their bills, but asking the experts can often reap dividends. One such expert is John Coleman of Dublin-based company Homesaver. He has been invited into high-profile companies such as the Irish school of Motoring, among others, to give advice to staff. “some of the most significant savings can be made on life assurance,” he reveals. It needs to be appropriate cover, and a qualified person must make the sale and provide the correct advice. ask yourself: can better cover be got elsewhere? “the cost of life cover has come down significantly over the past few years, but many people will have just gone with the bank they have their mortgage with. there are significant savings there. the insurance companies price match each other, so you

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07/06/2011 12:22:45

12 HealtH Matters

CommerCIal feature

could be overpaying by just not looking at the market, and s400-500 a year could be saved,” he says.

“there’s a lot the householder can do to chop down their bills, but asking the experts can often reap dividends. one such expert is John Coleman of Dublin-based company Home-saver.” then there’s home insurance: “the reinstatement value may be too high. Make sure you look at the reinstatement value when you’re getting your home insurance in place. Home insurance is going up, but building costs are down so that rebuilding your home is a cheaper exercise. “Health insurance has been a very topical issue over the past six months. they have to offer you a corporate plan. It’s much cheaper, though they’ll never offer it straight out – but they have to by law, if they’re asked. there are savings to be made there.” In relation to electricity and gas, look at it on a yearly basis, he advises. “If you move your electricity or gas supplier, you’ll have got your discount – but that disappears after a year and they’re back to normal rates. But the market is quite competitive. If you make a change, review it annually.” Home-saver offers two services. Firstly, there’s a full one-to-one income and expenditure analysis, looking at every direct debit that’s going out of the house in order to ensure people are getting the best deals out there. secondly, around 70 per cent of PaYe workers don’t make tax returns – but they’re entitled to tax back in a lot of cases. “the average refund in 2010 was about s900, but people aren’t making their claims on things like education, medical expenses and bin charges. On occasion, we’ve got

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s5,000 back for people,” he says. Uniquely, the company has recently introduced a deal whereby customers can obtain discounts from major retailers on items such as petrol, food and clothing from major retailers. For more information, see www.home-saver.ie.

put taX breakS to Work there’s a way of saving money that makes you fitter too: One4all Bikes4work utilises the Government tax break on bikes and safety equipment which was introduced in Ireland in January 2009. Under the scheme, bicycles and safety equipment can be purchased tax-free up to the value of s1,000. that means that you get to use your normal income tax, PrsI and UsC to put towards the price of your bikes and safety equipment, a saving of up to 52 per cent for employees on the higher rate of tax, and 31 per cent for those on the basic rate of tax. this equates to a saving of s520 for employees on the higher rate of tax and s310 for employees on the basic rate of tax. Your bicycle and safety equipment can be paid for over a maximum 12 month period through salary sacrifice as per government legislation, and can be availed of once every five years. With increased petrol costs, the introduction of the Universal social Charge and a stretch in the evenings, now is the perfect time to use the tax break and cycle to work.

the provider currently works with companies of all sizes offering support and encouraging employers to avail of the Government’s benefit-in-kind tax break. since the Government introduced the scheme, the One4all Bikes4work roadshow has travelled up and down the country demonstrating a range of bicycles and safety equipment to over 750,000 employees nationwide. as well as providing demonstrations to employees, the Bikes4work team provides a full support service to employers, explaining every aspect of how the scheme works, including their legal responsibilities and will even help employers and Bikes4work scheme coordinators promote the benefits of the scheme to their staff while keeping any administration to a minimum. this leaves little excuse for employers not to implement One4all Bikes4work. there are other benefits too – your carbon footprint, traffic jams, all sorts of tax, insurance and transport savings – and special offers when you purchase your bike through Halfords. to find out more about the One4all Bikes4work scheme, visit www.bikes4work. ie, call (01) 870 8181 or email: info@bikes4work.ie.

Save on your home phone With the cost of living increasing, and disposable incomes decreasing, it now makes more sense than ever to explore ways to reduce your monthly expenditure.

07/06/2011 12:22:49

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07/06/2011 12:22:50

Save up to 30% on your life assurance and mortgage protection plans Put Your Money Back in Your Pocket Are you tired of paying more than you have to for household bills? Would you like hassle free savings on utility and insurance costs? Do you want superior service? Well look no further. At Home-Saver we pride ourselves on massively reducing household outgoings and putting our clients on the path to ﬁnancial freedom Home-Saver can offer you fantastic savings across a range of monthly household bills through its partnerships with the most reliable and competitive suppliers in the Irish market.

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Contact us today to arrange your own private consultation tailored to your speciﬁc circumstances. Call 01 810 2032, email info@home-saver.ie or review our services on www.home-saver.ie

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07/06/2011 12:22:53

Health Matters 15

Commercial feature

That’s the eircom way. Here, the company shares a few tips on how to save money on your phone bill and ensure you are getting the best out of your home phone. What calls do you make? Who do you call? When do you call? Do you make calls in the evening or weekends? Are they mainly local, national or to mobiles? By understanding the calls you make you can save money by ensuring you are on the most cost effective package. With a range of packages to suit different needs, eircom will happily discuss your requirements to ensure you are getting the best value. Or perhaps you can benefit from bundling. You can often take advantage of some great deals by bundling similar products from the same supplier. For example, eircom has packages with broadband and home phone from just s39.99 a month, which include unlimited off-peak calls to landlines and calls to mobiles. Plus you can also save up to s10 a month off a mobile phone contract from eMobile if you’re an existing eircom customer. Make sure you are aware of all the deals and offers that are available when you sign up or if you are already a customer. Another great way of saving money is to use up your full entitlement on your eircom home phone. Most eircom home phone packages include off-peak local and national calls, and they can also include some calls to mobiles too. By using your eircom home phone more you may find you can save by reducing your mobile bill. So make sure you are aware of the calls your package includes and then use them - you might be surprised just what is included. Be sure to know when your call charges change. Do you know when your peak rate charges apply? You may find that by delaying some of your calls by a few minutes in the evening you will save money. Also, if you are on a call package that includes peak calls and most of your calls are off-peak in the evening or weekend, you may be able to save money by downgrading to a cheaper off-peak package. Customer service agents at eircom optimise customers every week, so if you are not sure you are on the right package just call us and we will analyse your calling patterns and ensure you are on the best-fit package.

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You can also save money by availing of the additional services that are offered by eircom. For example, eircom broadband customers have access to a suite of services that add value. There’s MusicHub – free music streaming over four million tracks, and download costs cheaper than iTunes. There’s SportsHub – free online access to Setanta Sports. And there’s also StudyHub – free access to s3,000 of online video tutorials for Leaving and Junior Cert students – saving parents money on grinds. Do you go over your broadband usage limit? It’s difficult to understand what a gigabyte of data is, so to avoid charges it pays to monitor your broadband usage if you have a limit. Customers with eircom are provided with an app that can be downloaded for free to your PC to tell you when you’re approaching your allowance. Also, if you exceed your limit regularly it’s often cheaper to upgrade to the next level rather than paying the usage charges. And finally: look out for hidden charges. It pays to look at the additional charges when buying flights and the same can apply to your home phone. There can be additional charges when you first join or monthly on each bill. It’s important to make sure you are aware of any connection or equipment charges when

you sign up, as these can be significant. Also: are you charged every month for not paying by direct debit? While eircom offers a range of payment methods without charge, some operators will charge for alternative methods. Your home phone remains a great way to stay in touch with family and friends - and if you follow these simple steps you can make sure you’re getting great value too. For more information on the great range of products and services that eircom has to offer, visit www.eircom.net.

“With a range of packages to suit different needs, eircom will happily discuss your requirements to ensure you are getting the best value.”

07/06/2011 12:22:57

16 HealtH Matters

feature

Top Tips for kids: greaT aDviCe for PareNTS K

eeping young children safe, healthy and well can be challenging for parents. the Hse’s Child Health Information services Project (CHIsP) resource packs, which have been recently re-launched, provide easy-to-read information to help parents care for themselves and their child during the first five years. the information provided is evidencebased and includes advice from professionals in child health, support services, voluntary organisations and parent groups. Public health nurses nationwide are now giving out the booklets to parents during routine visits. CHIsP comprises of a suite of three resource packs: Caring for Your Baby: Birth to six Months, Caring for Your Child: six Months to two Years and Caring for Your Child: two Years to Five Years. For busy parents, those with sight problems or parents who might have difficulty reading english, there is also an accompanying CD providing the same information as the booklet.

“there are useful web pages and phone numbers included at the back of the books, which will help parents reach a wide range of supports and services.”

were reviewed and updated in 2009 by the regional Child Health training and Development Officers to include up to date evidence and new service developments such as the new immunisation schedule for children, the making up of infant bottles and the recommendation of Vitamin D supplementation for all children from birth to one year. the CHIsP resources serve as the only comprehensive, parent-orientated source of information provided by the Hse, and are an integral part of the child health service. there are useful web pages and phone numbers included at the back of the books, which will help parents reach a wide range of supports and services. During development, the packs also underwent a rigorous quality approval process and were awarded the adult Continuing education award by the National adult literacy agency in 2006. the CHIsP resource packs will continue to be delivered nationwide by public health nurses in 2011 during three of the five recommended Child Health screening and surveillance Programme checks. the public health nurses work through aspects of the information based on their professional assessment of what parents require, coupled with parents’ expressed needs at the time. Other health professionals working with children and families are also aware of the resource. the books are available in

PDF format on the Hse Intranet at http://hsenet.hse.ie or on the Hse website, www.hse.ie/go/caringforyourbaby

reSource bookS

l-r: National Child Health training and Development Officers Marie Gleeson, Mari O’Donovan, eileen Maguire, Brid Brady and Grace O’Neill with the newly-launched booklets

the Child Health Information services Project originated in the Hse south east. CHIsP fills an identified gap in quality health information as a support for parents. the idea behind the project is to empower parents by enhancing their knowledge of childrearing. Ultimately this will be of benefit to the child. the resource packs were originally published between 2004 and 2006. they

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07/06/2011 12:23:03

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07/06/2011 12:23:03

Value through Innovation

Even after a century of experience, we remain intensely curious. For the sake of future generations. Boehringer Ingelheim has always remained true to its character as an independent family-owned company. Our vision drives us forward. It helps to foster value through innovation in our company and to look to the future with constantly renewed commitment and ambition. Today, we operate globally with 142 affiliated companies in 50 countries. With more than 41,500 employees worldwide and a track record developed over 125 years, we are dedicated to improving the outlook for healthier lives. www.boehringer-ingelheim.ie

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07/06/2011 12:23:08

HealtH Matters 19

CommerCIal feature

warfariN, STroke aND aTriaL fibriLLaTioN Common heart rhythm disorder is a major risk factor for stroke, but current therapies have limitations and are underused, as Ciaran McCarron, medical Liaison with boehringer ingelheim explains.

trial fibrillation (aF), a common heart condition, is associated with irregularities in how the heart conducts electrical impulses. aF affects approximately 58,000 people in Ireland. However, since it often produces no symptoms, up to 50 per cent of aF sufferers are estimated to be unaware that they have the condition. What many people don’t realise is that having atrial fibrillation can increase the risk of having a stroke fivefold. In aF, blood clots may form in the heart. these clots can travel through the circulation and lodge in a blood vessel in the brain, causing stroke. studies in Ireland have found that approximately 30 per cent of strokes are associated with aF and that these strokes are generally more severe and more liable to result in death or long-term disability than strokes that occur without aF being present. the National Cardiovascular Health Policy 2010 – 2019, published by the Department of Health and Children, has recommended that a screening programme for aF in primary care be introduced. an irregular pulse may be a sign that aF is present. However, formal diagnosis of the condition requires that an eCG be performed. aF patients are frequently prescribed medications to reduce symptoms, improve quality of life and reduce the risk of stroke. some medications correct the abnormal electrical impulses present in the hearts of patients with aF, whilst others reduce the excessive heart rate that is a frequent symptom of the condition. the most common medicine used to prevent strokes in patients with aF is warfarin. a medicine with a long history, warfarin was discovered in the early part of the 20th Century in the United states after it was noticed that a number of cattle which fed on spoiled sweet clover hay suffered major bleeds. the cause of the bleeding was found

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to be a by-product of the spoilage of the hay. Once identified, warfarin received usage as an anticoagulant ‘blood thinner’. Most famously, warfarin was prescribed for Us President Dwight D eisenhower after he had suffered a heart attack. In the 1950s, warfarin was marketed as a rat poison and the drug is often remembered for this usage today. However, the effectiveness of warfarin at preventing stroke in patients with atrial fibrillation is beyond doubt and has been proven in numerous clinical trials. these trials have shown that treatment with warfarin can reduce the risk of stroke in patients with aF by 64 per cent. Despite this, warfarin is not an easy drug to use. It is associated with a significant risk of bleeding, which can be life-threatening. In addition, the effectiveness of warfarin can often vary dramatically due to interactions of the drug with other medicines and food. Broccoli, brussels sprouts, alcohol, ginger and garlic are just a small sample of the foods that can have an impact on the effectiveness of warfarin. For this reason, patients receiving warfarin must undergo regular blood tests to ensure that their level of anticoagulation is within the recommended range. Due to these difficulties, warfarin is often not prescribed to patients with aF. Whilst 40-60 per cent

of aF patients are eligible for treatment with warfarin, studies in Ireland have shown that only about a third of patients who are eligible to receive the drug actually do. as a consequence, many patients with aF in Ireland are likely to not be receiving sufficient protection from stroke. the National Cardiovascular Health Policy sees the development of structured anticoagulation management services between primary and secondary care as a key element in the strategy to reduce the incidence of aFstroke in Ireland. several new drugs are in the pipeline which, in the future, may also play an important role in helping to reduce the occurrence of stroke in patients with aF. email: communications.dbl@boehringeringelheim.com

07/06/2011 12:23:12

MITIE PLC is a UK based company that was established in 1987. In June 2010 MITIE acquired the soft services business of Dalkia Ireland. MITIE in Ireland have grown from 62 staff to over 400 at present and this number is increasing all the time. MITIE are developing their soft services division by self-delivering cleaning, security and landscaping across utilities, IT, manufacturing, finance and printing contracts. MITIE is passionate about its people, and has skilled and dedicated employees to provide a broad range of integrated service delivery to make buildings and their facilities smarter, greener, safer and better run.

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145 Lakeview Drive, Airside Business Park, Swords, County Dublin, Ireland Tel: 01 8951988 Email: info.ireland@mitie.com www.mitie.com

07/06/2011 12:23:20

Health Matters 21

COMMERCIAL feature

A CLEAN SLATE Some time ago, a job in contract cleaning was not necessarily seen as a worthwhile career nor did the industry’s reputation have much to boast about. That perception can now change due to increased training, better all-round standards and an acknowledgement of their importance. The contract cleaner can keep areas habitually and carefully, neat and clean.

©istockphoto.com/eliandric

t is imperative that all health service stakeholders strive for cleanliness throughout the healthcare services. It can be a challenge to reach the necessary levels of sanitation with the increase of MRSA and other deadly bacteria, and in recent years hospitals have also had to deal with swine flu. Tackling these issues has focused increased attention on the cleanliness of hospitals in curtailing the spread of the debilitating viruses. The contract cleaner can keep areas habitually and carefully, neat and clean.

Skilled Welfare Professional cleaners strive to keep all areas uncontaminated. They can help free up resources for the core task of our hospitals – concentrating on returning patients to the fullness of their health. In our health services, it is critical that all cleaning staff are highly motivated and fully trained in the latest processes and procedures and they must be capable of keeping the hospital dirt-free. The public are dependant on them in helping prevent the spread of infection and ensuring that the highest principles are adhered to. Most companies involved in commercial cleaning adhere to a strict code of practice. Importantly, staff will be trained to the highest industry standards. This, in turn, gives piece of mind to healthcare workers and hospital management that the firm engaged at their hospital has the same impeccably high standards as they do. Patients need 24-hour skilled welfare; the surrounding area must also be treated with the highest amount of care and attention, in order to eliminate all discerning diseases before they spread. MITIE A reputable cleaning company will be an asset in the battle to stop infections spreading on a daily basis. One such firm

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“Health and safety is an important component of modern life and hygiene should be of paramount importance in society.”

is MITIE, a cleaning provider, looking after many commercial and public sector names in the UK and Ireland for over 20 years. They have an impressive history. From modest beginnings, they now have revenues in excess of £1.7bn and are one of only two FTSE 250 companies to have grown earnings per share for over 22 consecutive years, resulting in impressive returns for shareholders and it also underlines their ability in many different sectors. Many industries reap the benefit of their vast expertise, from catering to pest control or from security to landscaping.

Their cleaning division work across the UK and Ireland for numerous airports, hospitals, offices and schools. In partnership with customers, they will constantly help look after ever moving headquarters. The facilities management company employs 58,000 employees, with 400 people employed in Ireland. With their capabilities, they enable their clients to think, manage, and deliver.

Side-by-side Health and safety is an important component of modern life. Hygiene should be of paramount importance in society and contract cleaners must make sure that cleaning is properly administered. Hospitals must be aware that contract cleaning can help keep productivity and efficiency at a maximum level. Essentially, skilled cleaners can work side-by-side with healthcare professionals in order to provide the best possible service for hospitals and other healthcare facilities. This will assist doctors and nurses to do their jobs in a more sterile environment.

07/06/2011 12:23:21

novartis pharma is a world leader in discovering new treatments for diseases that cause suffering to millions of people around the world.

• Cardiovascular • respiratory • ophthalmology • neurology • oncology • Immunology & Infectious Diseases

Our global Pharmaceuticals portfolio includes more than 50 therapies, many of which are innovative leaders in their therapeutic areas. Novartis employs almost 1,000 people in Ireland Committed to research and innovation, with over 15 clinical trials on-going in Ireland More than 140 projects in our Product Development Pipeline

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07/06/2011 12:23:30

Health Matters 23

feature

Stroke patients benefit from increased exercise Stroke causes one in every three deaths in Ireland, and patients who survive can suffer major physical disability.

ew research funded by the Health Research Board reveals that additional daily exercise routines, on top of routine physiotherapy, can significantly improve survivors' walking ability, balance, confidence and social participation. In a simple but novel approach called FAME (Family Mediated Exercise), Dr Emma Stokes, Dr Rose Galvin and Dr Tara Cusack, from Trinity College and University College Dublin, developed a short exercise programme to be delivered by the family and friends of people who survived acute stroke. The role of family and friends was to assist the person in participating in a series of daily exercises and complete an exercise diary. “Routine physiotherapy is certainly of great benefit to stroke patients, but this cannot be delivered on a daily basis,” says Dr Stokes. “The FAME approach created the opportunity for patients to be active and interact positively with family on a daily basis. After just eight weeks of intervention, we found that the patients in the FAME programme were experiencing significant improvement compared to those who were not. Their walking, balance and confidence had all improved.” Follow-up interviews clearly showed that patients and family found that the programme was beneficial to them physically and psychologically. Family members felt empowered by being able to do something constructive for their parent or spouse and they were under less strain after three months than those family members who did not participate in FAME.

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Those with stroke stated that the involvement of their family members motivated them to carry out the exercises. “This project shows how a simple intervention can improve patient recovery

without demanding significant human or financial resources,” says Dr Stokes. “It is a concrete, evidence-based model that could now be delivered in a hospital or a home setting.”

07/06/2011 16:45:40

24 HealtH Matters

feature

FaNCY a DrINK? you can drink if you have diabetes but you need to know how to drink safely, writes Anne Mullan.

rish people love to drink. Birthdays, weddings, christenings, funerals, having a party, meeting old friends, celebrating the start of the weekend or commiserating the arrival of yet another Monday – we find many good reasons to enjoy a drink. so what happens if you have diabetes? Does this mean that you must sit stoically with your glass of sparkling water while everyone parties around you? Well, the happy answer to that question is no. Most people who develop diabetes can continue to enjoy having a drink. the main thing when you have diabetes is learning how to drink safely.

the drinks); and that your blood sugars are a bit lower than usual when you wake up (due to the effects of the alcohol you’ve had). However, if you have type 1 diabetes, or are taking insulin or sulphonylureas (eg Diamicron or amaryl) for type 2 diabetes you could end up having a very serious hypo (low blood sugar). this risk of a severe hypo can last through the night and right into the next day. and the more you have to drink the more likely this is to happen. so how do you drink safely when you have diabetes?

alcohol and your liver When you think of what keeps your blood sugars stable you probably think about insulin and the pancreas. What many people don’t realise is that your liver also plays a vital role in keeping your blood sugars steady. One of the jobs of your liver is to keep a store of sugar in it. If your blood sugar starts to drop too low (you are going a bit hypo) your liver sends this sugar out into your blood to bring it back to normal levels. However, the main role of your liver is to break down any food or drug that might be harmful to our systems. Now, much as we might love it, alcohol is essentially toxic to us. Because of this, as soon as we start to drink, our liver gets busy breaking down this alcohol in order to get rid of it. this is such a priority for the liver that it doesn’t notice as your blood sugar starts to drop. and the more drinks you have, the less likely your liver is to notice your sugar dropping.

“for most people with diabetes losing weight – or trying to keep it off – is a constant struggle. It’s easy to forget how many calories alcohol can contribute to your daily intake.”

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men Men should not drink more than 21 units of alcohol per week and not more than 3-4 units at any one time. 21 units of alcohol is approximately: • 10-11 pints of beer or lager, or • 21 shorts. everyone should aim to have a couple of alcohol-free days in the week. these healthy limits apply to all the population, both with and without diabetes. www. drinkaware.ie has a standard calculator that lets you work out the number of alcohol units in what you have had to drink.

Will drinkinG affect my WeiGht? For most people with diabetes losing weight – or trying to keep it off – is a constant struggle. It’s easy to forget how many calories alcohol can contribute to your daily intake.

What iS one unit of alcohol? One unit of alcohol or one standard drink is the amount of a particular drink that contains ten grams of pure alcohol. One unit of alcohol = • Half a pint beer or lager • One short or shot (eg. vodka, gin, whiskey, rum etc) • One small glass of wine or half a small bottle (size served in pubs) • Half a pint of cider • One alcopop

©istockphoto.com/Jamesmcq24

So hoW doeS thiS affect your diabeteS? If you have type 2 diabetes and are being treated with just diet alone or diet and metformin (Glucophage), after having a few drinks you might notice that your blood sugars are a bit higher than usual before going to bed (due to the sugar in

One of the most important things when you have diabetes is recognising that heavy or binge drinking and diabetes just don’t go together. even without diabetes, too much alcohol can cause liver damage as well as increasing our risk of developing heart disease and certain cancers. When you put diabetes in the mix, it’s even more damaging. sensible drinking is the key and happily there is evidence to suggest that moderate amounts of alcohol can actually be good for us (though this evidence isn’t strong enough to recommend that teetotallers take up drinking!). the recommendations for people with diabetes are similar to those for the rest of the population.

Women Women should not drink more than 14 units of alcohol per week and not more than 2-3 units at any one time. Fourteen units of alcohol is approximately: • Two and a half bottles of wine • Seven pints of cider, or • 14 shorts.

07/06/2011 12:23:32

Health Matters 25

feature

One pint of Guinness or beer contains around 200 calories, which is the equivalent to about three slices of bread. If you regularly have two or three pints of an evening, you are getting the calories of up to an extra nine slices of bread in the day. It’s no wonder the weight isn’t shifting! Some companies now do ‘light’ versions of their beers and lagers, for example Bud Lite, Miller Lite and Coors Lite. Most of these have a similar alcohol content to ordinary beers and lagers but they are slightly lower in calories (about 100-110 calories per 330ml/12 oz bottle or can); compared with the standard versions (about 130-150 calories per 330mls). Not a huge difference but if you are minding every calorie you might want to try them. For cider drinkers watching their weight, it is worth trying the Bulmers Light. This has the same alcohol content as ordinary cider, but has no sugar and contains just 78 calories per half pint compared to 115 calories for half pint of regular Bulmers. Wines – particularly dry wines – and shorts aren’t quite so high in calories at about 80 calories per small glass/ measure, but they add up over the week. Adding diet mixers can help you reduce the number of drinks that you are having. Sweetened shorts, like liqueurs, sweetened wines and sherries, are better avoided. The main thing to remember is that all alcoholic drinks contain calories and the more you drink the more they add up. With www.drinkaware.co.uk you can calculate the units of alcohol and the calories in what you’ve had to drink. And finally, perhaps the most important message for all of us with or without diabetes is: never drink and drive. Please note: In Ireland, it is illegal to purchase alcohol or to consume alcohol in a public place below the age of 18. Anne Mullan is a Regional Development Officer/Dietitian. This article originally appeared in the Spring 2011 edition of the magazine Diabetes Ireland, which is produced quarterly by the Diabetes Federation of Ireland.

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Top tips Reduce your risk of having a hypo For people on insulin or taking sulphonylureas (e.g. Diamicron, Amaryl), it is essential that you reduce your risk of going hypo when you are drinking. This is especially important as once you’ve had a few drinks, you may not notice your own hypo symptoms and the people around you may just assume that you are drunk. Never drink alcohol on an empty stomach Always make sure you have something to eat before you drink. Whatever you eat must contain some form of starchy carbohydrate, for example bread, potatoes, rice or pasta. Because most alcoholic drinks contain some sugar, many people make the mistake of thinking they should eat less before drinking. The opposite is true. Though initially the carbohydrate in your drinks may cause your sugars to rise, very soon the alcohol will lower your blood sugar and so you actually need to eat more when you are having a few drinks. Always have something to eat before you go to bed Because your liver will keep breaking down the alcohol in your system throughout the night, your sugars can keep dropping. A side effect of the alcohol may mean that you don’t wake up until your blood sugar is very low. If you’ve been drinking you must have some form of starchy snack, for example breakfast cereal, toast or a sandwich, before you go to sleep. Insulin and alcohol – keeping yourself safe Binge drinking is part of the Irish youth culture. A night of Jaeger bombs, supersplits, Mickey Finns and alcopops can add up to a huge amount of alcohol and sugar consumed in a very short space of time. This is about as bad as it gets for your diabetes as first your bloods soar with the sugar rush and then plummet due to all the alcohol. Not to mention the amount of calories you’re getting! If you’re out for a night make sure that you’ve eaten beforehand. As mentioned, never drink on an empty stomach. When you are out, try keeping to longer drinks with a lower alcohol and sugar content such as: • Beers or lagers • Spirits with plenty of diet mixers • Wine spritzed with soda water or diet lemonade. Avoid using high sugar energy drinks (like Red Bull) or sweet juices (like pineapple or orange juice) as a mixer. Having a non-alcoholic, sugar-free drink every second drink, for example fizzy water, diet Coke or diet lemonade, is also very helpful. • Make sure your friends or the people you are drinking with know that you have diabetes, that they know what your hypo symptoms are and know how to treat them • It’s essential that you carry (or better still, wear) some form of ID to alert people to your diabetes • If you are making a big night of it and heading for a club you’ll probably also need to eat throughout the evening • Most importantly, don’t forget your starchy bedtime snack. If you’ve nothing in the house, a burger or chips or kebab on the way home is better than nothing • Keep a check on your blood sugars. At the very least, check them before you go out and before you go to bed.

07/06/2011 12:23:32

Building our Future in Healthcare Examples of Recent Projects: • Cappagh Hospital Modular Theatre Project • New Mater Hospital Adult Hospital • Crumlin Hospital PICU • Holles Street Hospital Fit Out • Blackrock Clinic Extension • Galway Clinic Extension • Whitfield Private Clinic • Midwestern Hospital Limerick extension • St Michael’s Hospital

• Elysian Diagnostics Clinic, Waterford • Waterford Regional Dialysis Unit • Mallow HSE PCC • Ballyfermot HSE PCC • Mallow Primary Care Centre (PCC) • St. Mary’s Nursing home • Barchester Trim PCC • Naas Vista HSE PCC • Mount Mellick PCC

- umbrella structure for • • • • •

M.E.D. Surgical Cardiac Services Tekno Surgical Synapse Medical Eschmann have recently joined SISK Group

Tekno Surgical and Cardiac Services have developed online shopping facilities which provide access to comprehensive catalogues, visit; http://shoponline.tekno-surgical.com or http://shoponline.cardiac-services.com

Total Healthcare Solution Provider Build - Equip - Consumables Supply • • • • • • •

GP Surgeries Primary Care Centres Hospital Extensions New Hospitals Retirement / Nursing Homes Healthcare Fit-Out Full Coordination - Turnkey Solutions

SISK Group - Sicon Limited is a diversified building business involved in construction , specialist stone, architectural glazing, distribution and healthcare in Ireland , UK, Europe and Middle East. The SISK Group which celebrated its 150th anniversary last year is an Irish owned family business which has its origins in Cork in 1859.The Group is one of the largest privately owned companies in Ireland. In 2009, turnover exceeded €1.4 billion with 1,600 people employed across all of its operations.

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www.SISKhealthcare.ie

www.SISKgroup.com 07/06/2011 12:23:34

Health Matters 27

update

New Paediatric Intensive Care Unit (PICU) A

new state-of-the-art Paediatric Intensive Care Unit (PICU) opened in Our Lady’s Hospital, Crumlin, in March. The new unit will provide care for infants, children and adolescents who are critically ill, from all counties of Ireland. The project was funded in totality by the HSE at a cost of s9.8 million, on time and on budget. The new unit has replaced 13 existing beds, and adds four new paediatric ICU beds - bringing the total ICU bed complement at the hospital to 25. Phase two has now commenced, which will provide for staff education rooms and parents’ facilities. This phase is due to be completed in autumn 2011, which is on target. The new facility features a vast amount of natural lighting to help facilitate a safe healing environment for patients and families.

Staff at the new Paediatric Intensive Care Unit (PICU) which opened in Our Lady’s Hospital, Crumlin in March

Lorcan Birthistle, Chief Executive at OLCHC said that “a commitment to caring for patients and families is the inspiration for the new Paediatric Intensive Care Unit at Our Lady’s Children’s Hospital, Crumlin, which provides 80 per cent of paediatric tertiary services.”

“This new development will provide a healthcare environment which, in terms of design, ambience and support for families, will benefit critically-ill children.” Arrangements for the formal opening of the new unit are currently being made.

Recent Investments in Cappagh Hospital

ignificant recent investments have underlined Cappagh National Orthopaedic Hospital’s commitment to ensuring that the highest quality clinical service and facilities are available to its patients. The Dublin-based hospital has undertaken large developments, with the addition of 12 more single-room wards, three new operating suites and a new radiology suite including a 3 Tesla MRI – the first of its kind in a public hospital in the State. The new MRI utilises cutting-edge technology to ensure that the best quality images are available to enhance diagnostic capability and ensure a major reduction in waiting time for diagnostics. The hospital is the major elective orthopaedic tertiary referral centre in Ireland, conducting over 9,000 surgical procedures annually. The facility has been fully accredited by Caspe Healthcare Knowledge Systems (CHKS) for almost a decade, and obtained the highest score in the most recent HIQA national hygiene audits.

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Cappagh Hospital hosts undergraduate and postgraduate medical training in conjunction with the RCSI and UCD, the College of Anaesthetists, and postgraduate nursing training in conjunction with the RCSI. These established linkages play a vital role in maintaining Cappagh Hospital’s role as a centre of academic and surgical excellence, with a total of 23 consultant surgeons, four consultant rheumatologists and ten consultant anaesthetists providing a full range of orthopaedic and rheumatology services from spinal surgery through to bone tumour surgery for both paediatric and adult patients. Cappagh National Orthopaedic Hospital also provides a full range of sport injury care and rehabilitation and the hospital’s linkages with the Institute of Sport and the Olympic Council of Ireland have developed over recent years to consolidate its capability to provide a streamlined approach to the care of both professional and amateur athletes. The new state-of-the-art Pediatric Intesive Care Unit for Our Lady's Children's Hospital was constructed by John Sisk & Son.

+ The new MRI utilises cutting-edge technology

SISK Group is delighted to have had the opportunity to provide a total solution to the Cappagh hospital modular theatre project. They delivered the project on time and within budget in a matter of 20 weeks. TEKNO Surgical, part of Sisk Healthcare, supplied the state-of-art Stryker theatre equipment. TEKNO Surgical is the distributor of the full portfolio of Stryker equipment and implants in Ireland.

07/06/2011 12:23:36

IDS is a specialist Prosthetics/ Orthotics/Footwear provider based on the Cappagh National Orthopaedic Hospital campus in Dublin. We are one of the largest suppliers of such healthcare services in Ireland, covering the majority of the country via our main clinic in Dublin and a further 13 satellite clinics in other hospitals. Our staff are fully qualified to international ISPO standards and certified to provide our clients with state of the art products as well as the more regular bespoke and stock devices. We have our own manufacturing facility on site to produce our custom made Prosthetics and Orthotics. Today IDS is part of the world wide Otto Bock Healthcare Group of companies. Our direct link with Otto Bock not only aids us in our mission to be at the forefront of new methods of treatment and products, but it also gives us a significant resource should there be a need of further expertise. IDS also provides educational training to students studying Prosthetics

HM Iss7.2 p1-71.indd 28

and Orthotics at the Universities of Strathclyde (Glasgow) and Salford (Manchester), as well as education and assistance to allied Health Care Professionals. The services are available to Private and Publicly funded clients, with all initial assessments being free of charge. Feel free to contact us or visit our website where you will ﬁnd more information about our services and products for our clients as well as information for Health Care Professionals referring to our service.

www.idsltd.ie 07/06/2011 12:23:43

HealtH Matters 29

feature

New QUiT CamPaigN kiCkS off THiS SUmmer Dr Fenton Howell, Public Health Specialist, outlines the HSeâ&#x20AC;&#x2122;s new QUiT campaign, aiming to get smokers to turn their lives around.

ÂŠistockphoto.com/-art-siberia-

moking is the single biggest cause of ill health in our society, with smokers, their families and friends and the health service all paying a huge price for tobacco use. It is estimated that 5.5 million people worldwide die every year from tobacco-related diseases like cancer, chest and heart disease and diabetes, and many, many more live with long-term illness and disability. Our research tells us that most smokers want to quit, and that seven out of every ten smokers have tried to quit before. Unfortunately, for some people, their addiction to nicotine can be very difficult to overcome. However, it is not impossible. Of those who have quit, just over a third quit on their first attempt, and overall half of them succeed after their second attempt. the trick is to keep trying. While most smokers want to be smoke free, many are wary of the chances of success and so avoid trying again. there are about one million smokers in Ireland and, unfortunately, one in every two of those smokers will die from a tobaccorelated disease. this is a well-known fact in health circles, but we found that itâ&#x20AC;&#x2122;s

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07/06/2011 12:23:47

30 Health Matters

feature

“Our campaign hits them with the reality, but also then shows them how they can escape that frightening statistic. It provides clear signposts on HOW to quit, with a range of supports accessible to every smoker, should they need them.”

No matter what age you give up smoking, you will: • reduce your risk of cancer, heart disease and other killer illnesses • reduce your heart rate and blood pressure • look and feel better • have fresher breath and cleaner teeth, hair, skin and fingers • have more control of your life • be fitter and have more energy • reduce your risk of illness • reduce the complications of existing illnesses • have a better quality of life • be a good role model for your children or grandchildren • have more money • have a healthier family, as they will not be exposed to your second-hand smoke professional bodies, large sporting organisations and media partners over the two to three year lifetime of the QUIT campaign. Healthcare workers like GPs, pharmacists and smoking cessation officers will be provided with campaign material to allow them to encourage and help smokers to quit. The campaign will also support the HSE in becoming a smoke-free workplace by 2015, providing communications support and publicity for each smoke-free location as it comes on stream. This campaign is a significant step forward for the HSE, building on previous work carried out in this area. Key to its success will be how

all of us in the HSE, whether we are frontline or back of house support staff, whether we are health professionals or otherwise, whether we work in a tertiary hospital or in a community-based clinic, can help promote the key messages of the campaign and reach out to smokers, letting them know that there is help out there for them in their quit attempt. All of us have a role to play. And if you are one of the 1m smokers, remember, you can quit. Check out our new QUIT website (www.quit.ie), call the Quitline, join a smoking cessation course, or join us on Facebook – the help will help. National Smoker’s Quitline 1850 201 203 www.quit.ie.

©istockphoto.com/treasurephoto

not something that many of the public or smokers had heard before. That’s why we have made it the cornerstone of our new QUIT campaign, which kicks off this summer. We need to help smokers understand first of all WHY they should quit. While most people know the mantra that ‘smoking is bad for you’, very few know just how bad it is. Our campaign hits them with the reality, but also then shows them how they can escape that frightening statistic. It provides clear signposts on HOW to quit, with a range of supports accessible to every smoker, should they need them. The HSE will mobilise all of the resources at its disposal in this campaign – our staff, our buildings and services, along with our communications and public information services. We have established partnerships with other bodies and organisations – for example, the Irish Cancer Society, the Asthma Society, the Irish Heart Foundation, ASH Ireland – to spread the campaign messages alongside us. There are also options to link with clinical and

The Benefits of Quitting

Call the National Smokers' Quitline on 1850 201 203 HM Iss7.2 p1-71.indd 30

07/06/2011 12:23:49

Health Matters 31

feature

National Leadership and Innovation Centre

for Nursing and Midwifery The HSE recently established a National Leadership and Innovation Centre for Nursing and Midwifery, based in Limerick. Loretto Grogan outlines what the centre seeks to achieve.

he aims of the new National Leadership and Innovation Centre for Nursing and Midwifery are clear: to work with nurses and midwives in building innovation and leadership competencies, knowledge and networks in order to transform healthcare for patients. Effective leadership is vital at all levels to enable our health services to deliver high quality and safe care. Nurses at all levels need to be connected to our nursing and midwifery leadership and management structure. The centre was established in August 2010 with Cora Lunn as Interim Director and the team of Loretto Grogan, Elaine Fallon, Mary B Rice and Teresa Moore. Clinical leadership in nursing and midwifery has been described as involving, influencing and motivating others to deliver clinically effective care by demonstrating clinical excellence and providing support and guidance to colleagues through mentorship, supervision and inspiration. It is also concerned with demonstrating the distinct nursing and midwifery contribution within multidisciplinary contexts. Clinical leaders in nursing and midwifery not only contribute to effective patient care, but they also give a voice to their disciplines by participating in policy development and collaborating with other members of the multidisciplinary team. Projects to date involving the National Leadership and Innovation Centre for Nursing and Midwifery include: • A series of national nursing and midwifery networking events • A series of three masterclasses for senior nurses and midwives which included ‘Leading in uncertain times’, ‘How to be successful in my role’ and ‘How to be politically astute as a leader’. • The development of the two-day programme ‘Leading in uncertain times’ for staff nurses and CNM 1 and 2 grades

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which will be implemented in September. • The development of an introductory e-learning leadership and management resource pack for nurses and midwives. • The development of an online leadership and innovation learning and communication hub for nurses and midwives. The centre is currently working with HSE’s Learning and Development web service HSELanD to develop this initiative. A National Clinical Leadership Competency Framework has been developed, and is currently in the pilot phase. On completion, the centre will have responsibility for implementing competencies nationally. These competencies have been developed to reflect different levels of knowledge, understanding and behaviours in a nurse or midwife’s career, from staff nurse/midwife to director of nursing/midwifery. This facilitates individuals to understand and seek to develop those competencies needed to progress or to perform more effectively in increasingly complex situations and roles. The seven clinical leadership competencies are: self

awareness, advocacy and empowerment, decisionmaking, communication, quality and safety, teamwork, and clinical excellence. To truly develop leadership and innovation within each Irish healthcare organisation, we have to find the level at which every nurse and midwife is comfortable leading, and then we need to grow and stretch that mark. Nurses and midwives who feel like leaders are more likely to take a risk and challenge the status quo when they think there is a risk to patients. Leadership must be an integral part of education and training, and an expectation in the jobs nurses and midwives do from the beginning of their careers. For more information about the National Leadership and Innovation Centre for Nursing and Midwifery: Tel: (061) 483301 Email: nmleadership@hse.ie Web: www.hse.ie/go/ nurseandmidwifeleadership Address: C/O Nursing and Midwifery Planning and Development, HSE West, 31/33 Catherine Street, Limerick.

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Special Programme to Tackle Severe Self Harm T

he Endeavour Programme is the first of its kind in HSE South, treating those with Borderline Personality Disorder in an outpatient setting. It is hoped that the programme will not only be another step towards implementing mental health policy - Vision for Change - but will ultimately improve the lives of those with complex emotional problems by helping clinicians to treat people in a more systematic and effective way. In the current economic climate, we need to continuously review our practice to ensure its research evidence base, while being cognisant of managing within existing resource limitations. The Endeavour Programme is an example of such thinking, showing how staff commitment can lead to service improvement with little additional financial burden on the organisation. The Endeavour Programme is a new initiative in North Lee Adult Mental Health Service, with a focus on treating individuals with severe self harm behaviours such as cutting and repeated suicide attempts. The programme is built on an evidence-based treatment called Dialectical Behaviour Therapy (DBT); a widely-researched effective treatment for persons with a diagnosis of Borderline Personality Disorder (BPD). A Vision for Change â&#x20AC;&#x201C; Report of the Expert Group on Mental Health Policy (2006) highlights that BPD is recognised as one of the most distressing disorders for service users, and is most difficult for clinicians to treat. People with this diagnosis struggle with emotion regulation, and cope with life stressors in self destructive ways that impact on their own quality of life and that of their extended social network. Their presentation is often complex, with multiple other difficulties such as depression, anxiety and drug or alcohol problems. It is likely that these individuals have had multiple inputs across the health service, with a huge emotional cost to the individual and their carers and a significant financial cost to the State, with little improvement objectively or subjectively.

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+ Back row (L-R): Barbara Shorten, Art Therapist; Sinead Greaney, Clinical Nurse Specialist; Grainne Kearney, Clinical Psychology Assistant; James O Mahony, Clinical Nurse Specialist; Mary Kells, Clinical Psychologist. Front Row (L-R): Dr Nataraj Gojanur, Consultant Psychiatrist; Daniel Flynn, Senior Clinical Psychologist and Programme Leader Six staff from a multidisciplinary background â&#x20AC;&#x201C; including psychology, psychiatry, nursing and art therapy - who are already dedicating time to working with these service users came together in 2009 to explore how to progress these recommendations locally. The staff, partly funded by the HSE, grants from outside agencies and self funding, completed training in the UK in 2010, and have established the Endeavour Programme. Potential benefits of the programme include:

Improved Mental Health for Service Users Research reviews indicate benefits ranging from reduced number and severity of parasuicidal acts, to decreases in hospitalisations and few crisis or emergency department attendances. It also highlights decreases in reports of depression, hopelessness and suicidal ideation. Improved Value for Money In the current economic climate, the HSE is working to make improvements and demonstrating value for money to justify the use of tax contributions to the public. Given the anticipated reduction in hospitalisation,

there should be an economic value to the HSE in reducing the cost of admissions and length of hospital stay by offering a more appropriate and effective outpatients alternative to service users. A systematic co-ordination of the work with this client group will facilitate other community mental health team clinicians to focus on clients who do not pose the challenges of those with a diagnosis of BPD.

Policy Compliance and EvidenceBased Practice It is estimated that 11-20 per cent of attendees to services have a co-morbid BPD presentation. Vision for Change recommends that teams providing evidence-based interventions should be established to work with these individuals, with staff being co-opted from existing community mental health teams. The provision of such a programme will ensure that North Lee Adult Mental Health Service is leading the way in implementing the recommendations of the Vision for Change policy, and is ensuring that the care planning for clients with BPD is in line with international best practice.

07/06/2011 12:23:51

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feature

©istockphoto.com/BrianAJackson

HSE Updates Code of Practice on

Records Management The health service is a recordintensive service. Annually, there are thousands of contacts between members of the public and health service professionals across a wide range of services, writes Gay Murphy.

onsequently, a huge amount of records are produced arising from its internal operations and external business and service contacts. Prior to the widespread availability of information technology (IT), these records were generally all paper-based. Even though technology is now in common use, there is a tendency in many areas to retain both the traditional hard copy paper record and the electronic-based record.

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Healthcare records are a valuable resource because of the information they contain. High-quality information underpins the delivery of high-quality evidence-based safe healthcare for service users. Information has most value when it is accurate, up to date and available when needed. An effective records management service ensures that information is properly managed, is available whenever and wherever there is a justified need for that information, and in whatever medium it is required which is compliant with relevant legislation. The healthcare record plays a crucial role in the provision of services by supporting continuity of care and facilitating communication between all members of the multidisciplinary team. It is a legal document that provides an overview of the care and advice given, and is used as evidence in

litigation cases - so what’s written and how it’s written are crucial. No matter how much care or good advice is given, if it’s not documented then it is assumed that it didn’t happen. Healthcare records can be complex, and the needs within a healthcare organisation diverse. The range and location of records to be managed varies and includes: • Current healthcare records stored in the healthcare records library • Healthcare records in use in various locations throughout the organisation • Healthcare records no longer in everyday use that still need to be kept. Such records are often stored in secondary storage which may be on or off-site • Healthcare records that have been transferred to an alternative medium, e.g. microfilm.

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“There is a tendency in many areas to retain both the traditional hard copy paper record and the electronicbased record.” As you can see, the task of co-ordinating the retrieval and secure transportation of healthcare records from all areas for all services is mammoth, so good healthcare records management is crucial. Well-managed records set the tone of an organisation, and in the health services this is particularly so. Not only do the healthcare records themselves need to be managed from their creation and registration through to storage, security, confidentiality, retrieval and transportation, but what’s contained within is of vital importance and must also be managed and maintained. In this regard, a standardised national healthcare record was developed and implemented in the acute hospitals in January 2008. The aim was to have a unified healthcare record, for each patient, that will reduce error and improve patient safety and quality of care. This record is structured using three spines, and is divided into 11 sections. All sections are listed on an index page, which is colour co-ordinated to match the colour of the dividers. This is a useful guide, and helps when training staff until they become familiar with the record. Guidance is provided on the dividers throughout the chart, including best practice for record-keeping. Good record-keeping ensures that: • Staff can work with maximum efficiency without having to waste time searching for information • There is an audit trail which enables any record entry to be traced to a named individual at a given date and time with the secure knowledge that all

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alterations can be similarly traced • Those coming after you can see what has been done, or not, and why • Any decisions made can be justified or reconsidered at a later date • The records are secured against tampering or unlawful deletion. The national healthcare record is in use in the majority of acute hospitals in Ireland, and one of the major benefits is that HSE members of staff are now familiar with the healthcare record as they move between hospitals. Other benefits include: • Improved standards of documentation and filing • Easier to file loose documents • The structure facilitates the audit process • It will ease transition towards the electronic patient record • It will facilitate retrieval of records, or part of, from off-site storage. Managing healthcare records is vital whether resources are adequate or scarce. The Code of Practice is the benchmark for healthcare records management in the HSE. Because standards and practices in relation to healthcare records management will change over time, this document will

evolve to reflect those changes. It has recently been reviewed and updated based on feedback submitted following nationwide consultation. The Code of Practice for Healthcare Records Management V2.0 will be replaced by the HSE Standards and Recommended Practices for Healthcare Records Management V3.0 once signed off by senior management. The Healthcare Records Management National Advisory Group will be working with the community and continuing care services this year to adapt the standards and recommended practices to meet their requirements. The latest version of the code is available at: http://hsenet.hse.ie/ HSE_Central/Consumer_Affairs/Record_ Management/. An e-learning foundation training programme developed to support the Code of Practice for Healthcare Records Management and help staff to improve their performance in relation to healthcare records management can be accessed at www.hseland.ie. Gay Murphy (pictured below) is the Programme Lead for Healthcare Records with the Quality and Patient Safety Directorate. She can be contacted by email at gay.murphy@hse.ie.

07/06/2011 12:23:55

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

Believe in zero. HM Iss7.2 p1-71.indd 35

07/06/2011 17:26:34

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feature

How to Look After Your Teeth Effective daily oral hygiene is an essential part of your general health and wellbeing, according to the Dental Health Foundation.

©istockphoto.com/shironosov

e all want to have healthy teeth, fresh breath and nice smiles. Gum disease and tooth decay are the two most common oral diseases worldwide. Research has shown that people with disabilities may be more likely to have oral health problems and require more treatment than the rest of the population. Given the links between gum disease and oral health as well as diabetes and cardiovascular disease, it has never been more important to look after your teeth.

Toothbrushing Regular toothbrushing removes plaque, and so is good for gum health. There is evidence to show that brushing twice a day with fluoride toothpaste is more

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effective than brushing once. Evidence also supports the use of fluoride toothpaste. It is recommended to use a toothpaste with at least 1,000 ppm F (parts per million fluoride). Fluoride from the toothpaste can also prevent and even reverse decay in its early stages.

Effective Toothbrushing Routine • A gentle scrub technique involving very short horizontal movements is recommended • Spit out toothpaste and do not rinse after brushing • Brush twice a day: at bedtime and at one other time during the day

“Regular toothbrushing removes plaque, and so is good for gum health. There is evidence to show that brushing twice a day with fluoride toothpaste is more effective than brushing once.”

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feature

“While mouthwash can help fight tooth decay and/or gum disease, it should not be used as a replacement for toothbrushing. The Dental Health Foundation recommends the use of alcohol-free mouthwash.” Children • Parents and carers of children aged 0-2 are encouraged to brush their child’s teeth as soon as the first tooth appears, using a soft toothbrush and water • It is not recommended to use toothpaste for children aged 0-2 years • From age 2-7 years, use a small pea-size amount of fluoride toothpaste • Children under the age of seven should be supervised by an adult when brushing, and should be encouraged to spit without rinsing after brushing so that the effects of fluoride toothpaste are not diluted. Research shows that if a child has dental decay at a young age, they are likely to have dental decay and gum disease as an adult.

Flossing It is recommended to include flossing as part of regular oral care. Flossing reduces the amount of periodontal disease-causing bacteria present in plaque between the teeth – this is particularly important for diabetics. It also helps to reduce bad breath. Parents and carers should start flossing children’s teeth as soon as there is contact between the molars (flat teeth at the back of the mouth), and should continue to do so until the child is skilled enough to do it themselves. Age will vary depending on the child, however, if the teeth are crowded it may be from as early as three or four years old. Tongue brushing has also been proved as an effective measure in reducing bad breath.

Mouthwash While mouthwash can help fight tooth decay and/or gum disease, it should not be used as a replacement for toothbrushing. The Dental Health Foundation recommends the use of alcohol-free mouthwash. Your dentist will recommend the mouthwash most suitable for you. It is not recommended for those under seven years of age. Visit Your Dentist It is recommended to visit your dentist

twice a year for a dental check-up and cleaning.

Smoking and Oral Health Smoking increases your risk of oral and dental problems including: • Bad breath • Bad taste in your mouth • Tartar on your teeth • Gum disease which can lead to tooth loss • Stains on teeth, dentures and tongue • Mouth, head and neck cancers • Delayed healing after gum infections • Delayed healing following dental treatment or having a tooth removed Mouthwashes and smokers’ toothpastes may be effective in removing stains and making your mouth feel fresher, but they cannot treat any underlying damage caused by smoking. Smoking or using tobacco products puts you at greater risk of cancers to the mouth, head and neck. Your risk is even greater if you smoke and drink alcohol, or use products containing alcohol. Mouth, head and neck cancer can affect the throat, voice box, gums, cheeks, tongue, palate, tonsil, salivary glands, sinuses, nose and lips. For more information about caring for your teeth visit www.dentalhealth.ie.

Manual Toothbrushes The head of your toothbrush should be about the width of your four bottom front teeth. It is important to choose a toothbrush that effectively and gently cleans your teeth and gums. Modified toothbrushes are available for carers or people who may have difficulty holding brushes. ©istockphoto.com/Kameleon007

Powered Toothbrushes Some research has shown that toothbrushes with a rotation oscillation action (i.e. where the brush head rotates one direction and then the other) are more effective than manual toothbrushing. They are also beneficial for those who do not have the dexterity to brush effectively with a manual toothbrush.

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07/06/2011 12:24:01

38 Health Matters

feature

New Breast Pain Guidance Introduced Guidelines for professionals and patients issued by National Cancer Control Programme.

he National Cancer Control Programme (NCCP) has launched a new booklet and algorithm (guidance) aimed at assisting GPs in addressing and managing mastalgia, otherwise known as breast pain. Both the booklet and algorithm have been endorsed by the breast cancer charity Europa Donna Ireland, whose acting chair, Deirdre O’Connell, attended the event at the designated cancer centre at Waterford Regional Hospital. Devised and produced by the NCCP Community Oncology Team in association with Ray McLoughlin, Consultant Breast Surgeon at Galway University Hospital, the new booklet and algorithm are currently being distributed to GP surgeries and primary care facilities nationally. Mastalgia is very common, affecting 60-70 per cent of women at some stage in their lives. Although it can cause anxiety for some women, it is not usually a symptom of breast cancer. The degree of breast pain varies for each woman. It can range from being a mild discomfort to being severe enough to affect a woman’s quality of life. There are two main types of breast pain: cyclical and non-cyclical. Cyclical is the most common form, and occurs in women between the ages of 20 and 50, while noncyclical can occur both pre-menopausally and post-menopausally. It is more common in women over 40. The new booklet provides guidance on how to identify which form of breast pain the woman may be experiencing, how to manage this pain, how to be breast aware and how to correctly self examine. It is also an important information resource for GPs in discussing the information with women, who can then

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L-R: Hilary Murphy, NCCP Breast Nurse Advisor; Carmel Ann Daly, Consultant Breast Radiologist and Lead Breast Clinician at WRH; Dr Regina Codd, NCCP GP Advisor; and Deirdre O’Connell, Acting Chair Europa Donna; at the launch of the new National Cancer Control Programme booklet and algorithm at the designated cancer centre in Waterford Regional Hospital

retain the booklet for reflection following the examination. The new algorithm is currently being distributed to all GPs across the country, and will ensure that a standardised approach is taken in the management of mastalgia. According to Dr Regina Codd, GP Advisor to the NCCP, “it is really important to stress that mastalgia alone - in the presence of a completely normal breast examination - is rarely a presenting symptom of breast cancer. And of course on that basis, it is vital that we as GPs are fully educated and briefed, which in turn ensures we are in a position to educate and reassure our patients. “The purpose of the patient information booklet is to educate women selected by their GP - following a completely normal

clinical examination - on the types of, causes of and treatments for mastalgia. “The great advantage of the booklet is that women can use it by way of reference and reminder subsequent to the original examination. The algorithm means that all GPs, regardless of where they are based nationally, will be managing mastalgia in the same way.” Dr Codd further pointed to the inclusion in the booklet of a pain diary: “women are empowered by the inclusion of a pain diary to be completed over a three month period, and presented at the follow up consultation with their GP.” However, the GP advisor stressed the importance of revisiting the GP at any time if the pain continues or other symptoms become apparent.

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feature Good Communicators get the message across HSE staff were rewarded for their efforts to communicate their messages in a clear and accessible way at this year’s Crystal Clear MSD Health Literacy Awards.

+ Pictured at the Crystal Clear MSD Health Literacy Awards, which took place in the Royal College of Physicians in May, were (L-R): Inez Bailey, Director of NALA; Pauline Cooley, Practice Nurse, Athenry Health Centre; and Dr Neil Boyle, Medical Director, MSD. Cooley and her team were the overall winners in Category A, Best Project in General Practice, for their project Thou Shalt Hear

he HSE Dublin North East Health Promotion Department’s Be Active After School Activity Programme, the HSE South Cardiac Rehabilitation Working Group’s Take Heart programme and the ear care and ear wax information programme at the Health Centre in Athenry, Co. Galway were among the winners at this year’s Crystal Clear MSD Health Literacy Awards. The awards acknowledge those working in the health care setting who strive to address health literacy and communicate their message in a clear and accessible way. The entries were evaluated for how they addressed the issue of health literacy, which is a person’s ability to understand and use basic health information. The Take Heart programme comprises of a booklet also entitled Take Heart, which is used by patients before and after they have a heart operation. The publication helps patients to understand their diagnosis and make appropriate choices regarding their lifestyle following heart surgery. Margaret Byrne, Cardiac Rehabilitation Clinical Nurse Specialist said, “the booklet is unique because it involved health professionals from every acute hospital in the

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+ L-R: Emer Smyth, Dr Nazih Eldin and Eileen McEvoy, Health Promotion Department, HSE Dublin North East, who were overall winners in Category D, Best Health Promotion Project, for the Be Active After School Activity Programme

+ Margaret Byrne, Clinical Nurse Specialist; and Valerie Collender from Cork University Hospital; who were the overall winners in Category B, Best Project in a Hospital, for their project Take Heart - A Guide to Heart Surgery

Cork and Kerry region, public, private and voluntary. We wanted to make sure that this booklet would be accessible to all and that those who were given it would find it easy to read, explain their condition, help them on the road to recovery and that they would not get bogged down in health jargon.” Valerie Collender, Cardiac Rehabilitation Co-ordinator said, “the guide has improved the health literacy of our patients by making it easier for them to access relevant information and providing points of contacts which enable them to find their way through what can sometimes be a complex health system.” The ear care and ear wax information programme comprises of an information leaflet about ear care. Using plain English, it provides information in an easy-tounderstand and engaging way. Following the distribution of the leaflet, the practice carried out an audit which showed a reduction in the number of patients coming back for repeat ear-related appointments. The Be Active After School Activity Programme comprises of a 30-week structured activity programme, which introduces parents and children aged 7-8 years to a variety of activities to

sustain positive physical activity habits as children grow up. There are currently 1,200 children participating in the programme, with 300 parent leaders and 130 teacher leaders volunteering their time to facilitate the sessions. Resources for the programme, which are given free to participating schools, include 30 illustrated sessions and a handbook for teacher leaders. Where possible, the activities and formations are illustrated, and plain language is used throughout. Selected from more than 100 entries by a high-profile judging panel, the winners were announced at a special ceremony in Dublin which was attended by Dr James Reilly, Minister for Health. Speaking at the event, Dr Nazih Eldin, Head of Health Promotion in Dublin North East, said that “it is a great privilege to accept this award on behalf of the team who have worked hard to make this project a success. It is our ambition now to extend this project across the country in the coming months in partnership with the Irish Sports Council and in line with our goal to get children all over Ireland involved in physical activity and healthy lifestyles.”

07/06/2011 12:24:05

40 Health Matters

developments

First patients complete treatment in new Radiation Oncology Centres Carol Smith, a native of Donnycarney in north Dublin, became the first patient to complete her treatment at the new NCCP St Luke’s Radiation Oncology Centre in nearby Beaumont Hospital in May.

xpressing her gratitude to the staff at the new centre, Carol said she was impressed with the new facilities and delighted with the support provided by the staff at every level. Marking the occasion Dr Susan O’Reilly, National Director of the National Cancer Control Programme (NCCP) presented Carol with a bouquet of flowers. Staff in another new St Luke’s Radiation Oncology Centre at St James’s Hospital in Dublin also made a presentation to Donegal native Kathleen (Sarah) McNicholas who, within days of Carol’s final session, was also completing her radiation treatment. Sarah was equally impressed with her experience and, having travelled from Donegal, had availed of the accommodation facilities in the Lodge at St Luke’s Rathgar Centre. Part of an ambitious plan to develop a national network of radiotherapy centres with the capacity to meet patient demand for the next 25 years, the Dublin-based St Luke’s Radiation Oncology Network has become the first model of its kind in Ireland. The new model allows for radiotherapy services to be managed and delivered on a networked basis – known as the St Luke’s Radiation Oncology Network. This works across three centres at St James’s Hospital, Beaumont Hospital and St Luke’s Rathgar. The development has brought significant investment in personnel with 54 new health professionals recruited. These include radiation therapists, medical physicists and clinical engineers and there are currently over 450 staff working across the network at the three centres. The new appointments are in addition to the new consultant radiation oncologists appointed at centres across the country in recent years. St Luke’s Hospital entered into the governance of the HSE in August

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+ Dr Susan O’Reilly, Director of the NCCP presented patient Carol Smith the first patient at Beaumont to complete her treatment with a bouquet of flowers. Pictured (L-R): Jenna Burrows, Dr Jerome Coffey, Marita Endicott, Carol Smith, (patient) Brenda Thompson, Anne Marie Grimshaw, Dr David Fitzpatrick, Consultant Radiation Oncologist Dr Susan O’Reilly, Niamh Kerr, Angela Clayton-Lea, Dr Jamsari Khalid, Helen Stokes, Clare Farrell 2010 with the passing of the Health, Miscellaneous Provision Act. The board of the hospital was subsequently abolished and the hospital became directly managed by the NCCP. With the network currently consisting of the three centres, the longer-term plan involves radiotherapy provision only on the site of the acute hospitals. This will happen when Phase Two is implemented, and significant additional capacity is added to the centres at Beaumont and St James’s. Explaining the background to the development of the service, Dr Jerome Coffey, Consultant Radiation Oncologist and National Clinical Lead, said: “A detailed analysis of existing services was provided in the report of the expert group chaired by Prof Donal Hollywood (entitled The Development of Radiation Oncology Services in Ireland) published in 2004. The report compared our service with other countries and came up with a comprehensive proposal on how to meet the future needs of the Irish population by

means of network model. The report has become the foundation of the Department of Health policy and its implementation has resulted in the completion of the St Luke’s Radiation Oncology Network. “It should be stressed that there is also detailed planning ongoing for the second phase of development to upgrade radiation oncology facilities in Galway and Cork; along with the building of a new centre in Waterford and the assumption of a facility in Limerick, currently privately run. This will allow us to develop a national network of radiation oncology. “We have already significantly enhanced our surgical suite in St Luke’s to facilitate the introduction of new treatments including ocular and prostate brachytherapy”, Dr Coffey stated. Dr Coffey further added: “Two of our four new linear accelerators in the Beaumont Centre contain additional functionality to provide stereotactic radiosurgery for small brain tumours for which operating is not considered an option. This service will

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developments

“We have already significantly enhanced our surgical suite in St Luke’s to facilitate the introduction of new treatments including ocular and prostate brachytherapy.” + Donegal native Kathleen (Sarah) McNicholas pictured with Grainne Gleeson, Radiation Therapy Manager, St Luke’s Radiation Oncology Centre at St James’s Hospital. Kathleen was the first patient to complete her treatment at the new centre be run by the radiation oncology staff in the centre in close cooperation with the clinicians in Beaumont’s National Referral Centre for Neurosurgery and Neurology. Up to now, these patients had to be referred to centres in the UK and further afield.” Stressing the importance of the two new centres to be based at designated cancer centres, Dr Coffey noted: “For clinicians, the importance of providing organised care at the most sophisticated level in the most appropriate environment means that the skilled teams bring together their expertise for the benefit of the patient.” There is now an increasing emphasis on out patient/day case treatments – resulting in a decreasing need for in-patient care. The new network reflects this approach in its emphasis on ambulatory facilities. However, for those patients who require in-patient treatment dedicated facilities are provided within both designated cancer centres with in-patient beds available. According to Prof Brendan McClean, Medical Physics Lead with the St Luke’s Radiation Oncology Network, the expansion of the staff numbers, recruitment of key personnel, the commissioning of the most advanced technology and equipment means that patients are now accessing the most advanced level of treatment and services internationally available. “The aim of radiotherapy is to eradicate or achieve control of the tumour, while minimising the risk of toxicity of surrounding normal tissues. The eight new Varian linear accelerators together with the four most recent Elekta Synergy linacs provide

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a combination of two powerful tools to help achieve this aim: Intensity Modulated Radiotherapy (IMRT) and Image Guided Radiotherapy (IGRT).” For Juliet Kelly, Radiation Therapy Network Lead, the introduction of an ambulatory care model allows therapists to “work closely with nursing and medical colleagues within the radiotherapy department to deliver an outpatient service that allows patients to maintain as normal a quality of life as possible, without the need for in-patient admission.” “Radiation therapists are integral parts of the patient’s pathway through radiation oncology. They have specialised training in the management of cancer patients involving radiation planning and treatments utilising sophisticated

equipment. They are actively involved in the multidisciplinary team who manage and support patients throughout their radiation treatment. The new network has increased the number of therapists and this will enhance our ability to offer patients state of the art treatment techniques that are tailored for each patient.” According to Eileen Maher, Network Nurse Lead: “Nurses in radiation oncology work in a multidisciplinary setting – they collaborate with the patient and family and all members of the multidisciplinary team. Primary nursing is a common model of care enabling the patient and their families to build a rapport with the nurse who provides continuity of care throughout the patient journey in the centre.”

+ St Luke’s Radiation Oncology Centre at St James’s Hospital

07/06/2011 12:24:10

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HM Iss7.2 p1-71.indd 42

07/06/2011 17:14:35

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feature

Understanding Melanoma The incidence of malignant melanoma has increased significantly over the last 50 years in all western countries, writes Dr Clodagh Loftus.

here are many factors which are associated with the development of melanoma: the most obvious and most important of these is sunlight exposure. Intermittent sunburn is a risk factor in the development of melanoma, especially if this occurs at a younger age. An individual’s skin type is also an important potential risk factor - those who burn easily and never or rarely tan are at a higher risk of developing melanoma, compared to those who have darker skin and tan easily. The number of moles a person has is another identified risk factor for melanoma development: those with a lot of moles greater than 50 - are at increased risk. Genetic factors also play a role, and those with a family history of melanoma are at increased risk compared to the general population. Smoking has not been associated with an increased risk of melanoma. It can be quite difficult to differentiate a normal pigmented skin lesion from a melanoma. Warning signs that may suggest melanoma include: • A mole that suddenly becomes bigger or raised • A moles that changes colour • A mole that has a mixture of different colours, e.g. black, red, brown • A mole with an irregular outline or edge • A mole that becomes red or inflamed • Sensory changes in a mole, e.g. if it becomes painful, tender, itchy etc • A mole that bleeds or oozes

©istockphoto.com/mabe123

The ABCDE rule is advocated by many for helping patients to identify skin lesions that are suspicious and need medical review. A: Asymmetry: if a mole is asymmetrical when one divides the mole with an imaginary line, does one half look different to the other?

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B: Border: is there an irregular edge or border to the mole? C: Colour: is there colour irregularity? D: Diameter: is it greater than 6mm? E: Evolution: has the mole changed? Melanoma is diagnosed by history and clinical examination; many dermatologists use an instrument called a dermatoscope

to view the moles more closely, and this can help in the diagnosis. Sometimes it is necessary to surgically excise the lesion to confirm the diagnosis, though every attempt is made to avoid unnecessary excisions.

Benign Moles Benign skin naevi/moles can often cause

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feature

“Benign skin naevi/ moles can often cause confusion with melanoma. most adults have some moles. normal moles do change over time, but this is usually over years as opposed to weeks or months.”

caldeSun for kidS – Stay Sun Safe / commercial content some sunlight is good for us, but too much sun is harmful and can damage your skin. It is important to protect children from the sun’s harmful rays with a high factor sunscreen from the day they are born. Sun tipS • Children under six months should be kept in the shade at all times • Try to keep older children indoors from 11am to 3pm • Provide hats and sunglasses for your children • Dress your children in loose fitting clothes that cover arms and legs Most importantly – use Caldesun sun Protection before going out into the sun. reapply after swimming and during the day to protect your child from the sun. Caldesun has a unique formulation that contains UV-a, UV-B and Ir-a (infrared) protection filters. available in sPF 30 and 50, Caldesun is clinically tested and suitable for children with neurodermatitis. Caldesun is water resistant and contains no Peg emulsifiers, perfume, artificial colours or preservatives. Caldesun is distributed by ClonMedica and is only available in pharmacies.

HM Iss7.2 p1-71.indd 44

confusion with melanoma. Most adults have some moles. Normal moles do change over time, but this is usually over years as opposed to weeks or months. During childhood and teenage years, as the body grows then so do its moles, and this is normal. Many women notice that their moles get darker during pregnancy; this is a normal development in most, and is related to the hormone-mediated changes that occur during pregnancy. It is quite common to develop new moles during childhood and adolescence, however, as one gets older the development of new moles is less common. there are many types of normal moles. Junctional naevi frequently cause confusion with melanoma - they are flat, and in some can be quite dark. as one gets older they may become raised. Intradermal naevi are the most common type of moles seen in adults - they are raised and are often entirely skin coloured. Blue naevi are dark blue or black moles that occur commonly on the face. they are benign, but as they are very dark they are often a cause of concern. Seborrhoeic keratoses are very common. they are wart like - one is reassured by their multiplicity, people usually have quite a few of these as they age, and they are often found in non sun exposed areas, for example under the breasts and in the groin. Solar lentigines, also known as age spots or liver spots, are related to sun exposure and typically occur on sunexposed spots such as the face or backs of the hands. Dermatofibromas are benign, and feel like a small 'frozen pea’ under the skin. they represent a form of scarring in the skin. In summary, malignant melanoma is becoming more common. risk factors include skin type, sun exposure, genetic factors and an increased number of moles or atypical moles. Many benign skin moles can appear suspicious, and as such are a cause of concern. the aBCDe rule is useful in helping identify moles that merit clinical review. However, it must be emphasised that history is crucial, and a lesion that has changed over a short

period of time or a new lesion that looks suspicious merits review by a doctor. Dr Clodagh Loftus is a hospital registrar specialising in dermatology in St James’s Hospital.

the SunSmart code enjoy the sun this summer, but protect yourself from UV rays by following the sunsmart Code. • Cover up by wearing a shirt with a collar and long shorts. also wear a hat that gives shade to your face, neck and ears • Seek shade from the sun when UVA rays are at their strongest – between 11am and 3pm • Wear wraparound sunglasses, and make sure they give UV protection • Slap on sunscreen: Use sunscreen with sPF 15 or higher and UVa protection 30 minutes before going outside. re-apply every two hours – more often if swimming or perspiring • Keep babies under six months out of the sun see www.cancer.ie/sunsmart for more information. this information was supplied by the Irish Cancer society

Melanoma: this is a close-up of skin cancer on the body of a 46-year-old man

07/06/2011 12:24:20

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Ask your pharmacist for the FREE helpful Caldesun “Stay Sun Safe” leaflet. 2011/ADV/CAL/045

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07/06/2011 12:24:22

46 Health Matters

developments

Croke Park Agreement Update Ireland faces severe challenges to restore public finances and to reduce the deficit to less than 3 per cent of GDP by 2014, in part by achieving sustainability in the cost of delivering public services. For the HSE, the Public Service Agreement will ensure that the Irish public service continues its contribution to the return of economic growth and prosperity to Ireland.

ublic servants are, of course, concerned at the impact of difficult decisions taken by the Government which have effected them on a personal and day to day basis in the work environment, such as the pay reduction and the application of the moratorium on public sector recruitment and promotion. However, they understand that the Public Service Agreement (also referred to as the Croke Park Agreement) acknowledges the sacrifices made and gives in return a measure of security in terms of pay, including no further pay cuts or compulsory redundancies over the lifetime of the agreement. We do not however, underestimate the challenges that face the health sector

Background to the Public Service Agreement The Public Service Agreement was reached following a set of intensive discussions

facilitated by the Labour Relations Commission in March 2010, but was not ratified by the Public Service Committee of the ICTU until June 15th 2010. The agreement is unique, in that it doesn’t promise the delivery of pay increases in return for performance and modernisation of the public sector, instead its aim is to restore the public finances and reduce the current budget deficit. This is in part to be achieved by reducing the cost of delivering public services by restructuring and reorganising, and thus gaining greater efficiency and effectiveness for public expenditure. One of the key principles of reducing costs is through the reduction in staff (or whole time equivalents) while still maintaining services to the greatest possible extent through the best use of all available resources. The agreement promises, in return protection for pay, commitments on pension rates for those retiring and no further compulsory redundancies. Paragraph 1.6 of the agreement states “that compulsory redundancy will not apply within the public service”, while paragraph 1.15 confirms, “there will be no further reductions in the pay rates of serving public servants for the lifetime of this agreement. These commitments are subject to compliance with the terms of this agreement.” Following ratification of the agreement, the Government established an implementation body, with independent chair PJ Fitzpatrick, at national level to drive forward the process of change and ensure any difficulties which may be encountered are resolved in a fair and speedy manner. In the health sector, a sectoral implementation

©istockphoto.com/Yuri_Arcurs

HM Iss7.2 p1-71.indd 46

in delivering services this year against the severe budgetary measures required by Government, which require underlying savings of s960 million in the HSE’s budget for 2011, allied with the reductions in numbers employed under the public sector moratorium. This is the real test for the Public Service Agreement – the extent to which our services can be delivered as planned within the reduced resources requires pro-active cooperation from our management, staff and staff associations at all levels.

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Health Matters 47

developments

body has also been appointed and is chaired by independent chair Pat Harvey. In summary, the agreement requires the public sector to engage in a significant reform programme to ensure that the Irish public service continues its contribution to the return of economic growth and economic prosperity to Ireland, by working collaboratively to build an increasingly integrated public service which is leaner and more effective. The agreement offers an unprecedented platform to facilitate change on a scale and in a fashion that previously has never existed.

“The agreement offers an unprecedented platform to facilitate change on a scale and in a fashion that previously never existed.”

+ Sean McGrath, National Director for Human Resources, HSE linked to the agreement. The following are edited extracts from that report:

The Agreement’s commitment Many commentators have remarked on the lack of progress and delivery of changes under the agreement and are questioning whether it is capable of delivering the real changes that are required to be sustained. The health sector is clear in its conviction to work with staff and their unions to implement the real, and sometimes difficult, changes required, including minimising wastage, maximising efficiencies, improved skill mix, changes to work practices and staffing ratios, and implementation of the Clinical Care Programmes – an area that will substantially improve patient care from a quality, access and cost perspective. Progress Report In a progress report delivered to the Department of Health in May, Sean McGrath, National Director of Human Resources, outlined progress and savings under the Health Sector Action Plan

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2010 Budgetary and Staffing Position In 2010, the HSE met its commitments under the 2010 National Service Plan, to deliver services with underlying savings required of approximately s1bn and against a requirement to reduce staffing numbers. Health service staffing reduced by 4,179 WTEs (Whole Time Equivalents) from March 2010 to March 2011 (a drop of 3.8 per cent in overall staffing numbers). Health Service Staffing at March 31st 2010 = 109,843 WTEs Health Service Staffing at March 31st 2011 = 105,664 WTEs Community Welfare Service The arrangements for the transfer of over 1,000 staff working in the Community Welfare Service to the Department of Social Protection were in position by January 1st 2011. This was a significant achievement in the context of the need to achieve greater cost efficiency and

organisational effectiveness in the delivery of the public services. It was also a key milestone in the delivery of the overall Government programme for the rationalisation of the public service, as it is the first cross sectoral initiative towards the requirement for an integrated public service as envisaged by the Croke Park Agreement.

Laboratory Modernisation The agreement reached with the relevant staff unions affects some 3,000 staff, who now have a liability to be rostered between 8am and 8pm from Monday to Friday. In addition, agreement on a new payment structure for out-of-hours emergency work will deliver some s5m in savings in 2011. Reduction in absenteeism Against a backdrop of a reducing workforce, the HSE has reduced its level of absenteeism year on year from 2008, from 5.76 per cent in 2008 to 4.70 per cent in 2010.

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48 Health Matters

developments

Redeployment There has been significant movement of health sector staff between corporate functions, regional and service areas. Centralisation of medical card processing The centralisation project involves the modernisation of medical card processing to improve service to the public and reduce the associated administration and associated costs. The developments include: • An online medical card application service launched in 2010. Since its introduction, the central site at Primary Care Reimbursement Services (PCRS) receives more than 5,000 applications online each month; more than 50 per cent of these applications are made outside of normal office hours • The development of a new website, www.medicalcard.ie, which allows any individual who has applied for a medical card to the national office to view the status of their medical card application online • Medical card applicants who provide a mobile number are provided with SMS acknowledgement and application updates • Local health offices now have full visibility of the national database to enable queries to be addressed locally • General Practitioners (GPs) have access to weekly updates of their panel listings – over 75 per cent of GPs use this service • Ongoing development of systems integration with GPs and pharmacists so that medical cardholders can have eligibility confirmed at point of service to avoid undue delays

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Value for Money Initiatives The overall savings target for 2010 of s106m was exceeded by s20m in the health sector. Urgent and ambitious implementation There is now a need to emphasise the requirement for greater urgency and commitment to deliver these changes and others to benefit the public. There is a very high level of commitment from all sides – management and unions – to deliver change under the agreement and there is a clear understanding that there is a lot of work to be

done by all to deliver on its potential. Having robust local 'Croke Park' plans is crucial and provides the platform for managers and staff to understand and implement change. We are therefore according the highest possible priority to implementing the agenda for change set out in the agreement and to working with the implementation bodies and trade unions. Significant work has been ongoing since the agreement was ratified. The Croke Park Agreement is not a cost saving plan in itself. Cost savings will come through decisions on changing services and work practices, introducing new technology and reducing numbers of public servants. The Croke Park Agreement provides the framework to manage those changes to work practices and service delivery, to boost productivity and improve efficiencies, as the numbers of public servants reduce over time. The health service has a critical role to play during these difficult times in providing services to citizens and displaying flexibility in being able to respond to rapidly changing demands, and we must manage to do this with significantly fewer resources. We have a shared view in the Public Service Agreement between management and unions, of the sort of changes that will produce greater efficiency and better services for the public. The Croke Park Agreement will ensure that the public service is equipped to be capable of meeting the challenges of the future.

©istockphoto.com/shironosov

Agency Service Level Agreements The health sector has, over a number of decades, utilised agency workers to fill short-term vacancies in order to ensure continuity in service provision. This flexibility is an ongoing requirement to maintain necessary services. The rates for these services are set by the private sector companies providing such services.

The 2010 spend for agency services in the HSE was s138m. Across the wider health sector, the total spend was s184m. The obligation to deliver an ongoing reduction in the cost of delivering public health services, while maintaining the same level of service, requires all public sector organisations to consistently review their cost base. The HSE, as set out in its Service Plan 2011, undertook to reduce the cost of agency provision. A tendering process commenced in October 2010 in line with EU and procurement law. The outcome of this process has resulted in a potential cost saving of s33m in 2011 on agency spend based on delivery of agency services at the same volume as 2010 under the new arrangements. The contract(s) are in place.

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Health Matters 49

developments

HSE Targets s200m in Non-Pay Expenditure Savings One of the HSE’s priorities in 2011 is to deliver a major cost reduction and restructuring programme yielding net savings of s683 million, with some s200m of these savings being made in the area of our non-pay expenditure writes Julie Ryan, Assistant National Director of Procurement.

©istockphoto.com/gemphotography

he type and volume of service the HSE will provide directly this year is set out in its National Service Plan 2011, and savings in the area of nonpay expenditure are an essential part of the plan. The delivery of these savings requires significant engagement and negotiation with the HSE’s supplier base in seeking to reduce prices and control volumes of stock of supplies and services used by the HSE and the voluntary sector. In this context, HSE Procurement is progressing an ambitious programme of work to support the achievement of price reductions across a diverse range of categories of products and services. Typically the strategy includes a series of direct engagements with current suppliers

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to seek better commercial terms for current business arrangements on an interim basis. Single National Procurement Operating Model HSE Procurement is now operating on the basis of a Single National Procurement Operating Model. All staff engaged in procurement activity across HSE now report into HSE Procurement and this development was facilitated under the auspices of the Croke Park Agreement. The implementation of this model is a key enabler in achieving cost reduction, increased efficiencies and the adoption of streamlined standardised procurement processes to avoid duplication of effort.

“The delivery of these savings requires significant engagement and negotiation with the HSE’s supplier base in seeking to reduce prices and control volumes of stock of supplies and services used by the HSE and the voluntary sector.”

07/06/2011 12:24:26

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07/06/2011 12:24:32

HealtH Matters 51

Developments

By working together with common goals and objectives all staff engaged in procurement activity can make a positive contribution in enhancing the Procurement service and value achieved for its customers.

national procurement Group the National Procurement Group is progressing a procurement process that seeks to achieve best value for money in terms of quality of product, service support and pricing while maintaining an appropriate level of patient and clinical choice on a health sector-wide basis. a critical success factor in delivering this programme of work and achieving the targets set is ensuring that the appropriate stakeholder groups are represented as part of the various procurement groups leading out on these initiatives. this will ensure that the requirements of the customer base across the various categories are adequately met when each contract is implemented. In this regard, each regional director of operations has nominated a relevant member of staff per project to participate on the procurement groups. In addition, academic bodies have provided clinical support on some of the medical and surgical categories. the voluntary hospitals are also supporting delivery of this programme of work. the Biomedical engineering Departments across Hse are also actively involved in conjunction with Procurement on progressing cost benefits associated with service contracts. It is envisaged that the outcome of this programme of work will deliver sustainable value for money throughout the Hse. Below is a list of categories being targeted nationally by Procurement as part of this initiative: commercial arranGementS Once contracts are established and commercial arrangements are in place it is imperative that, in order to maximise the benefits, all customers are aware and comply with these new arrangements. an extensive communication exercise has been embarked upon to ensure that the

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“each individual needs to take responsibility to ensure compliance in order to protect against any negative impact on frontline services given the current financial climate.”

customer base is made aware, through their regional director of operations, of these value based initiatives as they are implemented and as the detailed information to support these price reductions become available.

In the absence of compliance the benefits cannot be realised. each individual needs to take responsibility to ensure compliance in order to protect against any negative impact on frontline services given the current financial climate. In addition, a logistics and inventory management work programme is leading a number of initiatives to create better efficiencies in terms of stock reduction, introduction of management of stock at point of use and management and use of aids and appliances. reducing discretionary spend is also a key success factor in delivering the savings required and in this context there is a moratorium on discretionary expenditure in respect of furniture, maintenance and vehicles purchased. Further information on contracts and pricing arrangements put in place as part of this initiative are available on the Hse staff Intranet.

SAVINGS PLAN 2011 – CATEGORIES BEING TARGETED NATIONALLY BY PROCUREMENT AS PART OF THE COST MANAGEMENT PROGRAMME National Framework agreement for the Provision, supply and support of Cardiology Products

laundry services

renal equipment/Consumables

Dairy Products

Orthopaedic Products and equipment

ambient Foods

endomechanic/laparoscopic supplies

Frozen Foods

Gloves (latex, Nitrile, surgeons)

Bread

Medical & surgical suppliers (Drapes and surgical attire, Invasive, stoma and respiratory, Giving sets)

Fire alarms & emergency lighting

Needle and syringes

external Catering

aids and appliances

Heat, Power and light

Dental related Products

Patient transport services

Drugs and Medicines

Bedding and Clothing – Disposables

Vaccines

Mobile Phones

laboratory

Perishable Goods

Mattress Purchase/rental

Domestic Waste

X-ray/Imaging

Incontinence

Medical Gases

Insurance

Cleaning and Washing Consumables

Contract Cleaning

Washroom services

agency staff

07/06/2011 12:24:33

52 Health Matters

feature

GOING FOR GOLD A team of 126 Special Olympics Ireland athletes and their 49 coaches are travelling to Athens, Greece to participate in the 2011 Special Olympics World Summer Games, writes Sarah Murphy.

ionnuala Treacy will live out a dream of a lifetime when she takes part in this year’s Special Olympics World Summer Games in Greece. Fionnuala joined Creagh Training Centre in Ballinasloe, Co. Galway, and little did she think that three years later she would be representing Ireland at an Olympic sport. But the 44-year-old, who has an intellectual disability, seems to be taking it all in her stride. In Ireland, it is roughly estimated by Special Olympics that there are 42,432 people living on the entire island who are classed to have intellectual disabilities. Before joining Special Olympics, Fionnuala was very shy and did not participate in sport. Now she has many friends; loves playing football and has also gained a great sense of independence and has no problem in making her own arrangements around getting to training sessions. Fionnuala trains at Creagh Training Centre and as the games draw closer she is taking part in two-day monthly training based in Dublin. Fionnuala is also taking part in the Special Olympics Ireland Health Promotion Project, which was initiated in 2008 following the allocation of funding from the HSE and the Daughters of Charity Service. The aim of the four-year project is to develop a health promotion resource pack for people with intellectual disabilities, and was brought to fruition with the production of such a pack. “Following this diet is good and it’s not difficult to follow. I really have to watch what I’m eating especially around protein and carbohydrates, as they are very important,” said Fionnuala. The project is the culmination of months of research, contribution from athletes and coaches, along with collaboration with statutory and non-statutory health organisations including staff from HSE Health Promotion. Special Olympics Ireland is ensuring that the most pertinent health needs of people

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Fionnuala with Johanna Lahart, one of her coaches

with intellectual disability are met, whilst formatting the event in a way that is both accessible and interesting. The resource pack is made up of a Health Toolkit for coaches in Special Olympics Ireland clubs to use to promote health, along with an Athlete Pack of accessible resources for athletes and family members. While Fionnuala is really looking forward to travelling to Athens, meeting the other athletes and sampling the local foods, she is also nervous like any athlete would be when she thinks about what is facing her. “Football has built up my self-confidence. In one sense I’m looking forward to it (Athens) and in another sense I’m not. I’m nervous about how I will perform and worried about the heat out there.” Fionnuala adds, “It will be a big change being away for two weeks, but my sister has been very supportive and people will be there with me in spirit. We will have a few days to settle in and acclimatise

“I never mind giving up my weekends when it comes to the athletes involved. Everyone involved has an absolute ball from start to finish.” to the heat before the games start. The Special Olympics can do so much for you. Just to be able to represent your country is great and if we win a medal that will be all the better. My family, friends and coaches have been wonderful.” Fionnuala was one of 34 athletes who travelled to Poland as part of Team Ireland

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HealtH Matters 53

feature

special Olympian Fionnuala treacy is one of the team of 126 Irish athletes participating in the 2011 Games

“the special olympics can do so much for you. Just to be able to represent your country is great and if we win a medal that will be all the better. my family, friends and coaches have been wonderful.” to participate at the 2010 special Olympics european Games. Fionnuala won a fourth place ribbon in the women’s seven-aside football in Poland. among her many achievements with special Olympics, Fionnuala lists winning the National Plate Competition in 2009 and winning a gold medal at the 2010 special Olympic Ireland Games in limerick as particular highlights. However, being selected to represent Ireland at the 2011 special Olympics World Games is a huge honour and she is very proud and excited at the prospect of travelling to Greece. Johanna lahart, one of Fionnuala’s coaches, says the chance to participate in the sport has simply “opened up her life.” Johanna became involved in training women’s football six years ago as a Hse instructor. since 2009 she has been a coordinator for women’s football in Connaught. Christine Kelly and emma Finneran, also from the Creagh training Centre, will be participating in the five-a-side team. Johanna feels very strongly about the need to encourage females into team sports. In general, as women get older, fewer and fewer participate in team sports and this is a pity as there is a great sense of camaraderie to be gained. “the diet and exercise toolkit the athletes have been following is a huge help. It lists out what they should and shouldn’t eat, talks about sun safety and how vital water is,” explains Johanna. Fionnuala adds,

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“along with the training, I’m also learning about diet and how important that is along with all this training. But all of this has really helped to build up my selfconfidence.” Overall, team Ireland will participate in 12 sports – aquatics, athletics, badminton, bocce, bowling, equestrian, football, golf, artistic and rhythmic gymnastics, kayaking, and table tennis. three teams will compete in the football competitions – 11-a-side male, five-aside female and five-a-side male, and basketball will be represented by one male and one female team. the athletes will be supported by a team of 49 volunteer coaches and management team, as they prepare for the World summer Games. travelling with them is medical co-ordinator and team Ireland’s official physiotherapist eimear O’leary, who first became involved with special Olympics in 2005.

“there is a lot of behind the scenes involvement and work with the athletes on the build up to going away and while abroad. It’s all about educating everyone involved. there have been two residential weekends away for the athletes where they have learned about how to cope while out there,” explained eimear. she adds, “the biggest thing at the moment is teaching about the hydration due to the heat factor out in Greece as they will be competing in 30°C plus temperatures and using sun factor. It’s great to be involved with special Olympics and I get a lot out of it. Once the competitions start it can get very emotional”. eimear has already been to one special Olympics World Games in shanghai, China and commented: “It (work) pays off when medals and ribbons are won and awarded. I sneak a few tears. I never mind giving up my weekends when it comes to the athletes involved. everyone involved has an absolute ball from start to finish.”

07/06/2011 12:24:43

54 Health Matters

feature

Music Lifting the Spirits A music programme for older people in a residential setting in north Dublin, initiated by the Health Promotion Department, Dublin North East, has highlighted the power of music – and the benefit it can have on quality of life for older people, writes Jo O’Rourke, Senior Health Promotion Officer.

laremount Services, in Glasnevin, Dublin was the setting for a new therapy programme designed to improve the quality of life of residents. It was developed in conjunction with Tolka Area Partnership and Volunteering Ireland. From the very start, the project was fortunate with the calibre of the musicians - which included a classically-trained violinist and guitarist, and a singer/ guitarist, who volunteered to help develop and run the initiative. Fourteen residents took part in an eight-week programme. Many of the patients had dementia, and also used mobility aids such as walking frames. They were selected by staff in the residential home: the staff submitted a biography on each participant, guiding the musicians in the selection of musical projects. Each session lasted 90 minutes. The sessions were structured to encourage participants to get in touch with their own natural rhythm - for example, clapping their hands and foot tapping - or to use their voices through singing or humming as a form of expression. Participants were introduced to percussion instruments such as tambourines, bodhráns and triangles, which they responded to very well. The Director of Nursing in Claremont Services was open and enthusiastic towards exploring the effect of the programme on some of the residents, and agreed to run a pilot. Questionnaires and focus groups were carried out by the researchers with staff and participants. Weekly observations of participants were recorded, and video clips were also taken. Each week there was an obvious and tangible positive effect from the music session. Weekly feedback from staff indicated musical appreciation, stirred memories, camaraderie, improved

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Mary Ellen Gormley enjoying the music

communication and fun. Participants’ enjoyment was further enhanced when individuals’ personal music choices were facilitated. One example of the powerful affect of the programme was spontaneous dancing from a man who had lost his ability to express himself through voice as a result of a stroke. He had previously been a singer. His enjoyment of the music was so strong that he was moved to respond through movement, and encouraged others to join in. This programme was presented at a conference in November 2010, hosted by the Social Policy Aging Research Centre (SPARC) at Trinity College Dublin. The response was very positive from all delegates. Everyone agreed that it would be beneficial to have regular music sessions available for all residential settings. There are national standards that support the implementation of participatory interactive programmes for older people. For example, the National Quality Standards

for Residential Care Settings for Older People in Ireland (2009) promotes: • Active participation by older adults in meaningful activities • Community involvement in residential settings, and • Health promoting policies being in place in these settings. Also, under The European Pact for Mental Health and Well-Being (2008) (MHP) Section 1V (for older people), the recommendation is to “provide measures to promote mental health and well-being among older people receiving care (medical and/or social) in both community and institutional settings.” Both of these standards strengthen the case for more facilitated music sessions to be funded in the future. For more information contact Jo O’Rourke, Senior Health Promotion Officer at j.orourke@hse.ie or Mary Connolly, Development Coordinator for Older People, Tolka Area Partnership at mary.connolly@tap.ie.

07/06/2011 12:24:44

Health Matters 55

feature

Protecting Children:

A Community Responsibility Ensuring that social workers, other care professions and the legal profession are working together collaboratively is crucial if we are to put the best interests of the child at the core of what we do to achieve the best outcomes for children in Ireland, writes Gordon Jeyes, National Director, Children and Families with the HSE.

©istockphoto.com/cpaquin

n the run up to the constitutional referendum on the amendment recognising the rights of the child there needs to be a debate, within Ireland and within communities, that is centred on respect for children’s humanity. We need to focus on the need for collective responsibility and emphasise that the Constitution represents and sets boundaries to protect all citizens irrespective of age, gender or ethnicity. It takes a community to keep a child safe. An informed debate focusing on our responsibilities, our contribution, our society and our values should be welcomed. As part of this, we must recognise that it is not possible to create environments which are risk-free. Risk certainly cannot be removed by policy and statute. There is a need to balance personal, community and State responsibilities. A narrative has been developed wherein we are fearful for our own children and afraid of other children. The referendum gives us an opportunity for mature reflection, informed debate and discourse at every level of society within our communities. It is an opportunity to move on from the current narrative and is an important step in developing the next phase in our society. • How do we move? • From crisis intervention to early intervention? • From exclusion to support? • From dependency to mutual respect? There is a need to build on the three Rs of rights, responsibilities and respect to a clear, compelling story describing the ingredients of an Irish childhood. To pursue this, there is a need to reflect on the relationships among the personal,

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the private and public. Reductions in child poverty are painfully slow, especially in these demanding economic times. Children are growing up in communities that have collapsed and families that are broken. Some children in poverty are exposed to drug abuse, alcohol abuse and physical, emotional and sexual abuse. Miraculously, many of them survive. A great many of them are, however, deeply damaged, with a range of emotional and behavioural disorders. The response required involves collaboration across Children and Family Services, the education services and youth justice, as well as an understanding of the social protection system and the wider community.

“We need to focus on the need for collective responsibility and emphasise that the Constitution represents and sets boundaries to protect all citizens irrespective of age, gender or ethnicity.”

Supporting Children and Families Children, when consulted with respect,

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provide common sense and wisdom. To support children at risk, families need to be supported and challenged. To support children at risk, there is a need to continue to pursue an agenda that is both universal and holistic. The Children First guidelines need to become statutory guidance. But this alone will not progress the change needed. Our universal institutions such as schools, health centres and youth and community facilities need to be resourced and supported to be for all children, not merely those who attend, who are healthy and who are loved.

Child Protection and Community Engagement There is a need for a community development model to take these matters forward. The devil is in the detail, but it is also in the big picture. There is need for a model which doesn’t limit effectiveness to crisis interventions. Children and Family Services, as well as health and social care services, need to understand that their own effectiveness is dependent on the effectiveness of civil society as a whole: family, playgroups, community centres, youth clubs and schools. There is a need to develop practices and institutional structures to square up to that understanding. A

paradigm is required that acknowledges that services can only be effective if they engage their communities across boundaries - in other words, not child protection alone, but community engagement. It takes a whole community to keep a child safe and nurtured. In building broader alliances for children, social impact bonds should be explored whereby corporate and social responsibility

“Some children in poverty are exposed to drug abuse, alcohol abuse and physical, emotional and sexual abuse. Miraculously, many of them survive. A great many of them are, however, deeply damaged with a range of emotional and behavioural disorders.”

is invested in evidence-based early intervention, with a view to a social return on investment and a sustainable reduction in costs for the taxpayer. For example: restorative justice schemes funded by investment, producing better outcomes, reduced costs and a return to investors from savings.

HSE’s Change Programme The HSE has put in place a major change programme to ensure accountable, well organised, evidence-based social work. I am entirely confident in the front line staff of all professions in Children and Family Services. They will rise to the challenge and provide high quality crisis and early intervention services. To deliver these services to the highest standard they need: • The support and permission of the community • Well-defined local mechanisms for accountability to ensure focused, disciplined relationships among those promoting the welfare of children • High support to enable high challenge within clear lines of management accountability • Strategy and policy set out on a nationwide basis, and decisions and practice taken forward at the most local practical level

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The Government has decided that such is the extent of reform required, a fresh start is needed. A new agency will ensure that child welfare and protection are given the priority level of attention required. The work of this agency can only succeed with the co-operation of the relevant professions across departments, support services and communities. On an individual level, it is everyone’s responsibility to make it work. The work of the agency will depend on alliances and partnerships. The political commitment of the Government to children is very welcome, and the political capital created is valuable. The Government deserves the unconditional support of all of those working in the area of children and families if the vision for our children is to be realised.

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Major Change Programme in Children and Family Services Children and Family Services have commenced the planning and implementation of a major Change Programme and Seamus Woods, Programme Manager, National Projects Office, outlines the process.

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ome of the key challenges facing Children and Family Services are: • Requirements to ensure connectivity between the high-level strategy statements and work performed by front line staff • Delivery of services in a consistent manner • Prioritisation of key projects • Minimisation of confusion around the Change Programme • Management and control of the Change Programme, including key risk factors • Consistency of implementation across all local areas. A framework will support movement from strategic to operational, including a project management framework that will oversee implementation at local level in a consistent way. The project management methodology has four key components: • A strategy mapping process • A customised project management methodology (decision model) developed by the National Projects Office to deliver on change projects • Project management training for identified project managers • A web-based portfolio/project management system that will support management of agreed strategic themes right down to implementation at project level.

Strategy Maps This methodology is based on a ‘balanced scorecard’ strategy mapping process, which allows the visualisation of a strategy as a chain of cause and effect relationships. Seven key ‘change themes’ which will enable Children and Family Services to realise its mission and goals are: Quality and risk; Resource allocation; Policy/procedures/practice; Workforce

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development; Governance/partnership; Culture/voice of child; Key service enhancements.

Project Management Methodology The National Projects Office has also previously developed a roadmap for improving the level of project management maturity within Primary Care Services. Key elements of this included a ‘tool set’ (Decision Model) that emphasises the key tools and techniques required for change management projects, recognising the fact that many project managers have other ‘workloads’ to contend with. This has now been updated. The National Projects Office has commenced a training progamme that will support project management across the service. It will ensure that: • Project plans reflect accurately the strategic need and the intended outcomes and acceptance criteria for the project itself • A robust approach is taken to the

implementation phase to ensure consistent transitioning to the agreed ‘new way’ in all HSE areas. The roll out of the training will reflect the needs of the change programme. To date, 35 project managers have commenced introductory training, and this will be followed later in the year by more advanced certified training to support their developing needs. Portfolio/Project Management System The monitoring of such a large change programme is very important, and in that context the Programme Office has implemented a web-based portfolio/ project management system that will support the management of the programme from a high strategic level down to individual tasks at a project level. A full version of this article is available on the HSE's Intranet. Go to Care Groups Hub, select Children and Families, then click on Training and Learning.

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

Allergies

Histopathology

Autoimmunology

Microbiology

Biochemistry

Molecular Genetics

Coagulation

Parasitology

Cytogenetics

Serology

Cytology

Specimen Transportation

Endocrinology

Toxicology

Haematology

Virology

The Biomnis Group was formed over 100 years ago by Marcel Mérieux, a protégé of Louis Pasteur. Since then, it has grown to become one of Europe’s leading specialist medical laboratories, with 65 pathologists and over 1,000 specialist scientists and technologists, offering more than 2,500 tests across all disciplines.

Biomnis Ireland, Three Rock Road, Sandyford Business Estate, Sandyford, Dublin 18, Ireland. Tel: +353 1 295 8545

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Fax: +353 1 295 8550

Email: sales@biomnis.ie

Web: www.biomnis.ie

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CommerCIal feature

THe evoLviNg LaboraTory Lab methods and equipment never stand still – recent developments are evolutionary rather than revolutionary, but the opportunities are substantial, as experts tell Health Matters.

pend any time in a medical environment and you’ll soon come to realise that the laboratory is a hub of very high-technology activity. Digital technology is the cause, and the trend goes in one direction only. Colin Darby of Micron Optical is a passionate believer in the slide scanners his company provides: as sales Director with years of experience, he is in a perfect position to explain just how far slide scanning technology, for example, has come. “ten to 15 years ago, I remember trying to push telepathology in this country – it was a nice idea, but most consultants would prefer to see the tissue slides themselves, and this could have taken up to 2-3 days,” he says. In a busier climate, results are now looked for quicker. telepathology is a hot topic at the moment: scan a slide into digital format and it can be accessed by whoever needs to, wherever they may be. they can reach a reliable conclusion without even setting foot in the building. the potential savings are enormous. Other changes are afoot. “recent changes in the technology used for routine analysis in the blood sciences have been evolutionary rather than revolutionary,” explains Dr. Mike louw, the Consultant Pathologist/Medical Director at Biomnis Ireland. “the emphasis in routine testing has been on developing speed, volume capacity, robustness and automation rather than on new analytical methods. technologies, however, are rapidly being developed in the areas of molecular diagnostics. New genetic/nucleic acid tests are emerging in the areas of infectious disease, oncology and pharmacogenetics, with the burgeoning of so-called ‘personalised

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medicine’.” to Biomnis, which provides end-to-end management of pathology services to its clients, not only is the lab evolving – but what’s being demanded of the lab is changing too. Slide ScanninG slide scanners, software analysis and remote access are Micron Optical’s business. “speed is a huge factor,” says Darby. “the technology is already there, by and large – consultants all have PCs. all they need is the software to log on and have a look at the different slides. they can get consultants in a variety of locations to sign off on it, and it’s done. You currently have consultants who go between two or three different hospitals – now they can log on remotely without having to get into their car just to view slides.” the lab technician scans in the full medical slide, which goes onto a local or a network drive, and access is granted to

the local or remote consultants. they can view the whole tissue area and then zoom in to look around the sample and focus on growth specimens and other details – all forms of slide tissue work can benefit from this. the technology also enables many more consultants to examine samples and share their expertise than was previously the case. another huge benefit of scanned slides is the space and resources that are saved. “Hospitals bank slides after they’re taken from the patient, and they’re kept in storage,” says Darby. “they are taking up ridiculous space that they don’t need to. they have to be kept for legal reasons to cover themselves, but this space could be better utilised. the trouble is that slides fade over time: when a patient comes back in 10 years time, for whatever reason, if the slide can be found they will have deteriorated and it will no longer be an exact snapshot of what happened.

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is about to g e n i c i d e et ra m e l dica Te . . . l . t . c a in Ireland. So c h the new . . . . . . . .. tech nolo gy wave! • Highest resolution medical slide scanners in the world! • Fastest slide scanner in the world with Scan 250 Flash! • Brightfield and Fluorescence in one machine • Virtual slides for telemedicine and teaching • Increase patient turnaround, improve quality of care • Cost savings for laboratories • No waste on travel times and commutes! • Remote diagnosis and remote teleconsultation • Diagnosis with image analysis • Micron Optical are Ireland’s ONLY digital slide specialists and creators of Ireland’s ICQC • Contact us to see the future, today!

email: info@micronoptical.com web: micronoptical.com tel : 053-9138711

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“That doesn’t happen when you’ve scanned your slide: you still keep your physical slide somewhere else if you need to by law.” An immuno-stained slide with fluorescence will fade and completely vanish within days, weeks or months, depending on what the sample is, in which case they’re gone forever. It also allows important cases to be logged: Darby has seen many instances where doctors from outside Ireland recognise unusual cases from their own experience, whereas Irish doctors will not have encountered them before. Now they can catalogue unusual cases, and in this way the technology has an educational aspect. Image analysis software is also a growth area: the use of software to aid the technician or consultant in working with a slide. “With image analysis, you can get quantitative data from a slide. You can select regions of interest and get area measurements, percentages of one measure versus another. It’s also useful for doing breast cancer: the ER and PR, and get your HER-2 scoring. That can be done with the software, and so the consultant will know what treatment to prescribe.”

Meeting an evolving demand To Dr Mike Louw of Biomnis Ireland, the laboratory must pay attention to what patients, and the wider healthcare climate, are demanding of it – as emphasised at the 2011 IFCC WorldLab-EuroMedLab conference in Berlin, which discussed the need for laboratory services to be consolidated into larger, automated laboratories with samples being transported from outlying areas to these centralised facilities. “At the same time, increased access to information (such as via the internet) has led to increased demand from patients for more information, and for more direct contact with laboratory physicians and scientists,” he says. “A much more patient-centred approach to laboratory medicine is needed. People are no longer satisfied with having to travel long distances and enduring long waiting times to have their samples taken for analysis.” Indeed, all these challenges are felt in Ireland, and to a particularly strong degree.

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To Louw and Biomnis, while there are very exciting developments ahead in diagnostic technologies, much emphasis will have to be placed on the rather more prosaic areas of sample transport, logistics and tracking, and the rapid delivery of laboratory results to clinicians and their patients. Context is key. “Community-based phlebotomy facilities will have to be established, and efficient and reliable transport networks put in place to transport samples to the centralised large laboratories. With modern instrumentation and laboratory accreditation, accurate test results are now largely a given. By far the majority of laboratory errors are caused by preanalytical factors such as sample misidentification and transport delay. Rapid and reliable information technology systems will have to be available to link the laboratories with distant clinicians, and a central result data repository is needed so that a patient’s health records are accessible to all clinicians involved in his or her care.

“A much more patientcentred approach to laboratory medicine is needed. People are no longer satisfied with having to travel long distances and enduring long waiting times to have their samples taken for analysis.” “Improved patient outcomes and satisfaction will increasingly depend on improved pre and post-analytical services rather than on breakthroughs in testing methods. Just as much of the increase in life expectancy in the 20th century was due to

civil engineering and vaccination rather than to high-tech medicine, much of laboratory medicine’s contribution to improvement in patient outcomes will be due to improved logistics, sample management and test result delivery,” he says. Together with their colleagues in France, the company provides a comprehensive range of over 2,500 analyses and a fleet of temperature-controlled vehicles to provide secure and reliable logistics. It has extensive IT connections to its clients via LIS-LIS and web-based results access, completing the ‘diagnostic supply chain’. As part of a commitment to investment in Irish pathology, Louw says that the company has initiated a process of ‘test repatriation’, in which it is setting up a wide range of tests in its Dublin laboratory - tests which were previously performed by Biomnis France. “We are doing this not only in keeping with the need to bring pathology testing closer to Irish patients and improve turnaround times, but also to foster local laboratory expertise and employment. Phase 1 of the repatriation process is now complete. “We have brought some 50 tests to Dublin, in the areas of allergy testing, autoimmunity, vitamin D, hormones and infectious disease serology. Phase 2, due to be completed this year, will entail setting up PCR testing for several gene mutations (such as haemochromatosis, Factor 5 Leiden) and infections (such as Chlamydia Trachomatis and C. difficile).”

Aiding patients and staff alike “I’ve been dealing with these machines for the past 10-15 years, and the quality has now become so good that consultants can now have confidence to stand over doing a diagnosis on them. A long time ago I would have said no,” says Colin Darby. “Computers and software are there not as a tool to replace humans, and they’re certainly not infallible, but they’re there to help you narrow down a search and get some of the information. By doing so, the process is sped up.” As both the laboratory and its context continue to evolve, technology will remain at the forefront.

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Speed and Reliability at Quest Diagnostics Q

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uest Diagnostics is no stranger to those working in the Irish health service. They’re most familiar with the system from having processed so many cervical smear tests since winning the National Cancer Screening Service contract in 2008 – the company estimates that 500,000 such tests for Irish patients have passed through their labs. Quest Diagnostics’ involvement in Ireland began in 2006, when the HSE engaged the company to clear a backlog of pap smears. “Cervical cancer is a terrible disease that often strikes when a woman is in the prime of her life,” said Ronald Kennedy, M.D.—the company’s Director of National Quality Assurance for Anatomic Pathology—in 2008. “Our goal for this historic cytologyscreening program is to ensure that Irish women experience the highest quality of testing and service excellence, with the goal of minimising the incidence of cervical cancer. Our commitment to women’s health, along with our industry leading quality-assurance practices, makes us imminently qualified to deliver the superior testing services that Irish women deserve,” added Dr Kennedy. There’s more to Quest Diagnostics than just the tried-and-trusted smeartest processing, though: the company offers 3,000 additional tests, with expert experience and a broad range of services very much to the fore. As the company itself explains: “Sometimes cases are difficult because they’re rare, meaning a pathologist, throughout his or her entire career, may have seen a particular tumor type only a handful of times – or never. To advance the knowledge of our cytology team, we conduct daily conferences using multi-view microscopes, and our volume and depth of experience make it likely that one or more of our pathologists has had experience with the rare tumor under discussion. For the

patient and for their doctor, this experience can make an all-important difference.” The company emphasises that peace of mind is a vital part of its service to patients, and so it aims to deliver results as quickly as it can, without jeopardising the reliability of test results. The long wait for important test results can be the most worrying time in a patient’s experience with healthcare providers. As such, its freefone results hotline for physicians is an innovative and fuss-free way of alleviating the trepidation of waiting for one’s results. The scope of Quest Diagnostics’ laboratory operations is one reason why the company can offer the service it does. It draws on favourable economies of scale, such as the approximately 43,000 staff it employs, including around 900 MDs and PhDs. The result? Approximately 148 million tests performed annually, and with no compromise on quality. Though it has extensive Irish operations, Quest Diagnostics’ main operations are in the United States. The company is headquartered in New Jersey and was founded in 1967. Its labs are accredited by the College of American Pathologists (CAP) and have implemented Six Sigma quality improvement programs. It has taken

up residence on Fortune magazine’s list of America’s most admired companies for the past four years. The company is a leader in test development, alongside its day-to-day laboratory testing services. This research is undertaken at the Quest Diagnostics Nichols Institute, the company’s centre of excellence where they develop new laboratory tests and perform highly complex, specialised tests rarely undertaken in the more conventional hospital or lab setting. Back at home, Quest Diagnostics is also familiar as sponsors of the HSE Achievement Awards, which celebrate outstanding work across the health sector. “The shortlist of nominations for awards demonstrates the outstanding level of innovation, progressive thinking and commitment to improving the service to patients and their families throughout Ireland,” the company said of last year’s event. “The breadth and depth of the projects mirrors the manner in which Quest Diagnostics worldwide strive to improve systems and delivery to our patients.” A firm fixture of Ireland’s healthcare scene for the past five years, Quest Diagnostics looks set to remain a key player in medical testing.

07/06/2011 12:25:03

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Combatting Clotting with

NaNoTeCHNoLogy i joined the National Sr/Spr academic fellowship Programme in 2009 and have enjoyed two very rewarding and productive years researching the use of nanomedicine to fight blood clotting, writes Dr Alan Gaffney.

ecause the emphasis of the programme is on integrating research and clinical practice, I have been able to continue higher training in anaesthesia, intensive care and pain medicine, while working towards a PhD in Pharmacology. Practicing clinician-researchers are ideally placed to identify and focus on areas of research that are most likely to result in a practical and tangible benefit for their patients. this â&#x20AC;&#x153;bench to bedsideâ&#x20AC;? - also known as translational research - approach requires significant additional training of clinicians. I believe that this fellowship programme provides such training, and is the ideal preparation for doctors committed to a career in research in Ireland. I am especially interested in intensive care medicine and cardiothoracic anaesthesia.

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as an anaesthetist, I am trained to look after patients who require the support of extracorporeal circulation technologies. extracorporeal circulation is where blood is circulated outside of the body and includes, for example, the heart-lung machine used during heart surgery, extracorporeal life support used in the intensive care unit and dialysis machines used for kidney failure.

a particular problem with extracorporeal circulation is that contact of blood with the surface of the tubing used to pipe blood around these machines causes blood within the tubes to clot. In order to stop the blood within the tubing clotting, it must be thinned out using anti-clotting drugs. the problem with anti-clotting drugs is that they can cause bleeding.

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Without them, however, clots can block the tubing or float back into the patient’s own circulation, causing blockages there. There is a fine balance between prevention of clotting and bleeding when using extracorporeal circulation. This is a very real problem for our patients. If we had tubing that prevented clotting and didn’t require us to give anti-clotting drugs, then patients would suffer from far fewer serious complications than they currently do. I am conducting laboratory research into this area under the supervision of Professor Marek Radomski of the School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, a professor of pharmacology and an expert in platelets and clotting. Platelets are the most important blood components that start the clotting process. They become activated when they come in contact with the tubing of extracorporeal circulation machines. Various drugs have been given to patients to prevent platelets becoming activated however, most have to be injected directly into the bloodstream. This means that all platelets in the body are affected and prevented from being activated, not just those in contact with the tubing, and so the risk of bleeding increases. If these drugs could be delivered only to those platelets that actually come into contact with the tubing, then clots could be prevented from forming at the wall of the tube. The rest of the patient’s platelets would remain unaffected and available to prevent bleeding if necessary. Nanomedicine (using nanoparticles which are less than one billionth of a metre in size as biological tools) is one of the most exciting new areas in medicine. Non-stick surfaces and molecules to deliver drugs directly to specific sites in the body have been developed using nanotechnology. Trinity College Dublin has an internationally recognised institute dedicated to nanotechnology, the Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN). In collaboration with Professor Yurii Gun’ko of CRANN, we have developed

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PhD Fellowships Awarded

he HSE and the Health Research Board have awarded the third round of fellowships under the National SpR/ SR Academic Fellowship Programme. This programme, which was jointly established by the HSE and HRB in 2009, awards scholarships to doctors at higher specialist training level to undertake integrated specialist training and research. This integration of clinical care and research ensures a greater emphasis on evidence-based patient care. Previously, doctors wishing to undertake research had to pause their training in order to complete PhD studies. Three doctors have been recommended for the award in 2011: Dr Siobhan Glavey Dr Andrew Smyth Dr Carol Sinnott There are six doctors currently on the programme: • Dr Clíona Ní Cheallaigh, Infectious Diseases • Dr Cathal Moran, Orthopaedic Surgery • Dr Conall Dennedy, Endocrinology • Dr Alan Gaffney, Anaesthesia • Dr Bairbre McNicholas, Nephrology • Dr Stephen Frohlich, Anaesthesia Details of their project areas are

a new tubing surface coated with nanoparticles. These nanoparticles have anti-clotting drugs attached, which may be delivered to any platelets that interact with the tubing surface. We hypothesise that such a surface could lead to less clot formation, less need for anti-clotting drugs and fewer complications for patients. Although most of my work takes place in TCD, I have been fortunate in being able to avail of a travel bursary provided by the fellowship programme to work in a laboratory abroad. Last summer I spent three months working in the Extracorporeal Life Support Laboratory of Dr Robert Bartlett and Dr Gail Annich

available from the MET Hub on www.hseland.ie. All applications are subject to an international peer review process. Successful applicants prepare an individualised training plan, which is flexible to allow varying commitments to clinical services and research throughout the duration of the programme. Fellows on the programme undertake their research project in an approved academic institution and train in clinical posts in appropriate training locations. The programme is jointly funded by the HSE and HRB, and fellows receive their salary for the duration as well as approved research costs through the HRB. The programme, which was developed in collaboration with the postgraduate medical training bodies and the academic medical departments, arose from a recommendation in the Report of the Postgraduate Medical Education and Training Group (2006), and addresses the Department of Health and Children recommendation for the development of postgraduate research training pathways, as set out in the Action Plan for Health Research 2009-13.

in the University of Michigan, Ann Arbor. This experience was not only immensely educational, exciting and fruitful but has also lead to ongoing collaboration between our laboratories. As I enter the second half of this programme, I appreciate enormously the opportunity afforded me to train as a clinician-scientist with the ultimate goal of enhancing patient care in Ireland.

Dr Alan Gaffney was awarded the National SpR/SR Academic Fellowship in its in augural year, 2009. He is currently undertaking clinical training at the Mater Hospital in Dublin and research at Trinity College Dublin.

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Tough Guy Gareth Makes Triathlons Look Easy Gareth Presch, who works as the Chief Officer of the National Haemophilia Council based in Dr Steevens’ Hospital in Dublin, is a fitness fanatic who likes to test his strength against opponents in ironman and adventure competitions whenever he gets the opportunity.

n recent years Gareth, from Ballinteer in Dublin, has been a competitor in rugged sporting events including Tough Guy UK (twice), and Ironman UK. He has also completed ironman events in France and Austria. Many of these are done for various charities. Since it began as a challenge between a group of American navy seals, the ironman has grown to become one of the most recognised endurance events in the world. Originally a combination of the Waikiki rough water swim, the Around Oahu bike race and the Honolulu marathon, the ironman consists of a 2.4 mile swim, a 112-mile bike ride and a 26.2 mile run. “The ironman events are the ultimate challenge for me,” says Gareth. “It‘s more about mental strength and that humans will not give up.” Always keen to test himself against the most dedicated of athletes, Gareth has also run the Connemara ultra marathon - which is a 40-mile race – the Wicklow 200 cycle, three Dublin marathons and various other triathlons in Ireland. Presch, who loves competing, cycles the 24km journey every day from his home to work in Dr Steevens‘ Hospital. This year, he and his friend Alan McGovern, a Garda, competed in the Fisherman‘s Friend StrongMan Run at Nurburgring in Germany. This involved them testing their strength on a 20km obstacle course unlike any other, where they had to scale buildings, slide off roofs and wade through mud swamps and freezing waters. More than 11,000 participants competed. He will also compete in a similar event called Turfguy in Ireland later this year. Explaining what motivates him, Gareth

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+ Gareth has run the Connemara Ultra Marathon (a 40 mile race), the Wicklow 200 cycle, three Dublin marathons, and various other triathlons in Ireland

says that “these events, for me, are just about being able to finish.” He doesn‘t intend to take it easy now that he has completed the daunting StrongMan Run: instead, he’s planning to continue pushing mind and body to the limit. His most recent event was the Connemara adventure race, part of the Gaelforce events which are becoming the must-do occasions for adventure-seekers in Ireland. “I really enjoyed the event because I was competing with my friend we finished together even though he was injured from the off,” he says. “Competing with friends makes the experience for me. My next event is the Gaelforce North, with my main event being the Gaelforce West event in August which I‘m doing on behalf of the Tania McCabe Foundation.” In 2013, he wants to compete in an event known as the toughest footrace on earth: the Marathon de Sables in the Sahara

desert in Morocco, and ultimately he would like to climb Mount Everest. You can follow Gareth‘s Gaelforce progress on www.gaelforce.com, where you will find his blog.

“He doesn‘t intend to take it easy now that he has completed the daunting StrongMan Run: instead, he’s planning to continue pushing mind and body to the limit.”

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Mental Health Garden wins Bronze Medal at Bloom Festival Eve Plantmarket, a HSE service for people who have experience of mental health difficulties in their lives, exhibited a special garden project and won a Bronze Medal at the Bloom Festival in Dublin’s Phoenix Park in early June.

he special exhibit won a Bronze Medal in the engaging space category. Gary Graham, an organiser with the festival, said it was an outstanding achievement for a first time entry to win a medal. The garden design focused on mental health recovery and was on display and open to the public to view for the duration of the festival. Margaret Webb, General Manager of Eve Services said: “We were delighted to be able to showcase the work of our trainees at Bloom 2011. The garden was developed by and for the trainees and was wholly representative of their vision. We know that the visitors to our garden enjoyed a unique opportunity to reflect on the organic nature of wellbeing and came away with a more positive and hopeful perspective on mental health.”

“Finding ways to overcome stigma and promote understanding is one of the most important ways to promote recovery for people who experience mental health difficulties.” The Bloom event showcased the best of Ireland’s horticulture and food industry. This year saw a record 27 spectacular showgardens and Bloom’s first international garden from China. For many who battle with mental illness the voyage to recovery and wellness can

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+ Senator David Norris, Minister for the Environment, Community and Local Government Phil Hogan TD and RTÉ broadcaster Brent Pope at the launch of the HSE Eve Plantmarket garden in Dublin’s Phoenix Park before the start of the Bloom festival

be all about opening up to how one feels. The HSE Eve Plantmarket garden entitled ‘Thermae Salute – Wellness Recovery’ was built in collaboration with FAS. EVE Plantmarket is located in Blakes Cross, Co Dublin and they provide amenity horticulture training courses, FETAC levels 3-5, for people who have experiences of mental health difficulties in their lives. Eve trainees who worked on the garden project wanted to raise public awareness about recovery from mental illness by creating an engaging visual display for Bloom visitors. The exhibit was designed to illustrate the journey to recovery and show that mental health difficulties are a part of everyday life. The garden depicted the journey to recovery from mental health difficulties using a sailing metaphor to reflect the “voyage”. Following the voyage of ‘OPTIMIST’ sailing boats through the garden visitors could follow the calm waters of wellness, into the choppy seas of distress, sometimes floundering, being adrift but with support visualising the path to recovery and achieving wellness again.

Bramble and nettle rushes were used as reflect chaos. Hostas, ornamental grasses, ferns and ground cover plants were used to visually represent transition to recovery while herbaceous perennials and summer bedding were used to reflect joy and wellness. Martin Rogan, HSE Assistant National Director for Mental Health said: “Finding ways to overcome stigma and promote understanding is one of the most important ways to promote recovery for people who experience mental health difficulties. I would like to commend the trainees and the managers of Eve Plantmarket for taking this novel approach to overcome stigma and ultimately bring the very important message that recovery is possible’ and is happening.” ‘This garden is a very positive example of what we are working to achieve in the implementation of Vision for Change, Ireland’s mental health policy. It puts the focus on placing the client’s recovery journey at the centre of all service efforts and this garden provides an excellent example of how the recovery journey can be practically demonstrated in a positive manner.”

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feature

Making a difference working in nepal In 2009, I decided to accept a four-month contract to work in a primary health care facility in a very remote mountainous area in west Nepal as the terms of reference were appealing, writes Catherine Tunney.

+ Catherine, pictured on the left, worked on a pilot programme to reduce childhood mortality and morbidity rates by identifying and managing acute malnutrition at an early stage

thought that coming from a community perspective - public health nursing - it would be interesting to work in a primary health care facility in Nepal and compare both systems. The idea of living in the country for a considerable length of time also appealed to me. My first impression of the Nepalase people was how difficult their lives were compared to ours. Infrastructure was quite delayed. There was a road into the administrative town where I lived, but it was a fair weather road. It was the rainy season when I arrived, and so the road was impassable. I had to walk hours to get to my base, and I walked everywhere for

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the period of time I was there. The variety of food and essential items available depended on whether or not they could be transported in. Items were more expensive in the rainy season, and outside the reach of many who live on less than a dollar a day. It was a common and acceptable experience to be without electricity for hours every day, and it was a bonus to be able to make a cup of tea in the morning. I was lucky because I had access to cold water in the house where I rented a room. Most people had to go to the local pump or water protected area. To compensate for any shortcomings, my room was situated on a third floor with fantastic

views of the surrounding mountains, trees, flowers and birds. I was amazed at how hard people worked, particularly women and children. It was commonplace to see women and children carrying heavy loads on their backs while climbing the mountains where they lived. Women were the main carers in the home and after working on the land, they went home to start their home duties. Unemployment was high, and many of the men had to travel to India for work, leaving the women to look after the land and the home for long periods of time.

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feature

The national dish was dal bhat, a lentil and rice-based dish. It was very healthy, and it varied depending on the vegetables available. I ate the same food for lunch and dinner ever day for four months (I really enjoyed my first steak when I arrived home!). The language barrier was a daily battle. The management team and the senior health workers had a good commend of English, and I had a translator. However, I missed the daily opportunities to communicate with mothers and children myself, as details get lost in translation.

Acute malnutrition A national survey estimated that almost 90,000 children in Nepal suffer from severe acute malnutrition at any one time. The Ministry of Health decided to implement a Community Based Management of Acute Malnutrition (CMAM) pilot programme through UNICEF and Concern in three districts equivalent to our counties - in Nepal. The main aim of the programme was the early identification and management of acute malnutrition, thereby reducing childhood mortality and morbidity rates. The programme linked into an already established and successful Ministry of Health community-based Integrated Management of Childhood Illness programme (IMCI). It involved introducing specific measurement tools for health workers to access for signs and symptoms of acute malnutrition and an intensive care pathway. The objectives of the project placed emphasis on capacity-building and strengthening the local health system rather than setting up a new parallel system, and it involved a ‘train the trainer’ approach which cascaded knowledge and skills down from the District Health Officer level to female child health volunteers at village level. Preparatory work was done before I arrived, including consultation at national Ministry of Health level and the development of training manuals in Nepali. At local level, there was agreement amongst health workers and managers to participate in the pilot programme. Concern was the lead agency implementing the CMAM programme in two districts. I was responsible for implementing the programme at local level in one district with a population of 160,000 people.

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A Nepalese family at a local health centre: a survey showed that almost 90,000 children in Nepal suffer from severe acute malnutrition

At the beginning, I felt overwhelmed and nervous, and I wondered if I would be able to meet the objectives set down in my contract. I received orientation from Concern prior to travelling and on arrival in Nepal. It was a challenge, however, to orientate quickly to a new environment and high altitude. As Concern’s main office was situated in Kathmandu, 30 hours’ travel away from my workplace, ongoing communication to my line manager, IT and other support was carried out by phone and email. However, the pilot programme was implemented and we did meet the timeframe. I believe that the success of the programme was due to the local management team and the health workers who took ownership of the programme from the beginning. This programme has now been extended to other districts of Nepal. It was a challenging working and living experience made easier by the cooperation and assistance I received from my Nepalase colleagues. The community and acute services were integrated, and I believe the Irish health service could learn from the Nepalese system. Catherine Tunney RSCN, RGN, RM, RPHN, M.Sc Community Health is a Pre-School Services Officer based in Meath.

HSE Global Health Support Programme In June 2010, the HSE signed a memorandum of understanding (MOU) with Irish Aid, the Government aid programme, and the HSE Global Health Support Programme was launched. The programme is situated in the HR Directorate, and is building on many initiatives already undertaken by health staff. These range from institutional partnerships with hospitals overseas, to individuals such as Catherine Tunney who - as outlined on these pages - go overseas for development projects. The HSE Global Health Support Programme is being implemented under the direction of a steering group which includes representatives from the Department of Health and Children, Irish Aid, NGOs and third level institutions. The programme aims to make an effective contribution towards improving health in developing countries. The steering group is currently looking at the development of objective criteria for working overseas, for working with institutions in developing countries, and for providing material assistance in emergencies.

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CommerCIal profIle BETTER information. BETTER workﬂow. BETTER patient care. did you knoW that mckeSSon iS the larGeSt healthcare ServiceS company WorldWide? For 178 years, it has been driving innovation in healthcare at every point of care. With a significant healthcare presence today, 52 per cent of the Us hospitals use two or more McKesson solutions, and 82 per cent of Hospital and Health Network’s (H&HN) Most Wired list are McKesson It customers. In the UK, McKesson has a proven 20-year track record of success in developing healthcare information systems. Implemented by McKesson, the NHs electronic staff record (esr), the world’s largest integrated Hr and payroll system, successfully continues to manage salary payments of 7 per cent of the working population in england and Wales, which is approximately 1.4 million NHs employees. mckeSSon iS noW eStabliShed in ireland In partnership with the Hse, McKesson will provide medical imaging technology across Ireland and create the benchmark standard for other health economies. NIMIs will enable Ireland’s health professionals to share patient imaging data, reduce the loss of medical images and ensure that patient information is readily available at every stage of a patient’s journey. Globally, McKesson touches the lives of over 100 million people every day and does so through a comprehensive array of technology solutions and services that streamline processes, reduces costs and allows more time for patient care, some of which include: nhS electronic Staff record (eSr) esr is a complete workforce management solution, with many more benefits such as a self-service facility, a complete training and competencies record, as well as the ability to transfer the employment histories of the 20,000 staff that move within the NHs every year, with ease and minimum disruption. this system is central to the NHs workforce strategy and has already delivered in excess of s240m in cash and non-cash releasing benefits since 2008 (as evidenced

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neXt Generation epr/paS earlier in May, McKesson announced that it has successfully completed its acquisition of UK Company system C, a specialist provider of software and services to the health and social care markets. this now provides McKesson with a next generation ePr/ Pas (electronic Patient record and Patient administration system) to meet the growing demands of healthcare organisations in the UK and Ireland. truSted, reliable and proven McKesson Corporation, currently ranked 15th on the Fortune 500 list, is a trusted global healthcare services and information technology company dedicated to making the business of healthcare run better. It currently employs 1,200 dedicated professionals in Ireland, UK, France and the Netherlands. Contact alan ryan, our health solutions executive, to see why thousands of healthcare organisations like yours have put their trust in McKesson. Email: alan.ryan@mckesson.ie or call: +353 86 020 4182 / www.mckesson.com

07/06/2011 12:25:18

Health Matters 71

Dublin north east// News

New Sensory Gardens for St Oliver Plunkett Hospital Two new sensory gardens at St Oliver Plunkett Hospital in Dundalk were officially opened in April. The project, which was managed by the Friends of St Oliver’s Forum, involved turning an unused piece of land into two beautiful garden areas. The gardens have easy access and a rubber tiling surface which provides for the safety of residents who are at risk of falling. There are raised garden beds for easy viewing from wheelchairs and + Frank O’Brien, Chairperson, Dundalk People’s Information and Training Centre, who secured a grant for those who are confined to bed, pergonas and shaded areas to ensure of s10,000 from the Civil Service Charity Fund towards the development, is pictured cutting the ribbon at the protection from the sun and wind, official opening solar-powered water features, brightly coloured flowers, and a variety of plants that provide sensory stimulation throughout the four seasons of the year. Kay O’Keeffe, Director of Nursing said that “the gardens improve the quality of life for residents as well as provide a place of beauty and peace where families and residents can spend time together. Many of our residents suffer from Parkinson’s, Alzheimer’s disease or the effects of strokes or arthritis. As mental functions decline with many of these conditions, people operate more on a sensory level. Positive sensory stimulation in the form of smell, touch, colour, sound of garden insects and birds or the wind chimes is of enormous therapeutic value to these residents.”

Certificate in Diabetes Nursing A group of 33 nurses recently completed a Higher Education and Training Awards Council (HETAC) accredited Certificate in Diabetes Nursing. The five-day standalone module was delivered by the Regional Centre for Nursing and Midwifery Education at Connolly Hospital, Blanchardstown. The centre was recently recognised by HETAC as a certified provider of educational programmes. The Certificate in Diabetes Nursing is equivalent to a HETAC level 8 qualification, and is the first of such modules to be delivered nationally. It was designed to support nurses working in a variety of care settings as they face the major challenges posed by diabetes mellitus, a chronic disease. Siobhan Beatty, Registered General Nurse at the Community Intervention Team in Rathmines in Dublin explained. “I was interested in attending this module as I work in the community and I regularly care for people who have diabetes. Attending the module has enhanced my knowledge of diabetes and has provided me with a better understanding of the up-to-date treatment options for people with diabetes. In particular I am more confident about my ability to educate these people about their disease.” The module was co-ordinated by nurse tutor James Lynch and was delivered by diabetes experts including clinical nurse specialists Margaret Corbett and Eithne Kavanagh, staff nurse Bernadette Goodwin and senior dietician Olive Tully.

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Alcohol Misuse Prevention Training Delivered to Navan Miners

+ Dr Sandra Okome, Alcohol Misuse Prevention Officer is pictured delivering the programme to Tara Mines employees

The Health Promotion Department in Dublin North East, in conjunction with Tara Mines in Navan, has engaged in a unique training programme with employees in order to highlight the myriad of issues around alcohol consumption. Tara Mines is the largest underground lead and zinc mine in Europe, with a workforce of over 680 employees. Given the nature of their work and the environment in which they operate, the company has a particular concern regarding the effects of alcohol, and in this context approached the Health Promotion Department. Following discussions with the company, a structured programme was agreed, with five key objectives: to highlight the company’s intoxicants policy and its obligations around relevant legislation, to provide information on low risk drinking guidelines, describe how to keep track of your drinking to ensure you don’t develop problems, explain how and where to get help, and to provide information on the size of the problem in Ireland. An intensive programme was delivered, with all employees trained in 16 separate interactive lectures. Dr Sandra Okome, Alcohol Misuse Prevention Officer and Programme Co-ordinator, said, “We don’t normally work in this way. However, given the specific needs of this company and the potential issues in its particular working environment we felt it necessary to take this approach. The course evaluation feedback was very positive, and participants also showed an interest in learning about other factors which determine health - such as nutrition and physical activity.”

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72 Health Matters

News // Dublin north east Yellow Flag for Health Promoting Schools St Aidan’s and Cnoc an Teampaill National Schools in Cavan were both recently presented with the Health Promoting Schools Yellow Flag. The Yellow Flag is presented to schools by the Health Promotion Department in the north east as an acknowledgement of their completion of the Health Promoting Schools Programme. The initiative is offered to all schools across the north east, and approximately 150 schools are involved in the programme to date. Health Promotion staff provide training for the schools’ staff in health promotion concepts and principles, and work with the Health Promoting Schools Committee set up to oversee the development of the programme to address areas such as the development of healthy eating and substance use policies, oral health training and physical activity action plans. Dr Nazih Eldin, Head of Health Promotion, HSE Dublin North East said that “our ultimate aim and vision is to have every school across the north east ‘flying the flag’. “Schools can achieve this by working with staff from our Health Promotion Department who will provide training, support and encouragement to enable teachers and staff members to embrace the Health Promoting School concept and to make it an implicit component of school policy and culture.”

Dundalk Receives Stroke Awareness Messages Staff from the Stroke Rehabilitation Team and the Health Promotion Department of the Louth Hospital Group hosted an information event in the Marshes + Rose Byrne, Health Promotion Manager; Iara Faria, Senior Occupational Therapist; Shopping Colette Viaz, Clinical Nurse Manager; Jane Shields, Smoking Cessation Nurse Specialist; Centre in Shay Englishby, Physiotherapy Manager and Robbie Callan, Health Care Assistant Dundalk pictured at the information event recently. The event was held to inform members of the public of what they can do to prevent having a stroke, the importance of early detection, and what to do if you suspect someone has had a stroke. The Irish Heart Foundation’s F.A.S.T. campaign was highlighted at the event. Stroke Rehabilitation Team members spoke to people about the services provided in the Louth Hospital Group, and Health Promotion staff provided information on how to give up smoking and what services are available to help people. They also gave advice on healthy eating, physical activity, alcohol awareness and what you should know about your blood pressure. The event was very well attended, and approximately 500 information leaflets on risk factors for stroke were distributed. A Smoking Cessation Nurse Specialist for Louth hospitals carried out carbon monoxide monitoring on smokers. The event was held to coincide with Ireland’s first Stroke Awareness Week.

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+ Joan Crawford, Senior Health Promotion Officer (second from left) with Gerry Roddy, Health Promotion Manager, HSE Dublin North East (far right) pictured with Cnoc an Teampaill Health Promoting Schools Committee members at a Yellow Flag raising ceremony

Navan service celebrates orthopaedic milestone The elective orthopaedic service at Our Lady’s Hospital, Navan recently celebrated the completion of more than 10,000 orthopaedic procedures since 2006. An event was held in the Regional Orthopaedic Unit to celebrate the significant work carried out to date, and a presentation was made to the staff of the Theatre Sterile Services Unit (TSSU) to acknowledge their contribution to the work of the unit. Paul Harrington, Clinical Lead, said that “the service has made a significant difference to the lives of so many patients and their families in the region and is attributable to the many dedicated staff of all the various disciplines involved in the delivery of this service.” The orthopaedic service for Dublin North East provides both a trauma and an elective service which is delivered by seven consultant orthopaedic surgeons, consultant anaesthetists, dedicated nursing teams, allied health professionals and support services. Our Lady’s Hospital in Navan provides a dedicated elective service, and the trauma service is based at Our Lady of Lourdes Hospital, Drogheda.

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Dublin north east // News Community Response Team host Public Information Event The Louth-based Community Response Team (CRT) hosted an Information Event in Our Lady of Lourdes Hospital, Drogheda to provide information and answer any questions about the service they provide for clients, their families and members of the general public. The CRT is a multi-disciplinary professional team whose main focus is the avoidance of unnecessary hospital admissions and + Some of the Louth Community Response Team members are pictured above. Back row (L-R): Michelle Boyle, Lourda to also facilitate the early discharge of suitable clients from Our Lady of Lourdes McBride, Emma Ross, Susie Callan, Catherine Kane, Frances Marron and Mary Carrie. Front row (L-R): Mary Hospital. The CRT acts as a bridge Markey, Patricia Mcgeeney, Sarah McGinty and Kate Calvey. between hospital and primary care services and provides a rapid and integrated response to clients in their own homes, helping them to regain as much independence as possible following acute illnesses. The CRT is comprised of one coordinator, seven community nurses, two physiotherapists, two occupational therapists and one clerical officer, and has access to home support workers. It is based in Dundalk, covering north Louth, and in Drogheda where it covers south Louth. The team operates from 9am to 5pm, seven days per week, with nursing and home support services only at the weekend. The service is currently accepting referrals as an admission avoidance measure from the emergency department (ED) and medical assessment unit (MAU), and as an early discharge measure from the wards of Our Lady of Lourdes Hospital. To qualify for the service, patients must be medically discharged by their consultants. They are also required to be medically stable and must meet the CRT referral criteria. Interventions depend on the clients’ assessed needs. The service is provided for a maximum period of up to three weeks, after which time the patient will either no longer need intervention or they will be referred to other appropriate community services.

‘Healthy Food Made Easy’ Course Delivered to 1,000 People More than 1,000 participants have completed a Healthy Food Made Easy course run in north Dublin. A peer-led community-based project, it aims to help people learn about healthy eating and healthy cooking in a friendly, relaxed atmosphere. The course is delivered by local women who are trained and supported by the HSE’s community dietician. It comprises six sessions and includes + Ina McDonnell, the 1,000th participant, receiving her basic nutrition theory and a practical HFME certificate from Kathleen Jordan, HSE Senior cooking element. The emphasis is on Community Dietician group learning and participation. Topics covered include healthy shopping habits, tips to increase your fruit, vegetable and fibre intake, how to read food labels, information on healthy fats, and family food issues such as fussy eating in children and junk food in teenagers. The course is open to community groups and individuals in the catchment area of Northside Partnership. To date, courses have successfully involved many groups such as parents of primary school children, older adults, drug rehabilitation groups, mental health groups, young teenage parents, travellers and clients of the disability services. For further information contact Kathleen Jordan, HSE Senior Community Dietician on (01) 870 8097 or Linda Scanlan, HFME Co-ordinator, Northside Partnership on (01) 848 5630.

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Positive Response for Child Development Training Programme

+ Marian Durand, Training and Development Officer, Children and Family Services (Chairperson and Course Co-Ordinator, second from left) with some of the trainers who delivered the course (L-R): Frances McArdle, Assistant Director of Public Health Nursing (Asylum Seekers); Nick Van Der Spek, Consultant Paediatrician, Cavan General Hospital; and Grainne Murphy, Clinical Nurse Specialist, Child and Adult Mental Health Services

Forty multi-disciplinary health professionals in the Dublin North East region recently completed a Child Development Training Programme designed to encourage disciplines and services to work together to establish a more holistic approach towards families. Initiated in 2006 by the Children and Family Training Services Training Team in response to an identified gap in the training area of child development, the five core areas of a child’s development - learning, communication, physical, social emotional and play - are addressed in the programme. Delivered by a mixed group of 12 health professionals, the programme provides factual knowledge and practical understanding of child development between the ages of 0 - 8 years, and enables health workers to identify when to refer a child and to which discipline. The course has evolved each year, as the various trainers feed back into the programme, in addition to reviewing and evaluating participants’ responses. Those responses to this year’s course have been very positive, and each participant commended the programme’s interactive training methods which included powerpoint presentations with video clips, poster exercises, a quiz, case study and a photo, among other exercises. For further information or to book a place on next year’s course, which is open to all disciplines, email kate.hoey@hse.ie.

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Gallery // Dublin north east

+ Household and portering staff members from Our Lady of Lourdes Hospital in Drogheda who completed the British Institute of Cleaning Science (BICSc) Cleaning Operators Proficiency Training Programme are pictured with Margaret Swords, General Manager, Louth/Meath Hospital Group; Yvonne Gregory, Operational Services Manager; Maeve O’Connor, Senior Manager, General Manager’s Office; Ian Broni, Support Services, Our Lady of Lourdes Hospital; and Colm O’Neill, Trainer, Fourknocks Learning Organisation at the presentation of certificates

+ Edith Daly, Infection Control Nurse and Finola O’Sullivan, Health Promotion Coordinator, both from Our Lady’s Hospital, Navan are pictured at an information stand in Navan Shopping Centre set up to promote WHO World Hand Hygiene Day. Staff from the Health Promotion and Infection Control Departments provided advice on the benefits of appropriate hand hygiene and when and how to perform hand hygiene, including video demonstrations on hand-washing techniques, checking hand cleanliness with an ultraviolet light box, and poster displays

+ At the launch of new Infection Prevention and Control guidelines for hospitals in the North East were, front row (L-R): Edith Daly, Clinical Nurse Specialist (CNS), Our Lady’s Hospital, Navan; Aisling Tinsley, CNS, Our Lady of Lourdes Hospital, Drogheda; and Bernie McArdle, CNS, Cavan/Monaghan Hospital Group. Back Row (L-R): Caroline Carpenter, CNS, Our Lady’s Hospital; Margaret Swords, General Manager, Louth/Meath Hospital Group; and Patricia Suresh, CNS, Louth County Hospital, Dundalk

+ Live Your Best Life is a peer-led, community-based healthy lifestyle programme developed by the HSE’s Health Promotion Department north Dublin in conjunction with Edenmore Primary Care Team. Programme participants included, front row (L-R): Liz Ryan, Joan Ryan and Rita Tierny. Back Row (L-R): programme trainers Brigid HalahanLyons, Paul Donnelly and Fiona Friel

+ Physiotherapists from Our Lady of Lourdes Hospital hosted an information event at Our Lady of Lourdes Hospital in Drogheda, where they provided information to visiting members of the public and staff members on the management of lower back pain, good back care and the treatment of back pain. The event was held to coincide with the Irish Society of Chartered Physiotherapists’ Move4Health campaign

+ The most up-to-date advances in stroke prevention, management and care were presented by a panel of multidisciplinary experts to staff from across all disciplines who attended a conference entitled A Team Approach to Stroke Care, organised by the Louth/Meath Stroke Project Group. Speakers and delegates are pictured here at the event

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Dublin mid-leinster // News

Making a Splash in Tullamore The idea that water has healing properties is being put to the test and succeeding at the Midland Regional Hospital at Tullamore, ever since the opening of its new hydrotherapy pool in February last year. Intense exercise – when one has conditions such as rheumatoid arthritis, multiple sclerosis or cerebral palsy – can be difficult or painful. But this is not a concern for some of the physiotherapy clients who do their therapeutic exercises in the pool. The age-old treatment of using warm water relieves pains, because it relaxes the muscles and allows the patient to exercise in greater comfort, while the buoyancy and resistance of the water can achieve excellent results. Hydrotherapy can deliver relief of pain, ease of movement, reduction of spasm, enhanced relaxation and improved cardiovascular fitness. More specifically, the physiotherapists at the Midland Regional Hospital at Tullamore are seeing patient benefits such as improved muscle strength, mobility, balance and coordination in many clients. According to physiotherapy manager,

Innovative Mental Health Project Under Way An innovative project centered around clinical services for individuals and families affected by psychosis is now under way in Wicklow. HSE Mental Health Services in Wicklow – in conjunction with a number of nonstatutory providers – will lead the project, funded by the Genio Trust, which will build capacity for better clinical services. A grant of s271,000 was awarded to the PROTECT (Personalised Recovery Orientated Treatment, Education and Cognitive Therapy) Project, a partnership initiative involving existing health, training and social care providers in Wicklow. The objective is to ensure that those identified in need of early intervention by DETECT in Wicklow are enabled to access all of the services they need or choose. Martin Rogan, HSE Assistant National Director for Mental Health, says that “the

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+ Patients and staff in the hydrotherapy pool at the Midland Regional Hospital in Tullamore. Hydrotherapy can deliver relief of pain, ease of movement, reduction of spasm, enhanced relaxation and improved cardiovascular fitness

Claire Donnelly, “people tend to think of rehabilitation services as an add-on to their initial medical treatment, but it is important in terms of getting back to the best possible level of function for your lifestyle. “We see people who have long-term conditions such as chronic back pain, and we also see people with short term injuries such as fractures. The hydrotherapy facility gives us another option when treating our patients, and overall it improves the quality of the physiotherapy service we already provide to our clients.” The pool was commissioned as part of the new hospital, with a generous

contribution of s100,000 towards its funding from the Friends of the Hospital. The facilities include a waiting area, a patients’ changing area with showers, a patients’ rest area, a store room, a shower for non-ambulant patients and a staff changing area. The pool consists of a shallow side, 1.2m deep, and a deep side of 1.5m. Ambulant clients can use the steps down into the pool, and there is also a hoist for clients with mobility problems. The pool has a recessed or dropped zone on two sides of the pool, allowing staff to monitor and assist clients without having to be in the water.

+ Caption

IMAGE ? + Dr Justin Brophy from Newcastle Hospital, Angela Lane, Ciaran Cobbe, Eimear Connaughton, Bridget Harney, Dr Brian Fitzmaurice, Mark Meakin from PROTECT and Martin Rogan HSE Assistant National Director for Mental Health at the launch of the innovative PROTECT project

PROTECT project is an excellent example of collaboration between the HSE mental health professionals, service users, our voluntary partners, local authority and the academic sector. When we listen closely to service users and accommodate their particular needs, we get far superior outcomes.” Dr Brian Fitzmaurice, Consultant Psychiatrist and Lead of the PROTECT project, explains further. “A key difference with PROTECT and any other programme of its type is the role of the mental

health service user, who will facilitate engagement between the client in the early stages of psychosis and the services, as this is regarded as an anxious and confusing time for patients and their families. “They will also have a role in gathering patients’ perspectives on how services are currently delivered, so that strengths and deficits are identified and service users’ views are incorporated into service planning,” he says.

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News // Dublin miD-leinster

Make a ripple: CHanging attituDes to Mental HealtH one in two irish people will not tell anyone if they experience a mental health problem, because of the stigma that surrounds the issue. in a bid to change attitudes, see Change - ireland’s national stigma reduction partnership - launched a new campaign called Make a ripple in May.

he see Change Make a ripple campaign invites people to tell their story, share their experiences and make a ripple to end the stigma of mental health problems. Kathleen lynch Minister for Disability, equality and Mental Health, spoke at the launch of the campaign in May. In Ireland, one in four of us will experience a mental health problem at some point in our lives. that is enough of us to fill Croke park 14 times over, it’s six times the number of students who enrolled in all our universities and all our Its combined right across the country last year, and it is more people than the combined populations of Cork, Clare, galway, limerick and Waterford. the campaign aims to build an online community of ambassadors, advocates, storytellers and volunteers to help reduce the stigma associated with mental health problems. the idea is simple. they want people to speak out against stigma by leaving a comment on the Make a ripple site, on their facebook page, or through twitter. the partnership also needs to gather at least 100 contributions so that the site has plenty of stories and pledges. Mark Byrne, Communications Coordinator, explains: “We’re asking for your help by signing up as one of our first 100 ambassadors. We only need 100 words or less, and it can be about your own experience of mental health problems and your journey to recovery, a message about how someone else’s experience affected you, or a plea for others to start talking openly and honestly about mental health problems.” last year, see Change asked nearly

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+ l-r: John saunders, Director, see Change; Kathleen lynch tD, Minister for Disability, equality and Mental Health; ray D’arcy, Broadcaster; Caroline Mcguigan, suicide or survive; scott ahearn, uCD Welfare; and Barbara Brennan, see Change, and (inset) Kathleen lynch tD, Minister for Disability, equality and Mental Health speaking at the launch

1,000 people about their attitudes to mental health. the results paint a worrying picture about how this country thinks about mental health problems and the stigma that surrounds them. “We found that stigma acts as a barrier to people asking for help. Nearly 30 per cent of young men would delay seeking help for fear of someone else finding out, and one in three people would hide mental health problems from friends, family and colleagues for fear of how they might react,” adds Byrne. “In fact, research shows that one in two Irish people wouldn’t tell anyone at all if they experienced a mental health problem. that’s a lot of people not talking.”

stigma is about negative attitudes to other people. It’s hurtful, isolating, and it’s one of the biggest problems encountered by people with mental health problems. as well as the enormous impact on the individual, stigma has a social and economic cost. stigma stops people from applying for and getting jobs that they’re qualified to do, it prevents equal access to housing and services, and it hurts relationships and families.” If you would like to help change minds and start conversations about mental health problems in Ireland, or if you’d like to become an ambassador, email Mark Byrne at mbyrne@seechange.ie or call a member of the see Change team on (01) 860 1620.

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Dublin mid-leinster // News Have you ever thought about volunteering?

+ Young people taking part in a Headspace event

young people Use Drama to Explore Mental Health Issues Over 40 young people in Co. Kildare recently took part in a unique approach to dealing with mental health issues. They came together to perform in several dramas dealing with questions of mental health, with the help of parents, schools and community groups. Headspace is a HSE-funded initiative which focuses on mental health promotion. It is part of an overall plan for responding to such needs in the communities of north east Kildare and Kildare/west Wicklow. A multi-agency steering group was set up to develop, implement and review a range of mental health promotion and suicide prevention measures across sectors and within the community. The group is composed of representatives from health, education, youth services and other key agencies working in the area. Kildare teenagers performed three dramas in Celbridge and explored issues such as peer pressure, isolation, alcohol and drugs. It is hoped that the initiative will trigger community discussion on such topics. Key partners in the community response are the North East Kildare Mental Health Sub Group, Kildare Youth Service and Crooked House Theatre Company, who expertly guided the young people through the task to hand. Des O’Sullivan, Manager of Kildare Youth Services, said that “this is an excellent way for young people to identify their own issues in a safe way through drama. It’s a novel approach to such issues, and it is a form of interaction they feel comfortable with. Headspace gives the opportunity for young people to learn from this experience and provide recommendations for the future.” The initiative reflects the focus of the Kildare/west Wicklow steering group to promote positive mental health, but also recognises the level of suicide and self harm that exists within the population. A series of information sessions for parents and local communities on issues such as bullying, dealing with exam stress and internet safety, as well as a mental health promotion and suicide prevention seminar, a research project, and a multiagency meeting with schools in the region to address areas of concern are all currently underway.

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Have you ever thought about volunteering some of your time to adults with intellectual disabilities? A friendship group is a volunteer buddy, befriending and mentoring programme for adults with intellectual disabilities in the Westmeath area. Gaynor Eksteen, Senior Occupational Therapist, who began working in adult disability services last October, found that adults with disabilities need to have meaningful daily routines, friendship and companionship with people. Gaynor is based in the Springfield Centre in Mullingar. “There is also a need for these people to be integrated into their local communities and to live a life the same as you or I would. Being disabled should not mean being disqualified from having access to every aspect of life,” she explains. “Volunteering is defined as the commitment of time and energy, for the benefit of the society and the community, the environment or individuals outside one’s immediate family. It is undertaken freely and by choice, without concern for financial gain.” Gaynor formed a committee with representatives from the different disability centres in the area, as well as members from the community. “A volunteer in no way replaces staff positions. Volunteers are there to complement staff and provide a one-toone friendship to service users,” she says. Volunteers who have special talents can provide assistance with music, drama, crafts, or sports activities such as training for the Special Olympics or just assisting by taking someone to a GAA match. They can assist by taking someone to help them with shopping or to drop into their local restaurant for a meal - or simply a cup of coffee and a chat. If any other service needs assistance with starting a volunteer programme, or if you are someone who would like to become a volunteer, Gaynor can be contacted at (044) 937334, or at gaynor.eksteen@hse.ie.

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gallery // Dublin mid-leinster

+ Annette Cleary, cellist, and Newcastle Hospital patient Phoebe Bennett chat after the LoveLive National Music Day performance. The Tullamore Classical Strings School performed at the Midland Regional Hospital Tullamore for the LoveLive National Music Day

+ Miriam Horan, Acting Hospital Manager and Orla O’Brien, Director of Nursing, pictured with members of the Tullamore Classical Strings School. Back Row (L-R): Sarah Gavin, Ellen Godley, Hannah Reilly, Vivieene Peters and Mary Sarah Gavin. Front Row (L-R): Natalia Shiel, Miriam Horan, Acting Hospital Manager; Gregory Shiel, Nicola Gavin, Sophia Shiel, Ellen Reilly, Clodagh Reilly, Cyiaph McCann, Adele O’Dwyer, Siobhan Godley; and Orla O’Brien, Director of Nursing

+ Pictured with the Robo Doc which is currently at use at the Midland Regional Hospital in Tullamore as part of the Dublin Midlands Stroke Network Partnership - a pilot telestroke service - are (L-R): Richard Lynch, ED Consultant; Dr Clare Fallon, Consultant Physician; Abel Wakai, ED Consultant; Trevor O’Callaghan, Hospital Manager; Katherine Kenny, Divisional Nurse Manager; and Anne Kelly, Director of Nursing

+ The nursing team who organised a Health Awareness Day in the Midland Regional Hospital in Tullamore last April. L-R: Sinead Boyd, Clinical Nurse Manager (Medical); Ann Raleigh, Cardiac Rehab Coordinator; Avril Gannon, Clinical Nurse Specialist, Respiratory Medicine; Tina Cooper, Clinical Nurse Manager; Clare O’Dea, Divisional Nurse Manager; Rita Gannon, Staff Nurse; Demelza Dooner, Clinical Nurse Specialist, Diabetes; and James Davison, Clinical Nurse Specialist, Cardiology

+ Avril Gannon performing the lung test at the respiratory stand for Health Awareness Day at the Midland Regional Hospital in Tullamore last April

+ Clare Conway with her project team, who recently presented the nursing management at the Midland Regional Hospital, Tullamore with their action learning project entitled 'Towards an improved access to healthcare information during outpatient waiting times: a visual presentation on bowel cancer'. The project team are studying at the Institute of Public Administration. L-R: Fiona McMahon, Catherine Egan, Clare Conway, Orlaith O’Brien, Peter Uzochukwu, Rita Marron and Bernie Mann

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South // News Improving the Health and Welfare of People with Parkinson’s Disease The HSE’s elderly care services at Wexford General Hospital were commended in a recent awards ceremony for their efforts to improve the health and welfare of people with Parkinson’s disease. WGH’s Day Hospital for the Elderly team received a special commendation award at the inaugural Astellas Changing + Mark Murphy, Chief Executive, IKA and a member of Tomorrow Awards, held at the Royal Astellas Changing Tomorrow Awards Adjudication Panel, College of Physicians in Dublin. Ann Roche, Kate Higgins, Caroline Donnelly, all Day Hospital for the Elderly Team at Wexford General Hospital and Congratulating the award winners in Patricia Kelly, General Manager, Astellas Pharma Co. Ltd WGH, the hospital’s general manager Lily Byrnes said: “We are delighted with this recognition for our services and we congratulate Ann Roche, Kate Higgins, Caroline Donnelly and all of the team at the Day Hospital for the Elderly at Wexford General Hospital.” “The multidisciplinary team noticed that a large number of patients were referred to a consultant geriatrician regarding Parkinson’s disease. It was decided to set up a multidisciplinary programme to ensure that any patient in Wexford with a diagnosis of Parkinson’s, or their family, had access to a programme of information and support.” The programme runs over eight weeks, and patients are assessed using the Parkinson’s disease rating tool. The award judges felt that the project in Wexford showed a strong community drive to improve the health and welfare of patients with this long term illness, as well as ensuring the best use of hospital resources. The team ascertained the needs of patients and carers, and secured funding for specialist nurse training.

New Initiative to Aid Grieving Families

+ L-R: Bernard Finnegan, Director of Nursing, Wexford General Hospital; Sheelagh Twomey, Clinical Nurse Specialist in Palliative Care, Wexford General Hospital; and Dr Colm Quigley, Clinical Director, Wexford General Hospital

A new symbol to alert patients, visitors and staff that a patient has just died has been launched at Wexford General Hospital (WGH). The ‘end of life care’ symbol, a threestranded white spiral against a purple background, will be displayed on the door of a room or ward where a death has occurred. Speaking at the recent launch in WGH, Bernard Finnegan, Director of Nursing, explained the significance of the initiative.

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“The ‘end of life care’ symbol is a signal to people passing that someone in a room or ward has just died and that a grieving family is nearby. Hopefully, that would lead to noise levels being kept down, privacy to be ensured and for people to be as sensitive as possible. It’s about giving others the respect that you would like yourself if you were in that situation. Up to now there hasn’t been a discreet way of informing people that a death has taken place and we hope that displaying the spiral symbol will prompt an atmosphere of quiet, respect and sensitivity in the immediate area.” Also speaking at the launch to endorse the new symbol, Dr Colm Quigley, Clinical Director and Consultant Physician at WGH said that “Almost 300 people die each year in Wexford General Hospital alone. We know that pain control, privacy, dignity and the presence of family are especially important at the end of life. As staff, we do our best to ensure patient comfort and to offer the privacy of a single room when a person is dying. We try to accommodate families to be present and to provide the support and information they need at this difficult time.”

HSE and WIT Partnership Strengthened A second memorandum of understanding has been signed between the HSE South’s Health Promotion Department and Waterford Institute of Technology (WIT), which will further enhance the delivery of Social Personal Health Education (SPHE). The successful partnership between the HSE and WIT was initiated in 1993, when SPHE was accredited as an extramural certificate at the college in Waterford. Five years ago, the programme was upgraded to higher diploma (level 8) and Master’s (level 9) status within the National Qualifications Framework (NQF) and has since been jointly delivered by WIT and HSE staff. Speaking at a ceremony to announce the memorandum, Andy Walker, Regional Health Promotion Manager for HSE South, said that “the HSE and WIT are committed to continuing the delivery of these unique programmes of study for the foreseeable future and intend to continue to support front line staff to deliver high quality health promotion to those most in need." To date, there have been 44 graduates from the higher diploma programme and seven Master’s graduates. A comprehensive recognition of prior learning (RPL) programme is also available to support those without the necessary entry requirements to get onto the higher diploma programme. + Pictured at the signing of the second memorandum of understanding between the HSE South’s Health Promotion Department and WIT were: Seated (L-R): Dr Michael Harrison, Head of Department of Health, Sport and Exercise Science, WIT; and Andy Walker, Regional Health Promotion Manager, HSE South. Standing (L-R): Catherine O’Loughlin, Health Promotion Officer, HSE South; Teresa Hennessy, Health Promotion Officer, HSE South; Beatrice Barry-Murphy, Course Leader, HSE; Dr Paula Carroll, Course Leader, WIT; Rosie Donnelly, WIT; Mairead Loughnane, WIT; and Joan Ita Murphy, Health Promotion Officer, HSE South

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NEWS // SOUTH Minister Opens New Medical School Facility at South Tipperary Health Minister Dr James Reilly TD visited South Tipperary General Hospital (STGH) in Clonmel in May to officially open its University of Limerick (UL) Graduate Entry Medical School facility (GEMF). The facility in Clonmel provides teaching and education space for medical students on placement at the hospital, one of UL Medical School’s five affiliated teaching sites. Clinical teaching in the third and fourth years of the school’s programme sees medical students placed in a variety of hospital and community clinical settings. There are currently eight UL students based at STGH at any given time, and the expectation is that this number will increase as student numbers grow. The new facility at the hospital enables students to participate in lectures. It also features dedicated study space, and is equipped with video conferencing facilities to link Clonmel-based students with colleagues at other sites, including St. Luke’s General Hospital for Carlow/ Kilkenny. In addition, UL will have up to 12 students undertaking their clinical training in general practice in the south Tipperary area. Welcoming the Minister to the hospital, Carole Broadbank, General Manager, said that it added greatly to the profile of the hospital to have such valued input from the UL Medical School.

+ Pictured at the official opening of the University of Limerick (UL) Graduate Entry Medical School Facility were (L-R): Dr Alan Moore, Consultant Psychiatrist, Mental Health Services; Dr Meera Varghese; Prof Stuart Walsh, Prof of Surgery, UL; Prof Colm Dunne, Prof of Bio Medical Research, UL; Prof Bill Shanahan, Prof General Practice, UL; Tom Hayes TD; Dr James Reilly TD, Minister for Health; Carole Broadbank, General Manager; Anna Marie Lanigan, HSE Area Operations Manager, Carlow-Kilkenny/South Tipperary; Dr Niall Colwell, Consultant Physician; Dr Tom Rice, Consultant Anaesthetist; Dr John Walsh, Consultant Paediatrician; and Dr Sam Kingston, Consultant Endocrinologist

+ Minister for Health Dr James Reilly TD and Tom Hayes TD (fourth from left) pictured at the official opening with UL/STGH medical students Aisling O’Regan, Aidan Jennings, Nessa Star, Laura O’Byrne, Patrick Kenneally, Carole Gaffeny, Anne Grace and Bernard Kenny

register for Conference on the Future of Dementia Care The nursing administration at St Finbarr’s Hospital, Cork, and the South Lee Department of Psychiatry of Old Age in Cork are hosting their second joint dementia conference, The Future of Dementia Care, on October 12th 2011 at the Silver Springs Moran Hotel. The conference content is specifically tailored to interest frontline healthcare professionals – medical, nursing and allied professionals – working with people who suffer from dementia. This year there is expected to be a lineup of strong speakers, recognised internationally for their expertise in the field of dementia and related issues. These may include: Prof

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Geri T. Hall, Memory Disorders Clinic, University of Iowa, USA; Mary J. Foley, ANP, Department of Geriatric Medicine, St Finbarr’s Hospital; Dr Joan McCarthy, School of Nursing and Midwifery, College of Medicine and Health, UCC; Prof Cillian Twomey, Department of Geriatric Medicine, St Finbarr’s Hospital; Prof Willie Molloy, Department of Geriatric Medicine, St Finbarr’s Hospital; Dr Tony O’Brien, Medical Director of Marymount Hospice, Cork. Topics for discussion include: • Assessment of dementia

• Management of Lewy body and frontal lobe dementias • Optimising functional ability • Ethics and decision making • Advanced directives and living wills • Capacity assessment • Management of the end of life. The registration fee has been specifically set at an affordable level of b65, including lunch. In 2009, there were approximately 320 attendees at the Conference on Dementia. To register, contact Irene Walsh at Irene.walsh@hse.ie or (021) 492 3270.

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South // News Nurse at the Forefront of Cancer Research in Cork University Hospital Clinical research nurse Teresa McKeogh, who works at Cork University Hospital, is one of three selected nurses nationwide who will support collaborative research at the designated breast cancer centres in Cork, Limerick and Waterford. The National Breast Cancer Clinical Research Programme is coordinated by the Royal College of Surgeons in Ireland (RCSI) in association with Aviva health insurance. The programme will create the country’s first Breast Cancer Bio Resource of tissue and serum samples. The project’s initial funding of b150,000 per year over the next three years has been provided by Aviva. Commenting on her role in this research project, Teresa said that she is “delighted to be a part of this collaborative research programme with breast cancer centres nationwide. The research will increase our understanding of this disease. “Working closely with the breast surgeons in Cork University Hospital, I will be meeting newly-diagnosed breast cancer patients and with their consent collecting tumour samples, blood samples and data for this programme. Such samples will help scientists understand the mechanism by which proteins in breast cancer cells interact and potentially help in the treatment of breast cancer. I am excited to play a role in this research programme.”

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Residents and Staff Welcomed at Heather House The HSE recently opened the first of three newly-constructed Community Nursing Units at St Mary’s Orthopaedic Hospital in Cork. The unit, known as Heather House, initially saw the relocation of 23 residents from Heatherside Hospital + HSE General Manager Gabrielle O’Keeffe welcoming Bernadette O’Leary, in north Cork. Built CNM2, and resident Mary Casey to Heather House Community Nursing Unit and commissioned at a cost of approximately s11m, Heather House is a modern purpose-built facility for the benefit of residents and the staff who care for them. The unit comprises of 50 beds and, when fully operational, will provide an additional 27 continuing care beds in Cork city. Heather House will provide continuing care along with a range of community supports and a wide range of activities and complementary therapies will also be provided to meet the health and social needs of all residents at Heather House. Joan Somers Meaney, Director of Nursing at Heather House said that “residents and their families were very positive about the move particularly as the new unit is closer for visiting family members. They are also appreciative of the fact that there will be many familiar faces amongst the staff relocating with the service.” “The unit is built with the comfort of older people in mind,” said Gabrielle O’Keeffe, HSE General Manager. “There are 34 single en-suite bedrooms, four two-bedded rooms and two four-bedded rooms available for occupancy together with therapy and social recreation space. “This will make an enormous difference to the lives of our residents; the new unit is bright, spacious and has plenty of landscaped garden areas for our residents to enjoy.”

Day Case Capacity Increases at Kerry General Hospital A new 15-bed Day Procedures Unit opened recently at Kerry General Hospital (KGH). This new dedicated unit facilitates an increase in the hospital’s day case capacity from five beds to 15 beds. The new unit will improve services for patients and enable more efficient use of beds in the hospital. The level of planned day surgical procedures at KGH will rise in line with national and international best practice. In addition, the length of time patients need to be in hospital will reduce - patients will present on the morning of their surgery and go home that same evening. More than 7,417 day procedures were carried out in KGH during 2010, and it is anticipated that with the additional day case bed capacity this will increase to approximately 9,000 in 2011.

Pre-Operative Assessment Unit The hospital has also recently opened a new Pre-Operative Assessment Unit. The unit has been developed by a surgical team including nurses, anaesthetists and surgeons. This unit will enable patients who are scheduled for a planned surgical procedure to have all their pre-operative tests carried out as an outpatient in advance of presenting to the hospital for surgery. This means that patients will no longer need to be admitted to hospital the day before their procedure in order to complete these tests. Instead, patients can turn up on the morning of their surgery and all their relevant results and information will already be with their clinical team.

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Gallery // south

+ A workshop was held recently to focus on increasing the efficiency of patient care in operating theatres at Cork University Hospital. Among those who attended were (L-R): Grace Reidy, Programme Leader; Sean Hennessy, Facilitator Portering Services; Darren Hickey, Acting Deputy Bed Manager; Billy Drake, Inventory Representative; Andrea Kennedy, Facilitator CNM2; Mark Stockil, Lean Expert; Teresa Wall, CNM3; Declan Reidy, Programme Leader; Ken Walsh, Consultant Anaesthetist; and Niamh McGrath, Orthopaedic Trauma Co-ordinator

+ The Children’s Leukaemia Association welcomed Eurovision stars Jedward to the Children’s Leukaemia Unit, Mercy University Hospital, Cork where they met staff of all disciplines

+ Dan O’Keeffe cuts a ribbon to officially open the HRB Discovery Centre at Cork University Hospital (CUH) with Tony McNamara, the hospital’s Chief Executive. Also pictured are Prof Jonathan Hourihane, Director of Paediatrics, HRB Discovery Centre, CUH; and Enda Connolly, Chief Executive, Health Research Board. Neil Danton Photography - www.neildanton.eu

+ Pictured to mark the opening of a Vagus Nerve Stimulator (VNS) Clinic at Cork University Hospital are (L-R): Colin Doherty, Clinical Lead; Maire White, National Nursing Lead; Mary Boyd, Director of Nursing, Cork University Hospital; Daniel Costello, Consultant Epileptologist and Regional Epilepsy Lead, HSE South; and Tony McNamara, CEO Cork University Hospital Group. The hospital’s Department of Neurology launched the new initiative in conjunction with the National Epilepsy Programme. The clinic will serve patients with complex epilepsy requiring VNS therapy

+ The West Cork Mental Health Services were recently presented with a ‘Most Improved Service 2010’ award at a seminar held in Dublin Castle to report on progress on the implementation of A Vision for Change, Ireland’s mental health policy. Dr Iseult Twamley, Senior Clinical Psychologist accepted the award on behalf of the service

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+ A volunteer programme providing guidance to asylum seekers on accessing health and social services has been developed in Kerry. The Kerry Peer Health Information Volunteer Programme was developed by the HSE South Primary Care Team, Tralee, in partnership with Tralee Women’s Resource Centre, Tralee International Resource Centre and Killarney Asylum Seekers Initiative. Pictured here are graduates of the Programme Miriam Karanja, Jenny Munyard and Yamoussa Bamgoura with Dr Ellen Ruane, a GP

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west // News

Health Event at Sligo General Hospital The increasing demands and pressures of everyday living are proving very challenging for many people in Ireland today. However, there has never been a better time for us to take individual control of our own lives and, in particular, our health. It is unfortunate, but often the only time we address health issues is when we are ill and forced to pay more attention to our health needs With this in mind, Sligo General Hospital organised a two-day Health Event in the spring to offer help and advice to the public. The Health Event marked International Women’s Day on March 8th by making a mobile unit providing cancer information and awareness available for both men and women. Staff from the Marie Keating Foundation highlighted the importance of early detection and self awareness, and offered practical

+ Pictured at the recent official launch of the Sligo/Leitrim Smoking Cessation Service information leaflet is Pat Dolan, ISA Manager, Sligo/Leitrim, HSE West (centre), with the HSE’s Smoking Cessation Team for Sligo/Leitrim

advice on healthy lifestyle choices. The following day was National No Smoking Day and, as part of the Health Event, the Smoking Cessation Team hosted an open day in the foyer of the hospital. Experienced staff from oncology, cardiology and obstetric care, trained in smoking cessation, were available to provide advice and information on all aspects of smoking

and stopping. A number of screening tests were also provided. The HSE smoking cessation service is available free of charge to all patients, staff and members of the public. The service is available in Sligo General Hospital, and there are also a number of clinics located in Sligo town, Carrick-on-Shannon, Drumshambo, Tubbercurry, Manorhamilton and Enniscrone.

Mental Health Trialogue Meetings Begin A series of mental health trialogue meetings – open conversations about mental health – commenced in Galway, Letterkenny and Castlebar during March, and will run monthly until the end of the summer. The meetings are aimed at those working in mental health, people who have mental health difficulties, and everyone who cares about positive mental health. Trialogue groups can help communities to change the perception that only those who work in the field of mental health are the experts in mental health. Mental health is everyone’s business, regardless of their background and experience. The trialogues are a Mental Health Irish Trialogue Network initiative funded by Genio, and has a multi-agency steering group which includes the Irish Advocacy Network, the National Service User Network and the HSE National Mental Health Office.

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+ L-R: Vinnie Flannery, Jigsaw; Lorna Ní Chéirín, Mental Health Trialogue Network Ireland; Evelyn McHugh, Trialogue Meeting Local Organiser; and Gerry Blake, HSE West Trialogue Meeting Local Organiser, at the first Mental Health Trialogue meeting in Galway

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News // west NCCP Education Programmes Take Place Three National Cancer Control Programme (NCCP) education programme events took place in the HSE West area this spring. An oncology education seminar aimed at community nurses was launched in Galway in February and some 50 primary care nurses - including practice nurses, public health nurses and registered general nurses working in the community – took part. Public health nurses in Donegal were the first nursing group to graduate from the new Community Oncology Education Programme in March, while in Galway, 15 community nurses from the county began an oncology skillsbased programme. The NCCP Cancer Education Programmes are supported by the HSE Office of the Director of Nursing and Midwifery Services and the National Professional Development Co-ordinators for Practice Nurses Group.

+ L-R: Sharon Linnane, PHN, Athenry; Marie Kirwan, PHN, Mountbellew; and Angela Mannion, PHN, Glenamaddy; public health nurses based in Co. Galway primary care teams at the launch of the NCCP Nurses’ Education Seminar at GUH in February

+ Donegal public health nurses have become the first in the country to graduate from the new Community Oncology Nurse Programme piloted in Letterkenny last September and completed this March. The nurses are nationally the first to deliver a specific range of cancer services to patients in their own homes

+ Community nurses from Co. Galway who began the oncology skills-based programme in March

Galway Nurse Awarded Bursary Michelle McNamara, Staff Nurse at Galway University Hospitals, has been awarded the second Learning Bursary Award from the Anna May Driscoll Foundation. The award was presented by Damien Dyar, Anna May Driscoll’s partner, at a ceremony in University Hospital Galway. Anna May Driscoll was one of the founders of Emerge Education, and the foundation was set up to commemorate the work that she pioneered in corporate and voluntary sector leadership. The Anna May Driscoll Foundation was established by Emerge Education in her memory. It is + L-R: Ciarán Dyar, Emerge Education; Michelle McNamara, Staff Nurse, GUH (Award designed to offer bursaries allowing nurses to continue their Winner); Mary McHugh, Director of Nursing, GUH; Anne O’Rourke, Infection Control, GUH; professional development. Dr David O’Keeffe, Clinical Director for Acute and Continuing Care Services for the Galway/ Michelle McNamara was nominated for the award, Roscommon Area; and Damian Dyar, Emerge Education along with colleagues Anne O’Rourke and Tricia Casey. Nominations were made based on the leadership shown by the candidates in their day-to-day work at Galway University Hospitals. Each nominee was interviewed to find out how the candidate would use the award to build learning and leadership skills. The panel was delighted with the strong leadership skills shown by all the nominees, but ultimately thought that Michelle would be able to make most use of the bursary to build her knowledge and skills. The Director of Nursing and Midwifery at Galway University Hospitals, Mary McHugh, said that “in the current economic climate it is very encouraging and morale-boosting for the nursing staff at GUH to be the recipients of such a generous bursary, particularly since its origin was based on appreciation for the delivery of an excellent standard of patient care. “The standard of the applications was exceptional, but unfortunately there could only be one successful candidate and Michelle McNamara is indeed a very worthy winner - and sincere congratulations to her. The awarding of the Learning Bursary will be ongoing, and I look forward to working with the Driscoll and Dyar families in the years ahead.”

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west // News Long Service Awards for Loyal Portiuncula Staff Some 57 members of staff who have given 10, 20, 30 and 40 years’ service to HSE West’s Portiuncula Hospital in Ballinasloe, County Galway, recently received Long Service Awards for their loyalty to the hospital. This was the fifteenth year the awards have been presented, and the recipients come from disciplines right across the hospital. Staff member Bernie Cooke received an award for her 40 years' service. The event took place at a special awardgiving ceremony in the hospital chapel, and

included a re-assertion of the tradition and values of Portiuncula Hospital. Denis Minton, Director of Resources at Portiuncula Hospital, paid tribute to the staff for their ongoing commitment to the hospital. Fr Bernie Costelloe, Hospital Chaplain said a few uplifting words on this year’s theme of ‘hope’. Minton, who presented the awards on the day, said that “the ceremony allows us once again to assert the mission and vision of our hospital and to ensure that those principles are the driving force behind the hospital’s

+ 10 year attendees. Front Row (L-R): Brenda Ryan, Maeve Doherty, Geraldine Sheil, Fidelma Gordon, Mary Donnellan. Back Row (L-R): Maureen Gordan, Teresa McDonnell, Joanne Page, Alceina O’Brien, Edel Horan, Catherine Lyons, Sally O’Connor, Breda Coughlan, Carmel McConn, Patricia Dempsey, Barbara Dowd, Bridgetta McHugh (Lorraine Cannon, Ena Colye-Fallon, Anne Fallon, Ann Flemming, Orla Grehan, Carmel O’Brien-Kirwan, Anne Lohan, Vivieene McCarthy, Angela Mulhern, Muriel Slymam, Michael Towey also received long service awards)

+ 20 year awardees. Front Row (L-R): Mairead Coyne, Patricia Conlon, Eileen Finneran, Hanoria Riddell. Back Row (L-R): Joan Kenirons, Olive O Byrne, Helen Glynn, Rosemay Reilly, Mary O’Neill, Ethel Leonard (Mary F Daly, Mary Glynn and Sarah Glynn also received long service words)

healthcare system in the future.” Both speakers stressed the importance of taking the time to celebrate. This year, Bridgetta McHugh, General Manager, received a Long Service Award for her 10 years’ service to the hospital. The event was organised by the Mission Effectiveness Team. This team comprises of personnel from all departments throughout the hospital, and its focus is to maintain the values of compassion, dignity, justice and professionalism among patients and staff.

+ 30 year awardees. Front Row (L-R): Eileen Quinn, Marie Egan, Jackie Coughlan, Gráinne HoganCashen, Ann Callaghan, Mai Finnerty. Back Row (LR): Colette Hoare-Daly, Denise Berrigan, Nora Dowd, Helen Lemass, Mary Briggs-Connolly, Máire Kelly (Mary Dooley, Breda Hession and Annette Kenny also received long service awards)

New MRI Scanner in Mayo General Hospital A new MRI scanner has been installed at Mayo General Hospital, and will have a very significant role to play in the detection and diagnosis of different types of cancer. The money for the scanner was raised through the generosity of the people of Mayo. Welcoming its safe delivery and installation, Charlie Meehan, Manager of Mayo General Hospital, said: “This is an excellent example of a joint venture between the local community and the hospital to ensure that the people of Mayo will have speedy access to the highest quality radiology services.” The funds were raised by a number of established cancer charities, and the core groups involved were Cancer Action Mhaigh-Eo and the Bright Eyes Campaign. MRI scanning has become an increasingly important tool in early and accurate detection and diagnosis of a range of diseases and injuries. The new MRI service is being provided on a four day per week basis, and will significantly reduce waiting times for cancer-type investigations.

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+ The new MRI scanner being moved into the hospital

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gallery // west Poems for Patience Launched at Galway University Hospitals The Galway Arts Trust recently launched the eighth series of the very successful Poems for Patience initiative at University Hospital Galway. The project, which was part of the Cúirt International Festival of Literature, involved contemporary Irish poet Dennis O’Driscoll introducing 21 poems he had selected. The poetry is on display in the waiting areas of University Hospital Galway and Merlin Park University Hospital.

+ L-R: Professor Pat Finnegan, Galway University Hospitals Arts Trust; Dani Gill, Director, Cúirt International Festival of Literature; Dennis O’Driscoll, Poet; and Margaret Flannery, Arts Officer, Galway University Hospitals, pictured at the launch of Poems for Patience at Galway University Hospital

croí host conference + Croí, the West of Ireland Cardiac Foundation, in collaboration with Mayo Primary, Community and Continuing Care (PCCC), hosted a conference on cardiovascular disease in Westport in April. L-R: Dr Jim Crowley, Consultant Cardiologist, University Hospital Galway; Dr Tom Walsh, Consultant Geriatrician/Stroke Physician; Dr Joe Clarke, National Primary Care Lead, HSE; Kathy McSharry, Professional Development Coordinator for Practice Nurses, HSE West; and Dr Pat Durcan, GP Lead, Ballina, pictured at the conference

'heart smart' mayo report launched + Pictured at the launch of the ‘Heart Smart’ Mayo report are (L-R): Ailish Houlihan, Croí Heart Smart Coordinator; Kathy McSharry, HSE; Thelma Birrane, HSE; Dr Jim Crowley, Consultant Cardiologist; Eithne Garrick, HSE; Neil Johnson, Chief Executive, Croí; Laurence Gaughan, HSE; and Irene Gibson, Croí

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in brief // News

UCD Commences Nurse and Midwife Prescribing Programmes Irish Heart Foundation Stroke Forum The Irish Heart Foundation recently launched has new online forum for stroke. The forum is aimed at stroke survivors and their families and friends who do not have access to a stroke support group, but would like to chat with others and share their thoughts. Forum members can chat online and exchange experiences and information. Sign up today at www.stroke.ie/ strokeforum.

Panels, Committees and Forums: Register Now The HSE’s National Advocacy Unit is currently updating its registered list of service user panels, committees and forums. Those registered will be provided with news alerts and reference materials, and in due course will be invited to join an online discussion forum through HSEland.ie to help improve the development, functioning, networking and overall work of the panels, committees and forums. Whether you are new or wellestablished, please visit https://www. surveymonkey.com/s/advocacyunit and complete the survey online. Alternatively, you can email or phone Rachel McEvoy at rachel.mcevoy@hse.ie or (086) 854 3695 and answer a few short questions.

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+ Back Row, L-R: Patricia Power, Ann Hogan, Christine O Connor Kelly, Gillian Farrell, Deirdre Scanlon, Christina Hamilton, Mary Quinn and Anne Doyle, the first group of nurse prescribers at the UCD school. Front row, L-R: Dr Linda Latham, Cecilia Manning, Aine McHugh, Course Co-ordinator; and Mary McNamara

The UCD School of Nursing, Midwifery and Health Systems has launched a number of new prescribing programmes for nurses and midwives wishing to prescribe medication and ionising radiation (x-ray). According to course coordinator Áine McHugh, the programmes have been designed to be flexible so that students can complete the course in six months, with a mix of classroom and online participation coupled with clinical experience. Dr Martin McNamara, Head of School, said that the school “has always been at the forefront of educational developments designed to support the nursing and midwifery professions to expand their scope of practice in order to improve patient care, and to support innovation in the health system. “Our suite of prescribing programmes adds to our extensive portfolio of clinicallyrelevant, academically-credible programmes, and provides several flexible pathways to the achievement of prescriptive authority for nurses and midwives.” All the programmes have been approved by An Bord Altranais, and may be taken at professional certificate or diploma level or as part of the MSc in Advanced Nursing Practice. Michael Shannon, HSE Interim Nursing and Midwifery Services Director, warmly welcomed the development, which is focused on assisting the HSE in significantly increasing the number of registered nurse prescribers (RNPs) in acute, community, maternity, children’s, mental health and intellectual disability services across the country. This initiative is important in supporting the implementation of the national clinical programmes set out in the HSE Service Plan 2011. For more information visit: www.ucd.ie or email Áine McHugh: aine.mchugh@ucd.ie.

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News // in brief

Hse interiM exeCutive boarD I

rish health services entered a new phase in May with a significant change in the relationship between the Hse and the Minister for Health and Department of Health. Health minister Dr James reilly announced the members of the new interim executive Board of the Hse. He said that the new board would run the health services in a more effective manner “with greater emphasis on service delivery, more integration and less duplication”. the new board would see senior figures from the Department of Health and from the Hse, including clinicians, establish a new, more direct line of accountability between the management of our health services and the Minister for Health. the board is chaired by Dr frank Dolphin, who accepted Minister reilly’s request to remain as chair until its later dissolution. Minister reilly made the announcement of the appointments following discussions with the Chairman and Ceo of the Hse and his secretary general.

Dr reilly also asked the Ceo and the secretary general to review the existing senior management roles and responsibilities in both organisations, to address any duplication of functions and explore the scope for more conjoint working. “I want to develop strong and coherent governance arrangements for the entire healthcare system which will continue to operate after the abolition of the existing legal governance structure,” said Dr reilly.

MeMbership of The new inTeriM hse board: dr frank dolphin, Chairman cathal Magee, Chief executive officer, Hse Michael scanlan, secretary general, Department of Health dr Tony holohan, Chief Medical officer, Department of Health paul barron, assistant secretary, primary Care and eligibility, Department of Health bairbre nicaongusa, Director, office for Disability and Mental Health and Citizen participation, Department of Health

+ frank Dolphin, Chairman of the interim Hse board

dr barry white, Hse National Director, Clinical strategy and programmes dr philip crowley, Hse National Director, Quality and patient safety laverne Mcguinness, Hse National Director, Integrated services – performance and financial Management brian gilroy, Hse National Director, Integrated services – reconfiguration. the remaining two vacancies will be filled in the near future.

nurses assoCiation Celebrates 10tH anniversary MeMBers of tHe Irish anaesthetic and recovery Nurses association recently met with president Mary Mcaleese in Áras an uachtaráin as part of the association’s 10th anniversary celebrations. the association was founded by a group of Cork nurses in 2001. the founders wished to establish a forum for learning and educational support for nurses working in the operating theatre and specialising in anaesthesia and post operative patient care. the association has grown nationally and internationally since, and has established strong links with nurses in the usa, united Kingdom, europe and the australia. Conferences are held annually to provide updated information to nurses and allied professionals working in this

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+ Members of the Irish anaesthetic and recovery Nurses association met president Mary Mcaleese in March to celebrate the 10th anniversary of the association. the gathering included edel silke, Margaret Healy, fionuala o’gorman, grainne Mcpolin (Chairperson), ann Hogan (vice Chairperson), sheila Murphy, lorraine Walsh, prof Josephine Hegarty and Jane Hickey

special area of nursing. the association, which published a journal twice a year, is a registered charity and is non-political;

its principles are based on safe practice through education and learning. for more information, visit www.iarna.ie.

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in brief // News

Masterclasses for Supporting an Unplanned Pregnancy Do you encounter clients with an unplanned pregnancy? In the course of your professional life, do you have some responsibility for supporting people who find themselves in this situation? You may be, for example, a doctor, nurse, social worker, therapist, chaplain, pastoral care worker, youth worker or volunteer. If so, the HSE Crisis Pregnancy Programme – in conjunction with the Department of Adult and Community Education at National University of Ireland Maynooth – has developed a suite of masterclasses which may be of interest to you. The aim of these masterclasses is to create

an opportunity for professionals to gain more in-depth knowledge and skills, to assist them in managing the challenges that present around unplanned pregnancy. These masterclasses further support the work of the HSE Crisis Pregnancy Programme regarding quality and standards development in the broad field of supporting clients with unplanned pregnancy. Masterclass 1: Termination of pregnancy: a lawful choice September 16th 2011; 10.00am - 4.30pm Masterclass 2: Supporting minors in crisis pregnancy

November 4th 2011; 10.00am - 4.30pm Masterclass 3: The role of the father in crisis pregnancy February 3rd 2012; 10.00am - 4.30pm Fee: s30 per masterclass. All masterclasses will be held in the North Campus, NUI Maynooth, Co Kildare. A brochure and application form can be obtained from the HSE Crisis Pregnancy Programme on www.crisispregnancy.ie, or email lynn.dowling@hse.ie. Further information on the work of the HSE Crisis Pregnancy Programme can also be found at www.crisispregnancy.ie.

Irish Heart Foundation F.A.S.T. campaign The Irish Heart Foundation is asking HSE staff to continue to support its F.A.S.T. campaign to help save the lives of stroke sufferers. For anyone not familiar with the campaign, F.A.S.T. stands for: • Face - has their face fallen on one side? Can they smile? • Arms - can they keep both arms raised? • Speech - is their speech slurred? • Time to call 999 if you see any single one of these signs. Many thousands of people have already helped to make this campaign a success – and none with more energy and commitment than those delivering frontline stroke services in the HSE, who led the charge to get the message out loud and clear. Supporters have already distributed over half a million flyers, as well as putting up 50,000 posters in hospitals, offices, shops, libraries, pubs and canteens countrywide. A poll conducted by RED C and the RCSI revealed that right now, Ireland has the highest recorded F.A.S.T. awareness in the world, with 69.8 per cent awareness of two or more warning signs, up from 30.7 per cent before the campaign started in May 2010. Rapid service improvements being delivered by the HSE’s National Stroke

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+ Stroke survivors of all ages launching the Irish Heart Foundation Act F.A.S.T. campaign

Programme will include the delivery of 24/7 thrombolysis in all hospitals admitting acute stroke patients by the end of the year. Stroke is our third biggest killer disease, claiming over 2,000 lives a year, as well as being the largest cause of severe disability. The IHF wants to ensure that the campaign continues to be effective and save lives into the future by developing the capacity of individuals and groups to use the promotional materials to run F.A.S.T. campaigns once a year.

HSE employees - who see the physical, mental and emotional carnage that stroke can wreak - can play a major role. Throughout the summer, the IHF will be supporting the running of local campaigns, big and small, in hospitals, healthcare centres, towns and villages across Ireland. If you would like to run a F.A.S.T. campaign, or to get a copy of the IHF’s Guide to Running a F.A.S.T. Campaign, please contact Sarah Horgan in the Irish Heart Foundation at 01 668 5001, or email: shorgan@irishheart.ie.

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developments

New Guide to Childhood Immunisation Launched Five GP visits are needed to protect children, as figures show drop in uptake of some vaccines.

he HSE National Immunisation Office recently launched a new guide to childhood immunisation for parents, as the latest figures show that while overall immunisation uptake rates are improving, parents need to ensure that children are seen five times by their GP for immunisation in the first 13 months of life in order to be fully protected. The guide, entitled Your Child’s Immunisation – a Guide for Parents, has been produced as a response to the drop in the reported number of children receiving their Hib booster, as well as their third doses of PCV and Men C vaccines which they receive at 12 and 13 months of age, according to head of the HSE National Immunisation Office, Dr Brenda Corcoran. “The guide aims to remind parents that five visits to a GP are necessary in the first 13 months of a child’s life to ensure that they are fully protected against a range of serious, but preventable, diseases. The importance of completing five GP visits is being reinforced by the HSE through a series of information materials including posters, fridge magnets and ‘immunisation passports’ for parents to keep records of what vaccines their children have received. These will be available from public health nurses when they visit parents of newborn babies for the first time, and available to download from www.hse.ie. The publication of Your Child’s Immunisation – a Guide for Parents coincided with the World Health Organization’s (WHO) European Immunisation Week, which ran until April 30th. “Immunisation uptake rates in Ireland have improved over recent years, but are still short of the World Health Organization target of 95 per cent. The HSE Health Protection Surveillance Centre (HPSC) figures for 2010 show that 94 per cent of children are protected against diphtheria, tetanus, whooping cough and polio by the

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+ Dr Brenda Corcoran with Leonore Brichard Rooney at the launch of the HSE’s new information booklet Your Child’s Immunisation – a Guide for Parents time they reach two years of age. This is a great improvement and a credit to parents, GPs and healthcare workers but some work remains to be done,” she says. “Uptake rates for the MMR (measles, mumps and rubella) vaccine have reached 90 per cent, although this is still not sufficient to prevent measles outbreaks. We have seen a number of measles outbreaks

in Ireland in recent years, which could have been prevented if enough children had received the MMR vaccine. “Immunisation is a simple, safe and effective way of protecting children against certain diseases. Vaccines have saved more lives worldwide than any other public health intervention other than the provision of clean water,” Dr Corcoran says.

07/06/2011 12:29:28

Healthcare Management at the IPA

The Whitaker School of Government and Management at the Institute of Public Administration (IPA) offers several part-time programmes in healthcare management. These nationally accredited programmes appeal to those who want to understand the key issues in modern healthcare delivery and bolster their career opportunities. IPA Healthcare Management Programmes Certificate in Health Services

Diploma in Healthcare Management

Diploma in Health Services Policy

BA (Hons) - Healthcare Management

Diploma in Health Economics

MA - Healthcare Management

These programmes are... part-time delivered in flexible, student friendly ways keenly priced

between levels 6 and 9 on the National Framework of Qualifications (NFQ) designed to allow students progress from Certificates to MA qualifications

So, wherever you work and whatever your responsibilities, make 2011 the year you return to education, obtain new qualifications, and re-charge your health services career. IPA Healthcare Management programmes commencing September 2011.

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information@ipa.ie

www.ipa.ie

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developments

Progressing Disability Services for Children and Young People A national programme called Progressing Disability Services for Children and Young People has been designed to change the way disability services are provided across the country. Caroline Cantan, National Project Co-ordinator, outlines the vision behind the new programme.

f your child has a disability, getting the services you need shouldnâ&#x20AC;&#x2122;t depend on where you live or the nature of your childâ&#x20AC;&#x2122;s difficulty. Disability services for children have a long history in Ireland and many organisations provide excellent support for children and their families. They have a high level of expertise and family-centred interdisciplinary teams, with nearly everything provided in one location. This is unlike the fractured way services are delivered in some other countries, which means that families have to travel to many different centres to get the services their child needs. But because services in Ireland have each developed independently and may look after only one specific group of children who have a particular disability, there is wide variation in the services available in different parts of the country and for different categories of disability. For instance, there may be a service for children with an intellectual disability in your

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locality, but none for children with a physical disability or with autism. As a consequence of this unco-ordinated development some children and their families have little or no service at all that they can access. We need a more equitable and consistent way to provide services for children with disabilities, and must work together to achieve the greatest benefit possible within our resources. A national programme has been launched which will change the way services are provided across the country. It is based on the recommendations of the Report of the National Reference Group on Multidisciplinary Services for Children Aged 5-18 Years, produced by representatives of the professions and management involved in delivering multi-disciplinary services to children.

How will services be organised in the future? Many children with delays in development

can be cared for by their local primary care team, but we need early intervention and school age disability teams in each network area to provide a more specialised service for children who require it. If there is one clear care pathway for all children with disabilities living in a locality, health professionals and parents will know where a child should be referred, it will be reasonably close to home, and no family will be left without a service to go to. As the primary care and network teams will be looking after children with a wide range of difficulties, they need to be supported by specialist services in fields requiring a high level of expertise. Examples of these areas are high-tech assistive technology and programmes for managing challenging behaviour. The specialist services will be involved in consultation and training for health professionals at primary and network level, as well as providing direct intervention with children when needed. Health services also need to develop close relationships with schools and to work together to make sure children with disabilities can make the very most of their education.

How will we get there? A National Co-ordinating Group has been meeting for almost a year, forming a project plan and producing guidelines for local services. The national group, including leads for each region, will be monitoring progress across the country. Representatives from services and parents will be brought together in each area by local leads for the project, to see how current services can be reorganised to achieve this improved structure. This will include finding out what is currently available for children with disabilities, planning how best to use these resources, and making sure throughout that there is good consultation and communication. Because there will be

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94 Health Matters

developments guidance and direction from the national level of the project, local areas will have support and assistance and there will be a consistent approach throughout the country. Agencies in some areas such as in the mid-west, north-east and west of the country have already reconfigured to provide a unified way of delivering services. While in each case they say that the change took effort, commitment and persistence and that more still needs to be done, they have found that it has resulted in a much improved way of providing accessible comprehensive services which address the needs of all children with disabilities. The experiences of staff and parents will be of great assistance to others as they plan what needs to be done and how to go about it in their own local area.

The vision for when the programme is completed: • One clear pathway to services for all children with disabilities according to need • Resources used to the greatest benefit for all children and families • Health and education working together to support children to achieve their potential Limited resources are of course an issue, and it may take a long time to achieve a comprehensive service structure throughout the country. However, if we have the vision of where we want to be, we can put the pieces in place according to this picture until we accomplish the whole.

“We need a more equitable and consistent way to provide services for children with disabilities, and must work together to achieve the greatest benefit possible within our resources.”

National Co-ordinating Group Breda Crehan Roche - Chief Executive Officer, Ability West (Chair) Barbara Bolger - HSE Regional Specialist Primary Care Grainne Bray - Director of Beechpark Autism Service, HSE Dublin Mid Leinster Caroline Cantan - National Project Co-ordinator Maureen Costello - Director, National Educational Psychological Service Aisling Curley - Department of Education and Skills Brendan Doody - Director of Child and Adolescent Mental Health Services Toni Gleeson - Support Officer, Disability Federation of Ireland Owen Hensey - Consultant Paediatrician, Children’s University Hospital Temple Street and Medical Director, Central Remedial Clinic Gabrielle Jacob - Office for Disability and Mental Health, Department of Health and Children Libby Kinneen - Organisation Development and Design Unit, HSE West Breda Long - Co-ordinator, Early Intervention Services Cork Lorraine Mangan - Disability Federation of Ireland Parent Representative Anne Melly - Regional Lead for Project in Dublin North East Suzanne Moloney – Regional Lead for Project in South Jacqueline Nix - HSE Human Resources Bernie Nyhan - Disability Services Manager, HSE Dublin South West and Regional Lead for Project in Dublin Mid Leinster Anne O’Byrne - Not For Profit Business Association Parent Representative Fionnuala O’Donovan - Not for Profit Business Association Michael Shemeld - National Disability Unit, HSE Aoife Thornton - Inclusion Ireland Maria Walls - Director of Research and Policy Development, Federation of Voluntary Bodies

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More information about this programme can be found on the HSE Learning and Development website www.hseland.ie You can enrol and then visit the Change Hub and scroll down from the reconfiguration section to Progressing Children’s Disability Services. Caroline Cantan has worked in Enable Ireland Children’s Service in Tallaght in Dublin for over 15 years, the first ten as social worker and since then as clinical coordinator. Email: ccantan@enableireland.ie.

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developments

National Clinical Programmes Will Save Lives and Achieve Success As the first set of National Clinical Programmes initiated by Dr Barry White, National Director for Clinical Strategy and Programmes, are beginning to be implemented, Paul Rafferty, Programme Manager, outlines the implementation approach.

ational Clinical Programmes have been designed to improve patient services in a variety of areas including stroke, heart failure, diabetes, lung disease, epilepsy, elective surgery, emergency medicine, acute medicine and primary care. How do we encourage local ownership and motivation for implementing the programmes, particularly when people are suffering from initiative fatigue and are working in a challenging economic environment? We hope that our staff will discover the value and merits of the programmes themselves, and we are confident that staff will get involved because they believe it is the right thing to do irrespective of the obstacles faced. The success of the programmes to date has been that they have grown organically. The programmes started with Dr White, motivated by his own experience of working in the health service, wanting to make the health service a better experience for his colleagues and his patients. Inspired by the clinical leadership model for change established by Prof Tom Keane in the National Cancer Control Programme, he sought to adapt this model for change in other areas of clinical services. With the assistance of the colleges and professional representative bodies, multidisciplinary teams were developed around key clinical services and patient conditions. Reference groups for patients, nurses, allied health professionals, GPs and doctors were established so that as many people as possible could be engaged in the development of the programme solutions. The desire to make a difference based around a common set of objectives and principles continues to spread. With the support of Cathal Magee, CEO of the HSE, his management team and

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the regional directors of operations, the programmes were placed at the centre of the 2011 Service Plan. Dr James Reilly, Minister for Health, has recently also articulated his public support for the programmes. I see the programmes not so much as a set of solutions to improve the quality, access and cost of clinical services, but as a movement or coalition for making clinician and patient experience better - a coalition that is growing organically. Recently, one of the national programme leads put it better than I could when he identified what he believed were the benefits of the programmes to date. He felt that they: • provided a working partnership model with a high likelihood of success • engaged the expertise and goodwill of the ‘silent majority’ • helped to build trust and positive working relationships • engendered optimism despite budget and salary reductions

Our mantra regarding the programmes from day one has been: • You get 5 per cent of the marks for developing a solution • 45 per cent of the marks for implementing it and 50 per cent of the marks for sustaining it Many of the programmes have got their 5 per cent for solution development. However, to achieve the next 45 per cent

“The desire to make a difference based around a common set of objectives and principles began to spread.”

07/06/2011 12:29:37

HRB Research 188x130.pdf

23/05/2011

10:10:22

Encouragement really works Simply telling a first time mum that she’s doing a good job can greatly reduce her chances of postnatal depression; while Type 2 diabetes patients take better control of their disease when given encouragement and support to do so. Both findings could help to make significant cost savings. ‘You might say that the old adage ‘a little kindness goes a long way’, seems to be true” says Enda Connolly, Chief Executive at the HRB. “Two HRB-funded research projects with completely different patient profiles have demonstrated both a positive patient impact, and reduced costs, through changing the approach used in supporting patients.” Dr Patricia Leahy-Warren at UCC found that first time mothers who had low levels of professional support at birth had nearly three times the risk of being

depressed at 12 weeks, than those who received good support. Strikingly, mothers who got little social support (from partners, parents, close friends etc.,) in the form of people Dr Patricia Leahy-Warren simply letting them know they were doing a good job, had nearly nine times the risk of being depressed at 12 weeks when compared with mothers who had high levels of such appraisal. Dr Susan Smith and Dr Karen Keogh and their team at Trinity College worked with patients with poorly controlled Type 2 diabetes. Their research found that patients who received additional motivational interviews to tackle false beliefs about

diabetes had better blood sugar control, psychological wellbeing, and were taking on board diet and exercise recommendations more readily than those who received the ‘usual’ treatment. Connolly adds, “The research shows that if the correct approach is taken in supporting patients, they can be empowered to take better control of their situation, improve their outcome and reduce down-theline impact on services. Both stories are featured in the Picture of Health 2010 published by the HRB.” The Picture of Health is available on the HRB website at www.hrb.ie/pictureofhealth2010

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developments

Key Solution Areas A range of the programmes have completed their design phase, received sign-off of their solutions and have been included in the Service Plan for 2011. The key steps for implementing the programmes, and the key solutions, are listed here. Examples of programmes which are implementing in 2011 include:

Programme

Example Objectives

Stroke

Save a life from stroke a day.

Nine new stroke units and standardise 18 existing units. 24/7 access to stroke thrombolysis nationally.

Every patient with heart failure is managed within a structured programme

Hospital HF units in place in 15 units by end of 2011. Develop primary care diagnostic model.

Diabetes

40 per cent reduction in annual incidents of new blindness due to diabetic retinopathy by end of year 5. 40 per cent reduction in the number of lower limb amputations due to discharges by end of year 5.

Rollout of National Retinopathy Screening Programme. Rollout of national multidisciplinary footcare.

COPD

To save 50 deaths a year from COPD.

Establish 12 COPD outreach centres.

Epilepsy

Reduction in number of deaths from epilepsy by one third. Rendering of 2,000 patients seizure-free.

Six new regional epilepsy centres. Roll out of population-based ambulatory nursing service.

Elective Surgery

Reduce wait time for elective surgery.

Implementation of national targets for average length of stay and day case rates Roll out of productive theatre series and surgical audit.

Emergency Medicine

Improve the safety and quality of care in emergency departments and reduce waiting times for patients.

Implementation of a standardised model of care.

Acute Medicine

Timely assessment of patients by appropriate senior clinician to enable early discharge and reduce average length of stay.

Implementation of standardised acute medicine model and pathway.

Primary Care

Integrate chronic disease management to reduce hospital admission.

Piloting of structured chronic disease management programme by GPs.

Heart Failure it is important to have local and regional change structure and planning discipline for implementing the programmes. But we will only achieve full marks if people at a local level believe it is worth doing and are motivated to step forward and bring about the change that the programmes offer. We welcome your support and your guidance.

Key Steps The key steps in the implementation strategy for the programmes listed in the 2011 service plan are: • Local change governance for the implementation of the programmes is established and agreement on what programme is to be implemented, in which site is agreed with local management, programmes and regional director of operations • Local clinical leads and teams adapt national models of care locally and agree variation in model with national programme leads • Quality, access and cost baseline measurement is set at local level against agreed key programme metrics • Local implementation plans and targets are agreed with the national programme leads and regional directors of operation • Implementation is tracked and coordinated through local and regional programme managers • Post-implementation, the national clinical programmes audit a site to confirm model of care is operating to agreed standard • Performance against agreed targets is monitored per the normal regional and national performance reporting structure.

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Key Solution Areas

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developments

Clinical Deterioration: National Early Warning Scoring System Agreed A national early warning scoring system to ensure the prompt identification and management of clinically deteriorating patients was agreed at a HSE National Governance Group meeting in April.

he new national early warning scoring system was agreed in conjunction with an interdisciplinary education programme which will focus on improving staff understanding of deterioration in patients’ conditions and the significance of altered vital signs such as blood pressure, pulse and respirations, for example. The programme also seeks to improve communication between hospital staff in terms of the timely management of patients. The education programme has been developed in conjunction with a modified early warning score. The early warning score system allocates points to routine measurements of vital signs, on the basis of their difference from the agreed ‘normal’ range. These points are added together to give a total early warning score for each patient. The score assists early detection of patient deterioration by categorising the patient’s severity of illness and prompting nursing staff to request a medical review at defined stages. Patient deterioration can occur at any stage of a patient’s illness, and it is important that this is detected as early as possible with appropriate action taken by hospital staff. In a recent report, the Health Information and Quality Authority (HIQA) recommended that the HSE should, as a priority, agree and implement a national early warning score to ensure that there is a system of care in place for the prompt identification and management of clinically deteriorating patients. The education programme for the

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modified early warning score has been adapted to suit the Irish context, incorporating NICE G 50 guidelines and escalation plans which are relevant to different models of hospitals, as defined by the National Acute Medicine Programme. The programme will shortly be available on the HSE website, www.hse.ie. This initiative is one of the work streams of the Acute Medicine Programme in association with the National Critical Care Programme, the National Emergency Medicine Programme, the National Elective Surgery programmes, the National Office of the Nursing and Midwifery Services Director, the Clinical Indemnity Scheme, the National Lead for Acute Hospital Services, the Quality

and Patient Safety Directorate, the Irish Association of Directors of Nursing and Midwifery (IADNAM) and the Allied Health and Therapy Professionals. Prof Shane O’Neill and Prof Garry Courtney are the national sponsors for this project. Further information is available from: Eilish Croke, National Lead - Early Warning Score project: eilish.croke@hse.ie or Avilene Casey, Chairperson of the Advisory Group avilene.casey@hse.ie. Ms Casey is also Project Manager for the Implementation of the National Early Warning Score and Education Programme.

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developments

Serious Incident Management Team Hosts Look-Back Review Exercise The HSE Serious Incident Management Team (SIMT) recently hosted an event to train almost 80 senior staff, from both community and acute hospital settings, on how and when senior managers should make the decision to conduct a look-back review as part of the overall management of serious incidents in line with national policy, governance and reporting arrangements.

he half-day event, held in May in the boardroom in Dr Steevens Hospital, was designed to be highly participative with attendees working in groups of ten to simulate the factors effecting the decision to conduct, plan and manage a look-back review. Dr Philip Crowley, National Director of Quality and Patient Safety, took the opportunity to welcome those present to the event and outlined his vision of the patient safety agenda for the HSE. Ms Cora McCaughan, Head of the Serious Incident Management Team, began the morning by describing that a look back review is undertaken when there are concerns that a number of people have been exposed to a risk of harm, and as an organisation we need to learn who has been exposed, what proportion of those exposed have actually been harmed, and how we need to take care of them going forward. Ms McCaughan emphasised that a look back review is not always required and if a look back review is conducted, it is always part of a wider investigation to determine why patients or clients were exposed to harm. Ms McCaughan referred to Dr Crowley’s introduction on the values that underpin the HSE’s Quality and Patient Safety agenda, including the HSE’s commitment to identify individuals harmed and take care of any such individuals going forward. Ms. McCaughan also told attendees that if there is evidence that people have been harmed we need to do a look-back review and to be meticulous in our public communications so that while people will naturally be concerned we do not cause unnecessary concern.

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The event was designed to be highly participative, with attendees working in groups of ten to simulate the factors effecting the decision to conduct, plan and manage a look-back review

Each team on the day was made up of the range of individuals that would make up an incident management team within a health service and included clinicians, allied health professionals, senior managers, communications experts, quality and risk personnel and senior administrative staff. Members of the Serious Incident Management Team worked with each table to provide expert advice throughout the exercises. Dr Joe Devlin and Cora McCaughan finished the training exercise by leading the room in a discussion and responding

to any questions raised throughout the day. Dr Devlin highlighted the existence of individuals with responsibility for Quality and Risk in each of the four RDO areas that are available, with the National Incident Management Team (NIMT), for support and advice on such matters through the RDO offices. Dr Devlin also emphasised that the decision to undertake a look-back review is always made in consultation with the NIMT/SIMT. The SIMT hopes to link with regional offices to roll-out the training exercise to staff that were not able to attend the recent event.

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New s25m Primary Healthcare Centre opens in Mallow A wide range of patient services and clinics are now being provided at one of the largest primary healthcare centres in the country, in Mallow, Co. Cork, which was officially opened in April by Dr James Reilly, Minister for Health.

he state-of-the-art development at Mallow is part of a strategy to radically enhance primary care services around the country, by meeting a variety of patient requirements at one central location. Almost 140 HSE staff are working closely with three Mallow-based GP group practices – The Medical Centre, The Cork Road Clinic and The Red House Family Practice, all based at the centre. At the Mallow Primary Healthcare Centre (MPHC), three HSE Primary Care Teams, in conjunction with GP practices, deliver key services to patients living throughout the north Cork region. The Mallow facility allows health professionals to work together to provide care for the community on the basis of locally identified needs and priorities, and to work in close collaboration with the local authorities, community groups and nongovernmental agencies. It presents the best opportunity to ensure the HSE, and health providers locally, respond to local demands and that people in Mallow feel that they can effectively influence and shape their local services. Commenting on the development Pat Healy, Regional Director of Operations, HSE South said: “The development of MPHC has enabled the HSE to provide a range of services in one centralised location. The new Primary Care Centre in Mallow sees greater collaboration between the GPs and the HSE services; something that is of enormous benefit to patients. The amalgamation of these and other services has allowed us to provide many new initiatives including a groundbreaking project on infant mental health which promotes social and emotional experiences in children,” he says. “We have also commenced a project that supports patients with early onset

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Pictured at the opening of the Mallow PCT with Minister for Health Dr James Reilly are (L-R): Dr Rosarie Crowley, Clinical Psychologist; Sheena Cadoo, Senior Occupational Therapist; Deirdre Scully, Operations Manager, Primary and Community Care Services; Yvonne Finn Orde, General Manager, North Cork/North Lee; Deirdre Madden, Area Administrator; and Mary Patton, Senior Executive Officer

dementia, as well as the employment of a research officer, funded by the HSE, working in collaboration with the GPs and UCC on various research projects demonstrating the efficacy of joint working in primary care.” Prior to the development of the new facility, some services were fragmented across several sites, creating problems for patients trying to access services and difficulties for health professionals involved in teamwork. Healy explains: “The development of this centre ensures that people can receive a wide range of services as close to home as possible from a team of professionals, working together to serve the population of Mallow and beyond and this will work as a building block for further developments in the area.”

Services Provided Three PCTs are located in the building and staff have been reconfigured, including community nursing staff, occupational therapists, physiotherapists and a home help co-ordinator. In addition, podiatrists, dieticians, psychologists, speech and language therapists, a community worker and a traveller health primary health care worker are also based in the building. Administration support has been reconfigured, with each PCT having dedicated clerical support ensuring that the disciplines work in a team. The centre has been equipped to provide clinical areas for nursing services, which include wound care clinics. Services such as occupational therapy have for the first time been provided with dedicated clinical areas, thus reducing the need for travel

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developments

A Day at Mallow Primary Healthcare Centre Dr Rosarie Crowley, Clinical Psychologist, describes a typical working day for her at Mallow Primary Healthcare Centre.

Dr Rosarie Crowley, Clinical Psychologist and Sheena Cadoo, Senior Occupational Therapist

and enabling more client appointments. An orthotics workshop has been provided for podiatry – the first of its kind in north Cork. On-site mental health services provide: • Outpatient clinics • Social work service • Occupational therapy service • Clinical nurse specialist – counselling and behaviour therapy • Community mental health nursing • Clinical psychology service HSE community medicine, school

nursing services, childhood immunisations and child development clinics are also provided in the facility. Southdoc has relocated to the facility, with HSE staff using the Southdoc facility during office hours. Cork University Maternity Hospital provides antenatal outreach clinics. Outpatient ophthalmology services are also provided from this area and it is hoped to increase outreach acute services.

9am: Meeting about an upcoming diabetes programme with a GP, a dietician and a researcher. Meetings with community groups and other health professionals are an important part of my work. I work with people with difficulties including social and emotional difficulties, stress and depression. Appointments are typically between one and one and a half hours long and today I had four varied client appointments. 10am: Appointment giving feedback to parents on the results of their child’s psychological assessment. Interviews, observations and standardised questionnaires were employed, looking at home and school settings. The child’s strengths and difficulties were discussed and areas for intervention were identified. 11am: Two concurrent appointments with adults whose difficulties include depression and stress. I use a cognitive behaviour therapy (CBT) model with both these clients. CBT is a type of speech therapy that focuses on improving current difficulties by helping people to change how they think and what they do. Research has shown that CBT can help with many difficulties like, anxiety, depression, phobias and stress. 2.30pm: I had an appointment with a young person, looking at coping skills to help with anxiety. Part of our work has involved using reading materials that explain what anxiety is and how to tackle it. This approach is known as bibliotherapy. 4PM: Follow-up on various clients.

Ger Reaney, HSE Area Manager, Cork, speaking at the official opening of Mallow Primary Healthcare Centre

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Research and Education The Education Centre’s vision at MPHC is to encourage staff to learn from each other and gain a greater understanding

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developments

of each otherâ&#x20AC;&#x2122;s role. The centre provides clinical placements for medical, nursing, occupational therapy and speech and language therapy students. A researcher is working in collaboration with the GPs, UCC and HSE members of the PCTs on various research projects, demonstrating the efficacy of joint working in primary care.

EARLI Questionnaire It is hoped that through the use of Emergency Admission Risk Likelihood Index (EARLI), the centre will be able to replicate significant reductions of emergency admissions for the over 70 age group in the Mallow area. It is expected that over 1,000 community dwelling adults will be asked to take part. This research is based on the completion of a simple seven point validated questionnaire, which identifies those at high risk and risk of emergency hospitalisation. Hospital â&#x20AC;&#x2DC;in-reachâ&#x20AC;&#x2122; by PHCTs will also reduce the length of stay if a person goes into hospital unexpectedly. Compliance Study Selected patients will form two groups, and based on three medications, one group will be sent a text message with a general reminder about the importance of taking medications appropriately, and any further necessary information. The other group will be a control group, and will receive no text message. This service will run for three months, after which both groups will take part in a survey to identify any changes in compliance, or if there has been an improvement in compliance. It is hoped that this service will improve compliance and become standard practice at MPHC. Family Intervention Programme for Diabetes Type 2 and Impaired Glucose Tolerance This intervention programme will run initially for six months and will approach those with diabetes and their families to come to the centre once a month to take part in sessions delivered by Primary Care Team members. This will have a strong research element, with structured interviews, questionnaires, and blood, weight, and BMI tests carried out before and after the family intervention programme.

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Dr James Reilly TD, Minister for Health, speaking at the official opening of Mallow Primary Healthcare Centre

The Community Psychology Department has been involved in an Infant Mental Health Project for the past five years, and this is being conducted in collaboration with the University of Minnesota and an Infant Mental Health Affiliate has been established in Ireland with north Cork as the lead. The Community Occupational Therapy Department is also conducting a dementia

project, and a dedicated occupational therapist has been assigned to carry out work to look at ways of providing support to clients with early onset dementia and their families and carers. The Nutritional and Dietetics Department will carry out the expert programme in collaboration with podiatry, occupational therapy and physiotherapy.

Patient benefits The Mallow Primary Care Centre is the first point of contact that clients have with the health service. There are many advantages and benefits to this approach including:

Integrated Care As all health professionals are co-located, this leads to a more co-ordinated approach to healthcare. As all services are within one building, this leads to a streamlined and seamless service provision. Prevent Hospital Admissions The range of services provided in this centre allows for an enhanced local health service. Instead of an immediate referral to hospital, patients and clients will be treated locally, in as far as is possible. Simple routine procedures can now take place closer to home.

Early Discharge from Hospital The Primary Care Team work together to ensure that when an individual is, for example, ready for hospital discharge, the local services required are also prepared and have developed an individualised care plan. Health Prevention and Promotion This Primary Care Centre has a significant role in treating the unwell, but it also has a role in maintaining a healthy community in Mallow through health prevention and promotion projects. This includes programmes, such as healthy eating, mental health initiatives, falls prevention, cardiac rehabilitation and breastfeeding support. The local community can expect easier access to health services from a team of health professionals working together with better health outcomes as a result for the greater Mallow population.

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feature

Raising Standards in Home Care Standardising how home care packages are provided across the country will help to raise standards within the sector, says Noel Mulvihill, HSE Assistant National Director for Older Persons Services.

that for the first time, no matter where in the country a person lives, they will receive the same needs assessment to determine what level of support is needed. An information booklet and details on the Home Care Package Scheme is available at http://www.hse.ie/go/ homecarepackages.

ÂŠistockphoto.com/AvailableLight

he Home Care Package Scheme provides enhanced home care services for people who require additional and specialist support in a home care setting. These enhanced services may include nursing, allied therapy services, daycare, respite care and additional home help support. The home care sector has grown significantly in recent years, and the HSE is now in the process of standardising how home care packages are provided across the country. This is to ensure that whether a client receives a service from the HSE directly or from a funded organisation, they can be assured that the services - and the staff providing them - are of a high quality and that minimum standards are in place.

Demand The demand for home care services has increased in recent years, and there is a

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need to provide high quality and flexible services that meet the needs of clients. The HSE is undertaking a range of work in relation to home help services and home care packages in order to standardise the services provided across the country and drive improvements in the services - in the interests of clients. This year the HSE will spend s211 million on home help services and s138m on home care packages. Almost 12m home help hours will be provided to an estimated 54,000 clients in 2011. In addition, home care packages will benefit approximately 14,600 clients in supporting people to continue living in their own home or to return home from hospital. A standard framework and guidelines for the implementation of the Home Care Packages Scheme are now used by all staff to support its implementation uniformly across the HSE. This means

Standards To ensure that all providers of home care packages meet agreed minimum standards, the HSE is currently in the process of conducting a comprehensive nationwide tender process for enhanced home care packages. When the tender is complete and agreements are in place, there will be four approved providers for home care packages in each local HSE area. Once a standard needs assessment has been completed and the home care package has been approved, clients will be able to access services from the HSE direct provision when appropriate, or from the list of approved providers in their area. This will bring a new level of transparency, consistency and standards to home care packages as well as greater choice for clients. The tender process is strictly governed by EU procurement regulations and is in line with HSE procurement policies. Future Clients Approximately 75 per cent of all home help services are provided directly by HSE staff, who provide high quality services to people in their own homes. These home help services will not be affected by the current tender process, which is solely for future home care package scheme clients. In addition to HSE directly provided services, home help services and home care packages are also provided through a range of voluntary organisations and private providers, both of which are funded by the HSE.

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Developments

a firM footing for PoDiatry in irelanD the new Podiatry Clinic in galway is providing a high standard of evidence-based podiatric care, as well as providing clinical placements for students studying the bsc Programme in Podiatry at nui galway. the clinic is fully funded by the Hse and is quickly becoming a centre of excellence for podiatry, offering the highest level of podiatry care for clients in galway, Hse west and beyond.

n the last issue of Health Matters we reported on the new clinic in galway that is offering the only podiatry Degree course in the country. Most people are aware of chiropody, which tends to refer to the nail, corn and callous care and although podiatrists are trained to provide this aspect of care, podiatry is a health care profession that specialises in the management of diseases and disorders of the lower limb and foot. In particular, podiatry services are important to diabetic clients as they have an increased risk of developing foot complications, and in some cases this can lead to foot ulcers. If these are not managed quickly and efficiently it can lead to poor outcomes for clients.

â&#x20AC;&#x153;the hse has developed a diabetes foot care model with foot care teams strategically placed around the country to manage problems as they develop.â&#x20AC;?

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the new podiatry Clinic in Merlin park

provision of healTh prevention is always better than cure, and it is the same with the diabetic foot. as the diabetes population increases, earlier screening and intervention reduces the risks of complications in later life. the Hse has developed a diabetes foot care model with foot care teams strategically placed around the country to manage problems as they develop. through appropriate screening and the provision of health promotion advice in the community it is hoped that clients do not develop problems in the first place. podiatrists are trained to carry out full assessments on clients when the screening suggests that there might be a problem. they can accurately pinpoint

any blood supply or nerve supply issues to the lower limb, help the client avoid any further complications and track any progression of the problem.

clinical innovaTion in diabeTes fooT care in galway Dr sean Dinneen, Consultant endocrinologist at university Hospital galway and his team have set up a new initiative called the Diabetes foot round where a multidisciplinary team is notified and then assesses every diabetic client who is admitted into the hospital with a foot ulcer. the team agrees a management plan and implements it with the aim of decreasing the length of stay in hospital for the client but also, where possible, to avoid amputation.

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Developments

Clinical staff from Merlin park podiatry Clinic graduating from NuI galway with post graduate Diplomas in Clinical education (l-r): louise Hepworth, senior podiatrist; David Watterson, podiatry Clinical Manager; and lynda Donnellan, senior podiatrist

In tandem with this, Dr David gallagher, registrar Infectious Diseases, uHg has started a high risk diabetes clinic in the podiatry facility. this clinic allows him the opportunity to hold a regular hospital outpatients clinic but also be on hand for any high risk community clients that

attend the podiatry clinic on that day. according to David Watterson, podiatry Clinical Manager, “this simple innovation really demonstrates the integrated model, with community staff working as part of a foot care team in the hospital setting, and traditionally hospital-based consultants

Members of the Hse West Diabetes Implementation group on a tour of the new podiatry Clinic (l-r): David Watterson, podiatry Clinical Manager; vincent Jordan, project Manager, Hse Information services; Dr Cathy McHugh, Consultant endocrinologist, sligo general Hospital; Dr David gallagher, registrar Infectious Diseases, uHg; Dr sean Dinneen, Consultant endocrinologist, uHg; and professor Dick firth, Consultant endocrinologist

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and registrars working in the community setting. the focus is on keeping the client at the centre of the process.” While across the country not all areas have access to a facility like the podiatry Clinic in galway, they will in the future have access to a podiatrist who will have the skills and expertise to help manage diabetic foot problems.

“this simple innovation really demonstrates the integrated model, with community staff working as part of a foot care team in the hospital setting, and traditionally hospitalbased consultants and registrars working in the community setting. the focus is on keeping the client at the centre of the process.” hse podiaTry posTs the Hse has a diabetes programme dedicated to developing services required to manage the growing problem of diabetes in Ireland. the programme has acknowledged that podiatry is an essential requirement of their foot protection team and has provided s1m to fund 16 Hse podiatry posts across the country. the posts are being advertised soon with the aim to have people in post before october 2011. David Watterson said: “this is a great step forward for the profession, but also for the diabetes population in Ireland. seek out the new or existing podiatry services in your area, and see how they can work with you to improve the outcome for some of the diabetics with foot problems that we all see on a daily basis.”

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developments

Working Together on Dual Diagnosis Clinicians are collaborating to develop a dual diagnosis pathway for mental health and addiction.

xperiencing addiction and mental health issues simultaneously can be very challenging for clients and their families. Two Cork-based clinicians with support from their respective teams have set about responding to the area of ‘dual diagnosis’, with best practice in mind. Their vision suggests that mental health and addiction can be successfully responded to in a collaborative and creative fashion, thereby reducing the demand on inpatient facilities. The mental health policy document Vision for Change suggests that if best practice and needs-led services are to be delivered, then multi-disciplinary teams should operate in a truly integrated way, and access to talk therapies should be made more available. Client participation should be paramount, and a recovery approach ethos should be embraced. Traditionally mental health services were based in inpatient units, and addiction services delivered from specialised treatment centres and out-reach services, but the rolling out of primary care teams provides an environment in which dual diagnosis services in the wider community can evolve. In the Togher/Ballyphehane area of Cork city, mental health and substance abuse professionals are working together to help addicts with mental health issues. Communication between the different professionals has been enhanced, allowing for the development of an integrated plan of care for clients. Historically, referrals between the addiction and the mental health services were often delayed. Lengthy waiting lists became a barrier to maintaining the initial motivation with which clients presented, and opportunities for recovery were often missed. In order to avoid this, the clinicians – John Connolly, a primary care addiction counsellor and Declan McCarthy, a mental health clinical nurse manager, with supervision from the consultant psychiatrist Dr Ann Duane commenced joint visits to the acute local inpatient mental health facility, and conducted joint assessments in the community in the

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L-R: John Connolly, Rick Deady and Declan McCarthy, authors of the peer-reviewed dual diagnosis paper

immediate phase of the referral. The referrals were then discussed at multidisciplinary team level, allowing for an integrated dual diagnosis care plan to be implemented.

Pooling Knowledge The clinicians met weekly to pool their professional knowledge, and it became evident that the integrated approach to care was beginning to save time and resources. These changes in work practices such as sharing roles, co-management of clients and a willingness to learn from each other were highlighted in a Powerpoint presentation to the wider Togher/ Ballyphehane Primary Care Team. A degree of scepticism was expressed at first. However, it emerged that mental health and addiction professionals shared more similarities than differences in their working with the dual diagnosed client. The two clinicians completed a dual diagnosis training programme. From this training, three fundamental elements emerged: • Their individual skills and knowledge were of great value to each other in practice • A community-based programme for dual diagnosis was possible • The formal development of policy and procedures was required. Within the South Lee Mental Health and

Primary Care Addiction Services, the work of the two clinicians has been reconfigured to allow the collaborative approach to develop. The initiative was recently profiled further when the clinicians, joined by Rick Deady of University College Cork (UCC), published a peer-reviewed article illustrating the developments in this specialised area (see reference below). While this dual diagnosis service has not yet secured funding for a specific research study, informal qualitative data from a number of clients has been collated. Some of this data suggests that a dual diagnosis service in this community setting can greatly benefit the client and his or her family. The challenge now for the clinicians and the service at large is to secure funding, time and resources so that the clients and their families who need this service can receive a comprehensive response.

Reference: Connolly J., McCarthy D., & Deady R. (2010) The emergence of a dual diagnosis pathway within a primary care setting in Cork, Ireland. Pier Publishing Ltd. Advances in Dual Diagnosis Vol. 3 (3). For further information you can contact: John.Connolly@hse.ie 087 648 6432 Declan.McCarthy1@hse.ie 086 728 1414

07/06/2011 12:30:14

maternity &

materni ty & infant magazin e on sale now!

Paediatrician of the Year

Whether it is being supportive, compassionate or going beyond the call of duty, paediatricians provide expert medical advice. Tell us about your colleague or peer and why they deserve the title of Paediatrician of the Year! We donâ&#x20AC;&#x2122;t just recognise paediatricians â&#x20AC;&#x201C; we are also looking for nominations for Midwife of the Year, Nurse of the Year and Obstetrician of the Year! Nominations are quick and easy through our website at www.maternityandinfant.ie and our Facebook page at www.facebook.com/maternityandinfant You can also vote for your favourite products and services for mums and babies. Vote now for a chance to win an annual pass to Dublin Zoo and a family weekend away! For all enquiries please contact Madeleine Derer on (01) 432 2250 or email madeleine.derer@ashville.com. The Awards will take place on November 18th, 2011, at the Shelbourne Hotel, Dublin. Sponsors

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NOWDOC

NoWDOC and the RCGP Quality Assurance Accreditation Award NoWDOC, a GP co-operative providing urgent out-of-hours GP care to patients in the north west, was recently presented with a Quality Assurance Accreditation Award. Angela Tysall, who was the HSE Service Manager for the NoWDOC Service during the accreditation process, describes the experience.

he NoWDOC journey to accreditation started in 2007 when we began working with CAWT* to set up a cross-border GP out-of-hours service for patients living in designated border areas in Co. Donegal. It became apparent to us that patients were accessing GP out-of-hours care on both sides of the border and that the service being accessed in Northern Ireland was quality assured with strict quality standards in place. We felt that in order to develop the NoWDOC service and other cross border services, we needed to demonstrate that the standards we work to are recognised as equivalent and acceptable to those in Northern Ireland. At this stage we made contact with the RCGP and started working with them to adapt their accreditation programme for suitability to the Republic of Ireland setting. The RCGP Quality Assurance Accreditation programme sets out 73 standards and these standards ensure that the GP out-ofhours service meets legal and professional requirements; ensures that risks to patients and staff are managed and minimised; and that the service meets the requirements of the clinical governance agenda. The essential features of the programme are that it is professionally led and multidisciplinary in nature with a focus on the activities of the entire out-of-hours team and the service delivered to patients. The accreditation process involves written submissions and an external peer review involving a detailed site visit, interviews with the co-op management, GPs, reception and clerical staff as well as conducting vehicle inspection and interviews with drivers. Our multi-disciplinary team worked

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on developing and improving systems in the service for two years in preparation for the assessment by the RCGP. We experienced tangible quality improvements within the service while preparing for accreditation and it was a very positive experience for the staff and GPs involved. We were well supported during this time by the RCGP and the ethos was very definitely formative, educative and supportive. Our site assessment took place in

â&#x20AC;&#x153;It is very important to us that patient care and the patient experience is central to how we organise and develop our service and that patients are involved in this process.â&#x20AC;?

access issues, sensory problems and disabilities are well cared for. It is a source of tremendous professional satisfaction for everyone in NoWDOC to be able to demonstrate to others that we provide a high quality service. It is very important to us that patient care and the patient experience is central to how we organise and develop our service and that patients are involved in this process. If anyone is interested in finding out more about the accreditation award and the NoWDOC experience, please contact Dr Diarmuid Hegarty, NoWDOC Medical Director on (074) 917 8135. Note: Co-operation and Working Together (CAWT) is a cross border health and social care partnership comprising the Health and Social Care Board and the Public Health Agency in Northern Ireland, the HSE in the border counties and the Southern and Western Health and Social Care Trusts in Northern Ireland.

mid-January and before the end of that month we were notified that we had achieved the accreditation award from the RCGP. NoWDOC is the first GP Cooperative to achieve this quality accreditation and it was the first international accreditation for the RCGP. The feedback from the assessment team was very positive and they made a special note of the additional care we have taken to ensure that patients with

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traininG

better treatment for COPD Patients

Pulmonary rehabilitation is assisting many individuals suffering from CoPD around the country, and the positive feedback from patients undergoing the treatment underlines the importance of this form of rehabilitation for people suffering with the disease.

roven to improve quality of life for Chronic obstructive pulmonary Disease (CopD) patients, pulmonary rehabilitation was the focus of discussion at the Hse pulmonary rehabilitation study Day held in March. the study day was aimed at mobilising staff and giving them the necessary tools and information to establish local pulmonary rehabilitation teams around the country. the event provided vital insight into the mechanics, benefits, guidelines and complimentary therapies that are associated with pulmonary rehab. CopD is a common lung disease that obstructs the airways, making breathing difficult. It is the most prevalent respiratory disease in adults in Ireland affecting more than 110,000 people, with some further 300,000 believed to be at risk or undiagnosed. as highlighted at the event, pulmonary rehabilitation programmes involve assessment, exercise, education and patient self-management support designed to improve a patient’s lung function and stamina. Multi disciplinary teams, typically led by physiotherapists and including dieticians, psychologists, pharmacists and

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smoking cessation officers amongst other health professionals deliver the programme. Currently there are 25 pulmonary rehab teams in operation around the country and this number is expected to grow. addressing the attendees, Dr McDonnell, Clinical lead for CopD said: “pulmonary rehabilitation is one of the most effective interventions available for patients with breathlessness from CopD and hopefully today’s conference will enable more rehab programmes to be available for patient suffering with this condition.” pulmonary rehabilitation has also been shown to reduce hospital admissions and coupled with treating patients in their own home this will afford greater efficiencies to the health system. air products Healthcare ltd sponsored the event and philip Hendrick, Business Manager of air products said: “We are delighted to be able to support this new initiative by the Hse to bring pulmonary rehab into community settings. We witness the benefits every day when we visit

“pulmonary rehabilitation has also been shown to reduce hospital admissions and coupled with treating patients in their own home this will afford greater efficiencies to the health system.”

patients with CopD who have participated in a pulmonary rehab programme. Many patients who attend a pulmonary rehab course have reduced symptoms, increased participation in physical and social activities and a general improvement in their quality of life.”

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112 Health Matters

Your stories

Meet the teams who keep Tullamore Hospital ticking over On these pages, we’re meeting some of the teams who play a crucial role behind the scenes in the new award-winning Midland Regional Hospital in Tullamore Co. Offaly.

ince its initial opening in 2007 and by the end of this year approximately 34,808 emergency admissions, 47,495 inpatient and 90,292 day case patients will have been treated in the hospital. Built at a cost of b150m, the hospital has currently 231 beds in operation spread across the specialties, including a 21-bed day hospital.

Telephonist/Receptionists When you call a hospital you will speak to one of the trusted telephonists/ receptionists who manage on average 1,500 calls a day. Dolores Lynam, who is a telephonist at the hospital, explains the crucial role her team plays in the operation. “There is a team of three people managing the internal and external telephone lines at the hospital daily. On the three-way system, there are about 30 lines which, as you can imagine, are always very busy.” The longest serving members on the telephonist/reception team have clocked up a staggering 89 years between them, which includes Dolores, who has worked at the hospital for the last 29 years. “There is a lot to be said for experience in this job. It’s so important that we are knowledgeable about services, departments and who doctors and consultants are, which is not easy given the constant rotation of staff on the medical teams,” she says. As well as answering the phones, the telephonists/receptionists are also responsible for the bleep system in the event of cardiac arrest and the major emergency plan. They also manage access to all doors in the hospital, which are

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+ Telephonist/ receptionists at the Midland Regional Hospital are (L-R): Dolores Lynam, Dorothy Bermingham and Bernadette Heffernan

operated on a card system since the move to the new premises. “I guess if you didn’t know, you would consider our job as just picking up the phone and directing calls but there is a lot more to it,” she adds. Dolores sees the role in reception as a kind of ‘fly-on-the-wall’ situation: “We have to be aware of everything that is going on around us. It has its challenges but as I have said, it helps to have the experience on the team.” The reception is the public’s first contact with the hospital and for this reason Dolores emphasises their contribution to its successful running. “We are the public’s first contact with the hospital, be it at the front desk or over the phone, so it is very important to be polite, have the common touch and have a reassuring voice and face.”

Maintenance Brendan Cuskley is Maintenance Manager and manages a team that includes electricians, painters, carpenters and plumbers. The team was closely involved in the move to the new building. “We supervised every element of the move, even to the extent of the location of a light fitting or electrical socket,” Brendan explains. The hospital is sitting on a campus of 27,500 square metres. It requires 24/7 on call cover to oversee the lighting, heating, cooling, ventilation, smoke dampers, chillers, medical gas pipe systems and air handling units, ensuring the hospital is always a hub of activity. On a daily basis the maintenance team could respond to between 30-40 calls per day on the grounds. During the final move from the old to the new campus this figure doubled.

07/06/2011 12:30:31

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+ The Maintenance team at Tullamore (L-R): Michael Kearns, Stores Supervisor; Joe Duffy, Building Officer; Brendan Cuskelly, Maintenance Manager; Glenn Haligan, Electrical Foreman; Johnny Dooley, Clerk Of Works; and Paul Maloney, Mechanical/Electrical Officer

The Maintenance Department monitors the 120,000 litres of water (on average) a day that is pumped through the building; they ensure 11,175,096 kWh of gas heating is running, monitored and serviced; and that 5,320,639 kWh units of electricity is functioning throughout the entire campus. Brendan explains: “It requires an awful lot to run an acute hospital of its size. If these crucial services were to fail it would be impossible to run a successful hospital. Furthermore, it also means we can closely monitor our energy efficiency.” Each critical service, which includes electricity, water flow, medical gas etc., has a ‘critical alarm’ monitor linked to areas such as Theatre, Emergency Department

and ICU. If there is a failure of a service, a text message is sent to the maintenance team, whether it is during the night or on weekends. Not only do the team undertake preventative maintenance on a daily basis, they also have to implement legislative maintenance, which includes adhering to hygiene standards and health and safety measures. “In line with our legislative obligations, we have also trained and appointed one of the team as a Dangerous Goods Safety Advisor, who oversees the medical waste area. We also work closely with infection control to ensure wards are compliant with the standards,” says Brendan.

Catering When Breda Bracken first started working at the hospital 30 years ago, little attention was given to menu plans and dietary requirements. Now, life as a catering manager at the hospital is not just about cooking a standard one-forall dinner. Patients at the hospital are now offered a menu which takes into consideration dietary requirements, portion sizes and tastes. When talking about the new kitchen facilities in the new hospital, Breda beams with delight. “The facilities in the kitchen are state of the art. It was not until we actually moved in that we realised the difference it makes to our day.” Breda describes managing the hospital kitchen as a military operation. With over 1,000 meals prepared and served each day across three sittings for staff and patients, there is no room for floundering. The kitchen staff include an executive chef, senior chef, chefs assistants, multitask attendants and clerical support. With the able assistance of Lisa Graham, they both take great satisfaction in a smooth running service. The kitchen opens at 7am to cater for the early staff shift; it is at this stage that Breda calls the kitchen troops for a routine day briefing of what lies ahead. This discussion includes menu options, prepping times, patient numbers and requirements, ordering of fresh food produce and the baking plan for the day. Everything is prepared within the hospital and all the food is sourced locally, which is something Breda is keen to emphasise. “We bake our own bread, scones and desserts.” Not only is shopping a consideration for the team, there is also storage of the produce. Following appropriate guidelines is imperative and monitoring the temperatures for each storage facility is essential to ensure the efficient management of the food shelf life. “This is nearly more important than purchasing the food; if the temperatures are not set correctly food will go stale which means we spend more money to replace them; this would not be beneficial to our budget.”

+ Breda Bracken, Catering Manager with her team at the Catering Department of the Midland Regional Hospital at Tullamore

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07/06/2011 12:30:32

114 Health Matters

your stories

Time for a challenge? Every weekend during the summer thousands of people are donning wetsuits, putting on helmets and slipping on runners as they participate in Ireland’s fastest growing sport – triathlon. Tim Downing, 2009 Irish National Sprint Champion, is encouraging us all to try a tri!

took part in my first Olympic distance triathlon (1500m swim, 40k cycle, 10k run) having not swam in the sea since I was a kid, never having cycled more than a few kilometers on a bike and not having ever run a full 10k. It was a baptism of fire on a beach in Skerries with a surfing wetsuit, my Dad’s bike and an old pair of runners. Not deterred by taking on one sport, some people like to enjoy the variety of a trio of disciplines all rolled into a unique and exhilarating adventure: a swim, cycle and then a run. Triathlons generally take place near seasides, rivers and lakes and on country roads and by-ways navigated by hundreds of other racers – new and experienced, young and old alike. Last year, Ireland had the honour of hosting the 2010 European Triathlon Championships in Athlone, which saw masses of people take part in their first ever race on the same spectacular course rocked by the world’s top pros. But what do you need to do one? Simply, a wetsuit, a pair of runners and any old bike – which can often be borrowed from friends, family and no doubt a few of your friends who have already done a triathlon. Of course, spending more will get you better gear but for those whose goal is to get across the finish line, any useable wetsuit or bike is fine – even if it does have a shopping basket on the front! Beyond that, a good-fitting wetsuit will save you time, and knowing what runners suit your running style will help. Some spend a lot on bikes – this is entirely to personal taste. Passing out a fellow competitor on under-used over-priced bike is much more enjoyable if achieved on an under-used old mountain bike.

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The first thing to do for training is to get out the door – no time like the present! Training will often give a buzz, both in terms of the sense of achievement and also a physiological rush as your body wakens from its winter hibernation. Swimming, cycling and running are all relatively different sports and so your approach should be unique for each, bearing in mind all of us have different backgrounds – most people who race have a ‘strong’ leg and a ‘weak’ leg. A great thing about swimming is that once you have developed good technique, it is very hard to lose – the downside is that you have to take the time to build this up. So if you’re new to swimming, practise, practise, practise. The best way to do this is to get proper supervision and direction

“Triathlons generally take place near seasides, rivers and lakes and on country roads and by-ways navigated by hundreds of other racers – new and experienced, young and old alike.”

07/06/2011 12:30:34

Health Matters 115

Your stories

an invaluable resource to anyone thinking about taking part. Race distances vary a great deal, and for people starting up there are sprint (750m swim, 20k cycle, 5k run) and olympic distance (1500m, 40k, 10k) and even longer races all around the land during the summer months (see www. triathlonireland.com for the events). There are also aquathons (swim/run) and duathlons (run/bike/run) as well, and also many other races right across sunnier climates in Europe and the world. I have done many races since Skerries, but there is nothing quite like the nervous thrill of your first race – so when will yours be?

from a coach: luckily there are triathlon clubs all over the country who have coached sessions. Doing it all yourself is very hard, and swimming in a group will help you learn faster, swim harder and pick up tricks from other swimmers. Cycling is an excellent way to develop your aerobic system. So once you have adjusted your bike for your build and stature, a mixture of short/hard and long/ steady sessions will see you come on leaps and bounds. Running likewise will work your lungs as hard as your legs – but with the risk of injury requires shorter sessions. The best way to start is also the best to continue – gradually adding a mile here and there so that you have no big jumps in volume week-to-week. Complete beginners can make great progress starting just 2k every second day at a nice easy pace, walking breaks allowed! Triathlon has a big social element as well – the burgeoning numbers in clubs across the land are a testament to the camaraderie and spirit among triathletes. I would advocate joining a triathlon club and would definitely recommend using www.triathlonireland.com to find one near you. You’ll find that most are new to it as well, and also a core of old-hands who will pass on their years of experience to you -

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“You’ll find that most are new to it as well, and also a core of old-hands who will pass on their years of experience to you - an invaluable resource to anyone thinking about taking part.”

COULD YOU DO IT? Sprint triathlon: 750m swim, 20km bike, 5km run Olympic triathlon: 1.5km swim, 40km bike, 10km run Ironman: 3.8km swim, 180km bike, 42.2km run Ultrarunning: Anything upwards of 42.2km

07/06/2011 12:30:35

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HM Iss7.2 p72-128pg2.indd 116

07/06/2011 12:30:39

HealtH Matters 117

traininG

training tHe trainer through its faculties and committees, rCPi has responsibility for the postgraduate education and training of doctors in ireland in 25 medical specialties, writes Dr Diarmuid O’shea.

importance of effective communication, and has designed the physicians as trainers courses to meet these objectives. the role of the trainer continues to evolve at a time of rapid change and expansion in medical education. rCpI is currently developing additional courses to support trainers in identifying the learning styles of their trainees, time management and effective delegation.

he mission of the royal College of physicians of Ireland (rCpI) is to develop and maintain high professional standards in specialist medical practice in order to achieve optimum patient care, and to promote health nationally and internationally. rCpI is fully committed to playing a full and proactive part in the transformation of the health service, as evidenced by its involvement in many strategic initiatives with the Medical Council, the Hse, the Department of Health and Children, and other Irish postgraduate medical training bodies. rCpI also aims to build positive relationships between the medical profession and the public through public education and engagement.

PHYsiCians as Trainers to support the continuing professional development of physicians as trainers, rCpI recognises the need for training, and has developed a number of courses that focus on enhancing skills of coaching and mentoring, workplace-based assessment, supervision and interviewer skills. Due to the increasing pressures and time constraints on consultants leaving the workplace, rCpI now provides online

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training. this training is enhanced with supplementary teaching and supervising skills workshops.

“a good trainer also accepts responsibility for the development of a trainee, and clearly communicates not only with trainees, but also with patients by using effective listening and questioning skills.” a key attribute in being an effective trainer is the ability to recognise the individual needs and strengths of trainees. a good trainer also accepts responsibility for the development of a trainee, and clearly communicates not only with trainees, but also with patients by using effective listening and questioning skills. rCpI recognises the

researCH over the last two years, rCpI has developed a series of workshops for physicians as trainers, focusing on effective teaching and supervising skills. a current study is investigating the impact the course has on teaching skills and behaviours. participants were asked to complete precourse and post-course questionnaires to see if the objectives of the course were met. early results indicate that the courses have had a positive impact on the teaching skills and behaviours of trainers in the workplace. rCpI is continuing to develop and modify future courses based on needs and feedback. Dr Diarmuid O’Shea is Vice President of Education and Professional Development at the Royal College of Physicians.

for furTher inforMaTion education and professional Development Department, royal College of physicians of Ireland, frederick House, 19 south frederick street, Dublin 2. Web: www.rcpi.ie; email: courses@rcpi.ie tel: (01) 863 9700

Dr Diarmuid o’shea, vice president of education and professional Development, royal College of physicians

07/06/2011 12:30:41

118 Health Matters

your stories

The End of the Beginning Final year medical student Kapil Sharma has been an undergraduate medical student at NUI Galway for the best part of six years. In the second of a four-part series, Kapil shares his experiences on his path to becoming a junior doctor.

lot of sage advice was dished out to me throughout this term, some of it practical - as in which books to buy or whom to arrange a tutorial with - but much was psychological in nature. A friend of mine who is an intern now put it like this: “Kapil, it’s a tough year, a horrible year, but you’ll get through it. I got through, just relax and keep your head.” To be honest, at the time I didn’t really pay much attention to this or to similar statements told to me, but having just completed my final year clinical exams last week I realise it was the best counsel I received. The clinical exams are what one prepares for all year; they are the source of all nerves and dread, they are the final hurdle and I could either soar over or trip and fall flat on my face right before the finish line. These clinical exams are carried out over a day; mine involved a long case in the morning and six short cases in the evening. The long case required taking a history and examining a patient on the ward for an hour, then presenting my findings to two consultants one medic and one surgeon – and answering their questions for approximately fifteen minutes. The short cases comprised of being escorted to six different patients and having to answer questions from two consultants for five minutes. Put like that it may not seem so arduous, but I cannot emphasise how nerve-wracking a format this is. By the day’s end, however, I had stuttered and sweated my way through and in retrospect it really wasn’t so bad. I really must acknowledge how understanding and kind the patients were and how fair and pleasant the consultant examiners were, which is no small feat considering they had to deal with dozens of agitated medical students that day. Currently it is difficult to describe how I feel - I am confident I have done well enough to graduate this summer, so I am

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elated and exhausted at the same time. I am spending the month of May as an 'intern shadow’ which serves as a preview of coming attractions, where I can learn what the day-to-day activities of an intern are so I am prepared for this July. I am looking forward to commencing work, and am excited about the new world which awaits. Apart from knowledge, what completing final med gives you is confidence in yourself and your abilities, and after six years of college it’ll be great to finally begin my working life. So presently I am somewhere in between a student and an intern. After months of long study-packed days there now exists a hollow which I intend on filling with as much rest and relaxation as possible.

“What completing final med gives you is confidence in yourself and your abilities, and after six years of college it’ll be great to finally begin my working life.”

07/06/2011 12:30:43

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Your stories

a Day in tHe life Dr Mary Cosgrave, executive Clinical Director with the north Dublin Mental Health service, gives us an insight into a typical working day.

y training, I’m an old age psychiatrist. I specialise in the mental health needs of persons over the age of 65. In my regular post that means dealing with people living at home, in long-stay accommodation and in the general hospital. I see a large number of people with dementia, depression and delirium but also those with longer-term mental illness. I’ve been executive Clinical Director of the North Dublin Mental Health service since october 2009. I have overall responsibility for the mental health service to children, working age adults, older adults, and those with learning disability in the area. our catchment area population is 226,000. I got up a 6.45am today and had a breakfast meeting at 8am in the city centre with the child and adolescent psychiatrists in our region. We discussed the service they provide and what is needed to enhance it. I then drove to my base at st Ita’s Hospital in portrane, arriving at 9.45am. We are in the process of reconfiguring our Mental Health services for older persons residential service. I attended two meetings with families regarding the proposed changes in location of that service, explaining our plans to relocate to st vincent’s Hospital fairview for two years. I then went to my office to check on messages and emails. there were about 20 issues to deal with. one involved a visit to see a lady from the Intellectual Disability service who has relocated from an old hospital ward to the new Knockamann development on the site of st Ita’s Hospital. she was finding it hard

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to settle and wanted to discuss it. this involved talking with the lady, a mental state assessment, consultation with the staff and an agreement to review the placement. another issue was the resignation of one of the junior doctors. I set in train steps to recruit a replacement without delay. at lunchtime I met with the Director of Nursing and Hospital Manager of the Mental Health service to complete an application form for registration as an approved centre for the Mental Health Commission. this was to do with the change in location of the Mental Health services for older persons residential service. We also spoke about some of the practical issues with this move in service and some operational issues to do with the general adult psychiatry service including bed availability for the weekend. In the afternoon I went to the Hse office in

swords to a meeting about a young person who needs a placement abroad. I also made an unscheduled visit to Beaumont Hospital emergency Department to see a teenager who needed acute admission for treatment of a severe depressive episode. No public bed was available so I had to review regarding funding. this involved reviewing notes and an interview with the young person and the parents. I recommended an emergency placement in the private sector, and the admission took place as is usual with those under the age of 18, with the consent of the parents. that finished at 5.30pm but I brought the computer home to do a final round of emails, checking new messages and responding as needed, finishing at 6.30pm. I had contact with every part of the service today!

07/06/2011 12:30:45

120 HealtH Matters

Your stories

getting to

know you... NAME: Brian Hughes JOB TITLE: Clerical porter BASE: ringsend/Irishtown primary Care Centre, Dublin 4

disability awareness. I am involved in the co-ordination of the health and safety regulations within the centre – this includes the removal of clinical waste and the sharps boxes. My duties include working as a receptionist/telephonist and directing service users to the relevant clinics.

wHo Has insPireD you tHe Most? Jane flynn, occupational therapist, because she encouraged me to participate in all training courses available to porters and to strive to progress in my career.

wHat Do you love about your job? I love meeting and helping people.

toP tHing on your DreaM list if you won tHe lotto? I’d travel the world.

Pet Hate? Manchester united supporters!

if you CoulD CHange one tHing about your job wHat woulD it be? It would be less frustrating if we had more nursing staff to facilitate the patients’ needs.

How long Have you workeD witH tHe Hse? 12 years DesCribe your job in five worDs Challenging, interesting, busy, rewarding and enjoyable. wHat's your average working Day like? I now have access to my own computer which enables me to email my stock straight through to central stores and maintenance when necessary. I have an onsite wheelchair which enables me to take patients from their car into the clinic. I have been highly trained in

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wHat's your favourite book anD wHat DiD you like about it? the World at War. I am interested in military history. wHat's your favourite filM anD wHat DiD you love about it? the Dirty Dozen. It was light hearted and humorous. wHat's tHe Most MeMorable tHing you Have ever exPerienCeD? getting married in australia. wHats tHe best aDviCe you've ever reCeiveD? Do not seek to know all the answers but to understand the questions.

07/06/2011 12:30:53

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redefining HM Iss7.2 p72-128pg2.indd 121

standards www.axa.ie

standards 07/06/2011 12:30:53

122 HealtH Matters

finanCe

your Questions answereD in this issue, we concentrate on the financial questions you want answered. we have received a steady ďŹ&#x201A;ow but please do keep them coming, writes eoin McGee, owner of Prosperous financial services. remember: although the answers are broad, if you have a particular financial situation you need resolved then you may wish to consult a financial advisor before making a decision. iâ&#x20AC;&#x2122;ve heard a loT abouT negaTive eQuiTy MorTgages recenTly. buT how do They worK? Negative equity and negative equity mortgages have been in the press a lot recently and sometimes even the press can confuse the meaning of them. Negative equity, in simple terms, is where you owe more than the house is worth. this causes many difficulties for both you and the bank. firstly, and probably most importantly, there is nothing more de-motivating than to have to pay a loan every month on a house that is worth less than the loan. from the banksâ&#x20AC;&#x2122; perspective it is more worrying for them, because if you default they will have to go after more of your assets than just your house. Interestingly, in the united states, when you borrow money for a house it is done on a nonrecourse basis. this means that if you default on your mortgage and the bank sells the house with the proceeds not clearing the loan in full, they cannot come after you for anything else you own to try and recoup their loss. Negative equity can leave many people in a stalemate situation - where they are stuck in a property they no longer either want or find suitable to live in. It stops people either trading up or trading down, and can stagnate the market. that is where the negative equity mortgage comes in: it is an attempt by the banks to try and get the property markets moving again. In theory, you should be able to sell your house and borrow more than 100 per cent of the purchase price of the new home, effectively carrying the negative equity with you into the new property.

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car and hoMe insurance / coMMercial conTenT aXa Insurance offers many healthcare workers great car and home insurance deals and gives many employees the option to pay their insurance through their salary over ten months at no extra cost. at aXa we know that customers have different Insurance needs. this means we will have a car policy that has variable features and benefits to meet your individual needs. Whether you are looking for insurance for yourself, you and your partner, as a young driver or you want to add your son or daughter we have the right policy for you. Home Insurance protection for your home and contents offers you peace of mind and aXa Insurance gives a choice to meet your needs. aXa have 41 branches nationwide ready to advise you on your insurance needs, call them today.

07/06/2011 12:30:54

HealtH Matters 123

finanCe

I say in theory because in practice that is all it is: a theory. although some banks advertise they do such loans, in reality they don’t - or let me correct that - I have yet to see one being done. the closest I have seen to any form of a loan on such a basis is where someone sells their house that is in negative equity, and the bank allows them to convert that negative equity into a personal loan over a long period of time at the same rate as the original mortgage. this loan, however, will hamper the client’s ability to borrow further funds – i.e. another mortgage. this facility is usually only made available for people struggling to make repayments or following a divorce or separation.

If you don’t have a hire purchase agreement, it is a bit more difficult. If you sell the car, the loan would usually have to be cleared in full - unless you make a prior arrangement with the lender. It is unlikely that trading down will help the situation, because when you do trade down the fact that you are currently in arrears will prevent you from getting a loan for the new car. If you are struggling, the best thing you can do is talk to your finance company about restructuring the debt. they may be able to stretch the term out, reducing your repayments, or they may be able to let you sell it and convert the balance of the loan to a personal loan.

i aM behind on My car repayMenTs and The car is no longer anywhere near worTh whaT i owe. can i Trade in and pay down soMe of The loan, and Therefore have lower MonThly repayMenTs? Many people find it difficult to keep up with loan repayments, so please don’t feel alone here. there are several options which many people should explore in a situation like this. the very first thing I would suggest you do is to check your original loan agreement: if it is a consumer hire purchase agreement you may just be in luck. they are protected under the consumer credit act - therefore you may be able to exercise the half way rule option. under a Hp (hire purchase) agreement, you do not own the goods until you make the final repayment. However, you have a statutory right that once you have made half of the total repayments you can return the goods (in a good state of repair) and walk away from the agreement. you will have to ensure that any arrears are cleared up and there are a few issues you would need to check before you go ahead and exercise your rights. If done correctly, this will not affect your credit rating. I actually did this myself with my own car and I have put the details up on my website: www.prosperous.ie.

“all the offers usually have catches, but use a credit card correctly and you should pay no interest.”

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whaT crediT card coMpanies are offering The besT deals? Credit card companies are all very competitive with their deals. that’s probably because there are currently more than two million credit cards in existence in Ireland. there are rules to all these deals, but play by the rules and it can be very beneficial to use a credit card. the offers available differ from company to company, and change so frequently that the best way to keep on top of them is to review the website run by the Central Bank, comparing the credit cards available in the market: http://www. itsyourmoney.ie/costscomparisons/cs_tab_ credit_card.html some of the more common enticements include little or no interest on balance transfers for a period of time. this means that if you transfer funds from an existing credit card or overdraft you will get a special introductory low interest rate on these funds. What you need to realise is

that when you make purchases using the credit card, they are not always included on this low rate. secondly, when you make repayments, the repayments go off the money that is currently borrowed at the lowest rate first. also, be aware of what rate you will move onto after the special offer period expires. a slight twist on this is when your existing card provider offers you a special discount on any cash advances. for example, some of the bigger credit card companies send you out cheques with your statement. If you write one of these cheques you will be charged significantly less interest than what you’re currently paying on the existing balance. By “recycling” your current balance you can sometimes half the rate you are currently paying. It’s difficult to get your head around this, so let’s use an example: you have s2,000 on your credit card and you are currently paying 15 per cent. your statement arrives and the bank send you one of these cheques and advise any money spent using the cheque will only cost 7 per cent until october 2011. let’s say you borrow s2,000 from your friend and use it to clear the balance on the card. once the card is cleared, then write the cheque to your friend for s2,000 to pay them back. What you will have done is recycled the money on the card, and you will now be paying 7 per cent until this october, instead of 15 per cent. all the offers usually have catches, but use a credit card correctly and you should pay no interest - and it can be a good way of utilising cashflow. Do be aware that all credit cards have to charge you the government stamp duty of s30 per annum - some companies will pay this for you. abouT The auThor eoin Mcgee is the owner of prosperous financial services, an independent firm regulated by the financial regulator as a multi-agency intermediary and mortgage intermediary. He has over 10 years’ experience giving financial advice to both individuals and companies. He can be contacted on eoin@prosperous.ie, (045) 841738 or 087 644 5533.

07/06/2011 12:30:54

124 Health Matters

your stories

Sporting Passions Dr Brendan Murphy, a Non-Consultant Hospital Doctor (GP Scheme) at the Midland Regional Hospital in Portlaoise, talks to Health Matters about his other life as an Offaly hurler.

hy did you decide to become a doctor? My father and brother are doctors so I suppose it was something I knew a bit about and looked like something I might enjoy. I have been working at the HSE since 2008. When did you start playing intercounty hurling and was your career path ever influenced by your sporting passion? I made my debut in the championship in 2000. I think the reverse is true; my sporting passion unfortunately has been influenced by my career in terms of time restriction in recent years.

What are your sporting achievements? Leinster U-21 winner 2000, Fitzgibbon Cup winner with UCD in 2001, All Star nominee 2003, Railway Cup winner with Leinster in 2002 and 2003, captain of Offaly senior team 2006, Dublin hurling championship winner with UCD in 2001/2004/2005. Away from hurling I recently ran the Paris marathon, which was a bit different. How do you balance work and sporting commitments? It is difficult to balance work and sporting commitments. Playing inter-county hurling is a big commitment, as is being a doctor. This year, one had to get priority so I had to give more time to my work. Hopefully I can get back to playing inter-county again when I have time. What benefits does it bring to your life? Team sport means you get to mix with people who have no connection with medicine which can be a nice change. Work/sport balance is obviously really important physically and mentally. Does being a sports person help you in your work? Maybe not in work, but I think sport and

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training after work is definitely a stress reliever.

What’s your best sporting memory? Beating Cork in the All Ireland semi final in 2000. Unfortunately the final didn’t go according to plan and was possibly my worst sporting memory! It was nice to get the opportunity to play in an all Ireland final though, with and against some of the greats of hurling including Brian Whelehan, Johnny Dooley, Joe Dooley, DJ Carey and Henry Shefflin. Is there any one thing that you feel helps a team win? Having some of the above hurlers! It’s a combination of good players and a great manager along with a lot of hard work and luck. Does your sporting mentality help your day to day work in a busy hospital? Maybe, I never really thought of it. I suppose the whole team ethos relates to hurling and hospital life. What is the toughest part of being an inter-county hurler? Time commitment, especially when the toughest part about being an NCHD is also the time commitment! Over the past 11 years I have been playing inter-county hurling, the time required is increasing annually. It’s practically a seven day a week commitment now. Training with the team four days a week, gym at least two days and ball alley/pool session the other night. Is there any stand out moment from your time playing with Offaly that you remember most? The last few years have had a few. Beating Limerick in 2008 in Limerick was great. I was working my first month as an intern and had been on call on the Thursday night in the Mater before the game on the Saturday and

took to the field feeling very sorry for myself, but all went well. Also beating Wexford in the Division 2 League final in 2009 was brilliant, and I somehow managed to win the man of the match award too which was nice. The standout is still Cork in 2000 though.

If you could do one thing to change the face of the GAA, what would you do? I think the divide in financial resources from county to county is massive. It’s nobody’s fault, but it is definitely not a level playing field. The larger counties definitely have the edge financially and facility-wise over smaller primarily rural based counties. What are your sporting ambitions for this year? To get back involved with Offaly if time permits. If that’s not possible, maybe to run another marathon before the year is out.

07/06/2011 12:30:56

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Obituary

Mr Aonghus O’Donnell (1961-2010)

– Cardiothoracic Surgeon A

onghus took up his senior post in Cork University Hospital in 1996. The Department of Cardiothoracic Surgery had been established and single-handedly maintained by his colleague Tom Aherne for the previous ten years. Aonghus’s arrival marked a point of much-needed expansion of all aspects of cardiac surgical and medical services in the region. With his energy, enthusiasm, strong administrative skills and great generosity with his time, Aonghus was a natural choice for Head of Division, a role he agreed to on a time-limited basis soon after his arrival in the department. His colleagues encouraged him to continue in this capacity, and this he did up to his untimely death. In this position he played a pivotal role in the development of the Cardiac Renal Centre. In the month before his death, at the centre's official opening, he spoke in characteristically humble terms of the planning, development and commissioning process which took more than ten years. While his administrative skills were widely appreciated and put to great use, it was the delivery of a clinical service that he especially enjoyed and where he excelled. In a specialty marked by its arduous nature, he was committed to hard work and thrived particularly in undertaking challenging cases with a paramount focus on patient care. His gregarious nature and innate conviction of the importance of a multidisciplinary team approach to clinical problems made for a particularly close and harmonious relationship with medical and surgical colleagues. His colleagues who make up the extended cardiac team and the wider hospital staff regarded him with the greatest of respect, but equally enjoyed his jokes and sharing moments of banter

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with him. Many patients recall how his humour was artfully deployed to put them at ease in times of particular stress around the time of their surgery. He trained in medicine in the Royal College of Surgeons in Ireland and qualified in 1985. He interned in Beaumont Hospital and his surgical orientation was evident at an early stage when he received an Honours BSc in Anatomy at UCD in 1987. He entered formal surgical training in Dublin in 1988, and obtained his Fellowship of the Royal College of Surgeons in Ireland in 1990. He began training in cardiothoracic surgery in 1990 in the Mater and St James’s hospitals. In the spring of 1992, he became the first non-US Senior Surgical Fellow in

Cardiothoracic Surgery at Massachusetts General Hospital in Boston, He returned as a senior registrar at St. James’s Hospital in 1993, and then trained in paediatric cardiac surgery in Our Lady’s Hospital for Sick Children, Crumlin, from July 1994 until he came to CUH. He maintained a particular interest in training, and was highly regarded by the trainees he mentored. Until the time of his death he was the National Programme Director for Cardiothoracic Surgical Training. Aonghus was an exceptional cardiac surgeon and colleague who loved doing what he did and practised his vocation with boundless energy, skill and care. Aonghus was a loving son, brother, husband and father. May he rest in peace.

07/06/2011 12:30:58

126 HealtH Matters

reCommenDeD

a bloCkbuster suMMer!

relax and unwind this summer by visiting your local cinema. Health Matters takes a look at five films hitting the big screen in the coming weeks that may be of interest… and don’t forget the popcorn!

larry crowne How do you make a movie guaranteed to be a success at the box office? the answer is simple… get tom Hanks and Julia roberts to star in it! Hanks stars as a middle-aged man that loses his job amid the backdrop of a recession. With his life needing a kickstart he enrols in the local college, where he becomes part of a colourful community of outcasts and also-rans, developing a crush on his public-speaking lecturer, played by Julia roberts. It’s a story of re-invention, laughter, and it’s a story that is in tune with the economic woes of modern society. released: July 2011 The help Kathryn stockett’s novel was a best seller. Now it’s time to become the jury and see if the film version brings the pages to life. the film stars emma stone, viola Davis and octavia spencer as three courageous women who strike up an unlikely friendship. set in Mississippi during the 1960s, this powerful and evocative tale shows

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emma stone as a young white society girl returning from college, determined to be a writer. she proceeds to tackle the status quo by interviewing the black women who serve the white families of the region. Her controversial thinking upsets the balance, threatens friendships and the generational way of life. the film aims to tackle the meaty subject, in a way that does the novel justice. released: august 2011

harry poTTer: deaThly hallows parT 2 It’s finally here: the eighth and last instalment of the Harry potter series. We’ve seen Harry and his loyal group of friends go through thick and thin and grow older and wiser. Now it’s time to say goodbye – but not before Harry, ron and Hermione go back to Hogwarts and attempt to find and destroy voldemort’s final horcruxes. It can’t be that easy for the brave wizard because when voldemort finds out about their mission, their most important conflict begins – and life as they know it will never be the same again! released: July 2011 green lanTern the superhero movie is back in fashion, and now it’s green lantern’s turn to save the world with ryan reynolds donning the green suit. In a vast and scary universe, a brotherhood of warriors called the green lantern Corps aims to keep intergalactic

order. But when a new enemy threatens the world, their protection is down to their newest recruit, the first human ever selected: Hal Jordan (ryan reynolds). Hal is a talented but arrogant test pilot who doesn’t have the infinite powers of the ring – but if he defeats parallax, he will become the greatest green lantern of all. released: June 2011

cars 2 In 2006, pixar animation released Cars. a hotshot racecar named lightning McQueen gets waylaid in the sleepy town of radiator springs, where he finds the true meaning of friendship and family – aided by the voices of owen Wilson and paul Newman. this time, lightning McQueen teams up with his best friend Mater for an international adventure as they go up against the world’s fastest cars, with Michael Caine’s voice making an appearance as the imaginativelynamed finn McMissile. released: July 2011

07/06/2011 12:31:04

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puzzles

CROSSWORD

by Colin White

15 Deliberate or unashamed (7) 17 Grandiose (4) 19 North American spelling of an autoimmune disorder (6) 21 Hooded pullover or a person with a strong interest in niche subjects! (6) 24 Extreme nationalism (8) 25 A puzzle (6) 26 More than a crow! (6)

ACROSS 1 Northern lights (8) 6 A game of chance (5) 8 Without motive or provocation (6)

9 An elegant public speaker (6) 11 Being one more than six (3) 12 A brush of absorbent material (4) 13 A modest biter! (7)

DOWN 1 An empire on your television screens! (9) 2 To pay back with punishment (9) 3 An adjective being used as a noun (6) 4 Existing in one from birth (6) 5 A promotional piece of text (5) 7 To proceed or advance in any way (6) 10 A miniature world (9) 13 Revolutionary anarchy (8) 14 An insect with declining numbers (3) 16 A band of decorative fabric (7) 18 One who nurtures (5) 20 Close, but noâ&#x20AC;Ś (5) 22 Tall grass (4) 23 A river in North Africa (4)

SUDOKU Crossword Answers Across: 1. borealis, 6. otto, 8. wanton, 9. orator, 11. VII, 12. swab, 13. nibbler, 15. blatant, 17. epic, 19. celiac, 21. anorak, 24. jingoism, 25. riddle, 26. murder. Down: 1. boardwalk, 2. retribute, 3. adnoun, 4. innate, 5. blurb, 7. travel, 10. microcosm, 13. nihilism, 14. bee, 16. necktie, 18. carer, 20. cigar, 22. reed, 23. nile. HM Iss7.2 p72-128pg2.indd 127

07/06/2011 13:29:01

128 Health Matters

competitions

Relax in Whites of Wexford

Escape to Delphi Valley

elphi Mountain Resort is a stunning four-star hotel located in the breathtaking Delphi Valley near Leenane, Co. Galway, with an award winning spa, exceptional adventure centre and gourmet restaurant all onsite. Explore Ireland’s only fjord on a seakayaking trip, you may even see some dolphins or experience the thrill of catching your first wave with a surf lesson on the picturesque Cross beach. For the non-adventurous there is a whole range of treatments in our spa that will leave you feeling thoroughly relaxed and pampered. Why not try an exquisite Delphi facial using 100 per cent organic products and our own mountain spring water. To complete the experience, sample the delights in our fabulous restaurant with locally sourced, expertly made dishes. Whether it is a family holiday, romantic escape or group event there is something for everyone. To be in with a chance to win a two night bed and breakfast stay, plus an evening meal at Delphi Mountain Resort, answer the following question: Q: In what county is Delphi Valley located? A: a) Wicklow b) Galway c) Donegal Email your answer plus your name to competition2@ashville.com with ‘Delphi’ in the subject line. Closing date for entries is July 30th.

marvellous malton

he Malton has been welcoming visitors since 1854 and continues to use the same high standard of quality and service to welcome its guest today! The arrival of Summer always means one thing: The Killarney Races! We are delighted to throw our doors wide open and allow the festival season to waltz right on through! The Malton situated on six acres of landscaped gardens in the heart of Killarney Town, adjacent to the train station and walking distance from the racecourse is the ideal retreat after a days fun at The Races. The Malton is also home to The Race Club, Killarney’s exclusive after race party on Ladies Day July 14th! Come join us and start your summer in style at The Malton! Contact reservations today on (064) 663 8000 or email: res@themalton.com. For further details on our Summer Family Fun Programme and self catering apartments log onto www.themalton.com.

entrally located in historic Wexford town, it is a great base for touring the sunny south-east as well as shopping, sight-seeing and visiting the beach. Whites of Wexford are celebrating their fifth birthday this month, and to celebrate they are offering a two night bed and breakfast stay, plus one evening meal. As part of the offer the winners will receive the following five gifts: free bottle of wine in your room; relaxing Thermal Suite voucher for our Tranquility Spa worth s20 per person; voucher for s5 to spend on food and beverage in the hotel; a box of chocolates on arrival; and a complimentary newspaper delivered to your room. Offer is subject to availability. To be in with a chance to win, please answer the following question: Q: What birthday are Whites of Wexford celebrating this June? A: a) 1st b) 5th c) 10th

For further information contact info@whitesofwexford.ie, call (053) 912 2311 or visit www.whitesofwexford.ie. Email your answer plus your name to competition2@ashville.com with ‘Whites’ in the subject line. Closing date for entries is July 30th.

• Win two nights bed and breakfast on July 13th and 14th 2011, for two people sharing • Entry to The Races on both days • Two tickets to the exclusive after race party The Race Club at The Malton on Ladies Day, July 14th 2011. Free text MALTON HEALTH to 50123. Closing date is Sunday 26th June 2011. Terms and conditions apply.

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07/06/2011 16:48:12