Health Matters Summer 2010

HEALTH Vol 6 I Issue 2 I Summer 2010

INSIDE - Skin cancer prevention - Foster Care - Tobacco Framework - Acquired Brain Injury

MATTERS National Staff Magazine of the Health Service Executive

Health Matters

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

MATTERS National Staff Magazine of the Health Service Executive

the dangers of buying medicine online

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

Summer 2010

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 18

96

Vol 5 I Issue 3 I Autumn 2009

56

More expertise. More opportunity.

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

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

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

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

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Graduate Foundation Modules Theoretical Bases of Nursing, Research Methodologies.

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

Holders of a graduate diploma in one specialist area may complete a graduate certificate in another specialist area.

Applications can be made online and flexible payment options are available. Apply by 15 July 2010 at: www.ucd.ie/apply For full details of the wide range of research training and taught graduate courses visit www.ucd.ie/nmhs or phone 7166490/7166491/7166499.

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Health Matters 1

welcome

Welcome...

WELCOME to the summer 2010 edition of Health Matters, the national staff magazine of the HSE. This summer issue has a maternity theme to it, where we focus on the development of midwifery-led care and the recent recommendation that maternity and gynaecology services in Dublin be located with adult acute services.

We hope you find this issue’s mix of features, interviews, news and updates of interest. For more regular updates, check out our staff Intranet site http://hsenet.hse.ie or the HSE website www.hse.ie

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Special thanks to all the contributors to the magazine. Enjoy the read!

Stephen McGrath – Editor Head of Internal Communications

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

Did you know?

• The number of live births here this year is expected to be more than 75,500

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• It is estimated that 64,000 Irish consumers are buying medicines online • There are more than 5,500 children in HSE care and 92 per cent of these are being cared for by 3,100 foster families • Almost 2,000 referrals were made to the elder abuse prevention service last year • Cystic Fibrosis is the most prevalent inherited disease in Ireland, with 1 in 19 of the population carriers of the CF gene • By the year 2020, it is projected that there will be 1,250 new cases of malignant melanoma skin cancer per year if current trends continue www.rsa.ie

• Each year, there are about 350 childhood deaths here from life-limiting conditions, defined as any illness in a child where there is no reasonable hope of cure

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.

Health Matters 3

ceo's message

A message from the CEO M

any health services across the world are facing the same challenge – how to provide more effective care to more people with less money?

I have seen many excellent examples during the past few years where our staff are going the extra mile to provide more care with less funding. Most of this is going on in the background and attracts little public attention. I want to publicly acknowledge this work and express my deep appreciation to those who are making it easier for patients and clients to access the care they need.

Because we have taken the fork on the road towards modernising the way hospital services are organised, building more community services and making team working the norm, we are in a far better position than most to meet the challenges ahead. Indeed other countries are taking a very keen interest in what we are doing in developing integrated care.

What is different is that we now have the building blocks in place and are driving what I hope is unstoppable progress.

Integration: Everything we do now is about integrating services. Put yourself in the place of a person who has a chronic disease, a disability and an addiction.

Consider how you would like to be cared for. Integration means that from the point you first come into contact with the health service, from GP, to addiction counsellor, to physiotherapist, to specialist consultant, to home help – all the services you need dovetail together with all of the professionals involved communicating clearly and working as one team rather than a series of unconnected, isolated teams.

Primary Care Teams: Already thousands of GPs and HSE staff are providing high quality care to hundreds of thousands of people through Primary Care Teams.

During the coming years, the range of services they provide will expand and they will become true one-stop-shops.

Hospital Reconfiguration: Thanks to the significant leadership shown by many clinicians and managers, hospital reconfiguration programmes that are underway are successfully leading staff and their communities in a direction that a few years ago we would never have thought possible; better quality and shorter waiting times.

Better Value: Our pursuit of better value has enabled us to reduce costs by almost b1 billion and still increase the level of service we provide. We are now providing care to more people than ever before with proportionately less funding and staff. This is being achieved in an environment where we are delivering major transformational change.

Clinical Leadership: For the first time in a long time we have a level of clinical leadership that can bring about unprecedented change and deliver better quality, access and value. It would have been hard to imagine back in 2005 that we would have so many clinicians active and willing to drive sustainable change at the frontline.

While I believe that solid progress has been made, it would be short sighted to think that we still do not have some way to go. We still have a lot of changes to make to the way we work and organise ourselves.

We have to do this in a difficult financial and HR environment. But we now have clarity and, I believe, acceptance by most professionals in relation to our goal of an integrated and predominantly communitybased health service. Coupled with the local leadership that is now in place, we are very well placed to deliver the type of services the public deserves.

We must remain passionate about the possibilities and believe, and help our colleagues to believe, that we are capable of continuing to build a very effective health service.

Professor Brendan Drumm, CEO, Health Service Executive

“For the first time in a long time we have a level of clinical leadership that can bring about unprecedented change and deliver better quality, access and value.”

4 Health Matters

Contents

Contents

90 Updates 92 Lenus A report on the Lenus health

repository 93 Communications Telephone Etiquette guidelines 94 Cystic Fibrosis Association plays key role as advocate 96 Mental Health World leaders in mental health meet in Ireland

1

Welcome

3

Message from the CEO

7 Achievement Awards Update on the 2008 winner

9 Updates 11 Warfarin therapy Online patient self testing 12 Patient OUTCOMES The HSE’s Directorate of Quality and Clinical Care

44 C hild Car Safety A feature that looks at different areas of car safety for children

99 Elder Abuse A Senior Case Worker describes her role in elder abuse prevention

45 Foster Care The Irish Foster Care Association outlines the organisation’s current role

100 Skin Cancer Prevention Programme targets outdoor workers and children

53 Palliative Care

Policy document on Palliative Care

for Children

103 Consumer Affairs Primary Care Teams urged to work in partnership with local communities

54 Bullying Cool School Anti-Bullying Programme

105 Personal Finance

Investing for retirement and personal

budgeting

16 Vaccination

HPV Vaccination Programme

56 Volunteering How hospital volunteers are helping patients in Galway

18 GP Feature Focus on the work of GPs

59 Regional Pages News from the HSE regions

24 Buying medicines online Why buying medicines online can be dangerous

70 Updates

112 Travel Three spots for a bargain break at home and abroad this summer

71 Health Research

114 Competitions

26 News in Brief

72 Haiti A physiotherapist spends a week in Haiti

31 Obstetrics

Clinical Programme for Obstetrics

care

115 Book Reviews Find out about our new Facebook book club

75 Tobacco Control A five-year plan to cut smoking rates

119 Crossword

32 Baby Boom A special report on the rising birth rate and our changing midwifery services

76 Health & Well-Being

Interesting features on fitness

and diet

120 ME AND MY JOB Adrian Ahern on working as a Mental Health Services Manager in Galway

41 Childcare Continuous improvement is the only agenda

79 Sporting Passions Tom McGuirk on participating in marathons

110 B rain Injury The silent epidemic of acquired brain injury

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Health Matters 7

Awards

Better Service recognised by HSE Achievement Awards The Community Nutrition and Dietetic Service from the Health Promotion Department in HSE South was the overall winner of the HSE Achievement Awards in 2008. The service used an education programme for people with Type 2 diabetes, called the X-PERT Programme. Today, there are almost 80 HSE community dieticians trained as educators of the X-PERT Programme around the country.

T

he X-PERT Programme was developed in line with international best practice for people with Type 2 diabetes. As part of the programme patients spend time on planning lifestyle changes and making use of education sessions to help manage their diabetes.

Community dietician teams in all HSE areas have worked towards implementing a strategy for the sustainability of high standard dietetic services by addressing the following: • Establishing a licence agreement for X-PERT Ireland between HSE and X-PERT Health.

• Refining the evaluation programme to allow audit during future roll-out. Clinical, psychosocial, attendance and satisfaction outcomes are being audited.

• Developing a quality assurance (QA) programme. QA commenced in 2007 addressing all aspects of the programme and QA of educators.

• Developing and delivering a ‘Train the Educator’ course to allow existing educators to become skilled as trainers, who would then train other health professionals as X-PERT Ireland educators (2009).

This latter development has facilitated the training of community dieticians to become educators by HSE community dietician trainers, avoiding the need to buy-in training from the UK. Three Irish ‘Train the Educator’ courses were completed during 2009/2010 in three HSE regions.

It is possible to support people with diabetes to self-manage when provided with

+ Dieticians trained as X-PERT Educators, October, 2008. Front row: Barbara Shinners, Hilary Devine, Dorothy Loane, Deirdre Howlin, Carola Diettrich.

Middle row: Siobhan Sinnott, Yvonne O Brien, Claire Whitham, Trudi Deakin, Karen Harrington, Freda Horan, Anne-Marie Tully. Back row: Maria Browne, Caroline O Connor, Carina Corridon, Fiona Moloney, Marie Branigan, Deirdre Walsh, Emma Reilly, Cara Cunningham, Margaret Humphreys, Sheena Rafferty, Pauline Dunne, Olivia Kelly.

the highest Standards of Patient Education (SPE). X-PERT Ireland offers patients and the HSE benefits through optimisation of diabetes control. Dedicated research time facilitates services to successfully re-orientate to deliver better patient services. Ireland’s first SPE programme for Type 2 diabetes is in operation. A strategy for sustainability and national roll-out of X-PERT Ireland is possible through collaborative working, dedication and staff pride.

HSE Achievement Awards 2010 The application process for the HSE Achievement Awards 2010 is now closed and applications are currently being evaluated by a Short-listing Panel. The evaluation process is scheduled for completion by July 2010.

The shortlisted applicants will then be reviewed by a National Selection Panel comprised of representatives from HSE, partnership, patient/service user advocacy groups and independents. This final selection process will be based on the written applications and presentations from the selected applicants and is due to be completed by October 2010.

National Event 2010 The national awards presentation ceremony will take place on Wednesday, 24th November in the Round Room in the Mansion House, Dublin. The Awards will be as follows: • The Derek Dockery Award for Overall Best Project with two runners up (three awards) • Best Project from each region and runner up (eight awards) At their discretion, the National Panel may make additional awards in the form of commendation for projects that excelled in particular criteria.

For further information email the National Coordinator for the Achievement Awards Denise O’Shea denise.oshea@hse.ie.

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Health Matters 9

update

CEO Designate T

he Board of the HSE announced in May the appointment of Mr Cathal Magee as the next Chief Executive of the HSE to succeed Professor Brendan Drumm whose term of office ends in mid August.

Cathal Magee is a former Managing Director of Eircom’s b1.3 billion portfolio of retail businesses that serve the consumer, business, corporate, and Government markets. He was also interim Chief Executive of the Group for six months to July 2009.

Previously he held other senior management posts in Eircom as Managing Director, Eircom Ireland, Managing Director, Business Transformation and as HR Director.

As well as his extensive commercial and business operating experience, he has been a central leadership figure in the extensive transformation and restructuring of the company. Early last year he concluded a major breakthrough agreement with the trade unions to enable the next phase of restructuring of the business.

Prior to joining Eircom, Mr Magee worked for the National Australia Bank Group in the UK and Ireland. He has also worked in a Business Transformation and HR Director capacity with Bord na Mona from 1988 to1992 involving business and operational restructuring. His early career was in the Health Service.

He holds a first class honours degree in Management from the IMI and a MSc in Organisational Behaviour from Trinity College, Dublin. He is currently a Non Executive Director of VHI Healthcare and the EBS Building Society.

The Chairman of the HSE Board, Mr Liam Downey stated, “The Board is very pleased to have attracted a highly experienced professional for the position of CEO for the HSE. Cathal Magee has an extensive record of implementing change and performance improvement in a number of organisations and different environments. He has worked in both the public and private sectors and

demonstrated a high level of achievement and successful engagement with a wide range of interests and stakeholders.”

Mr. Magee will take up his new appointment on September 1st next.

Dr Susan O’Reilly appointed as Director of NCCP

D

r Susan O’Reilly has been appointed as the new Director of the National Cancer Control Programme (NCCP) to succeed Professor Tom Keane whose contract with the Programme ended earlier this year.

Welcoming Dr O’Reilly’s appointment, HSE CEO Professor Brendan Drumm said: “We are delighted that Dr O’Reilly will be joining the HSE and leading the next stage

in the development of our national cancer programme. Dr O’Reilly will bring great experience, expertise and leadership to the continued transformation and development of cancer services in Ireland.”

Dr O’Reilly is currently the Vice President of Cancer Care at the British Columbia Cancer Agency (BCCA), based in Vancouver, Canada. She was appointed to this role in 2005 and is responsible for strategy, financial planning and delivery of both medical and operational components of all clinical programmes for cancer patients in the five Cancer Agency centres. She is the clinical Professor of Medical Oncology in the Faculty of Medicine at the University of British Columbia and for 13 years, until 2008, was Professor and Head of the Division of Medical Oncology at the University of British Columbia, Head of Medical Oncology at the BC Cancer Agency and Vancouver General Hospital and Provincial Systemic Programme Leader at the British Columbia Cancer Agency.

Dr O’Reilly grew up in South Wales and graduated with an honours degree (BSc) in Electrical Engineering from the University of Wales, Swansea. She subsequently completed her medical education at Trinity College, Dublin (MB, BCh, BAO, BA (Hons). After post graduate training in Internal Medicine in both Trinity College and University College Dublin teaching hospitals, she moved to Vancouver to specialise in Medical Oncology.

Her clinical interests as a medical oncologist in Vancouver have been in care and research in lymphomas, breast cancer and gynaecological cancers. She is a Fellow of the Royal College of Physicians of Ireland and of the Royal College of Physicians and Surgeons of Canada and her current interests are in provision of timely, high quality cancer control services and innovative programs in complex healthcare systems.

Dr O’Reilly will take up her new appointment in early September 2010.

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Health Matters 11

warfarin

Managing Warfarin Therapy Online is the Future Managing chronic or long-term disease is becoming a major challenge in the modern world.

Increasingly we are trying to find more effective approaches to manage these diseases and it seems ‘telehealth’ technology may provide one such solution.

A

recent study funded by the Health Research Board revealed that patient self-testing of Warfarin therapy, using an internet-based ‘expert system’, is more effective than the time-consuming conventional approach in the clinic. Fiona Ryan, School of Pharmacy, University College, Cork, who completed the study, explains.

Warfarin treatment is prescribed to manage a variety of illnesses associated with the ability of the blood to clot.

Some people find their blood clots too easily, causing conditions such as deep vein thrombosis. For others, their blood may be at an increased risk of clotting due to an irregular heartbeat e.g. Atrial Fibrillation. Conditions such as these require preventative treatment with blood-thinners. In many cases, this is achieved using oral anticoagulant therapy (OAT), such as Warfarin, and by measuring the length of time it takes for their blood to clot, using a test called the International Normalised Ratio (INR). In Ireland, most patients have to go to a hospital-based clinic, or to their GP to have their INR performed.

This is time consuming for staff in the clinics and requires regular hospital visits for patients.

With current demand for OAT expected to increase six-fold by 2050, great pressure will be felt in OAT clinics if an alternative approach is not identified.

+ Research team – Susan O Shea, Cork University Hospital, Fiona Ryan and Stephen Byrne, University College Cork.

We conducted the first ever randomised control trial of an internet-based, direct-topatient expert system that enabled remote and effective management of Warfarin therapy. Over the course of nine months, 132 patients were recruited to our trial.

They tested their blood (INR) at home using a portable meter, and entered this result along with other personal details onto the web page. They received instant feedback from the system, which described what dose of Warfarin they should take and when they should do their next blood test. Patients also visited the anticoagulation clinic every eight weeks to have their therapy reviewed, instead of approximately every three to four weeks in the routine care group. Our randomised controlled trial proved extremely successful on a number of levels.

• Patients reported a higher percentage of blood tests within their desired recommended range (X per cent versus Y per cent), compared with patients who had their blood tests performed in the clinic in the usual manner • The amount of patients attending the hospital-based clinic was reduced, which reduced pressure on clinic staff and patients • Patients were able to perform their blood tests while travelling abroad

According to the patient satisfaction survey: • 99.1 per cent said they found the equipment easy to use • 94.7 per cent said they felt their INR was more effectively controlled, compared to while attending the clinic • 98.3 per cent preferred patient self-testing compared to attending the hospital-based clinic.

This is a strong conclusion in support of using internet-based direct-to-patient expert system to manage Warfarin therapy. The next step is to work towards it being implemented nationally in practice effectively.

The results of this study have been published in the Journal of Thrombosis and Haemostasis*.

Fiona Ryan completed the study while working under the supervision of Stephen Byrne (Pharmaceutical Care Research Group, School of Pharmacy, University College Cork) in collaboration with Susan O' Shea (Haematology Department in Cork University Hospital). * Ryan F, Byrne S, O’Shea S., Randomized controlled trial of supervised patient selftesting of Warfarin therapy using an internetbased expert system. J Thromb Haemost.

2009 Aug;7(8):1284-90.

12 Health Matters

Patient outcomes

Role of new Quality and Clinical Care Directorate The HSE’s Quality and Clinical Care Directorate (QCCD) has been established to define how services should be delivered and measured and ultimately resourced writes Dr Barry White, National Director.

T

he Directorate is designed to help build improved patient care throughout the organisation by bringing together all clinical disciplines and helping them to learn and share innovative solutions to deliver benefits to every user of HSE services. We want to ensure that every patient gets the right treatment no matter where they live.

The work of Quality and Clinical Care Directorate is based on three main objectives: • To improve the quality of care we deliver to all users of HSE services • To improve access to all services • To improve cost effectiveness Critical factors for improving patient outcomes include: • Clinical leadership (to include all clinical disciplines) • Involvement of frontline staff in development of strategy and solutions • Local empowerment • Embedding data at the centre of all assessments and decisions With this in mind, clinician–led national programmes have been established around chronic disease and other areas of service pressures, i.e. emergency services and outpatient areas. The reason chronic diseases have been selected is because the evidence shows that a handful of chronic conditions account for up to 70 per cent of healthcare expenditure and up to 70 per cent of mortality. Significant improvements in these services will not only have a substantial impact on morbidity and mortality, but also free up resources for other areas. The purpose of the programmes is to implement

“The purpose of the programmes is to implement solutions known to improve quality, access and cost. The programmes are being led by a multi-disciplinary team of clinicians with substantial clinical experience.”

solutions known to improve quality, access and cost. The programmes are being led by a multi-disciplinary team of clinicians with substantial clinical experience.

Some clinicians may already be involved in these programmes and more will become involved in the months ahead. I believe that the involvement and engagement of clinicians, patients and staff is critical to the success of these programmes.

The clinical programmes and initiatives are as follows: Overarching Programmes • Primary Care • Elderly • Critical Care

+ Dr Barry White Chronic disease management programmes: • Stroke • Acute coronary syndrome • Heart failure • Asthma • COPD • Diabetes • Epilepsy • Mental Health Outpatient management programmes: • Dermatology • Neurology • Rheumatology • Orthopaedics Emergency function related programmes: • Emergency Medicine • Acute medicine • Acute and elective surgery • Diagnostic Imaging

Health Matters 13

Patient outcomes

The programmes are currently in planning phase with implementation due to commence in six months time.

The quality, safety and risk agenda will be at the centre of the programmes. However, the overarching activities that will be undertaken in this area involve the following: • Implementation of a clinical governance infrastructure under the direction of Dr Joe Devlin.

• Establishment of a national audit programme under the direction of Dr Joe Devlin.

• Establishment of a healthcare ‘internal audit’ function within the HSE. This will be a newly established unit under the direction of Edwina Dunne.

• Development of policies, guidelines, and procedures to support the implementation of the Strategy for Service Involvement in Health Services. The Advocacy unit is under the direction of Mary Culliton.

Finally, I would like to thank all staff who have so enthusiastically supported the directorate since its establishment.

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14 Health Matters

Patient outcomes

Clinical Care Programmes

Engaging Nursing and Midwifery

–

Nursing and midwifery is at the forefront in shaping the work of the Quality and Clinical Care Directorate (QCCD). The Office of the Nursing and Midwifery Services Director (ONMSD) is now aligned to the QCC Directorate and no longer within the Human Resource Directorate where it resided from 2006-2009.

T

he Directorate’s mission is 'better care and better use of resources'. One of the key vehicles for implementing the Directorate’s mission is the establishment of the Clinical Care Programmes targeting specific conditions.

The organisation and delivery of these Clinical Care Programmes will include nursing and midwifery professions as a key stakeholder. To this end, Dr Siobhan O' Halloran, Nursing and Midwifery Services Director, has agreed key roles for nurses/ midwives in the Clinical Care Programmes.

These include: • The assignment of Joan Gallagher, Clinical Care Programmes Liaison Officer, to work alongside QCCD in the development of the programmes and specifically in ensuring nurse/midwife representation on the programme interdisciplinary working groups.

• A Nurse Service Planner from a nursing and midwifery planning and development background has been appointed to each Clinical Care Programme. The purpose of the role is to support integrated workforce planning for the Clinical Care Programmes.

• A Lead Clinical Nurse with disease specific and service experience will be assigned to each programme team/ working group. This occurs through an ONMSD managed process, whereby Directors of Nursing/Midwifery will seek nominations/expressions of interest from nurse/midwives at CN/MM2 or

CN/MS level or higher. This process is near completion for the majority of programmes.

• The establishment of a Director of Nursing/Midwifery Strategic Reference Group – Clinical Care Programmes. The purpose of this group is to create a forum of senior nurse/midwife managers where the development of the clinical care programmes can be viewed, ensuring that decisions made by the Clinical Care Programme teams are informed by senior nursing/midwifery management.

The National Director of QCCD, Dr Barry White has clearly articulated that all healthcare professionals have a crucial role to play in the implementation of the programmes. Each programme will seek to achieve positive change in the outcomes of care provided to patients and service users. Nurses and midwives provide patient care around the clock; therefore it is imperative that they are involved in the Clinical Care Programmes design, implementation and evaluation.

These are challenging times for the Irish health system with our economic climate, government policy on healthcare staffing and the changes brought about service redesign, reconfiguration and transformation programmes, all of which impact on the traditional ways of working.

However, they are also exciting times where nursing/midwifery and other healthcare professionals can contribute to the change

+ Dr Siobhan O’ Halloran processes which allow for innovative ways of responding to patient and service needs. There is potential for role expansion, allowing for nurse/midwife–led care, enabling change to the way we work while bringing about better care and outcomes for patients.

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16 Health Matters

vaccines

Vaccination Programme Protects Girls from Cervical Cancer The HPV Vaccination Programme to protect girls from Cervical Cancer began in May – Dr Brenda Corcoran from the HSE National Immunisation Office provides an update.

More information on the HPV vaccine programme is available from a dedicated HSE website www.hpv.ie

Q&A on HPV Vaccine and Cervical Cancer

+ Dr Maureen O' Leary, Senior Medical Officer HSE, administers the HPV Vaccine to a student of Jesus and Mary School, Goatstown, Dublin.

T

he HPV Vaccination Programme began in second-level schools during the week of May 17th, where 21 schools across the country were visited by HSE Immunisation Teams. The first of three doses of the HPV vaccine was given to 1st Year girls in these schools. From September onward, all second-level schools will be visited and the vaccine will be offered to all 1st Year and all 2nd Year girls.

The HPV vaccine will protect girls from developing cervical cancer when they are adults and will be available free of charge from the HSE. Parents and schools have been sent information by the HSE, letting them know of the programme and when their daughter’s vaccinations will begin.

Launching the programme in May, Dr Kevin Kelleher, Head of Health Protection with the HSE said, ‘The HPV vaccination programme is about the protection of the future health of this generation of young girls in Ireland. The clear impact of the programme in the prevention of cervical cancer will most likely be seen in 20-30 years.’

“We hope to achieve a high uptake for this new programme of over 80 per cent, for a completed three-dose vaccine course”.

What is cervical cancer?

It is cancer of a woman’s cervix, the entrance to the womb. Each year in Ireland, about 250 women get cervical cancer, and 80 women die from it. Cervical cancer is caused by HPV.

What is HPV? HPV stands for human papillomavirus, which is a group of over 100 viruses. Most people will get a HPV infection during their lifetime, from sexual activity. Most of these infections do not need treatment, but in some women, HPV causes changes in the cervix that can develop into cervical cancer.

What vaccine is available to protect against HPV? From 2010, a HPV vaccine will be offered to young girls in Ireland. This vaccine is called Gardasil and protects against the types of HPV that cause seven out of ten of all cervical cancers.

Who is being offered the vaccine?

The HSE is offering the vaccine to: • All girls who are now in 6th Class and going into 1st Year this September • All girls who are now in 1st Year and going into 2nd Year this September Most girls will be vaccinated at school by HSE immunisation teams. Some will be invited to attend a HSE clinic to get the vaccine.

Arrangements are also being made to vaccinate girls who are not attending second-level schools, e.g. those who are home schooled or in special schools.

“We hope to achieve a high uptake for this new programme of over 80 per cent, for a completed three-dose vaccine course.”

When are vaccinations beginning?

Some schools will begin HPV vaccinations in May and some in September. Parents will be sent information from the HSE in the coming weeks letting them know when their daughter’s vaccinations begin.

Why is this age group being vaccinated?

We are offering the vaccine to this age group so that they are protected before adulthood and likely exposure to HPV. Older girls will not be vaccinated in this programme but they can get the vaccine privately from their GP. Is the HPV vaccine safe?

Yes, it has shown to be very safe, with 60 million doses already given worldwide.

How many doses are needed?

Three doses of the vaccine over six to 12 months are needed to give full protection.

How can girls be protected FROM THIS CANCER as adults?

The vaccine protects against seven out of ten cervical cancers, so it is still important for girls to have regular smear tests when they are adults. You can read more about HPV and cervical cancer on www.hpv.ie

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18 Health Matters

health service

+ (L-R): Catherine Bolger, Dr Christine Corr, Dr. Austin O’Carroll, Brenda Keenan and Sarah Kane.

Mutual support key for GPs and other health service workers GPs need support to prevent them becoming isolated due to their small size and physical disconnection from other HSE-employed primary care staff, while the HSE needs GP support at a time when the HSE is increasingly caught in a catch-22, where it faces increasing public expectations while experiencing decreasing public funding, writes Dr Austin O’Carroll, who is a partner in a practice located in Dublin’s north inner city, explains the need for mutual support

O

ur practice has always had a good working relationship with the HSE and it was the synergy between our energy and the HSE’s impetus to improve services that helped achieve some successes in addressing health inequalities. In truth, there are some in the medical profession who believe the HSE to be inefficient, unreliable and, in the most paranoid cases, ‘out to get’ them. There are those in the HSE who believe the only motivation for GPs is to earn money. However, in my experience, in between are the huge majority who recognise that we all wish to improve the health services and the health of our individual patients. This common desire needs to be exploited in future initiatives, in particular in bringing about the full implementation of the Primary Health Care Strategy.

Services Provided Our practice now comprises two partners, myself and Dr Ciara McMeel, five doctors, a nurse, practice manager, practice support manager and five administrative staff. We provide all the range of services that any general practice would offer to its patients.

However, we also seek to offer specialised services to address the health inequalities evident in our area. Early on the practice adopted a mission statement ‘to provide the highest possible evidence-based healthcare to our patients and to address health inequalities within our area’. As a result we have conducted a number of initiatives in line with this mission: • In the late 90's we set up an outreach clinic in a reception centre for asylum seekers at which we would see ten patients each day. We also provided

services to asylum seekers and people from new communities residing in the area. At this stage we have over 450 patients from new communities. All practice staff did cultural awareness training and also learnt French to converse with our African French speaking patients. I wrote the first Irish College of General Practitioners Guide for working with new communities.

We were awarded a prize for our work with asylum seekers from the African Refugee Network.

• In the early 2000s we set up specialised services for homeless people. These are services where they are operated from facilities that are used by homeless people. The surgery now operates GP-run clinics out of four hostels, (Cedar House, Maple House, Beech House and Back

Health Matters 19

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Lane) and two drop-in centres (Merchants Quay Ireland and the Capuchin Food Hall). Ideally, homeless people should be treated by mainstream services.

However, Irish research has replicated international research in that they do not actually make use of the mainstream primary care services and tend to go to hospital services instead. Research has regularly found rates of medical card uptake only between 55 per cent and 60 per cent, and even for those who do have a medical card many do not use their GP because of inaccessibility due to factors such as distance and appointment systems. Specialised clinics go to where the homeless person frequents. They exist all over Europe, including the UK, the US and Australia. Even in the UK, where primary health care is free to all, specialised services exist in all areas with large populations of homeless people.

• In 2006, along with Frank Mills of the HSE, the practice founded Safetynet, which is an organisation that networks all specialised services providing services to homeless people in Dublin and Cork. In 2009, Safetynet services provided over 14,000 consultations in Dublin alone.

Safetynet computerised all the various services so that they shared a common patient database. This allowed surgeries to work together in providing seamless care and to offer preventative services such as hepatitis B, flu and swine flu vaccination programmes. This service continues to be greatly supported by the Social Inclusion section of the HSE, and in particular Concepta de Brun.

• Our surgery, along with Dr Kieran Harkin, set up a specialised methadone treatment centre in two of the hostels for homeless people, which offers methadone treatment to over 30 homeless people at a time. We have reviewed patients who attended this service and found that the majority eventually controlled their drug usage and ended up in stable accommodation.

• In 2010, our surgery was instrumental in developing with Safetynet, Dublin Simon, Chrysalis, and the Order of Malta, a mobile outreach clinic which is delivered twice a week, one night working with

street-working women and one night with homeless people. It is staffed by GP trainees, Order of Malta staff and outreach workers and supervised by experienced GPs. This is an exciting new initiative that has already been very successful.

• Since 1997, the surgery has provided methadone treatment to patients from the community and in 2010 has over 50 patients on treatment. The surgery has conducted customer satisfaction appraisals of this service using questionnaires and has adjusted the service in response to the results of those surveys.

“Early on the practice adopted a mission statement ‘to provide the highest possible evidencebased healthcare to our patients and to address health inequalities within our area.”

• The practice was one of the founding members of North Doc/D-Doc and, as one of the original members of the Steering Committee, I negotiated that homeless people without medical cards would still be seen by D-Doc for free.

• The surgery has conducted and been involved in research into health inequalities, in particular homelessness, drug users’ perspectives on the health services and administrative blocks within the medical card system.

• Lastly, I have been involved in GP training since 2000. In 2010, I and Dr Ming Rawat have, in co-operation with the ICGP and HSE have set up a GP training scheme on the northside of Dublin that will focus on training GPs to work in areas of deprivation. To our knowledge, this is the first such scheme to be set up in Europe.

Early Years The practice I took over in 1997 had been run by Dr James Slein since the 1950s, in a run-down Georgian building on the corner of Western Way. Dr Slein was loved by his patients – single-handedly providing daytime and night-time care. He had also responded to the huge need within the inner city, particularly during the heroin epidemic that swept Dublin in the 1980s.

At the start there was only me and my receptionist, Chrissie O Connell. It was an amazing first year, where I was exposed to the realities of the effects of poverty on the health of a community while learning to respect and admire the resilience, humour and generosity of that same community. I met families that had lost several of their children due to drug overdose or HIV/ Hepatitis C. I met young people desperate to get off drugs with nowhere to obtain treatment. I also had sing songs in my waiting room, offers of presents of stolen goods and was flooded with chocolates, cakes and bottles of whiskey.

I had patients on addictive medication who became intimidating if I suggested detoxing them. I used some headed notepaper I had and wrote myself a letter admonishing my practice for prescribing too many benzodiazepines and advising we would be closed down if we did not cease prescribing these medications. I made enough copies for all the patients on these medications and explained how my hands were tied. We successfully detoxed almost all of these patients and they remained loyal to the practice.

One interesting story from my early years concerned the level of theft from the surgery. I remember one woman admonishing her child for bringing toilet paper in front of me. The child burst out crying saying, “but you told me to take it.”

We redecorated the surgery and I bought a lot of art – many people were adamant “it would be stolen.” Not only was the art not taken, all other theft stopped as well.

It proved for me that by showing respect to the community they would return it.

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Health Matters 21

health service

Simple staff measures make big difference for patients Dr Joe Clarke, HSE GP Lead, argues that simple measures taken by primary care staff can often make a huge difference for patients. It is estimated that more than 90 per cent of all medical problems are dealt with in primary care settings without patients needing to access hospitals.

P

rimary Care Services tend to score very highly in terms of patient satisfaction when surveyed. One reason for this is the personal and local service that primary care personnel, whether Nurses, General Practitioners, Dieticians or Physiotherapists,– deliver on a daily basis. As a working GP I have personal experience of how powerful and effective simple interventions can be in primary care. I recall a recent patient with diabetes whose disease was out of control despite the best efforts of the local hospital. The public health nurse called to let me know

that the patient's wife had recently reported that he was depressed and not looking after himself. I had a long chat with him and organised some local counselling and support, and within a short period his diabetes was back on track as he now had the motivation to look after himself.

This is a practical example of how team work at a very basic level can improve patient care. The problem up to recently was that the different frontline workers in primary care in general were working separately rather than sharing information and skills to help patients. A few years ago

“The problem up to recently was that the different front-line workers in primary care in general were working separately rather than sharing information and skills to help patients.”

+ Dr Joe Clarke, Summerhill Medical Centre, Co Meath. Pictured in his surgery with Kim Prendergast and her son Harry. Photographer: Barry Cronin. Picture courtesy of The Irish Times.

I conducted some research in my own area and I was very surprised at how few GPs, public health nurses and other primary care staff were in contact with each other or had even contact phone numbers.

As a result of these concerns, the HSE has put a big emphasis in recent times on the establishment of Primary Care Teams (PCTs) around the country. For GPs in

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Health Matters 23

health service

particular, this represents a big challenge as many have been working in isolation.

As time goes on we hope to see more and more of the teams around Ireland delivering the ‘joined-up’ local patient–friendly care that all citizens have a right to expect.

We are currently sitting on a demographic time bomb, which will see an increase in patients over 65 years, from 11 per cent to 15.4 per cent of the population by 2021.

At the same time, pressure on primary care will increase – by 2021 a recent ESRI report has estimated a 50 per cent increase in consultations for already stretched GPs and increasing workloads for other PCT members as the true extent of chronic disease management becomes apparent.

How do we try to deal with these major challenges?

Staying as we are is simply not an option as all the evidence points to the current hospital– based model being overwhelmed by the volume and complexity of chronic diseases.

International evidence suggests that countries with strong primary care systems in place are the ones that grapple successfully with some of the problems outlined.

In Ireland, the cost of accessing primary care is increasingly becoming an issue as patients without medical cards put off consulting their primary care providers often presenting at a late stage of the disease process.

On the other hand, the cost of providing up-to-date modern equipment and facilities is a real issue for GPs – the days of GPs practicing from car boots is thankfully well over. As a GP, I am seeing more and more young families who don’t have medical cards but who are struggling to afford the costs of medical treatment.

This is placing huge strain on already vulnerable people and the resultant mental health issues are becoming a major part of my day-to-day work.

We need more GPs. To this end, GP training places are being expanded by 30 per cent from July this year. Secondly, we need to put the resources and facilities in place to allow Primary Care to carry work to its full potential. This involves keeping focus on the development of PCTs and ensuring that IT systems are made available

to primary care to carry out its work in a streamlined fashion.

Chronic disease remains the biggest challenge facing our health service with up to three quarters of health expenditure being spent on diabetes, stroke, cardiovascular disease and chronic lung disease. Approximately 80 per cent of GP consultations are related to these diseases and the World Health Organisation has recently estimated that in developed countries, chronic diseases are predicted to increase by 10-15 per cent over the next decade. Clearly we need to tackle this situation urgently.

“As a GP, I am seeing more and more young families who don’t have medical cards but who are struggling to afford the costs of medical treatment. This is placing huge strain on already vulnerable people and the resultant mental health issues are becoming a major part of my day-to-day work”.

Recently, the HSE has established a Quality and Clinical Care directorate under the leadership of Dr Barry White.

This is a ground-breaking development in that doctors, nurses and allied health professionals are to be involved in real decision-making and resource allocation.

One of the first tasks of these groups is to tackle the chronic diseases aforementioned.

A clinical programme has been established for each of these diseases with

major input from primary care into the decision making. The top priority of these programmes is to make a real difference in terms of clinical outcomes for these patients.

A practical, evidence-based and pragmatic approach is being taken with a focus on what is simple, realistic and achievable.

Although proper chronic disease management can seem complicated and unattainable, often simple measures, such as having an asthmatic on proper preventative medication, ensuring that patients at risk of stroke get the appropriate blood-thinning medication to stop clots, or stopping someone with diabetes from getting foot disease can literally make the difference between life and death. These are interventions that can be made by primary care staff such as nurses, GPs, physiotherapists, dieticians and occupational therapists. If we could save a life a day over the next year from such an approach we would achieve something truly remarkable.

24 Health Matters

online medicine

Medicines Don't Buy Them Online Irish Medicines Board Chief Executive, Pat O’Mahony, discusses the findings of some recent consumer research that examined the issue of sourcing medicines through the internet and the associated risks.

I

n recent years, there has been an explosion of websites offering medicines for sale online. In addition, many of us are on the receiving end of email spam every day promoting these sites. This is certainly of concern to the Irish Medicines Board (IMB) and to our many partners, both in Ireland and internationally, who are working to counteract this problem.

As there are no guarantees that medicines bought online are effective, safe or of an acceptable standard of quality, these products could potentially have serious consequences for public health.

To ascertain exactly how many Irish consumers are using the internet to purchase medicines, the IMB commissioned a national consumer survey to examine the issue. The survey also reported on consumer use of the internet to gather general information about health issues.

64,000 Irish Consumers Buy Online The findings show that to date only a very small number – two per cent of the overall population – are purchasing medicines online. While this finding is encouraging, it does equate to 64,000 Irish adults who are engaging in a practice that could seriously damage their health. Also, it is of concern to the IMB that one in ten people said they would consider purchasing medicines online in the future.

While we welcome the fact that 66 per cent of respondents have a concern about the authenticity or safety of medicines available on the internet, 12 per cent do not have concerns in this regard and 20 per cent have never previously considered this issue.

The survey findings also reveal that the internet is playing an increasingly important role among Irish consumers, with a quarter of adults (25 per cent) using it as a source of information about medicines.

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online medicine

Always get Expert Advice While the internet is a readily available research tool when it comes to health, not all of the information sourced from the internet is reputable or indeed reliable. Our advice is to always talk to a GP or pharmacist about health concerns. A healthcare professional, who is likely to be familiar with the person’s medical history, is best placed to advise on what treatment or medication an individual may need. Our research results show that this is happening in the majority of cases and that GPs and pharmacists continue to enjoy huge levels of trust among patients.

In particular, medicines that require a prescription should only be used under the supervision of a doctor. Someone who buys prescription medicine without having seen their doctor may not have a proper diagnosis of their health problem. As a result, a serious health condition may go unidentified and untreated. It may even be mistreated.

Buy Safe, Approved and Effective Medicines We urge consumers to never purchase medicines online and to only buy from a trusted source. Prescription medicines for example, which must be first authorised by the IMB, can only be sold through approved retail pharmacies regulated by the Pharmaceutical Society of Ireland.

That will not be the case for medicines bought online. The internet is an unregulated source with no guarantees of ingredients, safety, effectiveness or quality of products.

The Dangers to Health The IMB strongly recommends that consumers never purchase medicines, and in particular prescription medicines, over the internet. The following are just some of the many reasons why we advise against this purchase: • Even where a medicine has been prescribed by a doctor, sourcing that product over the internet means there is no guarantee that it is effective or genuine. As a result, the medical condition may go untreated.

• There is no way of knowing if the product received has been tested and approved for human use. What is sent to the consumer may not even be the medicine that was advertised on the website.

• There is no way of knowing, with any certainty, how or where the product was manufactured. Because of this, there is no way of knowing if the manufacturer operates to acceptable standards.

• The medicine may not have been packaged, labelled or stored correctly

and could be out-of-date. It might also include incorrect patient information • The active ingredient in a medicine is what makes it work. A medicine bought online may contain no active ingredient, too much or too little of an active ingredient, or the wrong ingredients altogether. It could simply be useless in treating the medical complaint.

At best, it may be a waste of money. At worst, it could cause serious harm.

• The product received could be a counterfeit or fake. The packaging, labelling and colouring of some counterfeit medicines have been found to be almost the same as genuine medicines.

• Some medicines purchased online have been found to contain dangerous toxic substances.

• As there is no certainty about the ingredients used to make the medicine, consumers can’t be sure if it is safe to use alongside medicines they may already be taking.

Supplying Prescription Medicines Online is Illegal In Ireland, supply of prescription medicines through the internet is against the law and no online pharmacy is authorised to operate in this country. Illegal and counterfeit medicines seized by the Revenue Commissioners’ Customs Service are destroyed.

Our enforcement staff work closely with customs officials to prevent the illegal supply of mail order medicines. This co-operation has led to the seizure of many individual packets of medicines and has resulted in a number of prosecutions and other actions involving website operators. Many of these operators have tried to conceal their true identity.

those in the health sector and the public to contact us if they have any suspicions.

Contact the IMB The IMB welcomes any information that can help us reduce the threat posed to public health from the illegal importation of medicines. We continually monitor and investigate such activities and encourage

IMB Enforcement Section Phone: (01) 634 3436 Email: enforcement@imb.ie The Dangers of Buying Online – Information Leaflet This is one in a series of leaflets published recently by the IMB providing important advice on medicine safety. The leaflets aim to provide clear independent advice on how best to purchase, care for and safely use medicines. They are freely available to download from www.imb.ie, while printed copies can be requested by calling (01) 676 4971.

26 Health Matters

News // in brief Irish NGO Seeks Volunteers to Help Disability Services in Romania Comber, a leading Irish NGO, is calling for healthcare professionals to contribute their skills to a life-changing programme for children and adults with disability in Romania this summer and autumn.

Comber has been working in disability services in Romania since 1990 and during that time has placed over 500 professional volunteers there. Comber is committed to providing unique placements, offering personal learning opportunities and giving volunteers experience of volunteering abroad.

The focus of the volunteer programme involves working with Romanian adults who have recently been moved from institutional care into community homes, to develop independent living skills and employment opportunities; assisting adults with high level needs to access equipment and support needed for their imminent transition from institutional care to the community; assisting staff working with these adults in the community to further develop their skill level; delivering day care services in the newly established day care centre for adults with disabilities, the first of its kind in the area, and working with children with disabilities, who are living at home, to help manage their acute needs in partnership with their parents.

Comber’s services in Romania are expanding and volunteers will play a vital role in working with local staff to develop their skill level to meet the growing demands of the service. This year, a six week summer programme will run from July and a second programme, to continue this work, will commence in September. Placements are available for a minimum of three weeks up to a maximum of six weeks on each programme.

Programme 1: July 15th to August 26th Programme 2: September 16th to October 28th Applications are being sought from professionals in the following areas*: • Allied Health Professionals (including Occupational Therapy, Psychology, Physiotherapy, Speech and Language Therapy, Social Care Work, Social Work) • Intellectual Disability Nurses • Educators and trainers with experience of working with people with disabilities (including teachers, adult education and training providers and others with a relevant qualification and experience) *Newly qualified applicants welcome.

An application form is available at www.comber.ie For more information, please contact alison@ comber.ie or 087 222 2456.

HSE Community Games 2010 Minister for Tourism, Culture and Sport, Mary Hanafin TD, met participants during the first weekend of the HSE Community Games 2010 National Finals held in Athlone Institute of Technology in late May. The August National Finals take place over two weekends from August 14th16th and from 20th-22nd.

During the May weekend 3,000 children from all over the country were supported by more than 600 volunteers and organisers as they participated in various cultural and sporting activities, such as athletics, table tennis, soccer, chess, talent competitions, model making and art.

E-Learning in Pain Management A national advisory committee has been established to develop and provide an e-learning programme in pain management for nurses and midwives. This group is chaired

by Patrick Glackin on behalf of the Offices of Nursing Directors (ONSD) and Professor D Harmon is providing clinical expertise in pain management.

This project’s main aim is to provide an evidence-based educational programme in pain to address the fundamentals of assessment and management of pain across the care groups of midwifery, paediatrics, adults, learning disabilities and older persons. This educational programme will be accessible on www.hseland.ie, the HSE’s Learning and Development website.

Pain is an individual, complex experience and an integral part of life.

The negative social and economic impact of pain for patients and health services is substantial. Nurses and midwives have a fundamental role in providing comfort and in relieving suffering as well as identifying and managing pain. It is envisaged that this educational programme will provide nurses and midwives with fundamental knowledge in pain management.

For further information please contact: Mary C. McNamara, Project Leader.

Tel: (061) 482 678; email: maryca. macnamara@hse.ie

Shared Information Approach for Nursing and Midwifery The Office of the Nursing Services Director (ONSD) recently embraced the growing phenomenon of Twitter and Facebook. All are welcome to join their growing network at: www.facebook.com (Facebook – Nursing Services (ONSD) HSE) or Twitter – http://twitter.com/siobhanonsd Commenting on the development, Dr Siobhan O’Halloran, Nursing Services Director, said: “Embracing the future is something that ONSD is committed to. Twitter and Facebook allow our service to interact with all our key stakeholders in the best and fastest way possible, ensuring a shared information approach for nursing and midwifery.”

Health Matters 27

News // in brief

Online Support for People with Diabetes Nearly everybody with diabetes knows how important it is to sustain good control of blood glucose. Many measure their blood glucose using their own glucose meter, which allows the person with diabetes to track blood glucose changes at different times of the day, and this is very important in living an active and full life with diabetes.

The diabetes care team use another test to look at how a person’s diabetes has been controlled over the previous two months or so. This test is called the HbA1c test. It is very good at identifying those at greater risk of developing the complications of diabetes. The international organisations for laboratory medicine and diabetes have agreed that the way HbA1c is measured and reported should be standardised worldwide. This will make comparing HbA1c results from different hospitals and different countries much easier, and it will bring benefits to all involved in diabetes care.

People with diabetes will notice the change after the 1st of July.

From that day, HbA1c results will be reported in the new units called mmol/mol and in the traditional way as a percentage. This is called dual reporting and will continue until the end of 2011. After that only the new units will be reported.

It is likely that most people with diabetes will only have three or four HbA1c measurements made during the period of dual reporting, so it is important that they become familiar with the new numbers from early on, especially those numbers that concern the

management of their own diabetes. The diabetes care team will help in this regard.

The quality of HbA1c results provided by the laboratories in the publicly funded hospitals in this country is extraordinarily good.

Because of this, it is likely we will be able to use HbA1c to diagnose diabetes within the next couple of years and health service planners will be able to use community-wide HbA1c data to plan diabetes services into the future.

All of these changes provide a valuable opportunity for all involved in diabetes care to highlight once again the importance of good control of blood glucose in preventing the complications of diabetes.

Further information about the change is available on the ‘Diabetes’ page of HSE website (www.hse.ie/go/diabetes) and people can use a handy converter to convert results from one reporting system to the other.

For further information please contact: Loraine McGrattan, Project Manager, HSE – Palliative Care/Chronic Illness Care Group, Oak House, Limetree Avenue, Millennium Park, Naas, Co. Kildare. Tel: (045) 882 582

Health Services Management Masters Programme + Master Class, Graduates from the Health Services Management Masters Programme at Trinity College, Dublin, after conferral in May 2010. Martina Ryan, St Johns Hospital, Limerick, Deirdre Kenny, HSE PCCC LHO, North West Dublin; Ciara Fitzsimons, Central Remedial Clinic, Dublin; Siobhan O’Hanlon, Regional Drug Coordination Unit, Waterford, Breedge Finn, Beaumont Hospital; Norma Sheehan, Wexford Hospital; Kate Browne, Unicare Pharmacy, Cork; Lisa Brennan, HSE Child and Family Centre, Dublin; John Fox, HSE Dublin Mid-Leinster, Liam Donnelly, St Conals Hospital, Donegal; Mary McStay, HSE Intercountry Adoption Services Frances Neilan, Galway Clinic; Maeve Shanley, HSE Dublin Mid-Leinster Addiction Service, Carol O’Donnell, Cheeverstown House, Dublin, Enda Doody, St Ita’s Hospital, Donabate, Kathleen Williams, Our Lady’s Children’s Hospital, Crumlin, Amelia Cox, Regional Hospital Mullingar, Penelope Wiggle, Tallaght Hospital; and Colette McLoughlin, Children an Family Services, HSE, Dublin.

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Health Matters 29

update

Palliative Care for All ignificant progress has been made on the implementation of the recommendations of the joint HSE/Irish Hospice Foundation Report Palliative Care for All: Integrating Palliative Care into Disease Management Frameworks.” (2008) The report examined the palliative care needs of people with life-limiting conditions other than cancer and explored how the palliative care model can be extended to these patients within Irish healthcare. Initial focus was on chronic obstructive pulmonary disease (COPD), heart failure and dementia but its findings are applicable to all life-limiting diseases. It recommended that service models be developed to formalise palliative interventions with the care pathways of people with these diseases.

S

Following open competition, three two-year research projects began in 2010 to devise, implement and evaluate appropriate palliative care responses within dementia, respiratory and heart failure services, using action research methodology.

The anticipated outcomes include: clarity on the nature, potential and timing of palliative interventions; education material for key personnel and information for staff, service users and families; guidelines for introduction of palliative interventions and a framework that has national application to other relevant HSE services.

A part-time research project officer has been appointed to each project. The sites are:

Dementia and palliative care St. Joseph’s Residential Facility, Ennis, Clare Mental Health Services for Older People, with primary care and Milford Hospice, Limerick.

Research Project Officer: Marissa Butler marissa.butler@hse.ie

Palliative care and heart failure Mater Misericordiae and Connolly Hospitals with Northdoc Primary Care Network and St. Francis Hospice.

Research Project Officer: Rosemary McDevitt rmcdevitt@mater.ie

Palliative care and advanced respiratory disease St. James’s Hospital, Dublin with Liberties Primary Care Team and Our Lady’s Hospice.

Research Project Officer: Patricia White pwhite@stjames.ie

The projects are co-funded by the Irish Hospice Foundation, the Alzheimer Society of Ireland, the Irish Heart Foundation, the Baxter International Foundation and the Department of Health and Children and are supported by the HSE. Further information can be found on www.hospice-foundation.ie

Assessment tool developed for patients with chronic illness A

+ Members of the PARTNERS group, from left to right: Mary Lee, Julianne Ballard, Sue Paffrath, Caroline Walshe, Daragh Rodger, Rosaleen Lillalea and Pamela Henry.

client-centred assessment tool for individuals, 65 years and older, who live with chronic illness has been developed by a group of nurses interested in health informatics.

This tool incorporates a holistic assessment of clients’ needs and abilities using evidence based research. The information gathered allows for essential data to be easily communicated across and between the various agencies along the client’s journey.

As clients proceed on their care journey it is envisaged that the tool will facilitate continuity of care and improve communication between care agencies thus improving quality of care.

The tool was developed by a group known as PARTNERS (Participatory Action Research to develop Nursing and Electronic health Records).

The research was brought about through funding from the National Council for Nursing and Midwifery awarded to DCU to educate and train nurses on health informatics and clinical data standards. The Principal Investigator for PARTNERS is Pamela Henry, Lecturer in Nursing and

Health Informatics from the School of Nursing in Dublin City University.

The PARTNERS group includes members of the acute primary community and continuing care sector. Other members include an Educational Technologist, from the Irish healthcare consultancy company The Health Partnership, and software developers and engineers engaged in testing European health informatics standards from the Dublin Institute of Technology study EHRland.

Factors considered in the development include liaising closely with EHRland. As a consequence the design brief of the tool is underpinned by health informatics standards and will meet future European Health Record development requirements within Ireland.

To date this work has been supported by Dr Katherine Hannah a senior health information management consultant specialising in information integration in healthcare environments and a member of the Canadian Health Infoway Standards Collaborative Steering Committee.

For further information visit the PARTNERS website at www.partnersct.com or email us at partnersct@me.com

Health Matters 31

obstetrics

Clinical Programme for Obstetric Care A clinical programme for Obstetric care has been established as part of a major initiative by Dr Barry White, HSE National Director of Quality and Clinical Care, to standardise care across a range of medical specialities. The Obstetrics programme will define standardised care and audit for all aspects of Obstetric care in maternity services.

Prof Michael Turner of the Coombe Women’s and Infants University Hospital has been appointed as HSE National Clinical Programme Director for Obstetricsand Gynaecology. Prof Turner will be working with the HSE and with a range of clinical practitioners across Ireland in developing the work of this programme in the months and years to come.

The programme will be responsible for developing a standardised approach to all aspects of obstetrics, the need for which was seen in the recent response to misdiagnosis of early pregnancy loss in a number of hospitals.

In response to the reporting of cases of misdiagnosis of early pregnancy loss, a number of actions were agreed in early June by the HSE in conjunction with the Department of Health & Children. These actions are being taken to ensure the safe management of early pregnancy loss across the country and are ongoing at the moment.

A joint letter from the Dr Tony Holohan, Chief Medical Officer, DOHC and Dr Barry White, National Director for Quality and Clinical Care, HSE, was issued to all public and private Obstetrics facilities advising them to put in place immediate measures to ensure that the decision to use drugs or surgical intervention in women who have had a miscarriage diagnosed must be approved by a Consultant Obstetrician.

The HSE has undertaken to review cases over the past five years to determine the number of patients who were recommended drug or surgical treatment when the diagnosis of miscarriage was

“Prof Turner will be working with the HSE and with a range of clinical practitioners across Ireland in developing the work of this programme in the months and years to come.”

been made in error, and where subsequent information demonstrated that the pregnancy was viable.

The HSE gave guidance to all maternity services in relation to dealing with calls from concerned women and all Maternity Units nationwide made specific information and support services available to women who were concerned by media coverage and wanted information on their own care and experiences.

Prof Michael Turner, commented; “The diagnosis of miscarriage is made on the basis of a woman’s history, physical examination and investigations including ultrasound. It is important to treat the woman who is pregnant and not to consider the scan in isolation.”

As part of the work of the Obstetrics Programme, a guidance document for the

+ Prof Michael Turner management of early pregnancy loss will be developed in conjunction with the Institute of Obstetrics and Gynaecology.

32 Health Matters

Baby Boom

Midwifery Services Changing Amid Baby Boom Our midwifery services are changing as the number of births continues to rise. Dr Maria Fleming, HSE National Planning Specialist (Maternity Services) and Sheila Sugrue, National Midwifery Lead, provide an insight into areas where changes are taking place.

I

reland experienced a ‘baby boom’ during the decade between 1999 and 2009 with the number of births here rising from just over 50,000 to almost 75,000, according to HSE figures. Statistics indicate that the high birth rate is set to continue over the next eight-to-ten years.

The increasing birth rate has placed particular pressures on our maternity services. The delivery of maternity services is changing. Maternity and gynaecology services must meet the needs of women who, in the 21st century, are much more engaged with participating in their care with their lead caregiver. Maternity services often refer to women-centred care and this can be achieved by developing a culture of professional multidisciplinary collaboration and fully involving the users of the service.

Here we look at two areas where change is taking place – the development of midwifery-led care and the recent recommendation that maternity and gynaecology services in Dublin are located with adult acute services.

According to the Central Statistics Office, 2008 saw the highest number of live births registered here since 1896 (75,065) – an increase of 4,445 on 2007. The 2008 total is 41 per cent higher than in 1999 when 53,354 births were registered.

Development of midwifery-led care The HSE is currently studying the details of a report which compared consultant-led maternity care in the North East with a new model of care provided by midwives. The report was commissioned by the HSE and conducted by the School of Nursing and

Midwifery, Trinity College Dublin.

The study involved 1,653 women having babies in the North-East from 2004 to 2007, and compared the usual consultant-led maternity care with a new model of care provided by midwives in two integrated Midwifery-led Units (MLUs) in Our Lady of Lourdes Hospital, Drogheda and Cavan General Hospital.

The two MLUs, the first such units in Ireland, were opened in response to recommendations made in the Kinder Report (2001), to provide more choice in maternity care in the North East.

The study was carried out with the full support and co-operation of medical and midwifery staff in both units in the region.

The study showed that midwifery-led care, as practised in these units, is as safe as consultant-led care, but uses less intervention in pregnancy and childbirth. The number of babies needing resuscitation at birth, or admission to the special care baby unit, was the same in both groups. Six out of every ten women (59 per cent) having the usual care in the consultant-led hospitals (CLUs) had their baby’s heartbeat monitored continuously in labour by an electronic monitoring machine, compared with 38 per cent of women in the MLUs. Almost half of the women in the CLUs (49 per cent) had their labours speeded up by either having their waters broken or having oxytocin, a hormone, given intravenously by ‘drip’, compared with one third (34 per cent) of women in the MLUs.

“According to the Central Statistics Office , 2008 saw the highest number of live births registered here since 1896 (75,065) – an increase of 4,445 on 2007.”

Birth Statistics 80,000 75,000 70,000 65,000 60,000 55,000

2006

2007

2008

2009

Health Matters 33

Baby Boom

The model of care used in the two MLUs is one where midwives, working in partnership with the woman, are the lead professional.

They provide care in pregnancy, shared with the woman’s general practitioner if desired, and refer any problems to the GP or obstetrician as necessary. When the woman commences labour, she comes to the MLU, which is a separate unit within the maternity hospital, and is welcomed into her room where she stays for the labour, birth and postnatal resting time. Each room has a bed, pull-out couch for her partner to sleep on, a birthing pool, birthing aids, television, and tea/coffee-making facilities available.

Women’s satisfaction with the facilities was apparent in the study and 85 per cent of those attending the MLUs said they would recommend the care they had received to a friend, compared with 70 per cent of those having usual care.

In labour, fewer women in the MLU group chose to have epidurals (19 per cent) than did those in the CLU (25 per cent). Other methods of pain relief chosen included immersion in warm water in a birthing pool (24 per cent in MLU compared with three per cent in CLU). Despite having fewer epidurals, 83 per cent of women in the MLUs expressed satisfaction with their pain relief, compared with 68 per cent of women in the CLU. At birth, women in the MLU had a higher rate of spontaneous pushing and 20 per cent used upright positions for birthing, compared with six per cent in the CLU. In addition, 13 per cent did not require any drugs to speed up the after-birth, compared with just one woman (0.2 per cent) in the CLU. The results of the study concur with those from international research and the Cochrane review of midwifery-led care concludes that most women should be offered midwife-led models of care.

Independent Review of Maternity & Gynaecology Services in the Greater Dublin Area The HSE is committed to developing a strategic approach to maternity services nationally. The first stage in this work was the Independent Review of Maternity & Gynaecology Services in the Greater

MLU Service User One mother, who gave birth in the Midwifery-Led Unit at Our Lady of Lourdes Hospital in Drogheda in 2009, recently described the overall experience as “extremely positive”.

She said the information pack given to expectant mothers was very informative and comprehensive.

“Any concerns I had were dealt with in a very thorough and professional manner.

I took a more proactive role in preparation for the birth and I feel this was due to the advice and encouragement I received while attending the MLU,” the woman said.

She added: “I recall feeling an immediate sense of calm and relief as I entered the MLU in labour. Acknowledging the fact that it was my second labour I felt at ease and had little anxiety, feeling mostly positive, and Dublin Area published last year. The review, conducted for the HSE by KPMG Consultants, sets out recommendations and provides a high level action plan to facilitate the delivery of the best model of care for primary, community and hospital maternity services, to make available safe, sustainable, cost effective, high quality maternity, neonatology and gynaecology care services.

The publication of the Review followed a significant engagement and consultation with the main organisations and representative groups involved in the delivery of maternity and related services across the Greater Dublin Area.

The review concluded that Dublin’s

coping well with my labour as it progressed. I was regularly informed of my progress and went on to have a normal delivery with no complications.”

The woman said her time spent in the MLU post natal was peaceful and private.

“I was offered good support and encouragement in establishing breastfeeding and all related explanations were clear. So too was the advice and information I received on my discharge home. I felt that the follow up care for the week at home prior to discharge to the Public Health Nurse was also very attentive and thorough.”

She concluded: “I do feel that the care provided to me in the MLU was very personal and woman-centred, and I would strongly advocate referral to this service.” current model of standalone maternity hospitals is not the norm internationally. It is well recognised that for optimal clinical outcomes maternity and gynaecology services are located with adult acute services.

This allows the mother to access a full range of medical and support services should the need arise for for example, cardiac and vascular surgery, diabetes services, intensive care facilities, haematology services and psychiatric services among others. Therefore it is recommended that: • Coombe Women & Infants University Hospital is co-located with the Adelaide Meath & National Children’s Hospital (AMNCH).

34 Health Matters

Baby Boom

• National Maternity Hospital, Holles St, is co-located with St Vincent’s University Hospital • Rotunda Hospital is co-located with the Mater Hospital.

The HSE is aware of the widespread desire to progress the implementation of the recommendations and has begun putting in place appropriate supports for the work streams identified across service redesign, workforce needs, clinical governance, teaching and training, and physical infrastructure requirements. Progress to date is as follows:

Obstetrics & Gynaecology • A HSE clinical programme for obstetric and gynaecology has commenced with the appointment of two clinical leads for midwifery and obstetric/gynaecology. The roles of the clinical leads are to develop and implement a maternity and gynaecology clinical programme in accordance with the HSE Service Plan.

and gynaecology service physical infrastructure. A design brief for the recommended co-location projects is currently being prepared with specific emphasis on scope of service planning, design issues and shared services. Planning of new services will look at the potential for operational efficiencies and revenue savings that can be achieved to contribute towards development costs, as well as identifying and exploiting opportunities for revenue generation. It is proposed to set up project steering groups to progress these proposals in accordance with normal public sector capital works procedures. The groups will include representatives from the hospitals concerned, the HSE, the Department of Health and Children, and the National Development Finance Agency.

Scoping Proposals • Each of the three Dublin maternity hospitals has begun to develop site-specific

business/scoping proposals in relation to their proposed co-location moves. This process involves working closely with each of their proposed adult hospital sites and in the case of the Rotunda Maternity Hospital also with the National Paediatric Hospital project. Local project steering groups have been established between the maternity hospitals and their proposed adult co-location sites.

Learning Experiences • To inform the approach for design, operations planning and how to relocate, the HSE in association with the maternity hospitals has been researching the learning experiences of other relocated organisations including The Mater Mothers Maternity Hospital in Brisbane, Australia, and the new Maternity Unit that incorporates a Midwifery Led Unit in the Ulster Hospital NHS Trust in Dundonald, Belfast.

Coombe and Tallaght Hospitals aim to co-locate within four years Fetal Medicine • A fetal medicine clinical network has been established between the three Dublin Maternity Hospitals in line with the implementation of the Review recommendations pertaining to Fetal Medicine Services in Dublin.

Design Brief • The HSE is engaging all relevant parties in relation to the preparation of a design brief for the proposed co-located maternity + Dr Elaine Madden, Head of Midwifery & Gynaecology, South Eastern Trust, Belfast recently welcomed a delegation from the HSE and three Dublin maternity hospitals to the newly-opened maternity unit in Ulster Hospital, Dundonald. The visit was part of a planning exercise looking at the future of the maternity services in the greater Dublin area. The maternity unit in Dundonald had a total of 3,500 births last year. It has been developed to provide choice for mothers in terms of the model of care, with a consultant-led service for women deemed to have risk factors, and a midwifery-led unit on the floor below for women who are considered low risk, wishing to have no intervention in labour. Pictured: Dr Maria Fleming, Margaret Philbin, Patricia Hughes, Mike Robson, Dr Chris Fitzpatrick, Patricia Scott, Pat O’Boyle, Sheila Sugrue, Eleanor Mashese, Mary Brosnan, Elaine Madden, Louise McMahon and Pauline Treanor.

The Coombe Hospital and Tallaght Hospital in Dublin are working together to accelerate the co-location of the two hospitals.

Significant partnership initiatives include: • The Coombe-provided antenatal clinic in Tallaght • The provision of Occupational Health Services to the Coombe by Tallaght • Joint Coombe/Tallaght colposcopy MDTs • Co-ordination of Coombe/Tallaght

response to H1N1 influenza • Co-location financial business case prepared by senior management teams from both hospitals The two hospitals have also engaged positively with the National Paediatric Hospital project in relation to the Ambulatory & Urgent Care Centre to be constructed on the Tallaght campus. It is the intention of both hospitals to achieve co-location within four years.

Health Matters 35

baby boom

Maternity Updates Domino Community Midwifery Service

T

he Community Midwifery Service operating from the National Maternity Hospital in Dublin’s Holles Street, comprises a team of 17 midwives and offers a Domino, home birth and early transfer home services. It has delivered over 3,500 babies between January 1999 and April 2010 in the South Dublin and North Wicklow areas. Last year there were 530 Domino births, 33 home births and 1,250 women took early transfer home under the care of the service.

The service aims to provide a natural, woman-centered and community-based approach to pregnancy and birth within the realms of safe midwifery practice. It is designed for women who are deemed to be at low risk of complications. Research shows that breastfeeding rates increase with continued midwifery care at home.

• Within the Domino (which means ‘IN’ and ‘OUT’) service, all antenatal care and education is provided by the community midwifery team. The baby is born in hospital and mum returns home within six to 12 hours as long as there are no complications. All postnatal care and follow-up is in the mother’s home.

All this care is provided by the same team of community midwives.

• With the Home Birth service, scans and blood tests are conducted in hospital but all other antenatal appointments are at home. The baby is born at home. One of the community midwives will support the mum-to-be on the day or night of labour, and a second community midwife will be present at the birth.

Emergency services are always on standby.

• The Early Transfer Home (ETH) service is where mums and babies transfer home from hospital six-36 hours after delivery. All mums and babies’ follow-up care is given by one of the Community Midwives until day five after delivery.

+ Citizen 2010 – Laura O’Neill, Bruff, Co Limerick with her baby girl, Ava, born at 2.51am New Year’s Day 2010 in the Limerick Regional Maternity Unit.

Mums-to-be who live in the catchment area are encouraged to consider the Community Midwifery Service which provides a personal and supportive environment for women and their families in their own home.

The midwives work closely with women to offer high-quality, evidence-based care thereby supporting spontaneous birth with confidence and competence. Pregnancy and childbirth on occasion needs specialised responses to complications and the community midwives work as a

team with obstetricians to provide the most appropriate care for mothers.

Maternal and Newborn Clinical Management System (MN-CMS) Project The first installation of a national project to implement a modern integrated Maternity and Neonatal IT System is expected to take place in the second quarter of 2011.

The system will be designed to meet the needs of all maternity and neonatal services

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Health Matters 37

baby boom

nationally. It will support the main functions and processes of the maternity and neonatal services.

The procurement and implementation of a complete MN-CMS that is interfaced with the Hospital Information System (HIS) and other clinical systems will, in the longer term, provide a fully-integrated electronic patient system that manages and records all events for mother and baby.

‘What Matters to You?’ Survey – AIMS Ireland AIMS Ireland, the Association for the Improvements in the Maternity Services in Ireland, is a consumer-led organisation. It was established in 2007 by a number of concerned mothers who were dissatisfied with the care they received and who decided to advocate for change in maternity services.

The Association campaigns for mother-friendly birth practices and more choice. It provides consumer feedback to the maternity hospitals, the HSE, the Department of Health and Children and other agencies providing maternity services.

In 2009, the Association conducted a survey among women who experienced maternity services as currently provided.

The HSE welcomes such surveys as it gives a snapshot of the positive aspects of maternity care in Ireland and also highlights areas where more work needs to be done.

One of the main issues raised in the survey was that of choice during care provision. Women wanted more midwiferyled options, greater geographic equity in services and more “neutral” information on the choices available.

The ‘What Matters to You’ survey was carried out between July and December 2009 and had 367 respondents. Full details of the survey are available on the AIMSI website www.aimsireland.com National Disability Authority Reports Now Available A literature review and policy report relating to women with disabilities and their experiences of pregnancy and early motherhood are now available on the National Disability Authority (NDA) website www.nda.ie.

“In her new role with the HSE, Sheila will provide leadership support and guidance on a range of professional midwifery matters.”

The HSE participated as part of the Steering Group for these reports and is currently engaged with the NDA in relation to specific requirements for women/families with disabilities.

Appointment of National Midwifery Lead for the HSE Sheila Sugrue was appointed National Midwifery Lead for the HSE in March and reports to the Office of the Nursing and Midwifery Director in the Directorate of Quality and Clinical Care.

She was formerly Nurse/Midwife Advisor with the Department of Health and Children (2006 – 2010) working in the Nursing Policy Division.

In her new role with the HSE, Sheila will provide leadership support and guidance on a range of professional midwifery matters. The appointment provides an opportunity where midwives can contribute to change and respond to women’s and service needs in innovative ways.

Sheila’s appointment comes at a time when major changes for midwives are on the way in legislation and regulation. The publication of the new Nurses and Midwives Bill in April recognises midwifery as a separate and distinct profession for the first time since 1950.

The introduction of Clinical Supervision for all midwives in the Bill will require implementation throughout the profession. The purpose of the Bill is to enhance the protection of the public in its dealings with nurses and midwives and to ensure the integrity of the practice of both nursing and midwifery.

The first pre-registration midwives also known as direct entry midwives are due to graduate this summer, the first since the 1950s also.

The maternity services are a key component of the HSE’s Transformation Programme and midwives have a key role to play as the organisation moves to an integrated model of care.

During her career Sheila was Labour Ward Clinical Manager at St James’s Hospital Maternity Unit, Dublin and Clinical Manager, Coombe Women and Infants University Hospital, Dublin where she later became Midwifery Tutor and Principal Tutor at the School of Midwifery. She completed a Bachelor of Nursing Studies at UCD and later an MSc in Midwifery.

During her time working in the School of Midwifery, Sheila maintained a close link with the clinical environment and established a Midwives Clinic for low risk women. She intends to continue to maintain a close relationship with the clinical environment.

Additional material provided by Prof. Cecily Begley, Chair of Nursing and Midwifery, School of Nursing and Midwifery, Trinity College Dublin; Mary Brosnan, Director of Midwifery, NMH, Holles Street, Dublin; Noel Carberry, Project Manager Maternal and Newborn Clinical Management System (MN-CMS); Dr Chris Fitzpatrick, Master CWIUH; Krysia Lynch, PRO Coordinator AIMSI.

Health Matters 39

baby boom

My role as a midwife attending for antenatal care. We aim to provide holistic care to each woman and we understand the importance of personalising their care.

At present, the majority of women attend an obstetric-led clinic, where care is provided by both midwives and doctors. The majority of women have a healthy, uncomplicated pregnancy and these women are offered the opportunity to be cared for in the midwife-led clinic. Following very positive feedback from a recent review of the Midwife-led Clinic, we aim to increase the availability of this service for all suitable women.

Helen Moloney, Outpatients Department Midwife

S

taff in Cork University Maternity Hospital work as a multidisciplinary team, with each member of the team playing a key role in providing a world-class, women-centred, care facility. My role as a midwife in this team is to be with a woman throughout her journey from pregnancy to motherhood.

Working in the Outpatients Department, I am very conscious that this is where the women will meet the midwife for the first time. This first meeting is important and I try to put women at their ease and develop a rapport with them as it shapes their perception of the service and affects their entire experience.

My role involves taking an accurate history from the woman, including medical history, family history, social history and obstetric history. I document the care given.

I use my clinical skills and judgement at all times. Education and health promotion is key to the care. I am an advocate for the woman during her pregnancy. In our parentcraft classes, I facilitate women, and their birthing partners, to prepare for birth and the transition to parenthood.

Within the Outpatient Department my role varies immensely. I have the opportunity to work in a variety of clinics such as the midwife-led clinic, obstetric clinic, gynaecology clinic, fertility clinic, paediatric clinic and the hysteroscopy clinic. The majority of women attending CUMH are

“In our parentcraft classes, I facilitate women, and their birthing partners, to prepare for birth and the transition to parenthood.”

The Perinatal Medicine Clinic was developed to cater for women whose pregnancies are complicated by preexisting medical conditions or those who are experiencing complications of pregnancy. These women will often require more frequent visits to the clinic.

My role includes organisation of referrals, co-ordinating the running of the Perinatal Medicine Clinic and arranging appropriate follow up. I attend the weekly perinatal medicine meetings with the obstetricians where care is planned for these women, such as arranging additional scans and extra visits to see their obstetricians. The women attending these clinics can be quite anxious, and a large part of my role involves providing reassurance and ensuring they are kept fully informed and involved in their care at all times.

I enjoy working as a midwife in the antenatal clinic and being with these women on their special journey.

Janet Murphy – Advanced Midwifery Practitioner candidate I am currently a candidate to become an Advanced Midwifery Practitioner at Waterford Regional Hospital.

The advanced midwifery practitioner post at Waterford Regional Hospital was developed out of a need for an expert midwife practitioner for the hospital’s midwifery led services. The post was created after an extensive review of the local integrated hospital and community service.

The advanced midwife practitioner will provide clinical supervision for midwifery led services and develop an apprenticeship model of evidence based midwifery care to benefit both clients and midwives.

The advanced midwife practitioner will also be responsible for her own caseload of women with specific midwifery care needs.

Janet took up the post of candidate advanced midwife practitioner in midwifery care in December 2009. I am demonstrating my core advanced midwifery practice competencies through portfolio development and hoping to be accredited this summer.

My role has had a positive impact on the maternity services and midwifery profession through ongoing demonstration of clinical leadership.

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Health Matters 41

childcare

State Care for Children -

continuous improvement is the only agenda

Care, Protection, Quality, Change, Reform and Standardisation are all key themes to understanding the role and focus of the State and the HSE in protecting children. However the endless complexity of the task should never be underestimated and is often poorly understood during the course of public debate.

R

ecent tragedies regarding children and young adults involved in State care services have, not for the first time, brought about a level of public discourse on how the State cares for children in need of protection.

Many of the issues, which were highlighted by these cases, were not new to the people who work in or have experience of the Child Care services.

Much of the debate is focused on outcomes of State intervention and rightly so. It is however important to balance the

debate on outcomes with an understanding of the childrens’ experiences before they come to the attention of the HSE Child Protection Services. Neglect, unintended or not, abuse in all its forms, high levels of social deprivation, sometimes set against a backdrop of addiction or possibly violence, can be the context within which protection services encounter children and their families.

For the first 20 years of the Health Board system in Ireland the legal basis for State intervention to protect children had its

cHILD cAR seAT

excuse

know the law on child car seats every year too many children are killed or seriously injured on our roads – often because they are not properly restrained when travelling in a car.

It’s your responsibility as a parent, grandparent or guardian to ensure that the child car seat you buy is not just appropriate for their age, height and weight but that it also conforms to EU safety standards.

The law has been changed to afford children greater protection when travelling in cars. Under the EU law all children under the age of 11/12 must be in an appropriate child car seat. No exceptions, no excuses.

So make sure you visit www.rsa.ie/childsafetyincars understand the new law and give your child the best protection possible.

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Health Matters 43

childcare

origins in legislation written in 1908. During the past two decades there were many periods when Irish Child Care services were the focus of public attention, not dissimilar to today. When today we examine critiques of services to Children in Care we should remember that there were similar periods of public scrutiny in the past, such as that which led to a major move from institutional to group home care in the 1970’s following the Kennedy Report.

Some years later we had the Task Force report of the early 1980’s. Then we saw major progressive legislative change in the form of the Child Care Act 1991 and those who work in the area won’t be surprised to find that more attention and more reports were co-terminus with the full implementation of this legislation. We had the Kilkenny Incest Investigation, the Madonna House Inquiry and a range of internal reports which again served to remind us of the need to keep improving what we do whilst at the same time understanding the vulnerability of children in many situations regardless of State intervention.

It is in this context therefore that we must view the renewed focus in 2010 on Irish Child Care services. It is important, it is challenging, and its detail often disturbing for people and its outcome must be further improvement.

What then is the continuous improvement of recent times and planned for the near future?

Whether you are a professional working in the field or a member of the public reading this, here are some key important facts: • There are approximately 5,500 children in care in Ireland on any one day. We now have a regulatory and independent inspection system which challenges and reports on the HSE being compliant or not with the regulations. It is now a focus of 2010 to ensure each child in care has a social worker, a plan, a review of that plan and a level of care which can only be measured when you look at our individual social work/social care staff and foster carers. It was not that long ago when these basics could potentially go

“It is in this context therefore that we must view the renewed focus in 2010 on Irish Child Care services. It is important, it is challenging, and its detail often disturbing for people and its outcome must be further improvement.”

unchecked. Now apart from independent inspection, they form a key part of the monthly performance management review of the Health Service in the four HSE Regions.

• There are approximately 20,000 reports to HSE Social Work services every year.

When considered, they result in 2,500 child protection concern cases which require further intervention. Many more require Family Support which requires ongoing development. Recently and over the next 18 months the HSE will systematically roll out the nationwide uniform approach to Children First (National Guidelines for the Protection and Welfare of Children). This will be supported by key components such as the Referral and Assessment process, a clearly understood description of roles and responsibilities for all staff, a standardised and clear process for child protection conferences, and many more components which will be robust and uniform.

• Whether children are known to our services, in care or leaving care the fundamentals of our society are our support mechanism for the most vulnerable. The HSE spends a significant share of its child care allocation on grants to agencies that provide this

support in a way which is integral to and acceptable by communities as distinct from being viewed as ‘the long arm of the State’. We now also lead out on the Towards 2016 (Social Partnership Framework Agreement) commitment to the development of Childrens’ Services Committees but of equal importance is the day to day local engagement with many State and voluntary agencies to promote the well being of children and their families.

• Since 2008 the HSE has taken an evidence-based approach to services for Children and Families. Other developments include the advancement of a national child care information system, an analysis of social work structures and governance to inform change and a system of robust performance management of how we fulfil our statutory functions. In addition an internal Task Force is focusing on targeted statements of policy and procedure.

• In 2010, some 200 additional social workers will be employed by the HSE. The HSE reform programme is far reaching. Within it there are specific programmes for specific services be they medical or personal social service focused.

The tragedy for some children will always remind us of their vulnerability and our limitations as a service provider but more importantly as a society. Continuous improvement can be the only agenda in caring for and protecting them and supporting their families.

If you are concerned about a child please contact your local health centre.

44 Health Matters

safety tips

Make Child Car Safety a Priority A message from the Road Safety Authority

M

aking sure you use a child car restraint may be the most important thing you do for your child. Research shows that 77 per cent of child fatalities in collisions between 1996 and 2000 were due to a lack of or misuse of a child car seat. So no matter how short the journey, every child should be restrained correctly in the car in a child restraint that is suitable for their weight, height and age. Sounds simple enough, but the reality is this is a very serious problem among parents and guardians.

In fact, according to the Road Safety Authority (RSA), as many as three out of four parents fit their child’s car seat wrong and it is usually through no fault of their own. Any new parent will tell you that they are overwhelmed with information received from retailers, friends, parents and helpful neighbours about the various pieces of equipment they need for their baby. Advice can be helpful but what happens when you get the wrong advice, or worse, you don’t get any advice?

Mr Brian Farrell, Communications Manager, Road Safety Authority (RSA) says: “Buying a child’s car seat can often be a very confusing experience. The golden rule for selecting your child’s car seat is to make sure that the seat is suitable for their weight, height and age. Don’t use age only as a guide. Every child is different, as is every car seat, so it is vitally important that you only buy your child’s car seat from someone who knows what they are doing

and can show you exactly how to use and fit the seat properly.

“Research has shown that ensuring a child is properly restrained can reduce the possibility of death in a crash by a factor of 71 per cent and can reduce injuries by a factor of 90-95 per cent for rear-facing seats and 60 per cent for forward-facing seats,” he said.

To address the problem of incorrectly fitted child car seats, the RSA has taken its child safety in cars campaign, the ‘Check it Fits’ Roadshow around the country over the past five years. Parents are invited to come along to the roadshow and get their car seat checked by an expert. In five years, over 3,000 car seats have been checked by the experts and the results have shown cause for concern.

“Often parents underestimate just how important it is to fit their child’s car seat correctly, but research from our annual ‘Check it Fits’ Roadshow shows that over half of all child car seats checked would have provided little or no protection to the child in the event of a crash. This is a huge cause for concern and we would urge every parent and guardian out there to go to your local retailer and make sure that they show you how to ‘check it fits’. Do not buy a car seat unless you are shown how to fit it correctly yourself,” Mr Farrell concluded.

The research also revealed that almost

four out of ten child car seats required major adjustment with a further one in 20 (five per cent) deemed condemned, which could potentially cause serious injury to the child in the event of a crash.

Speaking on the consequences of not fitting child car seats correctly, Professor Alf Nicholson, Consultant Paediatrician at the Children’s University Hospital, Temple Street, said: “Every year, we see a number of children admitted to our Emergency Department at the Children’s University Hospital with injuries received as a result of not being properly restrained in the car.

These injuries can present themselves in many ways, including injuries to the face leaving permanent scars, broken bones and severe head injuries.

“I would ask any parent or guardian with children who should be using a child restraint to make sure their child restraint is fitted correctly and not run the risk of having to bring their child to our Emergency Department,” he concluded.

The Road Safety Authority has a dedicated Child Safety in Cars website (www.rsa.ie/childsafetyincars) where you can read the ‘Child Safety in Cars’ booklet and watch the ‘Child Safety in Cars’ DVD. Both the booklet and DVD are FREE and available to order online at www.rsa.ie/ childsafetyincars or by telephone at LoCall 1890 50 60 80.

Health Matters 45

Foster care

Vast majority of children in care with

foster families Foster care in Ireland has gone through many changes over the last 20 years. Deirdre McTeigue, Director of Services, Irish Foster Care Association (IFCA), outlines the organisation’s current role and the improvements it is seeking in foster care today.

U

nder the Child Care Act 1991, the HSE is responsible for the care of children in State care in Ireland. Generally speaking, the Child Protection social work teams are responsible for taking children into care following a thorough assessment of the child’s and family’s needs.

The fostering teams, through their link workers, are responsible for the recruitment, assessment, training and follow-up support to the foster family. The child and family social worker continues to work with the child and family throughout the placement.

Currently there are over 5,500 children in the care of the HSE in Ireland; 92 per cent of these children being cared for by 3,100 foster families. Twenty years ago, this situation was reversed with the majority of children in care placed in residential children’s centres.

There are a number of private foster care agencies operating in Ireland, but the families are approved at the HSE panels and the children are all in the care of the HSE. There are many kinds of foster care, but all foster care is designed to meet the assessed needs of the child coming into

+ Minister for Children and Youth Affairs Barry Andrews TD with Aidan Waterstone, National Specialist Alternative Care, HSE, Alice Parkinson, IFCA Chairperson, and Deirdre McTeigue, IFCA Director of Services, at the IFCA Seminar in November 2009.

“There are many kinds of foster care but all foster care is designed to meet the assessed needs of the child coming into care. This is why it is so crucial for each child to have a Care Plan” care. This is why it is so crucial for each child to have a Care Plan in order to identify the best possible family placement for him or her.

The Irish Foster Care Association is 76 per cent funded by the HSE. We work very closely with the Children and Families Social Services in the HSE. Our training packages are part of the core training for prospective foster parents around the country and we also train foster carers and social workers in our packages. We get many referrals from social workers and foster parents to our independent mediation and support services. We also provide additional insurance cover for legal expenses incurred in the event of an allegation being made against foster parents and their family.

46 Health Matters

foster care

The IFCA is advocating for the following health and social service improvements to support foster care: • A 24-hour social work service for children in care or their families.

• A consistent aftercare policy for those over 18 who are either in or out of care.

• IFCA, along with the other members of ‘Action for Aftercare’, are campaigning for aftercare to be put on a statutory footing.

• A Care Plan for every child in care.

• An allocated social worker for every child in care.

• A link social worker for every foster family.

• Access to necessary ancillary resources for every foster family to allow them to properly care for the child in their care, for example speech and language therapy or psychological services.

• Appropriate vetting and assessment for all foster families whether relative or general.

• Ongoing training and support for foster families to enable them to better understand and care for the child in their care.

The IFCA is advocating for these resources and sees them as a right for children in the care of the State. It is commendable that the embargo on recruitment for social workers has been lifted and that the HSE is honouring its commitment to appoint 200 social workers.

Types of Foster Care The terms foster care and foster parents refer to all individuals and families involved in foster care, be it general, relative, emergency, day, respite or high-support foster care.

Day Foster Care Day foster care is an alternative form of care that provides a support system in the community. Specially selected and trained foster carers provide care on a daily basis in their own home. In this way, the child’s family gets the chance to tackle and hopefully deal more effectively with their difficulties. This form of care can prevent the child being placed in full-time care.

Short-Term Foster Care Short-term foster care can provide temporary care for a child or children separated from their birth family. The reasons are varied and can include illness,

+ Phil Garland, HSE Assistant National Director Children and Families Social Services after he launched the IFCA Survey, The Voice of Foster Carers with Deirdre McTeigue, IFCA Director of Services and Brenda Irwin, IFCA Support/Mediation Officer (Author of Survey).

“Emergency care is where a child comes into care very quickly, or an existing placement breaks down and a child needs to be moved quickly. In both instances, a child is placed with emergency carers.” death, physical or sexual abuse, and neglect. A short-term foster family can offer family care on a temporary basis to such children. Being short term, the children will, after a period, move back to their family or move on to a long-term family or an adoptive family.

Long-Term Foster Care Long-term foster care is needed for children who are unlikely to be able to live with their birth family, and who, for a variety of reasons, cannot be adopted. Long-term care requires a commitment on the part of the foster family for a number of years. This could be until the child grows to a point in adolescence where he or she is entitled, and able to make, his or her own decisions.

Emergency Foster Care The health authorities around the country operate various ‘emergency’ care schemes.

Emergency care is where a child comes into care very quickly, or an existing placement breaks down and a child needs to be moved quickly. In both instances, a child is placed with emergency carers.

Respite Care Respite care is provided by some foster carers to provide a break for a child’s family or other foster carers. Where a family is under stress and a child may be displaying very difficult behaviour, a break gives breathing space to all concerned. Whether this break takes place during the week, at weekends or at other times depends on the needs in each child’s case. Where a child is

Health Matters 47

foster care

in foster care and the placement is at risk of breaking down or where planned breaks are part of the Care Plan, a support or respite family is identified and it is essential that both families work together in the interests of the child. Generally speaking, this will be for a weekend, a series of weekends or during a holiday period.

Relative Care When a child or young person comes into care in a planned manner, the fostering social worker looks to the extended family to see if the child could be placed with relatives. Approximately 32 per cent of children and young people in care today are in relative care, living with grandparents, aunts, uncles or other family members.

The Child Care Act 1991 provides for the reception of children into care, and all children in foster care are in the care of the State. The Child Care (Placement of children in foster care) Regulations 1995 and the National Standards for Foster Care 2003, set the requirements for the operation of a fostering service. Foster care services in Ireland are provided in the main by the HSE and by a small number of private and voluntary agencies.

The Voice of Foster Carers The IFCA has recently published a survey of its members called ‘The Voice of Foster Carers, 2009’. This survey was carried out to explore the current issues for foster carers in Ireland today. In particular, it was designed to collect evidence-based data on the current situation regarding aspects of fostering‚ such as allocation of social workers, prevalence of Care Plans‚ and supports and services for foster carers and young people.

Some of the key findings from this survey include: Contracts The foster carers interviewed stated that they had contracts for two thirds of the 156 children in their collective care at the time of the survey.

Care Plan Almost four out of ten (37.8 per cent) of the 156 children were in foster care with no current care plan.

Irish Foster Care Association The Irish Foster Care Association was set up in 1981 by a group of foster parents and social workers who recognised the need for a voice for foster carers in Ireland. Since then, the association has grown in number and stature with a membership base that represents about half the foster carers registered with the HSE, plus social workers, child care workers, academics and others with an interests in the area of foster care.

We work closely with the HSE and the Department of Children and Youth Affairs on all matters relating to foster care, always having the best interest of the child to the fore.

The Irish Foster Care Association believes every child has the right to a caring and functioning family. Where this is not possible with their birth family, the IFCA believes they have a right to a substitute family.

The IFCA provides a forum where all those who are interested or involved in foster care can get together to support one another, air their views and where necessary, campaign for improvements in policy and regulation. We also offer the following:

Independent and Confidential Support • I nformation and guidance: IFCA staff are informed and knowledgeable in all aspects of fostering. They are available to offer information, guidance and can respond to general enquiries in relation to foster care.

• Mediation: The mediation service offers professional independent support in the event of disagreements during the investigation of allegations or concerns, to ensure all parties remain constructively engaged and to facilitate the voicing of all perspectives. The aim of the mediation service is to find a compromise or way forward when there is a breakdown in communication.

•A dvocacy: The advocacy service provides independent advice and feedback with regard to understanding and responding to written reports plus independent support or representation at meetings where necessary to ensure the position of foster carers is adequately represented.

•E motional Support: Allegations, serious concerns about practice or standard of care and placement disruption can be very stressful for foster families. Telephone counselling, individual meetings and a listening ear, are an integral part of the support service from IFCA. Training The Irish Foster Care Association has a dedicated team of trainers who devise and deliver training in relation to all aspects of fostering. This training, which is delivered predominantly to foster carers and social workers, is available to all personnel who have contact with a child living in foster care. IFCA training is devised to promote best practice and partnership between the HSE and foster families, hence the training is cofacilitated by a foster parent and social worker.

Seminars and Conferences The association hosts an annual seminar on current issues which includes research and best international practice. In 2010, the theme of the seminar is ‘Sexuality and Young People’.

Publications We publish a range of leaflets and books as well as a newsletter, which is circulated three times a year.

Irish Foster Care Association, Unit 23, Village Green, Tallaght Village Dublin 24 Tel: 01 459 9474, Fax: 01 462 8014

48 Health Matters

foster care

General Support and Services While the majority of foster carers felt they were receiving adequate support and services to meet the needs of the children in their care, over a quarter (29 per cent) identified shortcomings in the access to professional services for young people in care, social worker support, information, aftercare, and psychological support for foster carers.

Current Issues of Concern for Foster Carers Foster carers involved in the survey were given the opportunity to identify areas of concern with regard to fostering. Seventy-two foster carers responded with a total of 193 comments.

The most common issues identified related to general foster family support.

Access to Services The majority of concerns related to accessing services such as occupational therapy, speech and language therapy, physiotherapy, psychology and counselling.

Some foster carers stated that the waiting lists were too long, forcing them to access and fund these services privately. The funding of assessments and treatments from essential professional services by foster carers was considered inappropriate.

There was a strong feeling that the ‘best interests of the children are not applied…’ and that there is an inappropriate onus and pressure on foster carers to advocate for the child’s needs and welfare at all times.

There was a sense that the priority was on the initial placing and settling of the child and that, subsequently, it was very difficult to get adequate follow-up support.

Special Needs Of the foster carers who are presently or have in the past cared for children or young people with disabilities or special needs, some expressed anger and frustration at the inadequate support and services available to them, and difficulties accessing specialised equipment or therapeutic service was highlighted.

One carer commented, “We received no additional help for the children with special needs,” while another described his sense of children with disabilities as “falling through the system.”

“Of the foster carers who are presently or have in the past cared for children or young people with disabilities or special needs, some expressed anger and frustration at the inadequate support and services available.”

Some carers interviewed expressed frustration that responsibility was often passed to disability services and that they were unable to obtain clear answers or guidelines with respect to entitlement or services for children with special needs.

Aftercare Serious concern was expressed by over a quarter (28 per cent) of those surveyed

with regard to the future welfare of the young people in their care. This concern was expressed predominately in relation to difficulties experienced in securing aftercare support and services for young people approaching 18 years of age. Foster carers highlighted the absence of aftercare plans and a sense of frustration and futility was expressed with regard to raising this issue with social workers or at review meetings.

Foster carers identified pressures experienced trying to source appropriate third-level education for young people in order to secure aftercare funding, while also highlighting concerns regarding the uncertainty and insecurity that exists for young people who are not academically, socially or emotionally ready for third-level education or independent living.

While the majority of carers with young people in this age group continued to provide a home for the young person involved, a minority expressed a sense of resentment and frustration at the expectation and presumption of the HSE that they would do so.

The survey highlighted the fundamental need for clarity and consistency for both young people and their foster families in relation to future care and support provision, in order to safeguard and

+ Mrs Justice Catherine McGuinness officially opening the new IFCA offices with Senator Camillus Glynn, Alice Parkinson, Chairperson IFCA & Deirdre McTeigue, IFCA Director of Services.

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Health Matters 51

foster care

promote the well-being of young people through this very important transition period.

IFCA Recommendations Following the completion of this survey, the IFCA proposes the following recommendations: 1. That the findings identified are communicated and shared through the existing collaborative channels between the HSE and IFCA. 2. That any discrepancy between policy and practice in relation to care plans and allocation of social workers and link workers are addressed. The IFCA recognise the challenges in achieving this objective but also recognise the positive implications for the welfare of young people in care and foster carers of achieving realignment.

3. The development and implementation of a national aftercare policy in all HSE regions to safeguard the transition from care to independent living for young people.

4. One of the keys to success for children and young people in care is the relationship between children in care, foster carers and social workers.

IFCA would welcome and are open to any initiatives that further promote and develop constructive and positive communication between foster carers and HSE representatives.

5. Where possible, access to professional supports and services should be prioritised with regard to the needs of children and young people in foster care.

6. The development and implementation of a consistent and effective ‘out of hours’ social work service in all HSE regions to safeguard and minimise risk to young people in difficult situations and their foster families.

We know that children grow best in families and the IFCA is supportive of early interventions and preventative work with families. Most children in care wish to return home and it is laudable to see how families can be helped to address their problems and be restored to a level of functioning to allow them resume care of their children. For those who can’t, we believe that permanent family placement through adoption, open

“Most children in care wish to return home and it is laudable to see how families can be helped to address their problems and be restored to a level of functioning to allow them resume care of their children.” adoption or long-term foster care the best solution. Whichever placement is deemed to be in the child’s best interests, it needs to be properly resourced to secure a successful outcome, to prevent young people being over-represented in the homeless and juvenile justice systems.

There are many excellent foster families providing great care for the children in their charge, supported by committed and enthusiastic social workers.

The HSE and IFCA are committed to continually addressing the issues that arise in foster care to ensure the best possible outcomes for children in care in Ireland.

Should any of your many employees in

the HSE wish to get further information on fostering, visit our website at www.ifca.ie.

Should you be interested in becoming a foster carer, please contact your local HSE fostering social work department.

Fostering for Families The Irish Foster Care Association has reduced the cost of a New Beginnings Training Pack and is making this offer available to all trainers.

The New Beginnings course is a preparation course for children of prospective foster carers. The sessions are designed to provide fun and interactive learning experiences that will enable the young people to consider and discuss information and issues related to fostering.

Each Pack contains sufficient material to run a New Beginnings course: • 2 x Leader’s Guides • 10 x Children’s Workbooks • 10 x Young People’s Workbooks Cost of Pack – c150 To order: contact Sandra Tel: (01) 459 9474 Email: training@ifca.ie

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Health Matters 53

Palliative Care for Children

Palliative Care for Children with Life-Limiting Conditions In Ireland there are approximately 1,400 children living with a life-limiting conditions. A recent policy document, Palliative Care for Children with Life–Limiting Conditions, provides a foundation upon which children’s palliative care services can be developed in Ireland. +

Pictured with Barry Andrews TD, Minister for Children and Youth Affairs are some of the members of the Children’s Palliative Care Working Group responsible for the development of the new policy. (L-R) Back: Geraldine Fitzpatrick, Department of Health and Children; James Conway, HSE. (L-R) Front: Service user, Claire Quinn; Minister Barry Andrews TD Dr Maeve O’Reilly, Consultant in Palliative Medicine; Eugene Murray, CEO, Irish Hospice Foundation, and Julie Ling, and Department of Health & Children.

C

hildren’s palliative care has evolved from the speciality of paediatrics rather than adult palliative care and is an active and total approach to care, embracing physical, emotional, social and spiritual elements. It focuses on enhancing the quality of life for the child and providing support for the family, and includes the management of distressing symptoms, provision of respite and care through death and bereavement. The challenges that must be faced are multiple and specific, and differ significantly with those relating to the care of adults. Adolescents requiring palliative care have their own unique needs.

A life-limiting condition is defined as any illness in a child where there is no reasonable hope of cure and from which the child or young adult will die. Children with these conditions are likely to need palliative care.

Each year, there are about 350 childhood deaths from these life-limiting conditions; the majority occuring in the first year of life.

The Report of the National Advisory Committee on Palliative Care (2001)

highlighted the need for a review of children’s palliative care services. A Palliative Care Needs Assessment for Children was undertaken and the results published in 2005.

The recent policy document aims to address the issues identified in the needs assessment in order to build a responsive service for children and their families. The policy defines palliative care for children with life-limiting conditions and draws on national and international developments in this small and highly-specialised field. It also describes services as they are currently provided, and gives clear direction for future development.

It says a comprehensive service needs to function within a co-operative model, with close liaison between general practitioner, paediatrician, nursing services, therapists and the voluntary sector. Children’s hospitals and hospitals with paediatric units are central to the ongoing care and management of children with life-limiting conditions. This policy recommends that a hospital-based specialist palliative care team led by a Consultant Paediatrician with a Special

Interest in Palliative Care be in place.

It also recommends that the palliative care service be based in the planned new national paediatric hospital, with the consultant having access to inpatient beds.

The policy states that in order to provide support primary care services should be developed. Services should include outreach nursing posts, therapy posts, hospice-in-the-home and respite care (both in home and away from the home) in each of the HSE regions. These developments would be in line with primary care/network developments. In order to plan and develop services, data collection is required and it is envisaged that the HSE will collect information on children living with and dying from life-limiting conditions.

The needs assessment identified a need for staff to develop the competencies required to address the palliative care needs of children. The policy identifies requirements in the education and training of healthcare staff and carers. Bereavement services developments are also required.

It is recommended that a National Development Committee for Children’s Palliative Care be established by the HSE to provide a national forum for the cohesive, integrated development of children’s palliative care services based on population needs, and to ensure geographical uniformity in the provision of services.

In developing the policy, the Department of Health and Children aims to provide a framework within which a seamless service can be planned, delivered and accounted for by the HSE.

54 Health Matters

bullying

Initiative tackles bullying in schools The case of an Irish student found dead after allegedly suffering months of bullying at an American High School has once again highlighted the problem. Ann Flynn, Education Officer, writes about the Cool School Anti-Bullying Programme designed to tackle school bullying.

T

he recent tragic death of an Irish teenager in the US has focused attention on the menace of bullying in our schools. News reports suggest that the teenager was a victim of what is referred to in the literature on bullying as ‘relational aggression’ from her peer group. This form of bullying is as common in Ireland as it is in the US or any other country. The questions raised by the case and the comments made about the school system in the US apply here as much as there. What are Irish schools doing to prevent such tragedies or to deal with the perpetrators?

Relational bullying refers to the manipulation of friendships and friendship groups in order to exclude and intimidate previous friends from a group. Much of this type of bullying was laid at the door of the girls. However, as more research was done it became clear that boys also engage in relational bullying. While the effects of such behaviour are more serious for girls because of the girls’ greater need for intimacy in friendships, boys who are bullied in this way also suffer. Some of the effects of relational bullying mimic other forms of bullying, for example anxiety, loneliness, humiliation and shame. The social alienation involved in relational bullying and the social exclusion from the peer group, along with the slander and defamation of reputation by malicious gossip, causes young people to be under particular psychological distress.

The first systematic intervention to have been developed in Ireland started in 1997 in the then North Eastern Health Board. Dr Maria Lawlor, Consultant Child Psychiatrist, became aware of the need for a programme to deal with bullying as a

direct result of her clinical experience with young people. She found that a significant number of the teenagers attending the Child and Adolescent Mental Health Service were being bullied in secondary schools across the region. These students reported that they were afraid to report the bullying for fear of making things worse. They had little or no faith in the teachers’ ability or willingness to deal with the issue in schools

“Relational bullying refers to the manipulation of friendships and friendship groups in order to exclude and intimidate previous friends from a group.”

and the vast majority of them suffered in silence. It was clear that a systematic approach was needed to improve matters.

Dr Lawlor set about establishing a multi-disciplinary team with the initial aim of finding out what was best practice in other countries. With the support of Principal Social Worker, Bernie Henry’ Research Psychologist, Dr Deborah James’ Group Therapist, Niamh Murphy’ and two teachers, Pat Courtney and Ann Flynn, both seconded from the Department

of Education and Science, the existing research was combed for ideas on what worked in other countries and what was possible. It was clear that a whole-school approach was required to make any progress. This involved training school staff, parents and students about the various aspects of bullying.

Cool School Programme Schools were keen to accept the training because the problem of bullying was worsening year by year and teachers found it difficult to deal with. Within two years of the Cool School Programme being offered to schools in counties Louth, Meath, Cavan and Monaghan, over 90 per cent of schools had accepted a full day’s in-service training of their staff. Parent awareness training was made available and many schools in the North East organised an awareness-raising evening for their parents.

A curriculum was developed for students and teachers were given training in the delivery of the curriculum.

Health Matters 55

bullying

A training programme was then developed in how to deal with bullying using a restorative approach. This approach encourages teachers to see bullying as a problem to be solved rather than a student/s to be blamed. It requires a less punitive approach and time to be given to teach empathy skills to students who use bullying behaviour and who lack such skills.While a restorative approach holds people accountable for their behaviour, it offers a more pro-social manner of dealing with perpetrators.

While all this was happening, the international research community was continuing to study the whole area of bullying. Keeping abreast of the literature was an extremely important part of a successful programme. It became clear in the mid-90s that relational bullying was a major problem in our schools.

To deal with this growing problem, the Cool School team set about developing a

“Keeping abreast of the literature was an extremely important part of a successful programme. It became clear in the mid-90s that relational bullying was a major problem in our schools.”

separate training for teachers and parents and a curriculum for students. The team also published two handbooks for teachers, Responding to Bullying and Investigating and Resolving Bullying in School. A book for parents, Bullying in Secondary School – What Parents Need to Know and a book for students, R U Bn Bullied? Tips for Teens followed.

The research aspect of the programme has been published in several prestigious journals.

Four years ago, the Department of Education and Science reviewed the Cool School materials and piloted the programme successfully in Dublin schools.

Recently, the Department has appointed Pat Courtney as Assistant Co-ordinator to the Social, Personal and Health Education service (SPHE) with a particular responsibility for dealing with bullying in Irish schools. This is a step forward in making school a safe place for Irish school children, but much more needs to be done.

In the meantime, Dr Lawlor’s team have been developing a programme for primary schools, modelled on the whole-school approach of the second-level programme.

You can contact the Cool School Programme at Hazel House, Kennedy Rd, Navan, Co. Meath

56 Health Matters

volunteer service

Hospital Volunteers Galway University Hospitals (GUH) comprises the city’s University Hospital Galway and Merlin Park University Hospital. Volunteer members of the public have been delivering a ‘Meet and Greet’ service to patients at the hospitals for more than 18 months with positive results.

T

he aim of the volunteers is to enhance services to patients and visitors and to support diversity programmes within Galway University Hospitals.

The main role of the volunteer is to provide a friendly welcome and to assist visitors to their various wards, departments and clinics. The volunteers are available at the main reception desk and at the outpatients department of University Hospital Galway from 10am until 12.30pm and from 2.00pm to 4.30pm, Monday to Friday. It is now proposed to expand the scheme to other areas of the hospital. The volunteers wear a tabard with ‘Volunteer University Hospital Galway’ and a name badge so they can easily be identified.

GUH provides secondary, regional and supra-regional services for the West. It is one of the major academic teaching hospitals in Ireland and aims to deliver high-quality and equitable care for all its patients in a safe and secure environment, and to achieve excellence in clinical practice, teaching, training and research.

Speaking about the volunteer programme Christy O’Hara, Head of Human Resources at the hospital, says: “The participation of volunteers is complementary to the work of the hospital staff and is a Staff Partnership initiative. The volunteers commit their time and energy for the benefit of patients and visitors; they are highly motivated individuals who choose to contribute their time and talent to supplement and enhance the efforts of our clinical and support staff in delivering a high standard of healthcare. I must also pay tribute to Phil Whyte from HR who has put in some

“Volunteers were recruited through a number of channels, for example, past employees, Friends of the Hospital, voluntary organisations, the volunteer bureau.”

excellent work in co-ordinating matters and in making the initiative a huge success.”

The initial idea came through the Quality Improvement/Hospital Accreditation process with input from the Services and HR departments. The hospital established a steering group to oversee the establishment of the volunteer service comprising senior management, a manager with overall responsibility for volunteers, a partnership representative, a service user and a volunteer. The steering group was tasked with developing the volunteer policy, disseminating information on the benefits of volunteering; defining the scope of the policy; agreeing on the role of the volunteer; and continuous review of the value and success of the programme.

Volunteers were recruited through a number of channels, for example, past employees, Friends of the Hospital, voluntary organisations, the volunteer

bureau, press coverage and advertising on notice boards around the hospital. To date, a varied group of 23 volunteers have been recruited and trained, including students, people on shift work, people who work from home and retired people.

The volunteers undergo a selection process which takes account of equal opportunities and is in line with the hospital’s recruitment code of practice.

Following interview, references are obtained on all interested volunteers which are also subject to Garda clearance. Once recruited, the volunteers are provided with appropriate training as part of an induction morning and this covers topics such as infection control, health and safety, diversity/disability awareness, fire precautions, confidentiality, briefing on the services and facilities at Galway University Hospitals and a tour of the hospital site.

Each volunteer commits to at least four months volunteering, and a minimum of two-and-a-half hours per week.

Mary McHugh, Director of Nursing and Midwifery at the hospital, says, “We all appreciate how worrying a visit to the hospital can be for patients and their families, and this, coupled with the ongoing developments within the hospital, creates an even greater challenge for people to find their way around. The volunteer service at the front hall alleviates this worry and they are instrumental in guiding and assisting patients and visitors to the various departments or clinics. The volunteers’ excellent interpersonal and communication skills also help to put the patient at ease while they are escorting them to the appropriate areas.

“It is very important that the first impressions for patients and their families of the hospital are of a friendly, welcoming and reassuring nature. The volunteer service is invaluable in this regard and as Director of Nursing and Midwifery for Galway University Hospitals, I would like to thank them most sincerely for their dedication and wonderful work in supporting our patients and visitors. They provide an extremely valuable service and for that we are most grateful.”

Eleanor Finn says of her experience as a volunteer, “With retirement looming and a desire to become involved in community work, I was fortunate to join the Galway University Hospitals Volunteer Programme.

I register my time and day of choice and partake on a weekly basis, operating from the main reception and outpatients. We take patients and those accompanying them to whatever area in the hospital complex they request. As many travel distances from Donegal, Sligo or Mayo, we deal with queries as varied as where to pay car park fees, to suggesting a place to lunch and general local queries.

“As we move around the hospital we assist people with directions from as simple as the ‘exit’ or the ‘coffee shop’, or

+

I would like to thank them most sincerely for their dedication and wonderful work in supporting our patients and visitors. They provide an extremely valuable service and for that we are most grateful.”

perhaps fetch a snack for the person who is too exhausted to fetch it for themselves.

In one instance recently, I helped a person locate their car which they had parked at a rear entrance and could not remember the entrance they had used to bring a patient to an appointment.

“For me there is a feel-good factor in being part of a team that can take an often anxious person directly to their destination

In the foyer of University Hospital Galway, (L-R): Ann O’Toole, Volunteer; Christy O’Hara, HR Manager; Mary McHugh, Director of Nursing and Midwifery; Pat Commins A/General Manager; Noel Reid, Volunteer; Phil Whyte, Volunteer Co-ordinator; and Michelle Guthrie, Volunteer.

within the vast hospital complex. It is a privilege to have been accepted as a volunteer and I would recommend it to others as a fulfilling experience.”

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Health Matters 59

Dublin north east // News Walking Bus

+ Some 1,454 pupils from Navan Primary Schools, in Co Meath set the longest walking bus record, promoting Navan’s bid to win the Department of Transport’s Smarter Travel competition (supported by the Health Promotion Department HSE Dublin North East).

Grangegorman Health Needs Assessed An assessment of the health needs of the 34,000 population living in the Grangegorman neighbourhood of Dublin was launched recently by the HSE in conjunction with the North West Inner City Network (NWICN) and the Grangegorman Development Agency (GDA).

The study aims to collect information on the health needs of the population in the area. The research will be used to develop health facilities and services, including the redevelopment of the 73-acre Grangegorman site. Under the management of the GDA, the land currently occupied by St Brendan’s Hospital is to be redeveloped for new buildings for the HSE’s Mental Health and Primary Care Services, as well as a new urban campus for Dublin Institute of Technology. A range of public facilities including sports, parks and a primary school will also be provided.

The Grangegorman Neighbourhood and Primary Care Area Health Needs Assessment is part of the HSE’s involvement in planning for the utilisation of the Grangegorman site.

A copy of the report is available on the HSE website.

Cultural Diversity Celebrated at St Mary’s in Dublin An evening of Cultural Diversity was celebrated recently at St Mary’s Hospital in the Phoenix Park. Staff from 16 varied nationalities work in the hospital, including natives of Africa, Cuba, Czech Republic, Italy, + (L-R): Anu Thomas and Figi Anthony, staff nurses perform an Indian dance at the Cultural Diversity Evening.

Lithuania, Libya, Mauritius, Pakistan, Poland, Romania, Scotland, Slovakia, Ukraine and the USA, with the largest numbers coming from the Philippines, India and Nigeria.

Kathleen Lynch, co-ordinator of the event, said, “Cultural differences in the approach to various aspects of nursing care have presented challenges and opportunities for all. Overall, the patients and residents have benefited from the rich mix of cultures. The changes seen in St Mary’s over the past ten years have made us reflect more effectively on all aspects of care, leading us to understand that we have to prepare for caring for a future population where customs and religious beliefs are different from the past.”

Many of the staff contributed to the evening to provide an exhilarating display of culture, colourful native costumes, song, dance and musical talent.

Older People Get Fit on FaME Physiotherapists in Dublin North Central, in collaboration with local agencies, recently held a successful community-based exercise programme for 15 older people from the Ballymun Whitehall area. The Falls Management Exercise (FaME) Programme aims to improve participants’ balance and mobility, improve their confidence and prevent falls. All of the participants had a problem with their balance and were at risk of falling and many were already being seen by a physiotherapist and the public health nursing service also referred clients to the programme.

Aine O’Riordan, Senior Physiotherapist, said, “We held a feedback session midway through the programme, during which the participants said they enjoyed the sessions and claimed their balance and confidence in walking had improved greatly."

Sixteen older people, including eight FaME Programme participants, have taken part in a 12-week follow-up Physical Activity Programme. Research recommends that it is important to have exercise programmes available for people to progress from the FaME programme.

+

Aine O’Riordan, Senior Physiotherapist presenting certificate to Kathleen McGinn, one of the participants who completed the FaME Programme.

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Health Matters 61

Dublin north east // News +

(L-R): Margaret Scott, Asst Director of Nursing, Cavan General Hospital, ‘Tommy Brady, local fundraiser, Irish Hospice Foundation; Eilish Sweeney, CNM2 Emergency Department; Bridget Clarke, Bereavement Committee, Cavan General Hospital; and Brian Nolan, Irish Hospice Foundation Bereavement Co-ordinator.

Louth County Hospital Gets Haematology Accreditation The scope of accreditation of the laboratory at Louth County Hospital has been extended to include Haematology. Last year, the Irish National Accreditation Board (INAB) presented Accreditation Certificates to the Blood Transfusion Departments of Our Lady of Lourdes Hospital, Drogheda, Our Lady’s Hospital, Navan and Louth County Hospital, Dundalk. Recently, the INAB awarded accreditation to the laboratory at Louth County Hospital to include Haematology. Louth County Hospital is now one of six hospital haematology laboratories in the country to be awarded accreditation by INAB to date.

The hospital had received registration from the INAB and was granted the International Organisation for Standardisation Award ISO 15189 Certificate from the Board of INAB for the quality of service at the Blood Bank of the hospital. This involved the establishment of a rigorous Quality Management System and intensive internal audit programme in the Blood Bank Laboratory, phlebotomy and haemovigilance to achieve the certification. This award now includes the Haematology Department.

Bereaved Relatives Area for Cavan Hospital Emergency Department A new Bereaved Relatives Area opened in the Emergency Department of Cavan General Hospital in February.

The area was developed specifically for bereaved relatives of patients who die in the Emergency Department. The facility enables the deceased patient to be viewed by their loved ones in a separate room in which they will not be disturbed, and which provides an appropriately dignified setting for the patient and their loved ones.

It was developed as part of the ongoing work of the Death, Dying and Bereavement Committee in Cavan General Hospital and the Hospice Friendly Hospitals (HFH) Programme. The development was supported by the local Irish Hospice Foundation from funds raised locally in the Cavan/Monaghan community.

Hand Injury Service in North East A special service for patients with hand injuries or conditions is being provided in the north east area. The Hand Therapy service is being provided by three Senior Occupational Therapists: Mohamud Amin, Deirdre Harmon and Philomena Brady.

The service provides hand assessment and therapy to maximise hand function following hand injury, surgery or disease. All three have British Association of Hand Therapy qualifications and two have experience of working in the Burns and Plastics Unit in Dublin’s St James’s Hospital.

One therapist is currently pursuing an MSc in Hand Therapy.

At present, referrals are received from the Orthopaedic Consultants of Our Lady of Lourdes Hospital, Drogheda, for patients both postsurgery and with soft-tissue injuries.

Occupational Therapy treatments

+

include: splinting, scar management, swelling control, sensory retraining and desensitisation, pain management following hand injury and advice on hand function.

The team greatly appreciate the support and the co-operation of the Orthopaedic Consultants in utilising this information.

Patients from the North East who attend Dublin hospitals are also referred to local centres for Hand Therapy. A very good working relationship exists between the Plastics Team in St James’s Hospital and the Hand Therapy Service in the North East.

For further information contact: Mohamud Amin, Senior Occupational Therapist, Our Lady’s Hospital, Navan.

Tel: (046) 907 8548.

Deirdre Harmon, Louth County Hospital, Dundalk. Tel: (042) 938 1238 Philomena Brady, Virginia Primary Care Team. Tel: (049) 854 6282.

(L-R): Philomena Brady, Mohamud Amin and Deirdre Harmon, Senior Occupational Therapists who provide a Hand Therapy Service in the North East region.

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Enhancing Care at End of Life For Everyone The Irish Hospice Foundation implements major projects

• As part of its Hospice Friendly Hospitals programme the Irish Hospice Foundation has developed The Quality Standards for End-of-Life Care in Hospitals in partnership with health care staff and interested parties, including bereaved relatives. The standards set out a shared vision on the end-of-life care each person should have and what each hospital should aim to provide.

• The Irish Hospice Foundation is committed to funding Ireland’s first children’s palliative care consultant and five of eight outreach nurses in the community, in partnership with the HSE. The nurses will provide support and co-ordinate care for children with life-limiting illnesses at home. The IHF will provide €2.5 million towards this programme.

• A Primary Care Palliative Care Steering committee was established by the Irish Hospice Foundation in partnership with ICGP and HSE. This group is seeking to identify palliative care initiatives, that support Community and Primary Care teams in their response to adults with advanced progressive diseases, who are expected to die within 12 months. Consultation meetings are being planned in Cork, Tullamore, Dublin, North West and North East over the summer to seek views of interested health care professionals.

Hospice Friendly Hospitals. Now Recruiting.

Mid-Western Regional Hospital (Dooradoyle) with the support of the Hospice Friendly Hospitals (HFH) Programme, and in collaboration with other hospitals, Milford Care Centre and Community Services in the Mid-West Region, wishes to recruit an End-ofLife Care Coordinator. This is a challenging position requiring someone with passion, determination and considerable strategic and operational abilities. The primary role of the post-holder will be to coordinate an End-of-Life Care Development Plan which will support the implementation of the Quality Standards and address issues arising from the hospital’s audit of end-of-life care undertaken in 2009.

Full details on www.hospicefriendlyhospitals.net

Further details from The Irish Hospice Foundation, Morrison Chambers, 32 Nassau Street, Dublin 2.

Tel: 01 679 3188; E mail: info@hospice-foundation.ie; Web: www.hospice-foundation.ie, or www.hospicefriendlyhospitals.net

Health Matters 63

South // News

St Finbarr’s Wins Bronze St Finbarr's Hospital, Cork, has been awarded a bronze certificate for participating in a Healthy Ageing Initiative in Residential Care (HAIRC).

The HAIRC is supported by the National Council on Ageing and Older People (NCAOP) and initiated + (L-R): Anne Corcoran (Practice by the Irish Health Promoting Hospitals Network Development Facilitator SFH), Mary J (HPHN). The awards promote the well-being of Foley (ANP Candidate), Catherine Buckley older people in residential care settings, with three (Practice Development Facilitator SFH) and core values: striving towards person-centred care; Ann O’Riordan (Director of Irish HPH creating a positive working environment for staff Network). and creating a family-friendly environment.

The results of the HAIRC informed the development of a St Finbarr’s Health Promotion Policy, while the benefits of participation include the promotion of well-being of older adults in long-term care, high-quality residential care for older people in accordance with HIQA standards and increased awareness among staff.

If you would like to register your interest in this initiative, you can contact: HAIRC Co-ordinator, Irish Health Promoting Hospitals Network, c/o Connolly Hospital, Blanchardstown, Dublin 15 or Tel: (01) 646 5077, Email: info@ihph.ie.

President Visits Skibbereen Arts for Health Project President Mary McAleese visited the Arts for Health project in Skibbereen Community Hospital, Co Cork, in April.

The Arts for Health project involves a team of artists regularly working in six west Cork hospitals, co-ordinated by the West Cork Arts Centre, and steered by a partnership which includes representatives from the west Cork community hospitals, West Cork Arts Centre, Cork County Council, west Cork day care centres and west Cork adult education services.

Ann Davoren, Director West Cork Arts Centre, said, “The overall aim of the

Arts for Health programme is to embed an appropriate arts programme into the culture and practice of all long-stay units and day-care settings as a core activity.”

A new strand of the programme was implemented in April in five west Cork day care centres. West Cork Arts for Health Partnership sees it as an opportunity for strategic development. Arts for Health endeavours to include all older people attending day care, with specific attention paid to developing ways of including participants suffering from dementia and related illnesses, creating opportunities for wider community connections.

Children’s Leukaemia Association Launch Tutor Service A unique home and hospital tutor service for children with leukaemia, cancer and other serious blood disorders has been launched by the Children’s Leukaemia Association at Mercy University Hospital, Cork on a part-time basis.

The first of its kind in the country, the service provides children being treated for leukaemia, cancer and other blood disorders with tutor services in hospital and at home. The new service is funded by donations and fundraising initiatives carried out by the public.

Dr Michael Madden, Consultant Haematologist at Mercy University Hospital, welcomed the appointment of tutor Mary Ahern.

“School is a normal activity for children and hospitalisation interrupts their education. Each student has an individual education plan, setting out his/her priority needs and the educational and interdisciplinary plan for meeting those needs.

Children have an opportunity to be creative and productive, while maintaining a sense of identity and hope.

Our tutor, Mary Ahern, is a highly experienced teacher, with a broad range of skills and knowledge,” said Dr Madden.

+

President Mary McAleese meets hospital resident, Jerry Sheehan, a participant in the Arts for Health project at Skibbereen Community Hospital.

+ Leukemia patients Carrie Anne Creamer from Castlemartyr and Molly Kennedy Trainor from Carrigaline with their tutor Mary Ahern at the Mercy University Hospital.

64 Health Matters

South // News

HSE and Barnardos launch Teen Parent Support Programme for North Wexford

+ At the launch of Barnardos Teen Parent Support Programme at Gorey Community Youth and Child Care Centre were Catherine Joyce, Barnardos, Assistant Director, South East; Margaret Morris, National TSSP Co-ordinator; Thelma Blehien, Senior Community Development Worker, HSE; Fergus Finlay, Chief Executive, Barnardos; Clare Murphy, Child Care Manager, and Redin Dunne, Barnardos TPSP Project Manager.

The HSE and its partner Barnardos officially launched the Teen Parent Support Programme for North Wexford in Gorey, Co Wexford, in April.

The programme aims to support teenagers and their extended families in dealing with the challenges associated with teenage pregnancy and young parenthood. It is available to young people aged 19 years or under who are

expecting a baby or who have already become parents.

The programme came about as a result of local partnership, where various professionals from the HSE worked with agencies such as Gorey Youth Community and Childcare Centre, schools, social welfare and local authority housing departments, medical practitioners and others in the community.

Kilkenny pioneers ‘Age Friendly County’ Kilkenny has become the first ‘Age Friendly County’ in the South region.

The programme, which has been backed by the HSE from its inception, brings together key service providers from the public and private sectors, along with service users, to enable older people to live in security, enjoy good health and continue to participate in society.

A seminar to officially launch the programme took place in Kilkenny in March. Among those who attended were: Minister of State Áine Brady TD, Laverne McGuinness National Director, Integrated Services Directorate, Pat Healy Regional Director of Operations, HSE South, Anna-Marie Lanigan Local Health Manager for Carlow/Kilkenny and Dr Emer Ahern Consultant and Community Geriatrician, St Luke’s General Hospital for Carlow/Kilkenny.

Pat Healy noted that the Age Friendly County initiative will build on the National Positive Ageing Strategy, announced by the Department of Health and Children earlier this year.

‘Healing Garden’ for Clonmel Hospital Staff at South Tipperary General Hospital in Clonmel, working with the Irish Hospice Friendly Hospitals Programme, are developing a ‘Healing Garden’ as a result of funds raised through their recent Gala Ball.

Located at the centre of the hospital, the garden will include water features, decking and seating areas for use by patients and their visitors as a place of tranquillity away from the wards.

Further fundraising plans by the staff committee in coming weeks include a barbeque and auctions of items donated by local horse trainer, Aidan O’ Brien, and the Tipperary hurling team.

+

Back (L-R): Fiona McGrath, Hospital In-Patient Enquiry system office, Gail Long (Laboratory), Carole Broadbank (General Manager), Joan Duggan (Surgical Ward Clark), Glenda O’Gorman (Day Ward), Nicola Burke (Radiographer), Jackie Hassett (Nursing Administration), Sandra McCormack (Staff Nurse), Ronan Corcoran (Emergency Medical Technician), Claire Williams (Staff Midwife) and Rosita Guidera (Hospital In-Patient Enquiry system office). Front (L-R): Jane Norris (Personnel), Kay Ryan (General Manager’s Office), John Hally (General Support Services) and Clodagh O’Donnell (Medical Secretary).

+

Front Row (L-R): Cllr Michael O’Brien, Cathaoirleach of Kilkenny County Council; Alison McGrath, CEO Kilkenny Chamber of Commerce; Anne Connolly, Director Ageing Well Network; Cllr Malcolm Noonan, Mayor of Kilkenny. Back Row (L-R): Joe Crockett Kilkenny County Manager, Nicky Brennan, (Glanbia), Geraldine Crowley (Office of Regional Director of Operations, HSE South), Mary Doyle (Department of an Taoiseach), Pat Healy (Regional Director of Operations, HSE South), Laverne McGuinness (National Director, Integrated Services, HSE), Anna Marie Lanigan (Local Health Manager, Carlow/Kilkenny), John Beard (Age Friendly Cities Programmes) and Patricia Goan (Age Friendly Counties Manager).

Health Matters 65

west // News

Roscommon Projects Scoop Two Awards Two Roscommon projects recently won prizes at the ARAMARK Healthcare Innovation Awards held in Dublin, ‘When Nature Calls!

Managing Incontinence Programme’ and the + Karen Myrent of Quest Diagnostics, Fiona Garvey, ‘Melting Pot’ initiative.

Quality Co-ordinator, HSE West, Roscommon; The Incontinence Programme has improved Andrew McDonnell, Manager Clorina House Training continence care for children and adults by Centre, Roscommon; Adrian Brend, Manager of redesigning the way services are provided and Melting Pot; Eamon Hannan, Manager Support delivered in all primary care and community Services, HSE West, Roscommon; and Áine Brady TD, Minister for Older People and Health Promotion. settings, as well as private nursing homes across the county.

Meanwhile, the Melting Pot project is a unique partnership of the HSE, Local Development Agencies and Voluntary Sector Support Services. The Melting Pot operates as an internet café and charity shop, providing a place to meet in a relaxed and friendly environment for a range of specified target groups.

New Critical Care Unit for Dooradoyle Hospital A new b35m Critical Care Unit is to be built at the Mid-Western Regional Hospital, Dooradoyle, Limerick. The development will be a major step forward in the reconfiguration of acute hospital services in the Mid West, and will follow radical improvements in the provision of emergency care, diagnostics and acute surgery. HSE Chief Executive, Professor Brendan Drumm, said the developments now underway in the region are setting a headline for the rest of the country.

The new unit will link with the existing hospital and will consist of a six-storey block over two levels of basement car parking. A new 12-bed intensive care

unit will be located on the first floor along with supporting accommodation. The second floor will provide a new 14-bed high-dependency unit, while the third floor will provide a new 16-bed coronary care unit. The fourth floor will accommodate a cardiac non-invasive investigations unit along with two catherisation laboratories and a nine-bed day ward. The ground floor will be available for later development while the fifth floor will be required to accommodate the building services plant.

Strong emphasis will be placed on the segregation of the different users of the building, very important from an infection control perspective.

+

Joan O’Connor, Clinical Nurse Manager, Sacred Heart Hospital, Roscommon; Donal Mitchell, Senior Buyer, Procurement Unit, HSE West; Joan O’Shaughnessy from ARAMARK Healthcare; Margaret Tiernan, Continence Advisor, HSE West, Roscommon; Dympna McDonnell, Clinical Nurse Manager, Aras Naomh Chaolain, Castlerea; Elaine Mannion, Continence Advisor, Ontex Ltd; John Nally, Supplies Officer, HSE West, Roscommon; and Aine Brady TD, Minister for Older People and Health Promotion.

Child Safety Information Evening Doctors and other specialists from Sligo General Hospital recently spoke at a Child Safety Information Evening organised by the hospital’s Research and Education Foundation, attended by over 100 parents and people working in childcare.

The next open public meeting being organised by the hospital’s Research and Education Foundation will be a two-day Men’s Health Event.

+

The HSE contract signing for the b35 million Critical Care Unit at the Mid-Western Regional Hospital, Limerick. (L-R): Joe McLoughlin, Director, John Sisk & Son; Brian Gilroy, HSE National Director of Estates; John O’Brien, HSE National Director; and Dr Paul Burke, MWRH.

+

At the Sligo General Hospital Child Safety Information Evening, (L-R): Tom McGoldrick, Senior Paramedic HSE West; Dr Dara Gallagher, Consultant Paediatrician; Janette Oman Power, Operational Ambulance Officer; Mr Fergal Hickey, Consultant in Emergency Medicine; Dr Hilary Greaney, Consultant Paediatrician; and Deirdre Staunton, Resuscitation Training Officer.

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Health Matters 67

west // News New Health Facilities for North Connemara New health facilities in north Connemara were officially opened by former Minister for Community, Rural and Gaeltacht Affairs, Éamon Ó Cuív, TD, in February. The facilities were the Primary Care Centre in Corr Na Móna and an extension to the Clonbur Primary Care Centre.

The Corr Na Móna and Clonbur Primary Care Centres have full-time Public Health Nursing and GP services, along with facilities available for visiting services such as Community Welfare, Speech and Language Therapy, Physiotherapy, Occupational Therapy, Mental Health Services, Dietetics, Podiatry, and Home Help Services. In addition, both Primary Care Centres provide facilities for WESTDOC out-of-hours GP services.

Clonbur Primary Care Centre also houses the local Day Care Centre, which provides a range of supports and recreational facilities to older people and people with disabilities in the community, including the meals-on-wheels service.

Health initiatives underway within the Clonbur and Corr Na Móna area include a pilot-integrated diabetes care pathway with University Hospital Galway and community cardiac testing.

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(L-R): Mary Coyne, Home Help Co-ordinator; Martina Abberton, Public Health Nurse; Loretta Walsh, Physiotherapist; Margaret Kineavy, Public Health Nurse; Sarah Lee, Occupational Therapist; Minister Ó Cuív; Dan Quaid, Community Development; Brid Quinn, Assistant Director of Public Health Nursing; Dr Joe Curran, General Practitioner; Rosaleen Coyne, Home Help; Ciaran McDonagh, Community Welfare Officer; and Marie Prendergast, Transformation Development Officer.

Leaders COMPLETE Clinical Leadership Programme Twenty two Clinical Nurse and Midwife leaders recently completed the second Royal College of Nursing Clinical Leadership Programme 2009/2010. They were facilitated by the Nursing and Midwifery Planning and Development Unit in the Mid West.

The Clinical Nurse and Midwife leaders were from different clinical health service practice sites within HSE West. They developed their clinical leadership skills over the last 12 months by participating in the programme.

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Geraldine Shaw, Director of Nursing, MidWestern Regional Hospital Limerick; Joan Phelan, Area Director, Nursing and Midwifery Planning and Development Unit, HSE South; Francis Rodgers, Area Director HR; Margaret Murphy, Patient Advocate; Pat Harvey, Chairman of the Clinical Leadership Steering Committee; Tony Quilty, Acting General Manager PCCC Limerick; and Annette Connolly, HSE Clinical Leadership Facilitator.

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(L-R): Hugh McDaid, Nurse Manager, Acute Mental Health Unit; Dr Cliff Haley, Clinical Director, Mental Health Services Donegal; Councillor Ciaran Brogan; Tánaiste Mary Coughlan TD, Minister for Education and Science; Michael Bermingham, HSE Estates Manager; Michael McCole, Administrator, Mental Health Services Donegal; Michael Martin, HSE Project Manager; Dolores Conaghan, Friends of Letterkenny General Hospital; Siobhan Friel, Friends of Letterkenny General Hospital; Kevin Mills, Director of Nursing, Mental Health Services Donegal; Councillor Niall Blaney; Cyril Gallagher, Clerk of Works; and John Moloney, TD, Minister for Equality, Disability and Mental Health.

New Acute Mental Health Unit at Letterkenny General Hospital John Moloney, TD, Minister for Equality, Disability and Mental Health at the Department of Health and Children, turned the sod for the new Acute Mental Health Unit at Letterkenny General Hospital in April.

The new Acute Mental Health Unit will be responsible for providing elements of a comprehensive integrated psychiatric service for a defined catchment area of approximately 138,000 people. It will be particularly geared towards the needs of

young adults with mental illness (18-24 years), taking into account the disturbing increase in suicide in young men in recent years.

The commencement of this project, coupled with the imminent commissioning of the Community Mental Health Team base in Letterkenny adjacent to the Primary Care Centre, marks a significant milestone in the advancement of Mental Health Services in Donegal, in line with the strategic Vision for Change policy document.

68 Health Matters

News // Dublin mid-leinster Successful Seminar for VES

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Front Row (L-R): Paddy Agnew, Irish Underwater Council Search and Recovery; John McGrath, St John’s Ambulance Brigade of Ireland; David Williams, Dublin Wicklow Mountain Rescue Team; Duncan Foster, Irish Cave Rescue Organisation. Back Row (L-R): Jimmy Maye Order of Malta Ireland; Bill Powderly Civil Defence; Melissa O’Sullivan, Irish Red Cross; Diarmaid Scully Glen of Imaal Mountain Rescue Team; Brian Haskins – Search and Rescue Dog Association of Ireland; David O’Sullivan Chief Emergency Management Officer, HSE Dublin Mid-Leinster; and Chairperson of the Voluntary Emergency Services subcommittee of the Eastern Regional Working Group for Major Emergency Management.

The Voluntary Emergency Services (VES) subcommittee of the Eastern Regional Working Group for Major Emergency Management (MEM) recently held a successful seminar in Punchestown Racecourse, opened by John Lahart, Director of Services, Kildare County Council.

Over 140 delegates attended the seminar in February, representing the organisations of the VES and incorporating the Civil Defence, the Irish Red Cross, Order of Malta Ireland, St John’s Ambulance Brigade of Ireland, the Irish Mountain Rescue Association, the Irish Cave Rescue Organisation, the Search and Rescue Dog Association of Ireland and the Irish Underwater Council Search and Recovery; in addition to representation from the Principal Response Agencies of the HSE, the Local Authorities and An Garda Síochána.

The seminar was convened within the context of major emergency management and under the guidance of the Framework for Major Emergency Management (Department of Environment, Heritage and Local Government, 2006), and its objective was to reinforce links between the VES and their respective Principal Response Agencies.

For further information, please contact: HSE DML Emergency Management Office. Tel: 087 782 5517

Parent Support Leaflet has proved huge success Clinicians in Beechpark Services, based in Clonskeagh, Dublin, possess many years of experience in providing specialised, evidence-based and best practice clinical support to children and families affected by Autistic Spectrum Disorder (ASD). In recognition of this bank of expertise, the bi-monthly, userfriendly Parent Support Leaflet was launched to provide information to parents of children under six with a diagnosis of ASD, and consists of articles from the different clinical disciplines within Beechpark Services.

Viewing the child’s development as firmly rooted in the context of the family as a whole, the leaflets provide a platform to distribute important information to parents in a positive, non-judgmental and informal manner.

Davida Hartman, Educational

Psychologist, Beechpark Services said, “The leaflet facilitates all parents to access this information, in addition to serving as a reminder of the services and supports available to them as clients of Beechpark Services.”

Meanwhile Grainne Bray, Director, Beechpark Services, said “The feedback from this initiative has been overwhelmingly positive, with parents praising the practical aspects of the leaflets.”

Beechpark Services, HSE, provides clinical supports to children with Autistic Spectrum Disorders ASDs without a significant intellectual disability who attend a range of designated classes and special schools in the Dublin, Kildare and Wicklow regions. For further information, please contact Beechpark Services on (01) 463 2210

New Facility in Mullingar Gets Green Light In a positive development for Longford Westmeath, approval was granted for construction of a 100-bed Care of the Elderly facility at St Mary’s Care Centre, Mullingar.

It is intended that the new centre will facilitate the enhancement of services for older people and mental health services in the locality. The development consists of a main entrance, administration area, ward areas, therapy areas, support services areas, staff facility and external services compound, and has been designed in accordance with the National Quality Standards for Residential Care settings for older people in Ireland and to standards as set by the Mental Health Commission, providing an accessible, safe, hygienic, spacious and modern facility to meet residents’ individual and collective needs in a comfortable and homely way.

It is intended that the project will be completed before the end of 2011.

Health Matters 69

News // Dublin mid-leinster HSE Information Day Marks Autism Awareness Month A HSE Offaly Early Intervention Team hosted an Autism Information and Screening day to mark Autism Awareness Month in April at the Riverside Centre, Tullamore.

The event was organised to raise awareness about Autism and provide screening for Autism Spectrum Disorder (ASD). On the day, a number of screening assessments were provided and a wide range of information was made available. In addition, the local Public Health Nurse, Physiotherapists and Speech and Language Therapists provided assistance and advice to parents, while the Occupational Therapists set up a room in which parents could see the range of activities that are undertaken with children on the Autism Spectrum.

Representatives from other organisations, such as Laois Offaly Families for Autism and Autism Ireland were present, and provided their new brochures and leaflets about ASD. Further information can be obtained from www.autismsupport.ie, Laois Offaly Families for Autism (www.loffa.ie), Autism Ireland (www.autismireland.ie), Aspire www.aspire.ie-irl.org). For information about local HSE services, see www.hse. ie. The Offaly Early Intervention Team is located in Riverside Centre, Riverside, Tullamore, Tel: (057) 936 6300.

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Students of Heywood Community School with their artwork. Also in the picture are art teacher Alice Power Murphy, Local Health Manager Liam O’Callaghan, Anne Fanning HSE Primary Care Team and Deputy School Principal Mary Fitzgerald.

Students Create Art on Addiction The HSE Abbeyleix Primary Care Community Addiction Counselling Services launched an art exhibition, ‘Reflections on Addiction’, in collaboration with Heywood Community School, Abbeyleix, in April.

The exhibition is a reflection of a young person’s understanding of addiction through art and each piece on show at the Parish Centre in Portlaoise was completed

by art students from fourth and fifth year at the school. Among the many on display, ‘Uncontrollable Night’, was a presentation of “drink driving and innocent fatalities and the effect on the bereaved family member.”

For further information on this initiative, please contact the HSE Addiction Counselling Service at (057) 873 0887.

New Child and Adolescent Service Facility Minister for Health and Children Mary Harney, TD, recently turned the sod for a new Child and Adolescent Mental Health Service facility at Cherry Orchard Hospital grounds in Ballyfermot, Dublin.

The new building is integral to the development of child and adolescent mental health services, in line with the recommendations contained in the Vision for Change Policy document. It will provide accommodation for the new Adolescent Community Team, the New Adolescent Day Hospital Team, the existing Ballyfermot Community Team, the existing Lucan Community Team, training and library facilities and administration staff for the service.

Welcoming the development, Minister Mary Harney, TD, said, “The new unit is a significant development for mental health services for the Dublin area. This unit will strengthen the community-based mental health teams that are doing such good work in community settings across the region.”

Dr Brendan Doody, Consultant Child and Adolescent Psychiatrist added, “The new Adolescent Day Hospital Team is a key component in the provision of a comprehensive mental health service for young people.”

(L-R): Jim Ryan, Local Health Manager; Kevin Lennon, Acting Area Manager; Jim Curran, HSE Estates; Noeleen Price, Director of Nursing; Minister for Health, Mary Harney, TD; Peader McCabe Assistant Director of Nursing; Dr Brendan Doody, Clinical Director; Martin Rogan, Assistant National Director Mental Health; Dorota Nieznanska, HSE Estates/Project Manager, and Sadie Tierney, Assistant Director of Nursing.

70 Health Matters

appointment

Adams to Join International Council of

Nurses in Geneva

Elizabeth Adams, HSE Office of the Nursing Services Director, is set for Switzerland after senior appointment at the ICN.

E

lizabeth Adams, HSE Office of the Nursing Services Director, is to join the staff of the International Council of Nurses (ICN), based in Geneva, Switzerland. Ms Adams will join the ICN staff in July 2010.

She will serve as Director, International Centre for Human Resources in Nursing, and as the ICN Nurse Consultant focusing primarily on socio-economic issues (SEW).

She will assume the position formerly held

by Mireille Kingma RN, PhD, who will retire in June following 25 years with the ICN. Since 2007, Ms Adams has been serving as Deputy Nursing Services Director for the HSE. In this national role, she actively drives the strategic direction and policy development of nursing and midwifery. Her areas of expertise include positive practice environments, workforce planning, strategy and policy development.

“We are delighted that Elizabeth has joined us. She brings a wide range of relevant experience,” said David Benton, ICN Chief Executive Officer. “Through her knowledge of and commitment to critical and contemporary issues, such as promoting positive practice environments, Elizabeth will develop new and exciting initiatives at ICN, as well as maintaining the momentum of our existing signature programmes in SEW.” In her current position, Ms Adams works to ensure that the nursing and midwifery professions are supported by appropriate legislation, regulation, policy, education, leadership, management, resources and research. She is responsible for the development and the implementation plan to introduce safe and effective nurse and midwife prescribing in Ireland. She also led the nursing and midwifery response to last year’s national strategy to establish mass vaccination clinics for the H1N1.

In an earlier position with the Department of Health and Children, Elizabeth co-

researched and established systematic procedures such as a National Nursing and Midwifery Human Resource Minimum Dataset, a critical instrument to effectively manage and deliver nursing and midwifery services nationally.

“We are delighted that Elizabeth has joined us.

She brings a wide range of relevant experience.”

Ms Adams also held the position of Principal Nursing Officer with the Department of Health, Western Australia, from 2002 to 2005, developing a statewide framework to introduce the nurse practitioner initiative there.

“It was a fantastic experience because I was exposed to strategic policy planning in another country”, says Ms Adams. “I was amazed at how many similarities existed and now appreciate that many countries confront the same challenges, such as aging populations, a widening health gap, shortage of staff and problems with their conditions of service, escalating demands in hospital care and increasing costs of technology. In short, countries face similar issues and there is great potential to learn from and support each other.”

In 2009, she received the Government of Western Australia Recognition Award for excellence for her work to establish and define nurse practitioners in Western Australia. She is currently an Adjunct Associate Professor at the School of Nursing and Midwifery at Curtin University of Technology in Perth, Western Australia.

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Elizabeth Adams

Adams was awarded a Bachelor of Nursing Studies (Hons) by the Faculty of Nursing, Dublin City University. She earned a Masters in Science (Research) from the School of Nursing and Midwifery at the University of Dublin, Trinity College, and is pursuing a doctoral degree there. Her awards include the First National and European Research Award and the All Ireland Research Fellowship Award.

“Dr Kingma’s groundbreaking work over the years, and her innovation and expertise in leading the profession on SEW issues has been an inspiration to so many nurses, including myself. It is a huge challenge to follow in her footsteps.” Ms Adams said. “I’m most enthusiastic about the opportunity to work in partnership and collaboration with ICN member associations. Worldwide ICN brings so many nurses together to share knowledge and I hope that my role will support that process.”

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.

Health Matters 71

health research

Small change could lead to less pain Dr Zena Moore, Lecturer at the Faculty of Nursing and Midwifery at the Royal College of Surgeons (RCSI) in Ireland, says a small change in patient management practices could lead to much fewer pressure ulcers in elderly patients.

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ew research funded by the Health Research Board (HRB) indicates that a small change in patient management practices could lead to fewer pressure ulcers in elderly patients, create significant savings and save time.

Having been a tissue viability clinical nurse specialist at Tallaght Hospital, I conducted the research as a HRB Fellow at the RCSI. I discovered that a simple change to conventional repositioning practices could dramatically reduce pressure ulcers among elderly patients and introduce significant savings and efficiencies in the delivery of care.

The new method uses a 30-degree tilt with bed-bound patients rather than 90-degree rotations. This led to a four-fold reduction the incidence of pressure ulcers, so it is clearly better for the patients. But it is also less time-consuming, requires less

nursing staff and it is more cost-effective when compared with standard care.

The potential cost savings of this change in practice across the HSE are enormous.

Our nursing research estimates show that the new method could save over €b250,000 through a reduction in staffing costs and wound dressing costs alone.

This is based solely on the number of patients who would require repositioning in 12 hospitals across Ireland where we conducted our research. If you extended this out across the HSE, it could introduce significant savings and efficiencies.

“My findings have generated much interest among the nursing community and I am currently developing an education module for nurses around the use of the 30-degree tilt to help ensure that it is delivered in practice.”

The work is closely in line with Health Research Board strategy and direction in terms of getting research findings into practice. This project clearly illustrates how dedicated research funding can generate

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Dr Zena Moore

evidence that will improve patient outcomes and create efficiencies in the health service that provide significant economic benefits.

From a nursing perspective, this research demonstrates how people working at the coalface can sometimes be the best people to identify problems and come up with the solutions. This work has the potential to put Irish health research firmly in a positive global spotlight and work will now start to influence policy and practice based on the new findings.

My findings have generated much interest among the nursing community and I am currently developing an education module for nurses around the use of the 30-degree tilt to help ensure that it is delivered in practice.

As President of the European Wound Management Association this year, it is also my goal to get the findings into practice on a national, EU and international level. A key focus of my presidency will be to make sure that the nursing profession in Ireland and worldwide adopts these new techniques as standard practice.

72 Health Matters

Haiti

My week in Haiti Andrew Murphy, a physiotherapist in Connolly Hospital, Blanchardstown, Dublin, was one of a team of people who left Ireland to travel to Haiti in April to work in a hospital there. He writes about his experience.

W

e travelled to a place called Cange about 80km outside of Port-au-Prince and worked there for one week, treating surviving victims of the earthquake that hit the country on January 12th, 2010. The group was organised by the Irish Orthopaedic Haiti Fund (www.iohf.ie) and was made up of three consultants, two anaesthetists, four nurses and two physiotherapists.

My first impressions of the country were ones of severe poverty. On leaving the airport we boarded a bus and had people knocking on the windows begging us for anything that we could give to them. Others were desperate to help us put our bags on the bus so as they could get a tip of $1, just about enough to feed them for a day. On the journey to Cange, we passed large campsites full of tents; small huts that

housed families; children with little or no clothes to wear.

As one of the physiotherapists, my role for the week was in relation to rehabilitation for inpatients, most of whom all there since the earthquake. The team was also involved in performing many tasks including surgeries as required, monitoring wounds and prescribing appropriate pain relief when needed.

Health Matters 73

HAiti

As the week progressed, I was humbled by what I witnessed. We treated adults, and even children, who had amputations as a result of injuries suffered in the earthquake. The extremity of one particular man’s experience is to the forefront of my mind – he spent three months getting to

the hospital by walking on a fractured hip, across mountainous terrain, using a tree trunk as his walking aid. This man lost all his family and possessions in the earthquake.

He was left with nothing. Once in the hospital, he had surgery, received adequate pain relief and his rehabilitation began.

We treated a little boy who had cerebral palsy. No one knew his exact age as he had been abandoned by his parents due to his condition. He was left in a cot for most of the day. His only two possessions were a special chair that had been made for him to assist with his posture and a little toy duck with a rattle on it. He loved interaction and constantly smiled the whole time we were there.

“The extremity of one particular man’s experience is to the forefront of my mind – he spent three months getting to the hospital by walking on a fractured hip, across mountainous terrain, using a tree trunk as his walking aid. This man lost all his family and possessions in the earthquake.”

+ Previous page: Haitian Red Cross first-aid post, Port-au-Prince. Steve, six, who lost his parents during the earthquake is now in his grandmother’s care.

This page, top: A patient receives treatment at the Norwegian Rapid Deployment Field Hospital in the grounds of Port-au-Prince University Hospital. Most patients have suffered crush wounds.

This page, bottom: The ICRC has set up two first-aid posts in Belaire, one of Haiti's most violent slums. The post is run by Haitian Red Cross volunteers. All images © ICRC / M. Kokic

One of the main problems the team encountered while there was infection.

Sanitation was very poor; I didn’t see any hand washing facilities at all on the wards.

As far as I could tell, there was only one toilet in the whole hospital which was located upstairs on the first floor and that made it extremely difficult for any patients with mobilisation difficulties to get there.

Overall the week went very well for us.

We managed to achieve all the goals we set out at the start of the week. The Haitian people are some of the nicest and friendliest I’ve ever met and considering all that has happened there, they are remarkably happy, resilient and upbeat. The country, however, remains very, very poor. Ongoing aid, volunteers, and re-building will be needed for many years to come.

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Health Matters 75

Tobacco Control

Five-Year Plan to Cut Smoking Rates Smoking kills up to 6,500 people in Ireland every year and it is estimated that related healthcare costs account for up to 15 per cent of all annual healthcare costs here. The HSE’s new Tobacco Control Framework sets out a strategic plan to address tobacco issues over the next five years, writes Martina Blake, Framework Project Manager.

The Tobacco Control Framework outlines our commitment to tackling the problem of tobacco-related harm within the population as a whole, and in particular within vulnerable groups such as children, adolescents and those at the margins of society. It provides a strategic plan to address tobacco over the coming five years and outlines national standards for service provision.

Why address tobacco use?

The social and economic cost of smoking is detrimental to society in terms of time lost from work due to tobacco-related diseases, productivity losses, medical, disability and mortality costs. In highincome countries like Ireland, smokingrelated health care costs account for between six per cent and 15 per cent of all annual healthcare costs, so controlling tobacco use in a comprehensive way is crucial to controlling costs within our health services.

The combined evidence of thousands of published scientific papers confirms that there is undisputable evidence that tobacco use has detrimental health effects for those who use tobacco and for those exposed to second-hand smoke (SHS). Second-hand, or passive smoke as it is otherwise known, is defined as a class ‘A’ carcinogen by the US Surgeon General’s Report.

Research tells us that half of all smokers are killed as a direct result of their smoking, and half of them die prematurely. Tobacco use is a significant cause of ill-health (particularly chronic illnesses) and mortality

76 Health Matters

Tobacco Control

in the population. As smoking is more common among lower socio-economic groups, it exacerbates health inequalities.

There are still a significant number of smokers in Ireland. The decrease in smoking rates that was evident between 1998 and 2002 has now ceased, with no reduction in smoking from 2002 to 2007.

Overall rates for smoking were 33 per cent in 1998, 27 per cent in 2002 and 29 per cent in 2007. It is estimated that there were 940,000 adult smokers in Ireland in 2007.

Tobacco Control Framework The Framework considers the best available international evidence base in tobacco control and is modelled on the World Health Organisation (WHO) Report on the Global Tobacco Epidemic 2008.

The approach is called ‘MPOWER’ which stands for the six most important, effective and evidence-based tobacco control policies: • Monitoring of tobacco use and prevention policies.

• Protecting people from second-hand smoke.

• Offering help to people who want to quit • Warning of the dangers of tobacco.

• Enforcing bans on advertising, promotion and sponsorship.

• Raising taxes on tobacco.

A Tobacco-Free Policy for the HSE The actions contained within the Framework, which will be progressed over the next five years, include the establishment of a tobacco-free policy for the HSE, both indoors and on health service grounds. This will require extensive consultation, planning and communication both from a management and staff point of view and will also amount to a huge cultural change for our service users and visitors.

The consumption of tobacco is a personal lifestyle choice for individuals (including staff). However, as an organisation dedicated to ‘enabling people to live healthier and more fulfilled lives,’ the consumption of tobacco within and on the grounds of our facilities is incompatible with the health promotion message and service we wish to portray. Healthcare services

+ HSE staff pictured together recently at a tobacco free society conference in Dublin were (L-R): Dr. Fenton Howell, Director Public Health, Martina Blake, Project Manager, Health Promotion, Biddy O'Neil, Health Promotion Manager, and Maurice Mulcahy, Enviromental Health Officer.

need to take a leading role in the prevention and reduction of smoking.

Tobacco-free rules contribute to a reduction in smoking. They prevent exsmokers from starting again. They prevent second-hand smoking risks. They are also a major element in fire safety.

Expansion of smoking cessation support services Another action which helps us to achieve our corporate aim of achieving ‘an integrated health and social care model’ is the expansion of smoking cessation support services via GPs, nurses in hospital and community settings, and other allied health professionals. Smoking cessation training standards to support this initiative are being prepared to quality-assure our services in line with corporate policy.

Partnership The HSE will implement the actions outlined in this framework by seeking to address the determinants of tobacco use and reduce health inequalities. However, the health sector is not the only sector that will play a role in the prevention

and treatment of tobacco use. Relevant government departments, including those responsible for taxation, together with social and community sectors, all have a role to play. The HSE will work and support these other relevant sectors to implement the actions that are outside the remit of the health sector.

The Tobacco Control Framework is an innovative evidenced-based document which will support the HSE to set standards for service provision, and it provides us with a strategic plan for tobacco control. We look forward to working with our partners to achieve our common goal. * The Framework for Tobacco Control was developed by the HSE’s Tobacco Control Framework (TCF) project group, guided by a national steering group, in order to inform HSE policy and provide a coherent HSE response to tobacco use in Ireland over the coming years. A population health approach was considered, as outlined in the HSE’s Population Health Strategy.

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78 Health Matters

health & Well-being

Top Tips

For a Healthy Heart

Happily, the way to a healthy heart is easier than it may seem. Try out some of these heart-healthy tips to keep your body moving to the right beat…

Kick the Habit Stubbing out that cigarette for the last time is the most important thing a person can do to improve their health. Ridding your life of cigarettes can cut your risk of heart disease or heart attack by half. From the very moment you stop, your risk of heart attack starts to reduce. So if you are thinking of quitting, don’t put off until tomorrow what you can do today!

Keep your Levels in Check High blood pressure and cholesterol levels are the biggest contributing factors to stroke, heart attack, heart disease, and other circulatory difficulties. Make a positive move and meet with your GP to have these checked. This will be a clear indication as to the lifeenhancing changes you need to make to your lifestyle.

Get Moving!

Say goodbye to that inactive lifestyle, and hello to a life of better health and increased energy levels. Cardiovascular or aerobic exercises are the best possible exercises to strengthen the heart and lungs and improve the body's ability to use oxygen.

Aerobic exercise has the most benefits for your heart. Over time, aerobic exercise can help decrease your heart rate and blood pressure and improve your breathing.

Monitor your Alcohol While it is all too tempting to go overboard at times, monitoring your alcoholic intake is an essential part of a healthy lifestyle. Excess

alcohol can damage the heart muscle, and lends itself to increased blood pressure and weight gain. Make an effort to eliminate binge drinking from your lifestyle and aim to limit your intake to one to two units a day.

Watch your Weight The number of adults becoming overweight or obese in Ireland is increasing at an alarming rate. Carrying a lot of extra weight as fat can greatly affect your health and increase the risk of life-threatening conditions such as coronary heart disease and diabetes. To combat these risks, start by making small but healthy changes to what you eat, and try to become more active.

Avoid Restrictive Diets It may come as music to the ears of many, but frequent dieting and fasting is bad for your health. It causes an imbalance in your electrolyte levels and, in turn, the weakening of the heart muscle and damage to the heart. Instead of experimenting with fad diets, try replacing some of your less healthy food choices with some of the options on our Healthy Heart Shopping List.

Cut Down on Salt The average daily salt intake in Irish adults is high at approximately 10g, while the RDA is under half that at 4g per day. When trying to reduce your blood pressure and cholesterol, be sure to check the nutritional information on the food you eat. Always choose the option with the lowest sodium content, and stay within the recommended

daily allowance. Be watchful of foods such as breads and cereals that may appear healthy, as they can also contain high levels of salt.. and try to put down that salt shaker!

Super Foods When deciding what to have for breakfast, opt for coarse, natural oats over instant varieties or sugary cereals, as they are fibre-rich and can help lower levels of LDL (bad) cholesterol and keep arteries clear.

At meal times, one serving of dried beans or legumes a day can reduce cholesterol by up to ten per cent. The fibre and other compounds present in legumes and beans can lower cholesterol, blood clotting and improve blood-vessel function. These are ideal foods to incorporate into your new daily diet.

Sweet Tooth Saver If you couldn’t bear to pass on dessert, then why not try replacing the butter in your recipes with a low cholesterol spread.

These are low in saturated fats and rich in Omega 3 and Omega 6, so you can enjoy the same delicious desserts as all the family.

Healthy Heart Shopping List: Apples, Apricots, Carrots, Cabbage, Dark Leafy Greens, Sweet Potato, Wheat Germ/Flax Seed Oil,

Low Cholesterol Spread, Salmon, Tuna, Whole Grain Bread, Pasta, Rice, Lean Skinless Meat/Poultry.

Health Matters 79

Health & well-being

Sporting Passions Health Matters talks to Tom McGuirk, who combines working as an Information Scientist in the National Disabilities Office within the HSE, and participating in marathons across Ireland and other countries.

Recently Tom completed the 26.2 mile marathon in Limerick as part of the inaugural Great Limerick Run, an event which attracted more than 6,000 runners.

When did you first start competing in marathons?

When I finally gave up playing football competitively, my fitness levels began to decline, so I joined the local gym. At first I used the normal array of equipment, but I always kept coming back to the treadmill for longer and longer periods. I signed up for some short races over 5 and 10k and half-marathons and then, inevitably, I set my sights on the full marathon distance of 26.2 miles. My first race was in Dublin in October 2004.

Describe your training plan or preparation plan prior to a marathon Preparation is the key to success in most walks of life and running is no different: I normally do four marathons a year with a 10-16 week training period. I tend to run four or five times a week, averaging roughly 35 miles. Running is a pastime not an obsession, so if I miss a training run due to other commitments or just plain tiredness, I don’t worry.

How many marathons have you competed in and can you describe some of your best experiences?

I’ve competed in 19 marathons in seven different countries; in huge city events such as London, New York, Berlin and Paris; and in small local runs in Longford and Dingle. I’ve enjoyed all of them and relished what each race had to offer. In Berlin, the Brandenburg Gate is a hugely significant historical, social and political symbol for Germany and you really got a sense of that.

There are lots of other highlights of course: like being cheered on by my family near the finish line in my first marathon in Dublin, standing on the Verrazano-Narrows

Bridge in New York with 35,000 others watching the Black Hawk helicopters fly overhead, running over the Charles Bridge in Prague or maybe running along the Dingle Peninsula staring at the Blasket Islands from the top of Slea Head. I also still have a soft spot for crossing the finish line in Valencia in 3.53.46 – my personal best time.

Describe the toughest race or your most difficult moment in a marathon.

I guess that has to be London in April 2009. It’s the most popular marathon in the world, as well as being one of the biggest, with over 175,000 trying to register for the event each year. About ten miles into the race, I went over on my ankle. I carried on for a mile or so and then finally hobbled to a St John’s Ambulance tent. My foot was

black and blue and severely swollen. More importantly, my race was over.

What goes through your mind as you are running the 26 miles?

At times you’re focusing on your running style or your breathing, other times you’re enjoying a chat with other competitors or taking in the views around you or enjoying the support and encouragement from the spectators.

“Preparation is the key to success in most walks of life and running is no different.”

+ Tom McGuirk pictured with Shigeru Nakaki from Japan at the finish of the Berlin Marathon in September 2008.

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Health & well-being

Salt and your health

– do you know the facts?

With the increasing evidence of the hazards of excessive salt in Irish diets, Dr Siobhan Jennings, Consultant in Public Health Medicine, proposes that we need to be more salt aware and to push for greater reformulation of foods to contain lower salt.

Why is salt bad for us?

We each need 4g of salt per day for proper functioning of the body but current Irish data shows that we eat approximately 10g – two-and-a-half times more than we need. The excess is bad for our health as it causes hypertension (raised blood pressure) and other conditions.

Hypertension is a major contributing factor to heart disease and stroke, which together account for almost four out of ten deaths in Ireland.

What does the science tell us?

For the technically minded there are now hundreds of research papers – observational, animal and genetic models, as well as interventional studies and subsequent meta-analyses to show that reducing salt in the diet results in reduction of blood pressure. In fact, the amount of evidence is almost as weighty as smoking and lung cancer.

At the launch of the Department of Health and Children report ‘SLÁN 2007: Dietary Habits of the Irish Population’, Professor Ivan Perry, University College Cork, emphasised the extent of the problem in Ireland, with 71 per cent of Irish people exceeding the upper recommended intake limit of 6g of salt per day.

Where is the salt in our diets?

Almost 80 per cent of salt is ‘hidden’ in the increasingly processed food that we eat.

Bread and processed meats make up about 50 per cent of the hidden salt in our diet. Other culprits are cereals, cheeses, soups and sauces. Also, about a third of us choose to add salt at the table or in cooking.

What can be done?

The solution in Ireland, as in most developed countries, lies in tackling two main areas reformulation of food so that it is lower in salt and increased public awareness of the

A take home message

need to omit added for readers! salt and all choose low-salt products when 1. Before you sprinkle salt when buying food. cooking, think again!

– Often isn’t necessary What hasitbeen done?

– Try herbs, pepper or lemon juice Many agencies have undertaken to instead influence the levels of salt in our food, such salt at the table as2. theHold Foodthe Safety Authority of Ireland – Maybe it is just a habit (FSAI), who have worked with the food – Remember can’t detect per sector to promoteyou reformulation of 10 bread, cent less salt in foodand rashers soups, sauces, sausages – When youAlso, omitacademic salt, you start to among others. institutions targeted notice more flavours inneeded food to have the research 3. Eat less processed overcome technical and foods and more barriers. fresh foods other Other – useinitiatives your consumer to such aspower Safe Food’s improve yourthe health when campaign, ‘Shake Habit’ andshopping!

Irish – To get tips for shopping,are cooking Heart Foundation promotions aimed at and eating out, check influencing the consumer to be salt aware. www.safefood.eu Consumer In being more salt aware,Go wetoincreasingly salt andathealthy living click on it omit the table andand in cooking. is it it shake the salt habit.

Health Matters 81

Health & well-being

it is lower in salt and increased public awareness of the need to omit added salt and choose low-salt products whenbuying food.

What has been done?

Many agencies have undertaken to influence the levels of salt in our food, such as the Food Safety Authority of Ireland (FSAI), who have worked with the food sector to promote reformulation of bread, soups, sauces, sausages and rashers among others. Also, academic institutions have targeted the research needed to overcome technical and other barriers.

Other initiatives such as Safe Food’s campaign, ‘Shake the Habit’ and Irish Heart Foundation promotions are

aimed at influencing the consumer to be salt aware. In being more salt aware, we increasingly omit salt at the table and in cooking. Also, we become more educated as consumers to actively select low-salt foods, which significantly impacts on achieving change in the food industry.

The HSE is also playing a part in dietary salt reduction by contracting for low-salt bread as a first step, and in 2010 new contracts for a number of other foods will be agreed. In 2009, the HSE commissioned the Public Analyst Laboratory to survey the salt levels in bread purchased for patients and staff. HSE contracted bread was one of the lowest salted breads on the market, being seven to 13 per cent lower than the agreed salt reductions with FSAI.

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

Maximise your Career Potential at the University of Limerick As a leading centre for health services management education the Kemmy Business School at the University of Limerick is pleased to offer three courses in Health Services Management to support health sector professionals in developing their managerial potential.

Certificate in Management (NFQ Level 6) This one year skills based programme equips participants with the skills to manage themselves, their work and the people they work with more effectively. It provides a sound introduction to management for those wishing to build upon their experience.

Diploma in Health Services Management (NFQ Level 7) This one year programme is suitable for both public and private sector candidates and focuses on identifying and integrating fundamental principles of management in the context of a changing healthcare environment.

Bachelor of Arts in Health Services Management (NFQ Level 8) This programme is aimed at developing the managerial competencies required by managers working in the Health and Personal Social Services in Ireland. Participants pursue this programme in order to develop their knowledge and skills in management to help them negotiate and drive the transformational environment within the Irish Health Sector.

For further details and an application form contact:

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

Courses Commence at the end of August 2010

Health Matters 83

irish heart foundation

Red Alert!

Heart attack and stroke combined is biggest killer in women writes Maureen Mulvihill, Health Promotion Manager, Irish Heart Foundation.

A

new campaign to raise awareness among women of their risk of cardiovascular disease (CVD), including heart attack and stroke, begins this September led by the Irish Heart Foundation and supported by the HSE. In 2008, nearly 5,000 Irish women died from CVD 1 but unfortunately, as in other countries, most women remain unaware of their risk of this major killer. In fact, research shows that Irish women deem breast cancer to be a bigger health risk – 60 per cent of those surveyed believe breast cancer is the biggest killer among women at 731 female deaths in 2008 compared to nearly seven times more deaths from heart disease and stroke in the same year. 2 Worryingly, only 18 per cent of women correctly identified heart disease as the main cause of female death. Another cause of concern is that 33 per cent of women also believed heart disease to be an exclusively ‘male disease’ even though just as many women die from it as men.

This September, the Irish Heart Foundation aims to increase awareness of these issues using the international brand for cardiovascular disease in women - Go Red for Women. As the national charity fighting heart disease and stroke, our aim is to help women understand their risk of

Red Alert – Key Messages

cardiovascular disease through a monthlong awareness and educational campaign.

A sharp rise in the prevalence of CVD is expected across the population over the next 10 years and of particular concern is the level of major risk factors among women. At present, 32 per cent of women are obese, 86 per cent have cholesterol greater than or equal to five mmols and 53 per cent have a blood pressure greater than 140/90 mmHG 3. By 2020, heart disease is expected to rise by 50 per cent, stroke by 48 per cent, high blood pressure by 40 per cent, and diabetes (Type 1 and Type 2) by 62 per cent. 4 That is why the Irish Heart Foundation’s Go Red for Women campaign will focus on specific issues for women including recognition of signs and symptoms of heart attack and stroke, healthy lifestyle behaviours and appropriate management of high blood pressure and high cholesterol as well as the impact of menopause on women’s heart health. Our charity’s national Heart & Stroke Helpline 1890 432 787 will be on hand to answer queries and further information will be available on request or through our website www.irishhearrt.ie In addition, there will be a FREE public lecture on women and CVD jointly organised by the Royal College of Physicians in Ireland

Enjoy life – take time out for yourself and keep in touch with friends.

Be active – at least 30 minutes of aerobic activity five times a week.

Eat more fruit and vegetables and less fat and fries.

Eat more fresh food and less convenience food.

If you smoke, try to stop.

Go easy on alcohol – no more than 14 standard drinks per week.

Have regular blood pressure and cholesterol checks with your family doctor Know your family history.

Know the signs and symptoms of heart disease.

and the Irish Heart Foundation on September 14th at 6.30pm. A webcast link will be available on the day and for viewing thereafter.

The month long campaign will end with the Foundation’s World Heart Day Walks on Sunday September 26th where everyone is invited to walk for 30 minutes or more to get their hearts pumping.

The Irish Heart Foundation Go Red For Women would not be possible without the support of the public and many other groups.

Many people do not realise but the Irish Heart Foundation is a national charity which relies on charitable donations for up to 90 per cent of its funding. We support, educate and train people to save lives, campaign for patients, promote positive health strategies, support research and provide vital public information.

We rely on public support – through donations, as a volunteer or on our training courses. To get involved or make a donation see www.irishhearrt.ie

References 1 CSO Vital Statistics Central Statistics Office, Government of Ireland (2008) Vital Statistics – Fourth Quarter and Yearly Summary Dublin, CSO. Dublin: The Stationary Office 2 Women’s Health Council (2008) – Omnibus Survey Women and Cardiovascular Disease.

Dublin: The Women’s Health Council http:// www.whc.ie/documents/28cardiovascularH eathRisk_factsheet.pdf.Accessed April 15th 2010, 3 Harrington J, Perry I, Lutomski J, Morgan K, McGee H, Shelley E, Watson D and Barry M (2008). SLÁN 2007: Survey of Lifestyle, Attitudes & Nutrition in Ireland. Dietary Habits of the Irish Population, Department of Health and Children. Dublin: The Stationary Office.

4 The Institute of Public Health Ireland (2010) Making Chronic Conditions Count (2010) Dublin

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Getting Ireland Active

With modern lifestyles becoming increasingly hectic, physical activity may not be something we spend too much time considering. Are we not eternally on the go from morning until night? However, if we stop to think, chances are many of us are busy going from house to car to work, then back into the car and home again. While we are continually going from task to task in both our home and work lives, we may not be expending enough physical energy doing it.

T

o help us increase the amount of physical activity in our everyday lives, the Department of Health and Children and the HSE have launched the National Guidelines on Physical Activity for Ireland – Get Ireland Active.

These guidelines highlight the recommendations for physical activity for children, young people, adults, older people and people with disabilities, for example: Adults (aged18-64yrs) need at least 30 minutes a day of moderate intensity activity, on five days a week (or 150 minutes a week).

Older people (aged 65+) need at least 30 minutes a day of moderate intensity activity, on 5 days a week (or 150 minutes a week), or as much as their ability allows. Focus on aerobic activity, muscle strengthening and balance.

Adults with disabilities should be as active as their ability allows. They should aim to meet the adult guidelines of at least 30 minutes of moderate intensity activity on five days a week.

For children and young people (aged 2-18 yrs), the guidelines recommend that they should be active at a moderate to vigorous level for at least 60 minutes every day. Include muscle strengthening, flexibility and bone-strengthening exercises three times a week Remember: To meet the guidelines, short bouts of at least ten minutes of physical activity can be accumulated throughout the day. To avoid weight gain or to lose weight you need to do more physical activity than the recommendations listed above.

The amount of additional time required depends on a number of factors; however, the general range is between 30 and 90 minutes of moderate activity per day.

Activities such as walking, swimming and cycling are great examples of pursuits that can help people of all ages meet the recommendations. Their nature ensures that people themselves can control the intensity at which they are active. Those hoping to gain the health benefits of being moderately active should aim to walk or cycle, at a brisk pace, where they feel some effort, but can still sustain a conversation. If people have not been active in a while, they should start their activity slowly and build up over time to a moderate pace.

Walking – some great ideas to increase your physical activity levels The Irish countryside makes for a very varied and scenic arena to get active. The many blue flag beaches, parks and forest walks provide perfect venues for some moderate activity, perfect for all the family.

For those who are perhaps routinely

active and looking to improve their fitness, the hills and mountains provide trails that will certainly get hearts beating faster.

Details of trails of all levels are available from www.walkireland.ie, www.nationaltrailsday.ie or www.coillte.ie For those hoping to get active in more urban areas, there are a number of walking routes developed in association with the Irish Heart Foundation, known as Sli na Sláinte. Some have been developed around training pitches and local parks, perfect for local residents and parents waiting on children. Details of all their locations are available from www.irishheart.ie.

What’s on where?

Little Steps is a HSE and SafeFood campaign, which aims to provide parents with information and support to make small changes to improve their children’s diet and increase their levels of physical activity. The ‘Getting Active’ section of www.littlesteps.eu

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has a variety of games and activities, both traditional and modern, which are fun for everyone. The website also has a ‘What’s on in your area’ section, with an interactive map that has a great list of fun things to do and places to go throughout Ireland.

Your Local Sports Partnerships (LSPs) are another great place to start when looking for new activities or places to go, from local venues such as swimming pools, tennis courts and pitch and putt courses to specific events such as cycle challenges, walking clubs, boot camps for children to sports ability events for people with disabilities. There is a network of countywide LSPs across the country.

To find one close to you, log onto www. irishsportscouncil.ie.

If you fancy something a bit more adventurous such as kayaking or abseiling, then check out the wide variety of Outdoor Education Centres around the country.

This type of activity not only offers an insight into the Irish environment, but also promotes a wide variety of

outdoor activities that will cater for all tastes and abilities, young and old. Details of centres and courses/activities are available on www.oec.ie.

A number of information resources are available, giving details on the guidelines for those working in the area of physical activity and for the public including: Get Active Your Way, an information booklet a factsheet for adults a factsheet for parents and guardians.

These are available at: www.getirelandactive.ie Local Health Promotion Departments HSE information line: 1850 24 1 850.

“For those hoping to get active in more urban areas, there are a number of walking routes developed in association with the Irish Heart Foundation, known as Sli na Sláinte.” www.dohc.ie

Other Relevant Websites: www.getirelandactive.ie www.littlesteps.eu www.hse.ie www.healthpromotion.ie

Benefits of living a physically active lifestyle Better cardio-respiratory and muscular fitness

Lower risk of type 2 diabetes

Lower risk of colon and breast cancer

Better cardiovascular and metabolic health

Lower risk of unhealthy blood lipids

Stronger bones

Healthier body fat composition

Lower risk of early death

Fewer falls

Lower risk of coronary heart disease

Lower risk of stroke

Better cognitive function in older adults

Lower risk of metabolic syndrome

Lower risk of high blood pressure

Reduced symptoms of anxiety and depression

86 Health Matters

update

HSE Golf Classic for BNT Zambia More than 70 HSE staff participated in the HSE Golf Classic for BNT Zambia, held at the Heritage Golf and Spa Resort, Killenard, Co Laois at the end of April.

The golfers raised more than b650 for the ENT Zambia Fund, established by surgeon Kieran O’Driscoll, who is involved with a clinic in Zambia where he performs operations twice a year.

David Lally achieved the best score on the day to win first prize – a wall-mounted CD player.

The full list of prize winners were: 1st David Lally 2nd John Parker 3rd Tony Ryan 4th Gerry Raleigh 5th Brian Kirwan Gross, Christy Weldon Nearest the Pin – John Kennedy Longest Drive (Men) – Brian McPhilips Longest Drive (Women) – Mary Malone Putting Competition – Helen Stokes Anyone who has yet to collect a prize should contact Mary Culliton at mary. culliton2@hse.ie. Thanks to Ashville Media who sponsored prizes for the raffle.

Paul Redmond, John Kenny and Denis Doherty at the HSE Golf Classic for BNT Zambia at The Heritage, Killenard, Co Laois.

+

Rory Culliton, Colin Costello and Dave Culliton.

+

+

Liam O’Callaghan, David Lally and Gerry Rally.

+

Susan Olden, Jacinta Culliton and Ann Gubbins.

Vitamin D Supplementation for Infants T

he HSE recently launched its policy on Vitamin D Supplementation for infants in Ireland.

Vitamin D is essential to help our bodies use calcium to build and maintain bones and teeth. Vitamin D is known as the ‘sunshine vitamin’ because our bodies can make Vitamin D from the sun. Ireland's geographic position in Northern Europe means that there is inadequate sunlight to allow sufficient Vitamin D production in our skin, especially between the months of October and March. It is not possible for babies to safely get the Vitamin D they need in this way as their skin should not be exposed to direct sunlight. As babies grow very quickly between 0-12 months they have a greater need for Vitamin D and since a baby's diet is low in Vitamin

D, there is a need to give babies a daily Vitamin D supplement.

The Department of Health and Children has endorsed the Food Safety Authority of Ireland’s (FSAI) recommendation that ‘All infants, whether breastfed or formula fed, should be given a daily supplement of 5µ (or 200I.U) Vitamin D. This should be provided by a supplement containing Vitamin D exclusively’.

The HSE Policy on Vitamin D Supplementation has been developed to implement this recommendation. The policy with supporting documentation is being distributed internally to all relevant staff.

The policy supports health professionals in advising parents/carers about the importance of Vitamin D supplementation. Community and Hospital Dieticians will inform and update

front line staff. The policy is also being circulated to general practitioners and pharmacists contracted to the HSE. Information leaflets for parents/carers and health professionals are available to download from www.hse.ie in the following languages: English, Irish, French, Polish, Russian, Latvian, Lithuanian, Romanian, Chinese (Mandarin), Arabic, Spanish and Portuguese. They can also be ordered on www.healthpromotion.ie or by contacting your local Health Promotion Department.

The HSE website will also contain a list of Vitamin D supplements suitable for infants.

A public awareness campaign to highlight the policy to expectant and new mothers on the need for infant Vitamin D supplementation is being rolled out in early September.

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Health & well-being

Tasty Temptations

The Renal Diet can pose major challenges for those diagnosed with Chronic Kidney Disease. Thanks to Truly Tasty, managing the diet has become a treat rather than a chore, writes Niamh Lynch.

V

alerie Twomey and her triumphant recipe book, Truly Tasty, have turned all preconceptions of specialised medical diets on their head. It was with zest and dedication that Valerie approached the concept of a recipe book especially catered to the renal dietary needs of people on dialysis. The result is an exciting collection of delectable recipes that can be enjoyed by adults the country over.

From the early age of, Valerie Twomey had to undergo various health procedures, from a number of eye operations to quadruple heart bypass surgery. In 2004, she faced one of her greatest challenges when she was diagnosed with end-stage kidney disease, which took her on one of the most testing yet rewarding journeys of her life.

Without time to adjust, her dialysis treatment began, and her life was forced to change dramatically. Valerie’s enduring positive attitude got her through this extremely taxing time and, while waiting for a kidney transplant, she had an epiphany. She realised that she wanted to do something to make a difference, in some small way, for other people living with kidney disease and their families going through this difficult journey.

In June 2006, Valerie received the gift of life from a kidney donor and, upon recovery, affirmed that she wanted to give something back. Following her transplant, to honour her donor and her donor’s family, Valerie embarked on an exciting and pioneering project, for which all proceeds would go to the Irish Kidney Association. “I felt there must be a way for people on the renal diet to enjoy recipes for special occasions, Sunday lunches, entertaining friends, or better still, friends entertaining for you, within the diet guidelines”, she explains.

While Valerie had successfully managed the challenging dietary restrictions of the

renal diet, she set about creating a recipe book that inspiringly turned these dietary restrictions into an exciting challenge, rather than a negative hurdle. In conjunction with dialysis, the renal diet is an essential part of treatment for people with chronic kidney disease (CKD). It is vital for the successful long-term management of CKD

“I felt there must be a way for people on the renal diet to enjoy recipes for special occasions, Sunday lunches, entertaining friends or better still friends entertaining for you, within the diet guidelines”

and for the prevention of the build up of waste products in the blood. The renal diet is certainly challenging, and requires planning, imagination and practical ideas. It is essential that the patient follows a tailormade dietary programme to ensure that the diet is adequate in protein, low in salt and, where necessary, low in phosphate and potassium. Therefore, the diet sheet specially designed by each patient’s personal dietician must be strictly adhered to.

Fully aware of the struggle which dieticians often face to continuously come up with new and interesting recipe suggestions for their patients, Valerie cleverly employed the help of some of Ireland’s top chefs to handcraft each delicious recipe in the book. Valerie told Health Matters that she was “overwhelmed by [the chefs’] generosity and kindness from the word go. They all gave of their time and expertise free of charge, and many are still helping with our regional cookery demonstrations.”

Temptingly mouth-watering, each of the 100-plus recipes in the book were created with the greatest of care, so that kidney disease patients, along with their family and friends, could savour every last one.

Amongst Ireland’s top chefs who partook in the project were Brian Fallon, Neven Maguire, Kevin Dundon and Georgina Campbell. You can also expect to enjoy such recipes as Melon and Raspberries with Cinnamon Jelly and Basil from Ross Lewis, Char-Grilled Fillet of Beef with Ratatouille from Derry Clarke, Tarragon Plaice en Papillote with Julienne Vegetables and Chive Mash from Clodagh McKenna and Pavlova with Passionfruit and Kiwi from Rachel Allen; among many more. All of these delicious creations are beautifully represented in the book with stunning photography by Hugh McElveen.

Ireland’s top chefs turned their culinary

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Health & well-being

expertise into caring, and worked closely with the Irish Nutrition and Dietetic Institute (INDI) on the project. The INDI’s Renal Dieticians rigorously tested each of the recipes to ensure that each one was suitable for an adult with chronic kidney disease. The Renal Dieticians involved in the cookbook remind readers that each adult with CKD is unique, and so the dietary needs of patients vary in relation to body size, age, the type of dialysis treatment, other medical conditions and the amount of kidney function that they have remaining.

As such, it is extremely important that readers discuss the incorporation of these new recipes into their diet with their dietician before they start cooking up a Truly Tasty storm.

Mark Murphy, of the Irish Kidney Association, praised the achievements of Truly Tasty, saying, “It has succeeded in making the Renal Patient Diet attractive.

The forensic detail involved in producing this accurate Renal Diet Book is invisible to the naked eye. The book has achieved something that I would have said was the impossible, and has produced a new world standard of cookbook for renal patients.” It is safe to say that Truly Tasty is pioneering in its field, and has set the bar extremely high for similar Irish health-related

"The book has achieved something that I would have said was the impossible, and has produced a new world standard of cookbook for renal patients." cookbooks in the future.

The project would not have become a reality without Valerie’s dedicated team, Lizzie Gore-Grimes, Brian Moore, Orlagh Murphy, and Karen Carty. The support of Abbott Ireland as main sponsor, as well as support from Bosch, Shire Pharmaceutical Ltd, National Lottery, Amgen Ireland Ltd, Shamrock Foods Ltd, the Irish Nutrition and Dietetic Institute and the Irish Kidney Association have made Valerie’s dream of producing a glossy, high-end renal diet cookbook a reality.

Visually, Truly Tasty has been produced in a glossy, lifestyle format, and its style and presentation ensures that it sits comfortably

on any bookshelf, be it in the family kitchen or in a commercial book store. Food and wine writer, Tom Doorley, perfectly synopsises the overall appeal of this fantastic cookbook. “It is a beautiful book, and not just because of the delicious images it contains. The beauty lies also in the generosity of the people who have put so much time and thought into its production. Truly Tasty is truly a remarkable achievement.”

Enclosed in each copy of Truly Tasty is an organ donor card, and all proceeds from the sale of Truly Tasty go to the Irish Kidney Association. Valerie says the reason for its inclusion in the book is that, “The demand for organs simply outweighs the supply.

Chronic Kidney Disease is rising and will continue to rise, so it’s important to create continuous organ donor awareness.”

Thanks to the valiant and dedicated efforts of Valerie Twomey and her team, sticking to the renal diet no longer has to mean missing out on the scrumptious food enjoyed by your friends and family on special occasions. Now the hardest part is deciding which culinary delight to cook first!

Truly Tasty is on sale in bookshops nationwide and online from www. corkuniversitypress.com (For more information see also www.trulytasty.ie).

Berry Frozen Yoghurt Serves 4

Ingredients:

275g (10oz) mixed frozen berries 70g (2½oz) each of redcurrants, blackberries, raspberries and strawberries or you could use just 275g (10oz) of a single berry 2 tbsp honey 450g (1Ib) natural yoghurt, chilled

Method:

Take the frozen fruit out of the freezer, place in a food processor and blend for ten seconds, then add the honey and yoghurt and blend until smooth. Transfer to an airtight container and put back in the freezer for an hour. If you don’t have a food processor you can mash the fruit with a fork then fold into the yoghurt and honey. To serve, scoop the frozen berry yoghurt into bowls or glasses as you would ice cream.

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Health & well-being

Moroccan Lamb Tagine with Lemon Couscous Per portion this dish provides one portion of vegetables and five protein exchanges. Do not use a homemade vegetable stock.

Ask your dietitian to suggest a suitable stock cube. Some of your vegetable allowance has been used to allow the inclusion of vegetable stock in this recipe and therefore we do not recommend that you use it on a regular basis. Check your daily allowances to see if you have enough remaining for this dish.

Ingredients:

FOR THE LAMB 1 level tsp ground black pepper ½ level tsp ground cinnamon ½ level tsp ground ginger ½ level tsp ground coriander 3 tbsp water 750g (1¾lb) diced shoulder of lamb, well trimmed 2 tbsp olive oil 1 onion, chopped 1 garlic clove, finely chopped 300ml (10fl oz) vegetable stock (use ½ suitable stock cube to 300ml water) 1 tbsp honey ½ level tsp turmeric FOR THE LEMON COUSCOUS 450ml (16fl oz) water 300g (11oz) couscous Zest and juice of ½ lemon 50ml (2fl oz) extra-virgin olive oil 1 level tbsp fresh flat-leaf parsley, chopped 1 level tbsp fresh coriander, chopped A pinch (¼ level tsp) freshly ground black pepper

Method:

Mix the black pepper, cinnamon, ginger, coriander and turmeric with three tablespoons of water to make a marinade for the lamb. Coat the lamb in this marinade, cover with clingfilm and let sit somewhere cool for approximately one hour.

While the lamb is marinating, make the couscous. Pour the couscous into a large pot. Heat the water to boiling and pour the

liquid over the couscous in a thin, steady stream. Stir in the lemon zest and set aside for three minutes, until the grains have swollen and absorbed all the liquid. Return the couscous to the heat, add the olive oil and lemon juice and cook gently for about two minutes, stirring with a fork to fluff up the grains. Take the pan off the heat. Stir in the parsley and coriander. Season to taste with pepper and set aside to keep warm. Drain the lamb. Heat the olive oil in a frying pan and sauté the lamb until lightly browned.Transfer to a saucepan with a lid (or a tagine, if you own one).

Add the onion to the frying pan that you used to brown the lamb and cook until soft, not brown. Add the garlic and lightly cook.

Transfer all to the saucepan (or tagine) with the lamb. Deglaze the frying pan with a little stock and then pour this and the rest of the stock over the lamb, adding in the marinade spices as well. Bring to the boil. Cover and simmer for approximately one-and-a-half hours or until the lamb is meltingly tender but still holding its shape.

Then add the honey. Keeping the saucepan

uncovered, cook for another ten minutes to reduce and thicken the sauce. Serve the tagine stew on individual warmed plates or on one large platter to share, with lemon couscous on the side.

COMPETITION! Health Matters has been given a few copies of the Truly Tasty cookbook to give away to our readers.

To be in with a chance to win this excellent cookbook, simply answer the question below and send your answer, your name and your address to competition1@ashville.com with ‘Truly Tasty’ in the subject line.

Closing date for entries is Friday 9th July.

All entries received by the closing date will be entered into a draw and winners will be notified by email and their copy of the cookbook will be sent in the post.

Good luck!

90 Health Matters

Update

Sit-down exercise DVD gets people moving Staff and clients of Lusk Community Unit for Older Persons in north county Dublin have made a sit-down exercise DVD – particularly suitable for people with reduced mobility. Susan Dunne, Staff Nurse and Project Leader, explains how they did it.

T

he need for a suitable Irish-based exercise DVD was highlighted to my colleagues and I when trying to encourage participation among our clients in our daily exercise programme. We had been using a US-based armchair exercise DVD which we identified as being outdated and unsuitable for our needs.

We endeavoured to resource a similar Irish DVD but weeks searching the web proved unsuccessful. We decided that if we wanted to motivate our clients and increase participation in the exercise programme, then we would have to undertake making our own DVD. A preliminary ethics approval meeting was held at local level to develop the proposed plan. This included medical, nursing and administrative staff, as well as two client representatives. The exercise programme was developed

by Mona Sweetman from the activities department in conjunction with the physiotherapy department.

Funding was applied for and the project was made possible by financial support from the Community Foundation of Ireland and the Health Services National Partnership Forum.

HSE Communications recommended Record It Studios in Dunleer, Co Louth, to us and they proved to be as efficient as they were professional. On the day of filming, our ten energetic and enthusiastic clients proved to be just as professional, completing filming ahead of schedule and without any rehearsal.

+ Susan Dunne, Project Leader pictured with Maura Ellis and Kevin Nugent, Client Representatives, Project Committee, both clients from the Day Hospital at HSE Lusk Community Unit for Older Persons pictured at the launch of "Le Cheile" exercise DVD for older persons.

The DVD is now an integral part of our exercise programme, immediately benefiting approximately 150 clients in Lusk Community Unit. An increased level of participation has been noticed and clients agree, with one reporting that “it’s nice to liven up the place,” and another saying “I love the music.” The familiar music has provided clients who are physically unable to participate the opportunity to engage with the DVD, often singing along. Since the launch of the DVD last September, it has been widely sought after. The DVD has been bought by a variety of different disciplines ranging from care facilities, day centres, occupational therapists, Special Olympics Ireland, and for personal use at home.

This has generated some income for the Friends of Lusk Community Unit charity.

We have sold over 250 copies and have received some very positive feedback.

We are very proud of this project, not least because of the finished product, but because the actual process of making this DVD proved to be an invaluable and rewarding experience to both staff and clients, many of whom reported that

participating in filming and providing editing opinions was a lot of fun and very rewarding.

I believe that this project is unique, as most aspects were completed by the staff and clients of Lusk Community Unit. Medical, nursing, physiotherapy and administration staff all worked together with the clients. Our activities department provided the very energetic and professional anchorwomen. Even the wonderful music was provided by a member of our security staff.

Le Chéile, meaning together, proved to be a very appropriate title as this genuinely was a team effort.

We have already had discussions about making at least one follow up DVD, Le Chéile Arís.

Copies of the DVD may be purchased from Lusk Community Unit. Tel: (01) 807 1240.

92 Health Matters

Health Online

Key Publications Available to All The Lenus health repository was launched in February 2009 by the Regional Library in Dr Steevens’ Hospital to address two related problems: how to preserve and make accessible online the published output of the Irish health services, and how to publish, promote and share the latest Irish health research in an easily accessible way writes Padraig Manning, HSE Librarian.

A

s part of the Open Access movement, www.lenus.ie is dedicated to making Irish health research and literature widely and freely available for the benefit of all.

So what will you find in Lenus? Broadly speaking, the vast mountain of information that comprises Lenus breaks down into two categories. Firstly there are the HSE publications – for example, corporate publications, reports and board minutes.

These include a large amount of material from the old health boards (going back in some cases to the early 1970s) and form a huge archive of health-related data, much of it available nowhere else. Additionally, Lenus stores the publications of the Department of Health and Children, along with reports, clinical guidelines and statistics from other regulatory and statutory organisations in the field of Irish healthcare. The oldest of these publications date back to the mid-1960s, while new ones are being added daily.

But Lenus is more than just a home for official publications. It also has a sizeable – and rapidly growing – body of original, up-todate Irish health research, much of it carried out by HSE employees themselves. Theses, dissertations and published journal articles

by Irish authors are all available to read and download. And there’s also a section dedicated to ongoing research projects being carried out within the HSE. Staff engaged in research can set up their own web pages outlining their field of study, and can collaborate with colleagues anywhere in the service.

An important feature of Lenus is its interactivity. Users can not only download information, they can upload it too. Anyone can submit Irish health-related publications or research to the repository from the comfort of their own PC. Of course, all this information is only useful if it can be easily navigated, and here Lenus really comes into its own. Its powerful search engine is both highly accurate and simple to use, while the user interface is clean, straightforward and intuitive.

Lenus is fully Web 2.0 enabled, meaning users can keep abreast of the latest updates through Facebook, LinkedIn, Delicious or Stumble it! Crucially, Lenus can be used with equal ease, whether you’re looking for the latest Irish research into cancer treatments, or searching for a copy of a HIQA nursing home inspection report.

Since its launch, Lenus has had a significant impact online as a showcase for Irish health research and literature.

Thousands of users visit the site every month, and their searches range from the Mental Health Assessment Tools (published by the HSE Dublin MidLeinster Mental Health Services), to the 1970 Kennedy report into the industrial schools system. Site visitors come from

places as diverse as India, the Philippines, Spain, the UK, USA and Hong Kong. And Lenus has now been included in the WorldWideScience Alliance’s online science portal (the only Irish site to be included), further boosting the profile of Irish health research on the global stage.

For further information, contact the Regional Library at regionallibrary@hse.ie, or at (01) 635 2555.

Health Matters 93

communication

Tools of the Trade –

Telephone Etiquette We all know how valuable good customer service is and in the HSE we interact with the public on a day-to-day basis, whether it is in person, on the phone or on email. Good communication is vital to improving our service to the public so in this first part of a series of communication updates, we offer a few tips to guide you when dealing with people on the phone.

1

ask, “Would you like me to transfer you to ______’s voicemail?” Do not assume that the caller would rather go to voicemail.

Always ask first.

2

When handling callers who are rude or impatient, stay calm, try to remain diplomatic, polite and speak slowly and calmly. Getting angry will only make them angrier. Always show willingness to resolve the problem or conflict and try to think like the caller – their problems and concerns are important.

Always answer the phone with a friendly, warm tone and identify yourself and your department.

Remember that you may be the first and only contact a person may have with your department, and that first impression will stay with the caller long after the call is completed.

Listen to the caller's query and if transferring a call, be sure to explain to the caller that you are doing so and where you are transferring them. If the caller has reached the wrong department, be patient and polite, sometimes they have been transferred quite a lot to many different departments. If possible, attempt to find out where they should call/to whom they should speak. If this is not possible take their name and number and pass it on to the most appropriate person who can help them.

When taking messages be sure to ask for the caller’s name (asking the caller for correct spelling) and the phone number and/or extension (including area code). Repeat the message to the caller to make sure you have taken it down correctly.

3 4

Don’t forget that if a caller is looking for someone else who is not available at that time, you can transfer them to voicemail instead of taking a message, but don’t forget to

5

6

If you have tried to deal with the caller (referred to in No.5) and the caller persists in making nuisance calls, do not engage him/her in conversation. If he or she is abusive then you should end the call and report it to your line manager. Do not hang up the phone! First tell the caller that you will not listen to abuse and that you will be terminating the call. If you are concerned about security as a result of the call convey your concerns to your line manager.

7

If you are making a call on behalf of the HSE, always know and state the purpose of the communication. If you need to delay the conversation, call to postpone it, but do not make the other person wait around for your call.

8

Voicemail has many benefits and advantages when used properly. However, you should not hide behind voicemail. If callers constantly reach your voicemail instead of you, they will suspect that you are avoiding calls.

Be sure to record your own personal greeting for your voicemail. People tend to feel that they have already lost the personal communication touch because of voicemail. Be sure to include in your name and department in your greeting so that people know they have reached the correct person.

9

10

Be sure to check your messages daily and return messages within 24 hours (or Monday if messages come in at the weekend). If it will take longer than 24 hours to get a response, call the person and advise him/her.

94 Health Matters

Cystic Fibrosis

Association plays key role as advocate for people with Cystic Fibrosis

2009 is the year that may well be regarded as one of the most important in the history of the Cystic Fibrosis Association of Ireland (CFAI) because of the progress made towards a more comprehensive framework of Cystic Fibrosis (CF) services, writes Philip Watt, Chief Executive of the Cystic Fibrosis Association of Ireland.

T

here is emerging evidence that the investment in CF services in Ireland, particularly in specialised health staff that make up multi-disciplinary teams in designated CF Centres around the country, is having a direct impact on better patient services and care in Ireland.

However, it is also evident that progress that has been made remains piecemeal and there remain significant gaps and weaknesses in the implementation of agreed government policy.

The CFAI is a voluntary body that draws

together mainly parents and people with CF, but also clinicians, specialised health staff and general supporters. It was established in 1963 and its key role today is to advocate and fundraise for better CF services, and to support research and provide advice and other services to our members. Cystic Fibrosis is the most prevalent inherited disease in Ireland, with one in 19 of the population carriers of the Cystic fibrosis gene and around 1,300 people with CF. CF produces a sticky mucus and primarily affects the lungs.

The digestive system, as well as other organs in the body, is also affected by CF. Cystic Fibrosis is managed through a mix of regular hospital check-ups and associated treatment, an intensive exercise and physiotherapy regime, and enzymes before meals to aid digestion.

The context in which we work as an association is increasingly challenging.

Of particular concern includes: • The increasing likelihood that future government funding for badly needed new capital projects related to CF

Health Matters 95

Cystic Fibrosis

services will be dependent on charitable fundraising.

• The embargo on recruitment within the health services, which has already caused the non-replacement of some key staff in CF multi-disciplinary teams, such as social workers and psychologists and on occasion CF nurses. The CFAI is monitoring this situation closely.

• Cutbacks in social welfare support and additional charges for people with a disability, including those with CF.

“Cystic Fibrosis is the most prevalent inherited disease in Ireland, with one in 19 of the population carriers of the CF gene and around 1,300 people with CF.” It is a sad fact in 2010 that some CF patents remain in multi-bed wards or in single-bed units that do not have adequate en-suite isolation facilities to prevent cross infection. It is equally unacceptable that in some hospitals, CF patients are exposed to unnecessary risks because of inappropriate location of Cystic Fibrosis out-patient facilities or lack of a dedicated CF day centre.

Cystic Fibrosis patients are now living longer and there are now slightly more adults than young people with CF. There is a concomitant increased need for CF adult services throughout Ireland. There has been a historic deficit in adult Cystic Fibrosis services.

This was highlighted by the campaign for the new CF facilities in St Vincent’s University Hospital, Dublin, in 2009, and continues to be highlighted in other CF Centres in Ireland such as the Mid-Western Hospital in Limerick and in Waterford Regional Hospital, where more resources are particularly required for adult services.

Despite the skills and efforts of the concerned hospitals and clinicians, the rate of double-lung transplantation in Ireland remains unacceptable, with only three

transplants in Ireland carried out in the past two years. There is an urgent need for two dedicated lung transplant surgeons in Ireland to deal with the backlog of 50 people awaiting lung transplants, including the 30 or so with Cystic Fibrosis. This backlog is primarily the result of systemic failures within the transplant/organ donation policy framework rather than one component, and requires urgent attention to prevent more patients dying on the transplant waiting list or being overly reliant on the transplants carried out in Freeman’s Hospital, Newcastle.

The Human Tissue Bill, 2009, when enacted, will put organ donation and transplantation on a sound legislative footing for the first time. We would like to see this Bill given high political priority. In its Corporate Plan, the HSE has promised that a Transplant Unit will be established in 2010, which is an important step in the right direction. The CFAI would like this unit to be given sufficient powers or resources to undertake its important tasks, including ensuring that the lung transplant programme is at least as effective as the kidney programme in Ireland.

The CFAI has called on the Government to establish a Cystic Fibrosis Reference Group at national level which would, among other issues, develop Key Performance Indicators (KPI) for all CF Centres in Ireland. We have been given an assurance that such a group will be established and this is indeed to be welcomed.

There have been important strides made in 2009. Most significant was the publication of the long-awaited HSE CF Services Report in October 2009. This report in large part endorsed the vision and approach set out in the Pollock Report commissioned by the CFAI in 2005, which provides the blueprint for: • Dedicated CF Centres in Ireland that are in effect ‘Centres of Excellence’.

• The recognition that CF can only be managed effectively through multidisciplinary teams which includes consultants, doctors, specialised CF nurses, physiotherapists, nutritionists, psychologists and social workers.

• The critical importance of preventing cross-infection based on international standards, particularly in respect of

Pseudomonas and B.cepacia, but also MRSA and other infections that some hospitals have struggled to prevent recurring • The introduction of screening for CF for all newborn babies as part of the existing Newborn Screening Programme The HSE has promised that the new ensuite in-patient and dedicated out-patient facilities in St Vincent’s University Hospital will be completed by the winter of 2011. The CFAI will continue to insist that the new unit will be built on schedule and will have the 34-bed in-patient capacity recommended by the CF Medical and Scientific Committee.

The CFAI is actively involved in the HSE steering group to extend the existing Newborn Screening Programme to include Cystic Fibrosis for the first time as part of the ‘heel prick test’. A further ‘sweat test’ is used to confirm a positive result for CF. Every week, three cases of Cystic Fibrosis may be undetected at birth because of the absence of CF screening. There is a growing body of evidence to prove that the early detection of CF can make a considerable difference to the long-term prognosis. The CFAI welcomes the commitment to bring in screening by the end of 2010.

“The Human Tissue Bill, 2009, when enacted, will put organ donation and transplantation on a sound legislative footing for the first time.”

Patient Registries play an increasingly important role in the management of disease in Ireland, for example, producing demographic data that shapes where CF services should be located. In this context it is important to pay tribute to Linda Foley, who gave many excellent years service as Director of the CF Registry and who died suddenly in December 2009. She will continue to provide inspiration for all those concerned with improving CF services in Ireland.

96 Health Matters

Mental Health

World Leaders in Mental Health Meet in Ireland

+

International and Irish leaders in mental health are pictured here in Killarney, Co Kerry during the ‘International Initiative for Mental Health Leadership’ (IIMHL) event.

The International Initiative for Mental Health Leadership (IIMHL) is a virtual agency which brings together national leaders in seven member countries – the USA, Canada, England, Scotland, Australia, New Zealand and Ireland, and this time it was Ireland’s turn to host.

T

he aim of the IIMHL is to enhance leadership in mental health and addiction services and enhance services for the public. Leaders are drawn from a variety of senior roles, including: government officials, major service providers, service users and carer leaders, representatives of indigenous/ ethnic peoples, senior clinicians, planners, commissioners, and the non-government (NGO) sector. The focus is on sharing innovation and making practical changes.

Ireland became a member of the IIMHL in 2006 and has since fostered links which have offered an opportunity to exchange

ideas and showcase promising practice, especially those involving the active inclusion of service users and carers in the planning, development, delivery and evaluation of mental health services. Every 16 months a Leadership Exchange and Network Meeting is held in one of the member countries, and in May 2010 500 leaders in mental health came together for the meeting, jointly hosted by the Department of Health & Children, the HSE, National Service User Executive and the Mental Health Commission.

From May 17th - 21st, Mental Health leaders visited over 40 sites throughout Ireland for two days of thematic ‘exchange

meetings, where Irish mental health leaders hosted their international peers in an active exchange of learning on specific topics.

Citizens in Partnership – the Inclusion of Service Users in their Recovery International colleagues came to Ireland to experience how service users, carers and service providers are working collaboratively in supporting Irish people in their recovery from mental illness. Service users have a representative body in the National Service User Executive (NSUE).

In order to deliver better recovery-

Health Matters 97

Mental Health

oriented mental health services, Ireland is bringing the service user voice to all levels, nationally, regionally and locally. Service users are active on interview boards selecting staff to work in supporting them in recovery. They are active participants on mental health services management teams across the country, and they work to plan and evaluate service delivery and to establish service user need. In doing all of this, service users are continuing to build the skills to be equal to the responsibilities which this brings.

Building capacity among service users is supported through innovations such as the Co-operative Learning Leadership Programme, delivered in partnership between the mental health services and DCU. This programme brings together a service user, a carer and a service provider to work as a team in developing the leadership and change management skills to deliver a change management project within their own service. Other innovations to support the service user voice are the Expert by Experience post in DCU and the activities of the Peer Advocates in acute inpatient units.

IIMHL International Network Meeting, INEC, Killarney May 19th – 21st The Network Meeting acted as a forum where the learning from the 40 Exchange Meetings was discussed. Feedback on the Exchange Meetings centred on the theme of the Network Meeting – ‘Citizens in Partnership – Inclusion or Illusion’. Each Exchange, as part of its deliberations, considered how the theme of the Network Meeting related to the Exchange Topic, recommended how the theme could be advanced within their context and proposed how the IIMHL could assist in promoting and delivering on the recommendations.

Ideas and proposals to give practical effect to supporting individuals with mental health difficulties were identified on a range of topics including: • Mental Health at a time of economic uncertainty; • A Focus on Recovery and Hope in mental health

+

Members of the Interrelate Service Exchange Group who met in Dublin Castle were Joan Edwards Karmazyn (Canada), Sonja Goldsack (New Zealand), Colette Nolan (Ireland), Jenny Speed (Australia) and Anne Beales (United Kingdom). This group has established mechanisms to enable participants to link together on a monthly basis to share ideas and to problem solve. The group is working to create national networks for service users. Anne Beales from London said the seven participating countries were all at different stages in the process of developing these networks. For example, in the US, service users were able to provide advice to President Obama’s administration and there was a state wide coalition of service user groups. In Scotland network members had a direct voice into the Scottish Parliament there is also a strong network in England.

+

Fran Silvenstri, Director, IIMHL; John Moloney, Minister of State with responsibility for Equality, Disability and Mental Health; Pam Hyde, Substance Abuse and Mental Health Services Administrator (SAMHSA), USA (appointed by President Obama 2009); and Martin Rogan, Assistant National Director, Mental Health, Health Service Executive.

• Promoting genuine Service User engagement in mental health care; • Protecting the mental health of young people; • Transforming capacity into capability in modern mental health care; • Attaining full citizenship and inclusion

Sponsoring Countries Leaders Group (SCLG) Dublin Castle was the venue for a number of Exchange Meetings on 17th and 18th May. The Sponsoring Countries Leaders Group (SCLG) met to explore how national policy can support positive mental health

98 Health Matters

Mental Health

for their populations and the development of recovery-oriented mental health services.

Consideration was given to the challenges facing each country in uncertain economic times; coping with emerging needs, the needs of young people, creating recoveryoriented approaches to service delivery and transforming capacity into capability in mental health care.

Leaders in Research Group The Combined Brisbane/Cincinnati Research Group are leaders in research in the mental health field who examined current international research and evidence-based findings which can support recovery. Ireland presented ‘Reconnecting with life: personal experiences of recovering from mental health problems in Ireland’, research recently published by the HRB which focuses on 31 individuals with experience of mental health needs who have recovered. This groundbreaking research has modelled the recovery process focusing on the reconnecting with self, others and time.

+

Members of the Clinical Leaders Exchange Group who met in Dublin Castle were Maurice Gervin, Owen Mulligan, Susan O'Connor, Ian Daly and Pat Bracken. Ian Daly, Executive Clinical Director at Tallaght Hospital in Dublin, chaired this group. Dr Daly said the group discussed service configuration, service quality, models of care, evidence based medicine and recovery. He said many of the issues were the same in different countries but often the approaches were somewhat different. The group had been a very useful learning experience and participants had seen presentations from Irish programmes.

Clinical Leaders Group The focus of this group is the role of clinical leadership in organisational change and effective change management.

Leading clinical leaders gathered to discuss how clinicians can lead organisations through the changes envisaged in ‘A Vision for Change’.

Interrelate Interrelate is a dynamic network of service user movements which articulate the viewpoint of the person with experience of mental ill health. They are a powerful resource in the reengineering of service planning and delivery, identifying what has benefited people in their recovery and what has impeded that recovery. Irish participation in this group is through the Irish Advocacy Network. + Complementary events – Youth Summit – May 19th Running in parallel with the IIMHL Exchange and Network Meeting, an International Youth Summit was held to consider young people’s mental health.

A group of both Galway Mental Health staff and international mental health leaders visited St. Brigid’s Hospital, Ballinasloe in May.

This was an event led by a number of organisations, including Headstrong, St Patrick’s Hospital, HSE, Orygen and St John of God Services. Dail Na nOg opened

the proceedings.

The event culminated in the publication of an International Youth Declaration on Young People’s Mental Health.

Health Matters 99

elderly care

Senior Case Worker role in responding to elderly abuse Most older people don’t experience abuse but a minority do. Elder abuse can be physical, sexual, financial, psychological or take the form of discrimination or neglect. Frances Clifford, Senior Case Worker in Sligo-Leitrim, outlines the nature of her work and provides an insight into the reality of responding to elder abuse in Ireland.

One of the key elements of the Senior Case Worker’s role is to manage and co-ordinate the response of the HSE to allegations of elder abuse. We work in co-operation with the various other professionals involved with older people (public health nursing, GPs, home helps, mental health services, hospitals and Gardaí) and this collaborative working reflects our shared duty of care to respond where there may be abuse.

Each report of elder abuse and each client’s circumstances are different and, therefore, our responses to cases vary.

Many factors will influence this, including the views and wishes of the older person, their capacity to make decisions, the seriousness of the case, or the question of whether some degree of criminality could be involved and the risk of further abuse.

Often the issues we are encountering are longstanding and have their origins in disputes over land, money or inheritance.

The older person may be reluctant to take any immediate action, particularly against a close relative. Much of our work in these circumstances is aimed at supporting the older person and empowering them to make decisions for themselves. Cases relating to financial abuse present particular challenges. An important part of the role of Senior Case Worker in these cases is assessing the needs and wishes of the older person and advocating on their behalf to achieve these wishes.

Cases of couples who have historic patterns of abusive behaviour (commonly in association with addiction problems) which continues into older age are, of course, disturbing. Effecting change in these cases involves building relationships

and establishing trust with the older person, which understandably can be a lengthy process.

The aim of our work is not about righting a wrong done, or establishing if a crime has been committed. The focus must be on responding to the wishes and needs of the older person and working with them and their family to resolve the issue. The older person invariably wants the abuse to stop but wishes their relationship with the abuser to continue. They do not want retribution but an end to the abuse and maintenance of the relationship. Older people deserve to be treated with the respect that their lives

and achievements warrant. It is crucial that we all maintain vigilance on this issue. In this context, a new community focused DVD will play an important role.

World Elder Abuse Awareness Day World Elder Abuse Awareness Day on June 15th sees the launch of the HSE elder abuse public awareness campaign ‘Open Your Eyes’.

This year’s campaign comprises of a number of different elements. In addition to radio advertisements and information leaflets, the HSE will also see the launch of an awareness-raising DVD, which will highlight the issue of elder abuse in community settings. This follows the success of a training DVD for residential settings, Recognising and Responding to Allegations of Elder Abuse, which was produced and distributed to all residential care settings for older people in 2008. It is hoped that the community-focused DVD will raise awareness of the issue of elder abuse among the general public.

In 2009, almost 2,000 referrals were

received by Senior Case Workers (SCW) nationally – 62 per cent of those referred are female. The abuse types most commonly reported are psychological, financial, neglect and physical abuse. Very often, the alleged perpetrators are family members, usually son/daughter, and more often that not they live with the older person.

For further information on the new community-focused DVD, contact one of the following Dedicated Officers for Elder Abuse: HSE West: bridget.mcdaid@hse.ie HSE Dublin Mid-Leinster: sarah.marsh@hse.ie HSE South: con.pierce@hse.ie Further details on elder abuse developments and staff contact details can be found on the HSE website www.hse.ie – Go to Find a Service then Older People and Elder Abuse.

100 Health Matters

Cancer awareness

Skin Cancer Prevention Programme Outdoor workers and young children are being targeted by the National Cancer Control Programme in a skin cancer prevention programme aimed at improving awareness of the damage caused by sun exposure and providing accurate skin protection advice.

Skin cancers are highly preventable, but Dr Marie Laffoy, Community Oncology Advisor and Specialist in Public Health Medicine with the NCCP, says that, “there may not be enough recognition of how common and easily preventable skin cancers are”.

There are two types – malignant melanoma (MM) and non-melanoma skin cancers (NMSC). “UV radiation is responsible for up to 90 per cent of skin cancers and most of our lifetime UV exposure occurs during childhood and adolescence. “It is proven that ultraviolet radiation (UVR) causes skin cancer. Any potential benefits of exposure to sunlight do not outweigh the known risks of skin cancer. We need to adopt a commonsense approach to sun protection for the purpose of preventing skin cancer,” according to Dr Laffoy.

“We will prevent skin cancer if we heed basic common sense guidance regarding sun exposure and protection.

The actions required for prevention may seem simple (for example, reduce sun exposure, especially between 11am and 3pm, seek shade, cover the skin with light clothing, wear sun glasses and use a broad spectrum sunscreen) however the real challenge for all of us involved in healthcare delivery is to motivate people to alter their attitude and behaviour towards protecting their skin.”

A major increase in MM and NMSC cancers occurred in Ireland during the latter half of the 20th century. Incidence continues to rise. Dr Laffoy noted that NMSC incidence is predicted to increase by over 90 per cent over the coming decade if current trends continue. “There were over

7,000 new cases registered in 2007 and it is forecast that it will rise to 13,000 if we continue to ignore the advice and fail to protect ourselves from sun exposure. NMSC accounts for 92 per cent of all skin cancers.”

Malignant melanoma can be lifethreatening. Over 600 Irish people are diagnosed with MM annually. Since 1994, the incidence rate has been increasing every year for males and females by two per cent and 4.5 per cent respectively.

Though MM accounts for just eight per cent of all skin cancers diagnosed in Ireland each year, it is responsible for 67 per cent of skin cancer deaths (approximately 100 annually). Overall, 60 per cent of these patients are female and 60 per cent are aged under 65 years. Malignant melanoma is the third most commonly diagnosed cancer in the 15-44 years age group,

representing 10 per cent of all new cancers diagnosed in this age group. By the year 2020, it is projected that there will be 1,250 new cases of malignant melanoma per year if current trends continue.

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102 Health Matters

cancer awareness

Sunbeds (artificial UVR) Dr Laffoy stresses that it is now proven that “sunbeds cause skin cancer. While there are no differences in the physical and biological properties of natural and artificial UVR, there are several additional health risks associated with sunbeds.”

“Overall, UVA doses received by regular indoor tanning for a half-hour session may be up to about five times those received from the sun. In addition, sunbed lamps may sometimes be incorrectly replaced, or filters may be broken, or timers may fail, leading on occasion to severe localised or generalised skin burning, sometimes even causing death, or permanent localised scarring.

“Like natural sunlight, sunbeds emit both UVA and UVB. UVB is more biologically active than UVA and penetrates the upper layers of the skin. It is the main cause of sunburn and skin cancer. In recent years, sunbeds have been manufactured to emit higher levels of UVB to speed up the tanning process, i.e. ‘fast tanning’, and

hence have become more damaging.

Effective primary prevention interventions should be sustainable, long-term, multidimensional, multi-agency and targeted.

Primary school children, outdoor workers and outdoor recreational settings are a priority for intervention.

On that basis, the NCCP is initiating cooperative working with several key groups representing outdoor workers, with a view to devising and delivering key preventive messages. “Quite simply we are urging people who do work outdoors – painters, decorators, builders, farmers – to cover up, wear a wide brimmed hat, use sun screen and where possible refrain from being in direct sunlight between 11am and 3pm,” says Dr Laffoy.

The NCCP is also targeting parents and younger children to remind them of the importance of prevention in the younger years. “We know that parents are more cautious and more aware of the dangers now, but when you consider the

anticipated increase of over 90 per cent in the incidence of skin cancers over the next ten years, it is the younger generation who need to be protected because of the impact of the sun on their skin. Equally, we want to educate our young people at an early age so they are sun-smart and can live that message in later life.”

“Our message to parents and carers for young children is clear and simple: seek shade where possible during 11am and 3pm; cover up, wear a hat that covers the head preferably with a wide brim and wear sun screen with a minimum of SPF 15.”

The NCCP is currently finalising GP referral guidelines for skin cancer. A baseline audit of current skin cancer services is being undertaken with a view to developing a network of pigmented lesion clinics.

Fitzpatrick Skin Classification Scale A person’s skin type is genetically determined and it cannot be changed. The Fitzpatrick Classification of skin type was developed in 1975.

The scale classifies a person’s complexion and their tolerance of sunlight. It allows for a common sense approach to self-protection.

Over 75 per cent of the Irish population is either ‘skin type I or II’.

Skin phototype

Skin colour

Sunburn susceptibility

Classes of individuals

% Irish Population

I

White; very fair; red or blond hair; blue eyes; freckles

Always burns; Never tans

Melano-compromised

26

II

White; fair; red or blond hair; blue, hazel or green eyes

Usually burns; Tans with difficulty

Melano-compromised

49.6

III

Cream white; fair with any eye or hair colour

Sometimes mild burn; Gradually tans

Melano-competent

19.7

IV

Brown; typical Mediterranean caucasian skin

Rarely burns, Tans with ease

Melano-competent

4.3

V

Dark Brown; mid-eastern skin types

Very rarely burns, Tans very easily

Melano-protected

0.3

VI

Black

Never burns; Tans very easily

Melano-protected

0.1

Health Matters 103

consumer affairs

PCTs urged to work in partnership with local communities Primary Care Teams (PCTs) are increasingly engaging with their local communities to exploit opportunities for health gain among the local population. Rachel McEvoy, Research Officer with Consumer Affairs, explains.

P

ublic policy recognises that communities should be centrally involved in shaping health services, including primary care services. More recently, the National Strategy for Service User Involvement in the Irish Health Service has reflected these commitments and prioritised the participation of “socially excluded groups and those whose voices are seldom heard”.

In 2008, in partnership with the former Combat Poverty Agency, the HSE Office of Consumer Affairs, supported the development of a Joint Community Participation in a Primary Care Initiative.

The initiative was designed to support disadvantaged communities and local health service interests to work together and plan for the participation of excluded communities and groups in local PCTs and networks and in the implementation of the Primary Care Strategy: A New Direction.

The initiative, which was evaluated, has led to some very promising outcomes that have relevance to the roll-out of community participation in primary care, including a better understanding and huge learning for community and PCT representatives of the role and impact of community participation in primary care, and of the different models of community participation that can be effectively implemented.

The initiative has also resulted in a wealth of innovative and creative approaches and outcomes to promote processes of community participation, for example, in carrying out information sharing, community needs assessments and in creating representative community structures. This has resulted in an improved capacity to identify and address the health needs of the most marginalised communities.

For many community projects involved in the initiative with the HSE, it has been a new

experience and this has resulted in significant learning and awareness in the community of how local needs can be raised in the development and ongoing work of PCTs. Many projects have highlighted the important role of engagement with the HSE. A participant said: “The project has opened doors to the community and the PCT has been very supportive of the project, and there have been good connections made.”

Another expressed how “the community representative can be an important gobetween, acting as a bridge between the community and health practitioners.”

Health professionals have experienced significant learning through this initiative, and as one stated “the learning curve has been huge and now we feel ready for community participation.” Some of this has enabled PCT representatives to understand how community participation can add value to their work and that it can provide a basis for joint work. One HSE community worker

+

stated: “It’s all about give and take, and we are now in a position to share different positions and genuinely engage with the community.” In the case of another PCT representative “the PCT now sees partnership with the community as being essential.”

A total of 19 projects participated in the initiative from Westmeath, Roscommon, Mayo, Limerick, Leitrim, Dublin, Monaghan, Cork, Wexford, Donegal, Offaly, Waterford and Tipperary.

It is anticipated that learning from the initiative will inform the ongoing implementation of the National Primary Care Strategy and, in particular, the policy commitment to establish 500 primary care teams by 2011.

The final evaluation report and the resources supporting the initiative will be made available at www.hse.ie. For further details please email rachel.mcevoy@hse.ie

Health professionals and community representatives who were involved in the Community Participation in Primary Health Care Initiative. From front to back, left to right Row 1: Mary Cleary and Breda Galligan (Liberties and Rialto Home Help Services), Vera Ashton(Community Health Worker, Dolphin Health Initiative) Edel Reilly (Community Health Coordinator, Fatima Regeneration Board), Sara Rigney (Senior Primary Care Dietician), Dr Kevin O’Doherty (GP) Row 2: Helen Fitzpatrick (Physiotherapist), Anne O’Neill, (Senior Physiotherapist) Debbie Lynch (Community Development worker, Rialto Community Network), Ellen O’Dea (Acting Primary Care Manager) Row 3: Dr. Michael Doyle (GP), Brian Murphy (National Primary Care Services Manager) Dr Fergus O’Kelly (GP).

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Health Matters 105

PERSONAL FINANCE

Investing in your future Independent Financial Advisor Eoin McGee gives advice on how to maximise the return on your additional voluntary contribution.

F

or most people it is a long road from when you decide you want to put a little extra away for your retirement and actually deciding whether to go the “buy back years”, “notional service” or the “AVC” (additional voluntary contribution) route. The purpose of this article is not to decide what you should do but more, what to do with your investment if you do decide to take the AVC route.

If you weigh up your options and you decide to go the AVC route, the next thing you need to do is decide how much to put in. However, don’t stop there, probably the most important decision you will make is what way to invest your money.

When the additional voluntary contribution is deducted from your salary it is then transferred to one of the life companies. The life company then invests this money on your behalf into a fund. A fund is a collection of all customers’ money into one “pot”. The fund manager, the person responsible for running the fund, then allocates the money based on the set criteria for that fund.

For example, all companies would have a managed fund. A managed fund is generally invested into a broad range of assets classes, such as shares, government bonds and gilts, property, cash and sometimes commodities.

When a fund is first set up, the parameters in which the fund manager can work are laid down. These parameters typically dictate what percentage of the fund can be invested in each asset class. A typical managed fund may be able to invest between 50-80 per cent in shares with the balance divided into the other asset classes such as bonds, property, cash and commodities.

What each fund manager is trying to do is to outperform their peers. This comes with some difficulties, however. The main one,

“If you weigh up your options and you decide to go the AVC route, the next thing you need to do is decide how much to put in.”

in my opinion, being that no fund manager wants to be caught with his or her pants down when the tide goes out. They usually play it safe and do not do anything wildly different to anyone else.

This results in similar returns and similar mistakes being made by all funds. There are one or two notable exceptions to this.

Some funds are actively managed. This means that there is a fund manager with a team behind them that not only decide what the appropriate asset split should be but also what individual shares to buy in what sectors and in what geographical area or what properties to buy and where.

There is another way of investing in funds, however, and this is by investing in indexed funds. The difference between an

active managed fund and an indexed fund is that the indexed fund simply tracks or mimics the index. The most well known index in Ireland is probably the ISEQ, the Irish Index of Irish shares.

The ISEQ is made up of the top 28 companies in Ireland based on their size.

A size of a company is calculated by multiplying the share price by the number of shares there are in the company. This gives you a value for that company. The bigger the value the higher up the index it goes.

Some people believe that in wellestablished markets such as the US, investing in the index will provide more

APRIL 2010

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Public Sector Times

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Health Matters 107

PERSONAL FINANCE

consistent returns than using an actively managed fund investing in the same market. Be wary of such claims because sometimes the people making them have poor active management records.

The main difficulty, in my opinion, with a managed fund is that it has to have a certain exposure at all times to the asset classes in which it invests. So, for example, when markets were collapsing a few years ago a managed had to remain exposed to shares.

Whether you want indexed funds or actively managed funds if you took an active role, along with your advisor, you could have more control and may avoid the pitfalls of a managed fund. This is a big decision to make and will require a lot more input from you.

If you do decide to embark on moving away from the managed fund approach you can look at what other funds are available from your provider. Most companies have a full suite of funds to choose from. The funds are usually divided up geographically or by sector. So, for example, you might want to invest in Asia or only in financial shares.

Alternatively, you might want to have some exposure to commodities. Some people believe it is around now you should consider investing in Irish or UK property.

It is likely that if you and your advisor construct your own portfolio there will be a fund to meet your investment appetite.

Remember some basic rules when constructing your portfolio. Take into account other investments you might have outside of the AVC. For example, if you own investment property, is it wise to invest more in property?

Try and design a portfolio using a core and satellite approach. At the centre of your investment, about 40-60 per cent of your fund should be invested in a safer, steady moving fund. Then make three or four

investments of 10-20 per cent each into higher risk satellite funds.

These funds will have more risk associated with them but the more risk you take the more potential return you

“Whether you want indexed funds or actively managed funds if you took an active role, along with your advisor, you could have more control and may avoid the pitfalls of a managed fund.”

can expect. However, be careful with risk.

If you are more than 10 or 20 years from retirement, you can certainly afford to take some risk. But if you’re closer than that you need to consider moving part of your fund into safer options.

Many life companies provide a service like this automatically, but you need to request it. They will move some of your fund out of your more risky investments and into safer options like bonds or cash several yearss from retirement. They do this on a systematic basis on a month-to-month or year-to-year basis. They might start five years from retirement and move 20 per cent of your fund per annum into the safer alternatives. This means if in the year before you retire the markets collapse you will only have 20 per cent exposure.

Be careful here and keep communication open with your advisor, an annual review is a must because you may change your plans and you may decide to retire earlier or later and your advisor; needs to be aware of this to make appropriate adjustments.

Designing your own portfolio with your advisor may seem like a lot of work, but if you can do it properly and review it regularly, it will pay off. If your fund outperforms by even one percent per annum it will make a significant difference to your retirement.

Jargon Buster Asset Classes – These are areas you can invest in that they typically consist of cash, government or company bonds, property, shares and / or commodities.

Diversification Quite simply spreading your risk across different asset classes.

Fund A collection of customer’s money which is then invested on everyone’s behalf in the same way.

Actively managed funds This is where the decisions on where to invest are made by individuals and teams.

Indexed Funds These are funds that invest based purely in the size of the companies. There is no human input in selecting the stocks/ shares.

Sector Funds

Picking a Fund Manager Review its history, is it a consistent performer?

How does it compare to its peers who invest in the same market?

Is it an actively managed fund or an index fund?

Has the investment team had any major changes recently?

What are the charges for investing in the fund?

A group of shares put together because they operate in the same industry e.g. industrial, financial or pharmaceutical.

108 Health Matters

personal finance

Shop Around for Clever Budgeting Eoin McGee reports on how to cut your everyday costs and save money on utility bills with some simple, yet clever, personal budgeting.

H

ave you noticed that most companies, particularly washing-up liquid companies have started to replay their old advertisements? There is a very clever marketing reason for this. As well as it being a very cost-effective way of producing an advertisement, it is believed that during recessionary times people tend to revert back to their roots, finding comfort in what they know. The advertisements are designed to remind you of your brand loyalty, remind you of the quality of the product – and they usually finish with some reminder of how cost-effective the products are.

But brand loyalty is not always a good thing. Sometimes we can get so caught up with a brand that we fail to see what else is available. If you find there is not enough cash available at the end of your month, then maybe you should revisit some of the old reliables and see if you could be saving money. This can be a difficult task to master. All the companies claim to be the cheapest, but with a little research online you can usually find out who is the best option for your particular circumstances.

home electrictiy With the introduction of the Big Switch from Bord Gáis, this market has got a lot more competitive. They have a handy cost comparison calculator on their website.

They claim savings versus ESB range from between b42 and b171 per annum depending on your usage.

Airtricity are also competing in this market and claim to deliver similar savings. They opt more for percentages, stating you should be able to save up to 13 per cent on your electricity costs. ESB don’t heavily market any type of savings calculator, instead they are going down the route of informing their customers of how to

cut down the use of electricity in their home. The appliance calculator is actually quite interesting and it helped me win the argument at home that leaving my laptop plugged-in overnight does not actually cost that much.

It will take a few minutes to shop around and see who is the cheapest for your particular usage and costs, but it will be worth it. A lot of people choose not to move because they are worried that they will either have to dig up the house, or in the case of Bord Gáis, that they are not a gas customer. This should not be a concern. The retail electricity industry has been open to competition since February 2005. This meant that ESB had to split into two different companies. One company is responsible for the delivery of electricity to each home and a separate company is selling electricity. This puts all the companies on a level footing, meaning that ESB customer supply is a separate entity to ESB networks and therefore has the same relationship with them as Airtricity and Bord Gáis Energy do. What this means for you is that, regardless of provider, the delivery of the electricity to your home is from the same person.

home Phone There are a lot more providers in this area and what packages to choose will depend on your own personal circumstances. Do you use broadband, do you ring local, national or international a lot? When do you use the phone? How often do you ring mobiles?

The easiest way to find out how much you can save is to use some of the cost comparison websites. They will enable to you to put in your specific details and will calculate what savings can be made. They will also advise you which company to

use. I used one such site, and discovered I could be saving approximately b70 per annum. I will keep the same number and no technician needs to call to the house.

Insurances To be honest, most people don’t tend to review the cost of their insurances until the renewal date. Legislation was introduced several years ago to try and encourage customers to be more active about looking for better deals throughout the year. The legislation dictates that if you cancel a policy during the year, that you are entitled to a pro-rata refund of any premiums paid subject to a deduction of a reasonable administration charge. This hasn’t had the desired effect and most people wait for their renewal.

Car insurance When you do shop around it would be typical to be able to save between b50-80 on a b450 car insurance renewal price.

The financial regulator recently published a survey on the type of savings that can be made on car insurance premiums.

The results show significant savings by shopping around. For example, a young male driver looking for comprehensive cover can save over b2,000 per annum by shopping around. The cost comparison results are available on the regulators consumer website, www.itsyourmoney.ie.

house insurance If you haven’t got your renewal in the post in recent months, be prepared for a big surprise with prices in some cases rising by about 20 per cent. This is as a result of the

Health Matters 109

personal finance

are no underlying medical issues, the cover is easy to arrange. Just be sure not to cancel the old policy before the new one is in place.

In the current economic climate, remember all your expenses and outgoings are up for negotiation. Now more than ever companies will respond to your enquiry. We have mentioned some of the old reliables here but have a look at your bank statements and see what outgoings you have. Spend an hour or two ringing or emailing the companies you identify and see if you can get a better deal or even better, get someone else, like an independent financial advisor, to do it for you. You’ll be glad you did.

weather in the last 12 months and also due to the fact that the insurance companies investments haven’t been going as well as they would have hoped. Again if you visit www.itsyourmoney.ie you will find their cost comparison results for the survey they carried out in December 2009.

health insurance Quinn and Vivas have certainly shaken up the market in recent years and there are noticeable savings to be had by shopping around each provider. By using the Health Insurance Authority website (www.hia.ie), I was able to compare the cost of a standard family plan for two adults and two children. There was a difference of about b400 per annum between the cheapest and the most expensive. Car, home and health insurance are very personal things and what is important to

you may not be so important for somebody else. Something less specific is life cover.

Life insurance & mortgage protection When you take out life cover, whether it is to protect your family, or your lender in the event of your death, is fairly straightforward when they need to pay out. You are entitled to shop around for cheaper cover at any time; you are not bound to use the cover provided by your bank and you can certainly save a lot of money on this.

In my experience, there has been a significant reduction in the cost of cover in recent years and it wouldn’t be unusual for you to be able to save about 20 per cent on the current cost of your cover. Checking the cost of the cheapest available on the market is easy; pick up the phone to an independent financial advisor and they will quote you over the phone. Provided there

Eoin McGee is the owner of Prosperous Financial Services, an independent firm regulated by the financial regulator as a multiagency intermediary and mortgage intermediary. He has over 10 years experience giving advice to both individuals and companies in relation to their finances. He can be contacted on eoin@prosperous.ie, 045 841 738 or 087 644 5533.

110 Health Matters

Brain Injury

The silent epidemic of Acquired Brain Injury While Acquired Brain Injury (ABI) poses a major and increasing public health challenge, as a phenomenon, it defies easy categorisation, writes Richard Stables, Information and Support Manager, Headway.

A

cquired Brain Injury (ABI) has a wide range of causes, results in a huge number of potential consequences for the individual and family and many of its effects may be totally invisible to the outside observer. No wonder then that it has been dubbed the ‘silent epidemic’.

Headway (www.headway.ie), is one of several organisations in the community and voluntary sector who work together and in partnership with the HSE on behalf of people who have been affected by Acquired Brain Injury. We help to rebuild lives following injury by providing rehabilitation services and support to injured people and their families once they return to their own community following treatment or inpatient rehabilitation.

The World Health Organisation (WHO) defines Acquired Brain Injury as ‘an injury to the brain which is not hereditary, congenital or degenerative’. So, rather than a single clinical condition, Acquired Brain Injury is more a collection of conditions with a common presentation resulting from a number of different causes. These are typically: Trauma, of which road accidents and falls would be the largest source; Vascular Disorders including Stroke or Haemorrhage; Anoxic and Hypoxic Injury and Infection.

Worldwide, the statistics about brain injury are bald. According to the WHO, traumatic brain injury is the leading cause of death and disability in children and young adults around the world and is involved in nearly half of all trauma deaths. In Europe, brain injuries from trauma are responsible for more years of disability than any other cause. If we are to assume that the average European incidence of head injuries applies to the Irish population, we expect to see 10,000 new head injuries each year, a figure which is consistent with data produced by the Hospital Inpatient Enquiry system (HIPE).

Stroke is the third most common cause of death and the most common cause of acquired physical disability in Ireland. The www.stroke.ie website, created by the Irish Heart Foundation, tells us that 10,000 people in Ireland are admitted to hospital with Stroke each year and that Stroke kills more than 2,000 people a year in Ireland – a higher death toll than from breast cancer, lung cancer and bowel cancer combined.

So, when we combine the statistics for traumatic injuries and vascular disorders, we can see that in Ireland, Acquired Brain Injury represents a major health burden, with an annual incidence of over 20,000 injuries and an estimated prevalence of disability in the region of 30,000 adults, or 0.7 per cent of the population.

So what are the consequences for a person who acquires a brain injury through any of the various causes? Our service users seek assistance with a range of activities from aspects of daily living through social participation to reintegration into the job market via training and vocational support. Inevitably, when an organ as complex as the brain becomes injured the potential range of consequence is huge and can vary enormously from individual to individual depending on the type and severity of injury, the location of any damage and the course of recovery following treatment and rehabilitation.

For many people following injury there are obvious physical consequences, such as paralysis, weakness, fatigue, headache or problems with coordination. Many may have difficulty communicating, whether expressively or receptively, or both.

For many more, it is the less outwardly visible consequences which nevertheless produce the more severe restrictions to participating in everyday life. Brain injury can affect your ability to maintain attention, to remember, to think, plan and problem-

Health Matters 111

Brain Injury

to overcome barriers. As she says, “Our brains are so complex, so clever, that an injury affects us all in completely different ways, but the good thing about it is that our brains seem to be pretty good at finding ways around just about any experience.”

Fortunately, there are organisations to provide a helping hand along the road.

The Headway Information and Support service provides a listening ear and a vital source of information and signposts to other services for people at every stage of the journey following injury. The service is available throughout the country for the price of a local phone call on 1890 200 278 and is accessible also through the Headway website at www.headway.ie

+ Headway Cork participated in a community boat-building programme organised in conjunction with Meithal Mara

solve and can hamper your insight and your ability to manage emotions. Everyday situations can be rendered almost impossible for some people with brain injury through damage to cognitive and emotional skills that the rest of us take for granted.

The psychological impacts of ABI are hard to overstate. As one of our service users put it: “It’s having to start again, your emotions, character, your whole makeup has to grow up again. For me, it was like somebody took your memory bank, your filing cabinets, and threw them up in the air, into the wind. And somewhere, five years on, I’m still catching things out of the clouds and trying to put them together.”

And if one person is injured in a family, the whole family experiences the turmoil and upheaval caused by such a sudden and unexpected event.

A significant proportion of the services provided by our team of psychologists, including neuropsychologists and counselling psychologists, is aimed at providing support to families, through support groups, psychotherapy, counselling and information.

Despite the obvious challenges dealing with such complex disabilities, our approach is positive and aims to

develop potential as far as possible.

Taking each person's skills and abilities into account, our approach is to develop individual plans informed by assessment and latest research. Rehabilitation programmes then take place in Headway centres around the country and in the person’s own local community.

Following his injury, Alan, one of our Community Integration service users in Cork, wasn't able to socialise or participate in any activity outside the home. Now, with the help of the service he works one day a week as a litter warden and attends his local gym. As he reports, "I can see the difference in myself now. My confidence has grown tremendously."

Adjusting to life following a brain injury is a journey that does not end. But people do progress. Gilly is an artist. Seven years after being injured in a horrific car accident, she no longer thinks of herself as having a brain injury, just as a survivor.

The years of painstaking rehabilitation and personal struggle to rebuild a life after the shattering event have taught her the value of persistence. “You have to live life, day by day, just working through the things you are dealing with now. You just do it.”

Maintaining a positive attitude has clearly been of benefit to her in finding solutions

“For me, it was like somebody took your memory bank, your filing cabinets, and threw them up in the air, into the wind. And somewhere, five years on, I’m still catching things out of the clouds and trying to put them together".

112 Health Matters

travel

Strike it lucky this summer

Karen Creed stakes out three of the best spots for bargain breaks at home and abroad this summer.

PORTUGAL Portugal is the perennial holiday favourite for families. With its sun, sea and beaches and the sleepy traditional fishing towns.

While it is hard to go wrong with a holiday in Portugal, there are inevitable tourist traps that you might want to avoid. The Algarve is a firm favourite for five million visitors annually, with over 200 kilometres of dramatic coastline. The west, running from Faro to Sagres, is mixed in its charm but away from the bustling resort towns, you can find many areas that have retained much of their Portuguese roots. The countryside surrounding the western part of the Algarve is dotted with picturesque hamlets, clusters of whitewashed cottages and sleepy cobbled streets where a traditional open air market is still the highlight of the week. For more life, the historic town of Lagos with its cobblepaved streets is brimming with restaurants and bars. The old fishing village of Salema is worth considering if you rather a tranquil holiday with its intimate beach setting and enticing sea-view apartments.

The incredible golfing and tennis facilities have earned Portugal the nickname Sportugal. It lives up to this reputation with extensive facilities across many resorts ranging from impressive golf academies to clay and grass tennis courts. You can expect the complete holiday lifestyle and rest easy that your children will have an active holiday whether they are swimming in one of the resort pools or making friends at the kids club. There are plenty of day outings to water parks and other attractions if you want a break from the beach. The best way to get around is by renting a car. Graced by one of Europe’s most chilled-out capitals, you can spend time in one of Lisbon’s many parks or beaches or wander through the museums and the cobblestone streets of the Bairro Alto district. Two of the lesser known but equally beautiful cities are Porto and Evora. There is also the region of Alentejo, north of the Algarve, which boasts many wine trails with its numerous vineyards.

The Portuguese love children, so follow their lead and enjoy long open-air evening meals. To taste something typically Algarvian choose the cataplana stew of shellfish,

or chicken piri piri. Nearly every region of Portugal has a variety in shapes and sizes when it comes to restaurants. Depending on location and style, prices are very reasonable and the servings are normally plentiful.

Savouring life is a Portuguese passion and this can all be enjoyed by taking in some of the traditional folk festivals, sumptuous food drowning in olive oil, and markets overflowing with fish, fruit and flowers.

For package holidays to Portugal visit www.topflight.ie or www.surfholidays.com

IRELAND It may not bask in a sun-drenched climate, but Ireland exhumes an energetic whirlwind of culture, and enough outdoor activities to entertain those ‘staycationing’ this summer.

Music, dance, food and craic play an integral role in holidays at home and you can be sure no matter what part of the country you visit there are always things to do and see.

In Cork, for example, it isn’t the city’s charm alone that bewitches its visitors. Kinsale is one of the most picturesque resorts and a

Health Matters 113

travel

a stunning setting. Being a university city, Galway caters to the budget-conscious and is packed with individual stores selling all types of accessories, bags, and jewellery.

However, high-end boutiques are also a main feature on Galway’s streets, given the style that comes to the city every summer for the Races among other big events.

Galway is also notorious for its pub scene and its live music sessions are legendary. It has no shortage either of trendy restaurants, nightclubs, wine and cocktail bars.

For more ideas or information on holidays in Ireland visit www.discoverireland.ie

florida prime location for yachting, sea angling and gourmet eating. Another pretty harbour town steeped in maritime history is Cobh. If you head the other direction from Cork city, to the south west there is magnificent Bantry Bay and neighbouring Glengarriff. The city also takes pride with some of the greatest golfing greens in Ireland and the wildest attractions with Fota Wildlife Park. This park is not like an ordinary zoo; here you can come faceto-face with free-roaming animals and birds from all parts of the world. Visitors also have the opportunity to see highly endangered species such as the Rothschild Giraffe and Lion Tailed Macaque and most of them without the obstacle of fenced-in exhibits.

If it’s into the west this summer, Galway will not disappoint. The city merely has to announce an event or festival and the crowds swarm to this thriving hotspot. As the gateway to Connemara, its diverse landscape and proximity to the sea lends itself perfectly to all sorts of adventures. One of the most popular is scuba diving where holidaymakers can get their PADI cert. Those who rather test their skills at a variety of land-based sports can try rock climbing and cycling at Delphi Adventure Centre. Many of the Delphi activities are catered towards young children making it an ideal option for family breaks. Free activities are within easy reach in the West also with Bearna Woods, Loughrea Lake and Kinvara being three cheap days out. Accommodation is wide-ranging with some beautiful guest houses, like Cashel House Hotel, boasting

Planning a holiday to Florida is a little like facing one of those splendid Sunday brunches: there are too many choices. With dozens of beaches, hundreds of attractions and thousands of places to shop, it’s a case of choosing the Florida holiday that suits your particular holiday interests. Central Florida is one of the most popular holiday destinations, especially for those with young children. If you are planning to visit Florida for the first time then chances are you’re heading for the most popular regions of Orlando, Kissimmee or Davenport. This state is one of the best child-oriented states in the world and there are great deals on both flights and package holiday to the Sunshine State this summer.

With an abundance of theme parks, kids will have a tough time choosing from a long list of fun as it is impossible to see everything in one visit.

If you don’t fancy the mayhem of the Disney and Universal empires for a whole two weeks then why not head out of town? With Tampa about an hour away to the west and the Everglades to the south, Florida lends itself to providing an ideal twin centre break. There are plenty of holiday villas and holiday homes to rent throughout the Sunshine State. A great

advantage of renting further out of town is that rental prices tend to be lower and are more readily available for longer or peak season breaks. There is no shortage of places in South Florida for families to swim, boat, fish, and sunbathe. And whether you’re interested in surfing, treasure hunting, people watching, snorkelling, history or romance, Florida has a beach to suit you.

Flanked by 76 miles of Atlantic coastline, the Space Coast has been a popular tourist destination since the 1950s, when Americans raced to the moon. It wasn’t long before the area had gained a reputation as space-age.

Fortunately, today’s Space Coast is not just about Starbucks, McDonalds and big-brand stores. Of course they are all there but there are also more enticing dining and shopping options in the charming tree-lined towns along the coast like Melbourne, Titusville and Cocoa Village. Food is excellent in Florida and cheap, with a family of four dining well for less than $50. For young families Florida’s reputation for early bird specials is of particular interest as they offer reduced rates for early seating. Florida also has every kind of shopping venue one could imagine, whether you’re a shopaholic or a practical purchaser.

For package holidays and flights to Florida visit www.touramerica.ie.

114 Health Matters

competitions

WIN A WEEKEND AWAY

IN BALLYHOURA FOREST LUXURY HOMES Ballyhoura Forest Luxury Homes is for everyone including eco-lovers. Six stunning self-catering holiday homes set in the Ballyhoura Mountains not far from the cities of Cork and Limerick are all fitted to the highest standards. They have been fitted with Junckers solid hardwood flooring throughout to create a cosy, natural Scandinavian feel that makes guests truly at one with the environment. As well as the natural warmth of wood, Ballyhoura Forest Luxury Homes also feature a number of other environmentallyfriendly products and materials. In each home there’s a Varde Ovne woodburner stove that’s won the Nordic Swan Ecolabel. The homes were built by an Austrian company, Griffner who are used to building in a carbon-neutral way, so each of the homes are perfectly insulated for maximum cosiness.

All holiday homes have three ensuite bedrooms. Homes have a superb ProNorm (German) fitted kitchen, Miele

appliances, granite worktop, the bathroom floors have polished Italian marble tiles and the bathroom walls have polished porcelain tiles. All en-suites have power showers.

Visit www.ballyhouraforestluxuryhomes.com To be in with a chance to win this amazing prize of a weekend in one of Ballyhoura Forest Luxury Homes, simply answer the question below and email your answer with your name, address and phone number to: competition2@ashville.com with ‘Ballyhoura’ in the subject line.

Q: Name the mountain range where the holiday homes are located (A) Ballyhouran (B) Cooley (C) Mourne Closing date for entries is Friday 9th July. All entries will be entered into a draw and the winner will be notified by Ballyhoura Forest Luxury Homes.

WIN A COPY OF THE BRILLIANT BOOK – The Happiness Habit – The Official Coaching Handbook of the Irish Institute of the Neuro-Linguistic Programming (NLP) Brian Colbert is one of only two licensed master trainers in Neuro-Linguistic Programming. In 2000 he co-founded the Irish Institute of NLP, which runs certification classes and courses. He has a burning passion for understanding human behaviour and what makes us happy. This means that he has spent his life exploring, dismantling, and investigating practical tools for personal development, change and transformation.

He has studied gurus, experimented with the mind-altering Amazonian plant extract Ayahuasca, tried energy healing, the Silva method, hypnotherapy, psychotherapy and has learned much from fifteen years spent working as a therapist, mind coach and NLP master.

In The Happiness Habit he brings together a variety of disciplines and a series of powerful exercises to create a formula guaranteed to make you happier. The dominant discipline informing this book is Neuro Linguistic Programming (NLP), dubbed ‘the science of success’.

The Happiness Habit challenges the prevalent method of therapy which maintains that finding the source of unhappiness in our past helps us to move forward. Instead he uses Neuro Linguistic Programming techniques (fans of this method include Bill Clinton, Tony Blair and comedian Alan Carr) which prove that no matter how unhappy your past has been, if you change your way of thinking now you can bring about greater personal fulfilment.

Brian focuses on the ‘The 7 Pillars of Happiness’, seven key needs that, if not met, can lead to unhappiness. He also discusses the 12 psychic defence mechanisms that prevent happiness. Everyone can identify with one or more of these such as hiding from unpleasant realities, shifting negative feelings on to others, detaching so you don’t feel disappointment, putting other people’s needs before our own and inventing excuses.

Using a series of powerful mind exercises, The Happiness Habit shows how to bring about changes in your life that will lead to

contentment, build confidence, and show you how to stay positive, face adversity and overcome challenges.

This book provides the opportunity to examine your life more closely and find the skills, ability, direction and focus to develop the habit of happiness.

The accompanying workbook to The Happiness Habit can be downloaded from www.thehappinesshabit.ie.

And we have five copies of this great book to giveaway to Health Matters readers. To be in with a chance to win a copy, simply answer the question below and email your answer, name and address to competition3@ashville. com with ‘Happiness Habit’ in the subject line.

Q: How many pillars of happiness does Brian Colbert focus on in his book?

Closing date for entries is Friday 9th July. All entries will be entered into a draw and the five winners will be notified by email and a copy of the book sent to you in the post.

Health Matters 115

Reading

Health Matters

BookClub

From across all genres, The Health Matters Book Club brings you our favourite books, for you too to pick up and enjoy.

W

e at Health Matters are true book lovers, and in each issue our Book Club will take you through our current favourite picks. We hope our selections will have something to suit everyone, as we dip into various genres with both current and upcoming titles. We would love to hear your thoughts, so be sure to join us on our Facebook page (www.facebook.com/health mattersbookclub), to give your opinion on our choices, or offer your suggestions on books that you think others would enjoy.

Miss Conceived Miss Conceived is the highly anticipated second novel from Emma Hannigan, who is tipped to be the next Cathy Kelly and is championed by Ryan Tubridy, and Cathy Kelly herself. The story follows three women, Angie, Serena and Ruby, on the rocky road to childbirth.

Angie Breen’s body clock is ticking so loudly she’s certain passers-by must be able

to hear it. Still single at 40 and beginning to despair, she goes to drastic lengths to ensure she won’t end up childless and alone.

Serena Doyle is the ultimate trophy wife.

Married to a dynamic businessman, she is the epitome of glamour and sophistication.

But Serena is harbouring a secret and her struggle to conceive blows the cover on an issue she’s been hiding - even from herself.

Ruby White is not yet 16 and a very precious only child. Her parents are in shock when she announces her pregnancy.

Determined to keep the impending baby a secret from their circle of privileged “it” people, they conjure up a plan to save face.

Will Serena and Ruby’s relationship survive, when Ruby’s worst nightmare turns out to be Serena’s biggest wish?

Miss Conceived, out now, tackles the issues of both pregnancy and infertility and the ups and downs that both can bring.

The History of Gaelic Football Written by Eoghan Corry, one of Ireland’s leading sports journalists, The History of Gaelic Football, traces the evolution of the game, from its humble beginnings to its present state and the challenges it faces in the 21st century, not only from within its own ranks but from other sports with their mammoth marketing efforts, competing to capture the attention of sports enthusiasts.

The book which charts the development of the game, from a change in tactics from the traditional catch and kick to the hand pass and finally a return to the more tried and trusted method; celebrates the respective roles of players, managers and supporters who have made Gaelic football the game of choice in Ireland.

The Truth Between From the author of Beyond Sin, Emma Louise Jordan, The Truth Between will hit shelves in July and promises to be another great read.

116 Health Matters

Reading

When Estelle Lynch takes her own life, she leaves in her wake a mystery that will rock her daughter Holly’s world forever.

A box of secrets which holds the key to Estelle’s true past is found in her possessions and the identity of Holly’s father is only inches away. As Holly battles with her grief, the obsession to find the perpetrators who made her young mother’s life a misery threatens to ruin everything Holly has ever known.

Soon, Holly finds herself dicing with a torrid and dangerous story that leads her into a cat and mouse chase taking her from Ireland’s northern shoreline to the heartland of Belfast… and to the city of Dublin and into the path of celebrity chef, Max Kelly.

Holly’s instincts go into overdrive as she becomes more and more convinced that the handsome father of two is linked to her mother’s death. But somewhere between her instincts, her mother’s diaries and what she learns about Max Kelly lies the truth between the life she knows and the life she only thought she knew.

A Thousand Splendid Suns From the highly acclaimed author of The Kite Runner, Khaled Hosseini, comes A Thousand Splendid Suns which recounts the experiences and emotions of two Afghani women, Mariam and Laila, whose lives become entangled with the history of recent wars in their country. Mostly bleak and heartrending, their story does offer the promise of hope and happiness in a land ravaged by

warfare, gender conflicts and poverty.

This is a breathtaking story set against the volatile events of Afghanistan’s last 30 years, from the Soviet invasion to the reign of the Taliban to post-Taliban rebuilding that puts the violence, fear, hope, and faith of this country in intimate, human terms. It is a tale of two generations of characters brought jarringly together by the tragic sweep of a war where personal lives, the struggle to survive, raise a family, and find happiness are inextricable from the history playing out around them.

Leadership & Management in the Irish Health Service Edited by Anne-Marie Brady, a lecturer at Trinity College Dublin, Leadership & Management in the Irish Health Service provides a broad overview of the current issues in Irish health care management.

It is designed to provide a practical understanding of the health services and health policy in Ireland and reviews recent developments in the area.

The book explores an array of areas, from the health care environment itself to the fundamentals of service provision, and developing professionals in the health service to the development of the health service in the future, and processes which can improve the quality and delivery of care.

Leadership & Management in the Irish Health Service is out now and is essential reading for students on undergraduate and

postgraduate nursing degree programmes, students on healthcare professional courses such as medicine, radiotherapy, occupational therapy and physiotherapy and students on health care management courses.

Jumping in Puddles From the bestselling author of Feels Like Maybe, comes Claire Allan’s latest offering Jumping in Puddles. Allan's novels to date have dealt with a variety of subjects – from post natal depression, through to infertility and unplanned pregnancies. Her latest novel Jumping in Puddles does not hold back in discussing some of this country’s most taboo subjects – not least domestic abuse.

Always faithful to the Chick Lit genre, Claire Allan wants to show with this novel, that books can dig deeper but still have an overall message of hope and joy. This book is triumphant in displaying her talent for mixing romance with serious issues and a dash of black Irish humour.

The Girl with the Dragon Tattoo The Girl with the Dragon Tattoo is an awardwinning crime novel by the late Swedish author and journalist Stieg Larsson, and makes up the first part of his “Millennium Trilogy.” An epic tale of serial murder and corporate trickery spanning several continents, the novel takes in complicated international financial fraud and the buried evil past of a wealthy Swedish industrial family. While dark in concept, the twists and

Health Matters 117

Reading

you how to stay positive, face adversity and overcome challenges. This book provides the opportunity to examine your life more closely and find the skills, ability, direction and focus to develop the habit of happiness.

Brian Colbert regularly contributes to national radio, TV and press and is currently retained as head mind coach on RTÉ’s Brain Academy on The Afternoon Show.

revelations in The Girl with the Dragon Tattoo make it a compelling thriller novel.

The Happiness Habit ‘You hold in your hand right now an exciting opportunity that will dramatically transform you in ways you may have never dreamed.’

Brian Colbert has a burning passion for understanding human behaviour and what makes us happy. This means that he has spent his life exploring, dismantling, and investigating practical tools for personal

development, change and transformation.

In The Happiness Habit he brings together a variety of disciplines, and a series of powerful exercises to create a formula guaranteed to make you happier. The dominant discipline informing this book is Neuro Linguistic Programming (NLP), dubbed ‘the science of success’.

Using a series of powerful mind exercises, The Happiness Habit shows how to bring about changes in your life that will lead to contentment, build confidence, and show

Hello readers!

BOOK

CLUB

Health Matters is delighted to announce the launch of our very own Facebook Book Club!.Each quarter in Health Matters we like to recommend some books for you to read, and now, through our Facebook Book Club, you can give us your reviews too. Good or bad, we want to hear from you about all of the books you read, discuss different authors, genres of books, rate your favourite books; and your favourite book shops.

While Health Matters is the HSE’s staff magazine, the Health Matters Book Club is not just for staff it is open to everyone, so we hope you will spread the word and tell all your friends to join us on Facebook too.

Be sure to check out our Book of the Month tab, which will recommend our must-read book of the month – we want your feedback and ratings!

We will have regular posts about new books, our favourite books, discussions about the classics, the worst books we’ve ever read, book signings happening around the country, and book and writing festivals. We hope to have guest posts from well-known authors and, of course, lots of competitions.

So please join the Health Matters Book Club at: www.facebook.com/health mattersbookclub We look forward to meeting you there.

TELL US YOUR STORY!

maternity &

AWARDS 2010 The maternity & infant Awards, now in their third year, celebrate the very best in baby related products and services as voted by you the parent. Our People Awards have also increased this year; honouring mums, dads and grandparents, in addition to child heros and midwives amoungst others.

The maternity & infant Awards take place this November, if you have a touching story or would like nominate in our People Awards log on to www.maternityandinfant.ie/awards Each person who nominates in our people awards will be entered into our FREE PRIZE draw to win lots of fantastic prizes!

• Mum of the Year • Dad of the Year • Grandparent of the Year • Business Parent of the Year • Nurse of the Year • Midwife of the Year • Obstetrician of the Year • Paediatrician of the Year • Baby Story of the Year • Little Champion of the Year • Young Achiever of the Year • Child Hero of the Year • Sweetest Moment of the Year

VOTYEOUNCOOWULD

AND ME WIN SO TIC FANTAS PRIZES!

Acknowledging the dedicated and inspirational people we have amongst us For more information please visit our website www.maternityandinfant.ie/awards or contact Hannah on 01 432 2205 or hannah.bates@ashville.com Media partners

Kindly sponsored by

Health Matters 119

crossword

Crossword No 2 ACROSS 1. Can a wan friar manage his by using the internet system? (8) 5. Paving material or paved surface (6) 9. Intimidation, often by other, more aggressive, children (8) 10. And 20 Down. Recent research may benefit those with this inherited disease.

(6,8) 12. Organ cared for by optometrists and opticians (3) 13. Adult male (3) 14. ___ General Hospital where volunteers are being sought (5) 15. Jelly-like material used in ultrasounds (3) 16. Regrettably .. by bad luck (4) 18. Destructive sea wave caused by earthquake (7) 22. Broken off a polar glacier - or type of lettuce (7) 24. Ornamental jar for flowers (4) 26. Floral arrangement or garland (3) 29. Puke, vomit or throw up (5) 31. Ancient art of __ chi, can reduce stress (3) 32. Former capital of Brazil, ___ de Janeiro (3) 33. Twist or wrench a ligament (6) 34. One who left their country when it rang time! (8) 35. Stress - such as when the train’s late (6) 36. One such as Louis Pasteur, he of the torn vein! (8)

DOWN 1. Digits connected by thin fold, as in Daffy (6) 2. Assuagement ..comfort ..ease… (6) 3. Labs may find this unfathomably deep! (7) 4. Cricketer’s turn .. or a good long life! (7) 6. Bottomless gulf or pit .. related to 3 Down (5)

Scribble box

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7. Is Mal itchy or is it from a fable (8) 8. Characteristic of a violent tropical storm (8) 11. For good health, reduce this sodium chloride! (4) 17. Mixture of gases required for breathing (3) 19. Health resort or watering hole (3) 20. See 10 Across (8) 21. Would Curt reel at this academic rank? (8) 23. Happy, grateful .. or dressed in the ___ rags! (4)

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24. D is the ‘Sunshine ___‘, necessary for calcium absorption (7) 25. Coarse beach gravel, or collectively herpes zoster (7) 27. Type of infant-feeding supported by the HSE (6) 28. Temporarily care for children in your own home (6) 30. W. Indies country hit by January earthquake (5)

120 Health Matters

Me and my job

Getting to

know you...

Name: Adrian Ahern Job title: Manager, Mental Health Services Base: Galway

How long have you worked with the HSE? Since 1977, in various roles from student nurse to staff nurse, clinical nurse specialist, administrator and manager.

Describe your job in five words Providing quality mental health services.

What's your average working day like?

I am responsible for managing Mental Health services in Co. Galway, including Regional Child and Adolescent Mental Health Services. As we are developing services in line with Vision for Change, my role can be very demanding. A typical day generally begins in St. Brigid’s Hospital, Ballinasloe, at 8.45 a.m., where I deal with outstanding emails and correspondence.

I am in daily contact with the three Clinical Directors, Directors of Nursing and the various Heads of Department dealing with day-to-day issues ranging from maintenance, patient issues, HR, finance and budget. It is a very varied day in which I am involved in managing a wide range of issues. I usually finish at around 6 p.m. but am generally available should emergencies arise.

What do you love about your job?

No two days are the same. The ability to influence the changes in service improvements across Galway, which impact positively on patient care and staff morale.

If you could change one thing about your job what would it be?

Increase autonomy to deal with issues as they arise.

What's your favourite book and what did you like about it?

Great Irish Speeches by Richard Aldous.

The inspirational nature and the ability of the orators to say what they meant without jargon.

What's your favourite film and what did you love about it?

Manhattan. I love Woody Allen’s wit.

What's the most memorable thing you have ever experienced?

From a work perspective, it was the signing of the contract for the new Child and

Adolescent Mental Health Unit in Merlin Park, Galway. From a personal point of view, it was the birth of my four children.

What team would you die for?

Connacht Rugby, as both my sons are keen rugby players and have represented Connacht.

Favourite sporting memory?

Seeing my son Robert be part of the Ballinasloe winning team in the All-Ireland U18 Rugby Final Who has inspired you the most?

Parents, family and Dr. Noel Browne.

Pet hate?

Poor decision making.

Top thing on your dream list if you won the lotto?

I am lucky in that I have most things I want. However, to win the Lotto would be great – I would probably buy a boat and retire.

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