Health Matters Winter 2010 by HSE Communications

HEALTH Vol 6 I Issue 4 I Winter 2010

INSIDE - Roll out of clinical pRogRammes - HigH blood pRessuRe - living witH diabetes - YouR seRvice YouR saY

MATTERS National Staff Magazine of the Health Service Executive

Health matters

H E A LT H

ssue 3 I Autumn 2009

MATTERS

onal Staff Magazine of the Health Service Executive

HEALTH

matters Vol 4 I Issue 2 I Summer 2009

National Staff Newsletter of the Health Service Executive

winter 2010

HSE AcHIEvEmENt AwArDS SpEcIAl

National Staff Magazine of the Health Service Executive

HEALTHMATTERS 48

Vol 5 I Issue 3 I Autumn 2009

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 2011 and enhance your professional knowledge, clinical and research skills and your professional career prospects. Graduate Research Training Programme

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

www.ucd.ie/nmhs

Health Matters 1

Welcome... ...to the winter edition of Health Matters. I would like to wish all of our readers and contributors a very happy Christmas and thank you for your support during the past year. Congratulations to all the HSE Achievement Award Winners – the winning projects are highlighted in this issue. We also look at new developments in the Quality Clinical Care Directorate; Aisling McGowan, Chief Respiratory Scientist, Connolly Hospital, Blanchardstown writes about sleep medicine; and we take a closer look at the Community Mothers Programme, which supports first time parents in Dublin. 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

Sites We Like... www.seai.ie

Special thanks to all the contributors to the magazine. Enjoy the read! www.powerofoneatwork.ie

Stephen McGrath - Editor Head of Internal Communications The magazine is produced by the National Communications Unit Publishers: Ashville Media – www.ashville.com Feedback: Send your feedback to internalcomms@hse.ie

Did you know? www.onegov.ie

• For every 1°C over the recommended 19°C in winter, heating bills increase by eight per cent • 150 volunteer Community Mothers provide support to 2,000 parents each year • The average lifespan in Zambia, Swaziland and Angola is less than 40 years • Stroke care costs up to b1 billion per year in Ireland • Dragon boating is one of the few sports which has 22 people on a team • Up to one in seven people have a chronic sleep related complaint. One in three of us complain of an intermittent sleep problem

The information in Health Matters is carefully researched and believed to be accurate and authoritative, but neither the HSE nor the publisher can accept responsibility for any inaccuracies, errors or omissions. Statements and opinions expressed herein are not necessarily those of the Editor, the HSE or of the publisher. Advertisements within the publication are not endorsed by the HSE or the publisher. Any claims made within the advertisements are not endorsed by the HSE or the publisher. Advertising or editorial promotion in this publication is unrelated to and unconnected with any tender process or contract award that is ongoing or completed in the HSE.

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3 Health Matters

contents

Contents 92 Informing families about Disability Guidelines to help staff to inform families with difficult news 96 Community Mothers Supporting parents within the community 98 Energy Efficiency A report on how paramount good organisational practices are to energy efficiency 1 Welcome 4 Update: HSE Global Health Support Programme 7 Update: The Roots of Empathy Programme 9 HSE Achievement Awards 2010 A full report and images of the winners and the event 25 Quality and Clinical Care Directorate Update on Chronic Disease Programmes, QCC assurance and Chronic Obstructive Pulmonary Disease 36 News in Brief A round up of all the latest news and events 47 Breast Cancer Services A report on the National Symptomatic Breast Cancer Services Forum 43 children and the media edited extracts from Dr Paul Connors' script at a recent childcare seminar 48 Plurabelle Paddlers A breast cancer support group with a difference 50 Sleep Medicine A special feature on sleep disorders, the diagnosis of sleep, the treatment available, case studies and the dangers of driving with fatigue

58 Genio Trust Changing lives across the country 61 Health Research Board Taking big strides to tackle pre-clampsia 62 Regional Pages News from all regions of the HSE 71 Public Service Agreement: Health Sector Implementation Body 72 Diabetes Federation Kieran O’Leary, CEO, Diabetes Federation of Ireland highlights the issues of living with diabetes 75 Diabetes Sneaky Saboteurs This feature looks at the importance of diet and how it affects weight loss 79 Health & Well-Being section Topical features on high blood pressure, Christmas recipes and sporting passions 87 Digital Marketing Institute How to make digital media work for you 88 Crisis Pregnancy Crisis Pregnancy Programme and National Disability Authority Workshops 89 Clinical Care for Nurses Clinical Care Programmes to provide opportunities for nurses 90 Fair Deal 16,000 apply to Nursing Homes Support Scheme during first year

100 Macular Degeneration Consultant Ophthamologist, David Keegan, highlights the global initiative ‘Vision 2020’ 102 Eye Cancer First patients avail of new eye cancer treatment 103 Protected Disclosures The Procedures on Protected Disclosures of Information 104 Green Efficiency Green healthcare saves money 106 Personal Finance How to tackle Christmas spending 108 Your Service Your Say A guide to dealing with complaints 110 Appointments 111 Update: National Ploughing Champioships 112 Christmas Gift Ideas For him, her, the kids and even some stocking fillers! 115 Health Matters Book Club Christmas gift book ideas and recommended reads 117 Crossword Fill it in to fill in time… 118 Competitions 120 Me & My Job

4 Health Matters

update

HSE Global Health Support Programme Our goal is to make an effective contribution towards improving health in developing countries writes Dr David Weakliam, Consultant in Public Health Medicine, Department of Public Health.

n June 2010, the HSE signed a memorandum of understanding (MOU) with Irish Aid, the Government aid programme, and the HSE ‘Global Health Support’ Programme was launched. The programme is situated in the HR Directorate and will build on many initiatives already undertaken by health staff. These range from institutional partnerships with hospitals overseas to individuals who go overseas for development projects or following disasters such as the Haiti earthquake. The programme is being implemented under the direction of a steering group which includes representatives from the Department of Health and Children, Irish Aid, NGOs and third level institutions.

Why should the HSE support developing countries? Firstly, developing countries have enormous health needs and investing in health is vital for their development. While the average life expectancy in Ireland is close to 80 years, it has fallen to less than 40 years in Zambia, Swaziland and Angola. Low income countries are particularly affected by the global economic downturn as their economies suffer and external aid is cut back. UNESCO has estimated the cost of this at between 1.2 and 2.4 million additional child deaths between 2009 and 2015. As a signatory to the Universal Declaration on Human Rights, Ireland has a duty to contribute to achieving the ‘right to health’ in less privileged parts of the world. Goal of HSE Global Health Support Our goal is to make an effective contribution towards improving health in developing countries. Our main resource is the experience and expertise of our staff. The steering group is looking at the

+ Síle Fleming, Assistant National Director HR and Dr Diarmuid McClean, Development Specialist, Irish Aid are pictured at the signing of the Memorandum of Understanding with Irish Aid. + Local people and staff at the health clinic in Mozambique

development of objective criteria for working overseas, for working with institutions in developing countries and for providing material assistance in emergencies. We intend to organise seminars where people can share experiences and learning.

Irish Aid Our most important partner in this programme is Irish Aid. Under the MOU framework, the HSE will provide expertise in priority areas of Ireland’s aid programme, ranging from technical advice for country programmes to working with international agencies such as the WHO and the Global Fund to Fight AIDS, TB and Malaria. In turn, the HSE will benefit from Irish Aid’s development policies, helping us to promote best practice in our global health support programme. In May, the World Health Assembly adopted a Code of Practice on the international recruitment of health personnel. The Code provides ethical principles for international recruitment in

a manner that will strengthen health systems of developing countries. The Global Health Support Programme will work with others in the HSE and with the Department of Health and Children to implement this Code. The benefits of supporting developing countries work both ways. Irish health issues are increasingly global issues and require global collaboration. We saw this last year with the flu pandemic. We can learn from developing countries, who tackle huge health needs with very scarce resources. We also need to build capacity to care for people who have come from diverse cultures, and working for developing countries will enhance our understanding of their health needs. As a result of the programme, the HSE will be able to help people with significant health needs in developing countries while becoming a more global, outward looking health service. For further information, please contact: Dr David Weakliam, Consultant in Public Health Medicine Tel: 057 935 9910

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How to apply

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To download the brochure and entry form or apply online, simply log onto www.healthliteracy.ie.

B. Best Project in a Hospital C. Best Project in the Community or in a Social Setting D. Best Health Promotion Project E. Best Health Communication through Journalism The closing date for entries is 12 noon, Friday 28th January 2011.

For further information contact: Crystal Clear MSD Health Literacy Awards 25 Merrion Square, Dublin 2 Tel: 01 661 8915/614 9654 Fax: 01 661 8914 Email: info@healthliteracy.ie

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Health Matters 7

update

Baby visits foster Empathy Skills in

14 Donegal Primary Schools The ‘Roots of Empathy’ programme involves a local parent and baby (two to four months old at the start of the school year) visiting a classroom nine times during the year.

ourteen Donegal primary schools are the first in Ireland to participate in an internationally acclaimed, award-winning programme called “Roots of Empathy”. The programme has been running with great success in Canada for many years, as well as in parts of New Zealand, USA, and in the Isle of Man. Anne McAteer, Health Promotion Officer, HSE West, said, “We are delighted to deliver Ireland’s first Roots of Empathy programme with the support of Donegal County Council and the Special EU Programmes Body. We are convinced that this is a big step in terms of creating safer, more co-operative classrooms, playgrounds and communities for our children.” The programme involves a local parent and baby (who is two to four months old at the start of the school year) visiting a classroom nine times during the year. Children observe and learn to understand the perspective and emotional life of the baby. They are then guided by the specially trained instructor to link this learning to their own lives. The instructor also facilitates 18 additional classroom sessions to compliment the baby’s visits. The students gain deeper insight into their own and others’ emotions and into the impact of their behaviour on others. Research has shown that this learning enables children to become much more socially and emotionally competent and much more likely to challenge cruelty and injustice.

Feedback from schools is already very positive. Sharon Graham, teacher at St Joseph’s NS in Rathmullan, said, “After only three weeks, I am already seeing the benefits of

+ Mum, Rona McGlynn, introducing baby Jack to the 1st Class children in Scoil Mhuire, Milford, County Donegal the programme. The children in my class are more aware of their own feelings and are more tolerant of the differences in each other.” Steven Cannon, teacher at St Finian’s NS in Falcarragh said, “It’s a truly unusual, yet positively enriching experience, encouraging a drive away from our selfcentredness towards an awareness of the feelings and emotions of others.” Taryn Gleeson, whose baby son Remi is participating in the programme is equally enthusiastic, “I’m finding it very rewarding and I noticed a positive effect in the classroom even during the first session.” Claire McBride and her baby son Eddie are also taking part. Claire commented, “The programme has been very enjoyable for my baby and I think the children in the classroom are finding it very positive too.

Another parent, Damain Dowds commented, “We are delighted to have our baby son Damhán participate in Roots of Empathy. We understand how valuable the programme could be in helping children to understand their emotions and to develop their social skills.” Roots of Empathy was designed in Canada in 1997 by the internationally recognised social entrepreneur, child advocate, best-selling author and educator Mary Gordon. For further information on the programme, please contact John McFall on 074 91 78540 or at john.mcfall@hse.ie The project is supported by the Peace III Programme, managed for the Special EU Programme Board by Donegal County Council.

Congratulations to all winners of the HSE Achievement Awards from the Quest Diagnostics Ireland team.

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in association with

Wexford General Hospital project is overall winner

+ The Wexford General Hospital project team pictured celebrating their Overall Prize win with Ryan Tubridy for their innovative site infections surveillance project at the HSE Achievement Awards held in the Mansion House, Dublin. Pictured are (L-R) Patricia Hackett, Eithne O’Sullivan, Dr Brian Carey, Ryan Tubridy, Lily Byrnes, Richard Dooley, Emer Ward, Colette O’Hare

Recognising excellence and innovation The HSE Achievement Awards were created to recognise and celebrate outstanding work by health and social care staff and ultimately reward best practice and raise standards within the health sector. A total of 326 healthcare projects and initiatives from all over the country applied for this year’s Awards. Of these, five entries from each of the four HSE Regions (HSE South, HSE West, HSE Dublin Mid-Leinster and HSE Dublin North East) were shortlisted to go forward to the finals. Three projects were selected by the judging

panel for special commendations and these awards were also presented. The HSE Achievement Awards, held in association with Quest Diagnostics, took place in November 2010 in Dublin. The Awards recognise best practice and innovation of healthcare staff in the delivery of quality patient care. The award for Overall Best Project the Derek Dockery Perpetual Award was presented to Wexford General Hospital representing HSE South. Their project, a Site Infection Surveillance Service, is a proactive and innovative patient post-discharge

surveillance system which monitors surgical site infection rates. The hospital has achieved a sustained decrease in such infection rates over the last three years. This project illustrated the dedication of staff in improving patient care, raising standards in healthcare and delivering a quality service and real benefits to patients. The 20 shortlisted entries were led by health sector staff committed to finding new and better ways of delivering improved care to patients despite the challenges the health services face.

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Projects devised by staff deliver for patients The Balance Matters project, the winning entry from HSE Dublin North East, is a collaboration between HSE physiotherapists and community groups which aims to improve older peoples’ balance and mobility, build their confidence and prevent falls. One in three older people aged 65 years and over fall every year, which can result in a serious injury and hospitalisation. Participants in the programme reported increased levels of balance, mobility and confidence. The programme is delivered in a group setting which is more efficient and effective and participants enjoyed the social aspect of the sessions.

+ Achievement Award – Overall Runner up / DNE Winner – Balance Matters Áine O’Riordan, Senior Physiotherapist, overall runner up and winner of the HSE Dublin North East category for Balance Matters for Older People, HSE Local Health Office Dublin North Central Physiotherapy Service

The ‘Anyone Can Eat’ tube weaning programme from Our Lady’s Children’s Hospital, Crumlin was the winner in the HSE Dublin Mid Leinster category and a runner up in the Overall Best Project category. One of the beneficiaries of this innovative project – a three week intensive programme to wean infants and children off tube feeding – is a little girl called Rose. According to her mother, Rose was tube fed from birth. “Before the ‘Anybody Can Eat’ programme I had tried a number of unsuccessful methods to help wean Rose off tube feeding. The team really understood Rose’s needs and helped her. The whole programme turned our lives and Rose’s life around, she is so much happier now. I never thought she would eat food and always thought she would be tube fed.”

+ Achievement Award DML Winner – Anybody Can Eat Programme Catherine Cunningham, Catherine Matthews, Ita Saul, Carina Kelleher, Dr David Coleman, Celia Butler, Bernadine Gormley, Pinewood Health, Dr Deirdre O’Neill,Margaret Rogers, Heart Children Ireland winners of the HSE Dublin Mid Leinster regional award and overall runner up

Representing HSE West, the Regional Anaesthetic Facility at Galway University Hospitals won their Achievement Award for a project which allows patients to have regional anaesthesia techniques performed which results in a decrease in the number of general anaesthetics given. The benefit to the patients is that they can avail of day procedures, avoiding hospitalisation, and they are mobile earlier which decreases the risk of side effects. It allows patients to avail of day case treatment where possible, in keeping with an overall move towards achieving an increase in day case activity and facilitates onsite teaching for doctors and nurses. The project has been such a success that the model has been used by hospitals throughout Ireland, the UK and mainland Europe.

+ HSE West Winner ‘Galway University Hospitals Regional Anaesthetic Facility’ (L-R) John Hennessy, RDO HSE West; Christie O’Hara; Cllr Padriag Conneelly; Dr John McDonnell, GUH; and Marie Dempsey, Development Head, HSE West

in association with

+ Pictured with the Derek Dockery Perpetual Award are Dr. Brian Carey, Consultant Microbiologist; Ryan Tubridy; and Eithne O’Sullivan, Surveillance Co-ordinator, Wexford General Hospital

+ Special Commendation

+ Achievement

+ Achievement Award –

Men’s Health and Well Being Back row: Paul Brownlee, Glasgow Celtic, Matt Moloney, Pfizer, Ciaran McGreal, Pfizer, Front row: Anne Flannery, Larkin Centre, Mary Martin, HSE, Mick Denver, course participant and Phil Dunne, HSE who won a Special Commendation for their Men’s Health and Wellbeing programme

Award – Special Commendation – COPE Geraldine Ryan, COPE wins a special commendation award for COPE Galway Community Catering

HSE Achievement Awards 2010 Winners List Derek Dockery Award for Overall Best Project Wexford General Hospital Site Infection Surveillance Service

Overall Runners Up Balance Matters for Older People, HSE Local Health Office Dublin North Central Physiotherapy Service “Anyone Can Eat” Tube Weaning Programme, Our Lady’s Children’s Hospital, Crumlin

HSE Dublin North East Regional Awards Winner: Balance Matters for Older People, HSE Local Health Office Dublin North Central Physiotherapy Service (also runner up of overall award)

Special Commendation – Conversation Partner Scheme Members of the Cork (South Lee) Community Speech and Language Therapy’s Conversation Partner Scheme which won a Special Commendation Award at the HSE Achievement Awards. Pictured are Susan Wallace, Kate Dunn, Anne Tangney and Melanie Spitere

Runner Up: Respiratory Passport for patients with COPD, Beaumont Hospital

HSE South Regional Awards Winner: Site Infection Surveillance Service Wexford General Hospital (also winner of overall award) Runner Up: West Cork Falls Prevention Service, Bantry General Hospital and West Cork Primary Continuing and Community Care

HSE Dublin Mid Leinster Regional Awards Winner: The “Anyone Can Eat” Tube Weaning Programme, Our Lady’s Children’s Hospital, Crumlin (also runner up of overall award) Runner Up: Kildare West Wicklow School Support Team, DML HSE Disability Services

HSE West Regional Awards Winner: Regional Anaesthetic Facility, Galway University Hospitals Runner Up: When Nature Calls Managing Incontinence in Roscommon, Local Health Office Roscommon

Special Commendation Awards Conversation Partner Scheme, South Lee Community Speech and Language Therapy, COPE Galway Community Catering, Men’s Health and Wellbeing Programme, Community Services, Local Health Office, Dublin North Central

For more information please visit the staff Intranet site or our website www.hse.ie

Note: The HSE Achievement Awards 2010 national finals event was funded by commercial partners through a sponsorship arrangement. Headline Sponsor – Quest Diagnostics Regional Sponsors – Complete Telecom, Pinewood Healthcare, Sisk Group and Zurich. Patron Sponsors – Abbey Healthcare, Aramark Healthcare, Boehringer Ingelheim, Claymon Biomnis, Dalkia, Diversey, GlaxoSmithKline, Pfizer, Novartis Ireland, Royal College of Surgeons in Ireland, Ulster Bank, Vodafone. Table Hosts – A&L Goodbody, Cornmarket Financial and Ecolab

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Congratulations to all participants and winners of this yearâ&#x20AC;&#x2122;s HSE Achievement Awards

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Sharing the Knowledge A total of 326 entries were received for the HSE Achievement Awards 2010 competition.

n addition to the 20 finalists selected, significant numbers of applications were of a very high calibre and demonstrated clear evidence of working toward the six criteria for the Awards, which means Integration, Experience, Engagement, Transferability, Efficiency and Unique Features. A key objective of the HSE Achievement Awards process is to facilitate the sustainability of the work that the best projects are engaged in especially in relation to service and quality improvements and where appropriate to consider the most effective ways to replicate or transfer the knowledge to other regions and nationally. A booklet was produced for the Regional Events, held in August, which provided a summary for each of the projects. This booklet is available on the HSE Intranet. As well as documenting and acknowledging the wide and impressive range of projects across the country this booklet has also enabled people to make contacts and linkages with colleagues in other areas. The HSE is now working to transfer and replicate excellent practice, knowledge and experience from outstanding projects. This process is being progressed at both national and regional levels with the support of senior managers. Case studies from some of the projects will be available to view on HSE’s Learning and Development website www.hseland.ie via the site’s Change Hub. Based on the experience of the 2010 HSE Achievement Awards we are endeavouring to improve the Awards process and the ongoing engagement process with the projects that entered this year’s competition. We are working to further refine the process, and in order to do this, feedback is being sought from the projects who entered. This will help to make the Achievement Awards process more effective and accessible in the future. Each entrant was asked to complete

a short survey the results of which are both anonymous and confidential. Best wishes to all 326 projects who entered this year’s Awards.

Mr Derek Dockery The Overall Best Project Award is called the Derek Dockery Award. This Award commemorates the late Derek Dockery who in his long career in the Irish health service, was a champion of quality and excellence.

Mr Dockery, who worked for the former Eastern Regional Health Authority (ERHA) in Dublin at the time of his death, was a former Chief Executive of the Children’s Hospital, Harcourt Street and the Meath Hospital. He also worked in a number of other voluntary hospitals as well as contributing extensively to the on-going education and development of staff in the health services. He was a member of the task-force which established the former Eastern Regional Health Authority.

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in association with

+ Marking the success of the Balance Matters for Older People project in Dublin North Central are

+ Celebrating the success of the Site Infection Surveillance Service, Wexford General Hospital

+ Geraldine Ryan of COPE. The organisation won a Special Commendation Award for the COPE

+ Celia Butler, Senior Speech and Language Therapist from the Cardiology Team which won

+ Marking the success of the Men’s Health and Wellbeing Programme at the HSE Achievement

+ Cathal Magee, CEO, HSE, Kate Dunn, Senior Speech and Language Therapist and

Antonia Martin, Dublin City Council, Mary Connolly, Tolka Area Partnership, Bernadette Rooney, Dr Frank Dolphin, Chairman of the HSE Board, Áine O’Riordan, Senior Physiotherapist, HSE LHO, Dublin North Central, Manus Bree, Community Development Worker’ (Ballymun Whitehall Area Partnership), Kemi Alonge and Titi Akindipe

Galway Community Catering project

Awards were: Back row: Paul Brownlee, Glasgow Celtic, Matt Moloney, Pfizer, Ciaran McGreal, Pfizer. Front row: Anne Flannery, Larkin Centre, Mary Martin, HSE, Mick Denver, course participant and Phil Dunne, HSE

are Emer Ward, Dr Brian Carey, Patricia Hackett, Barry O’Brien, Lily Barnes, Dr Frank Dolphin, HSE Chairman, Eithne O’Sullivan, Richard Dooley, Ber Kelly and Colette O’Hare

Best Project DML and was the joint Runner Up for the Derek Dockery Award for Overall Best Project for their Anyone Can Eat’ Tube Weaning Programme, Our Lady’s Children’s Hospital, Crumlin, Dublin

Kenneth R Finnegan, Vice President International Quest Diagnostics mark the success of the Conversation Partner Scheme winner of a Special Commendation

18 Health Matters

in association with

header here

+ Cathal Magee, CEO, HSE, Niamh McCormack, COPD Outreach, Beaumont Hospital and

+ Cathal Magee, CEO, HSE, Dr Brian Carey, Consultant Geriatrician, Bantry General Hospital

+ Carol Cuffe, Disability Services Manager, HSE DML with the Runner Up prize for the Kildare West

+ Cathal Magee, CEO, HSE, Margaret Tiernan, Continence Advisor and

+ Dr John McDonnell, Consultant Anaesthetist, GUH from the successful Galway University

+ Margo Fenton, Katherine Oâ&#x20AC;&#x2122;Leary and Alison Hartnett from the National Federation of

Melanie Mahon, SISK

Wicklow School Support Team project

Hospitals Regional Anaesthetic Facility project

and Kevin Murphy, Complete Telecom

Connor Brennan, Zurich celebrate the success of the When Nature Calls! project in Co. Roscommon

Voluntary Bodies with Mary Harney TD, Minister for Health and Children

in association with

+ Cathal Magee, CEO, HSE and Stephen McGrath, Head of Internal Communications, HSE

+ Dr Frank Dolphin, Chairman, HSE and Stephen Mulvany, HSE Regional Director of

+ Christine Mooney, St Michael’s Hospital, Reni Patel, CUH, Temple Street, Terri-Sue Cosgrove,

+ Robert Quinn, Director, Quest Diagnostics Ireland and Ken Finnegan, Vice President

+ Christine Heffernan and Florence Higgins

+ Aidan Gleeson, CEO, Cappagh Hospital and Laverne McGuinness, National Director, ISD

Pinewood Health, Eilish Nolan, St Michael’s Hospital and Debbie Davis, Pinewood Health

from Vodafone

Operations, Dublin North East. Front: Breda Deering, Niamh McCormack and Ann Marie O’Grady celebrating the success of the Beaumont Hospital’s Respiratory Passport project for patients with COPD

International of Quest Diagnostics with John O’Brien, former HSE Senior Manager

PFM, HSE

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+ Dr Frank Dolphin, Chairman, HSE with Conor Brennan, Zurich

+ Tracy De Bufanos, Marie Louise Chapman and Carol Cuffe celebrating the success of the Kildare

+ Broadcaster Ryan Tubridy with Robert Quinn, Director, Quest Diagnostics Ireland

+ Minister for Health and Children Mary Harney TD who spoke at the HSE Achievement Awards

+ Denise Oâ&#x20AC;&#x2122;Shea, National Co-ordinator, HSE Achievement Awards with SiobhĂĄn Regan,

West Wicklow School Support Team, HSE Disability Services

National Event

Performance and Development Regional Co-ordinator, HSE DML

6075 Lucentis Ad 188 x 130:Layout 1

23/11/2010

17:47

Page 1

potential risk to the foetus. Women of child-bearing potential should use effective contraception during treatment. Breast-feeding is not recommended during treatment. The treatment procedure may induce temporary visual disturbances and patients who experience these signs must not drive or use machines until these disturbances subside.

Lucentis® 10mg/ml solution for injection ABBREVIATED PRESCRIBING INFORMATION Please refer to the Summary of Product Characteristics (SmPC) before prescribing

Interactions: No formal interaction studies have been performed. Adjunctive use of verteporfin photodynamic therapy (PDT) and Lucentis in an open study showed a low incidence of intraocular inflammation following initial combination treatment.

Presentation: A glass single-use vial containing 0.23ml solution containing 2.3mg of ranibizumab (10mg/ml). Indications: The treatment of neovascular (wet) age-related macular degeneration (AMD). Administration and Dosage: Single-use vial for intravitreal use only. Lucentis must be administered by a qualified ophthalmologist experienced in intravitreal injections under aseptic conditions. The recommended dose is 0.5mg (0.05ml) initiated with a loading phase of one injection per month for three consecutive months, followed by a maintenance phase in which patients should be monitored for visual acuity on a monthly basis. If the patient experiences a loss of greater than 5 letters in visual acuity (ETDRS or one Snellen line equivalent), Lucentis should be administered. The interval between two doses should not be shorter than 1 month. Before treatment, evaluate the patients medical history for hypersensitivity. The patient should also be instructed to self-administer antimicrobial drops, four times daily for 3 days before and following each injection. Children and adolescents: Not recommended for use in children and adolescents due to a lack of data. Elderly: No dose adjustment is required. Consult SmPC for full administration details before using Lucentis. Contraindications: Hypersensitivity to the active substance or excipients. Patients with active or suspected ocular or periocular infections. Patients with active severe intraocular inflammation. Warnings and precautions: Lucentis is for intravitreal injection only. Intravitreous injections have been associated with endophthalmitus, intraocular inflammation, rhegmatogenous retinal detachment, retinal tear and iatrogenic traumatic cataract. Monitor during week following injection for infections. Patients should be instructed to report symptoms suggestive of any of the above without delay. Increases in intraocular pressure have been seen within 1 hour of injection. Both intraocular pressure and perfusion of the optic nerve head should be monitored and managed appropriately. Concurrent use in both eyes has not been studied. Bilateral treatment at the same time could lead to an increased systemic exposure. There is a potential for immunogenicity and patients should report an increase in severity of intraocular inflammation. Lucentis has not been studied in patients who have previously received intravitreal injections. Lucentis should not be administered concurrently with other anti-VEGF agents (systemic or ocular). Withhold dose and do not resume treatment earlier than the next scheduled treatment in the event of the following: a decrease in BCVA of ≥30 letters compared with the last assessment of visual acuity; an intraocular pressure of ≥30 mmHg; a retinal break; a subretinal haemorrhage involving the centre of the fovea, or if the size of the haemorrhage is ≥50% of the total lesion area; performed or planned intraocular surgery within the previous or next 28 days. Discontinue treatment in cases of rhegmatogenous retinal detachment or stage 3 or 4 macular holes. Ranibizumab should not be used during pregnancy unless the expected benefit outweighs the

Adverse Reactions: Serious adverse events related to the injection procedure included endophthalmitis, rhegmatogenous retinal detachment, retinal tear and iatrogenic traumatic cataract. Other serious ocular events included intraocular inflammation and increased intraocular pressure. Very Common: Intraocular pressure increased, headache, vitritis, vitreous detachment, retinal haemorrhage, visual disturbance, eye pain, vitreous floaters, conjunctival haemorrhage, eye irritation, foreign body sensation in eyes, lacrimation increased, blepharitis, dry eye, ocular hyperaemia, eye pruritus, arthralgia, nasopharyngitis. Common: Anaemia, retinal degeneration, retinal disorder, retinal detachment, retinal tear, detachment of the retinal pigment epithelium, retinal pigment epithelium tear, visual acuity reduced, vitreous haemorrhage, vitreous disorder, uveitis, iritis, iridocyclitis, cataract, cataract subcapsular, posterior capsule opacification, punctate keratitis, corneal abrasion, anterior chamber flare, vision blurred, injection site haemorrhage, eye haemorrhage, conjunctivitis, conjunctivitis allergic, eye discharge, photopsia, photophobia, ocular discomfort, eyelid oedema, eyelid pain, conjunctival hyperaemia, cough, nausea, allergic reactions (rash, urticaria, pruritus, erythema), hypersensitivity, anxiety. Uncommon: Blindness, endophthalmitis, hypopyon, hyphaema, keratopathy, iris adhesion, corneal deposits, corneal oedema, corneal striae, injection site pain, injection site irritation, abnormal sensation in eye, eyelid irritation. Please refer to SmPC for full listing of all undesirable effects. Marketing authorisation number: EU/1/06/374/001 Marketing authorisation holder: Novartis Europharm Limited, Wimblehurst Road, Horsham, West Sussex, RH12 5AB, United Kingdom. Full prescribing information, including SmPC, is available upon request from Novartis Ireland Limited, Beech House, Beech Hill Office Campus, Clonskeagh, Dublin 4. Telephone: (01) 260 1255. References: 1. Rosenfeld PJ, et al, for the Marina Study Group. Ranibizumab for neovascular age-related muscular degeneration. Engl J med. 2006;355:1419-1431. 2. Chang TS, et al. improved version – related function after ranibizumab treatment of neovascular age-related muscular degeneration. Arch Ophthalmol. 2007;125:1460-1469. Date of API Revision: November 2008 Date of Preparation: February 2009 No. 0109023

Congratulations... Claymon Biomnis Laboratories would like to congratulate all nominees and winners of the HSE Achievement Awards for their outstanding commitment and efforts to deliver a caring and quality health service to the Irish public.

... to all nominees of the HSE Achievement Awards 2010 Claymon Biomnis Laboratories, Three Rock Road, Sandyford Business Estate, Sandyford, Dublin 18, Ireland. Tel: +353 1 295 8545 | Fax: +353 1 295 8550 | Email: sales@claymonbiomnis.ie | Web: www.claymonbiomnis.ie

Claymon_HSE Awards_188x130.indd 1

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Health Matters 25

Quality and Clinical Care Directorate

Update on Chronic Disease Programmes

Four chronic disease programmes have been designed to improve patient services for stroke, diabetes, acute coronary syndrome and chronic obstructive pulmonary disease (COPD) writes Dr Barry White, National Director.

hronic diseases affect a large proportion of the population of Ireland and account for approximately 80 per cent of all healthcare costs. As part of the range of Clinical Programmes within the Quality and Clinical Care Directorate four chronic disease programmes have been rolled out to improve quality of care and access for patients with chronic disease while ensuring better use of existing resources. These programmes will target stroke, diabetes, acute coronary syndrome (heart attack) and COPD.

Stroke There is a high incidence of stroke in Ireland given our age profile. The stroke programme is seeking to develop rapid access to high quality stroke services across the country. The programme is aiming to prevent a stroke each day and to avoid death or dependence resulting from stoke in one patient every day. Currently, stroke care costs up to b1 billion per year in Ireland (Cost of Stroke in Ireland Report 2010). While our overall expenditure on stroke care is comparable

with other counties, we annually spend nearly three times as much on nursing home care of stroke patients than we do on rehabilitation. In comparison, in Australia and France, three times as much is spent on rehabilitation than on nursing home care and in Germany nearly six times as much is spent. We already have many of the resources we need and more can be achieved by the reorganisation of these services and improving how we work. The stroke programme is being led by Professor Peter Kelly and Dr Joe Harbison.

Merry Christmas & A Happy New Year. . . Claymon Biomnis would like to wish all our valued customers a Merry Christmas and a Happy New Year. In 2011, we look forward to providing you with the same first class medical testing service that you have come to expect from us.

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. . . to all our valued clients that have supported Claymon Biomnis throughout 2010.

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

Fax: +353 1 295 8550

Email: sales@claymonbiomnis.ie

Web: www.claymonbiomnis.ie

Health Matters 27

Quality and Clinical Care Directorate

“The Chronic Disease Programmes do not operate in isolation, they are working together to develop solutions that will provide the best care for patients. This is particularly necessary in the area of chronic diseases.” Diabetes Everyday, one person loses their eyesight and one person suffers an amputation of toes, feet or legs. The programme aims to save the eyes, limbs and lives of people with diabetes throughout the country. The programme is seeking to develop services to help prevent foot ulceration, which will reduce the number of amputations and foot complications resulting from the disease. By developing a national retinopathy screening service, the programme is seeking to reduce blindness resulting from diabetes. The programme is seeking also to improve integration between GP and hospital services. Diabetes care constitutes a significant amount of our healthcare budget with a large proportion of costs due to inpatient care of diabetes. Inpatient care is mainly due to complications. Reduced complications will have a positive impact on expenditure while improving quality of life for the patient. The clinical lead for the diabetes programme is Professor Richard Firth. Acute Coronary Syndrome Currently, the treatment of acute coronary syndrome varies nationally depending on the location and availability of services. The programme is aiming to reduce death and increase the quality of life for those that have suffered heart attacks by developing standardised protocols for the treatment of

heart attacks both in terms of pre-hospital care and acute care in a hospital setting. The programme is aiming to save up to 30 lives per year by reducing the incidence of Acute Coronary Syndrome. The programme also aims to reduce the length of stay for ST-elevation myocardial infarction (STEMI) patients thereby reducing the number of bed days by 1,800 per year. Professor Kieran Daly is the clinical lead for the acute coronary syndrome programme.

COPD In Ireland, over 110,000 people are diagnosed with COPD. However, it is thought that the real number maybe higher. The effects on society of COPD in Ireland are enormous. It is estimated that the disease will become even more prevalent in Ireland over the coming years. For those who have symptoms of COPD, even daily activities like getting dressed, crossing the road or doing the weekly shop are difficult to do. Seeking early diagnosis can greatly improve the quality of life for the sufferer. While COPD cannot be cured, it is treatable. The COPD programme is seeking to prevent up to 50 deaths per year from COPD. The programme is seeking to

“The programme is aiming to reduce death and increase the quality of life for those that have suffered heart attacks by developing standardised protocols for the treatment of heart attacks both in terms of pre-hospital care and acute care in a hospital setting.”

develop rehabilitation programmes within hospitals to improve quality of life and improve breathlessness of COPD sufferers and developing community based services to improve self management by patients and their GPs and pharmacists. The COPD programme is being led by Dr Tim McDonnell. The Chronic Disease Programmes do not operate in isolation, they are working together to develop solutions that will provide the best care for patients. This is particularly necessary in the area of chronic diseases as patients may develop more than one condition in this category in their lifetime. The programmes are currently in the planning phase with implementation due to commence in 2011. Elements of the programmes will be cost neutral and involve reorganising how existing services are delivered. The programmes are also seeking to identify ways in which savings can be made by achieving greater efficiency within services and by reducing the number of hospital admissions resulting from chronic diseases.

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HealtH Matters 29

Quality clinical care

CHroniC obStruCtivE pulmonary DiSEaSE CopD is a common disease and at least 110,000 people are diagnosed with the illness in ireland. many more patients have the disease but are not yet diagnosed writes Consultant respiratory physician Dr Tim McDonnell.

58-year-old patient was referred to me for evaluation of breathlessness. she had recently found that she climbed inclines with difficulty. she had stopped smoking 20 cigarettes a day 10 years previously. she told me that her sister had died from a lung disease which required her to use oxygen and resulted in her being housebound prior to her death. the patient was understandably concerned that she was heading in the same direction. Following investigations, including spirometry, a measure of lung function, I was able to tell her that she had COPD or Chronic Obstructive Pulmonary Disease. this was met with the lack of comprehension often seen in patients told they have this diagnosis.

so WhaT is CoPd? COPD is a chronic disease of the lungs associated with airway narrowing induced by cigarette smoking. It is a common disease with at least 110,000 people diagnosed with the illness in Ireland. Many more patients have the disease but are not yet diagnosed. the majority of problems associated with COPD are shortness of breath leading to reduced exercise tolerance and impaired quality of life. Patients can also experience deterioration of symptoms referred to as exacerbations of COPD. approximately, 12,000 patients a year are admitted to our hospitals with such exacerbations. the group of patients with the most severe form of the disease

often require frequent readmissions. this more severe group can be incapacitated with shortness of breath and a minority will require long-term oxygen. Most patients need a combination of inhalers and tablets.

Why is There so liTTle PUbliC reCogNiTioN iN irelaNd For a disease ThaT is oN The rise? the first problem relates to the name. COPD is quite a mouthful and is the modern name for what has been previously called chronic bronchitis, emphysema or ‘smoker’s asthma’. the confusion with asthma is most common. asthma is a different lung disease occurring more frequently, though not exclusively, in younger people and requires different treatment. Understandably, there is confusion among doctors and patients in differentiating between asthma and COPD. a disease that is sometimes difficult for even healthcare professionals to define is going to have a problem with name recognition. COPD develops gradually and patients may believe this is part of the ageing process. We start off with a large reservoir

of lung function which smokers puff away as they progress through life. Patients present when what is left is what they need of their lung function for day-to-day living. the principal cause of COPD is cigarette smoking, which is more concentrated in the lower socio-economic groups. Consequently, as many patients with COPD come from relatively disadvantaged sectors of society, this translates into less recognition for this as a public health problem. the chronic nature of the disease, together with a degree of guilt associated with the perception that the disease is selfinduced, leads to reluctance to demand better resources. even as cigarette smoking declines, COPD as a problem is on the increase. We are still suffering from the past decades of cigarette smoking. It is not all doom and gloom as there have been advances over the past few years. new drugs have made a major impact on the quality of life, exercise ability and breathlessness in patients with COPD. there’s evidence that patients who exercise on a regular basis are less likely to require admission to hospital.

30 Health Matters

Quality Clinical Care

The availability of pulmonary rehabilitation, a structured management programme for patients, also makes a big difference. We are becoming more adept at organising the care that we deliver to these patients and there are a number of examples of this in the Irish healthcare system such as the COPD outreach programme pioneered at Beaumont Hospital.

So what of my patient? Spirometry had demonstrated that she had a forced expiratory volume (FEV1) of 45 per cent predicted. This means that she had smoked away over half of her lung function and would indeed have followed the path of her unfortunate sister had she continued to smoke. She was now getting to the stage

where she needed what was left of her lung function for day-to-day activities. She started on a series of inhalers, received advice on how to deal with chest infections and did a programme of pulmonary rehabilitation. Over the following five years, her lung function has stabilised. She took on the exercise message to the extent that this year she completed the women’s mini-marathon. Dr Tim McDonnell is consultant respiratory physician at St Vincent’s University Hospital and HSE National Clinical Programme Lead for COPD. This article originally appeared in the Irish Times health supplement ‘Healthplus’ and is reprinted with the permission of the Irish Times.

+ Tim McDonnell

HSE staff mark World COPD Day 2010 +

ospitals throughout the country organised ‘walk-in’ spirometry clinics for people with concerns about the disease on World COPD Day, which took place on November 17th. COPD information posters and leaflets were also distributed to GP surgeries and hospitals nationwide to mark the day. Patient awareness stands were also organised in a number of hospitals including Mayo General Hospital. The first World COPD Day was held in 2002. It is now marked in over 50 countries, making the day one of the world’s most important COPD awareness and education events. The annual event is organised by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD works with a number of organisations and healthcare staff to raise awareness of the disease.

Members of the Beaumont Hospital COPD Outreach team, L-R: Consultant Physician Professor Richard Costello, Senior Physiotherapist and Co-Ordinator Brenda Deering, patient Marie Grimes and Respiratory Nurse Niamh McCormack

According to the latest World Health Organisation estimates (2007), currently 210 million people have COPD and some three million people died of COPD in 2005.

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Health Matters 33

Quality Clinical Care

Quality clinical care assurance People need to be confident about the quality of care that they get from the healthcare system, writes Edwina Dunne, HSE Director of Quality Clinical Care Assurance.

ur patients are entitled to services that are safe, provided by competent and confident staff and in their best interest. Managing risk is not just about financial or management probity; it is also concerned with improving the safety, quality and user experience of healthcare services. HSE management requires effective measured internal controls to be in place to manage risk. The Quality Clinical Care Assurance (QCCA) function was established to ensure the controls are in place and monitored. QCCA audits compliance with standards and provides evidence of good practice and safe sustainable services within the HSE. This function represents a second line of assurance (Level 2 Assurance) in the HSE Corporate Governance Framework.

We will be auditing various processes/ systems throughout the HSE, both clinical and services. The audit will identify where standards, guidelines, processes and procedures comply with best practice. Recommendations for becoming compliant will be made where necessary. Areas of good practice will be identified with a view to adopting these across the organisation where applicable. Followup audits will also form an important component of our work. We have a team in place with a wide variety of experiences in many functions that bring with them a wealth of valuable experience. The programme of audits to be conducted will include inputs from National Directors, Regional Directors of Operations and Care Programme Leads. The programme will be prioritised on

“The programme of audits to be conducted will include inputs from National Directors, RDO’s and Care Programme Leads.” an annual basis. A collaboration with Internal Audit (responsible for evaluating and reporting overall internal controls – Level 3 Assurance within the Corporate Governance Framework) will ensure good use of audit resources and an integrated

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Health Matters 35

Quality Clinical Care

Terminology Healthcare Audit is the assessment of performance against any clinical and social services standard in a healthcare organisation. control policies: procedures organisational structures put in place, in which reliance is placed to manage a risk and achieve objectives. Effective control: ‘a control that is properly designed and is systematically operated to deliver the intended outcome’ (NHS, UK).

approach to assurance in the HSE. This will happen in two ways: • Systems will be developed to ensure that recommendations from each audit report will be shared with people across the organisation. Although it is the responsibility of the relevant director to facilitate the sharing of these audit reports at a service level, QCCA will play a role in facilitating and supporting this shared learning across the organisation • The QCCA team will also conduct followup audits and by doing so will monitor the effectiveness of management’s response to audit findings and recommendations. An escalation procedure is in development for responses that are judged to be inadequate in relation to the associated risk Successful sharing and implementation of recommendations will, over time, enable us to learn from our failures as an organisation while supporting a culture of accountability, and learning which will ultimately drive quality improvement. Work recently completed includes an audits and data validation exercise for Waterford Regional Hospital as part of HealthStat performance metric. This included auditing: • average waiting time for consultant led out-patient clinics • audit of the structures and processes

currently in place in hospitals for the reporting of colonoscopy waiting times • audit on the first Corporate Risk Register Executive summaries in relation to these audits will be made available on the HSE Intranet site over the coming months. This work has prompted discussions about a formal research study on the value of Level 2 Assurance in a health care organisation. This research will inform the Corporate Assurance Framework for the HSE. It is envisaged that this study will include collaborations with people undertaking similar work in Canada and in the NHS in the UK.

+ Edwina Dunne, HSE Director of Quality Clinical Care Assurance

An assurance process: ‘a concept resting on best governance practice. It is a process designed to provide evidence that organisations are doing their “reasonable best” to manage themselves so as to meet their objectives and protect patients, staff, the public and other stakeholders against all kinds of risk’ (NHS, UK). Level 2 Assurance: QCCA, as part of the HSE Assurance Framework, will provide 'across the line' assurance on compliance with clinical and social care standards, policies and procedures, reporting to the National Director of Quality and Clinical Care.

Collaborations may extend to the private sector organisations over a defined two/ three year period. Agreed key performance indicators (KPIs) will also be monitored and procedures and standards of practice will be reviewed on a regular basis. Patient involvement is very important in this process and we intend establishing user panels and involving users on some of our audit teams. Service users bring an enormous contribution to the quality of audits. More information is available from the HSE website www.hse.ie or from the author, email: Edwina.Dunne@hse.ie

36 Health Matters

in brief // News

Vision for Mental Health Nursing - Inform your Future All Registered Psychiatric Nurses (RPNs) working in mental health in the Republic of Ireland are invited to complete an anonymous questionnaire, which explores RPNs’ perceptions of their current role. Focus groups will also be conducted nationally in the coming months to establish how the RPN can continue to respond to ‘A Vision for Change’. All interested parties, organisations and individuals are invited to make a written submission using an agreed format. This national project is being run by the Office of the Nursing and Midwifery Services Director (ONMSD) and Mental Health (Corporate), in partnership with all stakeholders in mental health, which aims to inform and strengthen the role of the psychiatric nurse to support the implementation of ‘A Vision for Change’ (DoH&C) 2006. Supported by the National Council and the Nursing and Midwifery Planning and Development Units, this project aims to identify nursing skills and competencies, which may need development in order for nurses to continue to provide accessible, communitybased specialist services for people with mental illness. This work will be informed by the recovery model of mental health with emphasis on advocacy, user involvement, psychosocial interventions, education and mental health promotion in order to maximise positive outcomes for service users, carers and the population as a whole. If you wish to complete the questionnaire on line please log on to one of the following websites: www.hse.ie/go/onmsd - follow link for capacity building/national mental health. Also visit www.nursingboard.ie, www.ncnm.ie, www.pna.ie, www.iimhn.org, www.mhcirl. ie, www.ncnm.ie/mhnmi. For further information contact: Fionnuala Killoury, Project Officer on 01 890 8792 or on email: fionnuala.killoury@hse.ie.

+ Back row: Eithne Cusack HSE, Fionnuala Killoury HSE, Aisling Culhane PNA, Mary Kenneally HSE, Mary McHale HSE, Patricia Gilheaney MHC, Professor Agnes Higgins TCD and Irish Institute of Mental Health Nursing, Martina McGuinness HSE, Patrick McGowan Expert by Experience, Una McCarthy HSE, Kevin Mills HSE, Adrienne Adams HSE Front row: Des Kavanagh PNA, Dr Siobhan O’ Halloran HSE, Martin Rogan HSE, Padraig Heverin HSE and SIPTU

Practice Nurse of the Year Maureen Delaney, a Ballinasloe-based Practice Nurse, has been awarded the 2010 “Practice Nurse of the Year” at the annual conference of the Irish Practice Nurses Association held in Ballybofey, Co. Donegal recently. Maureen completed both her nursing and midwifery training in University Hospital Galway, and has worked in her Practice Nurse post with Dr Eugene O’Brien in the Dunloe Medical Centre, Ballinasloe for the past eight years.

+ Maureen Delaney, a Ballinasloe-based Practice Nurse, receiving the 2010 “Practice Nurse of the Year” award at the annual conference of the Irish Practice Nurses Association recently

HSE National Counselling Service Celebrates Ten Years in Practice The HSE National Counselling Service (NCS) recently held its 10th anniversary conference, ‘Transforming the Shadows’, in Dublin Castle. This was the first NCS conference open to professionals outside of the NCS and the first to be funded completely by participants and sponsors. Martin Rogan, Assistant National Director, Mental Health, opened the conference and Christine Buckley, the Director of the Aislinn Centre for survivors of institutional abuse, welcomed participants. Key note speakers included Sir Richard Bowlby and Felicity De Zulueta. Each addressed a different aspect of attachment theory in relation to traumatic childhood experiences. Audrey Delaney provided a survivor perspective. The conference would not have been possible without the tireless work and dedication of all involved including the Conference Planning Committee over the past two years, as well as the administrators and volunteers. Particular thanks to Anne Doheny and Jennifer Gleeson, Administrators. Web: www.hse-ncs.ie / Phone: 1800 235 234

+ L-R: Gerard O’Neill, Anne Doherty, Mary Griffin, Felicity De Zulueta, Sir Richard Bowlby, and Dawn Nance

Health Matters 37

in brief // News

Mental health e-learning programmes HSE Mental Health Services recently launched a mental health services hub on the HSEland education and development website. The mental health services hub provides the launch pad for mental health e-learning programmes on aspects of the Mental Health Act 2001 and offers a repository for useful information, resources and tools. It offers an online space for discussions, knowledge sharing and collaboration for all HSE mental health and other associated staff. This facility is an important resource for achieving the blended learning that is a key feature of the organisational learning strategy. The hub is accessible to HSE staff members who are registered on HSEland and who submit an application to join online.

Push to raise Awareness of Primary Immunodeficiencies A new centre to treat a number of chronic conditions called primary immunodeficiencies has been opened. The Jeffrey Modell Research and Diagnostic Centre for Primary Immunodeficiencies will be run jointly by two Dublin hospitals, Beaumont and St James’s Hospitals and by the New Yorkbased Jeffrey Modell Foundation.

+ L-R: Dr Frank Dolphin, Chairman, HSE, Minister for Health and Children, Mary Harney TD, Fred and Vicki Modell of the Jeffrey Modell Foundation and Leslie Brett, Bio Science Business Director, Baxter Ireland

Edward Worth Library Events: December 2010-June 2011 The Edward Worth Library is a rare books collection, bequeathed to Dr Steevens’ Hospital by Dr Edward Worth (1678-1733), an early eighteenth-century Dublin physician. This year a number of events are taking place in the Library to commemorate the 300th anniversary of the death of Richard Steevens. A web exhibition on ‘Infectious Diseases in the Worth Library’ will be online. To mark the actual tercentenary of Richard Steevens’ death, on 15th December, a number of events are taking place in the board room of Dr Steevens’ Hospital including; talks about the history of Dr Steevens’ Hospital, the launch of a book about early modern medical texts and the launch of a photographic exhibition on the history of Dr Steevens’ Hospital, the latter jointly organised by the librarian of the Worth Library, Dr Elizabethanne Boran and the librarian of the Regional Library in Dr Steevens Hospital, Bennery Rickard. In 2011, the Worth Library Spring Seminar Series, which runs from February to May, will concentrate on the topic of infectious diseases and will include a number of seminars. As part of this theme Professor Ann Carmichael will give the Annual Grizelda Steevens Memorial lecture in Medical History on the topic ‘Plague in fifteenth-century Milan’ on 15th March 2011. Details of these exhibitions and events may be found on the Worth Library website: www.edwardworthlibrary.ie.

Beaumont launches novel Masters programme Beaumont Hospital in dublin has introduced a novel Masters degree course in organisational change and leadership development for its staff. The two-year part-time course has been devised by Beaumont in a three-way partnership with the Business School at Dublin City University and the Institute for Leadership Development and Healthcare Management at the Royal College of Surgeons in Ireland. The programme comprises of six taught modules and an action orientated dissertation. Its specific objectives are to enable change within the hospital, to empower staff and develop their leadership potential, to improve efficiency and to contribute to the development of Beaumont Hospital as a provider of best quality healthcare services. The programme, which is accredited by the National University of Ireland, is also open to staff from other hospitals in the Dublin North East region. The individual cost is b8,500 per year with each participant paying half and the balance funded by his or her employer. The first course has commenced with 20 participants from a variety of management disciplines within Beaumont.

38 Health Matters

in brief // News

HSE Staff Responsibility for the Protection and Welfare of Children As part of the HSE team, we are all responsible for the protection and welfare of children, no matter what part of the health service we work within. So if you have a concern about the welfare of a child, please act by sharing your information. The HSE has produced a new booklet, called ‘HSE Staff Responsibility for the Protection and Welfare of Children’. This booklet is available on the HSE intranet. The booklet sets out the procedure to be followed by all HSE staff when dealing with reports or suspected cases of child abuse. It also sets out the responsibilities of all HSE staff should they have a concern about a child who may be at risk. As well as covering all staff’s duties in this area, it also gives specific extra guidance to those staff grades who are specifically identified as a designated officer under the Protections for Person Reporting Child Abuse Act, 1998. It describes their more specific role and responsibilities and explains how to examine information in child protection reports and assess if reasonable grounds for concern exist. If you are concerned about the safety of a child and are unsure what to do, talk to your line manager, or a HSE Social Worker or in an emergency where you believe the risk is real and immediate, and you can not contact a HSE staff member, call the Gardai. Remember, as part of the HSE team, we are all responsible for the protection and welfare of children. If in doubt, check it out.

+ L-R: Dr Sapna Mitra; Maria O’Donovan; Anne Rigney; Dr Catherine Murphy; Sponsor Colin Edwards from Boehringer; Dr Agnes Bourke and Cathy Falvey

Introduction of Neonatal BCG in CUMH The Departments of Community Medicine and Public Health Nursing, HSE South and Cork University Maternity Hospital received a commendation at the Irish Health Care Awards in the Best Public Health Initiative category. In October 2008, after a gap of 36 years, community medical, nursing and administrative staff, with the cooperation of the maternity and Consultant Paediatric staff, introduced a Neonatal BCG vaccination programme in the new Cork University Maternity Hospital (CUMH). The objective of the programme was to offer the BCG vaccination to all eligible newborn infants born in the CUMH, to achieve a 95 per cent uptake of the vaccine to reduce the incidence of illness and serious side effects from tuberculosis in young children and to develop a relationship with acute hospital staff and a model for an integrated service involving acute and community services. Dr Catherine Murphy, Principal Medical Officer HSE South said: “Of the 15,376 newborns eligible for vaccination only 93 (0.6 per cent) have refused the vaccine outright. The number of parents who refuse has consistently decreased over time as they become more aware and more informed about the benefits of BCG vaccination.”

OUtreach Moldova OutReach Moldova, an Irish registered charity, founded in 2000 by Suzanne O’Connell a graduate of Medicine of the University of Dublin, Trinity College, is seeking volunteers from all walks to life to provide care, love, stimulation and attention to children living in difficult conditions in orphanages in Moldova. To date, over 1,500 volunteers have joined the programme and over 40 per cent return each and every year. Outreach Moldova cares for 500 abandoned and orphaned young girls in Hincesti and a baby orphanage in Chisinau. Moldova is seen as the poorest country in Eastern Europe, where if you can get a job, the average industrial wage is less than b2,000 per annum. Further information: Outreach Moldova, PO Box 8039, Dun Laoghaire, Co. Dublin. Ireland. Tel/Fax 01 275 1842. email: des_orm@hotmail.com / www.outreachmoldova.org.

Health Matters 39

in brief // News

HSE Procurement winners at the National Procurement Awards Ceremony

ST PAUL’S SERVICE FOR CHILDREN WITH AUTISM, BEAUMONT, SHORTLISTED FOR IRISH HEALTHCARE AWARD A Life Skills Programme, which was initiated in 2009 in St Paul’s community house, was one of six projects recently short listed for the Irish Healthcare Awards. Nominated in the category of ‘Best Patient Lifestyle Education Project 2010’, the project which focuses on preparation for adolescents with autism for life in the community. It was identified as innovative in that it involved teaching, learning and accreditation of functional and adaptive living skills for adolescents with autism and associated degrees of intellectual disability. For further information on St Paul’s Service, contact Cathy Hennebry, Director of Service, at 01 837 7673.

HSE welcomes the new Procurement Operating Model HSE Procurement is now operating on the basis of a Single National Procurement Operating Model with all staff engaged in procurement activity across HSE now reporting into the Procurement Directorate. The implementation of this Model is a key enabler in achieving cost reductions, increased efficiencies and the adoption of streamlined standardised procurement processes to avoid duplication of effort. Leo Stronge, Head of Procurement, stated that he would like to extend his appreciation to all staff for the level of cooperation received. He also said that by working together with common goals and objectives HSE Procurement can make a positive contribution in enhancing the Procurement service and value achieved for customers.

HSE Procurement won two prestigious awards at the National Procurement Awards Ceremony in Dublin. HSE Portfolio and Category Management in Kilkenny scooped the Health Care National Procurement Award for its work with the National Integrated Imaging System (NIMIS). As the Procurement Lead Miriam Rourke accepted the award on behalf of HSE Procurement and the NIMIS Project Team. In addition Eamonn Lally one of HSE Procurement’s new Category Specialists received the ‘Procurement Leader’ Award

in recognition for his excellent work in Mayo General Hospital. Leo Stronge, Head of Procurement, acknowledged the work, effort and the achievements of all HSE Procurement Projects that reached the final. The finalists at the award ceremony included many leading edge supply chain and procurement organistaions both from the public and private sector including Pfizer, Aer Lingus, Glanbia, Abbott Ireland, Microsoft, Bord Gáis, Yahoo, Vodafone and Symantec.

+ Clare McGrath, Chairperson, Office of Public Works, presents Miriam Rourke, NIMIS Project Team Lead with the award for ‘Healthcare Procurement’ (NIMIS Project)

+ Eamonn Lally, Mayo General Hospital, is presented with the trophy for ‘Procurement Leader’ by Jane O’Keeffe, President of the Irish Institute of Purchasing Materials Management at the National Procurement Awards in Dublin

40 Health Matters

in brief // News New ‘Mindfulness’ Programme at St Luke’s Hospital, Dublin St Luke’s Hospital, Rathgar has introduced a new eight week ‘Mindfulness’ Programme. The course is tailored for people who have completed their treatment for cancer and are living with chronic pain. The programme is being run by counselling psychologists Dr Natalie Hession and Allison Connolly. “Reducing stress and helping patients cope with living with a life threatening illness and uncomfortable symptoms is a huge challenge but is the central aim of our eight -week ‘Mindfulness’ course”, explained Allison. Mindfulness refers to a meditation practice that was devised in the late 1970’s with the pioneering work of Jon KabatZinn at the University of Massachusetts Medical Centre. For people dealing with cancer, many of the issues being faced are amenable to Mindfulness Based Stress Reduction, including fears of an uncertain future, pain and death, which are common reactions to a cancer diagnosis. The benefit of using mediation for the self-regulation of chronic pain involves the patient developing an ability to observe intense feelings as bare sensations. Natalie said: “By repeated practice the patient can learn to assume an attitude of detached observation towards a sensation such as pain when it occurs and following practice, it is hoped that this will lessen the grip that the perception of pain can hold over a person.” In the pain group, participants learned the fundamentals of the mind-body connection and how their interpretations of the world and their illness can reinforce both their experience of physical pain and mental suffering. Results from the group have been positive to date. Patients have reported an increased sense of control over their emotional and physical experience of pain and chronic illness. The Mindfulness Programme runs twice a year as part of the outpatient management programme at St. Luke’s Hospital, Rathgar for patients adjusting to life after being treated for cancer. For more information, please contact: Allison Connolly, Counselling Psychologist, St Luke’s Hospital, Rathgar, Dublin. Tel: 01 406 5263

Conference of the International Collaboration of Orthopaedic Nursing (ICON).

+ Left: Siobhan Byrne Murphy, CNM1, St Mary’s Orthopaedic Hospital, Cork; Right: Niamh McGrath,CNM2, Trauma Co-ordinator, Cork University Hospital; Middle: Siobhan Murphy, Lecturer, Catherine McAuley School of Nursing & Midwifery, UCC

The first international conference of ICON was recently held in Dublin. ICON is a collaboration of Orthopaedic Nursing Associations working together to raise global awareness of issues related to the care of patients with musculoskeletal conditions and to enhance the quality of orthopaedic nursing education, research, policy and practice. Some 280 orthopaedic nurse delegates from 22 countries attended the conference. The extensive programme consisted of keynote presentations with four further plenary sessions each day. The conference provided an opportunity for nurses working in orthopaedic and trauma settings in Ireland to gain a comprehensive insight, not only into current trends and developments in orthopaedic and trauma nursing worldwide, but also into the challenges and opportunities that lie ahead. It provided a forum for networking and for discussions with nursing experts not only in clinical orthopaedic practice but also in areas of research and academia. For further information, contact Rosemary Masterson, Nurse Tutor, Cappagh National Orthopaedic Hospital, Dublin, or visit www.icon2010.com.

Business Opportunities for Small Firms Association with HSE As part of its Supplier Engagement Programme, the HSE’s Procurement and Finance departments recently hosted information events in partnership with the Small Firms Association (SFA). The purpose of the engagement was to give small firms a better understanding of the Procurement Operating Model within the HSE and how small firms can avail and compete for opportunities that present across HSE. HSE Procurement is the largest purchaser in the State and supports procurement activity to the value of b4.5bn each year across a diverse range of products and services. HSE Finance also provided an overview of how payments are managed to suppliers across HSE. In addition businesses are being given an opportunity to meet HSE buyers representing business areas which are of particular interest to them.

Health Matters 41

in brief // News

Gabriel Byrne thanks staff at the Mater Hospital for their work on end of life care and to mark the appointment of Diarmuid Ó Coimín as End-of-Life Care Coordinator, the first in the country under the Irish Hospice Foundation’s Hospice Friendly Hospitals programme.

+ Actor Gabriel Byrne with Dublin’s Mater Hospital staff

2010 World Open Water Swimming Woman of the Year Nominee HSE Disability Services Manager, Anne Marie Ward, is one of twelve women nominated for the 2010 World Open Water Swimming Woman of the Year Award for her hard work and dedication to charity swims. In September 2010, Anne Marie made history as the first Irish woman to swim the North Channel between Ireland and Scotland. Anne Marie is now the 12th member of the most elite and exclusive marathon clubs in the world – the North Channel Club. Swimming in 12 degree water and continually being stung by jellyfish, her achievement in what is widely regarded as one of the toughest challenges in the world has been recognised by a nomination for the 2010 World Open Water Swimming Woman of the Year. The competition closes on 31st December 2010 and the winner will be announced on 1st January 2011. Vote for Anne Marie at: www.openwatersource. com/vote-for-the-world-open-waterswimming-woman-of-the-year.html

Palliative Care Conference 6th – 7th April 2011 Our Lady’s Hospice and Care Services in Harold’s Cross, Dublin is hosting a palliative care conference to explore the evolvement of palliative care; examine the transformational role of specialist palliative care; and address the challenges in meeting diverse needs at end-of-life in Ireland. The Moving Points in Palliative Care 18th Annual Conference is titled ‘Diverse needs at end of life: Traditions, Transitions and Transformations’. The conference will take place on Wednesday, 6th April from 6pm and all day Thursday, 7th April 2011. Wednesday evening is targeted at specialist palliative care and associated health and social care practitioners, managers, educators and service planners. Thursday is relevant to all those involved in meeting people’s needs at the end of life, including doctors, nurses, allied health professionals, service planners and managers, and general practitioners. Details of all courses can be found on www.olh.ie, by email education@olh.ie or tel: 01 406 8806.

Launch of Post Natal Depression Book Recovering from Post Natal Depression is a new book which launched recently, written by coauthors Madge Fogarty, Founder and Chairperson of Post Natal Depression Ireland (Cork) and Bernie Kealy, Founder of the Post Natal Distress Association of Ireland (PNDAI). With powerful clarity and refreshing honesty, this book describes the most common situations where a mother develops PND, the main symptoms, what it is like to live with PND (for us and our partners) and offers some proven and effective steps to help bring about recovery. Available from Eason stores nationwide and all good bookstores.

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Health Matters 43

children and the media

Children and the Media: Lessons for the Future Dr Paul Connors, HSE National Director of Communications, recently spoke about “Children and the Media: Lessons for the Future” at a seminar on “Children and the Media” organised by the Press Council of Ireland and the Office of the Press Ombudsman. Here we print some edited extracts from his script.

“I

prefer that they never took me into care at all. It would be better to live at home than to go through what the media have done. I can’t do it again.” Such were the words of one of the children in the so-called Roscommon case reported in a recent judgment by Mr Justice John MacMenamin in the High Court in October of this year. The words are stark, distressing, and they encapsulate an ongoing difficulty that exists in most advanced democracies – the freedom of the press to report and the privacy and welfare of vulnerable children The media plays a crucial role in society informing and educating the public and very often holding to account public bodies such as the HSE. However, as the 19th Century US journalist Silas Bent said, “Harmony never made a headline.” And so we have conflict – While doing their job – the media often conflicts with an individual’s rights to privacy and more worrying – as we saw in this quote from the Roscommon case – conflict with the well-being of vulnerable children. However to quote the English psychoanalyst, Mary Esther Harding, “Conflict is the beginning of Consciousness” In other words, it should be the first step towards improvement. It is broadly accepted that protecting vulnerable children is not easy. And it certainly is not an exact science. Nora Gibbons summed this up succinctly in the recent Roscommon Report when she said, “Child welfare and protection work is challenging. Child welfare and protection work carries risks. It is not easy to get it right. No person or system will get the balance right all of the time.”

That being said, the HSE acknowledges that our response in the Roscommon case had many shortcomings. I am certainly satisfied that in all of our engagements with the media on child care issues we have shown that we are acutely aware of the shortcomings that exist in how we deliver our services currently. That being said, and I may have a certain prejudice, but I can find little evidence in recent media coverage which highlights the process of significant change underway as

part our child-care programme including the recruitment of 200 additional child care social workers, standardising work practices and introducing a dedicated IT system.

Care System It is never a good day for any child who has to enter the child-care system as it means serious difficulties have arisen for them in their home lives. It is important that the child, their family,

44 Health Matters

children and the media

and society in general can have confidence in the care system that the vulnerable child enters. It is this confidence that the media shapes. I am not suggesting that such confidence can be absolute. However what is critical is the right of children and their families to have their confidence appropriately and objectively informed. If one child dies while in the care of the State – it is one child too many. However, children die for many and varied reasons. Despite much of the negative media reportage over many years, the story of child welfare and protection in Ireland, in many instances, is a good news story. In Ireland today, there are approximately 5,600 children in the care of the State. Of this number well over 90 per cent are living with foster families, or relatives who have become foster parents, to provide them with a loving, appropriate, and in the vast majority of cases, happy and fulfilled lives. A smaller percentage are cared for in residential or specialised facilities by staff whose dedication would be difficult to articulate. The vast majority of media reportage and interest is focused on this smaller number of vulnerable children. Unfortunately, the good news story, the one that can generate confidence in the system concerning the 5,000 plus contented children, is seldom carried in the Irish media.

Media The media plays an important role in the context of child welfare and protection in Ireland and has done so for many years It acts as a watchdog for society, holding accountable government and institutions, such as the work of my organisation the HSE. It also has an important role in terms of providing information to educate the public. For example, providing useful advice to children that can help them to protect themselves or creating awareness amongst the public with respect to looking out for tell-tale signs of child abuse or neglect in the community and to know what steps need to be taken.

“Despite much of the negative media reportage over many years, the story of child welfare and protection in Ireland, in many instances, is a good news story. In Ireland today, there are approximately 5,600 children in the care of the State.”

The media should provoke and stimulate an objective and balanced debate about this important topic throughout society for the betterment of child welfare and protection. Well considered media discourse also has the potential to influence policy and how services are delivered. There is little doubt that the attention to the Kilkenny incest case and the Madonna House Inquiry in the first half of the 1990s influenced the speed of implementation of the Child Care Act in 1991. So this short paper hangs on the following question:Is the media reportage in Ireland of benefit to child welfare and protection or is it damaging? In its watchdog role the media provides a very efficient and worthwhile service to society. For example, it’s constant reportage of inspections of care homes and foster care reviews. While it is often uncomfortable for the HSE the media asks the hard questions and keeps us on our toes across a whole range of child-care services. A good recent example is the media coverage surrounding foster families in November 2008 where the public were “educated” – with the help of the media –

about the benefits of fostering. This resulted in an eight-fold increase to the number of people visiting the fostering page on www.hse.ie It also translated into a big up-take of applications to information evenings in Dublin, Cork, Limerick, Wicklow and Carlow. One of my concerns is whether a fiercely competitive media environment is resulting in important information about vulnerable children becoming infotainment Or put another way – when does providing information to raise awareness and objectively inform people begin to impinge on the rights of the people involved (especially those of vulnerable children) This is an extremely fine line that must be considered but we will always say the line stops where it impacts on the welfare of the vulnerable child.

Children in Care Portraying the HSE as some sort of a clandestine organisation merely adds to potential vulnerability of future children in care as families in need of support - and foster families could decide not to trust us and decide not to come forward to us. I think we all have to accept that there can never be a one-size-fits-all way of dealing with the media’s requirements and yet protecting the welfare of children in care. Let me explore this point by looking at two categories of children in care, based on recent cases, and how the media report on them. The first category I want to mention involves children in care who have died. Recent examples include the well reported cases of a young mother and a youth, both in our care. In my opinion, the identities of children such as this remain protected by the Courts in death and as such it presents us all with some conflict as to whether or not we should be naming them in any forum. However, there was vast media coverage of their identities and prurient details of many aspects of their misfortunate lives earlier this year Once again, I do not for one second attempt to abdicate our responsibility to

Health Matters 45

children and the media

promote and protect the welfare of all children in this State as defined by law. However, there are a number of important other considerations that need to be mentioned. What is the impact of detailed media reporting on the close family members living siblings or parents of these dead children? For example, was any consideration given to the fact that the young mother’s children will be able to read in technicolour horrific details of their mother’s life when they are older. In some situations, family members are centrally involved in providing details of a highly charged story of children who have died to the media. However, some important questions: • Who exactly is a family member? • How wide is that net spread? • What is the relationship of that member with other family members? • When the media actively engages with family members – has any consideration been given to the fact that individual family members might consider “telling their story” a good idea at the time and may regret this decision later and if so when the media moves on to the next story who supports them at that stage? • A lot of reportage carried interviews with social workers and foster families – who provided graphic details of the lives of certain children in care. Has any consideration been given to impact that such reportage has on the 5,600 other children in care? Are they asking: • Can I tell my foster parents anything private and sensitive about me in confidence? • Can I trust that my foster parents will not be out tomorrow to the media describing the details of my life? Let’s not forget that many of these children are likely to be very untrusting of society anyhow and a scenario such as this is exactly what they don’t need. Let’s similarly not forget that there are close to 1,000 social workers responding to children and families in our system today. Like any large organisation, we have professionals who do not go that extra

mile that is required but invariably our experience is that the vast majority of our social workers working with children and families really go beyond the call of duty to protect their charges. It is important that media reportage of child-care reflect this. It will not benefit the care of vulnerable children in Ireland if this class of professional is not trusted by the families who most need support.

Conclusion I think we have learned significant lessons in this area over the past twelve months. And I think we can all work together in a way that will best advantage vulnerable children. In this regard I recommend the following: There should exist an ongoing forum between the health services, child-care practitioners and advocates, the media and the legal system. This could perhaps give rise to the establishment of a Media/Ethics Committee. Consideration should be given to the development of a guide for dealing with the

media coverage of different categories of children in care Additionally, it would be useful to gain an insight from media outlets as to what we can do better to help you as a profession to understand the impact that negative reportage has on the welfare of vulnerable children, for example, speak to schools of journalism etc. And equally, and importantly, to help the health services to understand that media reportage is not always negative and can serve a very useful purpose. In addition to the above recommendations, I would suggest that the most helpful way forward is that in all reportage of children’s issues, that notwithstanding the public interest, we benchmark all of our questions; our answers; our commentary; our pictures; and our headlines, against one simple standard: What is in the best interest of the child?

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Health Matters 47

breast cancer

National Symptomatic Breast Cancer Services Forum The HSE National Cancer Control Programme’s Symptomatic Breast Service now has the essential elements to establish it as a world class service. Addressing the inaugural NCCP Symptomatic Breast Services Forum in Dublin in October 2010, the new Director of the Cancer Control Programme, Dr Susan O’Reilly commented on the significant improvements that had been made since 2007, pointing to the emphasis now on building on the quality of the service through regular audit and rigorous risk management.

L-R: Ray McLaughlin, Consultant Surgeon, Galway University Hospital, Jerome Coffey, Consultant Radiation Oncologist, St Lukes Hospital, Dr Claire Smith, Consultant Radiologist, Mater Hospital, Dr Susan O’Reilly, Director NCCP, Malcolm Kell, Consultant Surgeon, Mater Hospital, Tony O’Brien Associate Director, NCCP, Constantino Castineira, Consultant Surgeon, Waterford Regional Hospital

aving become the first such Irish health service to be independently audited by HIQA, the NCCP Symptomatic Breast Service emerged positively from that process earlier this year, with the independent body confirming that all the essential elements for a quality service were now in place across the eight designated cancer centres (inclusive of the satellite unit at Letterkenny General Hospital). With the final transfer of breast cancer services having taken place last December – when the new breast unit was formally opened in Cork University Hospital – the expert teams from the eight designated cancer centres recently met in Dublin for the first of what will become an annual forum to allow the sharing of good practice, the promotion of learning and the building of the network of centres to ensure standardisation and service improvement. The gathering brought together consultant radiologists, pathologists and surgeons, clinical nurse specialists, data analysts along with the NCCP clinical leads from medical, surgical and radiation oncology. With the latest data projecting a 60 per cent increase in the number of women seen by the Symptomatic Breast Services since 2006, the forum examined the challenges that such increases have posed.

Confirming that the forum will become an annual event, Dr Susan O’Reilly said that the NCCP was planning to introduce similar events for other cancers, “This is a very important milestone for the National Cancer Control Programme. It is very clear to national and international observers that Ireland has made significant strides in the development of its cancer services over the past three years. “The Forum brought together many of those individuals in the symptomatic breast service who made the plan a reality – the doctors, nurses and analysts who made the concentration into the eight centres of the symptomatic breast services work and work well. “In coming together that day, we focused on the significant experience that we now have available. This will allow for greater standardisation, greater audit and greater examination of the services we are delivering.” Ireland has already experienced a significant increase in breast cancer survival rates over the past two decades. This is expected to further improve over the coming decade through the impact of the Breastcheck and other screening programmes, the recruitment of additional specialist staff, the concentration of services at the eight designated centres along with earlier detection and improvements in technology and treatments.

48 HealtH Matters

Breast CanCer support

A Breast Cancer Support Group with a Difference the PlurABelle PADDlerS the health Promotion Department of hSe Dublin North east has recently supported the development of a new breast cancer support group in Dublin.

any patients trying to get back to “normal life” after a serious illness are disheartened to find that the posttreatment phase of their care is sadly wanting. survivors of breast cancer are no exception. Many women describe a period of uncertainty and depression, often of considerable length, after active treatment ends. their anxieties and concerns about the illness remain, but they lose contact with the medical support network.

Dragon boating in Dublin Women who have been through breast cancer have established a dragon boat paddling group to reduce the risk and effects of lymphoedema, to support one another and to improve their fitness levels. the Health Promotion Department Hse Dublin/North east in conjunction with the royal College of surgeons of Ireland have facilitated them to do this by grant-aiding the organisation to purchase one of their two dragon boats, which are based in the Grand Canal Dock. benefits of Dragon boating Physical activity has been shown not only to lower the risk of breast cancer in women but also plays a role in recovery from breast cancer. Upper body exercise can: • Improve range of motion • reverse muscle atrophy • activate skeletal muscle • stimulate the immune system • reset the sympathetic tone of the lymphatic vessels the women are a great support for each other and have also become an inspiration to other women with breast cancer, demonstrating that they too can lead full and active lives. the only criterion for joining

the group is a history of breast cancer. age, athletic ability and paddling experience are not relevant! Dragon boating is one of the few sports which engage 22 people on a team. It builds harmony and a feeling of togetherness while it still complies with the basic principles of physical activity, which means, frequency, intensity, type and time. already 120 women have joined the group. they meet for a fitness class, under the supervision of a chartered physiotherapist, over a few weeks and then they are ready to paddle.

international Dragon boating although new to Ireland, dragon boating for survivors of breast cancer is an international practice with 150 teams worldwide. these groups meet and also share ideas on how to develop their teams on and off the boats (see www.abreastinaboat.com). For more information about breast cancer dragon boating in Dublin: Visit: www.plurabellepaddlers.com email: info@plurabellepaddlers.com/ dragonboatproject@gmail.com. Mobile: 086 036 3449

Irish breast cancer survivors participate in dragon boating to support one another

Irish breast cancer survivors use dragon boating in their fight against lymphoedema

Research Laboratory at RCS I

Professor Arnold Hill at BNY Mellon Lecture Series

BREAST AST HEALTH…

Plurabelle Paddlers

ensuring more personalised treatment plans are devised for breast cancer patients. Our goal is to help support the collaborative initiative we have established with each of the breast cancer

YOUR WEALTH

centres in Waterford, Cork, Limerick and Dublin, thereby enabling us to create the country’s first national Breast Cancer tissue biobank, which will in turn speed up discovery and ultimately translate our research into more effective and efficient treatment for patients diagnosed with this disease.

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

HOW YOU CAN HELP

developing the disease.

Funding research is paramount in our race against this deadly disease. Our goal is to transform breast cancer from often being a deadly disease into a chronic illness that can be maintained through treatment.

In light of this, the Royal College of Surgeons in Ireland has committed to developing a Breast Cancer Research

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Programme, funded by its charity, Breast Cancer Ireland.

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50 Health Matters

sleep

Sleep Medicine

Patients with sleep disordered breathing rarely notice shortness of breath or difficulty breathing at night, because (by definition) they are asleep during the episodes. However, the bed partners frequently describe loud snoring, periods of â&#x20AC;&#x2DC;breath holdingâ&#x20AC;&#x2122;, gasping, snorting, grunting and or restlessness during sleep says Aisling McGowan, Chief Respiratory Scientist, Connolly Hospital, Blanchardstown.

ll animals know how to sleep and it is a natural repair building time for the body. It restores energy levels and regulates growth hormone, improves mental function so we are less irritable, and improves memory. Fatigue and drowsiness are common in modern life. Car crashes, prescription errors, and a multitude of devastating financial and industrial accidents due to human error mainly occur because of fatigue, poor concentration, or excessive sleepiness. Poor sleep hygiene (having a late or irregular bedtime, shift work, late night meals, or jet lag) and lifestyle choices contribute to poor sleep patterns and many Irish people suffer from medical conditions which interfere with their nightâ&#x20AC;&#x2122;s sleep.

Sleep disorders Sleep Medicine is the study of disorders with a significant sleep-related component. Up to one in seven people have a chronic sleep-related complaint. About one in three complains of an intermittent sleep problem. Indeed, sleep disruption is one of the commonest complaints to a general practitioner. Other symptoms include difficulty getting to sleep, difficulty remaining asleep, early morning wakening and awakening unrefreshed often with headaches. However, there are other symptoms due to sleep problems, that may not appear directly related to lack of sleep or lack of good quality sleep. Some patients just report continuous fatigue or tiredness

Health Matters 51

sleep

during the daytime; some are very sleepy during the day and indeed can fall asleep unexpectedly and when doing repetitive monotonous tasks (at work, in public places and even driving). Some because of sleep deprivation may experience shortterm memory loss and a reduced ability to concentrate. Sleep deprivation causes irritability, anxiety and depression and reduced libido. This is frequently not apparent to the patient themselves but may be to their partner. Not uncommonly, the bed partner of a patient with a sleep disorder describes the patient as having changed over the years – ‘He’s not the man I married.’ Sleep disordered breathing is a common source of tension in a relationship, causing bed partners to sleep in separate rooms.

Sleep Apnoea Sleep apnoea is a sleep-related breathing disorder (Apnoea means a stop or pause in breathing). Obstructive sleep apnoea syndrome (OSAS) is a common condition in which airway collapse causes recurrent and frequent pauses in breathing during sleep. OSAS affects about four per cent of the adult population and one per cent of paediatric population. Obstructive sleep apnoea is very common, affecting 1 in 25 men and 1 in 50 women in western countries. It is estimated that over 100,000 people in Ireland suffer from obstructive sleep apnoea.

Apnoeas during sleep are thought to be due to loss of tone in the muscles of the soft palate, tonsils and tongue during sleep, narrowing the airway so much that it closes. When it occurs, breathing stops for several seconds, the oxygen supply to the body and the removal of carbon dioxide by the lungs is interrupted until (under the influence of low blood oxygen levels) the brain partly awakens to re-open the airway and restart breathing. This can occur hundreds of times each night in people with severe OSAS. Sleep disorders occur during sleep, so the patient does not realise that their breathing is seriously compromised.

Snoring Snoring is not only a sign of possible sleep apnoea, snoring is a very common sleep disorder that interrupts a good night’s rest. Snoring affects one in four men and one in ten women. Other common sleep disorders include periodic limb movements (which is a cause of restless sleep associated with daytime fatigue), affecting 1 in 15 adults. Narcolepsy is also common affecting 1 in 2000 to 1 in 4000 people, as per international studies, and by extrapolation, it is estimated that 1,000 to 2,000 are affected in Ireland.

Many sleep disorders are non-life threatening conditions but can affect the heart as it has to work harder when the body is deprived of oxygen, this can result in serious problems such as heart failure. Consequences of non-treatment of OSAS include fatigue, hypertension, cardiac disease, stroke, diabetes, sudden death, Road traffic accidents.

Managing sleep disorders Sleep disorders impact greatly on your quality of life and can be easily managed and there are a number of self care actions that you can take as well as a number of treatments that may be suggested by your doctor Lifestyle can also impact on the condition; sedentary jobs, obesity, high stress levels, anxiety, depression, illness, pain use of cigarettes, alcohol, caffeine, anti-depressants and sleeping pills. A sleeping environment with bright lights and loud noise provides poor sleeping conditions. Risk factors for OSAS are obesity, abnormal anatomy of the upper airway, endocrine disorders, cardiovascular disease and postmenopausal status. Weight loss can result in improvement or disappearance of the sleep related breathing problems, although up to 30

“Snoring and apnoeas are often more pronounced when people sleep on their back so changing sleeping position to your side can help.” +

Dr John Faul and sleep medicine team at Connolly Hospital, Blanchardstown

52 Health Matters

sleep

“The first sleep lab was set up in Ireland in 1985 and over the intervening years other labs have been established due to the increase in the waiting times for the diagnostics procedures and the increase in the awareness for the disorder.” per cent of patients with a sleep disorder are not overweight. Snoring and apnoeas are often more pronounced when people sleep on their back so changing sleeping position to your side can help. Patients should also reduce or cut out alcohol and caffeine several hours before bedtime and follow well defined patterns for good quality sleep.

Diagnosis of sleep OSAS The primary investigation used to diagnose sleep disorders is called a polysomnogram. A polysomnogram is best carried out in a sleep laboratory during an overnight stay in hospital. This is a highly-specialised procedure regarded as the “gold standard” requiring specialist training and expertise. The test records length and quality of sleep, breathing pattern, position of the body and heart rate and rhythm, snoring, oxygen levels, leg movements. Data recorded is analysed by the respiratory scientist and reported by the doctor. The quality of sleep, number, type and sleep stage of apnoeas are recorded, level of oxygen deprivation, leg movements, all confirm how severe the sleep disorder is and an appropriate treatment plan can be prescribed. Medical treatment A doctor may recommend an effective

treatment for OSAS which involves using a continuous positive pressure (CPAP) device which gently pushes air through the nose to prevent airway collapse in effect maintaining airway patency. This treatment can be continued for months or even years. Once a patient is trained in how to use the device, this is a very effective form of treatment for most patients. Oral appliances (mandibular advancement devices) can also be used in the treatment of OSAS to help enlarge the airways by advancing the lower jaw while sleeping, and they are custom made to fit the mouth. Education is an important part of the treatment. Providing the patient with advice on lifestyle changes and compliance with treatment is essential for success. OSAS is a common disorder that can have major effects on your quality of life. However, the disease is easily treated and most patients experience a dramatic improvement in their quality of life, often from the first night on treatment. Patients with untreated OSAS have an increased probability of having a road traffic accident due to sleepiness at the wheel. This is important for professional drivers and other road users. Patients who are successfully treated for OSAS no longer pose a traffic risk. Surgery is employed where there are specific abnormalities in the patient airway anatomy that are the cause of sleep disordered breathing. It also has a role in carefully selected patients who are intolerant of CPAP or mandibular advancement devices.

“Sleep deprivation causes irritability, anxiety and depression and reduced libido.”

National status The first sleep lab was set up in Ireland in 1985 and over the intervening years other labs have been established due to the increase in the waiting times for the diagnostics procedures and the increase in the awareness for the disorder. Sleep medicine is a multidisciplinary speciality involving different medical specialitists including; respiratory physicians, paediatricians, psychiatrists, neurologists, ENT surgeons, and dental specialists as well as scientists, and nurse specialists, nutritionists. Approximately 7,000 patients have been diagnosed nationally out of a suspected 100,000 sufferers within the HSE and private hospital sectors. In the HSE, there are 16 labs (13 adult and 3 paediatric). Dublin has five labs and eight others are based around the rest of the country. Demand for tests outweighs capacity and therefore has resulted in very long waiting times of up to one year and more. However, once tested and diagnosed the patient commences treatment without significant delay therefore successfully treating the condition and limiting there risk for developing additional health problems. CONTACT DETAILS: Sleep Medicine Service Connolly Hospital Blanchardstown Dublin

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54 Health Matters

sleep

Life before and after treatment by Mark Pentony

In early 2009, I was diagnosed with Obstructive Sleep Apnoea (OSA). A detailed questionnaire and extensive respiratory testing in Connolly Hospital, including an overnight session with an array or sensors and recorders, confirmed that I had OSA. I had not considered that the health problems I was experiencing were being caused, in part by OSA. At 47, I had very high blood pressure, was constantly tired, could sleep at the drop of a hat in an armchair, snored like a trooper, night sweats, was substantially overweight and woke a number of times each night, sometimes four or five times, to go to the toilet (nocturia). I had suspected a prostate problem but this was ruled out. I started using the CPAP machine in April of 2009 and from the very first night the improvement was amazing. The apparatus is a little cumbersome and the machine made a little noise but nothing compared to the snoring! It was as if a fog had lifted. I had a lot more energy and could think clearly and was sleeping without interruption for the whole night. I had a substantial decrease in my BP and am now tackling my weight and have the energy to exercise again. Having four children you learn to live with interrupted sleep when they were small, but as they started to get a full night sleep I continued having interrupted sleep. The approach of Prof Conor Burke and Dr Liam Cormican and their team is excellent. It is holistic and thorough and examines all symptoms and looks at the complete patient and their lifestyle, not just the presenting symptom. Since starting with the CPAP machine I have completed a further postgraduate diploma, something I could not even considered in my sleep deprived state.

Dr John Faul

Connolly Hospital Sleep Service The sleep service at Connolly Hospital Blanchardstown was established in 2006 for the surrounding population of approximately 290,000 people. This is the only sleep laboratory in this area. The service is provided by an experienced team which includes two Sleep medicine consultants, Dr Liam Cormican and Dr John Faul. While I, as the Chief Respiratory Scientist, manage the respiratory staff. The service complies fully with national and international sleep guidelines to provide a high quality service. Patients are referred by both GPs and hospital consultants. The patients are fully assessed at their initial visit (questionnaires, detailed history, physical examination, co-morbidities, sleep profile and sleep hygiene are documented) and some have appropriate diagnostics tests (lung function, chest X-Ray, blood tests) including an overnight stay in hospital in some cases. The sleep study is setup and analysed by the scientists and reported by the Sleep Consultants. The patients return to the clinic for their results and are then prescribed the appropriate treatment which is provided by the nurse specialist team. Sleep Medicine is a high turnover specialty. It makes excellent sense in terms of staff and bed utilization in the current constrained budgetary environment in which we work. Most importantly, it offers us a huge opportunity to improve quality of life and health in those affected and we are keen to continue to expand this service. At Connolly Hospital, we intend extending the therapeutic options available to our patients to include bariatric surgery. For further information please contact: Aisling McGowan - Chief Respiratory Scientist, Connolly Hospital, Blanchardstown, Dublin 15. Tel: 01 646 6160.

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Health Matters 57

sleep

Driver Tiredness Contributes to

one in five Deaths in Ireland Research has shown that tired drivers are a major road safety risk, both to themselves and to others says Noel Brett, Chief Executive of the Road Safety Authority.

ne-in-ten people admit to falling asleep while driving, according to research conducted by the Road Safety Authority (RSA) earlier this year. Drivers are more aware of driver fatigue and the dangers associated with it; however some continue to drive while feeling sleepy. Seven-in-ten people (67 per cent) now take breaks within two hours of driving compared to 53 per cent in 2008, which shows drivers are changing. This is a positive shift in behaviour, as research tells us that driver fatigue could be a contributory factor in as many as onein-five deaths in Ireland.

“While the majority of people who suffer from driver fatigue do so from a basic lack of good quality sleep, there is a group in society that suffers from sleep related disorders. This results excessive daytime sleepiness and places them in the high risk group for falling asleep at the wheel.”

Drivers between 35 and 54 years of age are most likely to drive for longer periods without taking a break. Four thousand deaths

in Europe every year are as a result of driver tiredness. Collisions in which tiredness is a contributory factor are three times more likely to result in death or serious injury. Noel Brett, Chief Executive, RSA commended those that have changed behavior and pull off the road when they are feeling tired. “It is great to see some drivers pulling over if they feel tired and taking a break, however there are still many that drive on. Driver fatigue contributes to road deaths just like any of the other dangerous driving behaviours. Stopping to take a nap or having a cup of coffee can make a huge difference.” Research conducted by the RSA found more than 40 per cent of drivers still open the window when driving to keep awake. However, opening the window has no effect on driver tiredness. Female drivers are more likely to pull over and rest than male drivers according to RSA research. Professor Walter McNicholas, Director, Sleep Disorders Unit, St Vincent’s University Hospital and President of the Irish Sleep

Society highlights the implications for driving by those suffering from a sleep disorder. “While the majority of people who suffer from driver fatigue do so from a basic lack of good quality sleep, there is a group in society that suffers from sleep related disorders. This results excessive daytime sleepiness and places them in the high risk group for falling asleep at the wheel.” Drivers who have fallen asleep at the wheel have a one in four chance of falling asleep again. This shows that drivers may not change their behaviour even after they have experienced falling asleep at the wheel. Charlie Mitchell who lost his brother because he fell asleep behind the wheel has asked drivers to pull over if they feel tired. “Don’t let this happen to someone you love. If you feel tired when driving, do something about it to make sure you get home safely.” For more information on driver fatigue consult the RSA ‘Driver Tiredness – The Facts’ booklet, which can be downloaded from the RSA website at www.rsa.ie

58 Health Matters

genio trust

Changing Lives across the Country More than b3.6 million in innovation grants have been awarded from the Genio Trust to disability and mental health projects across the country.

new organisation called the Genio Trust has combined government Health Innovation funding with an investment by Atlantic Philanthropies to back innovative disability and mental health projects across the country.

What is the Genio Trust? The Genio Trust was established in 2010 in order to foster innovation which supports people at risk of social exclusion to live full lives. Specifically, the Genio Trust has been developed in the context of converging interests on the part of government agencies; philanthropists, private investors and corporate bodies; and non-governmental agencies. The Trust is currently focusing on disability and mental health. People with disabilities and mental health difficulties need opportunities to achieve the life that’s right for them, supported by their families, friends and communities. Innovative projects supported by the trust are being carried out by voluntary and statutory organisations which are dedicated to providing individualised supports. These projects are tapping into, and unleashing the competencies and abilities of people with disabilities and mental health difficulties. Finbarr Flood, Chairperson of the Genio Trust and John Moloney TD, Minister of State with responsibility for Disability and Mental Health, announced in October, the allocation of 50 grants across Ireland from the Genio Trust, totalling more than b3.6 million. This followed a commitment by Minister Moloney to a b3 million Innovation Fund in the 2009 HSE Vote to support people with disabilities and mental health difficulties to live full lives in the community. The Genio

Trust combined government funding with an investment by Chuck Feeney’s Foundation – The Atlantic Philanthropies. At the announcement of the grants the Minister stated, “Ireland has a vision for people with disabilities and mental health difficulties to live as included and valued members of society; as citizens with a right to choice; and as contributing members of their communities. This is reflected in our national policy and grants are being awarded to initiatives who share this vision.” The Genio Trust is working with the HSE, the Office for Disability and Mental Health and Department of Health and Children to allocate the funding to projects which align with national mental health and disability policy.

What types of projects are being supported? Applications to the Trust were invited by

“Ireland has a vision for people with disabilities and mental health difficulties to live as included and valued members of society; as citizens with a right to choice; and as contributing members of their communities.”

advertisement in national press in April 2010. In total, 383 applications were received from across Ireland, from initiatives in both rural and urban settings, spanning different types and levels of disabilities and mental health difficulties and reflecting all phases of the life cycle. The Genio Trust awarded grants to 50 of these projects. Over 100 people will be supported through 17 of these projects to become more independent in the community where they belong, some of whom will be moving from institutions. These include individuals with mild to significant support needs. Other grants will support projects that develop and build on the skills of people with disabilities and mental health difficulties and their families, empowering them to take control of their own lives, strengthen and build networks of support comprising family, friends and neighbours, and provide support and training to service providers to allow them to offer more flexible, individualised supports to service users. The traditional approach of grouping people together in an effort to ‘fit’ them into available services, rather than designing customised services around the individual, usually leads to significant compromises, notwithstanding the dedication and commitment of staff involved. These projects are highlighting ways to achieve better value for money, by basing resources on individuals’ needs rather than a standardised ‘one size fits all’ approach. Pat McLoughlin, Chairperson of the Local Government Efficiency Review Group, CEO of the Irish Payment Services Organisation and Chairperson of Genio emphasises, “By moving to a more flexible system of resource allocation, which offers a better match between needs

Health Matters 59

genio trust

and services, individuals gain greater independence and resources can be used to best effect in the interests of those requiring support.”

What is the future of the Genio Trust? Thousands of people continue to receive traditional services, many still living in institutions, which isolate them from society. However, many service providers are working with individuals to put supports in place, which enable them to achieve the life they want to live. The Genio Trust is being developed further in partnership with those already working on the ground, to ensure that as many people as possible are given the same opportunity. Finbarr Flood, Chairperson of the Genio Trust concludes, “There are examples of very positive and innovative work being carried out around the country supporting people to live as included members of their communities. It is our responsibility as a society to ensure that every individual has the same opportunity.” It is hoped that the Trust will continue to forge alliances in the coming years between the public, private and social sectors. For more information visit www.genio.ie or email info@genio.ie Genio will be facilitating learning events throughout 2011 based on the work of the projects supported through the Genio Trust. Details will be available on the website. The Board or Trustees of the Genio Trust are: Mr Finbarr Flood (Chairperson) Dr Ruth Barrington Dr Edmond Molloy

arguerite Mahon, a young woman from Dublin has spent the last 12 years living in a residential centre for people with intellectual disabilities, segregated from the local community. For the first time in her life, she has moved into her own apartment, started a part-time job and has become engaged with mainstream society. With the

support of her service provider and the local community, she now has the independence she always wanted.Marguerite’s story is just one example of the many lives being changed through innovative initiatives across the country undertaken in partnership with voluntary and statutory providers and supported by the Genio trust.

+ L-R: John Moloney TD, Minister of State with responsibility for Equality, Disability and Mental Health, Finbarr Flood, Chairperson of the Genio Trust and Madeleine Clarke, Executive Director of Genio highlight the 50 projects supported by the Genio Trust across Ireland

+ John Moloney TD, Minister of State with responsibility for Equality, Disability and Mental Health talks to Tanya Byrne and her support worker. Tanya is moving from an institution into her own home with support from the Genio Trust

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Health Matters 61

health research board

Making big strides to tackle preeclampsia Irish researchers help identify biomarkers which should lead to a simple blood test to identify women at risk of developing preeclampsia later in their pregnancies.

rof Louise Kenny, HRB Clinician Scientist at the Anu Research Centre at Cork University Maternity Hospital explains, “The Health Research Board has funded Ireland’s participation in the SCOPE project (Screening for Pregnancy Endpoints). This is an international trial of approximately 7,000 women with first-time pregnancies, which aims to predict and prevent the major diseases of late pregnancy. As part of this project we were able to identify 14 different bio-markers which seem to accurately predict women who are at risk of developing preeclampsia later in their pregnancy.” Preeclampsia is a life-threatening condition which affects four or five per cent of pregnant Irish women. It is characterised by high blood pressure, swelling that doesn’t go away and large amounts of protein in the urine. It can prevent the placenta from getting enough blood which in turn prevents the developing baby from getting enough oxygen and food. “Everything we know about this condition suggests women do not become sick and present with preeclampsia until late in pregnancy, but the condition originates in early pregnancy. To develop effective treatment and prevention strategies — our ultimate goal — we need to be able to start treatment in early pregnancy. We need to be able tell who is at risk and who is not. Developing a predictive test for preeclampsia has been called the Obstetrics’ Holy Grail”, says Prof Kenny. At the minute, the best way to protect both mother and baby is to deliver the baby. However, depending on the stage of the pregnancy, it may simply be too early to safely deliver the baby when the symptoms manifest themselves. In that case, close supervision of the mother and

baby is necessary along with bed rest and medicines to control blood pressure. Most women with preeclampsia in the developed world go on to deliver healthy babies. However in the developing world, this is not always the case and preeclampsia is a leading cause of maternal death. The World Health Organization estimates that from 100,000 to 200,000 women die each year as a direct cause of preeclampsia. The next step is to develop a simple, inexpensive blood test that will be available to all pregnant women and that will identify all those at risk of developing this life threatening condition. We hope that this will be available within the next five years.

“The World Health Organisation estimates that from 100,000 to 200,000 women die each year as a direct cause of preeclampsia.”

The research team at Cork University Hospital – Back row; Joanna Teahan Dillon, Áine Gallagher, Jackie Kelly, Dr David O’Leary, Dr David Broadhurst. Front row; Nicolai Murphy, Professor Louise Kenny and Emma Snapes

62 HealtH Matters

News // dublin north east

SoilSE partiCipantS prESEntED WitH fEtaC aWarDS

+ l-r: eimear ni sheachnasaigh, supervising Pharmacist, Boots retail (Ireland) ltd, staff from Our lady's Hospital, Marie McConnell, CnM2, Jackie Meredith lynch, Clinical nurse specialist in smoking Cessation, Finola O’sullivan, Health Promoting Health services Coordinator, Dr Kate McGarry, Consultant Physician, Daisy Maria Gamis, Cardiac rehabilitation Coordinator ann lister, assistant Director of nursing, Janis Morrissey, Dietician, Irish Heart Foundation and regina tevlin, Clinical nurse specialist in resuscitation training, Our lady’s Hospital

Heart DIsease anD strOKe InFOrMatIOn evenInG OUr laDy’s HOsPItal in navan, in conjunction with the Irish Heart Foundation, hosted a Heart Disease and stroke Information evening for members of the public in Meath in October.the evening was one of a number of events which were held throughout Ireland in support of the Irish Heart Foundation’s ‘Go red for Women’ campaign. the ‘Go red for Women’ campaign aims to raise awareness of heart disease and stroke among women, to help women understand their risk and inform them of how they can reduce their risks and protect themselves from heart disease and stroke. On the night Hse staff provided information on heart disease itself – how it occurs and what can be done to minimize the risks. a former patient of Our lady’s Hospital, navan shared her positive experience of cardiac rehabilitation – she recounted her personal journey from her attendance at the emergency Department to full recovery.

Pat Carey, tD, Minister for Community, equality and Gaeltacht affairs presented FetaC certificates to successful participants at the soilse awards night. soilse is the Hse addiction rehabilitation service in north Dublin. soilse provides programmes for people who are in recovery from addiction. this includes individuals who are on methadone and those who are drug free. Gerry Mcaleenan, Head of services with soilse said: “We work to address the individual’s addiction, to create an understanding of how addiction affects all aspects of the person’s life and to show how drug dependency can be dismantled.” soilse has been a recent recipient of aontas and nala awards and is a FetaC quality assured centre. last year, the service worked with 150 people and is regarded as a leader in addiction rehabilitation.

CHIlDren’s BOOK OF reMeMBranCe a ‘CHIlDren’s BOOK of remembrance’ to commemorate babies and children who have sadly passed away, commissioned by the special Care Baby Unit and Paediatric Department of Cavan General Hospital was opened at a special service of remembrance. Julie sheridan, CnM2, Paediatric Ward said: “the ‘Children’s Book of remembrance’ is a safe place for families to place the names of their baby or child. Details have been gathered over the last 12 months from some families who have experienced loss spanning from early miscarriage right through to early adulthood.” “One of the biggest fears bereaved families face is that the memory of their baby or child might be forgotten”, said louise Dempsey, staff nurse, special Care Baby Unit. “By adding a child’s details to the Book of remembrance you will create an everlasting

memory that will live on in time.” the ‘Children’s Book of remembrance’ will be respectfully kept in a locked display cabinet in the Hospital Oratory at the hospital where it can be viewed by arrangement. Funding for the ‘Children’s Book of remembrance’ came from donations of families and friends of the special Care Baby Unit and friends of the Children’s Ward charity fund. the special service of remembrance also commemorated both International Baby loss Day, which is held for families who have lost their babies through miscarriage, stillbirth or neonatal death and the Children’s remembrance service for families remembering their children who have passed away.

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Dublin north east // News

New Coronary Care Unit opens at Drogheda The new state-of-the-art Coronary Care Unit (CCU) at Our Lady of Lourdes Hospital opened in September. The CCU is central to the provision of high quality care to acutely ill cardiac patients suffering from conditions including myocardial infarction, acute coronary syndromes, arrhythmia and heart failure. Emergency cardiac + L-R: Dr Doiminic Ó Brannagáin, Clinical Director, procedures such as pacemaker insertion Louth/Meath Hospital Group, Margaret Swords, Group can also be performed in an x-ray General Manager, Louth/Meath Hospial Group and equipped cardiac procedure room that is Dr Paul Keelan, Consultant Physician part of the unit. The CCU has eight fully equipped suites for individual patient occupancy with en-suite facilities. In addition, there are five rooms for step down patients requiring less intensive care. The new unit is approximately 1,150 square metres in size and signifies a major increase over the existing department. All CCU beds are served by a suspended pendant that is the latest in hospital technology. Each room has a sliding glass door to allow maximum patient visibility from a central nursing station. The total cost of equipping the new Coronary Care Unit was b1.2 million. The expanded unit will allow for enhancement of cardiology services and will meet the increased demand created by the re-organisation of acute hospital services in the North East.

+ John Moloney, TD, Minister for Disability and Mental Health pictured with Mary O’Connor (left) and Catherine Quinn (right), clients of St Joseph’s Intellectual Disability Services at the official opening of Knockamann

Opening of Knockamann Development Knockamann, the new residential development for clients of St Joseph’s Intellectual Disability Service, Portrane was officially opened in October by Minister for Disability and Mental Health, John Moloney, TD. Knockamann is a customised residential development comprising of 10 six-bed houses with a capacity to house 60 residents and a comprehensive day service facility. The first 18 residents moved into Knockamann in September when three of the ten houses opened. Knockamann is unique in that it offers its clients a much improved quality of life, with greater independence and choice in everyday living. It offers them the opportunity to live with a small group of people and to have their own space within a home that is theirs alone. A Day Resource Centre also opened at Knockamann over the summer months. It offers a range of services and facilities to cater for the leisure and educational needs of residents. It also provides an access point to a range of allied health professionals.

Children’s Services Committee for Louth +

L-R Back row: Jim McGuigan, Childcare Manager, HSE, Dr Pádraig Kirk, CEO Louth VEC, Anne Marie Hoey, Local Health Manager, Louth, HSE, Chief Supt Patrick McGee, Garda Síochana Louth, Joanne Murphy, Co-ordinator, Children Services Committee for Louth, Fiona Kearney, Manager, Family Support, Shirley McDonnell, HSE Louth Local Health Office. Front row: Claire Woods, Coordinator, Louth County Childcare Committee, Marie Dullea, Office of the Minister for Children and Youth Affairs, Joan Martin, Director of Services, Louth County Council, Colm Markey, Louth Leader Partnership, Terri McCormack, Office of the Minister for Children and Youth Affairs, Nuala Colton, National Education and Welfare Board

The first meeting of the Children’s Services Committee for Louth was held in September. The group is focused on working with statutory agencies to enrich and improve the lives of children and young people in Co. Louth. The VEC, Garda Siochána, Louth County Childcare Committee, Louth County Council, Louth Leader Partnership and the National Education and Welfare Board were all invited to attend the inaugural meeting. The Children’s Services Committee was established under the auspices of the National Children’s Strategy Implementation Group and by the Office of the Minister for Children and Youth Affairs. The Committee will be responsible for improving the lives of children and young people at local and community level, through integrated planning, working and service delivery. For further information contact Joanne Murphy, Co-ordinator, Children’s Services Committee in Co. Louth. Tel: 041 987 5273.

64 Health Matters

News // South Waterford Regional Hospital Extension + Front Row, seated from L-R: Martin Tritschler (Tritschler, Tritschler and Associates, Architects), Richard Dooley (Hospital Network Manager, HSE South East Hospital Group), John O'Shaughnessy (Deputy Managing Director, Clancy Construction Ltd.), Patricia Sullivan (General Manager, WRH) Back Row, standing from L-R: Ed Fennell (Estates Manager, HSE South), George O'Neill (Project Manager, HSE South), Lila Kelly (Director of Nursing, WRH), Dr Paul Mac Mahon (Consultant Paediatrician, WRH), Brian Cooke (Tritschler, Tritschler and Associates, Architects) and Mark Doyle (Consultant, Emergency Medicine, WRH)

Kelvin Court officially opened by Minister John Moloney Kelvin Court, the HSE’s purpose-built state-of-the-art facility in Carlow for clients with intellectual disabilities, was officially opened recently by John Moloney TD, Minister for Mental Health and Disability. Built through HSE-approved capital funding, since opening its doors in February of last year, this facility replaced Kelvin Grove, which closed in July 2007. In the interim, the client group were relocated to St Dympna’s Hospital. Speaking at the official opening, Minister Moloney said, “As Minister for Mental Health and Disability, I’m especially pleased to be in Carlow to officially open Kelvin Court. I’m very impressed with how the design reinforces normal care values – including individual dignity, privacy and safety.” In thanking the invited guests (including service users and their families), paying tribute to staff and all who worked to bring the new development to fruition, Anna Marie Lanigan (the HSE’s Assistant National Director for Primary, Continuing and Community Care and Local Health Manager for Carlow/Kilkenny) said that in these challenging times, it was refreshing to be associated with a very positive development where the quality of care delivered to the service user is enhanced.

Construction of a three storey extension at Waterford Regional Hospital is now under way and will feature an expanded Emergency Department, a new Intensive and Special Care Baby Unit for the South East counties and another floor to accommodate additional medical treatment facilities. Our picture captures those associated with the project finalising the documentation.

New Chair of HSE officially opens Dungarvan Community Hospital Dungarvan Community Hospital was officially opened recently by the Chairman of the HSE, Dr Frank Dolphin. The new 32-bed unit replaces the existing St Vincent’s District Hospital and links in with the existing long-term care and rehabilitation services provided at St Joseph’s Hospital. The new facility provides GP access beds, convalescent, respite and palliative care. It also provides short-term accommodation for dependent, chronically-ill young patients. The Dungarvan Community Hospital building also incorporates facilities for the Caredoc/GP out-ofhours service for West Waterford. Day Hospital facilities were included as part of the construction and will be operational as the HSE further develops its Transformation Programme and development of other services in the community. The integrated unit in Dungarvan also provides continuing care, a dementia specific facility and rehabilitation services. Speaking at the official opening in Dungarvan, Dr Dolphin said, “I’m delighted that one of my first duties as Chair of the HSE was to take up an invitation to come and see a new state of the art facility here in Co. Waterford. I share the staff’s delight at the development and the patients I met here today are also very appreciative. It’s also great to have representatives of the Friends of Dungarvan Hospital and the local hospice group with us here, as their trojan work in the community – particularly towards helping our care giving to residents in the hospital – is co-operation we in the HSE really value.”

+ Dr Frank Dolphin, Chairman, HSE, talking to patient Cathy Murphy at the official opening of the Dungarvan Community Hospital, Waterford. Included are Paula French, Director of Nursing, Pat Healy, Regional Director of Operations, HSE South and Michael Murphy

HealtH Matters 65

south // News DInGle COMMUnIty HOsPItal resIDents MOve IntO neW HOMe SOME 43 RESIDENTS of Dingle Community Hospital moved to their new home in the West Kerry Community Hospital in October. the new hospital, built at a cost of b16.4 million, will provide a much enhanced environment for residents, staff and visitors. the new unit was designed to provide residential care for people in the region as well as a wide range of community supports, including convalescent, respite and + Patient Bridie O’Connor is greeted by her daughter Brid Foley, a care worker at the new hospice care and direct GP admissions. hospital, as ambulance crew members Paddy Michael Fitzgerald, Hse local Health Manager Cronin and eoin Flynn look on for the Kerry region, said: “this hospital has been designed and built to ensure the utmost comfort and optimal care facilities for patients now and into the future. While Dingle Community Hospital has served people in the area well and the care the residents received was second to none, the building could no longer meet the needs of those we care for. the transfer to the new West Kerry Community Hospital is indeed an emotional one for all concerned given the iconic building that is st elizabeth’s Hospital and its history since the 1840s. However the new hospital, together with the existing Primary Care team services in west Kerry, heralds a new era in heath care provision to the Dingle Peninsula.”

Sam viSitS mErCy univErSity HoSpital + l-r: Paddy O’shea, louise O’Connor, Oscar O’Connor, Derek Kavanagh and Ciarán sheehan with the staff of st anne’s (Children’s) Ward

COrK FOOtBallers, Derek Kavanagh, Paddy O’shea and Ciarán sheehan accompanied the sam Maguire Cup on a very special visit to Mercy University Hospital. the football stars brought smiles of joy to the patients, visitors and staff in st anne’s (Children’s) Ward, st Catherine’s (ICU) Ward and st therese’s (Oncology) Ward; and in celebration, staff and patients sang ‘De Banks’ to the delight of the Cork footballers.

CuH CarDiaC rEnal unit opEnS

+ an taoiseach Brian Cowen and nurse Margaret O’Mahony CMn3 chat with John Murphy from rossmore, Co. Cork in Cork University Hospital’s new Cardiac renal Unit COrK UnIversIty HOsPItal’s new b85m Cardiac renal Centre was officially opened in October. the centre will see services centralised at CUH ensuring patients have access, on one site, to the combined expertise and skills of staff who care for people with cardiac and renal conditions. the centre, which commenced construction in 2007, was handed over to the Hse in early 2010. spanning 13,000m2, over six floors, the new unit represents the most significant service development in relation to cardiology, cardiothoracic surgery and renal medicine in the region to date. this development of the centre has been a consultative process involving staff and patient representatives from the Irish Heart Foundation and the Irish Kidney association.

West COrK Carers IssUe FOrUM tHe West COrK Carers Issue forum was established following a conference held on rural Disadvantage in 2001 which highlighted the need for structured communication between health service providers and community/voluntary organisations. the Forum meets three times a year, facilitated by the West Cork Hse Community Work Department. there have been many successes to date illustrating just how effective the forum can be.

these include the award winning saoirse Unit for alzheimer care in Clonakilty Community Hospital, a waiver scheme introduced by Cork County Council and the PHn service for carers on waste collection routes. a question on carers included for the first time in the 2002 national Census meant the subsequent 2006 Census confined the caring role to the provision of personal care

66 Health Matters

News // west Áras Mhuire Community Nursing Unit receives Award

+ Mary Egan, Director of Nursing, Áras Mhuire Community Nursing Unit, Tuam, with Catering Staff who have been presented with an EIQA Hygiene and Food Safety Award; L-R: Joe Barrett, HSE Food Safety Officer; Sadie Buckley, Catering Assistant; Anne Burke Farrell, Chef; Deirdre Shortt O’Grady, Chef; Mary Egan; Philomena Treacy, Catering Assistant

Áras Mhuire Community Nursing Unit in Tuam has received a Level Three Emerald Hygiene and Food Safety Award from EIQA, the Excellence Ireland Quality Association. This is the highest level of certification in the Q Mark for the Hygiene and Food Safety Programme, and is awarded to organisations that achieve a score of 75 per cent or higher in the unannounced audit. To achieve this level, organisations will have demonstrated that they are operating at the highest levels of food safety with a focus on continuous improvement. The awards are independently audited by EIQA, the independent certification body, which promotes excellence in categories such as Quality and Excellence and Hygiene and Food Safety across businesses and organisations. The finalists in each category go through the most rigorous of audit and assessment programmes designed to produce long-term commitment to quality in every aspect of the hygiene process and service delivery. Welcoming the Award, Mary Egan, Director of Nursing at Áras Mhuire, said, “We are delighted and honoured to receive this Emerald Award 2010 from EIQA in recognition of the Standard of Excellence achieved in our Catering Department by our Catering Team. In achieving this award, we have demonstrated our commitment in providing a high-quality hygienic catering service. I commend the Catering Management and the Catering Team for their dedication and commitment in being presented with this award.”

HSE West Roscommon Host Marte Meo Conference + R-L: Paddy Gannon, Childcare Manager, Roscommon, Pauline McDermott, Social Worker in Primary Care/Marte Meo therapist, Roscommon; Guest Speaker Maria Aarts, founder of Marte Meo; Deirdre Gallagher, Team Leader Social Work, Marte Meo Therapist, Boyle; Eithne Beirne, Childcare leader/Marte Meo therapist, Roscommon; Eva Beirne, Fostering Social Worker/Marte Meo therapist, Roscommon; Colette O’Donovan, Co-ordinator, Marte Meo training centre, HSE North Central Dublin; Hilery Greenan, Child Care Leader, Marte Meo Therapist, Roscommon and Martina McGrath, Principal Social Worker, Roscommon

The HSE West’s Social Work Department and Child Care Team in Roscommon recently held a conference in Donamon Castle to promote the Marte Meo Method. Marte Meo is a method of transmitting parenting skills to families. The Marte Meo method works as an intervention by a therapist, making short video recordings of everyday interactions. The video is then analysed by a therapist and the analysis is informed by the child’s needs and questions/concerns that a parent/carer may have. As part of the Marte Meo process, the video is reviewed by a therapist and parent. In the review, information on child development and suitable measures to support developmental needs are provided. The moments where the parent supports their child’s development are highlighted and opportunity moments are identified. The opportunity moments are presented as a working point. The parent is then given time to practice the newly acquired information. Another recording is then made and analysed to show the results of this information being put into practice. Five members of staff have been accredited as Marte Meo Therapists, and the method is currently utilized in Social Work and Child Care Practice in promoting parenting skills and as part of fostering assessment.

Official Opening of Colposcopy Unit +

At the opening of the dedicated Colposcopy Unit for women at Letterkenny General Hospital in October; L-R: Patricia Hirrell, Clinical Nurse Manager; Regina McCabe, Nurse Colposcopist; Tony O’Brien, Director of the National Cancer Screening Service; Dr Eddie Boud, Consultant Obstetrician and Gynaecologist; Sean Murphy, General Manager Letterkenny General Hospital; and Evelyn Smith, Assistant Director of Nursing Service Manager

A dedicated Colposcopy Unit for women requiring further investigation following a smear test has been officially opened at Letterkenny General Hospital. The Clinic will be staffed by a highly-trained team providing a quality-assured service, and patients will be assured of more privacy and comfort in the dedicated unit. The additional space will also allow staff to cater for increased numbers of clients attending the new unit, without overcrowding. Dr Aboud, Consultant Gynaecologist/Lead Colposcopist said: “I am delighted that the Colposcopy Unit is up and running in Letterkenny General Hospital. This clinic provides a vital service to the women of Donegal and will help, both in the short and long term, to manage pre-malignant cervical disease and reduce the occurrence of cervical cancer in association with the CervicalCheck screening programme and the HPV vaccination programme.” The Colposcopy service has been provided at the Day Services Unit at Letterkenny General Hospital since 2000. Since the introduction of the CervicalCheck programme, the service has expanded and the number of patients attending has doubled. The service moved to its dedicated unit in March 2010.

HealtH Matters 67

West // News syMPtOMatIC Breast Care servICes at UHG tHe 2009 annUal report for the symptomatic Breast Care services at UHG was launched in October. since the establishment of the nCCP in 2007, the Breast Care service at UHG has expanded rapidly with additional consultant and staff appointments, infrastructure developments and the opening of a purpose-built complex, which includes BreastCheck. the Unit also includes a satellite centre at letterkenny General Hospital. Dr David O’Keeffe, Clinical Director acute services and Continuing Care (Galway/ roscommon) said, “the symptomatic Breast Unit has developed over the last six years; the radiotherapy development and oncology services now provide every component of state-of-the-art breast cancer treatments.” some key findings: • Between 2003 and 2009, the number of patients attending the unit increased from 3475 to 9671; breast cancer diagnoses increased from 110 to 529 per annum (including Breastcheck) • Over the last five years 61-68 per cent of women diagnosed with breast cancer annually have been treated with breast conservation • 61 per cent of women who do need a mastectomy are given use of immediate breast reconstruction – one of the highest rates in Ireland and the UK

+ l-r: Dr Maccon Keane, Consultant Oncologist; Dr Paul Donnellan, Consultant Oncologist; Dr Joseph Martin, Consultant radiation Oncologist; Dr rachel ennis, Consultant radiologist; ray Mclaughlin, Consultant surgeon and lead Clinician at the symptomatic Breast Unit; Prof Michael Kerin, Professor of surgery; and Dr David O’Keeffe, Clinical Director acute services and Continuing Care (Galway/roscommon). Background shows video link to staff in the letterkenny satellite unit

miD-WEStErn rEGional HoSpital, limEriCK launCHES patiEnt forum + Front row l-r: Mary King, Breda Wims, Joan Dooley, and ann O’Friel, patient representatives. Back row l-r: Deidre King DeMontano, Business Manager, MWrH limerick, Dr anton Dempsey Clinical Director, Hse MidWest, Mark sparling, General Manager MWrH limerick/Croom/Maternity, Brid Boyce, Quality Manager, Mid-West acute services, tom Clifford, patient representative, Geraldine shaw, Director of nursing and Midwifery, MWrH limerick and Fergal Flynn MidWest acute services Manager a neW PatIent forum designed to enable patients, staff and members of the public to have their say in the quality of services being provided at the Mid-Western regional Hospital, limerick was launched in september by stephen McMahon, Chairman of the Irish Patients association. the purpose of the patient forum is to further develop the strong service culture throughout the hospital, to improve the quality of services by making them responsive to the needs and preferences of patients and to facilitate a collaborative approach between hospital staff and patient representatives in the planning, development and evaluation of services locally. the patient forum aims to help improve the service offered to patients and their families through consultation and participation, by providing its members with an opportunity to exchange information and opinions on the type and quality of services being delivered at the Mid-Western regional Hospital.

PatIent InFOrMatIOn BrOCHUre laUnCHeD at MayO General HOsPItal a PatIent InFOrMatIOn brochure aimed at helping patients and their families consider a range of practical aspects about their return home from hospital was launched at Mayo General Hospital in september. the Integrated Discharge Planning process, which was developed by staff from Mayo General Hospital and the Hse’s Primary, Community and Continuing Care services in Mayo, helps to make the discharge process for patients a seamless transition from one stage of care to the next. a key target of the hospital-to-home journey is effective discharge planning to facilitate patients leaving the hospital by 11am on the day of discharge. the leaflet is available at ward level for patients and families, and stickers are also available for staff to highlight the existence of the leaflet.

+ Back row, ll- r r: ruth Hoban, specialist Co-ordinator, Mayo General Hospital; Justin Kerr, assistant Director of nursing, MGH; Mary Prendergast, Public Health nurse, Mayo PCCC; anne Canning, Physiotherapy Manager, Mayo PCCC; seamus Moran, Principal social Worker Front row, l-r: anne Boland, a/Director of Public Health nursing, Mayo PCCC; Paula McGreal, Discharge Coordinator, Mayo General Hospital; Connie Moroney, liaison Public Health nurse, Mayo PCCC

68 Health Matters

News // Dublin mid-leinster Innovative approach will achieve positive impact Boost for Mental Health Services in Laois

John Moloney TD, Minister of State for Disability and Mental Health unveils the plaque at the official opening of the HSE Laois/Offaly Mental Health Services Moorville Day Centre in Rathdowney. Pictured: Brian Gilroy, HSE National Director, Commercial and Support Services, Mary Delaney, Community Services Manager, Sean Fleming TD, Cllr Brendan Phelan, Liam O’Callaghan, HSE Regional Manager and Rosarii Wall, Nurse Manager

A new centre for mental health day services was officially opened in August by Minister John Moloney TD. The centre is providing social activation programmes for approximately 50 clients of South Laois who attend the facility. Opening the centre, Minister Moloney said: “‘The Vision for Change’ document sets out a clear objective by the State to transfer the services of mental health from old institutions to more appropriate community settings. This is one of the first steps in this process for the South Laois area. This facility will make a big difference to the lives of so many people.” The clients of the service will avail of personal development, social interaction, group therapy, one-to-one supportive therapy, occupational therapy and ongoing education on mental health issues and medication. Support is also being provided by OT staff, Substance Misuse Therapists, Psychologist and medical interventions and services are supplied by voluntary groups Grow and Shine (Schizophrenia Ireland).

A new approach to how we deliver mental health services was launched for the four counties of the midlands recently. In partnership with its voluntary partners, HSE Midlands launched a community mental health initiative which is set to enhance the focus and co-ordination of how services are delivered across the midland counties of Laois, Offaly, Longford and Westmeath. The initiative will see a reorganisation of the delivery of elements of the mental health promotion programmes with a view to delivering a number of specifically targeted programmes to key groups within the community and in line with the HSE National Suicide Prevention Strategy and ‘A Vision for Change’ – report of expert group on Mental Health Policy. The primary objective of the initiative is to foster within the community awareness that mental health is everybody’s concern and that the best way to promote positive mental health is through community response. It will increase the community’s capacity to take care of its own mental health issues in a positive way with targeted and specific support from the HSE. The approach also involves a change in the funding arrangements of service providers with financial resources being allocated on the basis of effective delivery of specifically targeted programmes to key groups of people. The key groups/areas in the community identified to benefit from the initial phase of this initiative are:

Programme A > Secondary Schools Mental Health Ireland will deliver the Mental Health Matters Programme for senior cycle students across the midlands over the next 18 months. Programme B > Community Groups GROW will deliver the Gatekeepers Community Education Programme. It is anticipated that up to 16 such programmes will be delivered over the next 18 months. Programme C > Unemployed SHINE will deliver a pilot project focussed on the development, delivery and evaluation of a targeted programme for groups of individuals who have become unemployed. Programme D > Workplace GROW will deliver a specific programme which will assist organisations/workplaces in responding to and supporting persons who are at risk of suicidal behaviour. The initiative is running from June 2010 – December 2011 (19 months). The programmes will be evaluated by the HSE involving participants and providers. In adopting this approach to providing such important services in the midlands, the HSE is confident of achieving a greater level of positive impact in our community. For further information, please contact: LHO Laois/Offaly – 057 93 59784, LHO Longford/Westmeath – 044 939 5111, or Josephine Rigney, HSE Suicide Resource Office on 086 815 7850 or 057 93 27909

+ L-R: Liam O’Callaghan, Local Health Manager, Laois/Offaly, Gerry Raleigh, General Manager, Laois/Offaly, Josephine Rigney, Suicide Resource Officer, Jutte Kirramn, Irish Advocacy Network, Kevin Smith, Aware, Finola Colgan, Mental Health Ireland, PJ Lawlor, Director of Nursing, St Fintan’s Portlaoise, Geoff Day, National Director, National Office of Suicide Prevention, Peter McEvoy, Community Services Manager, Longford/Westmeath, Deirdre Oman, HSE Finance, Minister John Moloney TD, Catherine Rountree - Shine and Brian Howard, Mental Health Ireland

HealtH Matters 69

dublin mid-leinster // neWs laOIs FaCIlIty sCOOPs tOP CaterInG aWarD + Mary Ferns, Director of nursing at st Brigid’s Hospital, shaen, is presented with a bouquet of flowers by liam Callaghan, local Health Manager, Mary Gorry, assistant national Director Hr and Gerry raleigh, General Manager. Mary is accompanied by staff of st Brigid’s Hospital, shaen

st BrIGID’s HOsPItal, shaen, Co. laois has been awarded the Gold Medal award for Institutional Caterers by the Hotel and Catering review. “st Brigid’s provides exceptional care to all their customers. Health and well-being is at the forefront of this busy catering operation. Our expert catering industry judges were bowled over by the exceptional standards and care evident across the board at st Brigid’s”, said sarah Grennan, editor of Hotel & Catering review. st Brigid’s catering provides 110 meals a day for patients, staff and meals on wheels. The catering department provides a four main meal patient service, 24-hour patient snack service and staff dining room service for breakfast, lunch and supper. st Brigid’s catering department is hailed as ‘best practice’ within the Hse and the operation is now used as a benchmark for other healthcare caterers in longford, Westmeath, laois and Offaly

neW state-OF-tHe-art FaCIlIty FOr BallyFerMOt WOrK WIll nOW commence on the new Ballyfermot Primary Care and Mental Health Centre as Minister Mary Harney officially turned the first sod on the site. located on the old Ballyfermot Mental Health Centre site, the new facility will provide a new and modern setting for continuing the work of local mental health and + Mary Harney is welcomed by Jim Curran, primary care teams in the locality. assistant national Director of Hse estates and the new centre will provide General Practitioner adrian Charles, local Health Manager for Hse facilities, Occupational therapy, Physiotherapy, Dublin south West speech and language therapy, social Work services, Public Health nursing, Dental, Community Welfare, Mental Health and provision for addiction services. the facilities will consist of a Day Hospital, Day Centre and Outpatients Clinic ensuring the Ballyfermot and lucan Mental Health teams can continue their work in the community. For the service user, it means they have the option of being treated within their home, family and community as an alternative to hospital admission. In addition, the facility will also allow for the provision of a dietician service, psychology service and be home to the three Primary Cares teams of Drummfinn, Decies road and Cherry Orchard, while also providing a base for network services for the Ballyfermot area, Chaplelizod and Palmerstown.

CEo launCHES HSE primary CarE tEam for KinnEGaD tHe CeO OF the Hse Cathal Magee attended his first official engagement in longford / Westmeath in september when he launched the Kinnegad Primary Care team. Mr. Magee acknowledged the work of the team in the area and said, “Primary Care is about delivering comprehensive care to patients and clients as close to home as possible. the team here today is a critical building block for our health service developments in longford and Westmeath. the main priorities for PCts are delivering cost-effective community-based services. a significant amount of work has already happened in the area of primary care and there are a number of major steps required in the years ahead. I look forward to returning to Kinnegad, and indeed the entire longford Westmeath area, to see your progress and future developments.” In other primary care developments, four primary care teams were launched in Bray to provide health services for a population of 34,476 in Rathmichael, Bray, Kilmacanogue, enniskerry, Powerscourt and Calary. the launch of these teams in both Kinnegad and Bray sees the number of teams operating in Hse Dublin Mid-leinster region now stand at 82, the biggest area in terms of the number of operating PCts. For further information on the Kinnegad Primary Care Team, contact 044 939 4981 and for the four Bray teams, contact liz Doyle at 0404 68400.

+ Back l-r: John Gildea, local Pharmacist and Developer of the Centre, Jim Curran assistant national Director, Hse estates, Conor ryan, GP, Declan Brennan GP, Peter Mcevoy, General Manager, Community services, Mullingar Front left to right: Dorrie Mangan, General Manager, Community services, Mullingar, Cathal Magee, CeO, Hse and Grainne nicGabhainn, General Manager, Community services, longford

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HealtH Matters 71

PSA

Public Service Agreement: HeAltH Sector ImPlementAtIon Body Pat Harvey, formerly ceo of the north Western Health Board, has been appointed independent chair of the Health Sector Implementation Body (HSIB) under the Public Service Agreement (PSA).

he Public service agreement 2010-2014 (the “Croke Park Deal”) provides a framework for public service management and staff to work together to deliver an ongoing reduction in the cost of delivery of public services, while maintaining and improving the quality of services delivered to the public, in return for commitments on pay and security of employment for public servants. It enables the health sector to protect services to our patients/users, in as much as we can, within the context of whatever expenditure decisions are made by Government for 2011 and subsequent years. last autumn, Pat Harvey was appointed as Chair of the HsIB. this Body is responsible for driving the implementation of the action plan and is required to report on progress to the implementation body chaired by PJ Fitzpatrick. the nominees to the HsIB from the health sector side are seán McGrath and laverne McGuinness from the Hse; Nicky Jermyn, st Vincent’s University Hospital; Bernard Carey, DoHC and the trade union representatives are louise O’Donnell, IMPaCt; George McNeice, IMO; liam Doran, IMNO; and Paul Bell, sIPtU. Mr Harvey said he has been impressed with the level of engagement from the unions. “the unions are saying, ‘give us the details of all the plans, set them out together with details of implications for the staff in the various settings etc and we will engage very quickly and productively to ensure progress which is in everyone’s interest’”, said Mr Harvey. He added that the implementation body

has been placing much emphasis on ‘pace’ and ‘product’ and the need as far as possible to avoid any characterisation that management and Unions are engaged simply in a ‘process’ only. In October, the Hse in conjunction with the Department of Health and Children submitted an action plan for the implementation of the agreement across the health sector to the Implementation Body. Within the action plan, the Hse identified specific areas in which it considers that quality services can be delivered more cost-effectively through the implementation of the organisational and service changes required under the Public service agreement. this requires changes in work practices and attendance patterns as well as in staffing ratios and rostering arrangements in order to increase efficiency, and to achieve significant savings in non-pay fixed costs such as overtime, premium payments and agency spend. “Management have very ambitious plans of reform and development”, said Mr Harvey. “there is a lot to be handled (and especially now against the backdrop of the redundancy/early retirement scheme) but health service providers are well used to coping with very challenging odds. this is a great time to show our form”. Mr Harvey also said there is also a critical need to capture the stories of implementation and successes. “the public need to know about these success stories; they need to be informed of the huge efforts to create efficiencies for the sake of service quality. local and

national media need to be briefed. Good news stories can be reported...they do however need to be smartly presented and conveyed! every opportunity to inform should be seized in every locality. In the final analysis, it would be too bad if despite trojan endeavours and success the public somehow missed the good news “everyone is responsible for helping to ensure public confidence”. he said. Finally, Mr Harvey stated; “as Chairman of the sectoral Implementation Body, I hope to be in close touch with all that is happening and will assist the overall endeavour, along with colleagues on the Implementation Body, in every way possible.”

72 Health Matters

diabetes federation of ireland

Living with diabetes Living with diabetes is not easy. Diabetes imposes life-long demands on people, requiring them to make multiple decisions related to managing their condition. People with diabetes need to monitor their blood glucose, take medication, exercise regularly and adjust their eating habits. As health outcomes are largely based on the decisions they make, it is of paramount importance that people with diabetes receive ongoing, high quality education that is tailored to their needs and delivered by skilled professionals writes Kieran O’Leary, CEO, Diabetes Federation of Ireland.

iabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin enables the cells to take in glucose from the blood and use it for energy. The failure of the body to produce enough insulin leads to raised glucose levels in the blood. This is associated with long-term damage to the body and the failure of various organs and tissues. There are two main types of diabetes. Type 1 diabetes is an auto-immune condition characterised by the destruction of the insulin-producing cells in the pancreas. Consequently, people with type 1 diabetes produce very little or no insulin and must inject insulin to survive. Type 1 diabetes is most commonly diagnosed in children and young adults. Type 2 diabetes is marked by insulin resistance. People with type 2 diabetes cannot use the insulin that their bodies produce effectively. They can often manage their condition through exercise and diet. However in many cases, oral medications are needed and often insulin is required. Type 2 diabetes accounts for over 90 per cent of the 300 million people living with diabetes worldwide. A third type of diabetes is gestational diabetes, a condition in which women without previously diagnosed diabetes have high blood glucose levels during their pregnancy. Gestational diabetes affects about four per cent of all pregnant women. It has few symptoms and usually disappears when the pregnancy ends. However, women who have had gestational diabetes have a significantly

“As health outcomes are largely based on the decisions they make, it is of paramount importance that people with diabetes receive ongoing, high quality education that is tailored to their needs and delivered by skilled professionals.” increased risk of developing type 2 diabetes. In Ireland, the Institute of Public Health recently reviewed their expected prevalence rates for diabetes and now predict that by 2020, 5.9 per cent (233,000) of the population will have diabetes by 2020. The Diabetes Federation of Ireland, with the continuing support of the HSE, developed their Community Orientated Diabetes Education (CODE) programme. It is a structured education programme for people with Type 2 diabetes, which is run over a six month period. It consists of four two-hour sessions, three to deliver the programme (in the first three weeks), and two to facilitate personal and professional evaluation.

The CODE programme recognises that people deliver most of their own health care. There is good evidence that the development of diabetes complications can be prevented or delayed through good control of blood sugar, blood pressure and cholesterol. It is especially important that people with type 2 diabetes self-manage their condition to reduce the development of diabetes complications in later life. CODE is an interactive programme where people with diabetes can talk in a supportive atmosphere about their diabetes for the benefit of everyone in the group. The CODE programme gives general information about diabetes and it adapts to the needs of each individual. It shows people how they can measure the effect of their own behaviour, or their medical treatment, on their overall wellbeing. During the programme, the aim is for people to change their behaviour through an agreed course of action. These changes are different for everyone and the goals reached reflect each person’s ability and needs. Since 2007, over 1,700 people have participated in the programme which is accessible nationwide via local GP centres who request the programme from the Federation. By December 2010, there will be 35 trained CODE educators nationwide making it easier for people to access the programme. Year-on -year evaluation has consistently shown that on completion of the sixmonth programme almost everyone showed improvements in their diabetes

Health Matters 73

diabetes federation of ireland

management. They learned how they could take steps to improve their diabetes and were motivated enough to adopt a lifestyle that would benefit their long term health. On completion of the programme, participants are given free membership of the Diabetes Federation of Ireland which provides them with easy access to our Diabetes Helpline, invites to ongoing education via our many public meetings and through our quarterly magazine, â&#x20AC;&#x2DC;Diabetes Irelandâ&#x20AC;&#x2122;, access to various insurance initiatives such as specified illness and whole of life cover, motor and travel insurance coverage. A similar education programme has also been developed for parents of children with Type 1 diabetes with more than 200 parents participating to date. The Diabetes Federation of Ireland also has a childrenâ&#x20AC;&#x2122;s club that supports the family of children

with diabetes up to the age of 12 years and runs teen activities each year. With the prevalence of diabetes increasing, the Federation, with the support of the HSE, raises awareness of diabetes, its symptoms and risk factors through its health promotion and awareness programme as well as funding research into finding a cure. There are 23 local support branches of the Diabetes Federation of Ireland situated around the country. Their role is to promote the aims of the Federation and provide a local support network for people of all ages with diabetes and their families. During December, the Federation is running its Tea for Diabetes initiative, which aims to raise awareness of diabetes and a healthier lifestyle among workplace colleagues over a cup of tea and raise a few euros to continue our CODE education programme. All we ask is for you to

become a T4DI party co-ordinator by simply logging onto www.diabetes.ie or call 1850 909 909 for your Tea Party pack. Remember, awareness of diabetes symptoms and risk factors promotes early detection of the condition. Early detection and management leads to a better quality of life for the person with diabetes thus avoiding the serious complications of the condition. Creating awareness is as easy as making a cup of tea. The Diabetes Federation of Ireland aims to support people of all ages living with diabetes and this can only be done with the support of our external partners. The HSE continues to support our work and we are very appreciative of its continuing support. On behalf of the Diabetes Federation of Ireland, I would like to extend to all HSE staff a Merry Christmas and a prosperous New Year.

74 Health Matters

diabetes federation of ireland

CASE STUDY: Roger Dangerfield, Mayo What I got from the CODE programme? INFORMATION, INFORMATION, INFORMATION!

y brain told me that I did not suffer from diabetes but my blood tests proved otherwise. I knew I had to change my lifestyle, but how? Attending the CODE gave me the incentive I needed. Fourteen people were brought together as a group in Swinford and our nurse, Elaine Newell, came prepared to help us understand all aspects of our diabetes care. With type 2 diabetes, we all knew our pancreas was not performing properly, but we learnt through CODE about the self help that is needed to manage our condition. During our first week, we all discussed what diabetes meant for us and it was invaluable to speak with other people who are in the â&#x20AC;&#x2DC;same boatâ&#x20AC;&#x2122;. We learnt about what blood targets are recommended for people with diabetes and other topics included an understanding of how diabetes medication works. Elaine discussed with us, in terms that we could understand, and how to unlock our pancreas to enable it to perform better. Dietary needs were discussed at length and we learnt how to read food labels to find sugar and fat contents. All foods were discussed and we became more aware of healthy choices. Physical activity generated a healthy debate in our group and we concluded that to walk, run, jog, cycle or swim for a minimum of thirty minutes, five days per week is needed to raise our heart rate, help our metabolism and reduce our weight. During the course, our weight and measurements were taken. Six months later, at our final meeting, we were

weighed again. My target was to lose weight and I found I lost fourteen pounds and two inches from my waistline. I gained a lot of information from this course. The group became self help and

we encouraged each other to recognise our condition and motivate one another to become healthier. This course should be compulsory for all people with diabetes.

Health Matters 75

diet

The sneaky saboteurs Anne Mullen sheds some light on what might be happening when you’re eating all the right foods but still can’t lose weight.

hese days most of us are either minding our weight or else actively trying to lose a few pounds. But sometimes, despite our hard work, those pounds continue to creep on. And there is nothing more demoralising than making a great effort to lose weight and getting nothing for your trouble but an even tighter waistband and yet another chin. So, what are these sneaky little habits that sabotage our best efforts to lose weight? Too busy for breakfast Mornings can be frantic and breakfast is often a casualty of the rush. And yet, breaking our overnight fast is vital. It kick starts our metabolism and so helps us to burn our calories more effectively. It also provides us with the energy we need to meet the morning’s demands. And, of course, for anyone with diabetes breakfast is essential. But I always have a good breakfast What is a ‘good breakfast’? Cereals, especially oat-based cereals (like porridge, Oatibix, Oatflakes) and wholegrain cereals (like Weetabix, Shredded wheat and Bran Flakes) and good choices as they release their energy in a slow, sustained way and so can help avoid the mid-morning munchies. Many breakfast cereals also have vitamins and minerals added to them and can be an important source of these nutrients, especially for children.

Boiled or poached egg on wholemeal toast or bread is another option with grilled bacon and sausage as an (occasional) alternative. This is also a good time to get in one of your ‘five-a-day’ – fresh fruit and vegetables. This could be a banana or some berries on your cereal, half a grapefruit, an orange or a small glass of pure fruit juice. So far so good. So where is the problem? Portion size is the main problem at breakfast time. Are your portion sizes too big? Are you having a big bowl of cereal? Watch particularly for cereals with lots of nuts and seeds and dried fruit in them, like muesli, contain very concentrated calories. Are you flooding your cereal with full fat milk, putting cream or honey on your porridge, slathering butter, spread or jam on your toast? When pouring your fruit juice are you pouring half a pint instead of a small glass? Things like this can pile on the calories at breakfast and cause your sugars to rise very rapidly. There is nothing like a nice cup of coffee! Whether working or relaxing, we all enjoy a break. Up to a few years ago, that would normally mean having a cup of tea or instant coffee. Now, we can choose between cappuccinos, frappuccinos, lattes grandes and smoothies, to name but a few. It’s great to have the choice but some of these drinks and very high in calories, particularly if topped with cream. The table shows the

average calorie and carbohydrate values of some common drinks. The values listed are for the smallest available size of each drink served. If you are reaching the the ‘grande’ version, in most cases you can double the calories and carbohydrates. THE HIDDEN CALORIES IN DESIGNER DRINKS Calories

Carbohydrate (grams)

137

121

Hot chocolate, with cream and marshmallow, regular

285

Frappuccino, crème blended, tall

340

Latte, regular Cappuccino, regular Hot chocolate, plain, regular

Americano or espresso coffee

Drink sizes: regular = 250mls; tall = 375mls; grande = 500mls

To minimise the calories, choose an Americano or espresso coffee, tea, a diet drink or water and save the rest for the odd treat or special occasion. If you want a latte, cappuccino or frappuccino, always get the regular (smallest) size. Check if it can

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Health Matters 77

diet be made with low fat or skimmed (nonfat) milk and skip the cream and the shots of flavouring syrup. Fruit smoothies are generally perceived to be very healthy, low-calorie foods as they are made from fresh fruit. However, smoothies can come with a wide range of extra ingredients including peanut butter, protein powder, honey, muesli and ‘boosts’, all of which rack up the calories. The large size (500mls) of some smoothies may contain over 400 calories and 70 grams of carbohydrate. That’s as much as a light meal! If you want to have a smoothie, get the smallest possible size and choose one made from fruit only or fruit and low fat yogurt to help bring the calories down. Because they are based on concentration of fruit, most smoothies contain high levels of easily absorbed fruit sugar, which may cause a rapid rise in blood sugar. Remember that the best way of all to have fruit is to eat it fresh as this ensures we get all the vitamins, minerals and fibre it has to offer. But I thought salads were good for me! Most of us associate salads with weight loss and diets. They are often seen as low calorie and insubstantial – ‘rabbit food’ – and the perception is that they can be eaten in abundance without fear of weight gain. But there are many different kinds of salads and some carry a lot of hidden calories. Next time you order a salad, notice how many of the choices are served in a dressing. Coleslaw, potato salad, vegetable salad, pasta salad, egg mayonnaise, almost every choice is liberally coated with a creamy mayonnaise or oily dressing. Throw in a few ounces of grated cheese for good measure and your salad probably has more fat and calories than the steak and chips you so virtuously declined. Does this mean that all salads should be avoided? No, but what it does mean is that we have to think about the ingredients contained in the salads we are eating. Some salad vegetables are almost calorie-free, for example, lettuce, tomatoes, cucumber, peppers, spring onions, radishes, grated carrot, white cabbage, beetroot, celery, pickled onions or gherkins, raw or lightly cooked broccoli and cauliflower. These can be eaten in abundance and should form the basis of your salad.

Again, research has shown that the main answer to this is portion size. No matter how healthy our diet is, if we are eating more food than we need, the result will be weight gain. Other ingredients can then be included in moderate amounts to add interest and variety, for example, fruits such as chopped pineapple, apple, melon, a few grapes, cooked sugarsnap peas or mangetout, toasted sunflower seeds, a couple of olives. Finally, the dressing. This can be the most difficult and it is worthwhile to try a few alternatives and find one that you really like. Most supermarkets carry low calorie salad dressings now or you could try making your own at home. There are a lot of good recipes around. Low-fat natural yogurt, with garlic or fresh herbs added for flavouring, is a good standby to have in the fridge. If you can’t manage without the mayonnaise, go for the low-fat version and stick to small amounts. If you make a salad like this, it is a really healthy, low-calorie accompaniment to your meal. I only ever eat healthy foods Why am I not losing weight when I only ever eat healthy foods? Does that sound like a familiar cry to you? These days most of us know quite a bit about healthy eating. We know about: Cutting down on sugar by reducing the amounts of sweets, biscuits, cakes, jams and jellies that we eat Cutting down on fried and fatty foods Having our five fruit and vegetables a day Wholemeal bread and cereals being better than white Oily fish being good for our hearts

Alcohol being okay in moderation but not in excess In fact, research has shown that people with diabetes generally follow a good healthy eating pattern. But why isn’t the weight falling off? Again, research has shown that the main answer to this is portion size. No matter how healthy our diet is, if we are eating more food than we need, the result will be weight gain. Weight loss or weight maintenance is a balancing act between the amount of food we eat and the amount of activity we get. In order to tip the balance in our favour we need to either eat a bit less or else increase our activity levels. But I never sit down for a minute… Today many of us lead such busy lives, so much on the go that it feels like we’re never off our feet. All of our energy goes into planning and co-ordinating family and work; evenings spent attending meetings, on the phone, driving from place to place dropping off and collecting; weekends catching up on chores and housework. But the sad fact is that in the midst of all this busyness we may actually be quite physically inactive. It is recommended that, for health, we should all be getting 30 minutes of moderate exercise five days a week; more if we are trying to lose weight. The challenge is finding some way to introduce more physical activity into our everyday lives. Different approaches suit different people and the key is to find what suits you. For some people, this may be regular set exercise periods at the gym, swimming pool, doing exercise or dance classes or a daily walk. For others it may be incorporating more exercise into normal activities like walking or cycling to work or using the stairs instead of the lift. For many it will be a mixture of both approaches. The main thing is to find an activity that you enjoy and can sustain. Please note when you have diabetes you should talk to your doctor before undertaking any significant change in lifestyle or exercise in order to avoid hypoglycaemia or other complications. This feature was supplied by Diabetes Ireland.

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HealtH Matters 79

heAlth & Well-being

tecHnology cAn HelP US to redUce tHe IncIdence oF high blood pressure Professor Eoin O’Brien, vice President of the Irish Heart Foundation considers four problems that are contributing to what is now being dubbed ‘the hypertension epidemic’ and says cost-effective solutions can have an immediate and far-reaching impact on the health of the nation. HOW COmmON IS HIGH BLOOD pRESSuRE? In Ireland, as in other western societies, high blood pressure (known also as hypertension) affects 30 per cent of the adult population. as blood pressure (BP) rises with age, it is not surprising to find that nearly 70 per cent of those aged 70 have hypertension. Projections indicate that the Irish population aged 65 years or older will grow by around 107,771 persons in the period 1996-2011, to represent in total about 14 per cent of the general population; many of these are likely to have hypertension. WHAT ARE THE CONSEquENCES Of HIGH Bp? High BP damages the arterial blood vessels. In the brain this results in stroke, cognitive impairment and dementia; in the heart - heart attack and heart failure, in the kidneys - kidney failure and the need for dialysis and in the lower limbs - peripheral vascular disease. all these consequences are preventable and though these illnesses are influenced by an individual’s genetic make-up, lifestyle and environmental factors, the single most important causative factor is uncontrolled blood pressure, which if

reversed would bring the biggest benefit to Irish society and the greatest financial saving to the health care system. For example, in Ireland 5,000 of the 10,000 strokes occurring annually could be prevented if BP was controlled.

THE STATE Of Bp CONTROL IN IRELAND Despite knowing for at least two decades the importance of BP control in preventing stroke, and despite having more than enough drugs available to effectively treat hypertension, the ‘rule of halves’ is operative in most european countries: only half the people with hypertension are aware that their BP is raised; of those identified as having high BP, only half are on BP lowering drugs; and of those receiving treatment, only half are well controlled. Until the publication of slÁN 2007, we in Ireland held the misguided belief that we were at least as good as the rest of europe, in other words the ‘rule of halves’ could be applied to the Irish population. In the slÁN 2007 survey, 60 per cent of respondents had high BP, of whom 57 per cent were not on medication and of those on medication, 70 per cent were not controlled in that their BP remained high even on treatment.

“Projections indicate that the irish population aged 65 years or older will grow by around 107,771 persons in the period 1996-2011, to represent in total about 14 per cent of the general population; many of these are likely to have hypertension.” WHy IS Bp NOT CONTROLLED BETTER IN IRELAND? We now have a range of most effective drugs for lowering BP so why are we not doing better? I will consider four problems that are contributing to what is now being dubbed ‘the hypertension epidemic’ and I will provide cost-effective solutions that would have an immediate and far-reaching impact on the health of the nation. INACCuRATE Bp mEASuREmENT the technique of BP measurement used in practice is renowned for its inaccuracy. Quite apart from the inaccuracy of the technique, it induces white coat hypertension, a condition in

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Health Matters 81

Health & well-being

which the doctor-recorded BP is high but BP becomes normal as soon as the patient leaves the medical environment; over 20% of patients with so-called hypertension have this condition. By contrast, the doctor-recorded BP can be normal in some 15% of patients who have elevated BP during the day or night - socalled ‘masked hypertension’. It follows, therefore, that hypertension is being misdiagnosed in as many as a third of all patients attending for routine BP measurements. We now have the methodology of ambulatory blood pressure measurement (ABPM) that overcomes the shortcomings of BP snapshots in the surgery or hospital and provides a profile of BP over the 24-hour period. In addition the technique has been adapted in at least one system to provide an interpretative report of the 24-hour plot and the ability to collect data centrally. The RAMBLER Study in Ireland (the results of which are presently being analysed) has linked over 200 primary care practices with Galway University and has shown that ABPM and central hosting system can be a feasible means of improving BP control.

Inadequate educational campaigns The public remains largely uninformed about the prevalence and consequences of hypertension. Public education is required on the relationship between blood pressure and lifestyle factors, such as dietary salt, raised body weight, inactivity and high alcohol intake. A major ‘Know your numbers’ campaign is required and the public need to be alerted to the fact that taking BP lowering drugs is not enough; these drugs must achieve BP control over the 24-hour period. Failure to involve patients in BP management Hypertension is a life-long condition and patients must be involved in management. Patients must be made aware of the consequences of high BP and the importance of lifestyle change to reduce blood pressure as much as possible without medication. Though

“Public education is required on the relationship between blood pressure and lifestyle factors, such as dietary salt, raised body weight, inactivity and high alcohol intake.” the decision to start medication may be influenced by total cardiovascular risk i.e. the level of blood pressure as well as for example the blood cholesterol level and whether or not the person smokes, the majority of patients with sustained hypertension require drug treatment. Patients should be advised not only about taking drugs to lower BP but they must also ensure that the drugs are bringing BP to normal levels during the day and night. Towards this end the dabl® system is now available in a number of pharmacies so that patients can learn about their own 24-hour ABPM and see if treatment is being effective.

Failure to prescribe adequate BP lowering drugs - therapeutic inertia In the past a number of factors have led to therapeutic inertia whereby patients have not been prescribed adequate drugs to achieve BP control; these have included side effects, cost and poor adherence to medication by patients. However, with newer combination drugs it is possible to achieve BP control in the majority of patients with no adverse effects, but the patient must be shown evidence that medication is achieving BP control over 24 hours.

Conclusion We will do much better in our management of hypertension if we make changes to current practice. If not I fear we will be overwhelmed by the cardiovascular consequences of hypertension. We must take advantage of the technological advances that are available so as to change the future health of the nation in a very costeffective way. Only by being innovative can we ensure that an ageing population will enjoy active longevity. Professor Eoin O’Brien is Professor of Molecular Pharmacology, The Conway Institute, University College Dublin, and Vice-President of the Irish Heart Foundation. Email: eobrien@iol.ie The author has contributed financially to the development of the dabl® ABPM software program for ambulatory blood pressure measurement and is a member of the Board of dabl Limited, Dublin, Ireland.

82 HealtH Matters

heAlth & Well-being

HAve yoUrSelF An AlternAtIve

ChrisTmas feasT! everyone loves dinner on christmas day and it is usually a time to really indulge with the finest ingredients, sumptuous food and multiple courses! While the traditional dinner of prawn cocktail and turkey and ham is still a favourite in most Irish households, chef rozanne Stevens suggests trying something a little different is a great way to spice up your christmas day. rozanne has kindly created an alternative christmas menu for Health matters so you can try some family food with a fusion twist...enjoy!

starters

Chinese five-spice duck salad ingredients:

2 Barbary duck breasts 2 tbsp Chinese five-spice 150g baby salad leaves 1 mango, cubed 6 spring onions, finely chopped seeds of 1 pomegranate Juice of 2 limes Few drops toasted sesame oil 2 tbsp chopped coriander 100g Brocco shoots

method:

• trim any excess fat from around the duck breasts. score the fat in a diamond pattern. rub well with the Chinese 5 spice. • lay fat side down in a medium hot pan and render out the fat until a thin crispy layer is left. turn up the heat and seal

the breast from the other side. • Mix the baby leaves, half the coriander, spring onions and Brocco shoots together. arrange on a large platter or individual plates. • When the duck breasts are cooked to medium rare, remove from the pan and allow to rest for 10 minutes. thinly slice and return to the pan. • squeeze the lime juice over and stir over a medium heat until the duck is cooked to your liking. Duck breast should be served medium rare. • arrange the duck on the bed of salad, scatter over the mango and pomegranate seeds. Pour over the juice and toss gently. • Garnish with the rest of the coriander, spring onion and Brocco shoots. • sprinkle over a few drops of sesame oil.

HealtH Matters 83

heAlth & Well-being

MaIN COUrse

Venison with Chocolate Chilli sauce

ingredients:

Venison steaks or 1 haunch of venison 4 tbsp olive oil 2 cloves garlic, crushed thyme sprigs Black pepper Chocolate Chilli sauce 1 bottle very good red wine, (I suggest using a shiraz) 1 shallot, peeled and halved 4 juniper berries Pinch chilli flakes 4 black pepper corns 1 bay leaf 100g good quality 75% cocoa chocolate 1 beef stock pot 50g cold butter, cubed redcurrant jelly, optional

method:

• rub the venison with the olive oil, garlic and black pepper. stick on the thyme sprigs and leave to marinade for three hours. • Place the red wine, shallot, juniper berries, black pepper corns, chilli and bay leaf in a pot. • On a medium-high heat, simmer and reduce it down until there is a quarter of the original volume left. It should be thick and syrupy. strain and stir in the beef stock pot • Heat up a pan till very hot and cook the steaks to your liking. • If doing a whole bunch, sear very well then cook in the oven at 160°C for 35 minutes to an hour, depending on hour rare you like

it and how large the piece is. You can treat it like a roast beef, which should still be a little pink in the middle. • Melt the chocolate in a glass bowl over a pot of simmering water. • add the red wine reduction and whisk well • stir in the cubes of cold butter, whisking all the time. • If the sauce is a too sharp, add a little redcurrant jelly. • allow the meat to rest, then carve and serve with chocolate chilli sauce.

84 HealtH Matters

heAlth & Well-being

sIDe

braised spiced red Cabbage

serves 8

ingredients:

1 head red cabbage, finely sliced 2 red onions, finely sliced 100g butter 150ml port 300ml red wine 5 tbsp red wine vinegar 3 tbsp brown sugar 8 juniper berries 3 cinnamon sticks 2 star anise 50g dried cranberries 1 tbsp redcurrant jelly salt and pepper

method:

• Melt the butter in a large pot, add the spices and stir until fragrant. • add the onion and red cabbage and stir well. Cook for about 15 minutes until the vegetables start to wilt down. • add the vinegar, wine, sugar, cranberries and port. Bring to the boil, cover and simmer for an hour. • remove the lid, turn up the heat and cook for a further hour till the liquid evaporates and the vegetables start to stick to the bottom of the pot. • stir all this lovely caramelisation in. • Check the seasoning and stir through the redcurrant jelly

Dessert

Cape brandy pudding ingredients:

250g pitted dates, roughly chopped 250ml water 1 tsp bread soda 100g butter, softened 200ml castor sugar 1 egg 250ml flour 1 tsp baking powder 1ml salt 100g pecan or walnuts, roughly chopped Brandy syrup: 200ml sugar 100ml water 125ml brandy 1 tsp vanilla essence 4 tbsp butter Whipped cream, to serve straWBerrY COMPOte: 500g strawberries, hulled and halved 1 inch piece ginger, peeled and sliced into three Juice and zest of 1 orange 2 tbsp caster sugar

method:

• Combine the dates and water in a pot, bring to the boil, stirring. • remove from the heat and stir in the bread soda. allow to stand. Cream together the butter, sugar and egg until pale and fluffy. • sift in the flour, baking powder and salt and mix lightly. • Fold in the date mixture and nuts • Bake in a buttered oven dish at 180°C for 45 minutes. • Make the syrup by gently melting the ingredients together in a pot, stirring to dissolve the sugar. • Pour the syrup over the pudding when it comes out of the oven. • to make the compote, place all the ingredients in a pot, bring to the boil, then reduce to a simmer for five minutes. • remove the ginger. • serve warm brandy pudding with whipped cream and strawberry compote. for more delicious recipes from Rozanne, visit her website: www.rozannestevens.com

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86 HealtH Matters

heAlth & Well-being

SPortIng PASSIonS Health matters talks to david linehan who did Ireland proud earlier this year when he won two medals at the FInA World masters diving championships in gothenburg, Sweden. david took home a silver medal from the platform event and a bronze from the one metre springboard event. In his day job david works as a senior physiotherapist in dublin’s mater Hospital. DIvING IS AN uNuSuAL SpORT TO BE INvOLvED IN, HOW DID IT COmE ABOuT fOR yOu? I enjoy the personal challenge that diving presents – there is always something more difficult that you can aim for. My sporting background is in tumbling (a discipline of gymnastics) and I was excited to try a sport that could use some of the skills. WHAT AGE WERE yOu WHEN yOu TOOK up THIS SpORT? I took up diving in 2006. Initially I was training for 45 minutes once a week and over the years this has gradually increased. the great thing about diving is that you can start it from scratch at any age. I was 23 when I first dived, but there is no upper or lower age limit for new divers. Once you are comfortable swimming in deep water then you should be able to try it out. I would recommend diving to people of all ages. It is a very sociable sport and there is a great camaraderie between the divers because everyone knows exactly how the other person is feeling as they step up onto the board. as well as the social aspect, there are multiple physical benefits to the sport – diving is great for your co-ordination, strength, power, and flexibility. Diving is one of those sports that will build character; you have to rely on yourself to complete the dive correctly. there is a great sense of personal achievement that comes with doing a new dive, which is great for your self-esteem! It’s wonderful to see the kids’ faces light up when they emerge from the water having done a new skill. WHERE AND HOW DO yOu TRAIN? I train with Dublin Diving Club, which is based in the National aquatic Centre in Blanchardstown. I cycle to the centre from work and then home after training, so this gives me a 12-mile round trip four days

during the working week (Wednesday is my rest day) and also on sundays. I take this as my main cardiovascular training. Our training sessions are devised by ricardo Gutierrez who is a former assistant coach to the Mexican Olympic Diving team. the training is split between landtraining and diving. land training includes; gymnastics, trampolining, flexibility and strengthening exercises, as well as drills that mimic different components of a dive. the type of training that you do on the diving board will vary – you can do the dive itself or different exercises that concentrate on particular aspects of a dive such as the takeoff, the flight, the difficulty, or the entry into the water. Our website is www.dublindivingclub.ie where you will be able to find out more information about diving.

WHAT’S BEEN THE HIGH pOINT Of yOuR CAREER TO DATE? Winning silver and bronze medals at the World Masters Championships is definitely something that I will never forget. the first time that I won the senior National Championships was also a great moment for me as I was a relative newcomer to the sport at the time.

yOu ALSO COACH yOuNG DIvERS, WHAT ATTRIBuTES DOES A yOuNG DIvER NEED TO SuCCEED? One of the main things that a diver needs is courage – they need to have the self belief that they can do the skill that is being asked of them. this sense of self belief is something that can be developed over time. there are also physical attributes that will be beneficial such as gymnastic ability, strength, flexibility, and coordination. Our training programme in the club is designed to target all of these aspects – everybody has potential to be a diver, whether it is competitive or recreational. DOES yOuR SpORTING LIfE HAvE ANy ImpACT ON yOuR jOB AS A SENIOR pHySIOTHERApIST IN THE mATER HOSpITAL? Physiotherapy can be quite a physicallydemanding job so it is important to maintain a reasonable level of fitness. Diving helps me to do that and it is great for core stability which protects my back when I’m at work. While coaching, I spend my time analysing body movement. this is a skill which is equally important in physiotherapy, and coaching diving helps to give me a sharp eye.

Health Matters 87

digital media

Healthcare is transformed

in a digitally connected world

Ian Dodson, CEO of the Digital Marketing Institute explains how the internet can play a role in helping the HSE achieve its mission of enabling people to lead healthier and more fulfilled lives.

atients, consumers, customers – call them what you will – but they are all active and engaged on the internet. Whether monitoring their health, sharing their experiences or supporting others with similar conditions, the internet is allowing consumers to side-step traditional structures in dealing with their health issues.

Tracking and Monitoring As consumers we are tracking every facet of life, from health to sleep to mood to pain. Digitally connected devices are making their way into the smallest crevices of our lives. There are sites and tools for monitoring mood, pain, blood sugar, heart rate, cognition, alacrity and even sleep. Examples are; pedometers in the soles of our shoes (Nike Plus); phones that post our location as we cycle (Everytrail application for iPhone); twitter-based food diaries (tweetwhatyoueat.com), applications that track our heart rate (Heart Monitor application for iPhone); phone-based sleep monitoring (Sleep Cycle application for iPhone) – we are recording and monitoring every aspect of our health. Sharing and Comparing This level of tracking and monitoring, however, is just the first stage of a rapidly evolving digital world. We are also sharing and comparing our health with others online through these digitally connected tools. Nike Plus, for example, has gathered the largest global community of runners, more than 2.2 million, who have collectively tracked more than 230 million miles and burned more than 23 billion calories. Supporting and Helping Karen is a single mother with two children and was diagnosed with Relapsing Remitting Multiple Sclerosis in 2008. She is a member of PatientsLikeMe.com a site that was

created to give patients the power to control their disease and share what they learn with others. PatientsLikeMe.com is a community of patients, doctors, and healthcare organisations that provides an online symptoms and treatment tracker as well as comprehensive online support forums for people with various diseases. This type of approach is anathema to many health professionals who see unregulated medical advice as a dangerous side effect of the internet and this has lead to valuable online resources like Patients LikeMe being rejected by health organisations, while simultaneously seeing patients flock to them for support.

How can we engage with people through digital channels to help them improve their health? The American Institute for Cancer Research has again repeated what we have known for some time, that “despite widespread messaging behavioral change is notoriously difficult. Knowledge is in itself NOT sufficient to drive behavioral change.” What does drive behavioural change though is a person’s peer group. The

connectivity provided by digital technologies and social networks provides consumers with access to and membership of active peer groups and support networks. These networks are for the most part driven by people who give their time for free, who manage and moderate and facilitate a support network that would cost significant investment were it to be provided by healthcare managers. Using the internet to engage consumers to improve health does not simply mean thinking of consumers as partners in health management, it means allowing consumers and patients to take the drivers seat in supporting and helping each other. For healthcare organizations, that can simply mean getting out of the way. When it comes to digital networks, the HSE mission to “enable people to lead healthier and more fulfilled lives” could indeed be shortened to just the first two words – “enable people”. The Digital Marketing Institute provides practitioner lead training and certification in digital marketing. For more information, visit: www.digitalmarketinginstitute.ie

88 Health Matters

crisis pregnancy

Crisis Pregnancy Programme and National Disability Authority Workshops professionals, as well as supporting parents with intellectual disabilities. The author of the report, Joan O’Conner, also facilitated a workshop for health professionals and care givers on relationships and sexuality education. Siobhan Barron, Director of the National Disability Authority highlighted that the Crisis Pregnancy Programme and the NDA are committed to working together “to ensure that the sexual health, pregnancy and parenting support needs of people with intellectual disability throughout Ireland are met.”

L-R: Roisin Guiry, Crisis Pregnancy Programme, Rosemary Grant, the Coombe Hospital, Joan O’Connor, independent researcher, Siobhán Barron, NDA, Mary Van Lieshout, NDA, Ruth O’Reilly, NDA, Dr Stephanie O’Keeffe, Crisis Pregnancy Programme

series of workshops for health professionals working with people with intellectual disability were held in September by the HSE Crisis Pregnancy Programme and the National Disability Authority. The workshops were held to highlight issues surrounding intellectual disability, relationships, sexuality and crisis pregnancy. They coincided with the launch of a new research report which draws on Irish and international literature relating to these issues. Dr Stephanie O’Keeffe, Research and Policy Manager with the HSE Crisis Pregnancy Programme spoke to attendees in advance of the workshops and noted that, “Women with intellectual disability face many challenges in looking after their sexual and reproductive health, making it imperative that appropriate education and support services are available.” There are 50,400 people diagnosed with intellectual disability living in Ireland and 40 per cent of these are women.

The report was authored by Joan O’Connor and reviews international research which shows that women with an intellectual disability are at risk of crisis pregnancy due to having lower levels of sexual health knowledge than that of the general population. For example, research carried out among women with intellectual disability in Northern Ireland found that only 18 per cent of respondents knew the meaning of birth control/ contraception. The research also illustrates that a lack of knowledge of appropriate sexual behaviour or what constitutes abuse can make people with intellectual disability more vulnerable to abuse or sexual exploitation. One workshop covered the subject of “International Good Practice in Assessing Capacity to consent to medical treatment and sexual relationships”, while other workshops covered service development challenges for crisis pregnancy counsellors and other health

“To ensure that the sexual health, pregnancy and parenting support needs of people with intellectual disability throughout Ireland are met.” The publication of the literature review and the hosting of the workshops follows two years of collaboration between the two organisations who will continue to work together into the future on matters relating to crisis pregnancy and intellectual disability. The report ‘Literature review on Provision of Appropriate and Accessible Support for People with an Intellectual Disability who are experiencing Crisis Pregnancy’ is available for download at www.nda.ie and www.crisispregnancy.ie. A research summary summarising the key findings from the literature review is also available for download at www.nda.ie and www.crisispregnancy.ie. Hardcopies of this summary is also available by contacting the Crisis Pregnancy Programme on 01 814 6292.

Health Matters 89

clinical care

Clinical Care Programmes to provide opportunities for nurses Directors of nursing and midwifery need to develop, as a matter of urgency, a new clarity about the roles that they should play as both managers and leaders in the Irish healthcare system, according to Dr Mary Boyd the Director of Nursing at one of the country’s largest hospitals.

he time had come for nurses, managers and leaders to speak with a united voice in order to be heeded and not just heard according to Dr Mary Boyd, President of the Irish Association of Directors of Nursing and Midwifery (IADNAM). Dr Boyd was speaking at the annual conference of the IADNAM held in Tullamore, Co. Offally Nurse and midwife managers worked within complex organisations in an ever-changing and increasingly difficult healthcare environment, she said. “It was increasingly obvious that clarity about roles and responsibilities is not just essential to our effectiveness, it is at the very heart of quality assurance and patient safety, which is quite correctly what we are all about.” Dr Boyd noted the opportunities and responsibilities inherent in the new clinical care programmes now being developed by the HSE’s Quality and Clinical Care Directorate under Dr Barry White National Director. “Nurses will have the potential to develop new skills and to take on new challenges under these programmes and potentially to play a pivotal role in their evolution. And it will be up to us, as Directors of Nursing and Midwifery, to play our part in the implementation of the recommendations from these care programmes”, she said. Dr Boyd also told delegates that the moratorium on staffing would not go away simply because they wished it would. “The inconvenient truth is that Ireland Inc. is, to put it politely, ‘financially embarrassed’ and is set to remain so for many years into the future. The moratorium is not a deliberate and singular attack on nurses or midwives. It is whether we like it or not, expediency determined by those who control the purse strings – and find that purse feeling unpleasantly light and getting lighter by the day”, she said. “The challenge for directors of nursing and midwifery was to decide how they would deal creatively with these challenges, not just talk endlessly about them”. “How are we going to motivate and encourage our staff in these difficult and testing times? How are we going to ensure that our experience and knowledge is pooled and shared with policy makers to ensure the best outcomes for both patients and healthcare providers alike?”, she asked. To have an effective voice in these times we have to have a unified one.” To this end the Association would undertake the development of a clear new vision for the future of nursing and midwifery leadership in Ireland through a process of consultation with the membership, she said. Her intention was this would be ready for consideration by members, “By this time next year, at the very latest.”

Dr Mary Boyd, President IADNAM pictured with Kerry General Hospital General and Midwifery staff standing Amanda Coulson, Richard Walsh and May Quirke with seated Siobhan O’Halloran and Sheila O’Malley at the Annual IADNAM Conference

Paul Gallagher, St James Hospital, Suzanne Dempsey, Childrens Hospital, Temple Street and Mary Kelly, Beaumont Hospital attending the Annual IADNAM Conference

Dr Mary Boyd, President IADNAM pictured with Robin Plapa, NHS, London and Prof Trish Morris Thompson, Chief Nurse NHS, London at the Annual IADNAM Conference–

90 Health Matters

fair deal

16,000 apply to Nursing Homes Support Scheme during first year One year on from the introduction of the Nursing Homes Support Scheme almost 16,000 applications have been received and more than 70 per cent of these applications have been processed.

he Scheme provides financial support for people who need long-term nursing home care. It was introduced on October 27th 2009 replacing the Subvention Scheme which had been in existence since 1993. Under the Nursing Homes Support Scheme, all residents in long-stay residential care will make a contribution towards the cost of this care and the State pays the balance. This applies whether the nursing home is public, private or voluntary.

There are three steps to the application process â&#x20AC;&#x201C; Step 1: an application for a Care Needs Assessment The Care Needs Assessment identifies whether or not the applicant needs longterm nursing home care. Its purpose is to ensure that long-term nursing home care is necessary and is the right choice for them. The assessment

considers whether they can be supported to continue living at home or whether long-term nursing home care is more appropriate. The Care Needs Assessment is carried out by appropriate healthcare professionals, for example, a nurse etc, appointed by the HSE. An assessment may be completed at any time in a hospital or a community setting such as the applicantâ&#x20AC;&#x2122;s own home. The assessment includes consideration of the following:

Health Matters 91

fair deal ability to carry out the activities of daily living, for example, bathing, shopping, dressing and moving around medical, health and personal social services being provided or available to the applicant both at the time of the carrying out of the assessment and generally the family and community support available to them, and the applicant’s wishes and preferences The assessment may include a physical examination by a healthcare professional. The applicant must be assessed as needing nursing home care in order to be eligible for either State Support or the Nursing Home Loan.

Step 2: an application for State Support This is used to complete the Financial Assessment, which determines the applicant’s contribution to their care and their corresponding level of financial assistance (“State Support”). The Financial Assessment looks at the applicant’s income and assets in order to work out what their contribution to care will be. The HSE then pays the balance of their cost of care. For example, if the cost of their care was b1,000 and their weekly contribution was b300, the HSE pays the weekly balance of b700. This payment by the HSE is called State Support. The Financial Assessment looks at all of their income and assets. Contribution to Care – Having looked at the applicant’s income and assets, the Financial Assessment will work out their contribution to care. They will contribute 80 per cent of their assessable income and five per cent of the value of any assets per annum. However, the first b36,000 of their assets, or b72,000 for a couple, will not be counted at all in the financial assessment. Where their assets include land and property in the State, the five per cent contribution based on such assets may be deferred and collected from their estate. This is an optional Nursing Home Loan element of the scheme which is legally referred to as “Ancillary State Support”. The applicant’s principal residence will only be included in the financial assessment for the first three years of their time in care. Their contribution to care will be the same irrespective of whether they choose a ‘public’ or ‘private’ facility – provided the facility they choose is deemed appropriate to meet their care needs.

“For example, if the cost of their care was t1,000 and their weekly contribution was t300, the HSE pays the weekly balance of t700. This payment by the HSE is called State Support.” There are important safeguards built into the financial assessment, which are worth noting; • Nobody will pay more than the actual cost of care • Approved applicants will keep a personal allowance of 20 per cent of their income or 20 per cent of the maximum rate of the State Pension (nonContributory), whichever is the greater • If the applicant has a spouse/partner remaining at home, he/she will be left with 50 per cent of the couple’s income or the maximum rate of the State Pension (nonContributory), whichever is the greater

Steps 1 and 2 must be completed by all applicants. Step 3 is an optional step, which should be completed if the applicant wishes to apply for the Nursing Home Loan (this is termed “Ancillary State Support” in the legislation).

One Year On A total of 15,829 applications had been received near the end of October 2010. In addition 2,296 applications were received for Ancillary State Support (Nursing Home Loan), of which nearly 1,747 or 76 per cent were completed. Approximately 95 per cent of applications are processed within four weeks of receipt of all information necessary in order for the Nursing Homes Support Office to make a determination on an applicant’s State Support application. It can take longer where additional information is required from applicants and where they need to take time before submitting the information. The introduction of the Nursing Home Support Scheme has ensured that access to State funded long stay residential care is transparent and equitable, with standard processes introduced nationally to administer applications under the scheme. Feedback from users of the scheme has been generally positive, with applicants welcoming having clarity on their costs, and having their choice of nursing home.

92 Health Matters

informing families

informing families about disability

Difficult news is never easy to give or receive. For professionals, informing families of a child’s disability can be an emotional and stressful task, writes Alison Harnett, Project Co-ordinator of the National Federation of Voluntary Bodies.

he way in which a family is informed that their child has a disability is an important and sensitive task. The manner in which the news is communicated can influence the parents’ levels of distress, their attachment with the child and their relationships with professionals who are likely to be involved in supporting the child and family for years to come. It is vital that this relationship begins well to build trust and ensure the family are comfortable to access the services necessary for the development of their child. For professionals, informing families of a child’s disability can be an emotional and stressful task. It requires training, support and clear guidance on best practice. In 2007, the ‘National Federation

of Voluntary Bodies Providing Services to People with Intellectual Disability’ launched their ‘National Best Practice Guidelines for Informing Families of their Child’s Disability’. The guidelines, which were developed after a significant consultation and research process, were widely endorsed by professional bodies, parent and family organisations and educational institutions. For the past two years, the ‘Informing Families Project’ has embraced the challenge to translate research into practice through a two-year pilot implementation of the guidelines in the Cork region, across hospital, community and voluntary disability services. The pilot project, which took place between January

Health Matters 93

informing families

“The guidelines, which were developed after a significant consultation and research process, were widely endorsed by professional bodies, parent and family organisations and educational institutions.” 2008 and December 2009, was guided by a steering committee of professionals from nursing, medical and allied health backgrounds and was chaired by Katherine O’Leary, a parent of two children with disabilities. The work was carried out by six working groups who looked at areas such as dissemination of best practice guidelines; training; optimising privacy in the built environment; integrated working across hospital, community and disability services; information provision; and evaluation. The purpose of the pilot project, which has been successfully implemented, was to gain knowledge to inform a national roll-out. A range of valuable tools and materials, including a ‘Roadmap for Implementation’, were developed and can now be used by staff anywhere in the country to ensure best practice is implemented when they are informing and supporting the families of children with physical, sensory and intellectual disabilities. The Informing Families Project was a national Finalist in the HSE Achievement Awards.

Outcomes of the pilot project The website www.informingfamilies.ie was developed in conjunction with parents and professionals. The website contains information that parents need when their child is diagnosed with a disability. This information can be printed and supplied to parents by professionals. HSE members of staff will also find all of the materials and tools from the project on this website.

A training course was developed, delivered and evaluated during the pilot project. It demonstrated measurable improvement in the comfort, confidence and knowledge of participants about their disclosure practice. This course has now been incorporated onto the medical training and nursing and midwifery training courses in University College Cork, and in the training for Paediatricians through the Royal College of Physicians of Ireland. A room was made available in the Paediatric Unit in Cork University Hospital so parents now have a private, comfortable space where they can spend some time absorbing the news they have been given. A one-page summary poster of the best practice guidelines based on the ‘Safe Cross Code’ was designed and is available for download from www.informingfamilies.ie

Protocols for liaising across departments, disciplines and organisations were put in place. HSE staff members can access these protocols at www.informingfamilies.ie The work of the Informing Families Project was supported by the National Federation of Voluntary Bodies, the Health Services National Partnership Forum and the HSE’s Department of Social Inclusion. Alison Harnett is a project co-ordinator with the National Federation of Voluntary Bodies. For more information please contact: Informing Families Project National Federation of Voluntary Bodies Oranmore Business Park Oranmore, Galway Tel: 091 792 316 Email: info@informingfamilies.ie

Feedback on the ‘Informing Families’ pilot project “The huge benefit for me was sitting face-to-face with colleagues, teasing out ways of simplifying referral from acute to community early intervention services and at the end saying ‘yes, this is how it will happen’ and now finding that it actually works. The group found ways of simplifying processes and procedures by discussing and developing ideas. It struck me how much can be achieved when the various agencies and services meet and have open discussion and communication.” Breda Long, Early Intervention Project Officer HSE, Principal Speech and Language Therapist “Anywhere that is dedicated to sensitive or life-changing discussion with parents is essential to modern paediatric care, so the provision of the new room in CUH for communication with families is a very welcome development. Every hospital should have a room like this.” Professor Jonathan Hourihane, Professor of Paediatrics and Child Health, Cork University Hospital “The Cork project generated a special energy bringing people from different organisations and disciplines together to find real and tangible ways of implementing the National Guidelines… There was a real sense of working together to make a difference with improved communication between sectors allowing for improvements to happen all through the Pilot Project” Hilary Lane, Principal Psychologist, Enable Ireland “Seomra 7’ in Cork University Hospital was designed with a lot of care and attention to detail and with full awareness of the nature of its use. Informing families of difficult news concerning a child or much -oved family member is never easy and the manner and environment in which this is done will leave a lasting memory. With ‘Seomra 7’, we hope to proffer families a helping hand, an ease of pace and above all respect. The Social Work Dept CUH is very proud to be closely associated with this wonderful initiative.” Mary G Casey, Manager/Social Work Services, Cork University Hospital

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Health Matters 95

informing families

Katherine’s story

Katherine O’Leary with her son Diarmuid

Katherine O'Leary, Parent Chairperson, Cork Implementation Project Steering Committee writes about her experience of becoming the parent of two children with disabilities

‘

There are no words to describe the feelings that overwhelm you when a diagnosis of a disability is made concerning your son or daughter. In that moment your dreams are shattered. I was devastated, bereft of hope and terribly frightened about what life might have in store for us. The idea of disability was so alien to me. I wondered how I’d cope. I wondered if my husband was angry with me. Was I to blame? How would I care for this baby? How would I tell my parents? Who would look after him when I’d die? And of course I asked in my heart why me? why us? All these thoughts fly through your mind. Sometimes you remember the words spoken with absolute clarity. Other times you need to come back and ask questions. No two people will absorb the news in

the same way. Professionals need to be equipped with the knowledge and empathy to give this news. When our darling daughter Julie was diagnosed with Cerebal Palsy at 18 months old it was a huge shock and body blow. The consultant said, “Don’t invest too much in this child. Have other children.” When Diarmuid was born and diagnosed with Down syndrome and serious medical problems that included a bladder extrophy, I felt my life was over. He was given 24 hours to live. Of course he defied it and days grew to weeks. Two handsome boys Philip and Colm completed our family of four. There were tough days and endless hospital trips and surgeries but we learned to take one day at a time and get on with life. Disability was far from the end of the

world – it was positively the beginning of a new world. Recently, Julie got First Class honours in her masters in Journalism. She already has an honours degree in Applied Psychology. Diarmuid has been picked to represent Ireland in the World Special Olympic games in Greece in June 2011. I was deeply honoured to be asked by the National Federation of Voluntary Bodies to act as the parent chairperson of the Cork Implementation Project Steering Committee because I believe that difficult news can be broken in a way that is sensitive and above all does not remove hope. Nobody knows for sure what a child will become or how that baby will develop in the future. Difficult news is never easy to give or receive. I can’t imagine what it must be like to have to tell parents this news. My advice is to trust in your own heart and judgment. During the pilot scheme in Cork, I have witnessed extraordinary collaboration by professionals across all disciplines. Empathy with families and confidence in this delivery of news is enhanced. The news may be difficult but when parents feel that there is genuine concern for them, their dignity remains intact and there is room for hope. My dream is that over time this blueprint will be adapted to encompass the delivery of all difficult medical news.’

96 Health Matters

community mothers

Community Mothers Programme: Supporting parents within the community The Community Mothers Programme has been running since the 1980s in order to aid the development of parenting skills among first-time parents, mainly in areas that experience disadvantage, writes Brenda Molloy, Director of Community Mothers Programme.

et up in recessionary times, the programme has found a costeffective method of providing one-to-one support, with volunteers taking the place of nurses in community outreach. It is based on the belief that more experienced parents are in a unique position to provide skilled help to families. In the greater Dublin area, which includes rural as well as urban communities, around 150 volunteer Community Mothers provide support to around 2,000 parents each year. The programme is offered to all firsttime parents; choosing to participate or not, it is up to them. But in many neighbourhoods like Finglas in Dublin, over 90 per cent sign up. In 2009, 68 per cent of women who enrolled in the programme were single mothers and seven per cent were teenagers. This support is highly-structured and provided chiefly through monthly meetings of the Community Mothers with the parents in their own home during the first two years of their babies lives. The visits focus on healthcare, nutrition and overall child development, while recognising that parents know their children best and want to do their best for them. The one-to-one support is sometimes complemented by group sessions.

Volunteers in a professional structure The aim of the programme is to aid the development of parenting skills and enhance confidence, self-esteem and parenting practices among the parents

“Mothers discuss with parents any problems they are experiencing, as well as general childrearing issues, encouraging them to find their own solutions and allowing them to set themselves targets for achievement by the following meeting.”

supported. The Community Mothers also benefit, as the programme is based on models usually implemented by professionals and they are recruited, trained and supported by the eleven Family Development Nurses who work with the Programme. The Programme Director guides the work of the Family Development Nurses. The Community Mothers have an added advantage however in that they have already existing relationships within their communities. One of the main challenges, therefore, is to avoid professionalising the Community Mothers, as this can have a negative effect on their relationship with the parents and their communities. Some Community Mothers

have stayed with the programme for many years, while others work for only a few years before leaving, either to work professionally in community support services or to use their experience and skills in their own family environment. It isn’t unusual for mothers who have received the programme to go on to become Community Mothers themselves.

An ‘empowerment’ model: providing non-prescriptive support The approach is non-prescriptive and supportive of the parents’ own ideas. During the monthly meetings, the Community Mothers discuss with parents any problems they are experiencing, as well as general childrearing issues, encouraging them to find their own solutions and allowing them to set themselves targets for achievement by the following meeting. This helps to build and maintain trust between the Community Mothers and the parents and communities they work with. The Community Mothers also give the parents some health information and parenting educational teaching tools produced by the Community Mothers Programme. These materials serve to enhance the work of those who present the Programme. Measurable results Several outside evaluations including a randomised controlled trial over the lifetime of the programme have found that it made significant improvements to children’s diets and parents’ skills. It has been shown to lead to fewer

Health Matters 97

community mothers

+ Above:

Young mother Adrienne and baby Kate who participated in the Community Mothers Programme + Right: L-R: Patricia Curtis, Community Mother and Teresa Keegan, Family Development Nurse

From Family Development Nurse to Community Mother to new mother

F admissions into hospital due to household accidents, reduced physical abuse, increased immunisation rates and even made parents more likely to breastfeed any subsequent children they have. The randomised controlled trial of the Community Mothers Programme has been included in the UKâ&#x20AC;&#x2122;s Cochrane Review 2010. In conclusion, the Community Mothers enable parents to maximise their role and in doing so, help children to reach their full potential.

amily Development Nurses such as Teresa Keegan visit the Community Mothers on an individual basis each month to have one-on-one discussions on all the visits carried out by the mothers in the previous month. During a recent individual session, Teresa and Patricia Curtis went through each parent and baby that Patricia had visited in the previous month. They discussed the support given to each parent and how the babies were in terms of health, nutrition and stimulation through play and so on. Community Mothers fill out a report on each visit which forms the basis for the discussion with the Family Development Nurse. In the case of each baby, Teresa would give Patricia new material to guide her visits over the following month. Teresa works with 18 Community Mothers in the Finglas area, who are currently visiting 140 mothers in their own home between them. Each Community Mother carries out in the region of 5 to 15 visits a month. In addition, the Community Mothers in Finglas run mother and toddler groups and a breastfeeding support group.

98 Health Matters

energy efficiency

Supporting energy efficiency Paramount in energy efficiency is good organisational practices – what we, as individuals, can do locally to reduce energy wastage. It is all about careful energy use: switching off our computers, printers, copiers, lights where appropriate; reducing the heating settings if an area is too hot and ensuring that energy is not used when the area is unoccupied – the sort of things we all do at home writes Jim Murphy, Engineering Advisor, HSE Estates. What we can do to reduce our spending on energy? The HSE is one of the biggest users of energy in the country and we are committed to reducing energy usage and cost. There are two things we can do to reduce this annual energy spend: the first is competitive procurement of electricity, gas, oil and biomass. We already do this annually for electricity and this centralised national procurement has yielded substantial financial savings in the region of b8 million for 2010. We are now setting up the tendering process for natural gas. The second thing we need to do is reduce how much energy we use. When we think of energy efficiency we might think of infrastructural modifications – like changing light fittings and replacing boilers – which don’t require a lot of involvement for the majority of HSE staff.

However, paramount in energy efficiency is good organisational practices – what we, as individuals, can do locally to reduce energy wastage. It is all about careful energy use: switching off our computers, printers, copiers and lights where appropriate; reducing the heating settings if an area is too hot and ensuring that energy is not used when the area is unoccupied – the sort of things we all do at home. These may not seem significant, but good organisational practices can yield savings of 5-10 per cent. This would achieve savings of b3-b6 million a year, which could be redirected back to healthcare, without adversely affecting staff or patients. There is an environmental aspect to this too: we estimate annual CO2 emissions as a result of the energy used by the HSE amount to 300,000 tonnes. Delivering a 10 per cent saving on that is the environmental equivalent of taking 9,000 cars off the road.

Not bad for some straightforward energy efficient practices.

“Delivering a 10 per cent saving on that is the environmental equivalent of taking 9,000 cars off the road. Not bad for some straightforward energy efficient practices.”

Health Matters 99

energy efficiency

Examples of Energy Efficiency Project throughout the HSE HSE Dublin North East Following an energy audit conducted by SEAI in collaboration with the HSE at St Oliver Plunkett Hospital and Louth County Hospital a number of areas were highlighted as yielding the best value for money as follows: Louth County Hospital: • Upgrade of Building Management System • Improve controls in the main boiler house • Insulate heating pipe-work in the boiler house and main distribution routes in underground tunnels; and • Replace the existing outdoor lighting system with a single energy efficient lighting system. Work is now underway on these projects. Willie McClean, Energy Manager/Equipping Officer, HSE Dublin North East. St Oliver Plunkett Hospital: • Replace existing single glazed windows and doors with double glazed alternatives • Pumped Wall cavity insulation • External roof insulation • Solar water heating to supply 50 per cent of the domestic hot water demand • Replace existing T8 lighting system with energy efficient T5 alternative c/w daylight sensoring • Replace existing emergency lighting with energy efficient LED equivalents; and Improve local control of the low pressure hot water and domestic hot water in boiler house HSE South Energy Saving in Existing Lighting Systems We have used fluorescent retrofit products that can improve the efficiency of existing T8, T12 lamps to the latest T5 efficiency levels by a simple replacement of ballast and lamps while reusing existing light fittings, yielding savings of 40 per cent. We have also replaced some of the older T8 fixtures in a number of hospitals notably Waterford Regional Hospital and South

Tipperary General Hospital with newer fittings incorporating T5 lamps with 40 per cent savings on lighting costs and CO2 emissions. We received grants of b300,000 from SEAI.

Biomass Conversions Biomass is a renewable fuel supplied locally in the form of wood chips or pellet and we have a number of successful conversions in this area: St Columbas Hospital, Thomastown, Co. Kilkenny; St Josephs Hospital, Dungarvan, Co. Waterford; St Patricks Hospital, Cashel, Co. Tipperary; and the Ambulance Station, Kilkenny SEAI partly funded these conversions with a grant of b100,000. Combined Heat and Power (CHP) CHP is widely recognised as a very efficient form of in-house electrical energy production. We have a number of successful installations in this region: St Dympnas Hospital, Carlow and St Bridgit’s Hospital, Carrick on Suir . SEAI provided funding of b50,000 for these projects and they will deliver savings at about b30,000 annually. Donal Deering, Energy Manager, HSE South. Listowel Community Hospital Efficiency Programme In mid-2010, a web-based utility system to monitor water, electricity and oil usage across the hospital campus was installed. It allowed actual rates of energy and water use, verses activity rate of use, to be clearly identified and savings were quickly obtained by ensuring that energy was only used when required. Reducing the heating bill was achieved in most cases very quickly and cheaply by fitting time clocks and thermostatic radiators valves. By monitoring the water usage, leaks were identified and fixed, reducing consumption and water costs. The monitoring system also provided accurate water consumption data which allowed the hospital to recoup water costs. In October, an Energy Efficiency Campaign was launched. This was particularly effective

in ensuring that electrical equipment was not left on over the weekends, delivering a 20 per cent saving on this usage. By monotoring the heat usage identified savings which will be used to fit time clocks and thermoststic radiator families Edward Falvey, Maintenance Officer, Listowel Community Hospital.

Sustainable Energy Authority of Ireland We believe that the HSE is leading the way as an exemplar in public sector energy management, through its collaborative engagement with SEAI. SEAI has worked closely with the HSE to provide a range of direct supports to the HSE, including: • An assessment of the energy performance at 25 of the HSE’s facilities including the identification of opportunities for energy savings at each • Provision of SEAI’s Energy MAP training course to HSE personnel • Energy Efficiency Design Review for the National Paediatric Hospital • b1.2m of grant support for energy efficiency retrofit projects at 10 locations estimated to save b0.65m per annum – through our SEEEP Grants Programme • Assistance with the collation of baseline energy data • b1m of grant support for energy efficiency retrofit works at three HSE facilities through our EERF Grants Programme • Ad hoc consultancy support to point HSE in the right direction SEAI recognises the HSE’s genuine commitment to taking action in this area and welcomes its decision to join its Public Sector Energy Partnership programme. By doing so, the HSE will be among the first tranche of “exemplar” public bodies. Alan Ryan, Programme Manager, Sustainable Energy Authority of Ireland.

100 Health Matters

macular degeneration

Vision 2020 ‘Close your eyes for one minute and just think about being blind’ – was the appeal from Consultant Ophthalmologist David Keegan to RTÉ television viewers when he appeared on the ‘Four Live’ programme in October to mark World Sight Day, writes Laura Monaghan.

The Mater-based eye surgeon is on a mission to get people to recognise how precious our eyesight is. I close my eyes for a moment and try to imagine what life would be like if I couldn’t see…I can’t see what I’m typing; I won’t be able to get out of the office without bumping into things; I can’t use my mobile phone or make a cup of coffee; I wouldn’t be able to go for a cycle again; go to the cinema; drive; or watch the seasons changing. The list is endless. It’s an effective exercise which gives a tiny insight into how frightening it must be to lose your sight. Keegan is passionate about highlighting the global initiative ‘Vision 2020’, which aims to stamp out avoidable blindness by the year 2020. He said, “Vision 2020 is the global initiative for the elimination of avoidable blindness, all the health ministers in Europe, including our own has signed up

Consultant Ophthalmologist David Keegan is adamant that it makes economic sense to screen more people and reduce the numbers who develop preventable blindness

Health Matters 101

macular degeneration

to its aims – anything is possible if there is a political will and matching resources.” The issue of resources and political will comes up frequently. Keegan is adamant that the main causes of blindness in this country are preventable and that it makes economic sense to screen more people, provide timely intervention and reduce the numbers who develop preventable blindness. “The actual cost of blindness for a year in Ireland is between b140 and b200 million. The frustrating aspect is that managing preventable blindness is cost effective. That has been shown, for example, in programmes related to diabetic retinopathy screening in Iceland and the UK. Nowadays, everything has to be economically accountable and I’m all in favour of that. That is what the overall Vision 2020 strategy, ‘Eradicating Preventable Blindness’, is about – cost effective measures.” In Ireland, the main eye problems are cataracts, macular degeneration, diabetic retinopathy and glaucoma. “Screening programmes would capture many of the patients who are at risk of losing their sight because there are still a lot of people presenting too late – at that stage the damage is done.” The cost of blindness isn’t just about the cost of medical care. “It is also about the cost of support services, the impact on other members of the family. For younger patients with sight loss, there is the personal and societal cost of leaving the workforce. These are the cold facts – it doesn’t even address the individual despair associated with losing one’s sight.” There are two types of macular degeneration – wet (neovascular) type and dry (non-neovascular) type. Some 80 per cent of cases are dry type and 20 per cent are wet type where there is a rapid and dramatic loss of vision associated with it. But the good news is that, in the last five years, successful treatments have been developed for the wet type of macular degeneration. In Ireland, there are 1,600 new cases of wet type macular degeneration every year. Keegan believes there are patients out

“Vision 2020 is the global initiative for the elimination of avoidable blindness, all the health ministers in Europe, including ours, have signed up to its aims – anything is possible if there is a political will and enough resources.”

there suffering from macular degeneration who are not accessing the health system at all or early enough. “Also, we have people under our care that we can’t treat appropriately because we don’t have the resources to give the number of injections that are required. We’re still on the upslope of this curve, which means we are not getting to everybody. Only when we hit the plateau of the curve can we be confident that all necessary patients are receiving timely and appropriate care and we are still well off that point.” Historically, patients with macular degeneration would have been told, ‘you have macular degeneration, there’s not much we can do’. They would have been brought back to the hospital for a low vision aid assessment and they would have had on average two visits to the hospital every year. Now there is treatment and timing is critical according to Keegan. “If we get someone early we can start a course of injections, anti-VEGF agents. Some 95 per cent of patients will have stability of vision if they start this course of treatment and have appropriate follow-up injections. Some 70 per cent of patients will have improvement in vision from minimal to a lot and between 30-40 per cent will have

a significant improvement in vision if they start the injections promptly. The timing is critical.” In the UK, the Royal College of Ophthalmologists advises starting the treatment or injections within two weeks of the patient being referred for treatment. Within a fortnight patients should be seen, investigated with an angiogram and an OCT scan, assessed by a senior doctor and have their first injection. This type of rapid access isn’t happening for many Irish patients but Keegan is hopeful that this can change. Today, newly-diagnosed patients will have approximately 10 visits to hospital every year. Previously, to deal with the 1,600 new patients diagnosed every year, the health system would have had to provide 3,200 clinical appointments – now 16,000 appointments are required for the same cohort of patients and that clinical need rolls forward to the following three to five years. Keegan claims the figures give some idea of the scaling up required to manage the problem. The steep rise in the numbers who need to be treated is down to an aging population and greater awareness about the condition among the public, GPs and opticians. Keegan is adamant that proper care pathways need to be put in place to cope with the steep rise in patients. “A lot of this is about setting up the proper care pathways – it isn’t just about financial resources – it’s about putting systems in place, something similar to the cancer care programme in this country. We should be putting proper care pathways in place. We owe that to our patients. There are a lot of dedicated people but the system isn’t established. I would like a system similar to that now implemented in cancer care. Vision health doesn’t have a priority status and that’s what I’m pushing for. The Irish College of Ophthalmologists is fully behind the HSE in the development of care pathways and is keen to work with the National Director to develop these pathways alongside appropriate work practice, infrastructural and IT reform. Ophthalmology is tailor-made for their introduction.”

102 Health Matters

eye cancer First patients avail of new eye cancer treatment in joint Royal Victoria Eye and Ear and St Luke’s Hospitals project The National Cancer Control Programme recently announced a new eye cancer treatment for patients through a collaboration between St Luke’s Hospital, Rathgar and the Royal Victoria Eye and Ear Hospital, Dublin. Patients who previously travelled to the UK for the Ocular Brachytherapy (localised eye radiation) can now access the treatment locally – routinely resulting in the eye being saved and sight maintained.

L-R: Noel Horgan, Consultant Ophthalmic Surgeon, Royal Victoria Eye and Ear Hospital, Chris Walker, Radiation Physicist, St Luke’s, Dr Moya Cunningham, Consultant Radiation Oncologist, St Luke’s and (sitting) Eileen Maher, Director of Nursing/Acting Hospital Manager, St Luke’s Hospital

ased in the Royal Victoria Eye and Ear Hospital, Dublin, Consultant Ophthalmic Surgeon, Noel Horgan carries out the surgery in St Luke’s Hospital, Rathgar. The St Luke’s team includes experts from radiation oncology, radiation physics and specialist nursing staff who are assisted by the Eye and Ear nurse specialist staff. Involving an NCCP investment of b400,000, the first patient was successfully treated in September and by mid-October the third patient, 64-year-old Tony Donnelly from Navan, Co. Meath had been treated. Mr Donnelly told RTÉ’s Six One News that he had been delighted with the care he had received and was impressed with the speed at which he had been diagnosed and subsequently treated. Explaining that ocular (eye) tumours occur relatively rarely, Mr Horgan said, “Every year in Ireland between 40 and 50 new patients

are diagnosed with melanoma of the eye. Up to two thirds of these individuals are routinely considered suitable for the treatment. Up until now these patients had to travel to the UK for that treatment. The procedure that we are offering in St Luke’s Hospital involves treating the tumour within the eye by surgically inserting a radioactive implant (plaque) between the layers behind the eye – so the device can deliver radiation locally to treat the tumour inside the eye. That allows the patient to be effectively treated while saving their eye which might otherwise have to be removed. “The plaque/device is adapted for each patient and it is usually left in place between three and seven days depending on the size of the tumour.” For St Luke’s Consultant Radiation Oncologist, Dr Moya Cunningham, the development of this new service illustrates

the level of expertise at St Luke’s Hospital, “We are delighted that we can now provide this new service – St Luke’s has a significant combination of expertise and experience.” Acknowledging the commitment of nursing staff at both hospitals, Eileen Maher, Director of Nursing and Acting Hospital Manager at St Luke’s said, “The agreement that was worked out between the Director of Nursing and the Nursing Staff in St Luke’s Hospital and the Director of Nursing and Nursing Staff in the Royal Victoria Eye and Ear Hospital in relation to the provision of specialist nursing care should be particularly acknowledged.” According to Prof Brendan McClean, Network Medical Physics Lead, “In working closely with our skilled colleagues from nursing, surgery and radiation oncology, we are developing and delivering the best services for our patients.”

HealtH Matters 103

Protected diScloSureS

don’t tUrn A BlInd eye If you are a healthcare worker and have a workplace concern, don’t turn a blind eye. the Procedures on Protected disclosures of Information (commonly referred to as Whistleblowing) can help you.

he aim of these procedures is to enable health service employees report concerns without fear of penalisation. In the normal course of events, you should report your concerns to your line Manager or another manager within the workplace. If you are reluctant, for whatever reason, to report concerns in this manner then you should contact the authorised Person for Protected Disclosures of Information. You should report concerns where: • the health or welfare of patients/clients or the public may be at risk • your employer is not meeting their legal obligations • there is misuse or substantial waste of public funds

the Hse is committed to maintaining the highest possible standards of care for service users and providing employees with a safe system of work to enable them to deliver a high quality service. the organisation is also committed to promoting a culture of openness and accountability so that staff can report any concerns they may have in relation to their workplace. In the normal course of events, a member of staff should report concerns to a manager within the work place. However, in some instances, staff may be reluctant to report their concerns for fear of retaliation or victimisation. staff can now avail of legal protection under the Health act 2007 (Part 14), which provides a statutory basis for the making of protected disclosures of information. the purpose of this legislation, which came into operation on 1st March, 2009, is to facilitate health service staff to disclose matters of concern to an “authorised Person” and to provide statutory protection against penalisation in their employment and also against civil liability. to give effect to this legislation the Procedures on Protected Disclosures of

Information in the Workplace were produced by a joint management/union working group and the Hse has appointed an “authorised Person” to whom disclosures are made for investigation. If an employee reports a workplace concern in good faith and on reasonable grounds in accordance with these procedures it will be treated as a “protected disclosure”. this means that if an employee feels that they have been subjected to detrimental treatment in relation to any aspect of their employment as a result of reporting their concern they may seek redress by referring a complaint under the act to the rights Commissioner service. employees who wish to make a disclosure to the authorised Person Protected Disclosures of Information are required to complete a Protected Disclosures of Information Form. to receive further information on Protected Disclosures of Information or to contact the authorised Person, please call: 01 662 6984 or write to: PO Box 11571, Dublin 2. the Hse also operates the telephone “helpline” (01 662 6984), If you have a workplace concern, don’t turn a blind eye. The Procedures on Protected Disclosures which employees of Information (commonly referred to as “Whistleblowing”) can help you. may contact for The aim of these procedures is to enable health service employees to report concerns without fear of penalisation. In the normal course of events you should report your concerns to your line information/advice manager or another manager within the workplace. If you are reluctant, for whatever reason, to report concerns in this manner then you should contact the Authorised Person for Protected prior to submitting Disclosures of Information. a disclosure or to You should report concerns where: • the health or welfare of patients /clients or the public may be at risk request a copy of the • your employer is not meeting their legal obligations explanatory leaflet • there is misuse or substantial waste of public funds. for Health service To receive further information on Protected Disclosures of employees on Information or to contact the Authorised Person, please call: 01 6626984 or write to: PO Box 11571, Dublin 2. Protected Disclosures of Information.

“employees who wish to make a disclosure to the Authorised Person are required to complete a Protected disclosures of information form.”

Don’t Turn a Blind Eye

Do you have a concern?

104 Health Matters

green efficiency

Healthcare

Saves Money

With a few changes, it is easy to do your bit for the environment and to save money. By changing behaviour and taking individual responsibility healthcare employees can go green and save money! Energy Sustainable Energy Authority of Ireland (SEAI) sponsors a free independent energy assessment to help public sector buildings to become more energy efficient. Most energy efficiency recommendations are low cost measures and easy to implement. Refer to www.sea.ie or email business@SEAI.ie

By law, all public sector buildings (<1000m2) must display a Building Energy Rating (BER) certificate at reception. Even if the building is leased, the landlord is obliged to display a BER certificate. If the BER rating is poor the energy costs will be high. An energy efficient building has a Building Energy Rating (BER) of A or B. Refer to www.sea.ie The majority of energy consumption in healthcare facilities, which means; hospitals, offices and health centres, is for heat and hot water. The remaining energy use is by electrical equipment. However, electricity is the most expensive form of energy and generates more carbon than any other energy source

• Use the Power of One posters and stickers – www.powerofoneatwork. ie – to remind colleagues to turn off their computers, monitors, and lights etc • Ask all staff (especially after hours cleaning and security staff) to turn off electrical equipment in corridors, kitchenettes, meeting rooms etc, particularly in the evening and at weekends • Ensure lights and other shared electrical equipment; air-conditioning, nonperishable vending machines, printers, photocopiers, fax machines and kitchen equipment are turned off. Some of this equipment can be fitted with a seven-day timer switch

Health Matters 105

green efficiency

• With the introduction of the Carbon Levy in May 2010, heating costs will increase this winter. Don’t over heat the building. For every 1°C over the recommended 19°C, the heating bills increase by 8 per cent. Install thermostats – and set the heating temperature at 19°C - 22°C max • Do not have heating and air-conditioning operating at the same time. Heating should bring temperatures up to 19°C, and airconditioning should bring temperatures back down if they go above 24°C. Set time clocks so that the heating and airconditioning are not left on in the evening and at weekends • Ensure heating boilers, hot water cylinders are insulated and regularly serviced. Minimise heat wastage by closing doors and windows and making sure radiators and vents are not obstructed by furniture or equipment • Car pool with work colleagues if possible. If you can, walk or cycle to work – it costs nothing and it’s good for you too. Apply for a tax-free bike under the new Cycle to Work Scheme

Waste Prevention and Recycling The Environmental Protection Agency (EPA) sponsor free eco-efficiency assessments in healthcare facilities as part of their green healthcare programme. Eco-efficiency examines options to improve environmental performance by reducing wastage. For information on green healthcare options contact the Clean Technology Centre or email ctc. cork@cit.ie All healthcare facilities should recycle general waste. Recycling is half the cost of landfill disposal. The following waste streams are easily recyclable; cardboard, plastic packaging, tetrapak, paper, print cartridges, food, glass, wood, metals, batteries and textiles Since July 2010, healthcare facilities must recycle food waste. Recycling food waste is cheaper then landfill disposal. Check www.foodwaste.ie for guidance on the new food waste regulations

“By law, all public sector buildings (<1000m2) must display a Building Energy Rating (BER) certificate at reception. Even if the building is leased, the landlord is obliged to display a BER certificate.” Every ton of food waste costs b1,000 when all costs are factored in; purchase, cooking, preparation and disposal. Check out www.stopfoodwaste.ie for guidance on how to prevent food waste and save money

Water Healthcare facilities are dependent upon clean water to provide clinical care and maintain a comfortable environment for patients. On average, each acute hospital uses 500 litres of water per bed per day, while each healthcare employee uses about 100 litres of water per day Local authorities combined water/ wastewater charges vary greatly, with the highest charges in the South East, Dublin Mid-Leinster, Dublin North East and South A recent Forfas Report on water treatment capacity, predicted that the following locations would have routine water shortages from 2013 onwards; Athlone, Dublin, Galway, Letterkenny, Limerick, Tralee, Waterford, and Cavan. Last summer most western counties; Donegal, Sligo, Galway, Clare experienced water shortages because local authority water supply was not able to meet demand.

Metering is the best way to verify how much water is supplied and where or when water is used. Locate the water meter and check that the local authority takes water readings to provide accurate water invoices. The water meter should be checked on an annual basis by the local authority. Water leak detection studies indicate that the majority of the water leaks (58 per cent) occur on consumer pipe work, which means from the meter onwards. This is why leak detection surveys are vital. The EPA will sponsor water leak detection studies as part of the green healthcare programme. For information on green healthcare options contact the Clean Technology Centre or email ctc. cork@cit.ie In hospitals, it is worthwhile to sub-meter departments where water consumption is likely to be high, for example, a boiler house, canteen, sterilie services, laundry, dialysis etc. But in all healthcare facilities, worthwhile water savings can be made using low cost modifications to toilets, urinals, baths and showers. To improve water efficiency and save money in the workplace log onto www.taptips.ie

106 Health Matters

personal finance

The Cost of

Christmas Independent financial advisor, Eoin McGee, reveals the pitfalls of Christmas spending, how to try to avoid them and the best ways to get out of them in the New Year.

or a lot of families and individuals, this Christmas will probably be the most difficult financially of the last few years. I recently heard Ryan Tubridy talking about his Toys for Tubs campaign and he said at Christmas time kids should be recession proof. It’s a nice thought and one I have to say the sentiment of which I agree with. The only problem is that Christmas comes every year; it can be difficult particularly now, to keep up with last year’s momentum and top the big present that arrived. So while Christmas can be difficult financially, there are ways you can prepare for it. Christmas is now just around the corner so I’m sure you are thinking reading this, ‘is there much I can do now’? The answer is yes! But more importantly, it is what you can learn now that you can apply to next year that may be of most benefit. A lot of people don’t really know or don’t really want to know what the true cost of Christmas is. The cost of Christmas should include all additional expenditure that comes with it. That would include; the taxi home after the drinks with work colleagues, the cost of the drinks, Christmas dinner, the box of sweets you brought to your aunties on the 28th, the cost of the New Year’s celebration, the cost of that take away because you just couldn’t bother cooking that night, the cost of extra fuel for the fire because it’s cold and, of course, the cost of presents.

It is difficult to sit down in April or May and start planning out what all these things are going to cost. My suggestion to clients who find Christmas a difficult time financially is to sit down this year and use a journal. Take note of everything you spend that is considered “Christmas related”. So all the money you spend on things that you wouldn’t ordinarily have to spend on. Make sure the journal or notepad is small enough to fit in your pocket so you can bring it out and about with you. Get as much detail into it as you can – how much you spent, on what, etc.

“When the festivities are over, sit down and review everything. Total up what you spent and now, for the first time for a lot of people, you will know what Christmas actually costs.” When the festivities are over, sit down and review everything. Total up what you spent and now, for the first time for a lot of people, you will know what Christmas actually costs. You can then feel prepared and plan for next year. For simplicity, let’s suggest that your cost total comes to b2,400. Do you have b200 per month to put aside? If you don’t, you are either going to have to borrow next Christmas, dip into savings, or cut the cost of Christmas.

The ideal route is to save for Christmas. Some people use savings clubs with certain companies, but I have to say I am not a fan. In practice, they work for a lot of people. The problem I have is twofold. Firstly, when you save in these Christmas clubs you are usually morally bound, if not contractually bound, to spend your savings with that company when Christmas comes, which means you can’t shop around for better bargains. There may be clauses to allow you to take your money back, but in reality, if you save with a particular company it’s most likely you’ll spend your money with them. The second difficulty I have is that you are handing the control of your money over to someone else. One of the golden rules of personal financial planning is to leave your options open for as long as possible. Every week, or month, you will hand your money over to someone else who will benefit from the interest accumulated on that money. But more importantly, you will be digging into your “war chest”. Everybody should have a little war chest of money that they can dip into during the year if needs be. In my opinion, when you have established the cost of Christmas, I think it is harder to find a better place than the credit union to save your money. You will have instant access if needs be; you may not get as an attractive rate as some of the high street banks but you will have access to credit if needs be. Access to credit is not guaranteed to credit union customers but I will say your chances are much improved if you are an existing customer with a regular pattern of saving. If the saving doesn’t work out or you need a more immediate solution for now… what do you do? If you have some savings you can dip into, you may have to take that option. If you have money on deposit and in investments, consider carefully

HealtH Matters 107

PerSonAl finAnce

“if you have to borrow consider your options carefully too. credit cards are an easy line of credit, so much so that in ireland, there are currently more than two million credit cards in existence with approximately b1,400 on each of them.” where to take the money from. a leading life company estimates that encashment requests increase by about 50 per cent in the run up to Christmas. You might think that seems right, but I am not so sure all of those people sought financial advice on whether that was the right place to take the money from. sometimes there are penalties, and sometimes the assets are either performing exceptionally poorly or exceptionally well, resulting in plain old bad timing.

If you have to borrow consider your options carefully too. Credit cards are an easy line of credit, so much so that in Ireland, there are currently more than two million credit cards in existence with approximately b1,400 on each of them. strange as it might sound, I think credit cards used properly are a fantastic idea. But let me say it again very clearly – used properly. If you use credit cards in the right way, it is like the opposite of the Christmas savings club. You can use the banks money for a period of time without having to pay interest on it. But you have to be disciplined enough to clear the entire balance when it is due in order to avoid any interest payments. You also have to consider the cost of the government stamp duty every year, so if you spend very little on the card monthly, you might find this to be costly relative to the “free” money you are getting. If you do find yourself with a large credit card hangover in January, it is probably best to consider a couple of options. If you think you can clear the debt in a reasonably short period of time there are several credit card companies that will allow you transfer the balance to them and give you interest free for ten months. this is the most efficient way of clearing the debt. If you still have a balance after ten months, see if you can find another company to take it on for another ten

months. If not, and the balance is still there, consider approaching your local bank or credit union and try and organise a personal loan. this in the long run will work out much cheaper. Be careful of the terms and conditions and get good independent advice. Most of all remember what Christmas is about, if you can’t remember yourself ask any child half way through January what the best thing about Christmas was and listen to the response you get. In my opinion, one thing this recession has done is helped us all to rediscover our “Irishness” and that I think will make it a great Christmas regardless of the finances.

ABOuT THE AuTHOR eoin McGee is the owner of Prosperous Financial services, an independent firm regulated by the financial regulator as a multi agency intermediary and mortgage intermediary. He has over 10 years experience giving advice to both individuals and companies in relation to their finances, he can be contacted on eoin@prosperous. ie, 045 841 738 or 087 6 44 55 33.

108 HealtH Matters

your SerVice your SAy

‘deAlIng WItH comPlAIntS’ We are actively telling all those attending our services that ‘We want to hear from you’. therefore, it is vital we know the steps to take when dealing with complaints, writes mary culliton, Director of advocacy.

e recently ran a public information campaign to highlight the Hse’s Comments, Compliments and Complaints Policy ‘Your service, Your say’, which came into effect on 1st January 2007. ‘Your service, Your say’ invites all health service users to have their say about their experiences of the health service. Comments and feedback from the public enable us to continually improve and develop our services to meet the needs of our patients and service users. In 2009, the Hse received 7,984 complaints from service users which represent an increase of 63 per cent on 2008. this substantial increase shows that our work to promote knowledge of this policy and service has been a success and more people are now accessing the complaints process and feel able to make complaints.

WHAT DO SERvICES uSERS WANT? We have all had experience of the health service as a patient or service user and we know how valuable good customer service is. as a service provider, if we understand and meet the needs of people using our service, our work environment is more pleasant. WHAT DO I WANT? • a competent, efficient service • to be listened to and heard • Compassion • empathy • respect • Confidentiality • Professionalism

• Basic courtesy and friendliness • Follow through • Dedicated attention • to be taken seriously • to be updated in a timely manner • Honesty • to have my questions answered in a language I understand • to be informed about my diagnosis, treatment, care plans by someone who is knowledgeable about my condition

“your Service, your Say’ invites all health service users to have their say about their experiences of the health service. comments and feedback from the public enable us to continually improve and develop our services to meet the needs of our patients and service users.”

In 2009, the top three complaints were Delays/Waiting times 37 per cent, treatment/service Delivery 31 per cent, Communication 8 per cent. However, the root of most complaints is poor communication.

In the coming months we will be challenged by the changes in our service. Good communication will help us ensure that our relationships with service users remain positive, however, we also need to know what to do if we receive complaints so these are some guidelines which you may find helpful.

WHAT DO I DO If I RECEIvE A vERBAL COmpLAINT? • Use the lIsteN technique • Listen to the complainant • Identify the issues (remember there may be more than one) and identify what outcome the complainant is looking for • Summarise the issues and ask the patient/ service user to confirm that they agree with your interpretation of their complaint • Thank the complainant for taking the time to give us feedback • Empathise and acknowledge the feelings of the complainant and explain what will happen next • Now act; determine the appropriate action. assess the seriousness and/or the complexity of the complaint to determine if the complaint should be resolved at the point of contact or if the complaint should be referred to the Complaints Officer

Health Matters 109

Your service your say

Can the complaint be resolved locally? Yes • Review the complaint to identify any quality/safety issues to be addressed at local level • Pass on information about the complaint to your service manager

No • Advise the complainant of their right to submit a written complaint to the complaints officer • Help the person write out their complaint if necessary • Advise the complainant about advocacy services • Give the complainant the contact details for the complaints officer and/or transfer the caller to a designated complaints officer

The A&E of complaints management – Apologies and Explanations If a service or benefit has been wrongly denied or delayed to a complainant or we are clearly in the wrong, we should give a detailed explanation and/or an apology. Apologies and explanations should include the reasons why we got it wrong and an apology for any hurt, inconvenience or hardship caused. We must maintain confidentiality at all times except when required by law to do otherwise. I have received a written complaint – what now? All written complaints must be investigated by a complaints officer who will initiate an investigation. (A list of complaints officers in your area is available on the Your Service Your Say section of the intranet)

The complaints officer will issue a letter of acknowledgement, if contact details are provided, within five working days

Response Times Depending on the nature and seriousness of the complaint: • A response to a verbal complaint should be given as soon as possible and definitely within a 24-hour period from receipt of complaint • The complaints officer will examine a complaint within 30 working days of the date it was acknowledged. If it takes longer to examine all the issues he/she should notify the complainant within 30 working days and update them on what is happening every 20 working days after that • We can save valuable resources by dealing with complaints early in the process

What if the complainant is not satisfied with the local HSE response? If a complainant is not satisfied with the response they can request a review, within 30 working days of receiving the final report, by writing to: Review Office, HSE, Block 4, Central Business Park, Tullamore, Co. Offaly. They may also request an independent review of their complaint from the Office of the Ombudsman or Ombudsman for Children. For further information, see the Your Service Your Say section of the intranet or contact your local Area Officer for Consumer Affairs.

110 Health Matters

appointments

Gerry O’Dwyer elected Vice-President of European Association of Hospital Managers “Gerry O’Dwyer, who was appointed as Regional Director of Operations, Dublin MidLeinster in 2009, is the first Irish person to be elected to the position.”

SE Regional Director of Operations for Dublin Mid-Leinster, Gerry O’Dwyer has been elected Vice-President of the European Association of Hospital Managers – the professional body representing healthcare managers across Europe.

Gerry O’Dwyer, who was appointed as Regional Director of Operations, Dublin Mid-Leinster in 2009, is the first Irish person to be elected to the position.

A native of Dublin and educated in the Carmelite College, Moate, County Westmeath, Gerry trained as a psychiatric nurse at St Patrick’s Hospital in James’s Street before going on to become Director of Nursing in Our Lady’s Hospital in Cork and St Luke’s Psychiatric Hospital in Clonmel, South Tipperary, in the late 1980s. Formerly Services Manager and then Deputy General Manager of Cork University Hospital, Gerry was also the Chief Executive Officer of Our Lady’s Hospital for Sick Children in Crumlin and is a recent board member of the Irish Blood Transfusion Services. Gerry is a past president of the Health Management Institute of Ireland.

Frances O’Keeffe appointed Chair of the Council of Concern Worldwide A

County Limerick woman, Frances O’Keeffe from Ballingarry has been appointed chair of the Council of Concern Worldwide. Frances works as a public health nurse in Dublin’s north inner city. She studied general nursing in Essex in the UK, midwifery in Glasgow, her Public Health training in UCD and obtained a Masters in Community Health at Trinity College Dublin in 2000. “Concern was well known in Limerick and indeed there was a Concern support group in Rathkeale and my Latin teacher at secondary school, Padraig Feehan, was an active member. In 1988, I went along for an interview with Concern and to my complete shock they sent me to Bangladesh not Africa. My father thought that I was ‘cracked’ and Mam’s

“I worked with extraordinary people while in Bangladesh and I learned so much. I was sent to Mymensingh, which had the worst floods in 250 years.” comment was, ‘there she goes again’. I worked with extraordinary people while in Bangladesh and I learned so much. I

was sent to Mymensingh, which had the worst floods in 250 years. I was working at flood relief for the first six months and guess what? I can’t swim. I was part of an all-woman relief team and they were a fantastic bunch of people”, Frances recalls. While Frances knows we have severe social problems at home she says that you cannot compare Ireland with the developing world. “I believe we make a difference. I would not still be involved with Concern if I did not believe that. I have also been most fortunate to have made great friends in the countries where I have worked. I am convinced that only for Concern many people would be far worse off than they are today”, said Frances.

Health Matters 111

ploughing championships

National Ploughing Championships 2010 V

isitors to the HSE stand at the 2010 National Ploughing Championships in Co. Kildare last September had the opportunity to avail of free lung testing for chronic pulmonary obstructive disease. Hundreds of members of the public also availed of diabetes testing and had their blood pressure checked by HSE Frank Dolphin, Chairman, Board of HSE and Dara Purcell, Secretary to the Board of the HSE, with his family.

members of staff during the three-day event in Cardenton, Athy. A HSE physical activity co-ordinator was also on hand to answer questions about exercise and healthy lifestyle choices. HSE staff members used the opportunity to provide a health promotion and public

information service. Up to 140,000 people attended the festival which also featured a European ploughing competition. People were given information on a range of HSE services including data on meningitis, diabetes, medical cards, environmental health and immunisations.

Mary Culliton, Director of Advocacy talks to a visitor at the Your Service Your Say stand.

Maggie McNally, Senior Case Worker, Older Persons Services talks to a visitor about services available for older people.

Frank Dolphin Chairman of HSE board with (L) Mary Culiton, Director of Advocacy and (R) Dr Cate Hartigan, National Specialist in services for older people outside the HSE tent

112 Health Matters

Christmas Gifts

All I want for Christmas... Find the perfect present for any member of your family with our Christmas gift ideas!

Stocking Fillers

Unique Gift Ideas

Multi-tool set 12-piece d12

Glazewear lipgloss gift set (Iced Pink, Sundance and Clear SPF15) d7.50

Giftsdirect.com is an Irish online gifts delivery company providing gifts that can be delivered in Ireland or worldwide for special occasions such as Christmas or birthdays. Try the range of personalised gifts such as a personalised Christmas Santa Stocking, d25 (which allows a child’s first name to be embroidered onto the stocking) or a personalised bottle of champagne, d54. For lots more great gift ideas visit: www.giftsdirect.com or call freephone on 1800 21 00 21

Heatons knitted moccasin slipper socks €6

Snowman mug with chocolate shaker hat €7.50

warmer Reindeer feet tons ea H d10 from

Heatons hot chocolate tower set d10

Brush set with in neat black and teal zip-up pouch b7.50

keyrings 80s stressball Boots m fro d5 each

Health Matters 113

Christmas Gifts For Him

For Her Thomas Sabo Classic Collection – earrings d279, disco ball pendant d379 and ring d298 – all jewellery with black Zirconia

Classic Leather Hip Wallet €14 from Boots

A Next fairisle knit hood €68 Cath KIdson iPhone 4 electric flowers blue case d30

Philips executive iPod dock SD3000 €84 from Littlewoods Ireland

An outfit from Next – lace top dress d67, bead clutch bag d39 and bangle d17

Breville Cupcake Creations VTP100 €32 from Littlewoods Ireland

Ted Baker Wake Up Sleepy Ted d26

Cath Kidson check shawl €52

Davidoff – The Champion gift set €47 from Boots

Microsoft Lifecam VX-3000 €45 from Littlewoods Ireland

Canon 14.1 mega pixel digial camera in pink €320 from Littlewoods Ireland Ted Baker Kiss Me Quick €20 from Boots

114 HealtH Matters

chriStmAS giftS

for kids

Beauty and the Beast Belle doll €35 (suitable for ages 3+)

jet pack Buzz Lightyear €50 (suitable for ages 4+)

scrabble trickster €30 (suitable for ages 10+)

m&s foosball table €27

next for boys –

scarf €6.50, plaid shirt €17, skull t-shirt €11, Belted jeans €20, shoes €43, Hat €8, sweater €13, skate cuff jeans €24, shoes €13, Blazer €37, skull t-shirt €9, straight jeans €17, shoes €13, scarf €6.50, Faux Leather jacket €37, turn-up jeans €13 and strap shoes €17

next for girls –

stripe Hat and scarf (part of a 3 piece set) €16, sweater dress €18, Beanie €6.50, polka dot top (set of 2) €16, tutu €20, Hat €11, Quilt jacket €25, denim skirt €16, denim jacket €32 and tutu dress €26

m&s foosball table €27

HealtH Matters 115

book club

gIve A BooK For cHrIStmAS! Books are a timeless asset, they provide hours of enjoyment and a good book can make the perfect christmas gift. As always, there are a variety of new titles being launched in time for christmas, here are just a few that we feel would make great stocking fillers! HE SAID, SHE SAID Bernard share is a distinguished critic, writer and editor. a former editor of Cara, the aer lingus in-flight magazine, he has written many books, including the bestselling the emergency, a popular account of Irish life during World War II, and the hilarious Inish, a novel originally published in 1966 and re-issued last year. He said, she said is the pick of 2010’s polemics, protestations, predictions, faith, hope and uncharitableness; such as: “I’ve no idea how they get the figs into the fig roles”, Michael Carey, chairman, biscuitmaker Jocob Fruitfield and “all I know is that it is becoming a Celtic Chernobyl”, economist Peter Bacon on anglo Irish bank. b14.99 ITSA COOKBOOK like all modern women, Domini Kemp juggles all the important things in life on a daily basis – family, friends, work and all the pleasures and challenges that they can throw at you. Her new cookbook is for anyone looking for tasty, healthy food that works within the constraints of a hectic schedule, whether you are entertaining for friends, catering for fussy kids or whipping up a quick meal for one before flopping on the sofa after an exhausting day. its a Cookbook is filled with well-known recipes, which have been torn apart and simplified to take key factors like time, nutrition, satisfaction and taste into consideration. recipes emerge tastier yet manage to eliminate anything that isn’t utterly critical. b19.99

THE TRAvELLER’S GuIDE TO pLANET EARTH this is an exciting new collaboration between travel experts lonely Planet and award-winning BBC documentary Planet earth. From the highest mountains to the deepest seas, the hottest deserts to the frozen poles, the traveller’s Guide to Planet earth reveals the places you dreamed of visiting after seeing them on the BBC’s landmark series, and shows the reader how they can explore the destinations for themselves.b21.10 A mOvEABLE fEAST lonely Planet celebrates the role food plays in lives across the world in a Moveable Feast, a collection of tales from experts in the field, including celebrity chefs and best selling travel writers. anthony Bourdain, andrew Zimmern, simon Winchester and Matthew Fort are among the writers who serve up a gourmet selection of adventure, romance, camaraderie and crime from far flung destinations. What better way to explore the world than through a host of sumptuous culinary experiences? b10.55 SOuNDINGS In its original form just as you remember it! soundings was first published in 1969. It was intended as an ‘interim’ anthology of poetry for the leaving Certificate until such time as a more permanent volume could be devised. twenty six years later it was replaced. In

the meantime, it had passed through the hands of hundreds of thousands of students in Ireland. Now you can enjoy it once more! b14.99

WIN A SET Of BOOKS! Poolbeg Press, Ireland’s number one publisher of Irish fiction for women and now selling books online at www. poolbeg.com, has kindly given Health Matters three sets of books to giveaway to our Book Club readers. the set of books includes: the Big Book of Hope – compiled for the Hope Foundation for Vanessa O’loughlin with Hazel Katherine larkin, Murder at shandy Hall – the Coachford Poisoning Case by Michael sheridan, Ireland's Haunted Women by Christina McKenna, Harte – tyrone Manager Mickey Harte’s biography, It's Got to be Perfect by Claire allen and sarah love by Geraldine O’Neill. to enter, simply answer the following question and email your answer, your name, address and phone number to: competition1@ashville.com with ‘Poolbeg’ in the subject line. Which of these titles is a novel by nuala Woulfe and also published by poolbeg press?

(a) two to Waltz (b) three is a Crowd (c) two to tango

116 HealtH Matters

book club

recommended reaDs there is nothing better in winter, when the weather is cold outside, than curling up on the couch in front of the fire reading a good book. With so many great titles available at the moment, there is an abundance to choose from. Here’s our recommended reads to get you through winter! SACRED HEARTS by Sarah Dunant serafina, a willfull, emotional and furious girl, has just been ripped from her proposed marriage and sent by her noble family to santa Caterina. During her first night inside, such is her violent, incandescent rage that the dispensary mistress, suora Zuana, is sent to her cell to calm her with a draft of herbs. thus begins a complex relationship of trust and betrayal. and while outside the convent walls the forces of the Counterreformation push for ever more repressive changes, serafina’s rebellious spirit challenges not only Zuana, but many other nuns who have made peace with the isolated life. juLIET NAKED by Nick Hornby Nick Hornby returns to his roots – music and messy relationships – in this funny and touching new novel which thoughtfully and sympathetically looks at how lives can be wasted but how they are never beyond redemption. Nick Hornby uses this intriguing canvas to explore why it is we so often let the early promise of relationships, ambition and indeed life evaporate. and he comes to some surprisingly optimistic conclusions. THE mum’S GuIDE TO HAvING yOuR BABy IN IRELAND by Lucy Taylor If you’ve haven’t had a baby before you might be forgiven for finding the way the medical system works in Ireland today a little complicated, in fact, it can be a minefield for the uninitiated. Ignorance is definitely not bliss when it comes

to pregnancy and childbirth. With detailed chapters on getting pregnant, the different types of care available, the nine months of pregnancy, the specifics of giving birth in Irish hospitals, and what to expect in the first few weeks, this book, written from a mum’s perspective, is a comprehensive guide to the maternity experience in Ireland.

THE SuNDAy GAmE 2010 Packed with incisive commentary and evocative photographs, the sunday Game 2010 records the thrills and spills of the year’s Gaa season, with many of the sunday Game’s familiar faces offering their reflections on the 2010 championship. Illustrated with over 120 full-colour action photographs and featuring match reports on all the major games in hurling, football and camogie, the book covers the entire Gaa season from the National league finals right through to the all Ireland Finals. LONELy pLANET’S BEST IN TRAvEL 2011 looking for 2011’s hottest journeys, destinations and experiences? You’ll find hundreds of them in the eagerly-anticipated lonely Planet’s Best in travel 2011; the sixth annual collection of the best places to go and things to do around the world for the year ahead. among the essential and sometimes surprising selections made by lonely Planet’s extended family of writers, travellers, bloggers and tweeters are our picks for the best country, region and city to visit this year. For the first time, these are ranked these in order.

THE BIG BOOK Of HOpE Complied by Inkwell’s Vanessa O’loughlin with writer, journalist and broadcaster Hazel Katherine larkin, the Big Book of Hope is a unique collection of contributions from Ireland’s top writers, media personalities, businessmen and women, and political figures. this book really does have something for everyone and will keep you turning the pages every time you open it, but most importantly it brings you the gift of Hope with every story. Proceeds from the sale of the Big Book of Hope will go directly to the Hope Foundation. TWO TO TANGO In this new book by Nuala Woulfe, two women, Jennifer a thirty-something mum of three who is struggling with her own identity and has to deal with the bombshell of redundancy, and rebecca, young, attractive and married to an auctioneer, who is beginning to realise that years of trading on her looks hasn’t brought her happiness but has held her back from her dreams. But now, these two women begin to leave the past behind and start living more spontaneously, trying everything from latin dancing, playing rugby, sexy lingerie parties and even toy boys to find the meaning of happiness and rediscover their sense of fun. Don’t forget to join the Health matters Book Club on facebook!

Health Matters 117

crossword

Crossword No 1

by Colin White

ACROSS

1 The breakdown of food into nutrients (9) 5 No one really knows why we do it, but it seems to be contagious (4) 7 One must focus (4) 8 Blood cells that begin in the lungs (3) 11 Musical stage of sleep! (3) 13 Convulsion, fit, or spell caused by electrical activity in the brain (7) 15 Flakes of dead skin (8) 19 Whistling sound (6) 20 A flexible cord was once attached to (5) 22 A Twisting ladder (3) 24 Bump on the outside of your ear canal (6) 25 Keep your teeth attached, and chewing! (3) 26 A kind of x-ray (2) 28 Helpful if you have allergies (4-4) 29 Voice box (6)

8 9 11

17 18 19 20

22 23

26 27

DOWN 1 Stretches from clavicle to the humerus (7) 2 Death of body tissue due to the loss of blood supply (8) 3 A place to recover (3) 4 A sinew or tendon (5) 9 String to sew things together (6) 10 Will result in significant loss of intellectual ability (8)

12 Thick, spongy kind of jelly inside your bones (6) 14 Device to get medicine directly into the lungs (7) 16 A result of your body being invaded by germs! (5) 17 Can be caused by loud music (8) 18 A condition in which the immune system

begins to fail, leading to life-threatening infections (3) 21 Doctors use these to figure out whatâ&#x20AC;&#x2122;s going on in your brain (3) 23 A mark left on your skin (4) 25 The long tube in the body of a person or animal (3) 27 A prescription (2)

Scribble box

Down: 1 Deltoid, 2 Gangrene, 3 ICU, 4 Nerve, 9 Suture, 10 Dementia, 12 Marrow, 14 Inhaler, 16 Fever, 17 Tinnitus, 18 HIV, 21 EEG, 23 Scar, 25 Gut, 27 Rx Across: 1 Digestion, 5 Yawn, 7 Lens, 8 Red, 11 REM, 13 Seizure, 15 Dandruff, 19 Wheeze, 20 Navel, 22 DNA, 24 Tragus, 25 Gum, 26 CT, 28 Skin Test, 29 Larynx Answers

118 Health Matters

competitions

Happy Christmas

from Health Matters! Health Matters has some amazing prizes to give away to our readers; read on for details and how to enter...

WIN a Christmas Hamper! iftsdirect.com are an online Irish gift company providing gifts that can be delivered in Ireland or worldwide for occasions and special moments such as birthdays, weddings, anniversaries, engagements, Christmas and many more. Set up in 1987 by Lulu O’Sullivan, the company was one of the first online delivery businesses in Ireland and is now a highly successful, award-winning gift company providing an outstanding service worldwide. With over 1,000 gifts available online, there is something to suit every taste and budget. For more information, visit www. GiftsDirect.com or call the freephone number 1800 21 00 21. We are offering three lucky winners the chance to win a Christmas hamper or food gift from GiftsDirect.com

1st Prize: The Irish Banquet Christmas Hamper This includes; chocolate cookies, biscuits and other goodies; coffee and Irish afternoon tea; preserves, wholegrain mustard, cranberry sauce, brandy butter, Christmas pudding, mince pies and Irish porter cake, plus much more! 2nd Prize: A Taste of Christmas Gift This includes; a bottle of Chateau Montouliers Minervois; a gourmet Christmas pudding by Irish Pantry Foods; and luxury assortment of handmade chocolates by Butlers. 3rd Prize: Side of Smoked Irish Salmon Succulent salmon smoked the traditional, gentle way, over oak shavings. This prime salmon is carefully selected, cured, smoked and allowed to mature before slicing. If only all salmon tasted so good! To enter, simply answer the question below and email your answer, your name, address and phone number to: competition1@ashville.com with ‘GiftsDirect’ in the subject line. When was the Irish online gifts delivery company, GiftsDirect.com, set up? (a) 1999 (b) 1987 (c) 2003

Competitions’ terms & conditions Closing date for entries is Friday 31th December. All entries will be entered into a draw to pick a winner and they will be notified by email or phone as soon as possible.

Health Matters 119

competitions WIN a Neven Maguire DVD! iele Ireland, the German domestic appliance brand, regularly collaborates with awardwinning chef Neven Maguire; hosting cooking demonstrations in the Miele Gallery in Citywest Business Park, Dublin and he also moves around the country with the mobile Miele kitchen hosting demonstrations in hotels. Miele have also sponsored his cookery programme on RTÉ 1. We have two copies of Neven’s latest cookery programme Neven Maguire Home Chef on DVD to giveaway; just answer the following question and email your answer, your name, address and phone number to: competition1@ashville.com with ‘Miele Ireland’ in the subject line. Miele are known as the domestic appliance brand from which country? (A) Germany (B) France (C) Scotland

WIN a b50 voucher for M&S! hristmas at M&S is all about stylish and luxurious gifts, glittering decorations and decadent foods to make that time of year extra special. From gardening gifts to the perfect stocking fillers, foodie gifts to games for the whole family, from gadgets to delicate lingerie – there is plenty of choice, from the unbelievable value right through to affordable luxury. Visit one of our 21 stores in the Republic of Ireland for everything you need for a very Merry Christmas. We have two b50 vouchers for M&S to giveaway, to enter, simply answer the following question and email your answer, your name, address and phone number to: competition1@ashville.com with ‘M&S’ in the subject line. How many stores do M&S have in the Republic of Ireland?

(a) 50

(b)27

WIN A WEEKEND AWAY

IN BALLYHOURA FOREST LUXURY HOMES Set in the beautiful Ballyhoura Mountains, Ballyhoura Forest Luxury Homes are the perfect getaway location. Nestled within the forest, the six stunning eco-friendly, selfcatering luxury holiday homes are all fitted to the highest standards. Committed to providing quality rural tourism, the forest homes are the ideal place to unwind and explore the Ballyhoura and Shannon regions. The immediate area is a haven for outdoor pursuits such as walking, hiking, mountaineering, cycling, mountain biking, golfing and more. Architecturally designed to reflect the natural surroundings of the forest, and with the natural warmth of wood throughout, each three-bedroom Ballyhoura Forest Luxury Home also features award winning woodburner stoves and German fitted kitchens with Miele appliances and granite worktops. Each bedroom is en-suite, and these boast Italian marble floors, polished porcelain tiled walls, and power showers. For more information 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: Where are Ballyhoura Forest Luxury Homes located? (A) Limerick/Cork border (B) Cork/Limerick border Closing date for entries is Friday 14th of Jan 2011. All entries will be entered into a draw and winners will be notified by Ballyhoura Forest Luxury Homes. WHAT THEIR GUESTS ARE SAYING “What a delightful house in idyllic surroundings! We got exactly what it said in the brochure and more. The aspect, ambiance, décor and fittings were of the highest standard. We loved coming back in the evening and lighting the wood burning stove – so efficient we hardly used the central heating, even with gales blowing outside. The people were so welcoming and we enjoyed buying locally produced food and making some great meals in the superb kitchen. The perfect place to escape to and we will certainly return.”

ballyhoura comp.indd 1

19/11/2010 15:43:09

120 HealtH Matters

me And my job

getting to

KnoW yoU... Name: Donal Gill

+ Donal and Clare Kambamettu, the 2010 International rose of tralee

Job title: Medical social Worker base: University Hospital Galway WHAt do yoU love ABoUt yoUr joB? the fantastic teams I get to work with and the different people I meet on a daily basis. HoW long HAve yoU WorKed WItH tHe HSe? about ten years – four years in my current post. deScrIBe yoUr joB In FIve WordS Interesting, stimulating, broad, changeable and dynamic. WHAt'S yoUr AverAge WorKIng dAy lIKe? It’s hard to plan an average day in social work as anything can happen to change the most basic of plans, so you need to be good at adapting to a changing situation at a moment’s notice – almost accept the unpredictable! But generally, I get to work at 8.30am; check messages and email; go on the wards to meet with colleagues to see what patients may need my intervention; attend multi-disciplinary team meetings, journal clubs, case conferences, etc. I’m also involved in a stroke support Group that meets once a month, which is very interesting and is facilitated by colleagues from acute, community and voluntary services.

IF yoU coUld cHAnge one tHIng ABoUt yoUr joB WHAt WoUld It Be? longer days, but less of them – I’d love to have a morning or afternoon to be able to go to the post office! WHAt'S yoUr FAvoUrIte BooK And WHAt dId yoU lIKe ABoUt It? the shadow of the Wind by Carlos ruiz Zafon. I began reading it after coming back from holidays in Barcelona, where the story is set, and it brought me back straight away to the cobble streets and side markets. It’s a really good read. I’ve just started the Millennium series by stieg larsson, which is also really good, so the shadow of the Wind may have to move over! WHAt'S yoUr FAvoUrIte FIlm And WHAt dId yoU love ABoUt It? too many to choose from – Gladiator and the Indiana Jones films are never too far from the DVD Player! the recent sherlock Holmes film with robert Downey Jnr and Jude law was priceless, so I’m looking forward to seeing if a sequel is going to be made.

WHAt'S tHe moSt memorABle tHIng yoU HAve ever exPerIenced? Being an escort for this year’s rose of tralee Festival was an amazing experience, especially escorting the london rose, Clare Kambamettu, who is now the 2010 International rose of tralee. WHAt teAm WoUld yoU dIe For? I was always useless at sport so I don’t follow any specific teams. I like rugby and athletics though so they generally keep me quiet when they’re on television! HIgHlIgHt oF 2010 as mentioned already, being an escort in the rose of tralee. I now have an extended rose and escort family that goes from Galway to New York to Queensland and back, with plenty of stop offs in between! WHo HAS InSPIred yoU tHe moSt? My family. Pet HAte? Currently….Banks! toP tHIng on yoUr dreAm lISt IF yoU Won tHe lotto? Pay off the debts and travel the world.

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