SSTA FF MAGAZINE OF T H E I R I S H HEALTH SERVICE TH
MATTERS S P RI NG 2022
NURSE BERNIE REFLECTS ON TWO YEARS OF GREAT CHANGE
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A MESSAG E F RO M O UR ED I TO R Welcome to Health Matters and hope is certainly the theme of this latest edition. We have had many false dawns over the last two years but it is hard not to feel that we have finally emerged through that long dark tunnel of the COVID-19 pandemic and out into the daylight once again. The days are getting longer and brighter and the easing of so many restrictions mean that we can finally smile – and see others smile again. It has been an unprecedented two years, particularly for staff up and down the health service. We speak to staff from around the country who share with us the highs and lows of the pandemic, what they missed the most and what they are looking forward to doing now that much of the country returns to a renewed sense of normality. It has been the collective effort of people that has brought us to this point – we have done all that has been asked of us – wore masks, kept our distance and availed of the COVID vaccines for ourselves and our loved ones. Now is the time to enjoy the results of all those efforts. The team at Mallow Community Vaccination Centre give us a unique insight into their time on the vaccination frontline, noting how the whole experience will live long in the hearts and minds of those who experienced this ‘history in the making’. Staff at the Cavan-based HSE Vaccination Centre donned superhero costumes in recent months to create a more inviting space and welcoming experience for children attending. The centre, like so many others, was decorated in an appropriately child-friendly manner and among the superheroes and characters in attendance were Action Man, Spiderman and Snow White. COVID certainly hasn’t disappeared but we hope that we can all enjoy a bright spring and summer ahead. A sincere thanks to all those who have sent in contributions to this edition and I hope you find plenty of interesting reading in it.
Joanne Weston
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Message from Paul Reid Our COVID experience - staff look back at last two years Inside the children’s vaccination centres Reflections from a team of vaccinators High-support residence opens Information system for cancer treatment Car donation to island primary care team Staff pay programme Specialist menopause clinic opens Celebration of midwifery Medication safety award First National Nursing Home Experience Survey Overseas training scholarships Total bed management at TUH World AIDS Day celebrated UL Group surgeon gives prestigious presentation COVID memorial bench unveiled Staff helping out in multilingual messaging Kerry Integrated Care Martin bows out of nursing career Return to Nursing Day in the life of a community nurse Caoimhe tells us her quit story New National Clinical Guidelines to help people give up smoking Boy hailed a hero after father’s cliff fall St Luke’s long service awards Bye bye Bonnie New visitor app in UL Group Awards for public health teams Pathfinder keeping elderly out of hospital CHI video on managing allergies Get up, get dressed, get moving Mental health resources for young people Demo rooms at new children’s hospital Perinatal mental healthcare explored at conference New sanctuary of care Nurse-led care in oncologyhaematology clinic Mentorship programme at CUH Triage clinic cuts waiting list National Service Plan Childhood vaccines Specialist mental health service marks 20 years Health Passport gets new app ICF in Limerick opens eyes to new patient-centred model of care
46 Medicines initiative supporting patients 48 Urology clinic cuts visits from four to one 49 Digital initiative to prevent future cardiac arrests 50 Dementia advisers in every county 51 Sporting memories boost for people with dementia 52 Keeping track of the COVID-19 vaccine 53 Ground-breaking COVID research 54 Your Opinion Counts staff survey 55 Support and understanding for the bereaved 56 Data privacy is everyone’s responsibility 57 Be cyber security aware 58 Online health appointments using video 59 Innovation at Tallaght 59 Portlaoise rolls out Respirasense initiative 60 CxIO team brings insights of clinical work to IT team 62 Spark Ignite competition supports innovation on frontline 63 Cervical cancer prevention week marked 64 Teen pregnancy study reports major decline in numbers 65 Sexual wellbeing campaign hits TV screens 66 Nursing home expert panel 67 Trust and confidence in the HSE 68 Change practices 70 National Estates Information System 70 Patient safety is everyone’s business 71 Introduction to Human Factors 72 Reduce your risk of injury at your workstation 73 EU4Health programme 74 New recruitment operating model for HSE 75 Healthy Ireland report 76 Musicians on call 77 Keynotes choir 77 Local podcasts hit the airwaves 78 Menopause and Me webinar a huge success 79 Living Well helping patients manage long-term conditions 80 Get yourself summer ready
Editor
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M E ET T H E TEA M
H SE Head of Internal Communications Emma Finn Internal Communications Team Yvonne Costello
A M E SSAG E F R O M O U R C EO PAU L R E I D
Ann McLoone Jennifer Carrie Amy O'Neill Frances Plunkett Shane Larkin Paddy Crosse
As hvi l l e Med i a Grou p Editor Joanne Weston Art Director Áine Duffy Creative Director Jane Matthews
Published by Ashville Media, Unit 55 Park West Road, Park West Industrial Estate, Dublin 12, D12 X9F9. Tel: (01) 432 2200 ISSN: 0332-4400 All rights reserved. Every care has been taken to ensure that the information contained in this magazine is accurate. The publishers cannot, however, accept responsibility for errors or omissions. Reproduction by any means in whole or in part without the permission of the publisher is prohibited. © Ashville Media Group 2022.
It is time to let optimism, hope and positive plans come forth and dominate once again in society and in all our lives. It has been a difficult two years since COVID-19 first arrived on our shores, especially for those who have been ill or lost loved ones, who we shall never forget. We finally see a very welcome atmosphere, that life is returning to a new sense of normality and with that hope has emerged. It is important at this moment to re-iterate the gratitude we all feel for the extraordinary work carried out by health and social care teams all over the country, now but more especially over the past two years. Staff contributed so much and worked selflessly by continuing to provide services, albeit via new ways of working, which was challenging for you. This is an exemplary illustration of public service. We have always said that when this public health emergency ends we want to retain the innovation, empowerment and flexibility we have witnessed and experienced over the past two years. The planning around services, working practices and the return to the workplace will be appropriately structured to reflect this. As we begin to adapt to a new reality with greater openness we continue to urge everyone to retain awareness of COVID-19. At a senior operational level within the HSE, we are hopeful but also ensuring that we are in a state of readiness should any new variant or any cause for concern emerge. Throughout the pandemic, the National Crisis Management Team has worked to ensure the HSE acts in the best interest of the public, and it continues to ensure that everything we do is guided by the best public health advice. We are continuing to monitor the disease, manage our COVID-19 related services and work to ensure that all services, across all sectors operate efficiently given COVID’s presence. We are continuing to urge those who still require a COVID-19 vaccine or booster dose to come forward. We have seen the huge positive impact that the COVID-19 vaccine has made on lessening the spread of the disease, and reducing its severity, to the great benefit of people, our society and in maintaining our health service. Thank you for your immeasurable contribution since the start of the pandemic. Your collective actions have greatly improved the public’s trust and confidence in the HSE.
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R E F LEC T IONS O N A PA N DE M IC Hope and optimism replace dread and fear for 2022 2022 has brought fresh hope and optimism for the entire world. Plans can finally be made again, family hugged and friends visited. It has been a very long two years of the COVID-19 pandemic for everyone, not least our healthcare workers. COVID-19 has changed so much about ourselves, our society and how we do things. For healthcare workers, these changes took place as the volume and complexity of their work rose expediently. From virtual appointments and video conferencing, to the embracing of countless digital innovations, healthcare in our hospitals and out in the community has been utterly transformed and done so while under the most severe pressure. Staff from across the health service have shared with us some reflections of their life during COVID, how their job changed, how they coped with the worst of the pandemic, what they missed most during restrictions, and now.
T
he images of Bernie Waterhouse receiving her COVID-19 vaccine on December 29th 2020 was a welcome boost at the close of a horrific year for everyone. Bernie, a Clinical Nurse Manager (CNM) in St James’ Hospital, became the first healthcare worker in the country to get a dose of the longawaited vaccine. More than two years later, she has reflected on the many changes that COVID-19 brought about in her work life, completely revolutionising the delivery of healthcare in Ireland. “I got so much from our time dealing with COVID-19. It learned more than I did in any other stage of my career and I was so proud of all that we did. It has instilled in us such high-quality standards and patient-centred care,” she said.
“We did what we could to keep patients alive and get them back to their families. And we got great feedback from families who were so grateful to us so we knew we were doing the right things.” As COVID-19 hit the country in March 2020, Bernie, who was a CNM on a surgical ward, volunteered to work on a COVID medical ward. For her, the first wave of COVID-19 was the most traumatic as staff on the frontline battled an unknown beast. “It was really tough. The lack of PPE was the worst part at the start. By the second week, staff were dropping like flies and the anxiety around was huge. It was a very tough on everyone psychologically because of the very high death rates that we were experiencing on the ward,” she explained. “The number of deaths we would see in a year on the surgical ward, we were getting in just one or two weeks. On one
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day, we sent five people to the ICU and had two deaths. It was quite overwhelming. Patients were deteriorating so quickly. One lady was eating her lunch at 12pm and was dead by 2pm, completely without warning. And we were seeing that with both young and old people.” Bernie, like every healthcare worker, was impacted greatly by the lack of touch and physical contact with her patients, particularly as they were dying. “Patients weren’t able to see our faces and they weren’t able to hold our hands. It was just torture not being able to comfort them as they were so scared and anxious. Facial expressions and physical contact are so important in patient care and that was all taken away from us,” she said. “We ended up getting lanyards made with photos of ourselves on it so that our patients would know what we looked like underneath all that PPE.” She said lots of things changed by the time the following waves hit and, despite the volume of COVID-19 patients, the staff were much better equipped to handle it. “It was all so scary at the beginning. Patients were dying alone because we were afraid to let family in. We just didn’t know if the PPE was going to be enough to protect them. But we have all learned so much about the virus and how to treat our patients. It has made life much simpler,” said Bernie. The isolation was also a tough side effect of being on the COVID-19 frontline. “I had one of my staff who was living with her parents and she isolated by herself for four months. The only social integration people were getting was at work.” She credits her colleagues with helping to get her through the toughest of times during the pandemic, as well as a ‘phenomenal’ multidisciplinary team. “Everyone showed so much kindness to each other. We were a strong, united team that proved very resilient throughout. The multidisciplinary team were phenomenal. They were so nice and so respectful of nursing. There was no hierarchy at all.” Bernie said that there are many innovations in patient care that the entire team will be carrying forward. “Our end-of-life care has been transformed for the better. We now have a Spotify account approved by the Foundation here and we can play a patient’s favourite music to them. One patient recently loved Andre Rieu and he actually passed away listening to him. We
also have students in holding their hands while they are dying to help reassure them and keep them comforted,” she explained. She said that the Hearts for Heroes initiative is another that the staff in St James’ are only too delighted to continue. Early into the pandemic, the hospital was sent a box of knitted hearts by Angie Fennell, an outpatient of the hospital. Each heart had an identical match. When a patient was dying, a heart would be placed in their hand and a matching heart was given to their family. This gesture brought families closer to their loved ones when they were dying and could not be physically by their side. “I had families on to me crying, they were just so touched by the gesture. And it helped them to feel closer to their loved one even though they couldn’t be with them as they passed.” Changes to hospital visits have also been welcomed by Bernie. “It was obviously tough that patients had no visitors but it’s difficult to think back to the days when we had maybe 50 visitors coming through, children and babies. There is no doubt that the routine ward visits pre-COVID definitely impeded our ability to do our work and mind our patients, never mind the infection control perspective,” said Bernie. “We have set up visitor pods here
outside the hospital to facilitate off-ward visits and I think that is a good way forward. I don’t think I would like the visits to go back to the way they were.” She said she is happy to continue wearing masks on the wards and out and about in crowded settings. “Staff definitely feel more protected wearing them and are more than happy to keep wearing them. We’ve seen fewer absences through other illnesses on the wards too.” As restrictions are lifted, Bernie said she is looking forward to a lot of things. “It is great to be able to finally meet people again. There are some that I haven’t seen since the beginning of COVID. Seeing people without their masks is also a lovely thing. I have worked with some people that I hadn’t seen out of their full PPE so being able to see their face was wonderful. I have a lot of babies in the family that I haven’t met yet because they were born during the pandemic so I can’t wait for that,” she said. “It’s just great to be able to meet in bigger groups, go to restaurants and not have to plan everything that you do. I am also a big swimmer and used to go four times a week. I’m only back to it in the last month and it was brilliant. And, of course, holidays are back on the cards. It’s all feeling very hopeful.”
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JOHN KELLY, DIRECTOR OF PASTORAL CARE, TALLAGHT UNIVERSITY HOSPITAL
How did your job change during COVID? The pandemic presented me in my role as a healthcare chaplain with new challenges and opportunities. The distressing realities challenged my own abilities and also highlighted the unique contribution of pastoral care in providing end of life care, care for patients and their families and my role in supporting staff. My job changed with the sheer number of COVID-19 related deaths over a period of months and unprecedented levels of physical, emotional and spiritual distress I experienced. Who or what got you through the hardest moments of COVID? Through the pandemic, I witnessed extraordinary teamwork within TUH. This is what kept me focused and energised through the hardest moments. We truly had each other’s backs and kept each other going. Through it all: love, death, fear, guilt, pride, hope, friendship, alienation, and so much sorrow they kept turning up for work and caring for their patients. While working through COVID-19 will always affect me as a person, I refuse to let it define me. I’d like to think it pushed me into wanting more for my patients and colleagues.
Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? From a work point there are three areas that are worth holding onto: 1) pandemicera safety precautions that will improve health and quality for vulnerable patients, 2) rest and quiet time for all patients, 3) the use of technology for work meetings will be something to embrace for the future. From a personal point of view, a quieter world along with more reflective days and breaks near the sea or countryside are a must. What did you miss the most during COVID? Throughout the pandemic I missed meeting friends, family and my visits to the swimming pool. I also missed my involvement with a number of organisations where I do some voluntary work. What are you most looking forward to doing as restrictions ease? I am looking forward to taking to the skies again as I feel I only get a break from work when I am out of the country. I am also looking forward to a ski holiday with lots of sun and snow.
SHARON FARRELL, HSELIVE MULTI-CHANNEL OPERATOR What got you through the hardest moments of COVID? When COVID first came to light I was really frightened. It made me feel that there was a world war with an unseen army. I did not want to speak to close family about my fears as I did not want to worry them or add to their fears. I have a little Yorkshire terrier called Spartacus. I took to talking to him all the time just as if he was a person, he never disagreed or judged me on my fears or feelings. He just would look at me with these brown trusting eyes as if to say this too will pass. He kept me sane. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I have found time for me. Certain things in life that I thought important were actually not and my priorities changed. I learned that in my home life everything did not have to be done today - it could wait until tomorrow. I found a calmer me. In my working life I learned that it was ok to step outside the box and not to be scared of taking on new roles. I worked in the same department for over 10 years. I now work in a new department in a completely different role and I have embraced the change and the challenge. What did you miss the most during COVID? Freedom and family. I missed my freedom to travel. I had so much planned for 2020 - I turned 50 that year. When the dreaded 5km
lockdown came into place, this was my worst nightmare. I walked my 5k everyday but it was the same 5k. I felt like a gold fish in a bowl going round and around in a circle seeing the same thing. My daughter lives in Canada and I would visit her once a year. She struggled greatly because she was working from home and never got to see anyone. I could not be with her in person to give her a hug. We had many tearful phone calls but we started up the family group chat and we had a quiz night every Friday night. It was these nights that made up for the sad hard times. It was something to look forward to the end of a long week. What are you most looking forward to doing as restrictions ease? I’m looking forward to going to Canada to see my daughter. However, I have come to really like my current lifestyle the way it is. I’m more on the side of what it is I’m not looking forward to. I like my space. Before COVID, people would call in unexpectedly and I would drop what I was doing. After having time on my own I realised that this is not okay. The mask is a great thing - I did not have to slap on a full face of make-up just to go do a grocery shop. My skin is so fresh and clear and the saying ‘I’m having a bad hair day’ nearly became a thing of the past. Family became really close during the pandemic, sons and daughters had more time for their elderly parents even though at times the chat may have been over a fence or through a window. Neighbours once again started to look out for each other communities came together. I hope that this continues and that we don’t get caught up in the rat race once more. Maybe the Government could pick a weekend day in the summer time and we could all get together at a CCSP - COVID community summer party!
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HELEN STOKES, GENERAL MANAGER, SELF ISOLATION FACILITY, CITYWEST HOTEL
How did your job change during COVID? I was asked to take minutes of the Management Group that was setting up the HSE COVID-19 Self-Isolation Facility on March 19th 2020 and as a result was asked to join the Team. This resulted in me being assigned as the Operations Manager for the Self-Isolation Facility. When the Project Manager finished up in June 2020, I was the head HSE Manager. We were a multidisciplinary team consisting of GPs, Director of Nursing, nursing staff, healthcare assistants, an admin team and the hotel staff, operating 24/7. Who or what got you through the hardest moments of COVID? Knowing that the Self-isolation Facility was making a difference in relation to the spread of COVID and we helped a high number of people to stay safe. As the surges happened we reached full occupancy quite quickly and had to manage the bed numbers very closely – literally counting available rooms on a whiteboard. When a resident was discharged their room had to be locked for over 24 hours to kill any virus before the staff could enter and turn around. We had to secure translators of many different languages and dialects for residents from Direct Provision. Sometimes we could have a family of five or six people, some positive, some close contacts, and some asymptomatic, and these were often with us for up to six weeks. Having young children being couped up for this length of time, we ensured we had toys, books, extra clothing and
outdoor bits (footballs etc) so that they could entertain themselves. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I have developed new skills in knowing how to multitask in a very efficient and fast way. I’ve also learned to deal with many diverse groups across the country and have developed a strong understanding of how people have to do without! I now also engage more with all the various staffing groups and have an ‘open door’ policy. Communication is very important. What did you miss the most during COVID? Being able to have some ‘down time’. I was always on call to deal with many different eventualities. I also missed not being able to see my daughter and grandchildren here in Dublin when the lockdown was very strict. The lack of interaction with other family members and friends was also very difficult. During this period my mother-in-law also went in to a Nursing Home and it was a very difficult period for all involved. My second daughter is in Australia and not being able to see her and family has been sad (Skype and Snapchat are great). What are you most looking forward to doing as restrictions ease? Being able to meet up with family and friends and do one-to-one, face-to-face catch-ups; being able to go to a restaurant for a meal and stay out after 8pm. I also plan to visit Australia to see my daughter who is expecting her third baby in May.
DR AUGUSTINE PEREIRA, CHIEF CLINICAL OFFICER AND RCFS WITH RESIDENTIAL CARE FACILITIES.
How did your job change during COVID? The PH role changed overnight in unimaginable ways. From a service largely unknown, to a service at the forefront of the pandemic response in Ireland. From a service that had the odd out of hours calls in a week to a service where the OOH doctors phone didn’t stop ringing. I remember the sleepless nights at the start of the pandemic and starkly remember taking the on call phone off a colleague who hadn’t slept a wink the previous night. What kept us going was the team support to each other. My own role changed in many ways during this time too. As Director of Public Health I scaled up the team in Cork and Kerry to respond to pandemic within weeks working with UCC PH team, health
promotion and many CHO colleagues. From March 2020, I moved to some national roles- initially with contact management programme, then PH lead for test and trace working with all the 8 departments of Public Health and latterly clinical lead for HSE Live, the communications division of the HSE. Since October, at request of CCO, I have been at the PH Department in the North East, which had the highest burden of disease and was facing particular challenges including low staffing levels that needed strong leadership to address. Who or what got you through the hardest moments of COVID? The team. I saw such dedication, commitment and selfless service from my team, one which I am truly honoured to be leading. One phrase that rings in my ear is ‘Would you want me to cover this weekend?’’I think the RCFs need our support this weekend, so I shall keep an eye.’ So many times this was repeated ... They say when the going gets tough, the tough get going. Every so often, I have witnessed this to be the case in North East. It felt like there was nothing that could knock us down, wave after wave, we grew stronger. Are there any changes that you have made
in your work and home life during the pandemic that you will be happy to bring forward with you? Since we scaled up the team to nearly four times the size since I joined North East or rather nearly 10 times when compared to core capacity pre Covid, we didn’t have office space. Many of our redeployed staff came from across the country, so we quickly adopted a remote working approach. We’ve mastered the art of being effective in our role working from home. A word of caution as we bring that learning into future- ‘work’ shouldn’t encroach into ‘life’, ie maintain the work life balance. What did you miss the most during COVID? My family. I used to travel every fortnight to my wife and son in England. The toughest part was being unable to see my young son grow up due to the travel restrictions and to explain why I couldn’t be there for him. My wife bore the brunt of the caring responsibilities juggling her clinical duties as a doctor on the frontline. What are you most looking forward to doing as restrictions ease? Visiting my family frequently and them being able to visit every half-term as in the past. At work, seeing the smiles on my colleagues’ unmasked faces!
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BARBARA SLEVIN, ASSISTANT DIRECTOR OF NURSING, INFECTION PREVENTION & CONTROL AND CPE MANAGEMENTUL HOSPITALS GROUP
How did your job change during COVID? IPC was fundamental in leading and managing the COVID pandemic across ULHG from the early days in January 2020 and this lent to a greater awareness of our role. We up-scaled training for all multidisciplinary staff, including non-frontline healthcare workers. COVID-19 was a fast-moving, evolving situation with rapidly changing epidemiology globally. My role as Group ADON for IPC in ULHG, meant leading the nursing team and being adaptive to these changes in order to respond rapidly. This was especially challenging to maintain confidence among staff, one day we were recommending one thing and the next it was changed again. Often these changes led to stress among staff, increased re-training and education requirements, rewriting processes, and ensuring at all times that there was effective communication to staff to keep them informed of changes to guidance and practices. Who or what got you through the hardest moments of COVID? The support of and working collaboratively with our wide multidisciplinary IPC team and other work colleagues made even the most difficult days possible. My family are centre to my world and the moments I could grab with them were precious and most important to me. Those moments sustained me over tough days. When it was possible, I swam in the sea and to me it was as if the sea washed away all the stresses of COVID, the perfect antidote. And not forgetting copious amounts of good coffee.
COURTNEY CHASE, PUBLIC HEALTH NURSE, CO MAYO
How did your job change during COVID? My job changed in vigilance and in following COVID policy. There were
Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? Despite COVID challenges, there were also some definite positives, great collaboration and multidisciplinary team working, and a fantastic surge in Infection Prevention and Control training and education. Staff now have a greater awareness and appreciation of the importance of infection control and hopefully these practices will remain interwoven when COVID activity has decreased and will lead to improvements in practices at clinical level. Many meetings took place via teleconference and teams which is LEAN and efficient and definitely the way forward. What did you miss the most during COVID? Jokingly, I could say I missed most of 2020 and 2021 as it was all work and all COVID! However, it was the simplest things - not being able to rush in and hug my family when I came in the door from work-and the fear of bringing COVID to anyone’s door. I really missed contact with my wider family and friends, we managed this via Zoom but it isn’t the same. I also missed many great opportunities to celebrate important family occasions but also not being physically present with people who needed some friendly support during these difficult times. I also feel saddened being unable to share in the tradition of funerals of special people that were lost during the pandemic. This is something we do very well collectively as a community and it felt almost alien being unable to do these rituals and traditions that we normally do so well in shouldering the grief of others. What are you most looking forward to doing as restrictions ease? Quite humbly it’s the simple things - hugs! Seeing people’s expressions, smiles and laughs. I am looking forward to creating new memories for my children that don’t involve COVID, masks, and COVID testing. My youngest doesn’t remember life pre-COVID. I am looking forward to a bright, wonderful, free and happy summer in 2022.
constant updates and policies regarding the pandemic. We had to wear PPE gear into houses at certain times, wear different masks, and there was also a shortage of staff at times when they were close contacts or had COVID. There was a generalised fear amongst the public and a few times clients refused me to visit. Staying vigilant for the public’s safety I did not socialise and maintained COVID restrictions personally and professionally. Who or what got you through the hardest moments of COVID? My family, especially my husband and two kids. I am blessed to have supportive friends and colleagues at the end of the phone. It became about the small things that you appreciated like a takeaway, glass of wine and a coffee with a friend (when we could).
Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? The realisation that anything can happen at any time even a pandemic!! Be grateful and have gratitude for who and what I have. Try to always have a work-life balance. Appreciate the small things. What did you miss the most during COVID? I missed socialising with friends and holidays and seeing my family who live abroad. What are the most looking forward to doing as restrictions ease? I am really looking forward to travelling again. I went to Florida at Christmas to visit my parents. Going to concerts and social gatherings again.
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BERNI O’SULLIVAN, LEAD COORDINATOR FOR NORTH MAIN STREET VACCINATION CENTRE IN CORK How did your job change during COVID? I worked in the ICU in Cork University Hospital for 30 years. I worked in the COVID ICU for the first year of COVID and it was certainly the worst year of my career. It was so sad and so horrible. I felt so bad for the young nurses who were starting off and wondering if things were always going to be so terrible. I was at rock bottom. But then last March, I moved to the new vaccination centre at Pairc Ui Chaoimh as a Lead. Within a month I was so re-energised. It was so fantastic seeing the hope that was around the place, watching the older generation coming in to us dressed up to the nines and with huge smiles. Who or what got you through the hardest moments of COVID? It was definitely my colleagues who got me through the worst days. All the staff at the ICU, not just the nurses, but the doctors, cleaners, porters, everyone had your back. They always recognised when you were at your lowest and would offer their support.
Not being able to let families in to see loved ones was horrendous. After doing the video calls between the patient and their families, you were at rock bottom, it was a cruel thing. But the support from colleagues was overwhelming. And of course I have my brilliant family – my husband and two daughters have kept me going too. Are there any changes that you have made in your work and home life during the pandemic that you will be happy to bring forward with you? I didn’t make massive changes but I will definitely continue to wear a mask in a lot of situations to protect the people around me for the foreseeable future. What did you miss the most during COVID? The thing I missed most was family. I am one of eight in my family and I have three sisters that I am very close to. They are in Kilkenny, Galway and Longford so I didn’t get to see them and that was really hard. My daughter is a nurse in Liverpool and she wasn’t able to get home to us at all. It was so tough.
What are you most looking forward to doing as restrictions ease? Like everyone, I am looking forward to travelling again. And getting to be with all my family again is a big one. It is great that my daughter can get home to us regularly now from Liverpool.
CHARLOTTE CARTER, CNM 2 ICU, CCU, PORTIUNCULA UNIVERSITY HOSPITAL
How did your job change during COVID? The main change in my role was having to take in to account the bigger picture more than I would have done previously. Due to the focus on ICU capacity within our own ICU as well as other Saolta group ICUs, I needed to ensure that we were able to facilitate all admissions safely which included accepting several patients from other hospitals who were experiencing capacity issues. I was also very conscious of ensuring that non-COVID patients had their needs met as for a while it felt that globally like COVID was the only focus. As well as this we had to implement a variation of new practices in to our department in a short period of time. As a result, ensuring my staff got the neccessary updates on practice, as we learned it from our European counterparts, without overwhelming the staff was a very delicate balance. Who or what got you through the hardest moments of COVID? The ICU team have been amazing. I feel so proud to manage my nursing staff who respect me with my decisions and who trust me for ensuring that the safety of the patients and staff will never be compromised. From a personal point of view, my family have always been incredibly supportive of my career and know how
important it is to me, and without their understanding during such uncertain times it could have been so different. Are there any changes that you have made in your work and home lifeduring the pandemic that you will be happy to bring forward with you? At work, I am even more protective of the staff as I am so cautious of burnout and how it has all impacted them in their own lives. I make sure that they know I am there for them should they need anything and will do whatever I can to help them should they need it. As for home, it has made me think of how precious time is. My children are teenagers now who have missed out on two years of experiences which would shape them for the future. My focus now is to encourage them in to as many different things as I can to make sure they go forward in life not being afraid of trying new things and taking every opportunity that is presented to them. What did you miss the most during COVID? All my own family are all back in the UK, and I have not been able to visit for various reasons since COVID began. Before COVID I would could just hop on a plane for a few days, but the restrictions made this process much more complicated. Now that the restrictions are lifting, it will be on the top of my list to book a flight over! I love learning new things, so I am already on the look-out for short craft sessions such as pottery or jewellery making where I can learn new skills either by myself or with my boys. From a work point of view, we are all looking forward to organising a lunchtime get-together to catch up on all the missed conversations in the tea room!
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ELEPHANTS, RABBITS AND SUPERHEROES brighten children’s vaccination experience
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Staff play their part to make centres as child-friendly as possible
aking the vaccine as easy an experience for the young children attending vaccination centres around the country has been a major priority. Vaccination staff have been going the extra mile in recent months as the younger members of the public have come through their doors. Berni O’Sullivan, Lead Coordinator for North Main Street Vaccination Centre in Cork, explained how the centres are made as child-friendly as possible to ensure the children leave happy as well as protected from COVID. “We have looked at ways to make the centre more child-friendly and improve a child’s overall experience,” she said. “Some of our staff have dressed up in character costumes such as an elephant and a rabbit, with a focus to alleviate any stresses a child may have coming into the centre for their vaccination. We accommodate all children but specifically try to cater to those with sensory issues by bringing them to the centre at earlier times.” A comic book story has been produced to let children know what to expect during their short time in the vaccination centre. Staff at the Cavan-based HSE Vaccination Centre donned superhero costumes in recent weeks to create a more inviting space and welcoming experience for children attending. The centre, at the Kilmore Hotel, Cavan was decorated in an appropriately child-friendly manner and among the superheroes and characters in attendance were Action Man, Spiderman and Snow White. The children received a certificate commending them for their bravery and were given a ribbon to place on a wishing tree created by local artist Heather Brett. Eddie Ward, Operational Manager explained that they understood how some children may be nervous. But after the child-friendly approach taken, they found that ‘the children here are not fearful’. “They might be slightly anxious but they know they are somewhere
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they are being looked after. The more positive their experience, the more likely they are to return for their second vaccine. Some of the children don’t want to go home after the 15-minutes observation – that’s a good sign,” said Eddie. Staff at the centre also produced a video explaining the process of getting your vaccination. This video shows a walk-through of the vaccination process that is easy to follow. Filmed at Cavan Vaccination Centre and narrated by Eddie Ward, the video offers a step-by-step guide for children and parents on what to expect throughout their vaccination journey. “We wanted to explain to children and their parents what the process involves when they make their decision to get their child vaccinated. The video is filmed from the child’s perspective and aims to allay any fears they may have before they come to the centre,” said Eddie. The video also features some superheroes, as staff are wearing various superhero costumes in Cavan for all the children’s clinics.
CHO 1 Lead for COVID-19 Vaccination Programme and CHO 1 Head of Service for Health and Wellbeing Cara O’Neill said, “We would like to support parents/guardians to get all the information they need to make an informed decision about getting their child’s vaccinated. There is a wealth of factual evidence based information on www.hse.ie. We really look forward to welcoming you and your children to Cavan and Monaghan Vaccination Centres.” The video can be seen by clicking this link: https://youtu.be/1w5FZ-WxMnU
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From left to right: Cavan – Leona Morrow with her son Mackenzie after he got his vaccination in Cavan, with Superman Gary Coyle, vaccinator Roisin Sexton Smith, Supergirl Curran, and Private Bernard Harmon, 27th Battalion. Dundalk – Charlotte Weston following her vaccination in the Fairways Hotel, Dundalk.
COVID-19 VACCINE FOR CHILDREN AGED 5 TO 11 – GET THE VACCINE FACTS COVID-19 vaccine is available for children aged 5 to 11 years. Dr Lucy Jessop, Director of Public Health in the HSE National Immunisation Office shares the facts about the COVID-19 vaccine for children. How can I protect my child from COVID-19? “COVID-19 vaccination is recommended for all children aged 5 to 11. The vaccine is particularly recommended for children who have a health condition that puts them at higher risk of severe illness from COVID-19, or if they live with a child or an adult who has complex medical needs or are immunocompromised,” said Dr Jessop.“Though serious illness from COVID-19 is rare in children, they are even less likely to become seriously ill with COVID-19 if they are vaccinated.” What vaccine will my child be offered? The vaccine your child is being offered is made by Pfizer and is called Comirnaty. It is a lower dose vaccine than the one offered to people aged 12 years and older.It has been tested with over 2,000 children aged between 5 and 11 years of age as part of clinical trials. No additional safety concerns were identified in the clinical trial for children in this age group. How many doses of COVID-19 vaccine are needed? “Two doses of COVID-19 vaccine are recommended 21 days apart,” said Dr Jessop. Other vaccines cannot be given in the 14 days before or the 14 days after your 5 to 11 year old gets the COVID-19 vaccine. Children with a weak immune system may need an additional dose of COVID-19 vaccine, at least 28 days after their second dose. How does the vaccine work? “This mRNA vaccine teaches your child’s body how to make a protein that will trigger an immune response, without using the live virus that caused COVID-19,” explained Dr Jessop.
“Your child’s body then makes antibodies that help fight the infection if the COVID-19 virus enters their body in the future. Before vaccination, you will be asked to give consent for your child to get the vaccine and this consent will be recorded.” Can children who have already had COVID-19, get the vaccine? If your child has had COVID-19 they will likely have some protection from COVID-19 but they could get COVID-19 again. Getting vaccinated will reduce the risk of getting it again. Your child can get the COVID-19 vaccine four weeks after they first developed symptoms or four weeks after their positive COVID-19 test. Does the COVID-19 vaccine have side eff ects? Like all medicines, vaccines can cause side effects. Most of these are mild to moderate, short-term, and not everyone gets them. You should read the information on the HSE website and in the information leaflet so that you’re aware of possible side effects before you consent to your child’s vaccine. The information will also tell you what to expect after your child’s vaccination. How to get the COVID-19 vaccine for your child Parents and guardians can register their child for COVID-19 vaccination on the HSE website: www.hse.ie/book or you can call HSELive on 1800 700 700 to register your child over the phone. More information Visit the HSE.ie website for dedicated information for parents including a comic strip to help children understand what they can expect when they go for their vaccine. Visit the immunisation.ie website for information for health professionals including frequently asked questions.
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‘WE LEFT WITH WONDERFUL MEMORIES OF A HISTORIC VENTURE INTO THE UNKNOWN’
Anne Marie O’Gorman, Deputy Clinical Lead, Mallow Community Vaccination Centre, reflects on her time on the vaccine frontline
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s the doors closed for the final time on Mallow GAA CVC in North Cork, it was heart-warming to reflect on the small but significant part played by one of the 36 nationwide HSE Community Vaccination Centres in combatting the deadly effects of the unforgiving virus that is COVID-19. The CVC team formed, stormed, normed and then adjourned with wonderful memories of a historic venture into the unknown. The indefatigable support from Peggy Horan, General Manager for the project, was immense. The transformational
leadership of Mary B O’Sullivan, Clinical Lead, impacted positively on the whole team, and the sometimes inspirational and always welcome ‘Thought for Today’ provided that extra thought-provoking dimension to what was very repetitive work for the vaccination team. After weeks of on-site preparation, an atmosphere of anticipation and apprehension was apparent at the first morning ‘safety huddle’ on April 29th 2021. This was overshadowed by the overwhelming willingness and determination of everyone to ‘get the job done’. Dressed in scrubs, wearing face masks and with many people
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not knowing each other, name badges were very important. Safety was the keyword on the whiteboard and remained the cornerstone and the paramount focus of the whole team for the duration of the CVC. Open sharing of the many vaccine-related updates by the Clinical Leads, audit of individual vaccination techniques, the use of the few incidents as learning tools, and a focus on the importance of individual self-care were the catalysts that empowered each person to do their best. The importance of clinical focus and the need to take allocated breaks was stressed daily. Everyone was encouraged to ask questions and support each other, with the reminder that ‘there is no I in TEAM’. Someone was always ready with a word of thanks. The positive and supportive atmosphere that developed, coupled with the wonderfully spacious venue, created a workspace that was a truly enjoyable experience for all.
"The team were respectful and sensitive to the differing needs of the population attending the centre. Many people had come out of isolation or cocooning to attend their appointment and were blatantly scared to be in a large room with lots of people" The shared laughter and craic was a welcome antidote to the consistently focused aim of the whole team. The mission was to administer COVID vaccinations safely to all who wanted them, whilst following all relevant procedures. The team were respectful and sensitive to the differing needs of the population attending the centre. Many people had come out of isolation or cocooning to attend their appointment and were blatantly scared to be in a large room with lots of people, despite the mandatory wearing of face masks and the availability of hand sanitising stations. People who had needle phobias or extreme anxieties were spared the sometimes long queue via a quick access
Above and opposite page: The team at Mallow Community Vaccination Centre in North Cork.
route for those screened as needing it. Patience and tolerance were required to vaccinate some attendees for whom the reality of getting an injection was overwhelming. The handful of people who attended the vaccination centre to get their vaccination card but not the vaccine itself belied belief! However, most people were just desperate to get vaccinated. The on-site IT support worked tirelessly in the background supporting the vaccinators and highlighting individuals requiring an appointment to the clinical leads. The security team deftly handled all requests and demands and worked closely with the clinical leads to ensure that no eligible person was turned away. At times the commitment of the prep room team to not wasting a single vaccine led to long evenings waiting for people on standby to arrive. The cheeriness and efficiency of the admin team at registration and the friendliness of the Civil Defence and Irish Red Cross volunteers maintaining social distancing in the queue, put the public at their ease. The welcoming and competent vaccinators were supported by the affable and knowledgeable medic on duty. They listened patiently to anxieties, dealt with the various clinical challenges presented to them and skilfully vaccinated everyone. The mix of irrepressible and steadfast characters in the observation
team celebrated with the public, who were so relieved and delighted to be vaccinated that the 15-minute period flew. Behind the hilarity they were ever watchful for signs of adverse reactions and dealt swiftly with the minority who required medical attention. Despite the face masks, someone was always ready with a smile because, as one of the ‘Thought for Today’ reminded the team, a smile shows up in your eyes. By the time Mallow GAA CVC held their last clinic on October 29th 2021 the centre had also facilitated and embraced multiple Schools Immunisation Clinics and Peer Vaccination Flu clinics, while the core CVC team were off-site administering COVID booster vaccinations in the 15 residential care facilities across North Cork. As the inevitable closure drew near it was clear that the initial nerves of the early days had been replaced by friendships and a camaraderie that was palpable. A meaningful ‘bualadh bos’ at the last safety huddle acknowledged the courage, respect and sincere regard held by all team members for each other. The very gratifying total of 54,425 COVID vaccinations that had been safely administered through over 140 clinics was celebrated at a well-attended farewell social team gathering. The whole experience will live long in the hearts and minds of those who experienced this history in the making.
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NEW HIGH-SUPPORT COMMUNITY RESIDENCE OPENS IN DUBLIN Staff of An Grianán in the new facility
A new high-support community residence is a welcome addition to Dublin North City Mental Health Services. An Grianán opened as a replacement residence for Weir Home, which had opened in the early 1980s. A key element of continuous improvement in Mental Health Services is the provision of physical environments, which are conducive to recovery and which create a good working environment for professionals delivering services. “The name An Grianán means ‘the sunny place’ and we sincerely hope that this new community residence will provide a positive environment for our residents, staff and families who will live, work and visit there,” said a spokesperson for DNC Mental Health Services. “This community residence is purpose-built to an exceptionally high standard, has a very cosy, warm environment and is a place we believe the residents will be happy to call home. The residence has 10 ensuite bedrooms, including two wheelchair accessible rooms, over two floors.” An Grianán provides 24-hour nursing care, as part of a wider multi-disciplinary team approach. This residence will have a strong rehabilitation and recovery focus with the overall aim of assisting individuals with a mental illness to move towards independent community living. An Grianán is extremely well located, it is adjacent to the Technology University Campus and a short walk from the city centre. The residents will have access to a number of local amenities such as public transport with the Luas and local bus stops, shops, supermarkets, cafes, restaurants and cinema in Smithfield. So far feedback from service users, staff and family members has been really positive.
Left to right: Stephanie Togher, NCIS Lead Nurse; Julie Bradshaw, Staff Nurse; Grant Carroll, Pharmacist, National Cancer Control Programme; Chris Kane, General Manager, Galway University Hospitals; Emma Walsh, Pharmacist; Áine Cahir, Clinical Nurse Manager, Haematology/Oncology Day Ward.
NEW INNOVATIVE INFORMATION SYSTEM FOR CANCER TREATMENT IMPLEMENTED AT UHG University Hospital Galway is the first designated cancer centre to roll out and implement the National Cancer Information System (NCIS) which will be implemented in all 26 hospitals delivering Systemic Anti-Cancer Therapy nationally. The NCIS is a key priority project for the National Cancer Control Programme to facilitate hospitals to implement quality, efficient systemic anti-cancer therapy in line with the National Cancer Strategy 20172026. The project is jointly sponsored by the Director of the National Cancer Control Programme (NCCP), the HSE Chief Information Officer and the Director of Acute Hospitals and is prioritised within the Cancer IT programme of the eHealth Strategy for Ireland. The system, which is now fully live in UHG, provides a single national computerised system that records and stores information about a patient’s cancer case, diagnosis and treatment. The goal of this project is to deliver a clinical information system to support the care of oncology and haemato-oncology patients including the provision of Systemic Anti-Cancer Therapy or Chemotherapy across Ireland. Access to a patient’s longitudinal cancer record will be available through the NCIS. This will ensure that all relevant healthcare providers will have access to the patients’ data in an appropriate and timely manner.
MENTAL HEALTH SERVICE DONATES VEHICLE TO HELP ASSIST ISLAND’S PRIMARY CARE SERVICES
Ciaran Maguire, SEO, Office of Head of Service, Mental Health CHO Area 1, and Dermot Monaghan, Head of Service, Primary Care CHO Area 1.
The nursing service on Tory Island was delighted to receive a new four-wheel drive car from Mental Health Services. Tory Island, which is roughly 12km off the North West coast of Co Donegal, is one of the most remote places that CHO1 provides a nursing service on. The island is beautiful but has rugged terrain with its 150 plus residents scattered across its 2.5mile length and ¾ of a mile breadth. The island nursing service has had a small van for routine and emergency calls to date but is delighted to receive this Issuz Yukon vehicle from Mental Health colleagues. The vehicle has a four-wheel drive function which will be a useful asset when
assisting in urgent and emergency calls which can involve the navigation of difficult terrain. The island nursing team will also be able to use the vehicle to accommodate other HSE primary care professionals when undertaking clinical home-based calls on the island or running clinics at the health centre. This is an excellent example of services working together to improve the provision of services to all our communities including those living remotely. “We are delighted to receive this vehicle, it will be of great benefit to the nursing team and other health services personnel in delivering care to the local community on Tory Island,” said Dermot Monaghan, Head of CHO 1 Primary Care Services.
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MY HSE SELF SERVICE TO BE ROLLED OUT FURTHER National integrated Staff Records and Pay programme (NiSRP) My HSE Self Service is being made available to all HSE staff in the Midlands, North West and MidWest in the first quarter of 2022. Since mid-2019, NiRSP has successfully implemented SAP Staff Records, SAP Payroll, SAP time entry and SAP selfservice functionality across HSE East and South East, areas which feature more than 30,000 staff and pensioners. The online facility allows employees to view or change a range of personal information, view their payslip, request leave and submit travel expenses claims, and allows managers to approve applications for leave and travel. The NiSRP programme encourages all staff in these areas to set up an account for My HSE Self Service. Information webinars are available to all staff in these areas on the HSE Online Events and Webinars page of the
Create Project 2021 Digital and Assistive Technology Pilot The HSE Disability Services Department Longford/Westmeath will receive €100,000 from the CREATE 2021 initiative to conduct a focused pilot project to assess and provide Digital and Assistive Technology (DAT) to Adults with disabilities in County Longford. The Cooperative Real Engagement for Assistive Technology Enhancement (CREATE) initiative seeks to ensure that service users and providers work together to identify what will make a real difference to individual users of digital and assistive technology (DAT). The aim is to promote digital and assistive
SAOLTA GROUP CELEBRATION OF MIDWIFERY
Simon Kinsella, MTA in Portlaoise Hospital, and Olive Hayes, Project Lead, NiSRP at the Portlaoise Hospital Information Stand.
HSE website. In a survey, 86% of webinar attendees have found these webinars ‘extremely useful’. Watch a recorded version of this webinar series here: https://youtu.be/GpGiO_7FtZ8 Information stands are provided on-site in each of the areas as the system is made available, to support staff to log-on and use the system. HSeLandD eLearning certified course A-Z on My HSE Self Service is available and each module takes 15 minutes. Search for NiSRP at www.hseland.ie to find the course. For support information on My HSE Self Service, see: www.hse.ie/nisrpselfservice or the NiSRP Helpdesk Phone: 0818 300 296 or email: support.nisrp@hse.ie and request a call back.
technology to support independent living for up to 10 service users who: • Live in Longford County Council housing and would benefit from DAT in the home to increase independence. • Have a housing need, are on the Longford housing waiting list and would benefit from DAT which would support their application for housing. • Are keen and willing to try DAT to realise their independent living goals. The HSE will partner with Longford County Council to support persons moving to social housing and assisting those with applications for social housing. Funding will be available to pilot projects in February/March 2022.
In celebration of the Year of the Nurse/Midwife in 2020 an online event was planned by the Centre for Nursing and Midwifery Education (CNME) Donegal, to showcase SAOLTA Group initiatives and services in line with the Maternity Strategy (2016-2026). Despite the interruptions of a pandemic and then a cyber attack, the vision of this festival was shared by all involved and online teamwork ensured that this event was a success. This event brought together – virtually - a large audience and demonstrated that the SAOLTA Group are committed to ensuring high quality maternity care. Siobhan Canny, SAOLTA Group Director of Midwifery, and Catherine Cannon, Director, Centre for Nursing & Midwifery Education in Donegal, gave great support with the event to Midwifery Tutor Joanne O’Hare, CNME Donegal, who led out on this initiative. Each Director of Midwifery and Midwife Representative from the SAOLTA Group Maternity Services dedicated much time and effort to bring together what was a very successful online event showcasing the tremendous work that is taking place in line with the Maternity Strategy (2016-2026). Over 150 people linked into the live event nationally & internationally as well as many others who were able to access a recording of the event.
DEDICATED SPECIALIST MENOPAUSE CLINIC OPENS AT NATIONAL MATERNITY HOSPITAL A new clinic at the National Maternity Hospital (NMH) aims to improve menopause care for women with complex menopausal symptoms. The specialist Complex Menopause Clinic, supported by funding from the Department of Health and HSE's National Women & Infants Health Programme, is open and seeing patients. The service is dedicated to helping patients with serious medical conditions to manage their menopausal symptoms. The clinic is the first of four publicly funded specialist menopause clinics in Ireland and is staffed by GP menopause specialists,
a full-time nurse specialist and an administrative team. Mary Brosnan, Director of Midwifery and Nursing at the NMH said, “This is a great stride forward for women’s health. We are delighted to have this dedicated, specialist clinic at The NMH. As a woman, a midwife and nurse, I am acutely aware of how challenging the symptoms of menopause can be and of the life-changing benefits evidence-based treatment can give.” Initially, the clinic will care for patients living in counties Dublin, Wicklow and
Kildare with the intention of expanding to include Ireland East in the near future. The first of an intended four publicly funded specialist Menopause Clinics. it is planned that a further three specialist clinics will be approved, funded and developed in 2022. For further information, please visit www.nmh.ie
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ST JAMES’S HOSPITAL INITIATIVE WINS INTERNATIONAL MEDICATION SAFETY AWARD
Dr Una Kennedy, Medication Safety Facilitator Eileen Relihan, and Dr Barry O’Connell with the award.
The ‘Medication Safety Minute’ is an innovative education tool at St James’ Hospital that has been developed to promote the safe prescription of medication to patients. The project emerged from the review of real-world medication errors and discussions about how to optimally communicate the learning points to prescribers in the age of information overload. The initiative is based on the concept of ‘microlearning’ which involves the delivery of concise nuggets of information that are presented in a question and answer, two-slide format, which recipients can review and digest within one minute or less. Each week a new minute is distributed to recipients, allowing for the easy digestion of complex information. The project is the only European initiative to be awarded a ‘Cheers Award’ at the 24th annual awards ceremony. The Cheers Awards take place each year and seek to highlight institutions and individuals that ensure that the implementation of medication safety strategies are fully integrated into their organisation’s culture and clinical practice. The ‘Medication Safety Minute’ is a collaborative project undertaken by Dr Barry O’Connell, Dr Una Kennedy and Medication Safety Facilitator, Eileen Relihan, all of St James’s Hospital, Dublin. The project resources are currently used by 24 hospitals in Ireland and by a number of university undergraduate and postgraduate programmes. The material has also been made available as a free online access resource in the form of a digital fl ipbook as well as being published weekly on a dedicated Twitter page, @medsafetymin.
SCHOLARSHIPS AWARDED TO TRAIN OVERSEAS
The Dr Richard Steevens' Scholarship is awarded annually to Specialist / Senior Registrars with strong track records in achievement. The scholarship supports doctors to train in centres of excellence overseas in novel areas of medicine and patient care which are limited or unavailable in Ireland and to bring the skills gained back to the Irish health service. Scholarships were awarded to the following outstanding candidates: • Dr Aisling Looney, SpR in Surgery, will undertake a fellowship in andrology and male factor infertility based in University College London • Dr Fionnuala Cox, SpR in Immunology, will undertake a fellowship in adult drug allergy based in the Centre for Antibiotic
First National Nursing Home Experience Survey The National Nursing Home Experience Survey is the first national survey asking nursing home residents and their family members about their experiences of nursing home care in Ireland. It is a joint initiative by HIQA, the HSE and the Department of Health. A representative sample of nursing homes in Ireland have been invited to take part in the survey. In these selected nursing homes, nursing home residents and one family member or friend of each resident (also known as a designated representative) will be asked to share their experience of nursing home care in Ireland. The findings of the National Nursing Home Experience Survey will enable a greater understanding of the experiences of nursing home residents in Ireland, identifying areas of good experience and providing an evidence base to drive improvements. The survey will take place in early 2022. Two questionnaires have been developed – one questionnaire to capture the experiences of nursing home residents, and one questionnaire to capture the experiences of family members or friends. In order to develop these questionnaires, a review of international literature in the area of nursing home experience surveys was conducted, and a series of focus groups were held to identify key topics to explore in the questionnaire. This was followed by a Delphi study and cognitive testing of the final questionnaires with a small group of nursing home residents and their family members or friends. For questions about the surveys: Freephone 1800 314 093 (Monday–Friday, 9am–5pm) Email - info@yourexperience.ie National Care Experience Programme, c/o HIQA George’s Court, George’s Lane, Dublin 7, D07 E98Y
Allergy and Research, Heidelberg, Australia • Dr Kris Hughes, SpR in Paediatric Surgery, will undertake a fellowship in paediatric general surgery with a special interest in paediatric trauma based in The Karolinska Institute, Stockholm, Sweden • Dr Roisin O’Cearbhaill, SpR in Radiology, will undertake a fellowship in neuroradiology based in University Hospital network, Toronto, Canada • In addition to the prestigious and highly competitive Dr Richard Steevens’ Scholarships the NDTP HSE have also awarded three Bursaries in 2022: • Dr John Buckley, SpR in Cardiology, will undertake a fellowship in intervention cardiology based in Cardiovascular Centre, Belgium • Dr Patrick Moloney, SpR in Neurology, will undertake a fellowship in adult
neurogenetics based in National Hospital for Neurology and Neurosurgery, London • Dr Sinead Maguire, SpR in Rheumatology, will undertake a fellowship in pregnancy in axial spondyloarthropathy based in Toronto Western Hospital, Canada In addition to the prestigious and highly competitive Dr Richard Steevens’ Scholarships the NDTP HSE have also awarded three Bursaries in 2022 The call for applications for the 2023 Scholarships will run from autumn 2022. Please contact your Training Body for more information on the shortlisting process. The applicants guide can be found at www. hse.ie/eng/staff/leadership-educationdevelopment/met/ed/scholarships/ dr-steeven-s-scholarship-2022-applicantsguide.pdf
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Cathy Doyle, CNM 2 Crampton Ward; Helen Strapp, ANP tissue Viability; James Gargan, Commercial Director, Beechfield Healthcare Ltd; Áine Lynch, Director of Nursing & Integrated Care; Stuart O Connor, Contracts & Procurement Manager; and Patricia Morrison, Directorate Perioperative Nurse Manager
TALLAGHT LEADS THE WAY IN TOTAL BED MANAGEMENT Tallaght hospital became the first public hospital in the country to completely change their bed management to a Total Bed Management system. The system was established following a comprehensive review of the beds / mattresses in the hospital and the needs of patients by a small working group, made up of Patricia Morrison, Helen Strapp and Stuart O’Connor. This process began in February 2018. The appointment of one company to the contract means the hospital staff no longer have to manage multiple contacts / suppliers and ensures patients are in the best type of bed at all times. It will also reduce the time spent on ordering beds, reporting faults and there will no longer be the need to move a patient from one type of bed to another. The new beds have a highspecification mattress, resulting in improved patient comfort and reducing pressure, which will help with the prevention of pressure ulcers. These are hybrid mattresses, so if pressure relief needs to be upgraded a small pump can be added which saves the patient having to be moved off one mattress onto another. Patients have more independence by having access to control buttons so they can change their position enhancing their mobility and comfort. Because every bed is the same, it reduces the amount of training staff have to undertake on different bed types. One supplier provides all the bed needs for the patients, to include dynamic mattresses and bariatric beds when required. There will also be a full-time maintenance and supplies manager on site providing education to staff.
The Sexual Health team from Midlands Hospital Portlaoise on World AIDS Day.
WORLD AIDS DAY CELEBRATED IN PORTLAOISE World AIDS Day (WAD) takes place annually on December 1st. The occasion is always met with many events, campaigns and initiatives across Ireland. World AIDS Day 2021 marked the 40th anniversary of the first AIDS diagnosis. The theme this year is “End Inequalities. End AIDS”. To honour this milestone anniversary, the Sexual Health team at the Midlands Regional Hospital Portlaoise created an information stand in the hospital providing up-to- date information and statistics on HIV/AIDS treatment and preventative medicines. The
team created awareness amongst staff regarding the services provided within the Sexual Health/ PrEP clinic at the hospital. The Sexual Health team embraced the introduction of the SH24 (Sexual Health 24) service for 17 counties throughout Ireland. This service will be expanded to include all 26 counties by mid-2022. This is a free online self- testing Sexual Health screening kit that can be done in the privacy of the patient’s home. When patients receive a positive result, the clinic at the Midlands Regional Hospital Portlaoise follow up on appropriate treatment and education for the patient.
UL HOSPITALS GROUP SURGEON DELIVERS GRAND ROUNDS PRESENTATION FOR THE MAYO CLINIC UL Hospitals Group colorectal and general surgeon Colin Peirce had the honour of delivering a Grand Rounds presentation on his practice and research to one of the world’s most prestigious healthcare systems, The Mayo Clinic. Mr Peirce was invited as an exemplar of clinical practice and research whose Grand Rounds presentation on his career would have beneficial lessons for residents (trainees) currently based in the famous US healthcare system. 'Grand Rounds' presentations are given by experienced physicians to a varied audience of medical professionals within an institution. Mr Peirce’s Grand Rounds presentation for the Mayo Clinic was entitled, ‘A Surgical Journey’. “It was a very great honour to deliver this Grand Rounds presentation,” Mr Peirce
said. “I went through my career to date, showing the residents how a career can develop, and what can be achieved, firstly in the laboratory, and then in the clinical context, with new technology and innovations in practice.” Mr Peirce, a native of Crecora, Co Limerick, was appointed to UL Hospitals Group as a Consultant Colorectal and General Surgeon in November 2016. He is best known in this region for his work on the pioneering robotics team who use the Da Vinci Xi Dual Console robot to perform colorectal surgery, delivering innovative surgical options for patients in the MidWest.
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MEMORIAL BENCH
CO WESTMEATH HOSPITAL UNVEILS MEMORIAL AT BELVEDERE PARK Mullingar Regional Hospital marked Remembrance Month in a unique way, with the unveiling of a memorial bench in Belvedere House Gardens and Park.
Christine McDonnell, Katherine Kenny, Fr Phil Gaffney, Emma O'Sullivan, Kay Slevin, Marie Corbett, Rev Alastair Graham, Barry Lucy, and Eilish O'Connell at the memorial bench.
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he memorial bench overlooks the lake in the park. Belvedere House Gardens and Park have also kindly arranged to plant a tree beside the bench. Emma O’Sullivan, Bereavement Nurse Specialist, in Mullingar Hospital said, “The past 18 months or two years have been incredibly hard on families who have lost loved ones. People have been unable to mourn in a traditional way. We hope this bench will signify to the community that the staff of Mullingar Hospital are always thinking of those who have died in the hospital. Plus, we hope this beautiful location will allow people the space and connection with nature which can be so helpful when grieving.” Members of hospital management, clinical staff and local clergy met to unveil the bench and there was a tree planting ceremony. They were joined by Barry Lucy and members of his family, who will represent all bereaved families. They will honour the memory of their parents Sean and Clare (RIP). Barry said, “This bench is a physical reminder to all of us who have lost someone that the doctors, nurses and staff at Mullingar Regional Hospital care deeply for the welfare of their patients and that the work they do is more than just a job to them. I can never adequately express my family's gratitude for the dignity and consideration with which they treated my parents in their last days.” Prior to the COVID-19 pandemic, Regional Hospital Mullingar hosted remembrance services for all bereaved families. These services brought great comfort to families and staff alike. This memorial bench is the hospital’s way of reaching out to the community and letting all those who are bereaved know that they, and their loved ones who have died, are in our thoughts.
MY HEALTH, MY LANGUAGE
COVID-19 vaccine multilingual audio visual messaging Throughout 2021, a number of HSE Doctors, Nurses and healthcare colleagues supported the production of multilingual audio visual messaging about the COVID-19 vaccine in 12 languages. These colleagues gave of their time, while working through a pandemic to present videos in their first language aimed at reaching people in migrant communities in Ireland. The videos were commissioned by the National Social Inclusion office in partnership with HSE Communications, HSE National Immunisation Office, Irish College of General Practitioners and Translate Ireland as part of a project called ‘My Health, my language’. The HSE added the videos in a number of key languages to help share the messaging about the COVID-19 vaccine and the COVID-19 vaccine and pregnancy. These videos and up to date information on the COVID-19 vaccine, are available on the HSE YouTube channel. In 2022, a range of short videos highlighting key healthcare messages will be launched and available in multiple languages for HSE staff to share with service users.
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KERRY INTEGRATED CARE Programme shifts care away from acute hospitals and into the community
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ntegrated Care and cups of tea are very important at the Kerry Integrated Care Programme for Older Persons (ICPOP) hub in Tralee. Located in the McAuley unit at Balloonagh, the primary objective of Kerry ICPOP is to develop and implement integrated services and pathways for older people with complex health and social care needs, shifting the delivery of care away from acute hospitals towards communitybased, planned and coordinated care. Care is provided by a multidisciplinary team (physiotherapy, occupational therapy, speech and language therapy, dietitians, healthcare assistants and specialist nurses) under the clinical governance of a consultant geriatrician. Kerry ICPOP focuses on the clinical areas of frailty, falls and memory/dementia. The team works closely with acute and primary care services to support older people to live well in their own homes for as long as possible. And they also do a great cup of tea, according to Mairin Cullhane, who became a patient at the hub after a fall at home left her with a broken hip. The ICPOP team supported her to return to her own home
as quickly as possible - and far faster than she thought possible. “It meant everything. I was at home, and I was able to say what I wanted. Life was happier.” And the tea was plentiful, and made just right, with Mairin declaring, “We were offered it, we didn’t have to ask for it – and it was lovely.” The team at the hub work together to assess frail older people aged over 70, especially those who are at risk of a fall, and over a six-week period find ways to keep them safe and well at home. Simple things like a cup of tea and the warm welcome that goes with it make a healthcare appointment that could be stressful for people run smoothly. From the moment a member of the team picks up the phone or meets someone at the front door, everyone is guaranteed a warm and reassuring welcome. Situated in a calm spacious environment there’s plenty of space for the multidisciplinary team to carry out their work - a true one-stop shop. The physiotherapy gym is the location for transfer, mobility and functional assessments
and also the prescription of bespoke exercise programmes. Occupational therapist Emma explained how the the therapy kitchen is used to assess activities of daily living – including making the ever important cup of tea! The use of low tech equipment is often recommended to make life easier and support independent living. Communication and swallowing issues are assessed and some dietary advice can be provided by the experienced team. Patient medication is optimised and diagnostics ordered by the consultant geriatrician and the team of Registrars. Pat Cullane, Mairin’s husband, describes the key to the team’s success. “We were made feel important, we were made feel part of the system, everything was explained to us,” he said, adding, “The confidence they instilled in us was great, and we’d recommend it to people. We were apprehensive at the start, but it exceeded all our expectations.” * Referrals to Kerry ICPOP are made through GPs (using Healthlink), consultants at UHK or in old age psychiatry, or the Frailty Intervention Team. Contact 066 718 4910 or Kerry.icpop@hse.ie
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GRÁ FOR
Nursing
Decision to nurse after 23 years as a mechanical engineer best decision newly retired Martin ever made
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ome 23 years into life as a mechanical engineer with Irish Cement is not the obvious time for most people to pivot into nursing. Martin Smith, however, is not most people. And after an hour chatting about a record breaking fourth year scoring the highest flu vaccine uptake rates nationally, bell ringing, Irish Cement and nursing, you begin to realise how many unexpected and surprising dimensions there are to this particular Drogheda native. Having recently retired from a nursing career in Our Lady of Lourdes Hospital Drogheda, Martin reflects on not so much a job, but many jobs well done. “I loved every minute of it.” The enthusiasm, vigour and energy in his voice sells his passion. His joy in recalling the twists in his 65 years to date, from how he got into nursing, to outlining how he went from listening to the church bells locally as a child to ringing them on the 100th anniversary of Armistice in 2018 is consuming. And then there’s the local historical tours he gives often times to introduce Indian, Italian, Spanish medical and nursing staff to the area. His own story takes you back initially to the teenage Martin who clearly revelled in volunteer work. “When I left school there were no male nurses in general nursing, they were in psychiatric nursing. So at 18, post Leaving Cert, I hadn’t a clue even what psychiatric nursing involved. I had been in the Order of Malta for years and I really enjoyed that – the whole caring aspect. I had been on a number of Irish Wheelchair Association holidays helping out and I got so much from that. But there seemed to be nothing there in the nursing end for me so I went off and did mechanical engineering,” he said. Despite that decision however, Martin said he “never lost the grá or the want to do
Martin Smith in St Peter’s Church, Drogheda where he rings the church bells weekly
nursing. I applied as a mature student 22 years ago, was successful, and ended up training here in the north east. It was the best move I ever made – I loved it.” Regrets? “My only regret was that I left it so late because I loved and enjoyed it all so much.” Martin initially worked on a medical ward for a few years and then moved to Endoscopy (Exploratory Testing) as a CNM l (Clinical Nurse Manager). “I then moved into theatre and loved every minute there too. For years I was also the Health Promotion Co-ordinator for the hospital as well. I seem to be one of those people – I don’t see problems, I see solutions and results. And maybe that’s to do with having come into the service and job later in life. I tend to be positive and have always encouraged those around me to be likewise positive and look for solutions.” Martin acknowledges the support he received. “I was so lucky to be surrounded by great people – OLOLH CEO Fiona Brady and Director of Nursing Adrian Cleary. They were really encouraging - very professional, positive managers and colleagues.” Five years ago Martin took on a role that was to provide a national showcase for his leadership skills
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– OLOLH Lead with the Flu Vaccine Peer Vaccinator Programme. Reflecting on the programme, Martin explains that the appointment of peer vaccinators was a significant development nationally in the move to increase the number of health care staff taking the vaccine. “In OLOLH the year before I took over, the uptake was 14%. I was working in theatre at that time and decided to take it on. As a theatre staff nurse at the time I could see the importance for me personally in that role, ensuring that I had the flu jab for the sake of my patients,” he said. Success was swift. In their first year, Martin’s efforts, innovations and commitment pushed the uptake from 14% to 38%. By the following year it was 78% and within another 12 months it was 93%. And the following year they repeated their success with another 93% recorded. That success led to the hospital winning the overall national award for highest uptake four years in a row – a remarkable achievement. And while he was scoring high in flu vaccine rates, Martin also continued to move upwards within his career, taking on the role of Practice Development as a CNM ll. Martin also set up a Meet and Greet volunteer programme along with colleague Siobhan Lyons. COVID inevitably has had a huge impact, and Martin recounts the fear and uncertainty that gripped the hospital as with every other hospital across the globe in 2020. “For me, it was a case of being there for my colleagues and giving them every bit of information I could possibly provide on COVID and working through it. It was supporting them. For the community within the hospital, we were a team and we got through it. And of course, we don’t look back, we look forward.” As with all healthcare staff everywhere, Martin acknowledged the commitment and inevitable exhaustion that all continue to experience and points to the resilience and dedication of all. With a 12-year-old son, Nathan, who keeps him youthful and energised, Martin said he
is very positively disposed to his retirement years. Like everyone else, many of interests have been curtailed because of COVID – and post pandemic he plans to re-engage with his love of travel. However, he does have a pastime that is local and has not been quite as COVIDconstrained - campanology. He rings the bells in St Peter’s Church of Ireland church in Drogheda. “They are a great group of people – they have really taken me in.” As ever, there is a story on how he discovered this particular passion. “I am from the very centre of Drogheda, from Francis Street, and the church itself is about a three-minute walk from where I grew up. So when I was a child I would hear the bells ringing every day. They were part of my growing up. So, many years later on Facebook, somebody said they hated the bells – the noise they made. So I just put up a response to say I loved them, I grew up beside them and they always gave me that warm homely feeling when I heard them.” And then unexpectedly, he got a response from one of the bell ringers. “They invited me to come along and see the bells and the church. And that was where it all took off – for the last five years.” A history buff, Martin said he also runs a tour of the town from the hospital. “When we get new nurses in, if they are not local, they may be from India, Spain, Italy – I would bring them on a tour of an historical tour of the town and the Director of Nursing would come with me. And they loved it – its great because it gives them an introduction to the town, seeing things they probably otherwise wouldn’t see.” And so to the historical moment when he formally retired last summer. “I must be honest – I ended up suffering withdrawal symptoms - work and in particular the flu peer vaccination programme was my life for five/six months of the year. My wife would acknowledge that it was all consuming – I would be at home, maybe in bed and I would have a Eureka moment where I would think of something, like the idea for a poster and I’d sit up and I’d write it down and then go back to sleep,” he said. And now, several months later? “I’ve been having a good night’s sleep!” It’s clearly well-deserved as is retirement but you somehow know Martin will continue to fill his waking hours with surprising, interesting and generous endeavours.
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THINKING OF RETURNING TO NURSING?
Go for it!
Return to Nurse Practice Programme participant Michaela Kinnear reflects on her journey back to nursing
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fter many years of to-ing and fro-ing I decided to do the Return to Nurse Practice (RTNP) course based in Connolly hospital. I had asked myself all the questions: Am I too old? Have I been out of nursing too long? What about my IT skills? Excuses,excuses. Then came the day of my interview. I was well prepared for the interview and, despite my accompanying nerves, was delighted when I heard I had been successful. I was on my way back to nursing after 12 years out. What struck me the most about my interview was how much my experience was valued, experience is something ALL RTNP nurses have. What advice would I give to anyone thinking of doing the Return to Nurse Practice (RTNP)? Go for it! Your experience is so valued, you have so much to give. Be open to new experiences, you’ll meet some lovely new people and remember to always have a laugh! The first two weeks were online and as I’m not the most tech savvy, this was a huge issue for me. I needn’t have worried as there was great support from the nurse tutors and the course IT/administrator as and when I ran into an issue. Once a nurse always a nurse!
“I was welcomed with open arms and felt really valued and respected”
Anne Brennan, Director, Nursing & Midwifery Planning & Development Unit, HSE Dublin North; Michaela Kinnear, Return to Nurse Practice Programme participant; and Vivienne Browne, Director, Regional Centre of Nurse & Midwifery Education, HSE Dublin North.
As we covered the topics, some old some new, the flicker of recognition was lit. It was interesting to learn about the changes in nursing since I’d left, especifically the EWS, new paperwork, policies and procedures. I particularly felt that learning about working within my Scope of Practice really gave me the confidence to say no or to ask to be trained up in a task. Armed with theory, practicals, tutor support and a new uniform off I went to my ward. The initial arrival on the ward was nerve-wracking but there was no need to worry. It was like coming home! All of the staff without exception were fantastic, from the CNM 2 down. I was welcomed
with open arms and felt really valued and respected throughout my six-week placement on Laurel ward. I was part of the nursing team and felt very quickly that I’d been there forever. I tried to learn three things a day, so by the end of my six weeks I had 54 new or updated skills. As part of my assessment I had two assignments - one written, one Powerpoint. Both were research-based so again my knowledge was constantly being updated. I’m now working two days a week as a staff nurse, I’d never have thought at the begining of 2021 I’d be back working as a nurse, but as I said before ‘once a nurse, always a nurse’.
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A DAY IN THE LIFE OF A COMMUNITY NURSE Hilda Dunlea, Community Nurse, HSE Cork and Kerry 6.50am First up - I get the kids’ breakfasts before heading to work. 8.45am At the South Lee primary care centre, planning my day is critical - I lay out my schedule and prioritise calls. A daily COVID risk assessment is an unfortunate but essential element of our new way of working and it’s completed prior to each home visit. Infection control guidelines and personal protective equipment have always been a vital component of our role in the community, but even more so now. Assessing risk is vital at the start of each day to protect patients. High-risk clients are identified and left to the end of the day. 9.15am Dressing clinic organised for the health centre. Clients arrive at allotted times for wound assessment and dressings change. Noon I pay a home visit to a new mum and baby to carry out a postnatal review.
Mum was enthusiastic about breastfeeding but was having some challenges on my initial visit. She was disappointed it wasn’t working out so a breastfeeding support plan was developed. On this visit, it’s going very well. I’m currently completing my lactation consultant course and it’s hugely beneficial in assisting breastfeeding mothers. 12.45pm Complete paperwork and reply to an urgent message about a hospital discharge before visiting next client. 1.15pm I pick up messages and have lunch at the health centre. The social aspect of lunch has been challenged by COVID but we link in as safely as possible. 2.15pm Hospital discharge to be reviewed at home. My role is to review and assess the patient, their current clinical needs and home supports. This client is palliative and supporting the patient and family is one of the greatest privileges of my role. After the visit, I update the GP, palliative care team and refer to the physiotherapist and occupational therapist for home review.
3.15pm Next call is a catheter change for a client at their home. 4.45pm Back at the health centre, I brief the public health nurse for follow up as needed. 6pm Evenings are dinner/kids’ activities.
Community care programme aims to deliver services closer to people's homes The Enhanced Community Care (ECC) programme is a national priority for the HSE and is part of realising the vision of Sláintecare of delivering a safe, quality health and social care service that meets the needs of our growing population. A key goal of the ECC programme is to deliver more services closer to people's homes or in their communities. It aims to provide more services through general practice, primary care and community-based services. The 96 Community Healthcare Networks (CHNs) will be the foundation of our health system in years to come, and support integrated care across primary, community and acute care. CHNs are enabling decisions to be made closer to the point of care, and specific to population needs. Each CHN consists of between 4-6 primary care teams, with GPs involved in delivering services. CHNs are allowing for direct access by GPs to scans such as X-ray, ultrasound, CT, MRI and Dexa. The CHNs are further supported with Community Specialist Teams for Older Persons and Chronic Disease who will work in an integrated way with the National Ambulance Service and acute services to deliver end to end care. Working together in multidisciplinary teams, we will deliver the Sláintecare vision to provide the right care, in the right place at the right time for people using our services. For more information on Community Healthcare Networks, go to hse.ie/communitynetworks
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“I’d wake up in the morning - my eyes wouldn’t even be open and I’d reach for the vape" Caoimhe’s HSE Quit support vital in dispensing with vape and cigarettes
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aping was Caoimhe Casey’s go-to solution when she decided to give up smoking over two years ago. A dedicated and confirmed smoker since her early teens, she initially convinced herself it was a job well done. “I had tried to give up maybe three times and eventually on the third time I stuck with the vaping and had effectively given up cigarettes. And I was kind of proud of myself – I was initially telling myself that I didn’t smoke any more – I just vaped. Then I spent two years with ejuices spilling all over my handbag, running out of battery and charge on a night out and then trawling through everyone to see if anyone had a charger and then after all that I decided to have a second vape in my handbag just in case the first lost charge. I mean there was effort and not much glamour involved,” she said. “I’d wake up in the morning - my eyes wouldn’t even be open and I’d reach for the
Caoimhe Casey
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You can free call QUIT on 1800 201 203 to get the support you need to quit or visit www.quit.ie for stop smoking tips and resources, a free Quit Kit, and to create a quit plan or read other people’s stories. Peerto-peer support is available on the QUIT Facebook page www.facebook.com/HSEQUIT or on Twitter at HSE QUIT @HSEQuitTeam.
vape. We don’t smoke in my house, you have to go to the back garden, but the vape was different. You could vape in the kitchen and it wouldn’t leave a trace. You could sit and have a cup of coffee, have a vape and not feel like you were smoking in the house. So you had it with you at all times. And of course, working from home, you had it with you at your desk. It was practically attached to my hand. And when I realised that I couldn’t go anywhere – couldn’t walk to the shops for five minutes without it - I knew I had created another addiction.” Working as a Project and Office Manager, Caoimhe switched to home working, along with many HSE staff in March 2020. It was there last year that she was prompted by a HSE All Staff Broadcast Email to contact the HSE Quit Support Team. Having smoked since she was 14, Caoimhe knew that her vaping habit had to end for her nicotine addiction to end too. Through the Quit Support Team, she was put in contact with Stop Smoking Advisor Ann Scanlon. “I had an initial chat with Ann and said look maybe because I was vaping rather than smoking at that time, I wasn’t sure if I fell into that category of smoker. I thought my needs may be different, even regarding something like the amount of nicotine needed. But Ann was great – she worked out a plan for me for essentially getting off the vape,” said Caoimhe. “I didn’t feel in any way fearful. I didn’t feel for example that she was suddenly going to take the vape away or anything like that. And of course we talked about my smoking habit
– I knew I had been a fourteen year old who had taken up cigarettes because it was cool. When Ann asked why I was still vaping, I initially concluded that it was a social thing. If I was taking a break from the office, and going out to smoke, then I was inevitably chatting to someone and interacting. “Ann then asked if a lot of my friends smoked or vaped and I initially said yes, but then realised after pausing for a second and running it through in my head that in fact I was the last one standing in terms of smoking. Of my group of friends, those who had smoked had actually stopped. They had quit and had been quitters for a few years. So, really it was no longer a social thing as I was the only one still addicted.” Having worked through a plan that would involve weekly calls for an initial twelve weeks, and the offer of support outside of those engagements, along with Nicotine Replacement Therapy solutions (patches, inhalers, spray and gum) Ann and Caoimhe set a quit date. “I can’t remember the month but I do remember it was the ninth. And when we got to the ninth, I couldn’t do it. But I knew I had my call with Ann the following Monday and I couldn’t face telling her I hadn’t done it so I just switched to the eleventh and to be honest once I got through that first day I actually got a bit of a confidence boost. “I felt if I could do the first 24 hours, I could 48 and then I just continued. Overall the combination of NRT patches and inhaler worked well for me, along with the spray. I had actually thought I might just need to use them just for the first five or six weeks but Ann convinced me to continue for the full twelve weeks as the studies show that if you continue for the full 12 weeks you are more likely to succeed. “In the first six weeks we were in lockdown so there was no going out as such. And then once we began to come out of lockdown initially, I did know that if I went to a pub or out with my friends, it was almost a scary thing where I knew I probably would be very, very tempted. But I had talked to Ann about it and I had a plan – I would take a little Nicorette inhaler with me. And have a backup cartridge
too in my handbag just in case. I also planned not to go out to the smoking area, that I would stay inside or wherever as appropriate.” There were challenges, of course. “There were a couple of stumbles. When I went on holidays or away and I was taken out of my day-to-day routine, that just set me off. I needed my routine and the minute I broke that, I knew I was susceptible. There I was walking along a lovely street and I could see all these people sitting outside smoking, eating food and enjoying themselves and I am thinking why can’t I be that person? So I was tempted to vape again. Once I came back from holidays, I kind of said to myself – that was a nice holiday but now back to the plan and the routine.” As Caoimhe moved to the second 12 weeks, she describes the experience as “much easier”. “I had decided I was a non-smoker at that point,” she said. “Even during the first 12 weeks I was someone who had given up cigarettes, not a non-smoker or someone who had given up the vape.” That second 12 weeks provided more autonomy and while Ann was no longer making the weekly calls, she did check in and was always available. A firm non-smoker/non-vaper for almost a half a year now, Caoimhe reflected on her achievement. “Even now when I am completely off the patches and off the Nicorette inhaler, I actually still have the inhaler with me without any cartridge, sitting beside me on my desk at all times.” Her advice to anyone considering quitting is simple – make contact and get the support that is available through the HSE Quit Team and through the Stop Smoking Advisors nationwide. “If you can make one hour, you can make two and then you can make it 24 hours, so you can make it 48 and so on. That’s how I approached it – it wasn’t that I was giving up smoking, it was that I was going for an hour, then another hour and so on. And of course – reaching out for that support was absolutely critical. Having Ann there was wonderful and to get the NRT and seeing it through for the first twelve weeks was so good." HEALTH MATTERS SPRING 2022 | 23
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QuitCARE New National Clinical Guidelines to help people stop smoking
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reland’s first National Stop Smoking Clinical Guideline (Guideline No.28) was published in January 2022. This guideline was prioritised and quality assured by the National Clinical Effectiveness Committee (NCEC), Department of Health, and recommended by the Minister of Health to become part of a suite of National Clinical Guidelines for implementation across the health services in Ireland. In so doing, this places good quality stop smoking care on the same status as good care for the many diseases caused by smoking. This National Clinical Guideline is prepared primarily for all healthcare professionals working in Health Service Executive (HSE) across primary, community and secondary care settings in Ireland. The guideline is also relevant to healthcare planners and managers. Importantly, it also describes for the public who use our services the good quality stop smoking care they can expect to receive when using our health services. A Clinical Guideline Development Group was established by the HSE Tobacco Free Ireland Group led by Dr Paul Kavanagh, Consultant in Public Health Medicine and was comprising clinical experts, senior managers, service providers, research experts and service user representatives. Guideline development followed a rigorous process, and including a systematic review of evidence, consultation on draft proposals, international peer review and scrutiny by the National Clinical Effectiveness Committee. Healthcare professionals and the public can have confidence that the guidelines recommend care which is safe, effective and clinically sound. These National Stop Smoking Clinical Guidelines describe best practice for stop smoking care of members of the general adult population who smoke across a range of settings, as well as providing a special focus on helping women who are pregnant and users of secondary mental health services.
smoking medicine support options suit best as well as working with the client over a 12-month period to support the behavioural elements of stopping smoking, examining in detail the psychological and emotional dependence and working with them to overcome this.
MAXIMISE SUCCESS WITH RECOMMENDED PHARMACOLOGICAL SUPPORTS While many people who smoke make attempts to stop, too many go it alone and do not benefit from support which can increase their chances of success. The Clinical Guideline Development Group found high-quality evidence that stop smoking medications including Varenicline (Champix) and Nicotine Replacement Therapies (NRT) can help people who smoke to increase their chances of stopping successfully two to four-fold. If someone who smokes uses behavioural support combined with stop smoking medications and manages to stay smoke-free for 28 days, they are five times more likely to stay quit for good. Varenicline (Champix) in combination with a short acting nicotine replacement product is the most effective first line of treatment for those who are suitable for same. Otherwise combination nicotine replacement therapy products (a slow release product such as the patch in combination with a fast-acting product like nicotine gum or inhalator) for those that are unsuitable for Varenicline or prefer not to use it is recommended.
HOW CAN HEALTHCARE PROFESSIONALS REFER TO THE QUIT SERVICE? Healthcare professionals (excluding GPs & pharmacists who can make electronic referrals to the QUIT service – see links below) can make a referral to QUIT services by completing the referral form at www.hse.ie/eng/about/who/tobaccocontrol/resources/tfi-f-1rev-2-hse-stop-smoking-referral-form1.pdf and either emailing the completed form to QUIT@healthmail.ie or by emailing it to a local service, details of which are available at www2.hse.ie/quit-smoking/support-services/ Supporting People to Stop Smoking - Advice for General Practitioners Supporting People to Stop Smoking - Advice for Pharmacists
DELIVERING GOOD STOP SMOKING CARE IN DAY TO DAY PRACTICE In brief, the guidelines recommend that healthcare professionals help people who smoke to stop through consistently taking three simple and easy to remember steps in day-to-day practice: • Ask people routinely about smoking status • Advise people who smoke to stop and discuss the available stop smoking supports • Act by 1) Recommending or prescribing stop smoking medication and 2) Referring to QUIT The Clinical Guideline Development Group found the quality of evidence to support these steps was high and made strong recommendation they are routinely implemented in practice. Healthcare professionals can refer people to local stop smoking advisors for behavioural support. Trained stop smoking advisors can assess a client’s nicotine dependence and advise on which stop 24 | HEALTH MATTERS SPRING 2022
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Boy hailed a hero for raising alarm after father’s cliff fall Praise has been flooding in for a 10-year-old from Donegal whose quick-thinking saved his father after a fall from a cliff. Owen Cunningham being presented with his award by the HSE’s National Ambulance Service (NAS) outside of his school, Scoil Chartha Naofa, Kilcar, Co Donegal.
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wen Cunningham raised the alarm after his father Seamus sustained injuries when he fell off a cliff on November 16th 2021, while working on farm fencing. Realising the danger his father was in and not having a mobile phone with him, Owen ran home and raised the alarm before cycling back to his injured father and waited for help to arrive. Seamus was treated for his injuries by National Ambulance Service (NAS) staff including a Paramedic and Advanced Paramedic from Killybegs Ambulance Station and subsequently airlifted from the scene by the Coast Guard R118 helicopter. Those who attended the incident were impressed with Owen’s calm and brave response and wanted to acknowledge this with a certificate of bravery, which was presented to him at Kilcar National School earlier today. The event was attended by NAS staff, including the Advanced Paramedic and Paramedics who attended the call, Coast Guard volunteers who assisted in the rescue, along with the Coastguard R118 crew who also attended the incident. “On the morning of November 16th last, we received an emergency call in the Donegal area. A man had sustained a serious fall. National Ambulance Service paramedics attended and provided care on scene. We were supported by the Coast Guard Helicopter and the man was subsequently transferred to hospital. The alarm was originally raised by a child who was there when the incident occurred and local crews were incredibly impressed by his calm approach throughout the incident,” explained Robert Morton, NAS Director. “All of us at the HSE’s National Ambulance Service are delighted to present Owen with his bravery certificate today. And who knows, he may be a paramedic when he grows up?” Praising his son’s bravery, Owen’s father Seamus, added, “I’m very proud of Owen… the outcome could have been much worse. He is a very brave boy. It took a lot of guts for him to do what he did. He stayed with me the whole time.”
Owen and his family with members of NAS and members of the Coast Guard.
Owen with members of the HSE’s National Ambulance Service (NAS).
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‘It’s the staff and the patients it’s like a family hub’ St Luke's Radiation Oncology Network honours staff with over 30 years of service
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gnes Murray, a Clinical Nurse Manager, has been with From left to right: Clare Faul, SLRON Network Director St Luke’s St Luke’s in Rathgar for over 31 years and ran the day Radiation Oncology Network (SLRON) and Clinical Nurse Manager ward up until last September. 3 Agnes Murray, Principal Clinical Engineer at SLRON Stephen Broderick and SLRON General Manager Jackie Robinson, Network “Because St Luke's is a small unit and specialises in Deputy Patient Manager at SLRON Jacqui Purcell and PA to the cancer care, it makes it a special place to work. I have General Manager at SLRON Angela Martin, who have worked made lifelong friends, it's the staff and patients, it's like a family hub.” Down together for over 40 years at St Luke’s. the years, as well as working in the hospital’s theatre, Agnes nursed cancer patients who were receiving radiation and chemotherapy treatments. Agnes was one of 29 staff who received a special award for over 30 years Her good friend Jacqui Purcell began her of service to The St Luke's Radiation Oncology Network (SLRON). The Network’s General career with St Luke's as a clerical officer in Manager Jacqueline Robinson explained the awards were a completely new initiative. “We the lab. Today Jacqui works as Network have come through a really challenging period with the pandemic and then the cyberattack. Deputy Patient Manager providing admin We wanted to give something back to staff to show them how much we appreciate their support to all patient services and says she contribution,” she said. has really enjoyed watching the St Luke’s Two other staff who received awards are lifelong friends and colleagues Angela Martin network grow but smiles as she remembers and Jacqui Purcell who both started working at St Luke's in Rathgar in the same year, 1981. the resistance some staff had to the Angela, who now works as a PA to the General Manager, remembers how delighted her introduction of computers as they tried to parents were when she got the job after responding to a tiny ad in a national paper to cover hang onto their old typewriters and quips a maternity leave. Looking back over her 40 years of service, Angela reflected, “I always “We’ve come along way since the nineties!” got a positive response from people who gush with praise about what a wonderful hospital Of the past 34 years with SLRON, Clinical it is, how fantastic the staff are, how amazing our facilities and grounds are and this in spite Engineer Stephen Broderick said, “I liked of the trauma our vulnerable patients and families are going through.” the variety, I feel like I have had three Angela experienced this first-hand when her father was treated at the hospital in 1994. different careers and the job is not routine. “I know from personal experience the positive impact St Luke’s ethos and commitment has One of my personal highlights is the people on patients and their families. When you have lived through the trauma of cancer treatment, I work with and the fact among them there either as a patient or a family member, you don’t forget that single act of kindness or support, are lots of different disciplines and colleagues which St Luke’s has in abundance and gives unconditionally.” who are very technically gifted.”
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NEW VISITOR APP ROLLED OUT ACROSS UL HOSPITALS GROUP
BYE, BYE BONNIE
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Final rounds for beloved Children’s Ark therapy dog, Bonnie
he best friend of patients and staff at the Children’s Ark paediatric unit in University Hospital Limerick has made her final rounds, bidding a fond farewell to all before steppimg down into a well-deserved retirement. Bonnie the therapy dog has paid regular visits to the Ark for the past four years, playing with young inpatients and day patients, keeping them company during diagnostic tests and during their recovery from procedures, and brightening the day for all staff in the unit. On her last day, Bonnie met with baby Katie Liston from Newcastle West and young Sadie O’Malley from Castleconnell, Co Limerick, who helped make Bonnie’s final rounds a day to remember for the beloved Labrador, who received a ‘World’s Best Therapy Dog’ certificate to mark the occasion. Senior Play Specialist at the Children’s Ark, Kristina Buckley, said Bonnie’s last day was an emotional occasion for all in the paediatric unit, where patients and staff will greatly miss the 11-year-old Labrador’s regular visits. “Bonnie was our first therapy dog, and we’re so grateful to her owner, Emma Hogan, who works here in University Hospital Limerick. Bonnie has made such a huge difference to the children, cheering them up through her friendly presence, and assisting in calming children who are anxious about being in hospital. She’s an amazing dog, and we hope she has a long and happy retirement,” Kristina said. Happily for the Children’s Ark, Bonnie’s sister Bella has now picked up the baton. Emma Hogan, Bonnie’s and Bella’s handler and owner - and secretary to UHL respiratory consultant, Dr Brian Casserly - is a lifelong animal lover who became interested in the work of Irish Therapy Dogs after she’d witnessed the heartbreak of a relative who was separated from their companion pet after being placed in a nursing home. Although younger and of more diminutive stature than her big sister, Bella, a two-yearold miniature schnauzer, does not live in Bonnie’s shadow. She is the mother of five puppies who are now three months old.
From left to right: Sadie O’Malley from Castleconnell, Co Limerick, pictured with Bonnie during the beloved therapy dog’s final rounds at the Children’s Ark paediatric unit in University Hospital Limerick; Bonnie’s little sister Bella, who will be joining her owner Emma Hogan on regular visits to the Children’s Ark with the Irish Therapy Dogs Visiting Team.
UL Hospitals Group has launched a new Visitor Booking App to provide loved ones of hospital inpatients and women using maternity services with a convenient, efficient way of organising access to the Group’s six hospital sites. Inpatients or women accessing maternity services are asked to nominate their visitors, support persons or partners, and this information is recorded on the Group’s Integrated Patient Management System (iPMS). If patients are unable to communicate during admission, staff will organise this with their loved ones. When this information is entered, people are able to book their visit on the Visitor Booking App, which can be accessed from a range of devices, including desktop PC, laptop, tablet or smartphone. Project lead, Bernadette Murphy, Director of Nursing, Perioperative Directorate, UL Hospitals Group, said, “While COVID-19 continues to present challenges in healthcare settings, we recognise the importance of visiting and support for our inpatients, and for their loved ones. “We have worked with the Limerick-based company Ingenium to develop an app that will make this entire visiting and access process much easier for everyone in the busy hospital environment. “Throughout the pandemic, we’ve used technology in a positive way, to help our inpatients maintain connections with their families and loved ones. This Visitor Booking App is the latest example of this, simplifying the manual processes that we have put in place for inpatients and their loved ones during the pandemic.”
Project Lead for the UL Hospitals Group Visitor App is Bernadette Murphy, Director of Nursing, Perioperative Directorate, UL Hospitals Group.
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AWARDS AND RECOGNITION The virtual presentation of the HSE Excellence Award 2021 to public health staff in recognition of their work during the health services response to COVID-19 finally took place recently.
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arie Keating, National HR Lead for Public Health, welcomed over 40 staff from the eight Departments of Public Health, the National Immunisation Office, the Health Protection Surveillance Centre, Office of the National Clinical Director of Health Protection to the virtual event. Ms Keating said that having worked with all of the Public Health teams since the start of the pandemic, she knew first-hand the significant challenges they have overcome, the innovative solutions that have been put in place and the personal sacrifices that many staff had made in terms of their own family life. She acknowledged also the staff who worked with Public Health teams either through redeployment, retired staff, agency, other government departments and the Defence Forces. “On behalf of National HR, I want to commend you on the exemplary demonstration and commitment to public service shown by all of our public health staff,” she said. Dr Colm Henry, Chief Clinical Officer, then proudly presented the HSE Excellence Award in recognition of the significant contribution made by Public Health staff throughout the course of the pandemic. “I wish to acknowledge your considerable and unique contributions to our health service over these past two years. Hundreds of hard-working staff in every region, including doctors, nurses, surveillance teams, operations and administrative staff, have played a unique role throughout the COVID-19 pandemic. Public Health’s work is on-going in this pandemic; however, as we look towards recovery it is important that we reflect and acknowledge the successes and challenges we have all faced over the
past two years,” he said. “There have been many examples of great leadership within our Public Health teams who have guided us through this pandemic. Our Public Health leaders have: • Led and informed the public throughout great uncertainty and fear • Built support for essential public health measures • Provided guidance, expertise, and support to keep our schools open; • Used intelligence to intervene in a timely manner to break chains of transmission; • Developed clear, effective and evidence-based guidance to prevent disease spread in various settings and contexts; and • Provided information and reassurance to support informed consent and acceptance of vaccines. “This leadership at all levels will enable us to recover from this pandemic and deliver the fundamental reforms that will bring our Public Health service to where it ought to be – strengthened and aligned with international best practice.” Directors of Public Health then accepted the awards on behalf of their teams and each thanked their teams individually. On accepting the Award on behalf of the Public Health Department, Mid West, Dr Mai Mannix, Director of Public Health, said, “I want to thank all of the staff for their extraordinary work and sacrifice over the last two years of the pandemic. All of our staff including administrative
Dr Fionnuala Cooney and the team from CHO7 Department of Public Health East.
staff, contact tracing, surveillance, nursing and medical have gone above and beyond the call of duty and I am both very proud and very lucky to have such wonderful colleagues. “In addition, I want to acknowledge all those staff who were redeployed or returned from retirement to support us also – your help was invaluable. The pace and the volume of work, fast changing guidance and policy direction and constant training and upskilling of staff were very challenging but we overcame all of those challenges! “There were many things that kept us going during this period including support from the public, camaraderie, coffee, cake, kindness to each other and to the public and a sense of humour. “One example of kindness was one evening in the first wave, there were positive COVID cases in a local direct provision centre. The affected people had to isolate in their rooms and the staff in public health became aware that the cases were unable to get any food that evening. One of Public Health staff went off at the end of her long shift, paid herself for takeaway food and dropped the food to the cases in the direct provision centre. This is just one of many examples of kindness throughout the pandemic.”
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Department of Public Health East: Daragh McMenemy, Love Oweh, Margaret Brennan, Mary Ward, Elizabeth Oki, Michelle Connolly, Sarah Murray, Dearbhail O’Flynn, Grace Ezeokonkwo.
Department of Public Health North West: Emir McCann, Senior Staff Nurse; Dr Aidan Ryan, Specialist in public health medicine; Liz Comerford, Clinical Nurse Manager; Mette Jensen, Surveillance Officer.
The Department of Public Health Midlands: Stephen Malone, Jodie Fogarty, Orla Dunne, Anne Pardy, Edel Evans, Mary Hayden, Dr Una Fallon, Patricia Carney, Laura Smith, Therese Masterson, Niamh Kelly, Carmel McGreal, Sarah Hensey.
Joan Gallagher, Programme Manager, National Health Protection, HSE HPSC; and Dr Lorraine Doherty, National Clinical Director, Health Protection.
Accepting the award on behalf of Department of Public Health South is Dr Anne Sheahan, A/ Director.
Department of Health South East – Front: Dr Carmel Mullaney, Director of Public Health; and Dr Sarah Doyle, Specialist in Public Health Medicine. Back: Mags Murphy, Daniel Canty, Sandra Whelan, Carol Concannon, Lorraine Ryan, Bríd Murphy, Sarah Cripps, Kathleen Brennan, Patricia Vaughan, Mick Kavanagh.
Displaying the Excellence Award Certificate is Dr Bernadette O’Keefe and her colleagues from Public Health North East. Pictured are Dr Augustine Pereira, Director of Public Health North East; Dr Elaine Brabazon, Senior Surveillance Scientist; Dr Bernadette O’Keefe, Public Health Specialist; Helen Reilly, Staff Officer; Ita Cole, Staff Officer. Front: Jacquie Duignan, Covid Care Tracker/Section Officer; and Sharon Dowling, Administration Team.
Department of Public Health West: Damien Walker, Business Manager; Kate Gerrard, CNM II; Dr Kathleen McDonnell, SpR; Julie Silke, General Manager; Monika Stockenstorm, Administration; Patricia Opeoluwa, Surveillance Assistant; Dr Mary Jordan, SMO (holding award); Emma Duddy, Administration; Marion Commane, A/Director of Nursing; Laura Murphy, Administration; Padraig McMahon, Surveillance Assistant.
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“The average caller was 80 years of age and the average Rockwood Clinical Frailty Scale score was 6 (moderately frail). All patients, who were not transported to ED following initial Pathfinder visit, remained at home at 24 hours, while 90% remained at home at 7 days." The Pathfinder team: Paul Bernard, Grace Corcoran, Lawrence Kenna, Claire O’Brien, Peter Ward, William Howard, Laura Hogan, Rebecca Mooney, and Siobhan Masterson.
PATHFINDER A New service helping to keep older patients at home after they call 112/999
new service is safely keeping a high proportion of older people, who have phoned 112/999, in their own home rather than transporting them to the Emergency Department (ED) for assessment. Pathfinder is a collaborative service between the National Ambulance Service (NAS) and Beaumont Hospital Occupational Therapy and Physiotherapy Departments. The service consists of an Advanced Paramedic and Occupational Therapist (OT) or Physiotherapist (PT) responding to 112/999 calls. It also has a followup team consisting of OTs and PTs doing immediate follow-up visits as necessary. Older people are particularly vulnerable to adverse events while attending the ED. Pathfinder is improving outcomes for older people by minimising unnecessary ED attendances and offering safe alternative care pathways for older people in their own homes rather than in hospital. A study of 527 callers directed to the service in North Dublin found that 69% of them were supported to remain at home for assessment and intervention and didn’t have to travel to Beaumont Hospital ED. Traditionally in Ireland all 112/999 callers are transported to ED, unless they decline to go to ED. Lawrence Kenna, NAS Lead for Pathfinder, explained, “The Pathfinder Model demonstrates that Pre-Hospital Services can help to safely keep older people, who have phoned 112/999, in their own home rather than transporting them to a hospital ED for assessment. In North Dublin, Pathfinder is available to patients 65 years or older who have called 112/999 with a non-serious or non-life threatening concerns. In addition to being a first response to these low acuity 112/999 calls, Pathfinder also accepts ambulance crew referrals from higher acuity 112/999 calls. The North Dublin Pathfinder service operates from Monday to Friday from 8am to 8pm.” Lawrence discussed the results from a research paper published by the team. “The average caller was 80 years of age and the average Rockwood Clinical Frailty Scale score was 6 (moderately frail). All patients, who were not transported to ED following initial Pathfinder visit, remained at home at 24 hours, while 90% remained at home at 7 days. Patients with a diagnosis of dementia and/or a high frailty level were no more likely to be transported to hospital, or to re-present to ED following
the initial Pathfinder decision not to transport.” If an older person is deemed clinically well and safe to remain at home by the Pathfinder team on the initial 112/999 response, the Pathfinder Follow-Up Team can respond immediately and over subsequent days to provide a short period of intensive intervention at home. This role of the Follow-Up Team includes case management, rehabilitation and equipment provision. This input typically lasts for up to one week, with the aim of stabilising the situation and connecting the older person to alternative hospital and community based services for longer-term intervention where required. Bridget Clarke, NAS Lead, Out of Hospital Cardiac Arrest Strategy and Associated Specialist Programmes, said, “Pathfinder not only offers an alternative to assessment in the ED, but also acts as a connector and integrator of the person at home with the services and agencies in the acute, community, and voluntary setting that can most appropriately meet their needs. In terms of outcomes, it has demonstrated that it can keep patients safely and appropriately at home, at rates comparable with established UK pre- hospital services.” When it is necessary for the patient to travel to hospital, Pathfinder can manage a more planned interaction with the ED which benefits both the patient and those working at the hospital. Paul Bernard, OT with the Pathfinder Service, said the service is also helping to reduce unnecessary patient journeys to the ED. “Pathfinder is a good example of organisations working in an integrated way to improve outcomes for patients. To do this it has required the formation of a joint team from two organisations, as well as close collaboration with a wide variety of other organisations and teams including Dublin Fire Brigade, Primary Care, the Integrated Care Team, the Community Intervention Team and the NAS Community Paramedics. Patient feedback has been overwhelmingly positive and strongly confirms that older people hugely value the Pathfinder model”. The service received funding from the Sláintecare Integration Fund 2020 to test the model, and has been operational since May 2020. It is now in the process of being mainstreamed and it is intended to expand the model to other parts of the country so that older people who dial 112/99 with low acuity complaints in other areas of Ireland will also benefit from this model of care.
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CHILDREN’S HEALTH IRELAND LAUNCHES VIDEO FOR MANAGING ALLERGIC REACTIONS Following the success of the CHI Mass Challenge Initiative in CityWest in 2020, the Children’s Health Ireland Allergy team recently launched an interactive education video for families of food allergic patients called ‘Managing Your Child’s Allergic Reaction’. CHI’s Dr Aideen Byrne and Mairead Sheehan Allergy CNS created the video to empower families in the recognition and treatment of mild and severe allergic reactions, delivery of adrenaline auto injector pens and the management of a child while awaiting emergency assistance. Multilingual versions of the video will also be launched, ensuring this vital knowledge is even more accessible for families. Allergy CNS Mairead Sheehan said, “This video has made a hugely positive impact on how we educate and train our families, complementing and reinforcing our key allergy management advice in a calm reassuring manner. It’s a simple digital tool that is revolutionising how we educate our allergic families. “The allergy team want to empower and support families as they integrate care plans into family life for what can seem like terrifying scenarios,” said Consultant Paediatrician, Professor Jonathan Hourihane. “These cool videos are designed for easy stress free viewing at home and for sharing with friends and family.” During any allergic reaction it is important to remain calm, and the video is strengthening the confidence of families to manage allergic reactions. Dr Maeve Kelleher, Consultant in Paediatric Allergy, explained how the video format empowers parents in the care of their child. “Videos are easy to share and this is a great asset for parents; it helps them educate anyone looking after their child, ensuring that care giver can become more confident in managing a potential allergic reaction.”
To watch the video visit https://bit.ly/3G8iQgu
10 KEY MESSAGES FOR HEALTHCARE PROFESSIONALS MANAGING ALLERGIC REACTIONS 1. Children at risk of severe allergic reactions (anaphylaxis) should always have rapid access to two adrenaline pens. 2. Adrenaline delivered IM is the FIRST line of treatment for managing a severe allergic reaction (anaphylaxis). 3. Allergic reactions start within two hours of exposure to a trigger. 4. Positioning a person in a supine position with legs slightly elevated when they are experiencing a severe allergic reaction is an important part of successful management and should be encouraged. 5. A second dose of adrenaline can be delivered after 5 minutes if there is no improvement. 6. After delivering adrenaline ALWAYS call the emergency services in the community (999/112). 7. Every child that is prescribed adrenaline pens requires an action plan and education on the recognition and management of anaphylaxis. 8. Adrenaline when given to treat an allergic reaction is never harmful. 9. When discussing allergy management with families keep the tone positive and calm, there is no need to be frightened of allergic reactions. 10. Allergic reactions can happen anywhere and to anyone – everyone should know how to recognise and manage allergic reactions – remember if in doubt deliver adrenaline!
“The allergy team want to empower and support families as they integrate care plans into family life for what can seem like terrifying scenarios..."
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GET UP GET DRESSED GET MOVING Patients at 45 hospitals get up, get dressed and get moving!
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total of 45 wards in acute hospitals across Ireland took part in the first national ‘Get Up Get Dressed Get Moving’ 60-day challenge. There were over 50,000 patient interventions to encourage patients to get up, get dressed and get moving. It was an opportunity to educate and support patients to become more functionally active during their hospital stay. A series of webinars were run throughout the challenge to increase staff awareness of hospital acquired deconditioning and how older adults can be supported to maintain their functional independence while in hospital. Prof Brian Dolan shared his learnings from the #endPJParalysis campaign. A number of HSE colleagues contributed their expertise - Peter Ward, Senior Physiotherapist, Beaumont Hospital, Aileen Horgan, Nurse Manager, University Hospital Cork, Kieron Connolly, Acting Senior Physiotherapist, St James’s Hospital, Emma Grant, Senior Dietitian, Waterford Integrated Care for Older People and Danielle Reddy, Senior Occupational Therapist, St Luke’s Hospital Kilkenny. Feedback included, “I feel it empowers the patients to keep their independence”; “It’s something small that can make a big difference to the length of time a patient has to stay in hospital”; “Getting dressed into day clothes can help patients to feel better in themselves and help them to maintain their normal daily routine.” Data from the challenge is being analysed with support from the Health Pricing Office. The results will be shared in the summer edition of Health Matters. ‘Get Up Get Dressed Get Moving’ is an initiative of the Office of the Nursing & Midwifery Services Director and the National Health & Social Care Professions Office. Resources to run the GuGdGm challenge within your ward are available at: www. hse.ie/eng/services/list/4/olderpeople/get-up-get-dressed-get-moving
POCKET-SIZED MENTAL HEALTH RESOURCES MAKING A REAL IMPACT FOR YOUNG PEOPLE Stemming from the need for an accessible tool to support young people in adapting to the various stages of the COVID-19 pandemic, a group of students from St Joseph’s Secondary School, Tulla, Co Clare came up with the bright idea to create just that. The aptly named ‘I-Can’ project is an innovative mental health tool, aimed at supporting the well-being and resilience of young people. I-Can is a pocket-sized tin that contains daily mindful activity cards, as well as encouraging messages and a QR code which when scanned, brings you to a bank of additional mental health resources and activities hosted on the Tusla website. The project was funded through a Tusla Child and Youth Participation initiative and was developed in conjunction with HSE Primary Care Psychology in Clare, St Joseph’s Secondary School, and Tusla’s Clare Prevention, Partnership and Family Support (PPFS). This project is a brilliant example of how young people can participate and make an impact in their own lives and the lives of others. The team looks forward to seeing how much further they can take the I-Can Project and spread this message of hope and resilience amongst young people in Ireland.
Susan Quain, Assistant Psychologist (front row, second from left); Eliza Walsh, Assistant Psychologist (second row, far right); and Tusla PPFS Team: Aine Mellett, Senior PPFS Manager, Tusla (third row, far right), Aisling Mulhall, Senior CFSN Coordinator, PPFS, Tusla (front row, second from right).
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ROOM TO
Improve Inpatient, Emergency and Outpatient Demo Rooms showcase facilities at new children’s hospital
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he National Paediatric Hospital Development Board (NPHDB) and Children’s Health Ireland (CHI) have unveiled the new children’s hospital demonstration space adjacent to the new hospital site in Dublin 8. The demonstration space houses an inpatient room, an emergency department patient assessment room, and an outpatient area giving a very real sense of the world-class child and family centric facilities and services that will be available to children and their families when the hospital is completed and operational. The new children’s hospital will continue to provide 39 specialities to 25 percent of Ireland’s population as well as clinical education to medical and care staff. The new demo rooms include an en suite Inpatient room built to the highest standard as an example of the type of room that will be available for children admitted to the new hospital. These rooms promote infection control as well as providing privacy and dignity to children. The Inpatient room also has a bed for a parent/guardian to stay close to their child as they receive treatment at the hospital. Outpatient facilities that can be viewed include enhanced stations for nurses and clinical staff and other procedure rooms that will provide comfort and safety to children that are visiting the hospital for occasional or regular care. The opening of these demonstration rooms is a further significant milestone in the development of the new children’s hospital. The rooms will also play an important and practical role in the build process, helping to co-ordinate technical design inputs to the hospital facilities as construction of the new building continues while providing the commissioning, IT, and equipping teams a working space to test materials, equipment and layouts that will be used in the hospital when operational. The rooms will be used by both medical and clinical staff and by children and families on an ongoing basis to continue to inform aspects of the new hospital as construction progresses.
Speaking about the new demonstration rooms, Diane Lynch, whose daughter Molly currently attends CHI at Temple Street Dublin, said, “As soon as you enter the space it’s clear that both the child and their family are at the centre of the design. From the parent’s perspective it offers privacy and care for both child and parent. The fold out bed for a parent to stay with their child and individual bathroom space will be invaluable to families during what are very often difficult and stressful times. “Having spent a lot of time with my own daughter, Molly, attending CHI, I am looking forward to the vast difference the new children’s hospital will make to children and their families all around Ireland.” Molly Lynch (13) said, “The rooms are really bright, welcoming, and spacious when I compare it to previous experiences in hospital. The technology in the room is really cool. It will help with long stays and feeling connected and close to family and friends. Having your own bathroom will make stays more comfortable and help children feel like it’s their very own space when they’re in for treatment.” Access to the new demonstration rooms will be given to medical staff for training purposes and to familiarise themselves with the new facilities. In time the local community, youth and parent groups, and others will be invited to view and inspect the rooms ahead of the planned opening of the new children’s hospital.
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Perinatal CARE Art therapist, Emilie Brown, who discussed the role of music and art therapy in maternity care at UMHL during the perinatal mental health conference
Service innovations in perinatal mental healthcare explored at UMHL conference
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he benefits of innovative services such as art and music therapy for the mental health of women during pregnancy were among the issues explored at the fourth annual conference of the Perinatal University of Limerick-based music therapist and PhD candidate, Pui Sze Cheung, and art therapist Emilie Brown, discussed the role of music and art therapy in maternity care at UMHL, as part of a broader exploration of service development that also saw Dr Kristyn Dunlop, SHO Obstetrics & Gynaecology, discuss the Birth Experience Survey Tracking (BEST) practice study, a quality improvement initiative at University College Hospital Galway. Patients attending the service in UMHL have been able to avail of art and music therapy for 12 months now, thanks to funding support from Healthy Ireland. Ms Cheung and Ms Brown shared patient feedback about the service during the conference, answering questions from the virtual audience. For the Specialist Perinatal Mental Health Service team at UMHL, which was established in 2018 as a joint service of UL Hospitals Group and the HSE Mid West Community Healthcare Organisation, music and art therapy has long been championed as a therapy of the kind that has placed the Mid-West team to the fore in mental health services nationally. Currently, a team from the Irish World Academy of Music and Dance and the Department of Nursing & Midwifery at UL, in partnership with the Specialist Perinatal Mental Health service at UMHL, is undertaking a major study into how art and music therapy can support perinatal wellbeing. The findings will help to inform the design of programmes to further enhance the wellbeing of mothers and infants in the care of the service. Maria Gibbons, Mental Health Midwife Manager of the UMHL service, said, “Art and music therapy complements the work of practitioners in the SPMHS. This therapy has allowed mothers to discover themselves again after the birth of their babies; to improve their self-esteem; and, above all, has provided a safe space where they can express emotions that they have found difficult to express in words.”
The conference had the theme of ‘Collaborate, Change, Celebrate’, and had a rich and varied agenda, with international and national keynote speakers sharing insights with an audience of professionals working with women in the perinatal period, including midwives, nurses, GPs, psychiatrists, psychotherapist, psychologists, occupational therapists and allied healthcare professionals. The conference also provided the local team with an opportunity for information exchange and establishing bridges for inter-service collaboration, as well as increasing general awareness around perinatal mental health services and issues. Other topics covered included discussions on the national model of care; ensuring that perinatal services meet the needs of LGBTQ+ parent families; psychosis in the perinatal period; the attitudes of healthcare professionals towards perinatal substance abuse; a case study of cannabinoid hyperemesis syndrome in pregnancy; in addition of educational videos on stigma in perinatal mental health; as well as oral poster presentations and video testimony from service users at UMHL.
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John Mulhall, Mortician, MRHP; Sandra McCarthy Director of Nursing, MRHP; Maureen Revilles, Director of Midwifery, MRHP; Michael Knowles, General Manager, MRHP; Sharon Foley, CEO, Irish Hospice Foundation; Dr John Connaughton, Clinical Director, MRHP; Zara Dagg, End of Life Care Coordinator, MRHP; and Majella Bannon, Facilities Coordinator, MRHP.
The new Viewing Room and Family Facility associated with the mortuary at Midland Regional Hospital Portlaoise.
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idland Regional Hospital (MRH) Portlaoise has officially opened the doors of its new Viewing Room and Family Facility associated with the mortuary. Development of the new facility involved the redesigning and refurbishment of the viewing area of the mortuary. The facility will provide an appropriate space for bereaved families and includes extending the existing facilities to make provision for a separate waiting area, a new viewing room and an entrance porch. There is also a small external area. It will provide appropriate space for meeting with family members in advance of a viewing. The internal design provides for a space which has a tranquil and peaceful atmosphere. Michael Knowles, General Manager for MRH Portlaoise, said, “Hospitals can be very inhospitable places for newly-bereaved people and families. The staff at the Midland Regional Hospital Portlaoise are committed to providing compassionate End-of-life care in partnership with bereaved families. Our aim in these new developments was to provide a space of dignity and respectful repose for the deceased, a sanctuary of care and privacy, where families can be supported to spend time together.
DESIGN AND
Dignity
New facility provides bereaved families a ‘sanctuary of care and privacy’
“The mortuary is a sanctuary and the renovations convey a multi-faith environment of dignified respectful repose, creating a person-centred care pathway, for each deceased person and their families. It also sustains our hospital’s culture of compassionate care in life, death and bereavement. “We would like to thank the End-of-Life committee in MRHP and all of the staff that have helped to bring this project to completion. And we would also like to express our gratitude to the Irish Hospice Foundation for their ongoing support.” Sharon Foley, CEO of Irish Hospice Foundation, explained that the vision of Design & Dignity is that every adult, paediatric and maternity hospital in Ireland has ‘warm and welcoming spaces to enable dignity and respect for patients and families
Michael Knowles, General Manager, MRHP; Sandra McCarthy Director of Nursing, MRHP; Sharon Foley, CEO, Irish Hospice Foundation; Dr John Connaughton, Clinical Director, MRHP; and Maureen Revilles, Director of Midwifery, MRHP.
facing dying, death and bereavement’. “These projects significantly shape the overall culture of end-of-life care in Irish hospitals and it is truly wonderful to see the level of pride that staff feel, having played a vital role in bringing their Design & Dignity projects to fruition. I am delighted to see this happen here in Portlaoise,” said Sharon. Funding for this new development was awarded to the Midlands Regional Hospital Portlaoise by the Irish Hospice Foundation (IHF)/HSE Design & Dignity grant to further develop end-of-life and bereavement care.
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Patricia Carroll, CNM2 CIT-OPAT MRHT; Louisea Burke, Director of Nursing, MRHT; Yvonne Delaney, Interim Director of Public Health Nursing, Laois/Offaly; Linda Veighey, CRGN CIT Laois/Offaly; and Siobhan Geraghty, ADPHN CIT Laois/Offaly.
Extraordinary Measures Nurse-led oncology-haematology clinic shows integrated care in a changing landscape
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xtraordinary measures were initiated across the HSE during the pandemic and exploring means to reduce unnecessary hospital attendance was a key priority. The Public Health Nursing Service of Laois/Offaly Community Healthcare Organisation (CHO 8) and the Midlands Regional Hospital Tullamore (MRHT) initiated a quality improvement collaborative by establishing a nurse-led Oncology-Haematology Clinic. Service users that previously attended the Regional Oncology -Haematology Day Unit (ROHDU) in MRHT could now access specific services in the nurse-led clinic. MRHT provided the relevant oncologyhaematology competence by assigning an
experienced, skilled nurse to provide this service. Public Health Nursing Services also provided a registered nurse to facilitate service provision and primary care hosted the oncology-haematology clinic in the Primary Care Centre in Tullamore. The establishment of this dedicated service provides services such as chemotherapy disconnections, PICC line dressings, blood extraction, central venous access device port flushes and subcutaneous and intramuscular therapies specific to oncology-haematology patients. In 19 months to October 30th 2021, the nurse-led clinic as a joint working partnership with no additional resources allocated has facilitated 1357 patients; a fine example of collaborative practice in achieving patient-centred care.
Patricia Carroll CNM 2, CIT – OPAT, MRHT, Siobhan Geraghty, Assistant Director of Public Health Nursing, community intervention team (CIT), and Linda Veighey, Community RGN, CIT, are responsible for the operation of the clinic under the governance of both Yvonne Delaney, Interim Director of Public Health Nursing Laois/Offaly, and Louisea Burke, Director of Nursing MRHT, who have both encouraged and supported this integrated working. “Patricia, Siobhan and Linda have been instrumental to the success of this clinic. I would like to send my sincere appreciation for their on-going dedication,” said Yvonne Delaney. Staff of the ROHDU MRHT communicate with the Community Intervention Team- Out-Patient Antimicrobial Therapy (CIT-OPAT) Nurse in MRHT when they seek to make a referral to the nurse-led clinic in the PCCT. The governance of these service users remains at all times with their treating consultant at MRHT. This collaborative nurse-led clinic has resulted in many positive impacts for the service user who attended this clinic over a number of months. Aside from the therapeutic relationships formed with the service user, the feedback has been very encouraging and indicative of a real success story. Evidently, the nurse-led clinic has greatly reduced waiting times; has reduced duration of episodes of care; service users are allocated an appointment time with care completed within 20 to 30 minutes from arrival to departure within the primary care centre. The feedback from our service users has been phenomenal citing that they ‘feel safe’ and with greatest impact; ‘do not have to travel long journeys’ to seek relevant intervention, resulting in avoidance of unnecessary attendance in the acute setting and subsequent reduced risk of infection. One patient said, “During my time attending and still attending I found the experience stress free… and I found the one-to-one personal service made my life so much easier. Due to the swift professional and caring service it provides it eliminates long waiting times for patients. I would highly recommend this service to continue.” “These positive outcomes have ultimately led to greater patient satisfaction simply by delivering specialist care in the least complicated manner with patients accessing this service within their locality, upholding the ethos of primary care and bringing to life the principles of Sláintecare,” added Yvonne.
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NURSE MENTORSHIP A GREAT SUPPORT FOR NEW GRADUATES IN CUH Cork University Hospital (CUH) Nursing Services are delighted to be implementing an exciting new national nursing initiative, Nurse Mentorship, to support new graduate nurses at the outset of their nursing careers. This initiative is part of a collaboration between the Office of Nursing and Midwifery Services Directorate, the Chief Nursing office in the Department of Health, and the Nursing and Midwifery Board of Ireland, and is being led out by the National Clinical Leadership Centre for Nursing and Midwifery (NCLC).
Sinéad Favier; Bébhinn O’Sullivan, NPDU; and Louise Murphy, ANP Rheumatology.
What is Mentorship? Mentorship is a mutually supportive relationship between a junior nurse and an experienced nurse. The aim is that the mentor and mentee are working in different clinical areas so there is a degree of objectivity to the relationship. The mentor undertakes a 1.5 hour online training session provided by the NCLC. A database of mentors is accessible to the mentees who choose a mentor whom they feel is appropriate for their needs. Mentoring is largely about meeting, communicating and jointly thinking through problems and opportunities which enhance nurse development leading to improved patient care.
What qualifications are needed to become a mentor? Enthusiasm for nursing and patient care is the ultimate qualification. Maintaining high standards in patient care whilst performing as a role model are also key. Mentors need to be at least 2 years qualified. Andrea Moriarty, Mary Davey & Bébhinn O’Sullivan, CUH Nurse Mentorship Leads, were delighted with the enthusiasm of their nursing colleagues across all disciplines in signing up to become
If you are interested in implementing mentorship in your site please contact Margaret by email: margaret.williams1@ hse.ie
mentors during the CUH Mentorship Information week in December 2021. They are launching the Nurse Mentorship programme in CUH on Tuesday, 1st March 2022 with a Lunch & Mingle for Mentors and Mentees. The focus is on recruiting and retaining nursing staff in CUH through providing support to our graduate nurses. Linking graduate nurses with experienced mentors will help them Irenesupport Gibson, and PhD guide candidate and through their first year as qualified staff nurses. Director of Programmes and Innovation, National Institute for “We wish to sincerely acknowledge and thank our nurses. In spite Prevention and Cardiovascular of the recent and on-going clinical challenges they have committed Health; Neil Johnson, Chief to assisting our graduate nurses to support them to bring their best Executive, Croí; and Dr Lisa Hynes, to the bedside and enable them to reach full Programmes, potential. We Head their of Health Croí. would like to thank Margaret Williams, the National Lead for her assistance and support in the implementation of mentorship to CUH,” said Bébhinn.
14,000 discharged from waiting list thanks to work of triage clinic Orthopaedic musculoskeletal (MSK) triage services have been improving the pathway of care for patients at Galway University Hospital (GUH). The triage clinic was established in 2012 with recruitment of two Clinical Specialist Physiotherapists to GUH. This was an initiative by the National Clinical Programme for Trauma and Orthopaedic Surgery and National Clinical Program for Rheumatology in response to growing waiting lists and increasing waiting times for Orthopaedics and Rheumatology. The service in GUH initially focused on orthopaedics but over the nine years since its initiation, the service has expanded to four clinical specialist physiotherapists and now delivers a triage service to rheumatology. The specialist physiotherapists assess patients waiting on orthopaedic and rheumatology waiting lists and guide them to the most appropriate pathway of care for their condition. Those requiring specialist services can be identified more rapidly and directed to the most appropriate service. This has resulted in improved pathways of care for patients and more efficient use of consultant clinic appointments. To date almost 14,000 patients have been discharged from the waiting list without needing orthopaedic review. Of the patients attending specialist appointments following triage review, over 75% went on to have orthopaedic intervention.
Neasa De Búrca, Chartered Physiotherapist; Sharon O’Connor, Chartered Physiotherapist; John Galbraith, Consultant Orthopaedic Surgeon and MSK Triage lead; Eilis Dolan, Chartered Physiotherapist; Joseph Malone, Chartered Physiotherapist; and Eoin Connolly, Chartered Physiotherapist.
Colin Murphy, Orthopaedic Lead, GUH acknowledged the milestone. “The huge amount of work has been invested by a dedicated team of professionals to establish and run this service. Despite the recent setbacks in our hospitals, our MSK physiotherapy triage service has continued to see and assess a large number of patients, improving not only access to care for patients on particular orthopaedic and rheumatology waiting lists, and those in most need, but in selecting the most appropriate care pathway for each patient group and providing timely advice to those who attend MSK clinics.”
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National Service Plan 2022
HSE NATIONAL SERVICE PLAN 2022
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he National Service Plan 2022 was launched on 1 March 2022 and sets out the type and volume of health and social care services to be delivered by the health service in 2022, having regard to the funding made available and the level of staff to be deployed. NSP 2022 outlines the second year’s implementation of the HSE Corporate Plan 2021-2024 which lays out the key actions through objectives and enablers to improve our health service and the health and well-being of people living in Ireland. The NSP aims to reduce waiting lists, build hospital and other service capacity and continue to support the progress of important Sláintecare reforms through the allocated budget of €20.7bn. NATIONAL SERVICE PLAN 2022 KEY PRIORITIES
In his foreword, the Chairperson of the HSE Board emphasises the priorities of the HSE for 2022, which are to continue the provision of safe health and social care services and to progress fundamental reforms across service delivery, in line with Sláintecare, including addressing waiting lists and waiting list times. We will progress the implementation of national strategies, the provision of women’s healthcare and improve mental health services. We will ensure rigorous and meaningful risk oversight, prioritising the mitigation of the most significant risks for the HSE as identified in the Corporate Risk Register, and effectively monitor our performance against clearly defined targets. The National Service Plan 2022: • Provides details on priorities, actions and the type and volume of service that will be provided by our service areas • Describes the Financial Framework that supports the NSP, detailing the expenditure limits for the HSE at national level and setting out specific areas of investment in 2022 • Focuses on our Workforce and Corporate Human Resources, recognising the vital role of staff at all levels of our organisation • Outlines the priorities of the key enablers that support our services • Lists the performance indicators and activity measures against which our performance and volume of activity is assessed • Provides a focus to compel improvements in the security and resilience of critical national infrastructure following the cyberattack • Outlines how we will sustain the COVID-19 response in line with legislative requirements • Raises significantly the priority, profile and scope of our efforts in to reduce energy consumption.
Our Population
The population of Ireland was estimated to be 5.01 million people in April 2021. This is the first time that the Irish population has risen above five million since the 1851 census, when the population was recorded at 5.11 million. The population continues to grow across all regions and age groups. As before, the most significant population growth has been among the older age groups. Over the last decade, the number of people in Ireland aged 65 years and over has increased by over one-third, and growth in this demographic has been twice that of the European Union (EU) average in the same period. The growth in this older age group can be expected to continue into 2022 and can be attributed to better medical care, more accessible treatments and improved lifestyles. Life expectancy is increasing and the most significant factor is reduced mortality rates from major diseases. However, life expectancy is socially patterned and remains lower for unskilled workers compared to professional workers.
2022 BUDGET
The total 2022 operating budget is €20,683m. €310m of this budget is for investment in new measures, including: • • • • • • • • • • • • • • •
€54.5m for disability services, including €4m for Winter Plan measures €40.2m for PCRS / eligibility measures €38.6m for implementing national strategies €30.0m for new drugs €22.5m for older persons’ services, including €4.2m for Winter Plan measures €25.3m for women’s health €24.0m for mental health , including €1m for Winter Plan measures €22.3m for workforce and allied reform measures €9.1m for acute Winter Plan measures €10.5m for additional critical care capacity €6.0m for National Drugs Strategy €4.5m for acute eligibility measures €4.0m for Healthy Ireland €3.05m for palliative care, including €0.65m for Winter Plan measures €15.8m for other initiatives, including €3m for Winter Plan measures.
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Delivering Sláintecare – Strategic Reform and Innovation
The National Service Plan 2022 is aligned with the Sláintecare Implementation Strategy (2018). The Sláintecare strategy provides us with an unprecedented opportunity for the realisation of sustained improvement in the provision of healthcare to all citizens. Sláintecare sets out a tenyear vision, covering a wide canvas of complex issues across the health sector and implementing that vision requires concrete and well-defined steps to be taken over time. Health reform is central to the delivery of our vision for our health services, bringing us closer to the delivery of Universal Healthcare as set out in the Programme for Government - Our Shared Future. There are long waiting lists for scheduled care in hospitals and long waits in emergency departments (EDs), particularly for older people and those with more complex needs. Waiting lists for community-based services such as therapies, mental health and disability services also pose significant challenges. We must improve our services to become more personcentred and proactive. In line with Sláintecare and the Programme for Government objectives, our reform and innovation programme seeks to address these challenges and many others.
If you would like further information on the National Service Plan, please contact the Planning team in the Office of the National Director, Strategy and Research at planning.ddg@hse.ie or telephone 021-4923531. The National Service Plan 2022 is available at: https://www.hse.ie/eng/services/ publications/serviceplans/ hse-national-service-plan-2022.pdf
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Childhood Vaccines COVID-19 demonstrates enduring importance of early childhood vaccinations COVID-19 has impacted many aspects of life, including access to some healthcare services. Some people may consider delaying routine healthcare appointments. The early childhood vaccinations that babies get are as important as ever, and are considered an essential healthcare service. Throughout the pandemic, GPs have been advised to continue the recommended vaccinations for babies as a priority. WHY THE ROUTINE CHILDHOOD VACCINATIONS ARE IMPORTANT The significance of early childhood immunisation can be underestimated. We don’t see the effects of vaccine-preventable diseases as often as we did in the past, but the diseases they protect against have not changed. They can still cause life-threatening complications and even death in children who are not protected. As recently as the 1980s, 100 children a year in Ireland suffered from meningitis and other serious complications of Haemophilus Influenza B infection. Measles used to kill thousands of people every year. In the 1940s and 1950s, tens of thousands of children were paralysed or killed by polio. The rapid spread of the COVID-19 virus around the globe has shown us how quickly infectious diseases can spread. As recently as 2018, more than 80,000 cases of measles were reported in Europe with more than 70 deaths. Rates of uptake for immunisations have dropped globally during the pandemic. With increased travel we may experience outbreaks of vaccine-preventable diseases that are currently rare in Ireland. WHY VACCINATIONS SHOULD BE GIVEN AT THE RECOMMENDED TIME To complete their primary vaccination schedule, babies need 5 GP visits between 2 and 13 months of age. The vaccines and the visits are free of charge, and give babies protection from serious life threatening illnesses such as meningitis, measles, whooping cough, polio, pneumococcal disease and haemophilus influenzae b now and when they are older. The ages at which vaccines are recommended are chosen to give children the earliest and best protection against serious illness now and in the future. If any routine vaccinations are delayed, this puts babies at unnecessary risk at a time they are most vulnerable. For example, babies younger than 6 months are at the highest risk for serious complications from whooping cough; that’s why vaccination against whooping cough starts at 2 months of age. Several doses of some vaccines are required to build up lasting immunity. This is why it is important that babies attend all of their appointments or they will only be partially protected and could still pick up the disease. WHAT IF MY CHILD HAS MISSED VACCINATION APPOINTMENTS? If vaccinations have been missed or delayed it is important an appointment is made with their GP as soon as possible to catch up. Missed or incomplete vaccinations in childhood means children
Primary Childhood Immunisation Schedule Babies born on or after 1 October 2016 Age
Vaccination
2
Visit 1
6 in 1+PCV+MenB+Rotavirus 3 Injections+Oral Drops
4
Visit 2
6 in 1+MenB+Rotavirus 2 Injections+Oral Drops
6
Visit 3
6 in 1+PCV+MenC 3 Injections
months
months
months
No Rotavirus vaccine on or after 8 months 0 days
12
Visit 4
MMR+MenB 2 Injections
13
Visit 5
Hib/MenC+PCV 2 Injections
months
months
Remember to give your baby 3 doses of liquid infant paracetamol after the 2 and 4 month MenB vaccines. 1. Give 2.5 mls (60 mg) of liquid infant paracetamol at the time of the immunisation or shortly after. 2. Give a second dose of 2.5 mls (60 mg) 4 to 6 hours after the first dose. 3. Give a third dose of 2.5 mls (60 mg) 4 to 6 hours after the second dose.
Remember five visits to your GP (doctor) www.immunisation.ie
are not protected when they are older. Some infections are more serious in teenagers or adults than in children. For example, mumps in teenage boys or young men may cause swelling of the testicles and if a woman contracts rubella in the early stages of pregnancy this can cause major birth defects in their baby. WHERE CAN I FOUND OUT MORE INFORMATION? For more information, read ‘Your Child’s Immunisation: A Guide for Parents’ published by the HSE National Immunisation Office. https://bit.ly/PCIPBook You can also make an appointment to discuss vaccinations with your GP or practice nurse, or visit the HSE website www.immunisation.ie.
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YOUR OPINION COUNTS 2021 Staff Survey Results
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lmost 13,000 people completed the health servicewide staff survey, carried out by the HSE in partnership with Core Research. This represents an overall response rate of 8% and a 12% response rate for HSE services. Thank you to everyone who took the time to complete the survey in what has been a relentless two years for our health service. Some of the positive results from the survey show that nine out of 10 people feel their work makes a difference to patients and service users, and feel they are trusted to do their job. The survey results have highlighted areas where improvements are needed, with only five out of 10 people saying they have the necessary resources to do their job and people’s satisfaction with their job dropped overall in comparison to the 2018 survey. Speaking about the survey’s findings, Anne Marie Hoey, National Director, Human Resources, said, “The last two years have been very challenging for staff dealing with the pandemic and then the cyber-attack last May. The resilience and positive attitudes of those delivering health services shows the high level of staff commitment to work to make the lives of their patients and service users better. “Now we must use these survey results to inform how to make the Health Service a better place to work in the future by improving workplace culture and equal treatment, increasing frontline staffing numbers and allow more flexibility in working conditions, as articulated by respondents.” The survey questionnaire themes remained broadly in line with the 2018 research, with the addition of a section on COVID-19 experience and two open free text questions around staff ideas for improvement. The nine themes covered in the survey were: • My Job • My Role • My Organisation • Leadership and Management • COVID-19 Experience • Training and Development • Standard of Care and Service • Health and wellbeing • Dignity at Work THE FULL REPORT OF THE HSE STAFF SURVEY IS AVAILABLE AT WWW.HSE.IE/ENG/STAFF/STAFFENGAGEMENT/RESOURCES/YOUROPINION-COUNTSSTAFF-SURVEY-20211111.PDF
SURVEY SUMMARY • Overall, staff are enthusiastic (even more so than in 2018), and highly motivated compared to other large organisations. The vast majority feel their work makes a difference to patients and service users. • There is a strong sense of job security among staff. • There has been an increase in satisfaction with the level of care delivered since 2018, however, this is tempered by almost four in 10 saying they feel the service delivered by their organisation is deteriorating. • Staff are more likely to believe their manager takes a positive interest in their health and wellbeing compared to 2018. • More staff say they are involved in decisions that affect their work in 2021 compared to 2018. • The sense of recognition received for ones’ work is one of the lowest performing areas this year, however, it has seen an increase since 2018. • Levels of employee satisfaction and optimism about working in the Health Service into the future have decreased since 2018. • Communication, perceptions of senior leadership, and work/life balance are areas that require focus and improvement. • Bullying and harassment persists. In 2021, the same number of staff report experiencing bullying from a colleague as they did in 2018. • COVID-19 has had a mixed impact on staff. The majority felt supported throughout the pandemic and one third feel more positive towards the HSE since before the pandemic began. However, half feel there has been a negative change in their working environment. • The main suggestions to make the Health Service a better place to work in the future were; improving workplace culture and equal treatment, increasing frontline staffing numbers and more flexibility in working conditions.
NEXT STEPS Each health service area received their own report and were then asked by HR Director Anne Marie Hoey to engage with their staff and communicate their results and to identify a lead person in their area who will be responsible for developing local action plans and for communicating the progress being made to address the Staff Survey findings.
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SPECIALIST MENTAL HEALTH SERVICE Psychiatry of Old Age (POA) Service helping Sligo and Leitrim for over 20 years
The garden at Liscarney House which was a project during lockdown. Sharon McMorrow, Senior Occupational Therapist, Liscarney House and Gavin Sweeney, Team Coordinator, Liscarney House.
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he Psychiatry of Old Age (POA) Service in Sligo Leitrim with dementia that may have behavioural or psychological problems,” Mental Health Services is marking over 20 years serving she explained. the local community. “We have a multidisciplinary team, and it was my job to get the The POA service is a specialist mental health team service started from the greenfield site and to get a whole range of offering comprehensive, community oriented services for different disciplines involved from medical nursing, occupational people aged 65 years and over who develop functional mental health therapy, clinical psychology, social work. It's been really important to have a good evidence base for this service. illnesses or dementia with behavioural and psychological problems. The service, which was established in 2001, currently provides a “So from the very beginning, we've had a very strong research ethos range of consultant – led community and acute care for patients and we've been involved in a number of Interreg cross-border referred from Sligo, Leitrim, West Cavan and South Donegal with a European studies looking for example, at brain health and diabetes highly functioning Community Mental Health Team (CMHT) based to prevent depression and dementia. We're involved in a drug trial in Liscarney House, Sligo. for Alzheimer's disease, and we've done lots of services The specialist POA team has multidisciplinary based research to try to enhance the quality of care membership and includes doctors, mental health that we provide the right care, in the right way, at the nurses, occupational therapy, clinical psychology, right time, as close to the person's home as possible.” social work, administration staff and a multitask Dr Catherine Dolan, Consultant Old Age Psychiatry attendant, in line with National Mental Health Policy. Sligo Leitrim Mental Health Services, explained about To further explain what the service provides please The team operates using an assertive outreach the team at Liscarney House. see video here: HTTPS:// model, with rapid clinical response, and provides “I will be leading a new team that will be the full of YOUTU.BE/AJBTNH JZMYE specialised multidisciplinary psychiatric services multi-disciplinary professionals, including an through fixed and mobile clinics, domiciliary visiting occupational therapist, a social worker, psychologist, including Nursing Home/ Community Hospital visits a trainee psychiatrist and administration. It’s a very and Liscarney House Day Hospital attendance. exciting development, and it will improve services for older people This POA Service has an evidence-based practice emphasis and a in the area and build on the strong ethos of excellent culture of care strong research ethos with a focus on services based research leading for older people in the service. We will continue to in-reach to people's to continuous quality improvement of the clinical service provided homes into nursing homes,” she said. to service users and families. “We will continue to develop our day hospital, but the focus will Feedback from service users and families on the service provided really be on bringing care to people where they need it and where ever their home might be. And that isn't just that isn't just a hospital is encouraged through Care Opinion Ireland (careopinion.ie) to for us, it's in the community and linking in with all the services that facilitate ongoing service improvement. Professor Geraldine McCarthy, Consultant in Psychiatry of Old are already there, including voluntary services and community Age, established the service in 2001. “It's a community oriented mental services. It's a very exciting development and I'm looking forward to continuing with this and getting the team on board and we're in the health service for older people with mental health difficulties, mainly early stages of development.” functional psychiatric illness, depression or psychosis. And also people
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he HSE Health Passport helps people with an intellectual disability to communicate and express their unique needs when in a health care setting. It is now available as an app to make it even easier for people. Kathleen McBride, whose son Martin has intellectual disability, said their experience of using the Health Passport had been ‘very positive’. “When my son Martin who has an intellectual disability, was sent to the Emergency Department he had his Health Passport with him. It was of great help to both us and the medical profession as his files are not available on arrival. The information on his Health Passport allowed treatment to begin immediately as Martin was then diagnosed with pneumonia,” explained Kathleen. “It also gave important information such as to put drip in Martin’s left side and to take his temperature on his right side as in a stressful situation we forget to mention these important details. The doctor that attended Martin thought the Health Passport was a great idea and was grateful that all his important information was at hand.” The Health Passport app is funded by the Department of Health through the Sláintecare Integration Fund. One of the aims of the Sláintecare Integration Fund is to test and scale innovative new ways of providing care. This digital technology will ensure the patient voice is paramount, delivering a more accessible positive care experience. The five sections contained within the app include: All about me; Medical History; Communication; Looking after me, and Keeping me safe and happy. The app helps healthcare staff to get to know all about the abilities and needs of people with an Intellectual Disability who come into contact with a Healthcare Setting enabling them to provide better safer care by providing reasonable adjustments before undertaking any assessment, examination or treatment of people with Intellectual Disability. The development of the app was expedited as a direct result of COVID-19. It is well evidenced in the research literature that people with intellectual disability have more adverse health outcomes than their general population counterparts. Niamh Walsh, PhD Researcher, said, “We have been using the paperbased HSE Health Passport since 2017 but, with the support of Sláintecare, we were able to develop the app version which will enable further spread and scale and accessibility of the HSE Health Passport to those who need it, never has this been more urgent than during the pandemic.” Prof Mac MacLachlan, Clinical Lead, National Clinical Programme for People with Disability, described the app as an “excellent tool’ that enables people with intellectual disabilities and others with communication difficulties to exercise their human right to access quality services and supports across the health and social care sector. The Passport puts people with disabilities in the digital space and ensures that they are active participants in their services and supports.”
The HSE Health Passport ID app is available on IOS and Android.
SAFE AND APPY Health Passport ensures patient voice is always heard
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DEMENTIA ADVISERS NOW IN
every county
FIELD HOSPITAL OPENS EYES UP TO NEW PATIENTCENTRED MODEL OF CARE
Xxxxxxx
Intermediate care facility housed in local sports arena during COVID-19 pandemic now the subject of a research study
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or five months of the pandemic year of 2020, the Sports Arena in the University of Limerick (UL) was transformed into a field hospital to help with the battle against COVID-19 that threatened to overwhelm the hospital services in the Midwest. The field hospital, later named the Intermediate Care Facility (ICF), turned out to be the only successful operating field hospital in Ireland during this period, catering for 188 patients. “The weekend after the University was closed, I was contacted by the Department of Health to see what the University could do to help,” said Professor Des Fitzgerald, former UL President. Des was a member of the board of UL Hospitals Group (ULHG) where concerns had been expressed about the capacity within the hospital and their ability to cope if the case numbers continued to rise as expected. Colette Cowan, the CEO of UL Hospitals Group had been toying with the idea of a field hospital type initiative that would help with surge capacity in some way and assist in decompressing the acute and community hospitals if needed.
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The idea took hold and UL offered the sports arena free of charge as one of the possible options. A steering group was formed, chaired by Professor Paul Burke, Chief Academic Officer with the Head of Strategy in UL Hospitals Group, Suzanne Dunne, pulling the plan together. It was finally agreed that the space would operate as a rehabilitation facility, as championed by Fiona Steed, then Group Lead of Allied Health in UL Hospitals Group. It would take patients who required rehabilitation care with complex medical discharges, out of the acute hospital setting and give them the necessary supports and therapies to facilitate their journey home or to longer term care settings. This would not only assist in positive patient outcomes but also free up beds for acute care in the hospital. This opened the door to the more direct involvement of the UL School of Allied Health (SAH) in the process and particular opportunities for allied health profession students around placements and completing course requirements for graduation. Dr Aileen Wright, head of the School of Allied Health, said the sudden closure of the university and the almost overnight move to online teaching was very challenging for her staff. The ICF provided an opportunity for SAH students to both complete their clinical placement requirements and also gain valuable experience in the contribution to the care of patients in the ICF, under the supervision of qualified clinicians. Nursing students from the UL Department of Nursing and Midwifery (DN&M) could also avail of the learning opportunity offered by the ICF. Chief Director of Nursing and Midwifery Margaret Gleeson worked on securing the nursing personnel to staff the facility. Niamh O’Grady, General Manager for Operational Services in UL Hospitals and her team ensured that all the necessary facilities and personnel were in place - porters, catering, cleaning, security – to operate the facility. The issue of clinical governance proved to be one of the most difficult challenges to overcome as there was no spare capacity among consultants already working in UL Hospitals Group. Professor Paul Burke approached two of the most respected retired Consultants in the region – Dr Eithne Molloy and Dr Con Cronin. They agreed to come out of retirement to fulfil this clinical governance role in the ICF. Once the planning framework was finalised, it was handed over to Breda Duggan, Project Manager in UL Hospitals, to operationalise. The logistics of turning the Sports Arena into essentially a hospital ward was a mammoth task covering everything from infection control, catering, toilet and sewerage facilities, health and safety, equipment, patient transport and security. But perhaps one of the inspired ideas was to engage the Irish Army in the project. Once the planning was done with the project team, the local 12th battalion Infantry Unit, based in Sarsfield Barracks in Limerick, rolled in to do the ‘heavy lifting’. “The army was amazing,” said Project Manager Breda. “They laid out the units, put wheels on wheelchairs, dressed beds … they did everything, they were an amazing bunch of men and women and they just did what had to be done.” The doors were finally opened in the ICF on June 8th, just 10 weeks after the idea had been first floated. Consultants, allied health professionals, doctors, security, medical social workers, nurses, students, porters, cleaners, health care assistants, patient advocacy service (PALS), receptionists, caterers all came together in this 84-bed facility.
Top: Members of the Allied Health team at the Intermediate Care Facility. Front, from left: Aoife McCarthy, Senior Occupational Therapist; Joanne Mannion, Senior Speech & Language Therapist; and Mary Flahive, Senior Physiotherapist. Middle (from left): Fiona Steed, Group Lead, Allied Health; and Sheila Bowers, Dietitian Manager. with Joanne Hayes, Senior Medical Social Worker; Anne Hegarty, Principal Medical Social Worker; Catherine Daly, Occupational Therapist; Anne Harnett, Chief Pharmacist; and Scott Murphy, Physiotherapy Practice Tutor. Above left: Josephine O'Shea (91) from Oola, Co Limerick, taking exercise with Scott Murphy, Physiotherapy Practice Tutor, and Emer McGettrick, student physiotherapist: "With all the rest and exercise I’ve had, I feel so much stronger now. I have a much more positive attitude now as well." Above right: Tom Noonan from Dromcollogher, West Limerick: "I didn’t know what to expect when I was coming here, but I’ll tell you this, I couldn’t have come to a better place.”
Yvonne Young, who led the Centre in the Associate Director of Nursing role, and the entire team nurtured an ethos of kindness and compassion in the ICF that had a ripple effect across the whole facility based on a holistic approach to care. Patients arrived over the five month period with various needs ranging from post-operative care, to respiratory conditions, to post COVID-19 rehabilitation. While the patients and the students were the primary beneficiaries, the staff who worked there also derived huge personal satisfaction and learning from the process. It opened their eyes to a new patientcentred model of care, anchored by effective multi-disciplinary working in which the health and social care professionals are an intrinsic part. The ICF closed its doors on X with the last patient discharged. The experience has thrown up many new and exciting ideas about further incorporating health and social care professionals into patient care in the UL Hospitals Group, and about the benefits of inter-discipline training and education for students and staff alike. The Intermediate Care Facility is now the subject of a collaborative research study facilitated by the Health Sciences Academy with the Faculty of Education and Health Sciences and the UL Hospitals Group, led by Professor Judi Pettigrew in the School of Allied Health. The project aims to capture through in-depth interviews, the experiences of a wide range of stakeholders involved in the ICF from those who conceived it through to those who physically set it up to those who operated it or received care it in.
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iSIMPATHY project supports patients to ensure best use of medicines
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our senior clinical pharmacists have been successfully delivering medicine reviews as part of the iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) project The project is operating in nine GP practices in Donegal, Sligo, Cavan, Monaghan and Louth since February 2021 and in a 10th practice in Leitrim since January 2022. Over 1,000 patient medicines reviews have been completed to date as part of the project. The pharmacists carry out a face-to- face, phone or video consultation with each patient, focusing on their needs and wants as well as clinical and safety considerations. The pharmacists liaise with the GP who actions the changes to their medication as necessary. The iSIMPATHY project aims to support patients to be part of shared decision making and ensure the best use of medicines for them. Health Ministers from the three project jurisdictions - Minister for Health Stephen Donnelly; Health Minister Robin Swann, Northern Ireland; and Cabinet Secretary for Patient James Howard from Health and Sport Scotland Jeane Freeman Kingscourt, Co Cavan. joined health professionals including Dr Colm Henry, HSE Chief Clinical Officer, and Joe Ryan, HSE National Director, to announce the polypharmacy, optimise medicines use and reduce medicationproject launch at a virtual event in November 2020. related harm, in line with the HSE’s Patient Safety Strategy (HSE, The project addresses the challenges posed by polypharmacy 2019) and the National Service Plan (HSE, 2021). (use of multiple medicines) and adherence (being able and willing The reviews give people a personalised assessment of their to take medicines) through the provision of medicines reviews. medication and enable them to be part of shared prescribing Taking multiple medicines may be the most appropriate action, decisions, using a seven steps approach which asks ‘What matters but there can be an increased risk of harm from interactions to you? The reviews result in appropriate polypharmacy, between drugs or between drugs and diseases which outweigh the encompassing the person’s wishes and concerns about their intended benefits. medicines, together with clinical, quality, safety and costThe medicine reviews aim to improve patient adherence and effectiveness considerations. understanding of their medicines, reduce inappropriate
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HSE project lead Ciara Kirke explains that the iSIMPATHY project is enabling the delivery of a brand new model of quality, clinical care in border counties. “For the first time in the Republic of Ireland, outside of a research setting, we are delivering comprehensive medicine reviews to people who most benefit from them. Over 1,000 patient medicines reviews have been completed,” said Ciara. “These reviews are person-centred and holistic, delivered by project pharmacists working in primary care, within GP practices, engaging directly with patients and working in collaboration with GPs. We are seeing a reduction in the risk of medication-related harm, improvements in patient quality of life, a greater understanding of medicines through patient education and considerable savings as a result of reviews. Further evaluation is under way.” The Project Pharmacists taking part in the iSIMPATHY project are Leon O’Hagan in Co Louth; Clare Kinahan in Cavan/ Monaghan; Jacqueline Treacy in Sligo/Leitrim; and Emma-Jane Coyle in Donegal. Patient James Howard from Kingscourt, Co Cavan described his experience of having a medicine review with Clare Kinahan, senior iSIMPATHY pharmacist. “When I was out walking I used to get quite dizzy and I was then taken off a couple of tablets and now I feel great again. I think it is a great thing to have a review for these things. I benefited from the review because the lady in question [Project Pharmacist] was very patient and very good at explaining it. I think everyone should have a review,” said James. Participating GP, Dr Conor Mitchell, from Ballyshannon said, “iSIMPATHY has been very helpful and I am delighted to have Emma as part of the team. Yes, it is extra work but this is the nature of the beast when it comes to polypharmacy. It is time well spent. For the more complex patients, patients with 30 plus items on their prescription, iSIMPATHY has given a starting point to approach the patient medication record of these patients, optimise prescribing and remove expired items from the patient medication record.” GP Dr Grace Kenny, from Dundalk who also took part, said, “From my point of view, project pharmacist Leon’s work and input are invaluable. His approach is patient-centred, encouraging, and empathetic. I have had only positive feedback from the patients, who are willing to either take, cut down, change, or cut out certain medication. “His suggestions of change are always backed by guidelines, which he presents in typed format, making the changes easy to understand and comply with. I know I now find myself much more aware of polypharmacy and non-compliance, and I am putting some of what Leon has suggested into practice so it's a win-win situation for both doctors and patients. And I would imagine that the cost-effectiveness of the project will be evident, very soon.”
Emma Jane Coyle, Senior iSIMPATHY pharmacist in Ballyshannon/ Bundoran, said, “Patient uptake and reported experience has been very positive so far. Patients are extremely satisfied with the level of attention and detail that is paid to their care, as are my colleagues within the practice. Addressing appropriate polypharmacy is heavily dependent on a multidisciplinary team approach. The role of the iSIMPATHY pharmacist is complementary to the care that GPs, nurses and community pharmacists already deliver in primary care. iSIMPATHY has given patients an opportunity to voice concerns relating to their medications and be involved in future planning to overcome issues. Appropriately pitched patient education has been a large part of the discussion with patients.” POLYPHARMACY TRAINING COURSE FOR HEALTHCARE PROFESSIONALS A new online Polypharmacy training course will be available this year.The aim of the course is to prepare healthcare professionals including doctors, nurses and pharmacists to undertake comprehensive person-centred medicines reviews. More information can be found at www.iSimpathy.eu. For further information contact the iSIMPATHY HSE Project Manager: Celine Croarkin Celine.croarkin@hse.ie
The iSimpathy project is delivered across the three programme geographical regions of Northern Ireland, Scotland and the Border region of Ireland. The implementing partners are the Scottish Government (Lead Partner), the Northern Health and Social Care Trust, and HSE CHO 1 and CHO 8. The HSE project is led by the Clinical Lead for the National Medication Safety Programme in the National Quality & Patient Safety Directorate and is overseen by a representative steering committee chaired by the Head of Primary Care Services in CHO8. The EU North-South Unit supports the project, including the EU financial management responsibilities for the HSE.
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ONE-STOP SHOP Urology clinic cuts treatment down from four visits to just one
Christine McBrearty
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herese Kelly, Advanced Nurse Practitioner (ANP), Sinéad McGarrigle and Christine McBrearty, both Candidate Advanced Nurse Practitioners (cANP) Urology, are putting the patient at the centre of their work to deliver Sláintecare reform in the Saolta Hospital Group. Working on the Sláintecare funded Urology Pathway – Proof of Concept project, Therese, Sinéad and Christine are leading ANP Urology clinics to assess treat and manage patients with Lower Urinary Tract (LUTS) symptoms. 95% of treatment required in urology can be carried out as day cases. In a programme designed with the National Clinical Programme for Surgery, Models of Care for Urology, led by Professor Eamonn Rogers, patients are referred by their GP through HealthLink. Referrals are triaged with the consultant urologist and referred on to the ANP LUTS clinic. The clinics are run through a See and Treat model, which is a one-stop shop for the patient and cuts treatment down from a potential four visits, to one visit to the ANP LUTS clinic. During the 16-month pilot period for this project, the team delivered 3,832 patient appointments. 95% of these patient appointments (3,632) were ANP-delivered while the remaining 5% (200) were delivered by the consultant. Overall, 53% of these patients were new patients, who were
Rachel Kenna
removed from the consultant’s outpatient waiting list, and 47% were review patients. Therese Kelly is a Registered Advanced Nurse Practitioner Urology, working in Galway University hospital and Portiuncula Hospital Galway. She has worked in the field for nearly 30 years having worked in units in Dublin and the UK. Therese says her vision working on this project is to ‘enhance access to urological nurses' service for patients, enhance patients’ understanding of their condition and enable patients to manage their condition’. “I wanted patients to feel comfortable talking about their urological condition. I wanted to make a difference and influence change in nursing,” she said. Therese is involved in research to provide an evidence base for her practice, and in professional development for herself and her colleagues. “We have a journal club where we discuss latest research articles and discuss potential research projects for the unit. I do regular audits, guideline development and am involved in the training of two cANP LUTS.” Therese says that Sláintecare funding has now made urology services more accessible to her patients. “Sláintecare has enabled me to enhance the service I can give patients, it has made me more accessible via satellite clinic, mobile and virtual/attend anywhere clinics. It has empowered me to try change. There is more development we can do in non-oncology urology, Rome wasn’t built in
Sinéad McGarrigle
a day, but the change we have enacted in last few years in urology is amazing and all to the benefit of the patients which is why we all do our job.” Sinéad Mc Garrigle, cANP Urology in Sligo University Hospital, graduated from St Angela’s College and is currently completing a Postgraduate Diploma in Nursing (Advanced Practice). “From my experience as a staff nurse working in a busy surgical ward and caring for urology patients, I became aware of the importance for the urology patient to have the appropriate information and education around their urological condition. I was therefore keen to progress into a role where I could provide patient centred care working directly with the patient,” said Sinéad. “For me Sláintecare is ensuring that our patients are receiving safe, high-quality care, at the right time, in the right place. Through the roll out of the lower urinary tract symptoms shared care initiative and nurse led service pathway from the Urology Model of care for Ireland, we are contributing to the goals of Sláintecare. This pathway is enabling us to significantly reduce patient waiting times for LUTS assessment.” Christine McBrearty, cANP Urology in Letterkenny University Hospital, worked as a staff nurse for 17 years, and is currently completing a Masters in Advanced Nursing Practice. “Letterkenny serves a rural, older population. Population projections across the Saolta hospital group predict that from
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2019-2024 there will be an 14.5% increase in 65-84 year olds and an 18.8% increase in people over the age of 85 years. Evidence shows that the prevalence of LUTS is higher in the elderly population, increasing the demand on urology services,” said Christine. “Sláintecare means providing safe, quality healthcare close to the patient’s home. One stop ANP clinics result in decreased waiting times, earlier access to care and hospital avoidance which result in increased patient satisfaction.” Rachel Kenna is the Chief Nursing Officer in the Department of Health. Rachel is a Registered Children’s and General Nurse (RCN/RGN) and has extensive clinical and managerial experience. She previously held the Director of Nursing post in Children’s Health Ireland at Crumlin. Rachel is using her position to highlight the work of Advanced Nurse Practitioners (ANPs) and Advanced Midwifery Practitioners (AMPs) across the system. “I joined the Department of Health in 2018
as a Deputy Chief Nursing Officer and, in 2020, was appointed as Chief Nursing Officer. It has been an honour to hold this role throughout the COVID-19 pandemic at a time when nurses and midwives the length and breadth of the country continually went above and beyond to deliver excellent, compassionate, and expert care to patients,” she said. “As nursing and midwifery evolve to continue to meet patient needs and service challenges, caring for patients at the centre of a network of integrated care is becoming ever more important.” A recent evaluation has provided evidence of the emerging impacts ANPs and AMPs are having on patient care, waiting times, patient outcomes and service integration, in line with Sláintecare objectives. “ANPs and AMPs are delivering personcentred care in integrated care settings across the country. They can provide a full episode of care for patients, including
New digital health initiative helps prevent future cardiac events
assessment, intervention, prescribe medication, ongoing monitoring, management and discharge of the patient. “Together, they are operating at the top of their licence to provide optimum patient care through integrated care pathways. “Therese, Sinéad and Christine’s work in the field of urology in the Saolta Hospital Group is a prime example of the full scope of the ANP role. It is very clear that the patient is at the centre of everything they do, and listening to the patient, listening to what they want is key to delivering Sláintecare reform.” The Final Evaluation Report on the Impact of Implementing the Draft Policy on Graduate, Specialist and Advanced Nursing Practice September 2020 can be found here: https://www.gov.ie/en/ publication/55c2c-final-evaluation-report-onthe-impact-of-implementing-the-draft-policyon-graduate-specialist-and-advanced-nursingpractice-september-2020/
Irene Gibson, PhD candidate and Director of Programmes and Innovation, National Institute for Prevention and Cardiovascular Health; Neil Johnson, Chief Executive, Croí; and Dr Lisa Hynes, Head of Health Programmes, Croí.
An innovative digital cardiovascular disease prevention and recovery programme developed by Croí, the Irish heart and stroke charity, has delivered significant health improvements for participants. The Croí MySláinte programme, funded by the Government of Ireland’s Sláintecare Integration Fund 2019, had to be delivered virtually due to restrictions on traditional healthcare delivery imposed as a result of the COVID-19 pandemic. Croí’s pivot to virtual delivery involved the creation of a newly-developed interactive platform, which enabled participants to access the programme from the comfort and safety of their home, including access to pre-recorded videos, resources and links to weekly live Zoom sessions. The core components of the programme included lifestyle modifications such as smoking cessation, healthy food choices and physical activity; medical risk factor management of blood pressure, cholesterol and glucose; and electronic prescribing of cardio-protective medication where appropriate. A total of 105 people, who had experienced a cardiac event such as a heart attack, opted to take part in the initiative. Participants were aged between 35 and 84 years, and were referred from cardiac centres across the west of Ireland, including Galway, Mayo, Sligo, Limerick and Donegal. Following a total of 423 virtual consultations over a period of 12 weeks, a range of health improvements resulted for those involved, including: • Physical activity levels increased almost six-fold • Blood pressure control improved from 24% to 68% • LDL cholesterol target achievement increased from 14% to 41% • Over half of participants (57%) lost more than 2% of their bodyweight, with almost a quarter (23%) losing 5% or more • Anxiety and depression levels among participants were reduced by more than half. The programme, which was overseen by a consultant cardiologist, was delivered by a specialist interdisciplinary health team comprised of a cardiovascular nurse prescriber, a physiotherapist and a dietitian.
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DEMENTIA ADVISERS NOW IN
every county
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Vital service for thousands of patients and their families
he expansion of the dementia adviser service ensures dementia advisers are in place across the country providing a vital service for thousands of people living with dementia and their family carers. A dementia adviser is a point of contact for people who are concerned about their cognitive health or who have a diagnosis of dementia. Dementia advisers enable people to take control of their own lives by providing support, practical assistance, advice and information, and signposting people with dementia and their carers to appropriate services and supports. Funding was secured in this year’s budget for 11 new dementia advisers, bringing the total number of advisers to 29 nationally. Janette Dwyer, Assistant National Director, HSE Services for Older Person’s and Dementia Care, Change and Innovation, said, “The HSE is committed to the delivery and enhancement of Dementia Services and the National Dementia Advisory Services. A key part of our success to date has been the ongoing collaboration with the Alzheimer Society of Ireland and other important stakeholders across the country. This has ensured the development and promotion of an emerging care pathway for people living with dementia.
“The dementia adviser undertakes a key role in providing locally based individualised information and support to people diagnosed with dementia and their carers/supporters, at all stages of their journey, from diagnosis through to end-of-life care. The services provide a first point of contact to people in respect of available local services with referral from a diagnosing clinician.” The Alzheimer Society of Ireland CEO Pat McLoughlin said, “Dementia advisers offer a lifeline to people in their communities. It’s great to reach the point where everyone in Ireland who wants or needs access to this key community service can do so – no matter what part of the country they live. Each and every day, the dementia adviser team demonstrate the value and impact of the service and the evaluation of the service has provided a strong evidence base for its expansion.” An event announcing the expansion of the service featured contributions from Dementia Adviser Vanessa Bradbury in conversation with dementia advocate Kathleen Quinlan from the Irish Dementia Working Group; Regina Lafferty, Advanced Nurse Practitioner, Mental Health Services; and Dementia Advisers Joanne Brennan and Maeve Montgomery, Amy Murphy and Sean Donal O’Shea. The HSE continues to partner with the Alzheimer Society of Ireland to deliver this vital service across 25 counties and with Western Alzheimers who deliver a DA service in Mayo. The National Dementia Office is working with the Alzheimer Society of Ireland to support and enhance further integration of the Dementia Adviser Service within existing HSE and Community, providing a seamless pathway of care. The 25 posts have been recruited by Alzheimer Society of Ireland funded through a Service Level Agreement with the HSE. A joint HSE and Alzheimer Society of Ireland Oversight Governance Group has been established. Videos from the launch are available on www.dementiapathways.ie
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HEALTHCARE STAFF IN THE NORTH EAST GET UNIQUE INSIGHT INTO LIFE WITH DEMENTIA WITH VIRTUAL TRAINING A specially constructed sensory bus travelled across the North East region to give healthcare staff an insight into life as a person with dementia recently. 215 staff from older persons, intellectual disability, acute hospital, mental health and community services had the opportunity to participate in this virtual sensory training, organised by the Centre for Nurse and Midwifery Education (CNME) HSE Dublin North East to promote better awareness and understanding of dementia. The virtual dementia training provided staff with an opportunity to experience life through the eyes of a person who has dementia. This experience facilitated staff to then reflect on how they could improve their care of the person with dementia. This two-hour training session provided an opportunity for the participant to navigate a room as a person with dementia would experience. An information session followed the virtual component of the training, which explained and explored the sensory experience. Cathy Tobin, Nurse Tutor in the CNME HSE DNE (pictured below with UK training facilitator Sue Baker), was also present to discuss with the participants how the learning from this experience could be used to create meaningful changes to care practices when caring for people with dementia. A company in the UK provides this virtual dementia sensory training. A sensory room is created on a bus, controlled by a trained facilitator, and each participant is provided with equipment to wear prior to entering the room to enhance the virtual experience. The CNME HSE DNE hired its services for six days in December 2021. This training facilitated the participant to become aware of the difficulties faced by people living with dementia including their challenges in negotiating the environment, their sense of helplessness, issues with colour signage, lighting and sound. The CNME DNE HSE provides education for all services across Louth, Meath, Cavan and Monaghan, including a 2.5 day National Dementia Programme. This incorporates a quality initiative project which promotes the implementation of a change project which the learners undertake in the in their healthcare care setting. Information on this dementia training programme or any other dementia training within DNE can be obtained through contacting Catherine.tobin@hse.ie
SPORTING MEMORIES A new reminiscing programme for people with dementia An initiative of The Alzheimer’s Society Kevin Quaid, chair of the Irish of Ireland, Sporting Memories groups are Dementia Working Group, at intended to provide a forum for people the first Sporting Memories with dementia, families and friends to event with soccer club reminisce and talk about bygone sporting Shelbourne Rovers FC. days as well as encourage participation in physical activity. A new Sporting Memories Handbook has been developed to support local sports organisations in setting up Sporting Memories groups. The programme is supported by the HSE’s Dementia: Understand Together campaign. The handbook is part of the wider rollout of the Sporting Memories programme in communities across Ireland. The initiative hopes to inspire and encourage local sporting clubs and organisations to organise regular Sporting Memories groups within their localities. The groups bring people together to reminisce about their lives through the medium of sport, using images, video footage, memorabilia, quizzes, and guest talks to spark memories and encourage social engagement. By using sporting cues, the purpose is to stimulate memory, improve communication and social skills, as well as create a sense of camaraderie and belonging. The ultimate objective of the programme is to tackle isolation, depression, and loneliness through safe, friendly sessions, led by people with a passion for sport and a desire to help people stay engaged in their communities. The booklet is a ‘how-to’ guide for the development of Sporting Memories groups, and includes information on dementia, how to set up groups and organise different activities, as well as offering communication tips, ways to create a supportive environment, and details of how to access group resources. Physical activity is also a key part of the programme with light exercises built into each session. “The Dementia: Understand Together campaign is all about encouraging people to see the person with dementia for who they are and how, with the appropriate supports, they can live active and fulfilling lives. Human beings are social creatures, and this is no different for people with dementia. They just sometimes need that little bit of extra support to be involved,” said Fiona Foley, National Coordinator, Dementia: Understand Together. “The Sporting Memories programme is a wonderful example of this objective in action. It helps to build social connection by bringing families, friends, neighbours and supporters together. It provides people with an opportunity to keep their brains engaged by revisiting memories of yesteryear. And it offers people the chance to undertake some physical activity too in keeping active. I would really urge sporting clubs across the country to consider signing up for the programme. It will be a genuine demonstration of their commitment to being a club for the entire community and to ensuring that no one gets left behind.”
FOR MORE INFORMATION on the HSE’s Dementia: Understand Together campaign, the Sporting Memories programme, or to access the handbook, visit www.alzheimer.ie or www.understandtogether.ie. For support or advice, people can also contact The Alzheimer Society of Ireland on Freefone 1800 341 341 (Monday to Friday 10am to 5pm, Saturday 10am to 4pm).
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KEEPING TRACK OF THE COVID-19 VACCINE The shared learnings from the collaboration between the HSE National Immunisation Office, HSE Procurement and GS1 Ireland
John Swords
Dr Lucy Jessop
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he COVID-19 vaccination programme in Ireland has been one of the most successful in the world. As well as the huge number of staff involved in the administration of the vaccines, success was also assisted by working hard behind the scenes to ensure that the vaccine programme was delivered in a safe, effective and efficient way. Early in the programme, the HSE recognised the importance of electronically tracking the vaccine to the point of vaccination. Over the past 10 years the HSE has collaborated with GS1 Ireland on several national traceability initiatives. This article describes how the HSE and GS1 Ireland worked together to design in traceability standards for the tracking of the COVID-19 vaccine. “Traceability is a key part of managing the vaccine process. The use of barcodes has been very beneficial, and it is evident that while it has saved time and resources, more
importantly it is giving time back to clinicians while providing accurate information for decisions. Patient safety is key and TrackVax has been a real enabler in this case,” said John Swords, National Director of Procurement, HSE.” It was important for the National Immunisation Office (NIO) that no dose was wasted and that batches of vaccine could be tracked to the point of vaccination. Following an intensive design phase with the HSE project team, two software applications were developed: ScanVax and TrackVax. ScanVax allows the receipt of vaccines to the national vaccine administration system. TrackVax allows the CVC teams to identify, label, track, and report on the vaccines in their centres, allowing a much easier vaccine reconciliation process locally and nationally. Prior to the introduction of TrackVax, the discard time was handwritten on the vials, a time-consuming process that also posed a medication safety risk. The excellent data quality from TrackVax provides the NIO
with oversight of vaccine usage, logs accurate stock level data in CVC’s and keeps waste to a minimum. The software has enabled the tracking and management of nearly 50 per cent of the doses administered in the programme to date and provides daily stock reports to assist the HSE planning team. “The feedback on TrackVax from the Senior Management Teams and the High Level Taskforce has been really positive in terms of enabling visibility of vaccine usage and it has been recognised that TrackVax has made a significant contribution to the efficient rollout of the COVID-19 vaccinations across Ireland,” said Dr Lucy Jessop, Director of Public Health, HSE National Immunisation Office. The next step is to provide ongoing traceability support for the rollout of the COVID-19 vaccine in Ireland and, in time, for other vaccines. Read the case study and watch the video to learn more https://bit.ly/3r119Lm
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TALLAGHT HOSPITAL AT FOREFRONT OF GROUND-BREAKING COVID RESEARCH Ground-breaking research by Tallaght University Hospital supports continued booster shots for nursing homes residents.
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his unique NH-COVAIR study is the first of its kind in the world to examine what level of long-term protection the COVID-19 vaccine allows residents of nursing homes. A team of top level medical researchers looked at how effective it was in triggering the production of antibodies to fight off the virus. Older patients in full-time care homes are still the group in society most at risk from COVID-19. Blood tests were taken from 86 people living at five different nursing homes close to Tallaght hospital. The initial sample was taken just before residents had their first dose of the Pfizer vaccine. The study’s key finding was that participants demonstrated a very protective antibody response to vaccination at five weeks, however there was a significant decline in this response by six months. This was the case across the board (whether or not the person had previously been infected by COVID-19) and led the authors to conclude that nursing home residents should continue to receive booster shots. The study also discovered that older and frailer nursing home residents reported lower levels of antibody production and that even if a patient had previously caught COVID-19, there were still massive benefits to them taking the vaccine as it ignited fresh antibody production. The research, involving immunologists, geriatricians and nurses from Tallaght University Hospital (TUH), Trinity College Dublin and several translational research laboratories including Trinity Translational Medicine Institute (TTMI) and Trinity Biomedical Sciences Institute (TBSI). It has just been published in the Journal of the American Medical Directors Association (JAMDA). Dr Adam Dyer, who was centrally involved in the new research, said, “In our study there were no serious adverse events [reactions] to the vaccine. If there were side effects they were minor, a fever which passed within a day and soreness around the injection site. We found that among the nursing home residents that we tested, the vaccine was well tolerated. It is incredibly safe.” He said the big question now is what level of antibodies prevents you needing further vaccination. “There is already growing evidence in nursing homes of breakthrough COVID-19 infections due to low antibody levels, as the impact of the vaccine wanes, hence the need for the booster shot.” In fact, Dr Dyer believes older people living in care homes may need a third and perhaps a fourth booster shot and in time to come it might be necessary to produce a more personalised vaccine plan for those in this vulnerable group based on their antibody levels.
Dr Adam Dyer and Prof Sean Kennelly
“A lot of the literature says vaccines are not as effective in older people but our research has found this not to be the case, when it comes to the COVID-19 vaccine,” he said. There were found to be huge variations in how nursing home residents reacted to COVID-19. In the first wave of the pandemic 40% of patients in nursing homes who got the virus died. The remaining 60% didn't and doctors are still trying to understand why it proved so fatal for some and such a mild infection for others. As medics struggle to understand this difference, new areas of research will include a person’s inflammation reaction, diet, genetics and medical comorbidities. Dr Dyer said further research is needed to discover why some people produce better antibody reactions and hence have better COVID-19 protection than others. “Even within older adults with the same level of frailty there are huge variations in terms of how strong their antibody reaction is and how long it lasts,” he said. The lead author of the NH-COVAIR study was Dr Dyer, a Specialist Registrar in Geriatric Medicine and Irish clinical academic training fellow in Trinity’s School of Medicine. The study Principal Investigators were Professor Sean Kennelly, Consultant Geriatrician, TUH and Clinical Associate Professor at Trinity; and Dr Nollaig Bourke, Ussher Assistant Professor in Trinity’s School of Medicine.
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SUPPORT AND UNDERSTANDING FOR PEOPLE GOING THROUGH LOSS AND GRIEF
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e all experience bereavement, loss and grief at some stage of our lives, but the last two years has meant our familiar rituals at times of bereavement have been disrupted or even lost altogether. A HSE and Irish Hospice Foundation working group has collaborated on a new campaign to share stories and provide supports to people experiencing grief at this time. Dr Helen Coughlan, Irish Hospice Foundation, and Lived Experience Representative on the Bereavement Working Group, has taken the time to share how this period affected people’s grief: “Whether before or during the pandemic, everyone who has been bereaved holds a story, an experience and a grief that is uniquely theirs. All of us remember how our loved ones died. We turn to rituals to say goodbye and try to find a way to be in the world without them. The pandemic changed everything for so many people, like me, who had loved ones die over the past two years. Though our experiences are our own, there are threads of loss and pain that are woven through them all. “Some of us carry pain from times during the pandemic when services were restricted and those we loved suffered as they died or died alone. Most of us are in families where we didn’t see the person we loved for days or weeks before they died. Some had to draw straws to see if they could be one of the ten at the funeral. Many were deprived of the comfort of human touch. Though so many of us also experienced compassion and kindness from our communities, we are left with the legacy of all that we missed out on in our grief. We continue to live with the knowledge that our experiences and those of our loved ones cannot be changed. That we cannot reclaim the moments lost, when we were separated from the person we loved in their dying; when we needed to be held but were completely alone; or when we yearned to be with friends in our grief. “We may look like we’re doing ok, but so many of us continue to hold so much pain, trauma and grief, often silently. We hope for compassion from others. For people to say the names of those we love who died. For people to remember what we went through. To know that grief is something we all continue to hold, however long ago those we love died. And, to know that there are people and places we can turn to for support if we need it.”
New facility provides bereaved families a ‘sanctuary of care and privacy’
Dr Philip Dodd, Consultant Psychiatrist and Clinical Professor, is also a member of our Bereavement Working Group. “Healthcare workers have been particularly impacted during the pandemic. They have had to handle their own losses and grief, while at the same time tending to the needs of patients and colleagues during such a difficult period for our health services,” he said. “Healthcare workers may have been exposed to a lot more death during the pandemic than before and may have had to be with dying patients when their families could not. It is important to acknowledge this significant challenge, be gentle on yourself and recognise the impact this may have on you, and that you may be grieving.” In recent times, healthcare workers have called the National Bereavement Support Line, which is provided by Irish Hospice Foundation in collaboration with the HSE. On the death of their own parent, one healthcare caller recalled how, while they were “used to” dealing with grief in the workplace, “it's very different when it's personal to yourself and your own family”. This reminds us of the challenges we have faced in balancing personal grief needs, with those in our work roles and that, ultimately, each person’s grief is their own and how they experience it differs. There is no right or wrong way to grieve. The HSE Employee Assistance Programme (EAP) has also noted an increase in people seeking support or information related to bereavement. The EAP continues to provide counselling and support to all HSE staff throughout the country and is available to people who are experiencing personal or professional challenges related to their loss or grief. To learn more about how grief affects you and your colleagues, or how you can support someone else: • Go to www.hse.ie/grief for advice, guidance and support services • Call the National Bereavement Support Line on 1800 80 70 77 (from 9am to 1pm Monday to Friday). For more information visit www.hospicefoundation.ie • Contact the HSE EAP Employee Assistance Programme (EAP). To access EAP support visit https://healthservice.hse.ie/staff/benefitsservices/benefits/counselling.html or call the National EAP phone line on 0818 327 327 to speak to someone who can help.
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Data privacy is everyone’s responsibility HSE Data Protection Office highlights top tips to protect personal data as part of International Data Protection Day
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ata protection is the safeguarding of the privacy rights of individuals in relation to the processing of personal data. It is also about protecting the privacy of our patients and service users is a HSE priority. We have to lawfully and fairly process personal data about service users, employees, suppliers and other individuals. International Data Protection Day took place on January 28th and to mark this day the HSE Data Protection team reminded staff that data privacy is everyone’s responsibility and shared these key tips.
PASSWORDS • Never share your password with anyone • Change your password if you think it may be known • Never write down your password on or near your device(s) The HSE has a strict Password Standard Policy which is available on hse.ie
DATABASES/SYSTEMS • Databases can’t be shared throughout the organisation or with third parties without a lawful basis • Access should be confined to staff who need the database to complete their duties • Any third party/data processors who access or require access to a HSE database for a legitimate reason, must sign the appropriate HSE data processing agreement in compliance with Article 28 General Data Protection Regulation (GDPR) • Personal identifiable information, stored on a database, should have a defined purpose, clearly set out in a procedure and the appropriate technical and security measures attached to them • Always Check - is the data: 1. Being used for the purpose of which it was originally collected? 2. Being held in the agreed location, not being moved/copied without appropriate permission?
The Data Protection team has created a series of short, information videos offering practical advice on good practices around data protection and information management. You will find these video tips for staff on good data protection practice including email safety, preventing paper records breaches and safe remote working on the data protection staff section of healthservice.ie/staff. They cover a wide range of scenarios including how to reduce your risk of having a data breach when you are handling paper records, using email and working from home. The information videos show how to avoid simple mistakes that can be the cause of a data breach and will help you to reduce your risk of a data breach when processing personal data. If you suspect a data breach has taken place or are ever in doubt Stop, Think and Ask for Help from your line manager and from your local data protection officer.
SIGN UP FOR THE GDPR COURSE ON HSELAND To date, over 110,000 HSeLanD users have accessed and completed the Fundamentals of GDPR eLearning programme on HSeLanD. It is designed for all staff. To access and complete the programme, you can search for ‘GDPR’ on the HSeLanD dashboard or access it through the HR catalogue. The HSE Data Protection team are encouraging HSeLanD users to complete the Fundamentals of GDPR eLearning programme on HSeLanD. If you have already completed the programme, you can revisit it to refresh your knowledge and skills to help improve the way you process data and keep it secure. In this programme you will: • become aware of your responsibilities as a HSE staff member under GDPR • learn how to recognise and respond to an incident when personal data is not processed • correctly know how to direct a service user to get a copy of their personal data when requested It takes about 35 minutes to complete and includes a short assessment. It also includes ‘extend my learning’ pieces for those who wish to undertake further learning or who want practical activities to help transfer the learning into their local area of work. Information videos are available at https://healthservice.hse.ie/ staff/news/general/reduce-the-risk-of-a-data-breach.html
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HSE CYBER SECURITY AWARENESS The HSE has commenced the rollout of a Cyber Security Awareness programme
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eing cyber aware when working online is everyone’s responsibility, and it’s the first line of defence against potential cyber attacks. The Cyber Security Awareness programme aims to provide staff with the knowledge and skills they need to keep themselves, HSE systems and data safe and secure. A collective effort between the eHealth & Disruptive Technology Division, HSE Communications and external partners, led to the development of the cyber security awareness programme which is relevant to all staff, and built around the following elements: • Education and awareness programmes; • Simulated Phishing campaigns; • Online training; • Policy awareness. It will be rolled out throughout 2022 in a phased manner. 90% of cyber attacks stem from human error. Whilst the HSE has many technical controls and continuous security monitoring, it is so important that we as a community increase our knowledge around cyber hygiene, and that our cyber security awareness is peoplefocussed. The Cyber Security Awareness programme will begin with a number of simulated Phishing exercises, supported by information sharing
on best practices and how to recognise a Phishing email. Phishing emails can be very sophisticated and hard to identify. Here are some of the key warning signs to look out for when you receive an email: • The email address does not look genuine • The email is poorly written • It contains a suspicious attachment or link • The message is designed to make you panic • The email asks you to confirm personal information You should always make note these warning signs, and be particularly vigilant when working with emails. If you are unsure about anything, you should contact the sender if you know them or inform the ICT helpdesk. It is also important for staff to be familiar with ICT Security Polices and Practices. These are available on the HSE website. During the second phase of our programme we will bring you further information on these. For more information on the programme you may contact Peter Connolly or Chris Meehan at peter.connolly@hse.ie or chris.meehan@hse.ie
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Online health appointments using video Many benefits to virtual consultations for patients
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nnovative clinicians and business leads have enabled online health appointments using video to benefit patients. Blended care allows you to meet your healthcare professional in person sometimes, and online other times. To assist with this there is now a central location on the HSE website for service users to access clear information for online health appointments using video. If you are offered a video appointment or would like to assist a family member or friend go to hse.ie: • About online health appointments • Preparing for your online health appointment • Help with your online health appointment
Healthcare professionals offering appointments can direct their patients/service user to helpful information. Improving patient experience, patient empowerment and supporting patients is a key cornerstone of the HSE delivery of quality patient-centric care. This content has been developed collaboratively to enable clinicians nationally to adopt video for some health appointments in a blended care approach. We were able to get user testing feedback on this content from patient groups. This helped us to meet user needs and to ensure it is a valuable, accessible, up-to-date resource. Please let us know if you would like to see more information or have any suggestions for these pages via the your service your say or email virtualhealth@hse.ie Benefits of online health appointments • Less time consuming - you do not need to travel to your appointment • Cheaper - you do not need to pay for transport or parking • Easier to organise - you do not need to get time off work or a childminder • Improve accessibility from remote locations and for specialist care • Helpful for the environment due to fewer car journeys leading to reduced emissions FOR MORE INFORMATION about preparing for your online health appointment using video and help with your online appointment go to hse.ie
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PORTLAOISE ROLLS OUT RESPIRASENSE INITIATIVE Following on from the launch of the Irish National Early Warning Score (INEWS) V2 in September 2021 to support early recognition of the deteriorating patient the Midland Regional Hospital Portlaoise introduced Automated Respiratory Rate Monitoring (ARRM) with the Respirasense software and quality improvement initiative. Respiratory rate (RR) is a highly useful measure in monitoring respiratory health and is predictive of mortality in pneumonia and cardiopulmonary arrest. Despite strong evidence that abnormalities in respiratory rate are an early predictor of preventable patient deterioration, it remains the most inaccurately measured and recorded vital sign. The RespiraSense patient device is made up of a lobe and sensor. Digital readings from the device when attached to a patient are then fed into an iPad docked at the nursing station on each designated ward. The Midland Regional Hospital Portlaoise introduced Respirasense, supported by Director of Nursing Sandra McCarthy, Clinical Director Dr John Connaughton, and the hospital senior management team following engagement at national level with the HSE implementation team. The formation of a local implementation group was tasked with the roll out of this new nursing service quality improvement initiative. Discussion with Stakeholders for IT requirements locally began and commencement of on-site education at ward level July 2021. The required IT supports for connectivity were installed in September 2021. Engagement with IT and patient services management was central to the smooth installation. Information sessions for consultant physicians and Director of Nursing Sandra McCarthy prior to launch, as well ongoing engagement with Clinical Nurse Managers and staff on the designated wards were important to maintain momentum and bed in the use of the AARM into practice. To date, 12 lobe devices are available for use on the pilot wards Emo Court Ward and Dunamaise Ward. Ongoing training opportunities are encouraged and offered by PMD Solutions. Staff at the hospital are delighted with the Respirasense device which has supported the early recognition and escalation of deteriorating patients and supported the implementation of the Irish National Early Warning System (INEWS V2) at the hospital. Preetha Thomas, CNM2; Melissa Dunne, ADON; Sandra McCarthy, Director of Nursing; Patricia Clancy, CNSp Respiratory; Geraldine Britton, CNM2; AnneMarie O’Shea RANP Adult Respiratory; and Dr John Connaughton, Clinical Director.
Dre Jason Carty, ED Consultant & Chief Clinical Information Centre, with Jiby Joy, CNM in the TUH Emergency Department.
INNOVATION AT TALLAGHT New electronic patient record a great example of innovative approach at TUH
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nnovation week at Tallaght University Hospital got off to a strong start with the introduction of an Electronic Patient Record called Synergy. Synergy will replace some of the hospital’s legacy endof- life ICT systems and existing paper-based records and processes, enabling staff to access a single, reliable and integrated source of clinical information containing relevant patient details such as test results, medications, discharge summaries and other information associated with patients care. Synergy is yet another example of the hospital’s overall innovative approach to supporting the delivery of healthcare with digital technologies, known within TUH as Digital Enabled Care, a core pillar of the hospital’s Corporate Strategy. This is the most significant change the hospital has introduced in its 23-year history and has been years in planning. The hospital has a number of legacy ICT systems requiring replacement and identified a number of information gaps. The hospital decided against a major ‘rip and replace’ with a single solution and opted to implement an interfaced EPR, utilising some of the existing ICT systems in place, continuing to implement speciality specific best of breed systems e.g. ICE Order Communications Results Reporting, ICNet Infection Control, Opera Centricity (Theatre) and interfacing them through an single EPR platform, to create a single view of the patient record Synergy. This marks the completion of phase I of its EPR programme. The hospital has ambitious plans to further enhance Synergy with planning already started for phases II and III. Once TUH’s Synergy rollout is complete, there is potential for the Synergy to be accessible within the community, GPs and other services such as the onsite HSE Mental Health service enabling system-wide transformation and the delivery of truly integrated care. Chief Clinical Information Officer Dr Jason Carty commented on the positive changes Synergy will have for TUH. “Synergy offers TUH a major opportunity to transform the way we provide and deliver care to our patients. An additional benefit is that it will streamline workflows and processes which support care delivery and facilitate service user communication and information sharing between staff anytime anywhere and in time on any device,” he said. Fran Thompson, HSE Chief Information Officer, said, “This investment in TUH will have positive implications for health outcomes, patient experience and health system sustainability for all the patients of the hospital and surrounding area.”
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THE MEETING OF
TWO WORLDS As digital health leaders, the CxIO team bring insights of clinical work to the IT team
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ver the past 30 years, information technology has transformed many industries, resulting in better products, better services, and greater efficiencies. Unfortunately, compared to many other sectors, healthcare has lagged behind in the pace at which it has adopted digital technologies to realise the same benefits. Moreover, despite Ireland being an internationally recognised technology hub, and housing many of the global leaders in internet technologies such as Google and Microsoft here in our capital, in the sphere of healthcare Ireland has trailed behind in its ability to embrace digital technologies, clinging to paper and pen and traditional ways of working far longer than many other countries. Today, however, the tide is changing. There is greater recognition of how technology is an integral part of the running of all services in healthcare, and how using data and digital technologies can advance comprehension of human health and disease, and improve delivery of care. We are also learning how our failure to adopt and invest in technology in our health service is costing us daily, both financially and in the quality of care we deliver.
The challenge to embracing information technology (IT) in healthcare requires the meeting of two very distinct worlds, often with limited insight into each other. On one hand is the world of doctors, nurses, and health and social care professionals, trained to consider the patient in front of them, and requiring an understanding of soft skills and human emotion. On the other is the world of IT – one built on numbers, code, and binary questions. According to an OECD report, the limited understanding of the other’s world is often the reason that new IT innovations in healthcare fail, such as when healthcare professionals lack the skills and knowledge necessary to use digital tools; or when work processes in healthcare do not allow digital technology to add value; or when healthcare workers have not been involved in the design of the digital tool, rendering the tool unfit for purpose. From the need for clinical care and IT systems to meet, the area of Clinical Informatics was born. Clinical Informatics, also referred to as Health Informatics, is the interdisciplinary study of data, information and computing technology, and communication with respect to human health conditions. This includes understanding, developing, integrating, and applying IT innovations to advance comprehension of human
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The CxIO team: Emer O’Shea, Emma Cooney, Markus Hesseling and Moninne Howlett.
"From the need for clinical care and IT systems to meet, the area of Clinical Informatics was born" health and the delivery of health and social care. However, if Clinical Informatics was meant to be the bridge that linked healthcare and IT, as a term it serves to only further alienate one from the other. Thus the more human-centric term “digital health” was developed, defined as the use of information and communications technologies in medicine and other health professions to manage illnesses and health risks and promote wellness. While fundamentally similar in meaning to Clinical Informatics, the term “digital health” is more accessible to the wider healthcare workforce. Digital health articulates that healthcare remains at the centre, while bringing it into the digital age. The CxIO Team
With the move to the new Children’s Hospital, Children’s Health Ireland (CHI) is embarking on a journey to become one of the world’s leading digital paediatric hospitals. To lead this journey, a Digital Health Department is being formed, within which is situated the CxIO team, comprising clinical information officers from different disciplines: a chief medical information officer (CMIO), a chief nursing information officer (CNIO), a chief health and social care professionals information officer (CHIO), and a chief pharmacy information officer (CPIO). These clinical information officers work alongside technical IT staff, serving as clinical representatives. As such, the CxIO team members are digital health leaders for clinical staff, bringing insights of clinical work to the IT team. They have first-hand experience of the reality of delivering clinical care, and through this they bring a focus and an understanding of the end-user needs. They understand the challenges of working clinically, and know what matters to staff and patients alike. Importantly, they are also seen as allies for clinical colleagues, and can help with engagement along the digital health journey.
" They have first-hand experience of the reality of delivering clinical care, and through this they bring a focus and an understanding of the end-user needs"
The journey ahead
The CHI CxIO team is tasked with driving forward new digital technologies and ways of working to benefit clinical teams and patients. As part of this, the priority areas for the CxIO team include: • The design and implementation of the clinical systems for the new hospital • Engaging with children, young people, carers, and staff to understand their wants and needs • Promoting and establishing digital research and innovation in CHI • Building digital skills and capabilities in the workforce As a new team, working in the developing area of digital health, the exact path that lies ahead is uncertain. The journey will no doubt be challenging, but it will certainly be an exciting venture. The digital hospital is just the beginning from which true digital innovation and transformation can grow, and the CxIO team intends to position themselves at the forefront of this journey. Meantime, as the route is being determined, the vision of the CxIO remains clear and simple: to use digital technologies and digital ways of working to improve health, experience, and access for children, young people, and their carers. Ultimately, this is what digital health means: using technology for better outcomes and experiences for the patients we care for.
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SPARK IGNITE Competition supports frontline innovation
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ollowing the phenomenal success of last year’s competition, the Spark Innovation Programme is delighted to announce the launch of the HSE Spark Ignite 2022 innovation competition, which opened in February 2022. The Spark Ignite initiative is funded by the HSE’s Spark Innovation Programme, a collaboration between the Office of the Nursing and Midwifery Services Director (ONMSD), National Doctor Training and Planning (NDTP), the National Health and Social Care Professionals Office (HSCP) and the National Quality and Patient Safety Directorate (NQPSD) to support frontline innovation and quality improvement across the HSE. Do you have a solution that will have a real impact on the patient and/or the healthcare system? HSE SPARK IGNITE WOULD LIKE TO HEAR FROM YOU. APPLICATIONS WILL BE ASSESSED ON THE FOLLOWING FOUR AREAS:
• What is the problem you wish to address? • What are the current solutions? • Who does the problem affect – patients, carers, clinical teams, administration, managers? • What is your solution? HSE Spark Ignite 2022 is the only staff-facing, bottom up, innovation competition available to the 115,000+ HSE employees. Its mission is to enable HSE staff to validate unmet needs in healthcare, determine if a market exists for their proposed solution, product, service, or process improvement to meet that need, and to support the further development of those ideas. HSE Spark Ignite is open to all disciplines and departments nationally within the HSE. Its mission is to enable HSE staff to bring their ideas for improvements towards reality. A national remit allows more opportunities for people to test their ideas and vie for funding. Applications are simple and straightforward submitted via our online portal. Successful applicants will benefit from a bespoke healthcare focused innovation workshop delivered by experts to hone their idea and proceed to pitch for €3000. For further information on the competition and how to apply, go to www.hse.ie/spark
Aoife Collins, the best individual overall winner for 2021, a senior physiotherapist and co-ordinator of Active Back Care Program.
LAST YEAR’S WINNING PROJECTS The best individual overall winner was Aoife Collins, a senior physiotherapist and co-ordinator of Active Back Care Program in the Physiotherapy Department, Cork South Lee PCC, HSE. Aoife won for her ‘Rapid Access Online Active Back Care (ABC) Programme’. Aoife plans to adapt and deliver her existing award-winning, evidence-based, group-rehabilitation program online via a customisable platform, provided by Salaso Health Solutions. The team prize went to Dr Kevin Deasy, respiratory special registrar, and Dr Marcus Kennedy, consultant respiratory physician and interventional pulmonologist, with their ‘Remote Learning in Bronchoscopy using a Low-Fidelity Airway Simulator' at Cork University Hospital. They plan to develop a low cost flat-pack bronchoscopy and pleural ultrasound kit for home assembly and remote learning. Their ultimate goal is to develop a formal, well researched simulation program encompassing real world and distance learning through remote video platforms using this flat pack simulator.
"HSE Spark Ignite 2022 is the only staff-facing, bottom up, innovation competition available to the 115,000+ HSE employees. Its mission is to enable HSE staff to validate unmet needs in healthcare, determine if a market exists for their proposed solution, product, service, or process improvement to meet that need, and to support the further development of those ideas."
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CERVICAL CANCER PREVENTION WEEK
National Screening Service (NSS) raising awareness of value of CervicalCheck among key groups
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ervicalCheck marked Cervical Cancer Prevention Week in January with three communications initiatives aimed at increasing uptake in key groups and improving information resources for media on CervicalCheck. The team targeted uptake in women aged over 50 and in counties where women are a little less likely to come for screening when invited. Additionally, the NSS developed a set of media guidelines for journalists and commentators about CervicalCheck, which were sent to editors. A new HSE public attitudes survey carried out by Core Research in 2021 has reported on the barriers women of menopausal age face when considering taking up their screening invitation. These barriers included a fear of the process; finding screening more uncomfortable at and finding screening embarrassing. In addition, half of all women surveyed said a fear of finding something was wrong would deter them from attending screening, whilst 1 in 5 women said they were concerned about attending their screening appointment due to COVID-19. New screening data also has shown that attendance declines as women age – meaning women over 50 are less likely to have any changes picked up and treated if they are there. The National Screening Service programme has begun a targeted campaign to raise awareness amongst women over 50 that screening is still for them. And that screening at regular intervals is one of the best ways to reduce their risk of developing cervical cancer. Dr Sarah Fitzgibbon, Primary Care Clinical Advisor with CervicalCheck, said that women over 50 can benefit from regular cervical screening tests. “Once women have finished having periods they often feel, ‘Screening is not for me, I don’t have a period, why would I need a screening test?’ In fact, we do encourage women to continue attending screening up to the age of 65.” She said that if women aged in their 50s haven’t ever had a cervical screen done through CervicalCheck, the programme is “actively” encouraging them to take part: “We are letting women know that just because you haven’t had a test done before, and you’re 55 say, you absolutely can come in and have a test done.” As part of Cervical Cancer Prevention Week, CervicalCheck also targeted six counties with the lowest uptake of cervical screening. The programme’s national target coverage rate is 80%, and the latest available figures from CervicalCheck show the five-year coverage (ending March 31st 2020) was 78.5%. There was some variation within this with 20 counties exceeding 75%; however, six counties had coverage below 75%. These were: • Clare (74.5%) • Dublin (73.9%) • Kilkenny (69.7%) • Laois (69%) • Monaghan (74.3%) • Roscommon (74.5%)
NATIONAL SCREENING SERVICE CELEBRATES OUTREACH SUCCESSES From policy launches to online talks to camogie teams, NSS has enjoyed huge engagement with events online The first of our online events was in February last year when we organised two hour-long webinars Cervical Screening from Public Health to Clinical Outcomes. They gave 763 GPs and practice nurses to the opportunity to engage with the CervicalCheck management team. Soon after, we hosted the annual CervicalCheck Annual Colposcopy Meeting with Nursing and Medical Teams online for the first time. It attracted strong attendance level of 96 colposcopy professionals. Since that time we have followed-up with a series of online events, both in webinar and meeting formats, covering topics such as CervicalCheck Laboratory Services; the Assisted Decision Making Act; and hereditary bowel cancer syndromes. We also successfully reached out to communities using this format, delivering a well-received presentations explaining screening to the Camogie Association of Ireland; and at BIAS, a high-profile event focusing on the inequality in women's healthcare and research, supported by the Royal College of Surgeons of Ireland and the Rotunda Research Department. Soon, we will hold the annual colposcopy meeting again online, marking a full year of online events. We’re grateful to all our staff and stakeholders for embracing this new way and engaging with our events to make them so successful.
CervicalCheck Clinical Director, Dr Nóirín Russell, said, “Lower participation in screening increases a woman’s personal risk of developing cervical cancer and also reduces the screening programme’s impact on population health. It is very important to offer services that meet the needs of the people who are eligible, and that we address lower uptake where we find it. “We know that certain groups – such as those in poor social circumstances; those with disabilities; members of the Traveller community; and members of the LGBT+ community - can feel excluded from using health services for many different reasons. We also know that women aged over 50 are less likely to take up their offer of screening. Or it might be that women aren’t aware that they can choose screening at any registered sample taker, and not just their own GP.”
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SIGNIFICANT DECLINE IN TEEN PREGNANCIES OVER LAST 20 YEARS The rate of teenage pregnancies in Ireland has dropped significantly over the past 20 years, a new report from the Sexual Health and Crisis Pregnancy Programme (SHCPP), HSE Health and Wellbeing has revealed.
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nformation Summary on Teenage Pregnancy in Ireland 2000 – 2020’ (January 2022) highlights a decrease in the total fertility rate in European countries over the past four decades, with women older when they first give birth, and fewer births among teenagers. While teenage birth may not be negatively experienced by every person, women and people who experience teenage pregnancy may be more likely to experience impediments to continuing education and lower incomes later in life. • In 2000, there were 19.2 per 1,000 teenage births in Ireland. By 2020 this had decreased to 5.2 per 1,000 • There has been a 73% decrease in the number of births to teenager mothers from 2000-2020 • Most teenage births occur in people aged between 17 and 19 years of age. In 2020, births to mothers aged between 17 and 19 accounted for 93% of teenage births. WHY HAVE RATES DECLINED?
1. Increased educational attainment Greater educational attainment brings a higher chance of engaging in protective health behaviour. Many young people now complete post-primary education and more are entering third-level education. Of people entering first year of postprimary education in 2014, 91.5% stayed to complete their Leaving Certificate, compared to only 78.3% 10 years previously. 2. Improved access to ‘Relationships and Sexuality Education’ (RSE) Teenagers who receive RSE are more likely to use contraception when they first have sex. The SHCPP works with the Department of Education, HSE partners, professional bodies and nongovernmental organisations (NGOs) to develop education resources to support RSE delivery in schools. Consistency in
FURTHER INFORMATION ‘Information Summary on Teenage Pregnancy in Ireland 2000 – 2020’ (January 2022) is available to download at https:// www.sexualwellbeing.ie/for-professionals/ research/research-summaries/
RESOURCES The HSE SHCPP offers a series of booklets both in Irish and English for parents under the title, ‘Making the ‘Big Talk’ many small talks’. These booklets seek to normalise and support parent/child conversations about
delivery of high-quality RSE is important and its delivery in primary- and post-primary education is under review. 3. Availability and uptake of contraception There is growing availability of short and long-acting reversible contraceptives, complemented further by access to emergency contraception from pharmacists without prescription. In Ireland, 80% of sexually active 17-18 year olds reported using some form of contraception. The SHCPP leads several initiatives that promote access to information and which seek to increase availability of condoms. 4. Enhanced parent and child communication There has been increased focus on the importance of parental conversations about relationships and sexuality. Parents can play protective roles in the development of children’s sexual health and well-being. In an Irish study, 45% of young people reported having discussed sex and relationships with their parents by 13, and those who talked to their parents about sex by the time they were 13, were more likely to use contraception at ages 17-18. The SHCPP has published a range of parental resources. MAINTAINING PROGRESS
These positive trends in educational attainment, lifestyle choices, sexual health communication and access to and use of contraception are testament to young people living in Ireland today, as well as their parents, carers and educators. Improvements in policy and service provision are facilitated via strong partnerships between state agencies and NGOs. Work must continue to reduce health inequity, increase availability of educational and professional opportunities for young people, encourage and facilitate frank and open conversations about relationships and sexual health, and ensure youth-friendly clinical services and contraception are accessible if needed.
relationships, sexuality and growing up; encouraging on-going communication about these issues from very early childhood through to young adulthood. The books are available to download at https://www.sexualwellbeing.ie/ for-parents/resources/ Busy Bodies - a booklet in Irish and English for children on the topics of puberty and adolescence can be found here https://www. sexualwellbeing.ie/for-parents/resources/
For more information on sexual health and wellbeing, including guidance on how to start the conversation at home for parents and carers please visit https://www. sexualwellbeing.ie/for-parents/ The Healthy Sexuality and Relationship Development Toolkit to support staff working with children, young people and families can be found here https://www.sexualwellbeing.ie/ for-professionals/supports/resources/
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SEXUAL WELLBEING CAMPAIGN MAKES ITS RTE ‘FIRST DATES IRELAND’ DEBUT The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP), HSE Health and Wellbeing recently launched the latest part of its campaign promoting condom use. Twitter: @_respectprotect Facebook: @hserespectprotect Instagram: @hserespectprotect For more information on the campaign please contact Muireann Kirby, Campaign Manager for sexual health campaigns at muireann.kirby@hse.ie. For information about the work of the Sexual Health and Crisis Pregnancy Programme contact Anita Ghafoor-Butt, SHCPP Communications Manager at anita.butt@hse.ie
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he short ad, which appears every week during RTE’s ‘First Dates’ series, delivers a simple, educational message that using a condom correctly reduces the risk of sexually transmitted infections (STIs). The TV ad takes an upbeat approach to deliver clear information about sexual health. Younger adults are likely to be familiar with the voiceover artist, comedian Seán Burke. The new TV ads are the latest addition to the much broader ‘Because’ condom promotion campaign, which first launched in November 2019. The campaign, aimed at young adults aged 18-30, was developed as people in this age-group have an increased risk of acquiring STIs. In 2020, over 11,000 STIs were diagnosed in Ireland. The main objectives of the campaign are to: • build awareness about the risk of acquiring an STI • emphasise the role of condoms in minimising this risk • sign-post people to www.sexualwellbeing.ie for further information about sexual health and wellbeing Young adults have been at the heart of the communications approach since the campaign was first formulated in 2019. Focus groups with 18 – 30 year olds informed the campaign; the feedback showed that young people were looking for clear information and messaging about sexual health, with humour and an educational element to it. The 2021/2022 campaign continues this approach. The consistent tone and artwork, builds on the existing awareness of the campaign among the target audience. Based on a 2020 omnibus, 31% of 18 – 30 year olds recalled seeing or hearing advertising relating to the sexual health campaign and 44% of this group say they would more likely use a condom after seeing the ads. In November 2021, new creative and messages for this campaign were launched across multiple channels. Throughout 2022, the new digital creative will appear across various platforms including YouTube, Facebook, Instagram and Snapchat targeting the 18 – 30 year old audience. In December 2021, SHCPP launched a video element of the ‘Because’ campaign which will be promoted throughout 2022 on platforms such as Youtube, Sky on Demand, Twitch, Spotify Sessions and social media platforms.
‘Sex: Fact or Fiction?’ is a series of engaging videos aiming to debunk myths around sexual health. The new series was shot in UCD and UL campuses in November 2021, showing real students responding to statements relating to sexual health – revealing whether they think the statement is fact or fiction. The reaction is often a mixture of humour, curiosity or surprise. The videos are judgement free and reinforce the importance of condom use to reduce the risks of STIs. The videos provide accurate, accessible information which aim to challenge the myths surrounding sexual health. The videos align with the different poster messages, and encourage discussions on these topics, with a view to normalising broader discussions around sexual health and wellbeing. They will be placed across different platforms targeting the younger audience and across social media platforms. Overall, the campaign messages are positively-framed, with the aim of developing a positive attitude to sexual health and wellbeing in young people.
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NURSING HOME EXPERT PANEL - STRONGER CONNECTIONS IN LONG-TERM CARE A look at service improvements being designed and implemented by HSE teams, responding to the work of the 2020 Nursing Homes Expert Panel
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or those living in long-term care, and those who care for them and live alongside them day-to-day, and for their loved ones and families, COVID brought severe hardship, isolation and loss. The Expert Panel report gave everyone connected to long-term care – residents, families, healthcare teams, providers and advocates - a clear review and analysis of how Ireland’s long-term care system responded to COVID-19. As well as representing the experiences of those involved, the expert panel report also aimed to be future-focused, giving guidance on what can be improved in our services. This is so that we are better placed to respond to any future risk and to improve people’s day to day experience of long-term care. HSE teams all over the country are involved in implementing over 60 of the report’s recommendations. COVID-19 Teams (CRTs) actively support prevention, preparedness and management of outbreaks, in public, private or voluntary provider facilities. CRTs facilitate access for nursing homes to a range of HSE supports, including Public Health and Infection and Prevention Control advice and guidance, support and training, PPE and temporary staff accommodation. As acknowledged by the Expert Panel, these interventions played a central role in supporting the welfare of nursing home residents throughout the pandemic. While significant progress has been made with regard to the number and severity of COVID-19 outbreaks, supported by high vaccine uptake among residents and staff, there is a need for continued vigilance. The focus for the CRTs is increasingly to proactively engage with facilities, including those who have previously experienced significant outbreaks or where concerns have previously arisen. Work is also underway to establish Community Support Teams, who building
on the work of the CRTs, will support nursing home providers to self-manage prevention, preparedness planning and outbreak management in the event of further Covid-19 surges or other infectious outbreaks. Training and professional development is another area of focus, and funding has been secured to support gerontological nursing training, as well as engagement with our existing staff on training needs.
"While significant progress has been made with regard to the number and severity of COVID-19 outbreaks, supported by high vaccine uptake among residents and staff, there is a need for continued vigilance." Work is also well underway to strengthen the public health workforce, who support nursing homes as part of their work, and also in delivering enhanced multidisciplinary teams. Recruitment campaigns have progressed at pace to deliver 250 WTE additional permanent multidisciplinary resources, 210 of these posts have been accepted, and recruitment is now 83% complete. Structured and attractive career pathways have been developed for Health Protection Nurses and Public Health Surveillance and Epidemiology. The HSE has also progressed recruitment campaigns for the first 34 WTE Consultant in Public Health Medicine posts in Ireland. One of the significant challenges experienced during the COVID response was the lack of connected IT systems across this sector. This hampered services’ ability to share information with central teams, and increased pressure on staff on the ground, on facility management, and on central
co-ordinators, public health teams and more. The eHealth ICT Capital Plan includes provision to implement an IT platform within our Community Services, including in Older Persons Services. Responding to recommendations enhanced approaches to end-of-life care, at all times, but also in the context of a pandemic, the HSE and Irish Hospice Foundation are collaborating on a national programme on palliative, end-of-life, and bereavement care for the nursing home sector. Part of the HSE response has been to agree a community strategy for infection prevention and control. This sets out priority actions to 2023 for the establishment of community based teams to ensure Infection Prevention and Control and Antimicrobial Stewardship expertise is available in CHOs and Community Health Networks. The HPSC continues to offer ongoing guidance to support safe visiting with residents of Nursing Homes during COVID, which is continuously updated to reflect current public health advice, and to ensure that the personal needs, dignity and wellbeing of residents is at the heart of the guidance. COVID-19 is still very much with us, though we have turned an important corner by efficiently and swiftly vaccinating a large majority of our population. The work done to respond to COVID, to support and care for our residents and clients in unimaginably difficult circumstances, is hard to encompass, and each member of staff should feel extremely proud of their efforts. As we work through the Expert Panel recommendations and implement them as a service, we want to thank each member of our teams for all they do to improve the experience of each person and resident we have the privilege to care for. For updates and progress reports go to: https://www.gov.ie/en/publication/3af5acovid-19-nursing-homes-expert-panel-finalreport/
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UNDERSTANDING TRUST AND THE HSE Trust is a vital part of how we live our lives. We make trustbased decisions every day, and we give our trust when we believe that a person, an institution or even a process, is worthy of it.
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roviding health and care services that people can trust and have confidence in is part of the HSE’s core purpose. In the health service, if people feel they can trust us, they are more likely to seek our help at the right time. This includes reporting symptoms, following treatment plans and attending screenings. In February 2021, we started work to help us understand what trust means to the public, our staff and patients and service users. This involves a programme of research, consultation and action. We want to be able to measure public trust in the HSE on an ongoing basis and use the results to make service improvements. With this in mind, we took the following actions: • Commissioned a review of research on trust and healthcare internationally. We also analysed previous research conducted by the HSE • Undertook an online survey of 2,000 representative members of the public and held a series of workshops with staff • Gathered colleagues, patient reps, health leaders and subject matter experts to form a Trust Working Group. The Trust Working Group defined four leading drivers of trust and 25 behaviours and action statements to assess the HSE. RESEARCH FINDINGS We are broadly trusted as an institution, but many are uncertain one way or another. 39% said they had a high level of trust, 43% a medium level of trust, and 18% a low level of trust. The research found four leading drivers of trust in healthcare services and organisations: • Public good - we should put people first, treat everyone equally and provide good value for money • Respect – we should communicate better, listen more and be inclusive and responsive in our relationships • Integrity – we should be ethical, honest and more open; particularly in owning up to our mistakes • Competence – we should provide high-quality and safe patient care which is reliable and consistent and we should support our staff to fulfil this aim.
INSIGHTS FROM THE PUBLIC, STAFF AND PATIENT GROUPS The biggest drivers of trust for the HSE focus on public good. This includes HSE’s success in delivering on its core purpose of providing high-quality care for the people of Ireland. The greatest area of concern in this area is long waiting lists and access to care. Personal experience also has an impact on trust with negative or poor past experiences shared by those who have a low level of trust. The research highlighted the importance of respect of listening and involving people in a systematic way. Issues relating to integrity have a significant impact on whether people trust the HSE. There is a keen desire for transparency and a culture of openness in the HSE. The competence and commitment of frontline staff in providing a caring and effective service was seen to be an important generator of trust in the HSE. PROPOSED ACTIONS FOR 2022 Here are some examples of the actions we have already agreed to implement as part of this programme. •
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Earning trust through supporting Public Good Communicate with the media openly, building trust with the media and the public. Earning trust through Respect Improve visibility and leadership for patient and public involvement within the HSE. Earning trust through Integrity Evaluate and improve openness and disclosure policies. Earning trust through Competence Acknowledge and celebrate everyday successes. This will include the development of a new peer to peer staff recognition programme.
The work we’ve done and the evidence we’ve gathered suggests that to improve levels of trust, the public must have confidence that the HSE will stay true to its values, can fulfil its vision and that all objectives, values and actions are pointed towards the common good. We know that this work will be challenging and will take time and we’ve started to take action on our programme of work already. We look forward to working together to protect the public’s trust and confidence in the services we provide. HEALTH MATTERS SPRING 2022 | 67
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“WHO MOVED MY CHEESE?” What can I do to understand change in my workplace?
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elivering good change practices is critical right now to benefit from the rapid pace of change and innovation across the health system. COVID-19 is part of our on-going reality as we continue to balance service continuity and ongoing service pressures. Disruption is a positive force for change that needs personal and team agility to make sense of it. The HSE Organisation Development & Change team is offering all staff the opportunity to enhance their change management skills, knowledge and capacity. We have put together a number of supports and resources available to all staff.
The diagram below shows what we are providing to “equip our people with the skills, supports, and resources necessary to embrace, participate in and effect positive change” - HSE Corporate Plan 2021-2024. We invite everyone in health and social care to avail of our offerings. BUILDING YOUR CHANGE CAPACITY
Our eLearning Programme is the first foundational offering and is part of the other options outlined below. Depending on your own learning and support needs you can consider what will work best for you.
CHANGE GUIDE ELEARNING PROGRAMME (70 MINUTES)
Our eLearning Programme – Delivering Change in Health Services available on HSeLanD takes you through all you need to know about people and culture change in 4 accessible modules. It provides you with practical help including tools and resources to support your service improvements and is relevant for staff at all levels. By the end of the eLearning Programme you will be able to: • Focus on creating the conditions and readiness for change and service improvements, using the people and culture change platform. • Understand how best to engage with everyone who will be impacted by the change. • Use the key change activities to define what needs to change, design a better service and deliver on key results for service users and staff.
Access the eLearning Programme by logging onto HSeLanD. Go to the Course Catalogue section and search for Delivering Change in Health Services.
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CHANGE GUIDE IN ACTION - VIRTUAL INTERACTIVE WORKSHOP (90 MINUTES)
The ethos behind the Change Guide in Action is to support collaborative practices and connect those working in health care with content from experts on key topics relating to change and service improvement but also from colleagues who have used the Change Guide in practice. The virtual workshop: • Allows participants review a co-design people and culture change shared experience. • Focuses on an examination of the Change Guide in action and the application of the core concepts, tools and templates to a specific change challenge. • Signposts other resources from the Change Guide.
Contact us to access this workshop. You can also look out for details on the email training updates. The workshops run the fourth Wednesday of the month excluding July and August. Updates will be on the Change & Innovation Hub, HSeLand.
CHANGE CONSULTATION CLINIC - ONE-TO-ONE CLINIC
Our one-to-one scheduled Change Consultation Clinics are for those who are immersed in change and who would like support on a once-off basis. • The Change Consultation Clinics are facilitated by experienced HSE Organisation Development (OD) Practitioners who take a systems approach using the Health Services Change Guide / Framework. • Following your application for assistance you will be allocated a HSE Organisation Development (OD) Practitioner to explore needs and challenges.
HOW DO YOU ACCESS THE CHANGE CONSULTATION CLINIC? These clinics take place on the second Thursday of the month excluding July and August. Updates will be on the Change & Innovation Hub, HSeLand.
CPD CERTIFICATE – DELIVERING CHANGE IN HEALTH SERVICES (12 CPD POINTS) Available to all involved in change delivery. The CPD Certificate is a collaboration between HSE Organisation Development and Change and the RCSI Graduate School of Healthcare Management. Completion of the eLearning Programme is a prerequisite to advancing to the CPD Certificate Programme. This programme supports professional development within health and social care services. It will also be of interest to change and improvement practitioners and will complement the people approaches for all who currently practice quality improvement, project approaches. Once you have completed the eLearning Programme you are encouraged to identify a change challenge within your service and apply the learning, knowledge, skills and tools to your service improvement in collaboration with your service manager and team colleagues. The application of learning to your change challenge can take place over 9 months from completion of the eLearning Programme. Submission dates are February 1st, May 1st, October 1st, December 1st yearly and your application is submitted to changeguide@hse.ie.
CHANGE CONSULTATION CLINIC - ONE-TO-ONE SCHEDULED CLINIC
Our one-to-one scheduled Change Consultation Clinics are for those who are immersed in change and who would like support on a once-off basis. • The Change Consultation Clinics are facilitated by experienced HSE Organisation Development (OD) Practitioners who take a systems approach using the Health Services Change Guide / Framework. • Each applicant will be allocated an HSE Organisation Development (OD) Practitioner to explore their needs and challenges.
Registration for the clinic involves answering some questions focused on your service and a live change challenge. These clinics take place on the second Thursday of the month excluding July and August. Updates will be on the Change & Innovation Hub, HSeLand.
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NATIONAL ESTATES INFORMATION SYSTEM Better Data, Better Decisions, Better Outcomes
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EIS (National Estates Information System) is on track to transform how HSE Capital and Estates does business and will enable development of new improved business processes to strategically manage the HSE Capital and Estates Portfolio. The next phase for the NEIS timeline refers to the Operations and Maintenance module which also includes Medical Equipment. This module will enable HSE Capital and Estates to manage the Equipment Replacement Programme and to monitor the maintenance and performance of certain modalities of medical equipment throughout the HSE on one central database. The Operations and Maintenance module will allow the HSE to manage traditional maintenance activities through the new IBM TRIRIGA platform. These activities include planned and reactive maintenance tasks required to keep HSE facilities and equipment operating at optimum levels for front line service delivery. The system has been procured in conjunction with the Office of the Chief Information Officer and is approved by the Department of Public Expenditure and Reform and the Digital Government Oversight Unit. It is available and intended for use by all HSE and HSE funded Maintenance Departments. The rollout of the NEIS Operations and Maintenance module will be carried out on a phased basis with initial pilot sites going live on the system in April 2022. The NEIS team has initiated engagement with the Maintenance Group to explain the benefits of the system, and will be providing support and training for all Maintenance Departments and end users before, during and after implementation. KEY BENEFITS OF THE NEW SYSTEM ARE:
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Real time work task information and updates Replaces paper based processes and outdated technology Support the national standardisation of work processes and documentation Provides detailed real time reporting for maintenance activities Easily accessible information for audit and research purposes Greater access to current technical, safety and quality knowledge MORE INFORMATION:
Access the NEIS Webpage on HSE.ie www.hse.ie/eng/about/who/healthbusinessservices/estates/national%20estates%20 information%20system%20.html NEIS helpdesk is now live and welcomes any feedback, queries or suggestions to NEIS.Support@hse.ie
Dr Orla Healy
PATIENT SAFETY IS EVERYONE’S BUSINESS Introducing the National Quality Patient Safety Directorate
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ccording to national and international evidence, one in eight patients suffer harm while using healthcare services and up to 70% of this harm could have been prevented. The HSE has set up a new Directorate to help prevent and reduce these harms in Ireland.
As the National Quality Patient Safety Directorate (NQPSD), our goal is to work alongside the health system (HSE operations, patient representatives, staff and other internal and external partners) to improve patient safety and quality of care, and reduce common causes of harm. Our aim is to help create a more
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TO ERR IS HUMAN… to improve is learning
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magine this scenario. Mary is admitted to the ward and is scheduled for an operation. She has insulin dependent diabetes. Her nurse notices that insulin has not been prescribed by the admitting doctor. She contacts the doctor on call to prescribe the insulin. When the doctor arrives to the ward, the nurse is on her tea break. She left a message for the doctor to come to see her in the break room to discuss it further. The doctor insists that the nurse returns to the ward to discuss the matter. The nurse leaves her tea break and has a disagreement with the doctor about the situation. The doctor is annoyed that the nurse “doesn’t have the manners to come out to the office from her break to discuss the issue”. The nurse feels the doctor could just have come to the tea room. The Clinical Nurse Manager (CNM) is asked by the nurse to intervene in the disagreement. Both the doctor and the nurse agree that they were stressed and tired. The nurse has a heavy caseload of sick patients and this was her first time to have a break in hours. The doctor has three wards to cover and is working alone. The manager mediates in order to get the best possible outcome. The manager feels “calmness and understanding is required”. The insulin is prescribed and Mary is safely taken to theatre for her operation.
compassionate health service, one that learns when things go wrong, responds accordingly and reduces harm to those who entrust their lives and care to us. We provide this care through our seven teams: • Patient Safety Programme • QPS Improvement • QPS Intelligence • QPS Incident Management • QPS Education • QPS Connect • National Centre for Clinical Audit
The Directorate is led by HSE National Clinical Director, Dr Orla Healy (working within the Office of the Chief Clinical Officer). A native of Cork, and a graduate of UCC, Orla has worked and trained in Hospital and Public Health Medicine, has extensive experience in community and hospital group management, and health service improvement. Orla hopes “to engage and collaborate with the health system to co-design quality and safety improvements”. Co-design in healthcare involves a partnership between healthcare staff, patients (and their families and carers)
WHAT IS HUMAN FACTORS? The story above shows us how the individual behaviour, the job we do, and the organisation’s supports contribute to safe care. In healthcare the focus for Human Factors has been to improve patient/service user safety. However, Human Factors also have much more to offer to the areas of quality improvement and efficiency. Safety Improvement – A Human Factors approach can support our understanding of the contributors to incidents at all levels of the healthcare system, as well as how to proactively improve safety through mitigation. Quality Improvement – Human Factors approach can support improvements in quality of care, work practices and workforce satisfaction. Increased efficiency - A Human Factors approach can support an improved understanding of how work processes and systems can be designed in order to optimise performance and productivity and cost effectiveness The National Quality and Patient Safety Directorate launched an Introductory Guide to Human Factors. The Guide is written for all healthcare workers and aims to use Human Factors to improve patient and staff safety in healthcare. Our full Guide can be accessed on our website www.hse.ie/eng/about/ who/nqpsd/qps-incident-management/incidentmanagement/a-guide-to-human-factors-inhealthcare-2021.pdf along with a summarised graphic www.hse.ie/eng/about/who/nqpsd/qpsincident-management/incident-management/ human-factors-guide-infographic.pdf Follow us on @NationalQPS for your daily updates on quality improvement and patient safety.
and the “designers” of the new system. Orla reminds us that “the Patient Safety Strategy anchors all that we do in the NQPSD” and believes patient safety is everyone’s business. As such, we invite those in the health system to engage and work with us in our ambition to improve quality and patient safety. For example, this past November, the NQPSD worked with HSE quality and patient safety leads across the system to launch an introductory guide to Human Factors, with the purpose of using these principles to improve safety, quality and efficiency.
MORE INFORMATION: You can read more about our work and teams at www.hse.ie/eng/about/who/nqpsd/ We would love to hear from you and encourage you to reach out to us on nqps@hse.ie and follow us on Twitter @NationalQPS.
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REDUCE THE RISK OF INJURY AT YOUR WORKSTATION Ergonomic programme ensures safety, health and wellbeing of staff during work
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rgonomics is the relationship between the worker and the job, and focuses on the design of work areas or work tasks to improve job performance. Poor ergonomics can lead to Musculoskeletal disorders also known as Work Related Upper Limb Disorders (WRULDs) and Repetitive Strain Injuries (RSIs). These are soft tissue injuries that affect the muscles, tendons, nerves, ligaments, joints and/or blood vessels. The issue of ergonomics was first identified for vaccinators in the Mass Vaccination Centre (MVC) at Citywest. This site was later used as a pilot for the development of a tailored vaccinator ergonomic programme to ensure the safety, health and wellbeing of staff onsite. Phil O’Neill was the Site Operational lead for the Citywest Vaccination Centre and as well as her many other responsibilities, health & safety fell under her remit. Phil was instrumental in the rollout of this tailored ergonomics programme onsite. “Risk assessments were completed for the vaccination centre which looked at the tasks undertaken by staff and identified risks associated with poor ergonomics. One of the remedial actions taken was to engage the expertise of an ergonomist to review the vaccinators work practices and establish control measures that would reduce the risk of injury and promote the safety, health and wellbeing of our staff,” said Phil. Phil explained that the ergonomic risk factors identified from the risk assessment included: • Awkward postures: due to work practices where vaccinators were standing and bending to deliver the injection. These are non-neutral postures that put more stress on the vaccinators musculoskeletal system.
• Repetitive tasks: High task repetition, when combined with other risks factors such high force and/or awkward postures, can contribute to the development of a Work Related Musculoskeletal Disorders. The duration of these stooped postures with vaccinators ranged from 5-13 seconds repeated every 3-6 minutes. Although the load was not heavy, the weight of the vaccinator arm and positioning was the issue. • Psychosocial and organisational factors: Issues such as workload demands, scheduling and task rotation etc. Staff questionnaires reported fatigue and discomfort mostly in the upper body with some reports of discomfort and fatigue in the lower body. Staff morale was crucial, and the operational management facilitated this by acknowledging staff participation and making each milestone in the vaccination progress. The National Health & Safety Function (NHSF) co-ordinated postural awareness sessions for vaccinators. “The sessions were a great success, feedback from the staff was extremely positive and they liked the fact that we were looking after their safety and not just the safety of the recipients of the vaccine and the vaccine itself,” said Phil. She said her experience working with the NHSF was ‘very positive’. “It improved conditions for the staff, thus contributing to the efficiency of the operation. The practical changes made were welcomed, and just as significant, they contributed to the overall positive culture of the operation,” she said. She urged fellow managers to embrace health and safety “not only as a challenge, but also as a positive contribution to the operation, to the benefit of the entire team”.
FURTHER INFORMATION If you have any musculoskeletal symptoms, let your manager know. Your manager will refer you to Occupational Health for assessment and support. You can also self-refer to Occupational Health. They may recommend specific workplace accommodations to enable you to continue to work. In more complex circumstances, it may be necessary to engage the services of an ergonomist. Contact the health and safety helpdesk for ergonomic service details. Phone 1800 420 420 Monday to Friday 10.30am to 12pm and 2pm to 3.30pm. https://healthservice.hse.ie/staff/benefits-services/ health-and-safety/health-and-safety-helpdesk.html https://healthservice.hse.ie/staff/benefits-services/ health-and-safety/musculoskeletal-disorders.html
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EU4HEALTH New funding opportunities for HSE service areas under the EU4health Programme
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here are significant new funding opportunities for HSE service areas in 2022, as €835 million will be made available to EU members under the EU4health Programme. The EU4Health Programme is an integral part of the EU’s response to the COVID-19 pandemic and post-COVID-19 recovery. In terms of key priorities for funding, the 2022 programme is based around five key strands: • Crisis preparedness and preventing shortages of medicines • Disease prevention, early detection and health promotion • Research that supports the fight against cancer and Europe’s Beating Cancer Plan • Reforming and strengthening health systems and the healthcare workforce • Health digitalisation The EU4Health Programme will support a
wide range of actions across these strands. The HSE EU and North South Unit are tasked with co-ordinating HSE funding applications and are contacting senior managers of the relevant areas directly to identify projects or programmes that suit the funding criteria. Joe Ryan, National Director for Operational Performance and Integration, said the opportunities the programme provides “will contribute significantly to the post Covid-19 recovery.” “I welcome the significant funding offering from the Programme in 2022.” Paula Keon, Assistant National Director at the HSE’s EU and North South Unit, said the EU4Health Programme “provides an added dimension to EU Investment in health across member states addressing the post pandemic recovery.” “The EU and North South Unit looks forward to working closely with HSE colleagues in
developing new funding proposals and taking full advantage of the collaborative opportunities offered by EU4Health,” she said. The first wave of Open Calls was recently announced while application deadlines for the remaining priority areas have yet to be finalised. Regular calls for proposals will be issued throughout 2022 and communicated to the relevant HSE Managers. Individuals are not eligible to apply for grants under the EU4Health Programme. For further information on EU4Health HSE, contact Michael O’Brien, Corporate Business Manager, EU and North South Unit. E-mail: Michael.obrien15@hse.ie Phone: 071-9820430/087-7102641. Full details on EU4Health and the 2022 work programme: www.hrb.ie/funding/ eu-funding-support/eu4healthinformation/
EXWELL PROGRAMME HELPING RECOVERY PROCESS The Dublin Midlands Hospital Group have just started a new ExWell Medical Programme which offers specially tailored exercise classes to people recovering from a serious illness. Participants must be referred by a medical professional and the classes are free of charge and funded by Dublin Midland Hospital Group. The special fitness classes are delivered by a highly trained instructor and are currently taking place at Athlone Regional Sports Centre. The aim is to provide effective, high quality, safe and accessible exercise rehabilitation to those with chronic illnesses. This brand new programme has just begun after a very successful pilot project that Tullamore Hospital undertook with Exwell Medical in 2021. The results of the pilot, attended by nearly 100 participants on medical referral from the Midland Regional Hospital Tullamore and from local GPs, showed dramatic improvements in strength, aerobic fitness, frailty and self-rated health. The participants' feedback was that the classes were really enjoyable and safe. One of the participants of the pilot programme Colm
Connolly, said "When my doctor suggested I do this programme, I must admit I was hesitant. But now 12 weeks later, I am so glad I took his advice … I’ve lost a stone in weight, I can walk a lot more and I can now do the whole hour of class without getting breathless.” ExWell Medical is a social enterprise pursuing the mission of transforming the lives of people and families living with the burden of chronic illness through community-based exercise programmes. One of their key aims is to provide social interaction, which tackles the loneliness that so often accompanies chronic illness.
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A NEW RECRUITMENT OPERATING MODEL FOR THE HSE
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programme of work has been under way to evaluate and review how recruitment is delivered across the HSE. The objective is to ensure the health service is supported by a new Recruitment Operating Model which will enable robust recruitment capability, along with enhancing the quality and success of recruitment across the health service. Since June 2021, the Programme Team has engaged extensively with representatives from Acute Services, Community Services and HR Shared Services to co-design the new Recruitment Operating Model. “It is a priority for the organisation to ensure we are best set up to deliver on the recruitment needs of all our services both now and into the future. I am delighted with the progress that has been made in relation to designing the new Recruitment Operating Model for the HSE. Collaboration is central to this extensive transformation journey, and we will continue to work in partnership with our colleagues and stakeholders to ensure its success,” said Anne Marie Hoey, National Director, National HR.
WHY ARE WE CHANGING? As the largest employer in the state, recruitment teams in the HSE handle high volumes of applications, across a wide variety of roles, to support delivery of our services to patients and service users. It is envisaged that the new Recruitment Operating Model will deliver an easily accessed, transparent, efficient and meaningful experience, meeting the needs of our candidates and service managers.
OUR PROGRAMME DESIGN PRINCIPLES The Design Principles (pictured above right) were created and agreed with over 40 representatives from Acute Services, Community Services and National Services. These underpin the design of the new Recruitment Operating Model and act as the measure of success for the design. In addition to our Programme Design Principles, a rigorous decision-making process has been created to ensure appropriate input and governance, with key decisions being further endorsed by the Executive Management Team (EMT).
OUR JOURNEY SO FAR Since June 2021, the Programme Team has engaged extensively with representatives from Acute Services, Community Services and HR Shared Services to co-design the new Recruitment Operating Model. Firstly, a high-level Recruitment Operating Model was defined outlining the key elements of the new Model and clearly articulating responsibilities so that our recruitment teams will be equipped to deliver on requirements into the future.
Further detailed design was completed for all of these key elements to ensure clarity of responsibilities between the Local Services Recruitment Teams and National Recruitment Service and as well as detailed responsibilities for new supporting units to enhance quality and success of recruitment across the health service.
THE NEW RECRUITMENT OPERATING MODEL The new Recruitment Operating Model includes standardised processes for the end-to-end recruitment lifecycle and defines clear roles and responsibilities to enable recruitment teams to successfully deliver on recruitment activities both now and in the future. The new Recruitment Operating Model will streamline and modernise our recruitment model, ensuring we are best set up to deliver on the recruitment needs of all our services, limit duplication of effort, ensure clarity of responsibility and establish clear governance. In addition to the current Local Services Recruitment Teams and National Recruitment Service, the new Model introduces three new supporting units at a national level: • Quality, Standards and Advisory Unit - providing training and guidance to further develop knowledge on leading practice recruitment. This unit will share standardised recruitment tools, resources and methods to ensure a consistent and transparent experience. • Talent Attraction and Engagement Unit - focused on understanding short and long-term talent requirements across our services and then attracting candidates, both locally and internationally. • Third-Party Agency Management Unit - focused on managing service delivery and performance of any of our recruitment agency partners.
LOOKING TOWARDS THE FUTURE Moving towards these new ways of working under the new Recruitment Operating Model is the first step on a longer journey to modernise and improve our recruitment offering across the HSE. Work is also under way to provide HSE-wide technology capability to enhance our efficiency at both a local and national level. We will continue to seek out opportunities to improve service delivery for candidates and service managers, ensuring we are setting our recruitment teams up to successfully deliver on our recruitment needs, and attract the very best talent both locally and internationally. As we move forward with these new ways of working, all those supporting recruitment, hiring staff or partaking in the recruitment process itself will be kept updated. Training will be made available to those supporting recruitment, and guidance will be provided on how to engage with the newly established recruitment units. Further information will be provided on the progress of the recruitment improvement programme in the coming months, as the journey continues to modernise and optimise the HSE recruitment service.
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STAFF CONCERT BRINGS CHRISTMAS CHEER
Healthy Ireland Great progress being made by Healthy Ireland in the health services
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he HSE recognised very early Progress Report 2015 - 2020 on that the scale of the Healthy Ireland agenda would take vision, organisational and system changes and a radical shift in culture. It called on every individual in the health services and all its partners to build momentum for a larger scale movement for change at an individual Healthy Ireland in the Health Services and organisational level. The Healthy Ireland in the Health Services Progress Report 2015-2020 was officially launched in November 2021. The production of this report was an opportunity to reflect on the "OVER 90% OF THE 126 SPECIFIC achievements over this time and will help focus ACTIONS HAVE BEEN FULLY and plan for the next phase of this work. DELIVERED, WITH THE BULK OF Over 90% of the 126 specific actions have been THEM RELATING TO ON-GOING fully delivered, with the bulk of them relating to ACTIVITIES. THE REMAINING ACTIONS on-going activities. The remaining actions are ARE CLOSE TO COMPLETION, WITH A close to completion, with a very small number VERY SMALL NUMBER (3%) HAVING (3%) having been superseded in the interim. The implementation of these 126 large-scale BEEN SUPERSEDED IN THE INTERIM. " actions was embraced through collaborative working with national strategic direction and established, local implementation plans local ownership. They have been taken on with created and programmes of work integrated energy and creativity, employing critical alongside core traditional health and social thinking and strategic capability and robust care services. The Healthy Ireland in the Health Services programme management. Our National Policy Priority programme brings Progress Report 2015-2020 was officially leadership and high-level expertise to support launched by Dr Stephanie O’Keeffe, former the development of evidence-based policy and National Director for Strategic Planning and practice, with their programmes being central Transformation via webinar in November in supporting the delivery of high-quality health along with Dr Philip Crowley, National and wellbeing services with our partners Director for Strategy and Research; Sarah McCormack, HSE National Healthy Ireland internally and externally. During the launch, Dr Stephanie O’Keeffe, Lead; Tom James, Head of Healthy Ireland former Director for Strategic Planning and DoH; Collette Cowan, CEO ULHG; Martina Transformation, noted the tremendous efforts Queally Chief Officer Community Healthcare and commitment across our Community East; and guest speaker Prof Ciaran O’Boyle, Healthcare Organisations and Hospital Groups. Founding Director, RSCI Positive Psychology New governance structures have been and Health. Health Services Executive Dr Steevens' Hospital Steevens' Lane Dublin 8, Ireland www.hse.ie
NATIONAL IMPLEMENTATION PLAN 2015
ISBN: 978-1-78602-184-7
To browse all progress achieved see www.hse.ie/eng/about/who/ healthwellbeing/healthy-ireland/publications/healthy-ireland-in-the-healthservice-progress-report-2015-2020.pdf
We were all in for some spectacular surprises and treats during the 2021 HSE Staff Christmas concert. Over 700 staff joined in to watch or perform on the day which was packed from start to finish with Christmas choral and Festive cheer. A further 706 viewed the concert via the HSE Health and Wellbeing You Tube Channel the following day. Many of the HSE’s choirs from across the length and breadth of the country performed a selection of popular Christmas songs and hymns, showcasing the fantastic talent among our staff. There were many words of praise, encouragement and thanks from our very own CEO, Paul Reid, the famous Niall Horan, the radiant Derval O’Rourke, the wonderful Daniel O’Donnell and a special interview from HSE employee, Noreen Rafferty from the Rafferty Family Band. Comments, chats and well wishes came flooding in throughout the performances thanking everyone for a wonderful concert and wishing each other good health and happiness in the spirit of Christmas.
Watch the concert https:// www.youtube.com/ watch?v=k0Kr1GMMn0w
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Musicians on call Musicians-on-Call strike a chord with residents and staff of community hospitals
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esidents and staff of community hospitals in Limerick and across the Mid-West region have enjoyed a series of live musical engagements as part of a pilot project led by Limerick City and County Council and supported by Creative Ireland. Musicians-on-Call, a Music in Healthcare concept by Kids’ Classics, was spearheaded by the Council’s Limerick Arts Office in collaboration with Age Friendly Limerick and Healthy Limerick. It was delivered in partnership with artistic partners Kids Classics, the HSE and Clare and Tipperary County Councils. The aim of the project was to promote health and well-being by improving the quality of life and cultural access for those who live and work in healthcare settings, by bringing high quality live music to vulnerable older members of our communities living in nursing homes. But rather than the musicians just coming to play a particular set, the music was tailored to the specific audience, who were key to leading each music visit as an active participant. This Outside-In Music approach placed the residents’ interests and choice at the heart of music making, by connecting closely with the community setting before each visit and allowing the residents to curate each visit through a two-way responsive engagement. It’s hoped that Musicians-on-Call can be further developed and expanded following a review of the pilot programme. Musicians called on residents in St Camillus Hospital, Limerick, St Ita’s Hospital, Newcastle West; as St Joseph’s Hospital, Ennis; Raheen Community Nursing Unit, Scariff; Ennistymon
Community Nursing Unit and Regina House, Kilrush in County Clare; and St Conlon’s Community Nursing Unit, Nenagh; Dean Maxwell Community Nursing Unit, Roscrea and Community Hospital of the Assumption, Thurles in County Tipperary. The project was delivered by professional musicians trained to work in Healthcare Settings and also offered an opportunity for local and regional musicians new to this field of practice to gain experience in this person-centred creative engagement approach to live music in Nursing Homes. Mayor of the City and County of Limerick Cllr Daniel Butler has praised those behind the initiative. “At the heart of the project are the benefits of music and culture in supporting mental health and wellbeing. It demonstrates the power of partnerships and the power of music. The Arts Office, the Age Friendly Programme and Healthy Ireland of Limerick City and County Council worked together, along with the HSE, and with our colleagues in Clare and Tipperary County Councils to bring this wonderful programme into the community.” Sian Rowe-McCormack, Director of Nursing, St Camillus’ Hospital said they were delighted to see the impact that this music programme had on residents and staff. “Its value grew from session to session with our residents delighted to attend the sessions. There was excitement preparing for the musicians and the craic in the session led to chat and banter for days after. Our residents embraced the opportunity to be entertained and to entertain.” Musicians-on-Call was funded by the Creative Ireland Creativity in Older Age Fund.
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‘IF MUSIC BE THE FOOD OF LOVE, THEN PLAY ON’ Joe Healy is the ‘The Keynotes Choir’ Conductor and Training Centre Instructor, Roscommon Mental Health Services. He explains how the choir came about.
The Keynotes Choir in action before Christmas.
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The video of the choir performing ‘O Holy Night’ can be viewed at https://youtu.be/1ALOnY4HwQ
any wonderful things have been said and written about the benefits of music while we continue living in these troubled times. Well, imagine having the honour of being involved with a group of people who sing, laugh, cry, hope and generally pull each other through the times we’ve been dealt. We are The Keynotes Choir and our members are drawn from the HSE - service users, staff, retirees and even the odd volunteer. We started out about four years ago when Mental Health Services Roscommon facilitated a music programme in their training centres in Boyle, Castlerea, Clorina House and Strokestown Day Centres. From humble beginnings we grew to performing at many HSE launches and a couple of years ago, we closed off a street in Roscommon and put on a street concert to celebrate the completion of a very enjoyable Music in Mind course facilitated through the National Concert Hall. Then along came COVID-19. Everything stopped. But giving up is not in the nature of our members. We were even thinking of changing our name to something to do with resilience. However, I digress. Once restrictions lifted a little bit, we started sending out CD’s or WhatsApp recordings to everybody containing the various music parts. Then we’d get a couple of people in at a time, record them, mix it on site in Castlerea and the end product distributed to all. They say no knowledge is ever wasted and this week proves it. We were asked to sing a song for the HSE virtual Christmas concert which aired before the Christmas break. A rough mix of ‘O Holy Night’ was put together for each individual with a separate ‘take’ for the harmonies. We recorded everybody in pairs, mixed it and prayed it would work out. It did. Participants were shattered but ecstatic. During the recording my eyes were truly opened. When ordinary people are thrown together in a common but unfamiliar task, the reaction is the same anxiety, fear, comradery, relief. The next day, we had to do D’Video! We all met on the grounds of Plunkett Community Nursing Unit, Boyle, Co Roscommon. The same emotion prevailed but multiplied by 10. It was freezing, but not many felt the cold. Then it was finished. We nearly blinded each other with the beam of our smiles. Hands were thrown up in the air with relief and bliss. This was as close as you are going to get to total happiness. For all of us, for those 10 minutes, the world was fixed.
LOCAL PODCAST ‘MEATH TALKS’ ABOUT LOCAL HEALTH ISSUES BY LOCAL PEOPLE FOR LOCAL PEOPLE Meath Talks is a collection of health and wellbeing podcasts developed and produced by the HSE Health Promotion and Improvement Team, Midlands Louth Meath Community Healthcare Organisation and supported by Meath Partnership. Meath Talks have been created as a wellbeing resource, cover a wide range of health related topics and feature the agencies which provide this support and guidance across Co Meath. Health Promotion and Improvement Manager, Emer Smyth, explained, “It is important that people living in our communities are aware of the large array of supports that exist to help them to stay well and to work their way through difficulties that happen as is normal in life. The conversations, like the work in health promotion are broad in range and topic and give a flavour of the work our team are involved in every day.” Meath Partnership CEO, Michael Ludlow, said that the company is delighted to have an opportunity to work in partnership with the HSE in communicating with those in need of healthcare services. He said the use of the podcast medium as produced by the HSE, enables service providers such as Meath Partnership to reach out and speak directly to those in the community entitled to support. Stressing the importance of the Wellness Hub, recently opened by Meath Partnership, and which offers support to both young and old, Mr Ludlow said this new service has a focus on mental wellbeing with a special interest in young people. Developer and host of Meath Talks, Anthony O’Prey, HSE Health Promotion Officer, said, “These podcasts give everyone an opportunity to listen to the voice of support that is available to them within their community. I would encourage everyone to listen to these conversations and share them among your loved ones; they are an invaluable resource especially during these challenging times.” Meath Talks joins the collection of health and wellbeing podcasts developed for the Midland counties, including Offaly Talks, Longford Talks, Westmeath Talks, Kildare Talks and Laois Connects Podcasts. Meath Talks can be accessed by visiting the Meath Partnership website using the link below or by searching on the Spotify app. https://www.meathpartnership.ie/pages/ meath-talks/
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Menopause and Me T
Menopause and Me webinar a resounding success
he Health and Wellbeing division of HSE Mid-West their GP or other health professional, making a lifestyle change, talking Community Healthcare recently hosted a free and to someone about what they learnt at the webinar and talking to empowering evening webinar on menopause family or their partner.” called Menopause and Me. The event acknowledged Dr Cassie McVeigh gave a very holistic overview of perimenopause World Menopause Day 2021 and the need to open up a and menopause and reminded women that every menopause is conversation around the topic. Almost 380 women joined the webinar different and therefore needs to be responded to and managed on the night and thousands more have viewed the video of the event, differently for each woman. “It is not just a time to survive, but a time to thrive. It is a good time which is available online. to take stock, make lifestyle changes and Anne Ryan, Head of Service for HSE "It was especially heartening to Health and Wellbeing in the Mid-West, where necessary, get the right professional opened the event by noting that help,” she said. see 153 women identify actions menopause is such a significant part of Dr McVeigh gave an overview of they are going to take following Hormone Replacement Therapy (HRT) a woman’s journey in life. “I hope with the webinar – these included this event, we can make menopause an and other options, including lifestyle easier and more supported journey for changes, to help women. “The good news talking to their GP or other women. This is the start of a conversation is that menopause is finally becoming a health professional, making which I have no doubt will expand into mainstream topic of conversation. a lifestyle change, talking to Women are educating themselves and future initiatives. We are very grateful to all those who participated in the webinar someone about what they learnt supporting each other – so they no longer for sharing their knowledge and for their have to feel ashamed or isolated or feel at the webinar and talking to like they are giving in by choosing to opt willingness to open up and speak of their family or their partner" own experiences of menopause,” she said. for Hormone Replacement Therapy Mairead Kelly, HSE Health Promotion (HRT),” she said. Officer with a specific remit for sexual “I view menopause as a time for positive health promotion in the Mid-West, said, “We are delighted the webinar change to get ourselves in the best health we can to ensure that we was the affirming and empowering conversation for women in the are able to live into old age with the best health possible.” Mid-West that we wanted it to be. The feedback from HSE staff and Charlene Hyland, a physiotherapist with a special interest in women’s the public has been overwhelmingly positive and the feedback on health, provided a comprehensive overview of the physical aspects the night indicates an increase in confidence and knowledge in relation of perimenopause and menopause. She explained how a trained to menopause for those who joined the webinar. physiotherapist can help with many of the physical symptoms and “The three guest speakers covered a number of important topics emphasised the protective role of exercise. that responded to questions we received from women experiencing Finally, Dr Nodlaig Moore, a clinical psychologist, explained the perimenopause and menopause both prior to, and during the event. psychological aspects of perimenopause and menopause, how we relate It was especially heartening to see 153 women identify actions they to them and therefore, how we manage them. In particular, Dr Moore are going to take following the webinar – these included talking to spoke about memory loss, anxiety and depression and what can help.
The webinar is now available to watch on the HSE Health and Wellbeing YouTube channel, under the title ‘Menopause and Me' HSE Health and Wellbeing Webinar. (https://www.youtube.com/ watch?v=3oPxZQ_4zkk)
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Living Well Living Well helping patients manage long-term conditions
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iving Well has been operational since August 2020 across seven CHOs, with over 1,600 participants on 160 programmes. The programme adapted to an on-line offering during COVID-19 which proved popular with our service users. Interim research results to date for the online programme indicate that it is having the same well-documented benefits as the in-person programme and that the programme is making a difference in helping people to selfmanage their long-term health condition. These findings, along with strong support from Heads of Service in Health and Wellbeing, have helped to secure main stream HSE funding and will see the programme continue in 2022 and beyond. As the pandemic restrictions have eased, it is hoped that in-person programmes
will resume, while online delivery is set to continue given its success.
WHAT IS LIVING WELL? Living Well is an evidence-based self– management programme for adults with long-term health conditions. Over the course of six weeks, participants develop practical skills and confidence to better manage their health so that they can live well with their health condition. Workshops are facilitated by two trained leaders, one or both of whom are living with a long-term health condition (peers). Unlike clinical education programmes, Living Well does not give clinical advice or information but instead focuses on developing and enhancing the self-management skills of those who complete the programme. In this way, it complements regular treatment and structured patient education programmes. HEALTH MATTERS SPRING 2022 | 79
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GET YOURSELF
summer ready Focus on minding your mental health
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he ‘Be Summer Ready’ campaign is a whole-ofgovernment initiative which is led by the Department of Defence’s Office of Emergency Planning, on behalf of the Government Task Force on Emergency Planning. It is supported by the HSE’s Emergency Management Team. The campaign’s messages will be delivered through internet and social media across Government and by the provision of the ‘Be Summer Ready’ information booklet and a ‘Minding Your Mental Health’ leaflet which will be both available after the launch at www.gov.ie/summerready.
SKIN CANCER
Skin cancer is the most common type for cancer in Ireland, accounting for over 13,000 cases annually. The number of people being diagnosed with skin cancer is rising rapidly, with figures set to nearly triple by 2045. Yet most skin cancers can be preventable. Skin cancer develops when cells are damaged and grow uncontrollably. Exposure to UV rays, from the sun or sunbeds, is the most common cause of skin cancer. UV radiation from the sun is measured using a UV index –this is highest in Ireland between April and September even on cloudy days. Stay safe by limiting time in the sun when UV is strongest, typically between the hours of 11am to 3pm. You are at higher risk if you spend a lot of time outdoors, due to your work or leisure activities. It is particularly important to protect the vulnerable skin of babies and young children. Children’s skin is very sensitive to UV from the sun. Plan ahead and check the UV levels near you at the Met Éireann website at www.met.ie/uv-index SUMMER HEAT
MINDING YOUR MENTAL HEALTH
The focus of this year’s Be Summer Ready leaflet is on ‘Minding your mental health’. It was compiled by the HSE’s Mental Health Service, highlights practical ways to maintain good mental health. It’s important to mind your mental health all year round but the summer can be busy and it can be easy to fall out of good routines. The message is that keeping active can help protect both your physical and mental health and summer is a great time to try something new. Making the most of the good weather and longer evenings will be so valuable this year and you are advised to meet up with a friend for a walk, get out your bike and explore a new area or try a new activity, such as swimming.
During the summer months, the HSE advises people to protect their skin from UV (ultraviolet) radiation, maintain cool living environments and take care of their health during extreme heat. Each HSE service area needs to ensure that a safe, climatecontrolled environment exists for the delivery of care to patients and service users and staff are advised to report the emergence of challenges to line managers.
Helpful links: HSE Exhaustion and Heatstroke information HSE Melanoma information UV Index information and weather forecast can be found at www.met.ie Irish Skin Foundation HSE Severe Weather information
NO EXCUSES - EXERCISE SESSIONS ANY DAY OR ANY TIME To help keep staff active and well, HSE Health and Wellbeing produced a suite of exercise videos to encourage staff to take time out to improve their health and wellbeing. Self-Care is so important at any time of the year, so if you have not yet tried out some of these videos, maybe now is the time. You can choose from 8 x 30 minute sessions of Pilates, Yoga or Strength and Conditioning or 4 x 10 minutes sessions of chair-based Yoga. One of the most important things to do, in order to help you stick to a regular routine of exercise is to plan ahead. Ideally you should pick an evening or day and time that you are free to exercise each week. Try to keep that time just for ‘you’ and commit to doing one of the many Exercise sessions available through here. It’s up to you now – any day or time – you decide, but try to stick to the weekly plan.
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Grief can be unpredictable.
When someone dies, the grief that follows can be difficult and feel overwhelming. Some feelings of grief come and go while others can persist. Everyone’s experience is different. But it’s important to remember that you’re not alone. Talking about your loss with the people around you can help. Reach out to someone you trust. We’re here too if you need extra help or support. · Visit hse.ie/grief or bereaved.ie
· Call our Bereavement Support Line on freephone 1800 80 70 77 (Monday to Friday, 10am to 1pm).
· Or speak to your GP.
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When you let hackers in, who knows what you are letting out. Be cyber safe and aware when you’re online at work. DO Use a unique password for each website and social media account Report suspicious emails to your IT helpdesk Lock your screen when you leave your computer or laptop Log out and shut down your computer or laptop at the end of the day DON’T Don’t open an email if you don’t know the sender Don’t click on a link in an email or text message if you don’t know the sender Don’t select the ‘keep me signed in’ option on websites, Apps or social media Don’t use a personal USB stick. Order a password-protected USB stick from your IT helpdesk Never download and use free software or online games
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Find out how to be cyber safe at healthservice.ie/cyber 16/03/2022 13:53